The following is an interview between Dr. Larry Nichter, MD, FACS and RealSelf about ultrasonic cavitation, a painless, FDA-approved fat reduction procedure.
How long does it take to see results from ultrasonic cavitation?
Following ultrasonic cavitation assisted liposuction with devices like Liposonix or VASER, normal post-operative edema and swelling tends to be slightly more in my experience during the first 3 days and takes a little bit longer to resolve, however the results are often better than liposuction alone due to skin contraction. It is also very usefult for body sculpting. External ultrasonic fat reduction (e.g. Ultrashape Plus) is painless, and results in significant but less dramatic fat reduction than liposuction. The results can take weeks to months to be seen and usually are part of a series of treatments.
How long do results last?
If your weight is stable, your results will be long lasting – many years to lifetime. I like the analogy: if you had an identical twin and only you were treated you would always look better your entire life. However, please note that hormonal, age and other factors are also associated with increased fat.
How much does ultrasonic cavitation cost?
This is dependent on the experience of the surgeon, geographical location, number of areas treated, if it is performed in the doctors office vs outpatient center, vs hospital, type of anesthesia — local vs IV vs general anesthesia, and finally on the overall operative time.
Does ultrasonic cavitation tighten skin?
Ultrasonic cavitation assisted liposuction can tighten the skin by creating heat which leads to skin contraction. External ultrasonic cavitation (e.g. Ultrashape) focuses its energy.
Does it destroy fat cells?
Yes, this process is called lipolysis. Fat cells are both destroyed as ultrasonic waves cause cavitation which is rapid oscillating sound pressure waves that create microbubbles that can selectively damage the fat cell membrane.
What are the side effects and complications of cavitation?
For ultrasonic cavitation assisted liposuction- side effects include initial swelling may be more significant, and Incisions are slightly larger. Complications include: there is a potential risk of localized thermal burns in addition to the usual risks of liposuction such as seroma (collection of fluid). Side effects from external liposuction cavitation are few and far between and there is essentially no recovery time.
For women, having a child life-changing event. The capability to create, foster, and give birth to a child of your own distinguishes women in the human species. The nine-month transformation from a tiny embryo to a human being in itself is a magical event, but it transforms the mother’s body as well, often in a non-favorable direction. A mother goes through many different changes during pregnancy and the birth process. In many cases, areas of a woman’s body may not return to the same shape prior to pregnancy.
Thanks to current medical procedures, mothers are often able to restore their bodies back to their pre-birth shape or even better. After breast feeding is complete and you have fully recovered from pregnancy, there are various steps that can be taken to get your body back into shape. In what is commonly known as the Mommy Makeover — various procedures such as breast augmentation, breast lifts, liposuction, tummy tucks, fat transfer, and other procedures — can be done to get your body back into top condition. Most of these procedures can be done in combination to complete your makeover or can be done in separate steps.
In most cases after childbirth, women often find that their breasts become out of shape due to breast-feeding or growth then shrinkage after pregnancy. The breast often loses volume on the top and sags and becomes less firm and out of shape (post-partum involution). This can produce visual changes that women want to fix and improve. With straightforward procedures, breasts can be transformed to the desired state with a variety of techniques including breast augmentation using fat transfer (called California Breast Lift in my practice) or implants with or without a lift. These procedures can give your breasts a natural look and maintain volume that was present prior to pregnancy. Some surveys have stated that up to 90% of patients have found success with these procedures, with remarkable results and happiness.
After breastfeeding and childbirth, mothers often find that excess skin results or the skin around the breasts is loose resulting in sagging. In these cases, a breast lift can also be done to reshape the skin envelope and uplift the areola/nipple position. By itself, this procedure isn’t done to change the size of the breasts, but is done more to affect the contour and firm up the breast skin and underlying breast tissue. Newer, minimal scar breast lift techniques, can affect the breast size if combined with a breast augmentation or reduction procedure to enhance the shape, size, and position of the breasts.
Tummy and Hips
Following pregnancy, women often find that the tummy and hip areas are the main concerns for improvement following delivery. After giving birth, women often try to return to their pre-baby weight and find that even if they lose those pregnancy pounds, that they cannot get their tummies back into the desired shape. A tummy tuck with or without liposuction can be performed in this case to remove excess skin, fat, and tone up your tummy muscles. This tried-and-true procedure in the hands of an experienced plastic surgeon will result in a firmer and smoother stomach. Weakened, stretched, and separated muscles (Diastasis Recti) are reshaped during this procedure and will transform your abdominal wall into a well-toned tummy. Giving birth can result in your abdominal skin and muscles being stretched out of shape. A tummy tuck will reshape it back into its toned natural shape, sometimes even better than before you were pregnant. Liposuction is often done at the same time and the fat removed can be used by transferring it to areas that may have lose volume such as your buttocks (Brazilian Butt Lift) or breasts.
Most women following pregnancy will get stretch marks but this doesn’t mean you can’t do anything about them. Stretch marks, also called striae, can also occur as a result of pregnancy. The tummy tuck not only reshapes the stomach muscles and skin, but also removes these a large number of stretch marks below the belly button. Certain lasers are also available that can get rid of the redness and shrink the width of stretch marks while improving the texture of your skin. Spider veins or red spots (angiomas) following childbirth can vanish seemingly instantly with special lasers and without downtime afterwards. Prominent superficial veins in the legs and other areas also can occur after having a baby. These can be treated in the office with lasers and injections (sclerotherapy).
Skin tone and texture can also be improved. For example, Cellulite and skin wrinkling can be tightened noninvasively. Likewise, circumferential reduction of the waist and thighs with a series of non painful, non-invasive treatments combining the energy sources of RF (radiofrequency), IR (infrared) aimed at improving the skin and superficial fat (e.g. Velashape III).
After pregnancy and with age, fat can accumulate in different areas that are resistant to diet and exercise. In concert with the Velashape® treatments, Liposuction or other non-invasive non-surgical fat reduction procedures are often helpful. Whether it’s the tummy, hips, thighs, back, or upper arms, liposuction can get rid of the excess fat collection that occurs after pregnancy. By getting rid of these excess bulges along with a sensible diet and exercise plan, you can get your body back into top shape. Other non-invasive techniques such as CoolSculpt® and newer techniques such as Ultrashape®, and Vanquish® are all possibilities for non-surgical fat reduction. As all techniques work differently make sure you go to an expert plastic surgeon to decide which is best for you. These techniques reshape your skin and body towards to your desired shape and best of all there is no down time and minimal if any discomfort. With regular core exercises, you are well on your way to an “abs of steel six-pack”. Exercise maintenance and a stable weight should give you a life-long result.
Another part of the body that might be affected post pregnancy is the belly button, also called umbilicus. The pregnancy cycle can stretch or distort the belly button area. The tummy tuck can assist with making your belly button smaller, however if this is your only concern, improving your belly button’s appearance via a procedure known as umbilicoplasty is possible. An umbilical hernia usually recognized by an “outie belly button” can also be repaired at the same time and often performed under local anesthesia as an office procedure.
Vaginal and Labial Rejuvenation
Especially following vaginal delivery, and important to femininity and intimacy, sometimes the vaginal area is stretched out and loses optimal tone. This can be corrected with a vaginoplasty to firm up and increase tone to the vaginal canal, giving increased intimate sexual satisfaction to the woman and her mate. Likewise, the labia minora (inner lips) might be overly large as a result of pregnancy or genetics. Labia reduction is corrected with a procedure called labiaplasty. The mons pubis, hair bearing area, often becomes bulky, sags, and shows through clothes following pregnancy. This can be corrected with a “monsplasty” procedure. These procedures are often performed as an outpatient procedure, often at the same time as other mommy-makeover procedures.
Lastly, persistent darkened skin pigment changes may occur on your face, also called Chloasma or Melasma (“mask of pregnancy”). Tailored medical grade lightening creams, peels, and lasers can be done to help with the discoloration that can occur following pregnancy in the facial and other areas.
All of these mommy makeover procedures and others are done in an effort to regain your ideal image, shape and composure following pregnancy. Just because you’ve had a baby, this doesn’t mean your body should be neglected. You can choose from a combination of procedures to get your body back into shape, firmer, and smoother following pregnancy. As always, consult an experienced board certified plastic surgeon before any procedure, discuss treatment options, as well as recovery time, risks, and possible non-surgical alternatives to surgery. Where the gift of lift is a wonderful thing, a mommy makeover can be the best gift you give yourself after pregnancy.
Body contouring techniques can be separated into non-invasive and invasive techniques.
Liposuction, though “invasive”, still remains the gold standard in body contouring. The procedure uses small suction cannulas sometimes assisted by lasers, ultrasound, propulsive jet sprays, radiofrequency energy or vibrational movement (power-assisted liposuction) to actively remove fat by suction from localized areas of fatty accumulation. Liposuction, also called suction assisted lipectomy or “lipo”, is still by far the most successful and predictable way to quickly, safely and effectively create the contouring figure that you desire. However, compared to non-invasive techniques there is some risk, increased recovery time, and discomfort associated with liposuction. Less invasive techniques involve inserting a Radiofrequency (RF) probe (e.g. ThermiRF™ to melt fat for smaller areas without liposuction, but still has more risk than non-invasive techniques). This has led to the growth of non-surgical, non-invasive body contouring.
Non-invasive body contouring technologies use an energy delivery system to injure, destroy, “convince cells to die slowly over time” or alter the architecture of the fat cells without any incisions or placing any device under the skin, and without performing any surgery. Other techniques that are evolving include injecting a substance to reduce fat (Kythera®, FDA approved to reduce fat under the chin).
The common non-invasive energy types utilized to create non-surgical body contouring include RF, focused ultrasound, infrared, RF-coupled suction and massage, and diode laser energy. These non-invasive energy sources that reduce areas of enlarged fat concentrations such as tummy, hips, thighs, and the back — reducing fat without harming other structures like nerves and blood vessels. Some are more effective than others. For example, Zerona® claims that its cool diode laser has a generalized “whole body” slimming technology by making fat cells leaky rather than using thermal mechanisms or cavitation energy to alter or break apart the fat cell. To scientist physicians like myself, it is hard to believe that low level cool laser light waves will be able to penetrate more than a millimeter or two, much less where the majority of the fat lies. It is no wonder that at the time I write this it is ranked as only having 28% satisfaction rating on RealSelf.
On the other hand, there are many effective non-invasive fat reduction technologies available.
CoolSculpting® is effective but has some discomfort noted by many patients, and the applicator paddle sizes can only treat a few areas at a time, require several treatments (3–5), have to wait between treatments, and takes several weeks to see the full effect and occasionally fat ridges are seen above the treated areas.
UltraShape® by Syneron Candela uses focused ultrasound energy, can treat at three different levels, and the different size applicators can treat just about anywhere on the body and even do lipo-sculpting. It is painless and the results are seen quickly with treatments a few weeks apart (series of 3 is typical, more depending on desires may be recommended). It is great for localized areas.
BTL Vanquish uses RF energy to heat the fatty layer precisely, painlessly and selectively to a temperature that causes fat cells to undergo early cell death (apoptosis) by destroying the integrity of the fat cell. Like other techniques that accomplish the same effect, the body then clears the remnants by the lymphatic system.
The VelaShape III, is new technology and much more effective than its predecessors (VelaShape I and II). It is a non-invasive body shaping device used to reduce cellulite, and reduce (slim) the area around the tummy, back, hips and thighs. The machine combines four different technologies — infrared, bi-polar RF, pulsed vacuum, and massage rollers — to improve skin texture and reduce the overall volume of the treated area. It is often used alone for cellulite reduction but often used in conjunction with the other devices I mentioned to magnify their efficacy by smoothing and warming the tissues and clearing much of the edema and fat breakdown products using as an advanced lymphatic massage device. Please note RF devices cannot be used for patients with pacemakers.
For large areas of troublesome fat collections as well as specific areas of focal fat and accumulation you may be best served by the various forms of liposuction. The non-invasive focal fat contouring technologies now in the market place may not be as effective, but have reduced risk and recovery time. Deciding between these options should be done on a case-by-case basis between patient and physician.
Volume redistribution – loss of volume in some areas, fat pockets in other areas
Surface characteristics – sun exposure, acne, etc.
All three of these issues are evaluated by Dr. Nichter during the consultation and recommendations are made as to which procedure or combination of procedures will provide the best outcome. Treatment may include any one or more of the following: facelift, neck lift, fat transfer or fillers, liposuction, laser resurfacing, laser tightening, chemical peel, skin care regimen.
Any woman or man who has a lot of redundant skin, stretch marks, loss of abdominal tone due to pregnancy or significant weight gain/loss. A tummy tuck frees the redundant skin and removes it, tightens the underlying muscles, and liposuction contours add additional contouring to the abdomen and waistline.
Dr. Nichter discusses the Top 5 characteristics of the neck that he evaluates for potential improvement.
Amount of fat beneath your chin – younger patients may just need liposuction.
Platysma bands – Located in the front of the neck. Muscles that separate and present themselves as 2 bands (a.k.a Number 11 bands).
Amount of redundant skin – The amount of loose skin will determine if a surgical or non-surgical procedure is needed.
Skin quality – Skin texture, acne, age spots or sun spots, broken capillaries, volume or lack of volume, fine lines and wrinkles are all taken into consideration when assessing what treatment or procedure is necessary.
Misc. features – A prominent mandibular gland or recessed chin
Dr. Nichter talks about the people who may be a candidate for a neck lift in the video above. He states that candidates can range in age from their 20’s or 30’s up to their 80’s. Younger patients seeking neck improvement often times complain of fullness beneath their chin, which is an excess of fat, which can be removed with liposuction. If the skin doesn’t tighten from the liposuction procedure, Dr. Nichter may recommend using the Sciton® SkinTyte laser for additional neck contouring improvement. Patients who are older who are seeing the effects of aging in their neck, will often times require a combination of procedures to achieve optimal results. The procedures could be any one or more of the following: liposuction, platysmaplasty, neck lift,facelift, or laser tightening.
The Mommy Makeover is a combination of procedures, which improve the breasts,abdomen and hips after pregnancy or significant weight loss. Dr. Nichter explains who makes an ideal candidate and how the Mommy Makeover is performed. He also mentions many women comment on how they look better after surgery than pre-pregnancy.
One of the most common complaints from women seeking liposuction or a tummy tuck is the storage of excess fat in the abdomen. In some cases even through diet and exercise there may still be some unwanted fat pockets. Dr. Nichter provides an explanation as to why fat stores in the abdomen and how a tummy tuck or liposuction can offer a solution to this common problem.