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CUSTOM ACOUSTIC LIPO (C.A.L) also termed Vibroliposuction is a new take on the popular Power-Assist Liposuction (PALS) which this Practice often uses. 

In technical terms the power-assist method employs a rapidly reciprocating powered  tip, that permits the surgeon
to glide through the fatty deposits reducing the stress on the operator's shoulder and back.  The recently introduced CAL system uses a motion technology called Vibroliposuction where air pressure in the unit producings a complex 360 degree motion of the cannula tip to which helps it glide through tissues extracting fat with efficiency.   The motion is termed ''nutation" .   It is being reported as smoother and better able to loosen fat. 

 As an aside, when using this device under local anesthesia, the vibrations produced may generate a light tickling sensation for the patient who make actually cause them to laugh.   Some 60% of patients may experience this heightened vibratory sensation that prompts them to chuckle.   have had the experience of two patients on whom I have performed some minor local liposuction with a suction device only, and the act of pushing the cannula back and forth did prompt to the patient's to laugh during the procedure.  Often pressure and vibratory sensation can be perceived as heightened tickling and cause the nerve response to incite laughter.

This new device is worth examination, but appears to be similar in reducing stress on the surgeon for the most part.  Further review will determine if it will become popular with plastic surgeons and whether it offers distinct advantages to power-asssist (PALS) liposuction with respect to smoother extraction, shorter operating times, and improved patient outcomes. 

Local anesthesia may not be suitable for everyone, but all methods in current use may be applied with local, sedation, or general anesthesia.    Our current preference for liposuction is Power-Assist for larger longer duration procedures, with standard suction for delicate areas of the neck, calves, and ankles.


KEY TERMS for this new technology

nutation technology of 360 degree cannula motion
tickle liposuction
Custom Acoustic Liposuction
CAL
CALS
Vibroliposuction--------------------
VL Liposuction


Vibroliposuction (VL)

Vibroliposuction represents a development of the PAL concept. In this system, the cannula is activated by air pressure, producing a complex movement of the tip. This movement, combining antero-posterior, superoinferior and parasaggital displacement is called “nutation”. The amplitude of this movement depends on the cannula length and diameter as well as the pressure entering the handpiece. A recent publication by REBELO (44) describes this technique.

REBELO A. Power-assisted liposuction. Clin Plast Surg, 2006, 33 : 91-105.

"In conclusion, this technique allows easier tissue penetration and causes less fatigue to the surgeon"
 one study-------

Thigh Lift  (INNER THIGH)

What You Need to Know
.What is a thigh lift?
 A thigh lift reshapes the thighs by reducing excess skin, and in some cases fat, resulting in smoother skin and better-proportioned contours of the thighs and lower body.
Beauty for life
Enhancing your appearance with a thigh lift
 If fitness and weight loss efforts have not achieved your goals for a body that is firmer, more youthful-looking and more proportionate to your overall body image, a surgical thigh lift may be right for you.
This surgery reshapes the thighs by reducing excess skin, and in some cases fat, resulting in smoother skin and better-proportioned contours of the thighs and lower body.
Is it right for me?
Candidates for thigh lift are:
•   People whose weight is relatively stable
•   Individuals with excess soft tissue along the inner or medial thigh region and/or the outer thigh
•   Healthy individuals who do not have medical conditions that can impair healing or increase risk of surgery
•   Non-smokers
•   Individuals with a positive outlook and realistic goals for what thigh lift surgery can accomplish
•   Individuals committed to leading a healthy lifestyle including proper nutrition and fitness
What it won’t do: Thigh lifts are not intended strictly for the removal of excess fat. Liposuction alone can remove excess fat deposits where skin has good elasticity and is able to naturally conform to new body contours. In cases where skin elasticity is poor, a combination of liposuction and thigh lift techniques may be recommended.
What to expect during your consultation
The success and safety of your thigh lift procedure depends very much on your complete candidness during your consultation. You’ll be asked a number of questions about your health, desires and lifestyle.
 Be prepared to discuss:
•   Why you want the surgery, your expectations and desired outcome
•   The options available in thigh lift surgery
•   Medical conditions, drug allergies and medical treatments
•   Use of current medications, vitamins, herbal supplements, alcohol, tobacco and drugs
•   Previous surgeries
Your surgeon may also:
•   Evaluate your general health status and any pre-existing health conditions or risk factors
•   Examine and measure your body, including detailed measurements
•   Take photographs for your medical record
•   Discuss your options and recommend a course of treatment
•   Discuss likely outcomes of thigh lift surgery and any risks or potential complications
Preparing for sugery
 Prior to surgery, you may be asked to:
•   Get lab testing or a medical evaluation
•   Take certain medications or adjust your current medications
•   Stop smoking well in advance of surgery
•   Avoid taking aspirin, anti-inflammatory drugs and herbal supplements as they can increase bleeding
Special instructions you receive will cover:
•   What to do on the day of surgery
•   The use of anesthesia during your thigh lift
•   Post-operative care and follow-up
Your plastic surgeon will also discuss where your procedure will be performed. Thigh lift surgery may be performed in an accredited office-based surgical center, outpatient of ambulatory surgical center, or a hospital.
You’ll need help
If your thigh lift procedure is performed on an outpatient basis, be sure to arrange for someone to drive you to and from surgery and to stay with you for at least the first night following surgery.
Procedural Steps
What happens during thigh lift surgery?
Step 1 – Anesthesia
Medications are administered for your comfort during the surgical procedures. The choices include intravenous sedation and general anesthesia. Your doctor will recommend the best choice for you.
Step 2 – The incision
Incision patterns vary based on the area or areas to be treated, degree of correction and patient and surgeon preference.
One common technique used for a thigh lift places incisions in the groin, extending downward wrapping around the back of the thigh. The underlying tissue matrix will be reshaped and tightened, and skin will be reduced and redraped resulting in more proportionate and smoother body contours.
You may qualify for a minimal incision medial thigh lift which involves an incision only in the groin area. Your surgeon will determine what’s appropriate.
Medial Thigh Lift
 
Improving the contours of the outer thigh may require an incision extending from the groin around the hip.
Through these incisions your plastic surgeon will tighten tissues for a smoother, better-toned lower body contour.
Advanced techniques usually allow incisions to be placed in strategic locations where they can be hidden by most types of clothing and swimsuits. However, incisions may be extensive.
Outer Thigh Lift
 
Step 3 – Closing the incisions
Deep support sutures within underlying tissues help to form the newly shaped contours. Sutures close the skin incisions.
Step 4 – See the results
The smoother tighter contouring that result from a thigh lift are apparent almost immediately, although initially obscured by some swelling and bruising.
You may be required to wear a compression garment for several weeks following your procedure to minimize swelling and support the tissues as they heal.
Following a thigh lift, skin quality is dramatically improved both in appearance and feel.
Important facts about the safety and risks of thigh lift surgery
 The decision to have thigh lift surgery is extremely personal and you’ll have to decide if the benefits will achieve your goals and if the risks and potential complications are acceptable.
Your plastic surgeon and/or staff will explain in detail the risks associated with surgery. You will be asked to sign consent forms to ensure that you fully understand the procedure you will undergo and any risks and potential complications.
Possible risks of thigh lift surgery include:
•   Unfavorable scarring
•   Bleeding (hematoma)
•   Infection
•   Fluid accumulation
•   Poor wound healing
•   Skin loss
•   Blood clots
•   Numbness or other changes in skin sensation
•   Anesthesia risks
•   Skin discoloration and/or swelling
•   Fatty tissue found deep in the skin might die (fat necrosis)
•   Major wound separation
•   Asymmetry
•   Pain, which may persist
•   Unsatisfactory results such as highly visible surgical scar location, unacceptable visible deformities, bunching and rippling in the skin near the suture lines or at the ends of the incisions
•   Deep vein thrombosis, cardiac and pulmonary complications
•   Recurrent looseness of skin
•   Sutures may spontaneously surface through the skin, become visible or produce irritation that require removal
•   Possibility of revisional surgery
When you go home
If you experience shortness of breath, chest pains, or unusual heart beats, seek medical attention immediately. Should any of these complications occur, you may require hospitalization and additional treatment.
The practice of medicine and surgery is not an exact science. Although good results are expected, there is no guarantee. In some situations, it may not be possible to achieve optimal results with a single surgical procedure and another surgery may be necessary.
Be careful
Following your physician’s instructions is key to the success of your surgery. It is important that the surgical incisions are not subjected to excessive force, swelling, abrasion, or motion during the time of healing. Your doctor will give you specific instructions on how to care for yourself.
Be sure to ask questions: It’s very important to ask your plastic surgeon questions about your thigh lift procedure. It’s natural to feel some anxiety, whether it’s excitement for your anticipated new look or a bit of preoperative stress. Don’t be shy about discussing these feelings with your plastic surgeon.
My recovery
 When your procedure is completed, dressing or bandages may be applied to your incisions, and you may be wrapped in an elastic bandage or a compression garment to minimize swelling and to support your new contours as you heal.
One or more small, thin tubes may be temporarily placed under the skin to drain excess fluid or blood that may collect.
You will be given specific instructions that may include: How to care for the surgical site(s) following surgery, medications to apply or take orally to aid healing and reduce the risk of infection, specific concerns to look for at the surgical site or in your general health, and when to follow-up with your plastic surgeon.
Be sure to ask your plastic surgeon specific questions about what you can expect during your individual recovery period.
•   Where will I be taken after my surgery is complete?
•   What medication will I be given or prescribed after surgery?
•   Will I have dressings/bandages after surgery?
o   When will they be removed?
•   Are stitches removed? When?
•   When can I resume normal activity and exercise?
•   When do I return for follow-up care?
The results will be long-lasting
 The results of a thigh lift are visible almost immediately. However, it may take several months for the final results to fully develop.
Some visible scars will remain, but the overall results are long lasting, provided that you maintain a stable weight and general fitness.
As your body ages, it is natural to lose some firmness. However, most of your initial improvement should be relatively

Our experience with the minimally scar periareolar purse string breast lift has been accepted for publication.  Final proofs are completed. Will appear on line in 6-8 weeks or so. read more...

   The article discusses our experience from 1992-2006 regarding a circular scar breast lift, popularized by South American Plastic Surgeon Dr. Sampaio-Goes of Brazil where breast lift requiring 4 to 9 cm of elevation can be performed.  This reduces scarring significantly in most patients presenting to the surgeon for breast lifting. We continue to perform this method which is especially well received in patients of color for whom scarring from plastic surgery is important.
There are a few tradeoffs in the method since there can be some stretch to the diameter of the areola due to the circular tension.  But, there is no vertical or horizontal scar as with the Anchor, T pattern, or  vertical scar as with the Lejour, Hall-Findlay, or Vertical approach.

Our experience with the minimally scar periareolar purse string breast lift has been accepted for publication.  Final proofs are being completed. Will appear on line in 6 weeks or so.  It will be featured in the Journal of Plastic Reconstructive and Aesthetic Surgery formerly the British Journal of Plastic Surgery.  It reviews our 14 year experience from 1992 to early 2006.  About 1-3 % of surgeons worldwide use this method for more challenging cases of breast lift and reduction.  It is a


Application of the Goes double-skin peri-areolar mastopexy with and without implants: a 14-year experience    •   REVIEW
In Press Corrected Proof , Available online 04 January 2010
Donn M. Hickman
Journal of Plastic, Reconstructive & Aesthetic Surgery
DOI: 10.1016/j.bjps.2009.11.033
Abstract | Full Text | Full-Text PDF (1823 KB)

[CROTON OIL-PHENOL PEELS or CROTON OIL PEELS]

CROTON OIL-PHENOL PEELS  or  CROTON OIL PEELS
The deepest peel a plastic surgeon performs involves phenol and croton oil.  It has been around in its basic form since the early 1960s.  A new understanding of the basis for this deep peel came with the writings of Plastic Surgeon and now retired, Dr. Gregory Hetter, in 2000.  The ingredient croton oil, the element that gave depth and penetration to the peel, and provided the extraordinary wrinkle reducing properties is now considered the true peeling component of the classic phenol peel.  With adjustments and modifications, it can be the best choice significant facial aging.  It does not require an expensive laser, but simply an application of solution to the skin, which takes a few days to two weeks to provide stunning rejuvenation of the face.

Read more...

CROTON OIL-PHENOL PEELS  or  CROTON OIL PEELS

The deepest peel a plastic surgeon performs involves phenol and croton oil.  It has been around in its basic form since the early 1960s.  A new understanding of the basis for this deep peel came with the writings of Plastic Surgeon and now retired, Dr. Gregory Hetter, in 2000.  The ingredient croton oil, the element that gave depth and penetration to the peel, and provided the extraordinary wrinkle reducing properties is now considered the true peeling component of the classic phenol peel.  With adjustments and modifications, it can be the best choice significant facial aging.  It does not require an expensive laser, but simply an application of solution to the skin, which takes a few days to two weeks to provide stunning rejuvenation of the face. 

THE CROTON OIL PEEL can be termed  the CROTON OIL-PHENOL PEEL  rather than the older term PHENOL-CROTON OIL PEEL.

This Practice has been performing the peel in variations for over 25 years and the results can be seen in the BEFORE AND AFTER SECTION ON SKIN RESURFACING PHOTOS.



The peel can be adjusted for skin type, the patient's desired end result, and is planned to encompass a consumer's schedule and time budgeted for skin improvement.

The pendulum may be swinging back to peels as a key element in skin resurfacing equalling and perhaps surpassing the laser.

This PRACTICE HAS PERFORMED OVER 5700 peels since 1984. 

The skin types included for this method can include those with darker skin, but special 4 week preparation may be necessary, with an explanation of some early delays in the final outcome, that if accepted, make these peels suitable for practically everyone.

 We encourage patients to secure the extended warranty with their implants.  The companies honor these with great compassion and it usually takes 6 weeks or so after receipt of the implant in question that may have failed.  (such as a breast implant deflation that may uncommonly occur during its anticipated lifetime).   Click Here For More...

The new collagen called EVOLENCE underwent FDA clearance in June 2008 for a 6 month clearance to assess its clinical effectiveness.  In June 2009, it received another 12 month clearance, now for the use in moderate to deep facial wrinkles and folds.  It is derived from  from pig but is naturally cross linked in the lab to mimic the three dimensional structure of human skin collagen.  This is why it requires no allergy testing, which is a quantum leap for consumers who don't wish the two-visit requirement to have standard collagen (Zyderm) skin treatments. Click Here for More...

Surgicil Corporation has introduced a new soft, rubbery, quite pliable, and natural feeling silicone implant for the lips which may provide the long term solution for patients  unsatisfied with repeat injections of fillers such as restylane, juviderm, and fat.   The PERMALIP implant is made of FDA approved silicone and the device itself is FDA approved for facial enhancement. click here for more...

[Zerona Laser]

Zerona Laser
There is a new technology that has just been released at the beginning of 2009 with work culminating in 2008, on a laser which gently targets fat cells, right through the skin, causing them to leak fat which is released and eliminated from the body. click here for more...