With fractional resurfacing being clearly the most popular treatment over the past 1-2 years, patients are seeking procedures with the most limited downtime to accomodate their busy lives. Although there will always be some degree of ‘no pain, no gain’ to laser treatments, technologies are certainly maximizing results with limited recovery. Recently the developers of Fraxel released a fractional device called Clear & Brilliant. Although not as clinically dramatic in results as other Fraxel devices, the technology uses a novel wavelength of light that minimizes peeling during recovery. From our experience thus far, the technology benefits younger patients with limited amounts of sun damage or more advanced patients who are looking for no downtime maintenance to other procedures they have done in the past. The treatment takes about 15 min and produces mild redness that lasts only a few hours. Makeup can be applied immediately and the skin will feel dry for a few days only. Thus far, Clear and Brilliant seems like a very promising minimally invasive treatment for overall skin rejuvenation. Although the results are not as dramatic as other Fraxel procedures, it will certainly fill a much needed niche in the field of laser resurfacing.

So there is a new treatment on the block. It may not seem like anything new in skin tightening and fine line wrinkle treatments. Thermage, Titan and newer treatments such as Ulthera have the same premise of delivering heat deep in the skin causing immediate contraction and future development of fresh collagen. The problem with many of these effective treatments is that they hurt quite a bit and for some of the stronger ones can cause some degree of swelling which can effect daily activities. Pelleve is a radiofrequency device that delivers skin tightening energy in a low level and deeply penetrating continuous fashion rather that intense pulses. This manner of delivery allows for extremely comfortable treatments that can be done at 2-4 week intervals until the desired result is achieved. There is zero downtime and most patients are describing the treatment as a pleasurable warm facial massage. The catch is that it does require several treatments- usually 3-6 depending on a patient’s needs. Is it better than the other devices? Not likely in efficacy. But for that patient that is adverse to any downtime and discomfort and is willing to get several treatments, I believe the Pelleve device is an excellent addition to the battle against time. To find out more about it go to our website-www.pfrankmd.com

So it been years now that the US market has been waiting for effective non invasive fat removal devices. Zeltiq is the most popular now but has alot of limitation in terms of lack of sculpting , time for treatment and ability to treat various areas and sizes. Zerona was a total failure and a bit of a scam, if you ask me. But Liposonix is an ultrasound device that has been used in Canada and Europe for a few years now. Although the first device was not overwhelmingly impressive, there is science behind it and most importantly, room to grow in the technology. Well, just recently, Liposonix developed a second generation machine that promises to work faster and better than its predecessor. Solta medical, the distributors of Fraxel technology, will be marketing it in the US as early as the begginning of 2012. Although it will certainly not be a replacement for the tumescent liposuction procedures i perform everyday, i do believe that it will be a good addition to the armamentarium we use in fat reduction….Stay tuned. We will very likely be one of the first practices in the country to offer this exciting new device. Check in with our website www.pfrankmd.com and sign up to our newsletter for updates on Liposonix.

With all the obsession with vampires in pop culture, the prince of darkness has infiltrated the cosmetic world with what has been called the ‘vampire facelift’. This is nothing particularly new. The vampire facelift is a technology called PRP or platelet rich plasma, a natural portion of blood that can be isolated from patients and injected for various purposes. All the growth factors that circulate throughout the body can be found in the processed blood and “theoretically” would be of some use. Orthopedic surgeons have used the technique of injecting one’s own blood with mixed success to help healing joints and tendons. As a cosmetic application, we have found very limited to no benefit as compared to the huge success of various fillers on the market. Aside from its limited effectiveness for wrinkles, we do not know the long term effects of injecting any sort of growth factors into the skin. There are some studies that show improved healing with aggressive lasers and similar procedures. The improvement may not be enough to significantly incur extra cost though. As for PRP for beauty, filling and wrinkles, Dr. Frank’s consensus- don’t believe the hype. Just keep watching ‘True Blood’ and ‘Twilight’.

So much skin to tighten and so many toys! What to do? what works better? These are the daily questions. Well, here’s the update. Thermage has been a gold standard for a decade in skin tightening, offering modest but significant efficacy in well chosen patients. Technologies advance and time moves forward. Ulthera has been out for a year and up until recently has been unimpressive in its differentiation from other technologies. With time, experience, and technological tweaks, the treatment protocols and technology has advanced dramatically. Although i still use thermage regularly on the body, I find Ultherapy to be the most effective facial tightening treatment to date. The technology definitely penetrates deeper into the skin with greater, more controlled energies as demonstrated by the ability to visualize the skin on the ultrasound screen. What is also unique is the ability to treat specific areas as opposed to only entire faces. What is still essential is choosing the right candidate. This is not for patients with loose sagging skin. Ultherapy treats mild to moderate laxity and is appropriate for patients in their 30’s 40’s and 50’s. You can read more about it at www.pfrankmd.com

Pores are one topic that never seems to gets old. People are obsessed with them. Understandably so….they are the portals to your skin and body. They allow the skin to breath, to lubricate, to control heat regulation and to generally control the skin’s well being. So the answer to everyone’s question is- you cannot remove them.Unfortunately, many people have complaints about their pores. Some are bigger than others, some secrete too much or too little oils, some are more visible or scar looking than others. It is obvious why pores are such a popular topic and why billions of dollars in cosmeceuticals and laser treatments have been spent trying to alter them. What must be remembered is first- we can not rid of them. They are an important part of our skin. Second- their visibility and size has a lot to do with genetics, normal aging and with progressive sun damage. You can control the sun damage part. Any finally, although you cannot close them for good, there are ways to minimize them, conceal them, and help control any dysfunction they may present.. Many topical agents, including many acne medications, can keep them empty of sebum, thus making them appear smaller and keeping them from progressively swelling. More procedural things that can be done range from chemical peels to microdermabrasion to pore cleansing acne lasers such as Isolaz.
As with most cosmetic concerns, sometimes the best treatment is good lighting and makeup. There are several pore refining and matte finishing products out of the market that help conceal the pores that perturb so many. One of my favorites is Z-pore by GoodSkin Labs. This product give a smooth matte finish to the skin that lasts all day. A product such as this alone or along with other pore refining techniques can minimize the appearance and concerns regarding the pore dillemma.

This is the most commonly asked question in the 1000 plus liposuction consults I do a year in my practice. The accepted answer amongst the surgical community has always been that it does not reaccumulate as long as the patient keeps their weight stable. Surprisingly, a small study published in the journal Obesity has results that show otherwise. 14 Patients had small volume (non obese) liposuction performed. 18 controls were used who had no procedure. They performed scans on the patients to determine the loss and/or gain of percentage body fat. Surgical patients generally lost about 2.2% fat after surgery but after 6 months and then 1 year seemed to gain that percentage back either in the same area or most importantly elsewhere. What is unknown is whether weight was kept stable during that year and what the lifestyle issues were during recovery, which is THE most important factor. The concept proposed is that the body fights the loss of fat and subsequently produces more. Although very interesting as a study, and one that should be elaborated on, i do not think is a concrete game changer for liposuction surgeons or patients. After performing over 3000 cases in the last decade, i can honestly say that liposuction surgery has one of the highest satisfaction rates when the right candidate is chosen. Patients with limited fat removal and healthy, stable dietary habits continue to be satisfied years after their surgery. I am sure most liposuction experts have the same experience as liposuction surgery has been and generally remains the most popular cosmetic surgery in the country. This study does give food for thought, though. It certainly points out the need to screen potential candidates carefully and ensure that nutritional and excercise monitoring be part of the overall goal of the procedure. I regularly consult the services of a nutritionist for most of my liposuction patients. Changing the body form is a multifaceted goal. There is no one treatment or easy route. Liposuction surgery does continue to be an essential piece in this puzzle.

Sorry people, I have been a bit lax in my blogging. Spring is here and life is getting busy for everyone. I do have a ton of info for you folks and i will try to make my regular blog entries. For the bulk seasonal information you can go to my website and sign up for my spring newsletter to regularly keep you up to date- www.pfrankmd.com
For now, lets talk a bit more about scars. There seems to be a dramatic misconception about when to treat a scar from surgery or trauma. Unfortunately, the misconception is often perpetuated by plastic surgeons who usually reccommend a full six months before any treatments. This is partially right and mostly wrong. To cut out a scar for surgical revision, this is true. We want complete healing before we induce a dramatic physical trauma such as surgery. But, as for as laser treatments and cortisone injections are concerned it is essential to start treatment as soon as the stitiches are removed at about 2 weeks. There is an enormous amount of literature now to support that the use of a pulsed dye laser (ie VBEAM) will dramatically reduce chronic redness and swelling of a healing scar if treated early, particularly in patients who are susceptible to hypertrophic or keloid scarring. In addition, as soon as a scar appears elevated it should be injected with cortisone. Unfortunately, most patients are merely told to use silicone tape, which is the scar treatment equivalent of chicken soup. Fact is, there is alot that can be done with lasers and scars and the current and accepted thought amongst us laser surgeons is the earlier the better. 1st treat the redness with VBEAM and then treat the texture and appearance with resurfacing lasers such as Fraxel. The longer a scar sits the tougher it is to treat!

This is a very common question with a very long answer and a few key points. The several options that exist can certainly be researched online and on my website- www.pfrankmd.com , as well. But… what is essential to realize is that there IS NO BEST TREATMENT. Often people seek the newest, latest and greatest. This is not always the best though. Often older techniques can be more effective than newer ones. Often companies and Drs use NEW technologies as a selling point….beware. Sometimes new means experimental. Scars are different, just like people. The goal of any consulting physician is to provide several options that consider scar type, skin type, expected efficacy, and certainly cost efficiency. Give these variables and current technology, there are obviously several options. And within those option (ie lasers),
several brand names of very similar technologies. So….remember if someone only has a hammer, everything will look like a nail. What you want is a doctor with a full toolchest!

Yet again, another miracle non surgical facelift device has entered the marketplace. This time, the magic is performed with ultrasound technology. Its been on The Doctors….and its been on the Dr. Oz show. Now, that must mean it really works, right? ( does sarcasm translate easily through medical blogging). Unfortunately, the hype is often greater that the delivery. It is no different in this instance.
Ulthera is the first technology that utilizes ultrasound to tighten skin and has the ability to visualize the deeper “targeted” layers of the skin during the treatment. As with the several technologies that are already on the market, this technology heats up skin to contract tissue and boost collagen. Other technologies such as Thermage and Titan, amongst others, utilize radiofrequency wavelengths to accomplish the same tasks, instead of ultrasound.
There is science to all of the various technologies and to some degree, in the right candidates, all of them can show efficacy. The problem is how much effect is created and is the cost/benefit ratio worthwhile. There certainly are no comparative studies between all of these tightening toys. I can only say that I have used the Thermage technology for 10 years now and have successfully found that when the RIGHT candidate is chosen (mostly 35-45 yrs of age) then the results are appreciable and patients are happy. BUT ….admitingly, I feel that skin tightening technologies, as a whole, are one of the most over-utilized treatments in my field with potentially the least “bang for one’s buck”. And hear lies my concern with the newer Ulthera technology. The device appears to be the same treatment in just a new package. Although it may be modestly effective, i do not believe, as of yet, that it is dramatically better than technologies that already exist. Now, as always, my opinion may change if the technology progresses. But….as i saw with the past devices, I believe there will be a large population of loose skinned patients who are going to be sold the pot of gold and merely get a bowl of cold soup. Skin tightening technology to date only gives modest results and many patients who seek these treatments require a surgical approach or, as i often do in my practice, a treatment plan that also includes fillers and toxins to maximize one’s results. Once again, it comes down to patient selection and, as a physician, providing appropriate expectations for patients. We shall see what happens this time around…some things never change.
Happy Holidays everyone.
Dr Frank
www.pfrankmd.com