Medesthetics

SEP-OCT 2013

MedEsthetics magazines offers business education and in-depth coverage of the latest noninvasive cosmetic procedures for physicians and practice managers working in the medical aesthetics industry.

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SLIMMING & SHAPING with a 50% average using his minimally invasive Sciton CelluSmooth (sciton.com). While other devices focus on fat reduction, this laser-based device smooths the bumps in places like the saddlebags that often can be hard to target with fat reduction applicators. According to Dr. Salzman, CelluSmooth requires a 30-minute session using a local anesthetic fluid to control discomfort. "Most patients experience about one week of bruising and swelling and cannot exercise for a week," he says. Full results manifest about eight to12 weeks following treatment. UPSIDE DOWNSIDE The ablative laser treats a main cause of cellulite by releasing the fibrous septa tether that leads to cellulite's characteristic dimpling. The nonablative laser tightens and generates collagen for smoother skin. The minimally invasive device works only on cellulite, usually requires local anesthesia and can produce some minor, temporary side effects. Radiofrequency Just as cryolipolysis uses cold temperatures to freeze fat, radiofrequency uses heat (46°C-49°C) to kill fat cells or at least increase their metabolism, causing the breakdown of the fat from the cells, says Karol Gutowski, MD, FACS, a board certified plastic surgeon with MAE Plastic Surgery in Northbrook, Illinois (maeplasticsurgery.com). An added benefit of radiofrequency-based devices is that the heat can also tighten skin and stimulate the fibroblast cells that make collagen, Dr. Gutowski notes. Like nonablative lasers and ultrasound, radiofrequency delivered at specific wavelengths generates heat in the adipose tissue, which can either stimulate metabolism to release fat and shrink the cell or induce cell apoptosis. Devices with adjustable wavelengths can help the technician determine a specific depth according to where the fat sits on any particular area of the body, says Dr. Gutowski. The Reaction device by Viora (viorareaction.com), for instance, has four settings to determine depth and function. "If you're tightening collagen, you want to get into the dermis. If you want to target fat, you need to target the subcutaneous fat layer," says Dr. 36 SEPTEMBER/OCTOBER 2013 | MedEsthetics Gutowski. Typically, that target is no more than 1cm to 2cm deep. There are several radiofrequency-based devices now available, including the Viora Reaction, Syneron VelaShape II (syneron-candela.com), Solta Medical's Thermage (solta.com), the Cutera TruSculpt (cutera. com), Chromogenex i-Lipo (chromogenex.com), the Venus Freeze (venus-concept.com) and Alma Laser's vShape (almalasers.com). Most offer multiple treatment applicators for the face and body and deliver comfortable doses administered over several treatment sessions. Several companies are combining RF energy with other modalities—including low-level laser and magnetic pulses—to provide equal efficacy with lower energy levels. Gita Meshkat Razavi, MD, medical director at Foreviva Medical Clinique in Palo Alto, California (foreviva.com), administers a minimum of three sessions—usually four to six—when treating patients with her Alma vShape. A typical leg treatment, for instance, might require four sessions at 25 minutes each. In Dr. Razavi's medical spa, she's had great success contouring the bodies of patients who dropped a significant amount of weight. One woman who lost 200 lbs. bought 12 sessions to help tighten and contour her body, while a mother of twins who lost 70 lbs. purchased eight sessions. "She's absolutely tighter now," says Dr. Razavi. "If you're tightening collagen, you want to get into the dermis. If you want to target fat, you need to target the subcutaneous fat layer." At Israel's Keren-Or Medical Aesthetic Center, researchers tested the Reaction for skin tightening and wrinkle reduction on 16 healthy female patients. The subjects underwent three treatment sessions at three-week intervals with results showing moderate to significant improvement in 81% of the patients. "You won't see results right away. There's initial tightening, but you have to wait for the collagen to synthesize. Final results are typically seen up to six

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