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The Latest Surgical Treatment for Cellulite is Now Available!

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Treating cellulite

Just to bring you all up to speed, there are currently two surgical treatments for Cellulite: Cellulaze and VASER Smooth

Do you have those puckered dimples and lumps on your hips, thighs and buttocks? Have you tried non-surgical means (massage, topical agents) with no improvement?

There is a reason why non-surgical means do not treat cellulite. The problem does not lie on the surface of the skin. Cellulite is a condition where there is dimpling in the skin due to fibrous bands that attach to the dermis on the underside of the
skin above and to the deep tissue and muscle below. These fibrous bands pull on the underside of the skin causing the dimpling. In the past, a vacuum (Endermologie) was applied to the surface of the skin to stretch these bands and pull up the skin. This did not work very well. As the problem is not the fat itself, losing weight won’t work as well. Neither will traditional liposuction, which is designed to remove fat. Remember, the fat itself isn’t the problem, so removing fat won’t correct the problem.

Surgical approaches are aimed at cutting these bands from within the skin to release the skin to reduce the dimpling. Both Cellulaze and VASER are designed to do this. Cellulaze is made by Cynosure, the laser company that created Smart Lipo. VASER Smooth is made by Sound Surgical.

Liposuction Background

First, a little background on liposuction just to make sure everyone understands what it is and how it works. I will also explain the difference between VASER Smooth and liposuction. Liposuction was originally created in the early 1980′s. It consisted of passing a long thin tube called a cannula into the skin. Suction was applied to the tube and fat was sucked out. The removed fat was also accompanied by a lot of blood. There was pain, swelling, and contour deformities.

In the late 1990′s, tumescent liposuction was created. In this technique, saline solution with local anesthetic (to numb the skin) and epinephrine (to cause constriction of the tiny blood vessels in the skin to reduce bleeding) was placed into the fat under the skin with a long thin blunt needle called an injection cannula. After the skin was tense with the fluid, it was now also numb and because the blood vessels were constricted, far less likely to bleed.

The next step was to put in a suction cannula (tube) attached to a vacuum source and suck out the fat (hence the name lipo meaning fat + suction). This time, the fat was mostly yellow with very little blood loss. Refinements in cannulae design and smaller cannula for fat removal led to better results with less dimpling and local tissue trauma. Tumescent technique was probably the single greatest advance to liposuction.

In the mid-1990′s ultrasound was used as an adjunct to break of fat and facilitate its removal with liposuction. This was attempted by applying the ultrasound onto the top of the skin surface (external ultrasound) as well as internally through the liposuction cannula (internal ultrasound).

Meet the doctor Dr. Mark Epstein
Dr. Mark D. Epstein is a board-certified plastic surgeon with additional qualifications in surgery of the hand, currently practicing in Stony Brook, New York. Dr. Epstein also serves as the Chief ... » Learn More

The next advance was the application of energy to the fat internally after the fat was tumesced (filled) with saline but also prior to its removal with suction. This was attempted in two different ways: First, laser energy was delivered to the fat via a fiberoptic cable. This is the approach of Smart Lipo. Laser energy is not tissue specific. In other words, the laser indiscriminately will destroy anything in its path: fat, blood vessels, nerves, fibrous tissue, muscle and skin. Ultrasound energy on the other hand is tissue specific and will only target fat. Ultrasonic energy causes the naturally dissolved air bubbles within the saline to progressively dilate and cleave the fat away from the body like “little microscopic crowbars”. There are two advantages to this technique over laser techniques. First, only the fat is affected. Secondly, and this was only discovered recently, the fat removed is viable! This means that the fat can be used for grafting purposes elsewhere in the body. So, in summary, if you use laser (Smart lipo), then the fat is not re-useable as grafting material, and if you use ultrasound (VASER) the fat can be re-used. Also, the VASER ultrasound technique is more amenable to treat larger areas than the Smart lipo laser technique.

This brings us to cellulite. When treating cellulite, you can use either laser or ultrasound technology to treat the problem (the tissue bands within the skin). Cellulaze is an attachment sold by Cynosure for their Smart Lipo equipment. VASER Smooth is an attachment sold by Sound Surgical for their VASER ultrasound liposuction equipment. As this is extremely new technology, there are very few surgeons equipped to do this. On the VASER side, Sound Surgical has just started producing the equipment and I have one of the very first produced units.

VASER Smooth Procedures

VASER Smooth procedures are performed under local anesthesia, the same way as described above for liposuction. First, markings are placed on the skin in the preoperative area, noting both the peaks and valleys in the skin with different colored markers. Next, you are brought to the operating room. While you lie on the operating table, the affected areas are cleansed with antiseptic solution. A few small (approximately 1/8 inch) incisions are made in the skin in areas less likely to be visible. Next, the VASER ultrasound probe is introduced painlessly under the skin through the fat. When the bands that tether the skin and cause dimpling are created, the edge of the probe is brought against the band and the ultrasound energy is turned on. This cuts the bands. After the bands are cut, any “peaks” of fat are taken down with the regular VASER ultrasound probe and then using a suction cannula. Usually, a think layer of fat is placed to fill the voids in the dimpled skin. Lastly, the wounds are dressed. It’s that simple!

Downtime is minimal and scarring and bruising are minimal. You can return to work in a day or two, and resume regular exercise and normal activities in about two weeks*.

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