[BalaGire]

I agree with Dr. Petro that the acumen of the practitioner better determines the outcome rather than expensive equipment. Liposuction is very much a part of stem cell therapy. It is used in conjunction with adipose derived treatments as well as cosmetic treatments that use stem cells. When considering an adipose derived therapy, make certain the doctor is very experienced. Removing even a small amount of adipose tissue can be painful if done by someone that isn't experienced in the procedure.



e-Journal of Age Management Medicine | December 2010


A Review of the World Congress on Liposuction Surgery and the California Academy of Cosmetic Surgery 12th Annual Conference: Interview with Jane Petro, M.D., Robert Shumway, M.D., Maurice Sherman, M.D., Robert Jackson, M.D., and Kevin Jovanovic, M.D.
Jeffry Schafer, M.D., FRSM, and Ron Shane, Ph.D., OMD


[World Congress on Liposuction Surgery, Oct. 1-3, 2010, Washington, D.C.; 12th Annual CACS Symposium, Oct. 15-18, 2010, San Diego, CA]

There were a plethora of intriguing medical topics discussed at these meetings. According to Dr. Jane Petro, there were also many essential questions generated which must be empirically ascertained. This Board Certified plastic surgeon stated that there need to be more research studies to determine what aesthetic protocols can produce the greatest skin tightening as a function of liposuction. Dr. Petro still believes that the acumen of a particular cosmetic practitioner is what actually reflects the degree of patient skin tightening rather than having expensive technologies.

Dr. Jeffery Klein, Dr. Jane Petro and Dr. Michael Will argued for the necessity of empirical research in order to truly comprehend what is actually efficacious with respect to laser-assisted liposuction. Dr. Petro pointed out, both in our interview and at the California Academy of Cosmetic Surgery, there must be more research being executed by medical aesthetic practitioners. Moreover, she stated in our interview that it is likely that laser-assisted liposuction may not be efficacious in terms of inducing greater skin tightening. Dr. Will alluded to the fact in his lecture at the CACS meeting that this laser technology may not be beneficial in terms of enhancing a patient?s aesthetic outcome. Furthermore, many of the cosmetic surgeons at the CACS meeting asserted that they are compelled to purchase these technologies by their patients which may not have authentic aesthetic benefits.

Laser companies purport that their specific wavelength is the most effective for skin tightening. According to Dr. Jane Petro and others, the media and television programs are educating the public to desire particular technologies which may not be cosmetically edifying. There was a consensus of opinion at the CACS meeting that laser-assisted liposuction is not necessary for inducing skin contraction. Furthermore, Dr. Petro, a leading cosmetic researcher, stated there is not any reason to believe that cosmetic surgeons need to employ laser-assisted liposuction to facilitate greater skin tightening in patients undergoing liposuction surgery.

There was considerable discussion at the CACS meeting that medical practitioners are being foiled by commercial interests; and patients believe that particular technologies will engender miraculous results. Laser companies are seducing medical practitioners to purchase their equipment in order to procure heighten revenue and a greater patient population. The field of cosmetic surgery appears to now be moving toward pursuing more research studies rather than being modulated by a practitioner?s anecdotal responses which influences his or her financial auspiciousness. Dr. Petro asserted that all aesthetic surgeons should insisting that their patients fervidly to adapt a more salubrious lifestyle.

Liposuction was originally developed for the purpose of mitigating specific adiposity in those patients who have achieved their ideal body weight. Unfortunately, it is now being utilized as a weight loss strategy. Clinicians are being pressured financially to be compliant to the dictates of their patients. Moreover, those patients 40 pounds overweight where 5 liters of fat are removed at a surgical session in most instances will instead replace adipose cells with a degree of scar tissue. Thus, the circumference of their waist will not necessarily improve with liposuction in the overweight patient as visceral adiposity was not reduced; and a certain amount of scar tissue will replace the extracted subcutaneous adipose tissue.

Patient education is still quite problematic in terms of the heuristic merit of this cosmetic procedures. For example, many reluctant cosmetic surgeons are being compelled to execute this procedure where the patient should have obtained a stable BMI as well as actively pursuing a robust exercise regimen. It was discussed at the CACS conference that this phenomenon is not likely nor possible in our pathophysiological cultural milieu. Furthermore, the cosmetic surgeons at this meeting were distraught over the fact that laser manufacturers with sagacious advertisement have conditioned the patient population to believe that their technologies are more beneficial than traditional liposuction protocols.

There is nothing in the literature to date to support the supposition that laser-assisted liposuction is less invasive, has a quicker healing time, engenders enhanced skin tightening, and is associated with less complications. Moreover, Dr. Petro, the editor-in-chief of the American Journal of Cosmetic Surgery, has not seen any convincing empirical evidence to support the assertions of the laser companies. Furthermore, Dr. Will presented evidence that the diffuse nature of thermo injury may in fact be causing soft tissue destruction in a variegated array of cells which are interfused with adipose tissue. Dr. Will, from his histological analysis, has observed with laser-assisted liposuction prolonged inflammation compared to traditional liposuction modalities. Thus, most practitioners who attended the CACS meeting believe that laser-assisted liposuction is a much slower procedure compared to traditional liposuction protocols.

Furthermore, there is no indication that this technology is a more favorable protocol for enhancing skin tightening. Dr. Klein, the father of tumescent liposuction, is involved in creating a multiple center study to empirically comprehend if any kind of laser-assisted liposuction is as efficacious as other more traditional modalities. All these cosmetic surgeons concurred that they have the responsibility to educate the public rather than be financially compelled by commercial interests. Furthermore, there is no empirical understanding at this time as to what particular wavelength or fluence would be most effective for skin tightening with laser-assisted liposuction.

There are many new technologies which are emerging to non-invasively eliminate excessive subcutaneous fat from that of freezing tissue to cool laser strategies. In the most optimal scenario, there could be some slight temporary mitigation of subcutaneous body fat from these non-invasive technologies. There is still not any magical technique which miraculously eliminates subcutaneous fat from the body. We have worked with the Zerona Cool Laser System which encourages patients to practice caloric restriction and exercise. However, the results from this technology are inconclusive and very temporary. According to Dr. Ziya Saylan ?there is no perfect liposuction;? however, it surpasses any other strategy for reducing subcutaneous body fat.

Dr. Jovanovic stated at his lecture during the World Congress on Liposuction from his review of the literature on the average there is a 25% revision rate for most cosmetic surgeons. He further expressed in his initial cases when he was learning this surgical procedure that there was a 50% need for a secondary surgery. In his view, there is a definite learning curve which must be obtained by any surgical practitioner when learning liposuction. Moreover, there will always be a need even for the most accomplished practitioner to perform for revision surgery. Furthermore, Dr. Petro stated in her interview that a certain phenotype affords a practitioner with a greater likelihood for favorable aesthetic results with liposuction surgery. Skin laxity and areas of irregularities will certainly occur in some patients even when the liposuction procedure is performed by the most competent and exquisite practitioner.

Dr. Robert Jackson is involved in the initial phase of a research study to mitigate the problematic phenomenon of cellulite in the female population. Moreover, he has determined from his anecdotal findings that higher levels of estrogen could be contributing to this cosmetic malaise. Stress and the epidemic of obesity are engendering higher levels of estrogen in a female population. Furthermore, soy products are also contributing to increased levels estrogen in the U.S. population. It is estimated that 92% of females are disinclined to exercise; and even walk 10,000 steps a day. Dr. Jackson is proposing an all inclusive approach involving several distinctive judicious modalities. Moreover, he is suggesting that there is a hormonal modulation of estrogen and testosterone as well as an execution by a female of a robust exercise regimen and low fat diet. Furthermore, patients will likewise be treated with a laser protocol.

Currently, only a certain degree of cellulite is attenuated with liposuction surgery. Cosmetic practitioners are looking for viable strategies to mitigate this aberrant aesthetic phenomenon. There are an increased number of women in America who are affected by this cosmetic condition. Dr. Jackson?s proposed prophylaxis could have propitious efficacy; and may actually be a viable way to attenuate cellulite in the female population. Furthermore, even if all a patients? subcutaneous body fat could be eliminated the cellulite would still persist. Clinicians must adapt innovative protocols to ameliorate this aesthetic problematic scenario.

Dr. Salas from Mexico gave a presentation at the World Congress on ?megaliposuction?. In the United States, cosmetic practitioners have asserted that for patients? safety that not more than 5 liters of adipose tissue should be aspirated during a surgical procedure. Dr. Salas presented findings that he was able to extract as much as 10 liters during a surgical session without any debilitating consequences. Moreover, this practitioner has taken this cosmetic procedure which was designated to improve overall bodily symmetry as well as eliminate excessive fat in particular quadrants of the torso to be now a seemingly weight loss strategy. It is questionable whether cosmetic surgeons should be utilizing this propitious cosmetic procedure as a weight loss protocol. Practitioners are not doing anything to mitigate visceral adiposity; and thus the patient will still not appear to be thinner nor will his or her BMI be considerably reduced, since there is not any change in the fat tissue underneath musculature.

All of the speakers at both conferences concurred that facial fat grafting with higher concentrations of stem cells is an intriguing area of aesthetic innovation. There were lecturers at both conferences regarding fat grafting with adipose cells combined with additional isolated stem cells. There are many questions that need to be empirically determined by clinicians to fully understand this intriguing procedure. One of the most important questions that concerns this aesthetic strategy is which harvesting technology is preferable for obtaining the highest concentration of stem cells to be transplanted in either the face or the breasts. It has been stated in literature that angiogenesis as a function of enhanced vascularity or an increased proliferation of CD34 cells is an essential factor which prevents the necrotic attenuation of transplanted tissue. There is now some speculation that adipose stem cells themselves are not necessarily responsible for increasing blood supply in the transplanted area, but rather it is the platelet rich plasma (PRP) which is inducing the propitious molecular activities. Furthermore, some cosmetic practitioners state that the utilization of a centrifuge is retrograde to obtaining robust concentrations of stem cells. Conversely, it has been suggested by certain other cosmetic surgeons that the washing method increases the stem cell survival compared to employing the centrifuge technology. Furthermore, it is certain that cosmetic surgeons quintessentially are now concerned with improving the volume deflation in their patients which is characteristic of the aging face.

George Brennan has demonstrated that the vertical lifting of the SMAS flap should likewise be repositioned with a lateral vector approach for both the mid and upper facelift as it mollifies the deflated appearance. Moreover, Dr. Robert Goldberg asserted that he is now more inclined to use fillers or fat transfer in most of his patients rather than perform a traditional blepharoplasty. The hollow lifted appearance in this region of the upper face is now being replaced with a naturalistic volumized strategy. Drs Petro and Klein at the CACS conference argued there certainly need to be more empirical research in this field of cosmetic surgery. Furthermore, many of these cosmetic surgeons believe the scalpel may be in part replaced by molecular transcriptional or translational modulation in a bevy of senescent genes where the body itself endogenously improves its compromised aesthetic physicality.


Jeffry B. Schafer, M.D., FRSM is a fully trained Cosmetic & Reconstructive Surgeon and has been in practice since 1978. Along with his 25 years of experience in cosmetic surgery, he has 15 years of liposculpture experience. Dr. Schafer was a former staff physician with Scripps Clinic and Research Institute in La Jolla. He was a clinical instructor at The University of Alabama School of Medicine. Dr. Schafer taught at the University of California at San Diego.

Ron Shane, Ph.D., OMD is the Director of Optimal Medicine and Health for the Zen Beauty Institute. As a post-doctoral research scholar, he has worked in and studied academic disciplines such as renaissance mysticism literature, psychology, neurobiology, and endocrinology. He is also a sixth-degree black belt and international instructor in Taekwon-Do, as well as an Esoteric Yoga master. Contact Dr. Shane at zenbeautyinstitute@gmail.com or drron73@gmail.com.

[draigenia]

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