Brazilian butt lift with Body jet technique

Since I practice in the very body conscious environment of Marbella, where beauty is a must and my patients spent most of their time on the beach, buttock augmentation and lift is a frequent request of my patients.

There are two methods to augment the buttocks : inserting an implant or transplanting your own fat.
“Brazilian butt lift” is the most common term for fat transfer buttock augmentation.

Brazilian buttlift does not really come from Brazil, as many people think, but rather from the United States, so the term “Brazilian butt lift” is somewhat misleading.
The Brazilian butt lift creates a curvy and attractive shape of the buttock as popular in Brazil, hence the name, at least I presume so.

The Brazilian butt lift works with fat transfer for buttock reshaping.
There is no foreign body involved, we use the patient’s own fat.

This is especially important on the buttocks, since foreign bodies such as implants tend to create a lot of problems here.

In the vast majority of Brazilian butt lift surgeries, we take this fat from the flanks, thighs and abdomen, which indirectly also makes the but curvier an more attractive.
In Braziliian butt lift surgery, this effect is called „accentuation“ .
I believe that this accentuation is a very important contribution to the overall result in Brazilian butt lift surgery.

Brazilian butt lift surgery has been made much more attractive both for surgeons and patients with the Jet assited fat harvest technique.
This technique enables harvest of high quality fat grafts within reasonable time and with excellent take rates.
This makes the operation not only less invasive and faster, but also more cost effective for patients.

If needed, a large volume fat graft can be harvested and simultaneously filtered in the Lipocollector system.
The fat harvested in this way contains the highest percentage of viable fat cells, which are the best ones for transfer.
The quantity of good quality viable cells harvested in this manner is much higher than with other fat grafting technqiues (Based on centrifugation and/or stem cell enrichment.

The results are excellent, and we have downgraded an operation which used to take around 5 hours to 1,5 hours under local anesthetic.

We have observed a marked increase in requests for this kind of surgery in the last years, and it seems that the Brazilian butt lift is becoming a strong trend in cosmetic surgery in Europe.

For me as a surgeon, the new fat transfer technique with jet assisted liposuction has made this a much more enjoyable procedure, since the fat harvest is much more straightforward.

Should you require some more extensive information on this procedure, either in the Department of Plastic Aesthetic and Reconstructive Surgery at Hospital Quiron Malaga or in Cirumed Clinic Marbella please contact us.

Modern Liposuction

Liposuction technqiues have seen some signifcant advances in recent years, the most important ones being minimally invasive techniques such as water jetstream assisted liposuction (Body Jet or Aqua Lipo, as it is often called in the U.S.) and the laser liposuction technique.

In many cases, the best way forward is to combine the two.

The main advantage of jet stream assisted liposuction is as follows: no extensive infiltration of fluids is required and therefore it is much more precise, it is virtually bloodless and enables removal of large quantities of fat in a relatively short time.

The third, and crucial advantage of the water jetstream assisted liposuction technique is that it enables to simultaneously harvest excellent quality fat grafts, which in our practice is mainly used for breast and buttock augmentation as well as a natural filler in facial rejuvenation.

Body Jet uses a very precise waterstream to remove fat preserving viability of the cells. The fat harvested in this way can be used to inject it elsewhere.
The basis for Body Jet is that the fat harvested in this way contains all its inherent growth factors and stem cells, resulting in optimum conditions for graft survival.

The main advantage of laser liposuction is that it provides very even and reliable retraction of the skin. I like to use the laser technique especially for arms and neck (double chin deformity).

In cases of larger deposits, it is ideal to first remove the deeper bulk of fat with Body Jet liposuction, and then treat the more superficial layer with the laser for best skin retraction.

Both of the abovementioned body contouring techniques have significant advantages over “conventional” liposuction.

I have in fact completely abandoned tumescent lipsouctuion in my department.
Tumescent liposuction, to my opinion is an outdated technqiue which has no other advantage than it does not reuqire any major investments in gear other than a suction tube and a cannula.

Both techniques, laser liposuction and water jet stream assisted liposuction are day case procedures under local anesthetic.

For more information visit our Homepage:
www.beautymedicine.es/liposuction-smartlipo

What are advances in fat grafting in modern aesthetic surgery practice?

In our Marbella practice demand for natural breast augmentation with long lasting results and minimum or no scarring at all is very big.

We practice in a very body conscious environment, with very body conscious patients, who mostly embark on a very outdoor orientated lifestyle.

Use of fat for cosmetic procedures has been limited historically because transplanted fat has shown a tendency to re-absorb back into the body, making the increase in volume temporary.
If one reviews contemporary scientific literature, it seems that most publishers report results which are rather a lottery, rather than being in any form predictable.

However, cell-enriched cosmetic surgery harnesses and focuses your body’s own innate healing abilities.

Studies have shown that this helps the specially prepared graft tissue to fully incorporate into the transplant location, thereby increasing the chance of the graft taking.

According to current scientific literature, the most effective modality here is the Body Jet fat harvest procedure, which has originally been developed for effective large volume liposuction.
The technique does largely leave the harvested fatty tissue viable and maintains the viability of the stem cells naturally inherent to human adipose (fat )tissue.
The effectiveness and safety of the procedure is proven in very robust scientific literature and has been breakthrough in modern Plastic surgery technique.
We successfully apply Body Jet fat grafts for natural breast augmentation and buttock augmentation (brazilian butt lift). Take rates are documented to be consistenly around 80% making the procedure very predictable.

Should you require some more extensive information on this procedure, either in the Department of Plastic Aesthetic and Reconstructive Surgery at Hospital Quiron Malaga or in Cirumed Clinic Marbella please contact us.

Natural fat transfer breast augmentation-the Body Jet technique

For years, women have dreamt of having their breasts augmented using their own fat. The idea is to get rid of unwanted fat deposits and naturally augment breasts in the same session.

Prior attempts at autologous fat transfer to the breast have not proven to be constantly successful .
They were successful in some cases , but no so in others, in summary the results were very unpredictable.

New techniques in Natural Breast Augmentation employ the latest technologic advances in fat harvesting.
The principle of these techniques is that they “wash and filter” fat instead of “centrifugation”.

“Wash and filter “techniques are much better to handle and our current scientific data suggests that they also give superior results in fat transfer breast augmentation.
We believe that the less the fat is manipulated the higher the survival, provided of course that the harvesting process is gently enough to keep fat cells alive.

The Body Jet technology (also known as “Aqua-Lipo”) in the U.S. is currently the best option for “wash and filter techniques.
It has been extensively “road tested” and scientific data gained is impressive.

Since Body Jet natural fat transfer breast augmentation does also eliminate unwanted deposits of fat, mostly from thighs, flanks and abdomen, at the same time, patients suitable for this breast augmentation modality do also seem to be much happier with the final results.

The procedure will not interfere with future mammograms because the fat is never injected into the breast gland directly, but in different planes around the breast.
After fat transfer breast augmentation the breasts are more like natural breasts.

Other advantages of natural fat transfer breast augmentation are massive:There is no need for implant exchange ever nor any risk of implant related complications.

From my surgical perspective, the handling characteristics are also a crucial advantage of the Body Jet.
The simultaneous irrigation , suction and filtering process has made natural fat transfer breast augmentation much more user friendly.
Previous centrifugation techniques were extremely time consuming and a lot of fat was lost during the preparation process.

With Body Jet, we do normally need about 1-1,5 hours to complete the breast augmentation procedure, which is done under local anesthetic.
That makes natural fat transfer breast augmentation a much more realistic alternative for many patients.
In our Marbella practice, natural fat transfer breast augmentation does already make up for about 60% of breast augmentation cases, with numbers further rising.

Rhinoplasty…Plastic surgery or ENT ?

Rhinoplasty, is one of the most frequently performed procedures in our department.

The operation of rhinoplasty has traditionally been between the disciplines of ENT and Plastic surgery, with continous diputes regarding who does it better, the ENT’s or Plastics ?

In my Plastic surgery department in Hospital Quiron Malaga I have tried to find the ideal soultion for this.

We have managed to contract one of Spain’s leading ENT, Dr.Ortiz, as a permanent staff member of our Plastic surgery department, enables us to operate all noses in a team of minimum two specialists, an ENT and a Plastic surgeon, which is really to the benefit of the outcome.

To my knowledge, there are only very few centres in Europe doing it this way (I am not aware of any other practice in Spain or the UK who does this as a standard protocol), but I think that it is a concept that is in th best interest of patients.

Our audit data confirms that this seems to be to the real benefit of patients. I have always enjoyed operating rhinoplasty very much, although rhinoplasty is a very delicate operation.

However, for the functional part of the operation I find it of real benefit to do this together with a very experienced ENT surgeon.

I do increasingly see patients who after purely aesthetic rhinoplasty report taht there breathing is better although they had not been aware of any impairment before.

We have also included pre-and intraoperative rhinoscopy into our protocol, which revelas for instance the need for turbinectomy (which we currently do in about 40-50% of our rhinoplasty patients).

Overall, the experience in my department does strongly encourage me to think that our protocol to operate noses in such an interspeciality team is a very good one.

Should you require some more extensive information on this procedure, either in the Department of Plastic Aesthetic and Reconstructive Surgery at Hospital Quiron Malaga or in Cirumed Clinic Marbella please contact us.

Cosmetic Plastic Surgery Spain-Trends for 2011

To keep up with new trends, the American Society for Aesthetic Plastic Surgery (ASAPS), the leading national organization of board-certified plastic surgeons who specialize in cosmetic surgery, publishes its predictions for cosmetic surgery for the coming year, publish their predicition of trends yearly, and of course also for 2011.

These predictions are based on patient questionnaires as well as interviews with surgeons who are chairing the countries leading academic Plastic surgery departments.

They are also influenced by publications in relevant scientific literature.
This expose is a very valuable predictor both for patients and surgeons working in the field of aesthetic surgery.

These forecasts have shown to be very reliable in recent years.

For me the most interesting trends for cosmetic surgery in Spain trends are the following:

1. The society foresees that demand for facelifts and other facial rejuvenation surgery will increase.
This is a relativeley easy prediction since growing age in the overall population will always fuel facelift surgery numbers.
Recent techniques with less invasive procedures have made the procedure regain popularity.
Non-surgical facial rejuvenation procedures will also see some growth, and I believe they will continue to do so in the coming years.
I see a steeply rising interest both amongst surgeons as well as, naturally, patients in less invasive and scar free facelifts.
I believe that especially new advances in fat grafting and possibly improvement of the PRP (plateteled richened plasma) technique promise ome exciting advances in 2011.

2. Our population is more and more aware of the dangers and health consequences of obesity, and the number of patients seeking plastic surgery procedures for body contouring after dramatic weight loss (abdominoplasty, lower body lift, upper arm lift, etc.) will rise in 2011.

We have seen a steady increase in such surgeries in the last years, with specific demand for combined body contouring procedures (so called „mummy makeover“).

In this kind of surgery, an abdminoplasty(tummy tuck) is usually combined with a breast surgery procedure, usually breast augmentation with or without breast uplift.
Other combinations are possible and frequent.

Recent publications have clearly shown this to be a safe procedure for a skilled surgcial team and patient satisfaction rates tend to be signifcantly higher as compared to single stage procedures.

In our own publication of 132 cases treated in Cirumed Clinic Marbella we have reported the second largest series published worldwide so far.
In summary we have seen the difference in patient satisfaction to be nearly 15 % in favour of the combined group.
With weight loss procedures on the rise, especially the gastric ballon procedure, this trend will likely continue both in Europe as well as in the U.S.

3.Breast implants, the second most popular cosmetic surgery in Spain (and worldwide), will continue to grow.
This year many baby boomer women who have aging implants and/or breast ptosis will replace their implants and have breast lifts.
In my department, we have also seen a marked increase in demand for non-implant breast augmentation, mainly Macrolane and fat transfer.
Again, very promising advances in fat transfer techniques, such as for example jet assisted liposuction, promise exciting advances in 2011.

4. To my assessment buttock augmentation with fat transfer (“Brazilian butt lift”) will be one of the most popular procedures in coming years.
In our department , we currently see a dramatic increase in demand for this kind of surgery, which relies on transplanting fat , usually from flanks and thighs, to augment the buttocks.
The procedure has seen great advances enhancing the survival of fat grafts in recent years, and will continue to do so in the future.
Again, I think that the jet assisted fat tarnsfer procedure is the one that is so far the most promising advance.
Recent advances in fat transplant technique have made the procedure more predictable and reliable.
It requires a lot of experience in tissue transfer to do the procedure correctly, but I think that the rates of patient satisfaction are really worth it.
I think that the secret of success in this procedure that patients somehow have the feeling to “kill two birds with one stone, since harvesting of the fat, which is done by liposuction with special cannulas, results in some good toning of abdominal and hip areas.

5. As the popularity of non surgical and minimally invasive procedures continues to grow, surgeons and manufacturers will develop new techniques and products that advance the science, produce even better results and lessen recovery time.
This will of course continue in 2011.
In our department laser liposuction is currently an innovative technique which we develop with great enthusiasm.

The quality for Plastic surgery research has steadily increased in recent years and will continue to do so in 2011.

Reproducible data and quality documentation will increase consumer safety and satisfaction.
Patients will be able to rely on reproducible data and less on self declared „artists“.

Following the trend in increased consumer sophistication patients will increasingly want to know if the latest procedure and device being touted on the internet and TV talk show really works and if it is safe.
By incorporating evidence-based medicine into the core specialties of plastic surgery, we will make it easier for both doctors and patients to determine fact from fiction.
This will raise quality in cosmetic surgery in this and coming years.

Should you require some more extensive information either in the Department of Plastic Aesthetic and Reconstructive Surgery at Hospital Quiron Malaga or in Cirumed Clinic Marbella please contact us.

Mommy makeovers

Currently, we observe an impressive increase in demand for so called “mommy-makeover” surgery.
Mommy makeover is the usual terminology for the combination of two body contouring procedures, most popular are the combination of breast augmentation/uplift surgery and tmmy tuck (abdominoplasty).

The advantage is that patients , to my experience, are much happpier with the more dramatic change of a combined operation.

We have recently published our experience of 138 cases of such “mommy makeovers”, which is the second largest series published so far. Like other surgeons publishing on the same topic, we have alos found such combinations to ver very safe and pleasing for patients.

The only objection we had after review of our data was that large volume tumescent liposuction with large fluid load seemed to increase problems, therefore we do not include large volume tumescent liposuction into the mommy maleover surgery any more.

If liposuction is necessary, we do now use laser liposuction which has significantly less blood loss and faster recovery, and does also require less fluid load.

A factor attracting patients is also the issue of cost-effectiveness, and whilst combined procedures do doubtlessly offer an imopressive saving potential, I recoemmend to never base any decisions for or against surgery on that.

Choosing the right implant in breast augmentation

In my opinion, individuality is the key to success in any kind of aesthetic surgery, and also for breast augmentation.
There is no one-size-fits-all implant. There are different types of implants for breast enlargement that come in different sizes.
Preferences vary amongst patients one pateint may like what the other one may not.

In the South of Spain, I work in an environment where patients will spend half of the year on the beach, and good implant size correction is of utmost importance.
Most of our patients are eager to have scar free minimally invasive breast augmentation surgery, and natural fat transfer breast augmentation has become one of our most frequently performed operations.

Fat transfer breast augmentation is our procedure of choice for all patients who are suitable, this means who have at least one problem zone fat to spare.
Removing this problem zone together with the breats augmentation does significantly increase patient satisfaction.

However, not all patients wanting breast augmentation have such extra fat.

When using implants, I generally use cohesive silicone gel implants. Cohesive means that the gel is stable, and no evacuation of fluid can occur.

I do not regard saline implants as indicated for any breast , at least not in my practice.

There is no substitute for accurate measurements. The size of an implant is just one aspect, but form and projection are equally important for a perfect result.

Another important factor is skin laxity or looseness. To achieve successful augmentation, you must have enough tissue to cover the breast implant. It is also important to make sure your breasts are even.

My experience, and other surgeons seem to share this, is that patients tend to rather err on the conservative side, meaning that it is very common that patients go for bigger implants later rather than for smaller ones.

Should you require some more extensive information on this procedure, either in the Department of Plastic Aesthetic and Reconstructive Surgery at Hospital Quiron Malaga or in Cirumed Clinic Marbella please contact us.

Volumetric facelift: modern facelift surgery with less scars

There are many types of facelifts.

Every surgeon may have different preferences, but more importantly not every facelift is the same.

The vast majority of facelifts in my department are done with the so called scar sparing (MACS) technique (although not every facelift candidate is suitable for this).

I think the ideas of the majority of Plastic surgeons including myself have changed in recent years , and the trend is going to less invasive procedures and most importantly, have changed from mere stretching to an understanding of volume loss.

When patients come to my Marbella practice for a facelift consultation, I normally ask them to bring me a photo showing themselves at closer range 10-20 years ago.

One nearly always sees that over the years they have lost volume in the midface (a normal effect of aging).

There are some exceptions of this rule, but not many.

Every aging face does also show frequent areas of skin sagginess (mostly skin and jowls).

We do therefore work a lot with volume restoration in the face together or instead of a facelift.
All patients seeking facelift surgery benefit from that, sometimes together with a facelift, but sometimes even instead of facelift.

In cases of marked nasolabial folds I prefer to restore facial volume with fat grafts (the Bod Jet hydrosurgery technique has made this a very quick and reliable procedure) instead of surgical facelift.

Patient satisfaction with that is very high, and togheter with endolaser (Smartlipo) treatment this combination can make surgical facelift indeed unnecessary.

If an additional surgical facelift is required, volume restoration with fat grafts makes the result significantly better, and helps to keep scars shorter.

Should you require some more extensive information on this procedure, either in the Department of Plastic Aesthetic and Reconstructive Surgery at Hospital Quiron Malaga or in Cirumed Clinic Marbella please contact us.

Scar free facelift-Voluma

The working mode of the Voluma facelift is reshaping of ptotic facial soft tissues.

The concept is to retore a more youthfuul facial anatomy naturally.
It is far less traumatc than conventional facelifts and, the results are more natural and is if far less traumatic than a „conventional“ facelift.

Usually I take a fat graft , usually from the abdomen. Fat grafts have historically been a very troublesome and lengthy procedure, requiring extensive centrifugation of grafts.

The Body Jet technique, which uses a waterbeam irrigation suction system to harvest such fat grafts, has changed this dramatically, and has converted fat grafting into a very swift and straightforward procedure. With the Body jet technique graft take rates are excellent.

In areas of saggy skin, mostly the nasolabial folds and the neck, we add the Smartlipo technique, which is able to add some significant skin retraction of about 25%.

The whole voluma facelift procedure takes about one hour and is done under local anesthetic.
Pateints can go home immediately afterwards. There are no scars.

In my current practice, about 50-60 % of patients wanting a facelift are suitable for this technique, and , in fact, I find that satisfaction rates of these patients are somewhat higher than with „conventional“ facelift techniques with scars.

Should you require some more extensive information on this procedure, either in the Department of Plastic Aesthetic and Reconstructive Surgery at Hospital Quiron Malaga or in Cirumed Clinic Marbella please contact us.

Modern, minimally invasive liposuction……..more than just sucking fat

Modern liposuction techniques are mainly the Body Jet liposuction technique (water jetstream assisted liposuction) and laser liposuction (also known as Smartlipo).

Other alternatives exist…………we have extensively road -tested all of them, but these water jetstream liposuction and laser liposuction are the best by far.

We mostly combine these two liposuction techniques , especially in cases where patients want removal of larger quantities of fat, the Smartlipo with Body Jet body sculpting is ideal.

The combination gives the best possible result: Body Jet is a very precise water jetstream device with simultaneous irrigation and suction.

For the surgeon it is great to work with because it is very precise.
With jetstream liposuction it is no longer necesssary to inject large volumes of fluid such as in “conventional ” tumescent liposuction.
Body contouring with Body Jet is very precise and the rates of postoperative irregularities are about 20 times less than conventional liposuction.

The Body Jet liposuction procedure is virtually bloodless and large volumes of fat can be removed in a comparably short time.

Body Jet liposuction does also offer the massive advantage that it can be combined with a lipocollector filter system to harvest a top quality fat graft, which in our Marbella practice is mainly used as a facial filler and for breast augmentation.

Another major indication is buttock augmentation (brazilian butt lift) which is a very common request in our Marbella practice. Body Jet has made this a much faster procedure.
The swift and easy fat harvesting has also brought a further advantage for patients seeking fat transfer surgery: less theatre time is needed and therefore the procedure is less costly.

The Brazilian butt lift is a procedure which is increasingly (at least it seems to me). The advanced lipoharvesting technique with Body Jet has made this procedure much more versatile and successful.

Laser liposuction has got the advantage that it retracts skin…..which is a huge advantage from the surgical point of view. I think it is a phantastic technique for treating the “double chin deformity (neck lipsouction), and on the arms and inner thighs.

To first remove the bulk of fat deep layer with Body Jet and then tighten the skin with more superficial Smartlipo laser liposuction seems the ideal combination in modern liposuction therapy.

Conventional tumescent liposuction has been banned in our practice.
When communicating in the surgical community, I find that the only advantage of this technique is one for the surgeon, because he does not need any more technology than a suction tube and a cannula.

Medically it is not justifiable to use tumescent liposuction any more, since this technique is very traumatic and has traditionally got a very high revision rate.

For more information visit our Homepage:
www.beautymedicine.es/liposuction

Breast augmentation: Implants versus fat

Different patients request different options, and a solution which is desired by one patient may not be so good for another patient.

This does not only apply to breast augmentation, but also to all other types of cosmetic surgery.

There is no precut “one-size-fits-all”recipe which applies to all patients, therefore we suggest to take sufficient time to discuss in depth all options between surgeon and patient.

In my practice, we have seen a major change in breast augmentation with introduction of the Body Jet fat transfer system.
This technique has solved most of the problems that we have seen with fat transfer breast augmentation in the past.

Less volume is lost during harvest, the „take“ rates of the fat exceed 70-80%, there is no interference with mamograms and the procedure is safe and easy to perform under local anesthetic.

I regard it as ideal for all patients who have fat to spare elsewhere, and in fact the treatment of such „problem zones“ seems to add significantly to patient happiness.

However, there is alsways a certain number of patients who have no fat to spare, and for those silicone gel implants remain the best option.

I have developed a certain faible for microtextured impalnts, which give a more natural feel especially in very thin patients.

For more information visit our Homepage:
www.beautymedicine.es/breast-augmentation

Breast enlargement without implants

Autologous fat transplantation

The one of the dreams of Plastic surgery, and like most surgeons (at least the ones that I talk to) is the future of Plastic surgery.

Take the patient´s own (autologous) fat from somewhere else and inject it for breast enlargement (or buttocks or face.
In the past, this has been a very troublesome procedure since it was very time consuming suctioned fat for transfer, and the survival rates where somewhat unpredictable.

This technique has experienced a major boost lately with the introduction of the Body Jet transfer system, which is a special,water assisted liposuction system.
This enables atraumatic harvest of fat without destroying single fat cells,and is currently the only fat transfer breast augmentation technique with guaranteed success rates.

In our practice, Body Jet assisted breast augmentation with the patient´s own fat is currently our procedure of choice for the greater part of patients seeking breast augmentation already.

In comparison to the classical centrifugation techniques (like the Coleman technique), the Body Jet is significantly superior both in handling as well as success rate.

They main difference between the two philosophies is that the Body jet technique puts emphasis not to damage the fat during harvest and manipulate it as little as possible afterwards, since every manipulation of the fat will decrease survival.
Our data suggests that about 90% of fat cells survive the harvest process and are therefore excellent for survival.

In contrast the centrifugation techniques are more traumatic and leave only aboput 5-10% of fat cells alive, which do then undergo lengthy preparation processes.

In our experience take rates of fat with the Body Jet technique are somewhat 10 fold higher.

Most importantly, the Body jet procedure has made the procedure quicker and more cost effective for patients, since it is no longer necessary to waste hours of theatre time with the harvest and preparation process.

That does also make the Body jet natural breast augmentation technique much more cost-effective for patients.

For more information visit our Homepage:
www.beautymedicine.es/breast-enlargement

Gynecomastia…….scar free male breast reduction

Whilst it is difficult to verify exact statistics, it seems that gynecomastia (male breast reduction) is the most frequent request for cosmetic surgery among males, competing with liposuction and rhinoplasty.

There is a multitude of reasons for the condition, we have clearly identified a few drugs causing it, I personally see increasing numbers of steroid abusers.

Other common culprits causing gynecomastia are a couple of antihypertensive drugs, hormonal problems, and often, simply genetic predisposition to gynecomastia (in other words bad luck).

What is the ideal age for operating a gynecomastia?

There is none because the problem can occur at very different ages. Depending on the cause, the ideal age is when the condition becomes unbearable for patients. The most difficult question is normally what to do with young patient. Whilst cosmetic operations on miors are obsolete, gynecomastia is not strictly cosmetic and psychological distress can be unbearable.

Under these circumstances psychological distress for patients may well be unbearable and needs relief.

Does social insurance pay for gynecomastia ?

That depends. Some insurers, at least in Spain, accept grade II+ grades as medical indications. This reflects my opinion as well, certain degress of gynecomastia are rather resonstructive by nature than cosmetic. Not all insurers share my opinion though.

In Spain the majority of cases are treated outside the social insucrance system,

Can gynecomastia be solved by liposuction alone?

In selected cases yes.

In most cases resection of breast gland will be necessary.However, this depends always of the individual case.

As a rule of thumb, being deliberately vague, one can say that the older you are the more fatty tissue you will find and the more likely liposuction alone will be successful. However, we do not use “classical” liposuction” anyway. Both myself and all other surgeons of my team seem to find this a rather traumatic and outdated technique.

In gynecomastia, we prefer the endolaser technique (has become very popular as “Smartlio”) in the US. We have found that increasing the energy level of the laser to a higher level and changing into “cutting” mode enables us to destroy the glandular tissue with laser alone and no incision are necessary.

What scars are involved ?

None. The endolaser technique, which is the technique that we prefer, does not leave any scars. The endolaser does lead to significant skin retraction, so there are no problems with lax skin.

92% of our gynecomastia cases are now done with the scar-free endolaser technique.

What is the biggest problem around gynecomastia ?

Recurrence. The gland behind the nipple needs to be resected in true gynecomastia cases, some part of it will usually remain and possibly lead to recurrence. There is no difference regarding recurrence whether classical surgical incision or endolaser is used, and the percentage is about 2-3% (higher in steroid abusers).

What is recovery time after a gynecomastia operation ?

Usually very short, defintely depending on the extent of resection. The scar free endolaser technique for male breast reduction is an ambulatory day case procedure, and there is no physical recoevry.

I like to use a compression garment of a minimum of two weeks post surgery, possibly longer.

For more information visit our Homepage:
www.beautymedicine.es/gynecomastia

Combine cesarean section with abdominoplasty ?

This is an interesting idea that, to my knowledge, still enjoys certain pouplarity in the United States.

The idea sound appealing, because the concept is to use the cesarean incision to perform the abdominoplasty in one go. Nevertheless, our experience with combining a ceasarean with abdominoplasty in the same session is slightly controversial.
It may be done, but the rates of certain complications are , although not uniformly confirmed in scientific literature, slightly raised.

We do routinely use laser scalpel dissection technique in abdominoplasty surgery which improves scar quality and makes the procedure less traumatic.
Laser dissection does also reduce blood loss during the procedure and therewith makes abdominoplasty surgery safer.

For certain patients with very large birth weightsthe combionation is still be an option, because their muscle distension seems to be quite extensive.

On the other hand, scientific literature clearly opines that there is no higher incidence of grave complication such as deep-vein thrombosis when perfoming an abdominoplasty together with a cesarean section.

Whether to the tummy tuck together with the cesarean section or not is something that I indivisually discuss with my cooperating gyneoclogist depending on each individual case. It is, and will remain a controversial topic in the future, and best restricted to patients who have finished their family planning.
Classical abdominoplasty complications, especially seroma, are definitely raised in comparison to sole abdominoplasty.

We do noy have a clear protocol neitehr approving or disregarding this procedure, but decide case dependent together with our cooperating gynecologists.

For more information visit our Homepage:
www.beautymedicine.es/abdominoplasty

Dr. Ramin Pakzad, Clinica Ginecologica Banus

Can abdominoplasty and hernia repair be done in one operation ?

They can and they normally should.

A lot depends on the extent of the hernia, and BMI guidelines for repairing larger hernias together with a tummy tuck a normally somewhat stricter.

Case example patient after massive weight loss, abdominoplasty and hernia repair

The scar shown is the most frequently used extended cesarean type.

The postoperative picture shows the appearence 5 months post op and does normally face much further in the follwoing year.

The scar should ideally be located as low as possible.

Especially in patients seeking abdominoplasty after bariatric surgery (gastric band) it is not uncommon to also find hernias of varying sizes, mostly umbilical hernias which can be repaired together with the abdominoplasty (tummy tuck) without problems.

In some cases, and larger hernias, I use the deepithelialised dermis of the resected skin as a kind of natural mesh (so called coriumplasty) to reinforce the abdominal wall. This works as a kind of autologous (patient’s own tissue) mesh and gives very good results regarding abdominal wall stability after hernia surgery.

We do usually see a significant number of patients every year who undergo, for example, inguinal hernia surgery, and want to use the possibility to kill „two birds with one stone“.
Our audit data has shown that abdominoplasty surgery performed together with this procedure is not different to abdominoplasty alone.

For more information visit our Homepage:
www.beautymedicine.es/abdominoplasty

Reconstructive rhinoplasty after trauma

If patients approach a nose correction after having had an accident, the procedure can be a lot more complicated.

Depending on the nature of nasal trauma, in case of multifragmented fractures the osteotomies (which is the correction of the position of the bones) may be less stable than in a primary rhinoplasty.

Also, posttraumatic rhinoplasty frequently involves work on the nasal septum as well because septal deviation frequently follows nasal trauma.

I have made a policy of operating all rhinoplasty surgeries togther with an ENT specialist. I have managed to contract an excellent ENT and head and neck surgein as consultant for my department.
We operate all rhinoplasty surgeries together.

I stronlgy believe that this interdisciplinary concept is the future in rhinoplasty surgery, since it is to the benefit of patients, giving best possible rhinoplasty results both from an aesthetic as well as from a functional point of view.

This results in a slightly higher risk of secondary dislocation of bones and possibly patients undergoing such a reconstruction may look at waering the nasal splint, which normally needs to be worn for 7 days, for about three days longer.

Some irregularities irregularities may be camouflaged without a full rhinoplasty operation, but with fillers. I prefer to first apply a permanent filler and secondarily a permanent one.

For more information visit our Homepage:
www.beautymedicine.es/rhinoplasty

Breastfeeding after breast augmentation?

Is not normally a problem after straightforward breast enlargement, since the majority of techniques does not interfere with the breat tissue itself, but works underneath the breast muscle or the breast gland.
Scientific data shows that 25% of women having had breast augmentation surgery cannot breastfeed.The number of patients who cannot breastfeed although not having had any breast augmentation surgery is also 25%……this means identical.
Therefore, there is no correlation between breast augmentation surgery and breast feeding.

The same applies to modern technqiues of breast augmentation with fat transfer. This is a technique very much favoured by us.

We do follow the protocol of the American Society of Plastic Surgeons here, which demands to strictly limit the placement of fat grafts to subcutaneous and intramuscular planes, and never to inject fat directly into the breast gland.

For more information visit our Homepage:
www.beautymedicine.es/breast-augmentation

Is mammography necessary before aesthetic breast surgery ?

The decision depends also on the preference of the individual surgeon; it is not absolute necessary.

In our Cirumed Clinic specialist group, we solved the question in the way that a highly qualified gynecologist furnishes patients before breast enlargement, breast uplift or a breast reduction with a so-called 4-D- ultrasound.

Dr.Ramin Pakzad, extremely experienced in the field of  breast disease and especially in the area of the breast cancer treatment and is our partner in these cases and since I can absolutely depend on the accuracy of his assessments, I prefer the ultrasound diagnostics done by him.

That provides me and my patient the security of a thorough preoperative diagnostics and saves young patients partly extensive -x-ray exposure.

A possible history of breast cancer within the family will also endorse the indication for preoperative breast screening. There are different approaches to breast screening before aesthetic surgery like breast augmentation, but we regard this one as best. Suspective findings in the age group seeking for breast augmentation are lessthan 0.5%, but nevertheless they occur.

Although the chance of a positive finding is very low especially in young patients, who are the majority of patients requesting breast augmentation, it still merits the effort. “If we are able to spot 1:1000 breast cancer cases just by the coincidence of screening for a breast augmentation operation, it was totally worth it”, says Dr.Pakzad, who teams up with Dr.Aslani and two oncologists forming a breats cancer unit in the Malaga area.

The 4-D-ultrasound technique does also play a significant role in spotting ruptured implants after breast augmentation.

For more information visit our Homepage:
www.beautymedicine.es/breast-augmentation

Dr. Ramin Pakzad Pakzad, Clinica Ginecologica Banus

Laser versus tumescent liposuction….the differences

When performing liposuction with laser, the laser does selectively brea down fat cells. The advantages for the patient are faster recovery, less irregularities, less pain and overall a better result.

Most importantly, laser liposuction leads to far better and mor even skin retraction than conventional tumescent liposuction.

The amount of fluid in relation to the amount of fat extracted determines into what category the liposuction falls. Should less fluid be injected than fat extracted, then it qualifies as dry, if the other way round, it is superwet.

Case samples of liposuction

Patient requested removal of diet resistant fat deposits on outer thighs, flanks and buttocks

Procedure selected was soft touch liposuction under local anetsteic and sedation

Result after removal of 2200cc of fat in sof touch technique

Good skin retraction

Overall pleasant change of body contour

Result 5 months post OP

Case 2

Patient with good skin quality

No skin ptosis

Reqeusts body contour correction in lower abdomen and flanks

Result after removal of 1700cc of fat

Soft touch technique

Good skin retraction

Result 3 months post op.

The advantage of laser liposuction technique normally is that there is less pain and bleeding, although oozing of residual injection fluid commonly occurs postoperatively. This is often mistaken for bleeding after the liposuction, but its occurrence is normal and should normally cease within about two days.

For more information visit our Homepage:
www.beautymedicine.es/liposuction-smartlipo

Will aesthetic medicine rise average facelift age?

Possibly yes, however, aesthetic medicine is a widespread field where different treatments are applied for different symptoms. Aesthetic medicine can definitely not replace facelift surgey on a wider range , but we do observe the average “entrance” facelift age for  being slightly on the rise.

Certain aesthetic medical measures, such as dermal fillers, facial resurfacing and mesotherapy, have a preventetive effect that can withhold the effects of dermal aging but it can not withold the effects of gravity on your face.  I personally feel that in cases of moderate soft tissue sagginess of the face and increasing wrinkling effects effective aesthetic medical measures can herald significant results and enhance appearence, therefore not replacing a facelift, but prolonging the period till such is desired. In patients requiring a facelift, I think the easiest way to describe the difference is to make them aware of the difference between  gravity related changes and changes in the skin structure by aging effects. A facelift tackles the gravity effect, but not the skin structure.

Additionally , the result of a facelift can be considerably enhanced by additional aesthetic measures, so combination of the two can make a lot of sense.

For more information visit our Homepage:
www.beautymedicine.es/facelift