Because microneedling is relatively cheap, simple to perform and with no downtime, it has gained popularity over the past 10 years.

The treatment is also known as percutaneous collagen induction therapy (CIT) or as dermarolling from the brand name of the tool used to perform this minimally invasive procedure.

Microneedle rollers or derma-rollers

The Dermaroller is a cylinder with tiny needles protruding from its surface; the needles have a height between 0.5 and 1.5 mm. The cylinder is attached to a handle and it is free to spin and the tool is sterile and disposable. The microneedle roller is pushed over the skin to roll it over the treatment area.

How does microneedling work?

Microneedling creates thousands of tiny puncturing wounds in the epidermis (outermost layer of skin) and on the superficial part of the dermis layer, known as papillary dermis. These wounds cause some bleeding with release of platelets; the platelets and the inflammation trigger a natural healing response with release of growth and healing factors, while also stimulating the fibroblasts to produce more collagen and elastin. Needles also break down old collagen, which will be removed and replaced by new collagen fibers. Healing is over within the first 5 days after treatment, but tissues remodeling goes on for several months.

4 to 6 treatment sessions are usually advised in order to achieve good results and depending on the patient’s characteristics and expectations. Treatment sessions are spaced from 1 week to 1 month apart.

Indications of microneedling

Microneedling is indicated for skin rejuvenation in the early stages of facial aging and photodamage both to treat lines and wrinkles and to treat skin laxity; the face, neck, arms and all body areas can be treated. It is also indicated to treat scars and stretch marks, pigmentation issues and melasma, and in the treatment of hair loss as adjuvant therapy to minoxidil. Skin needling is also used to enhance topical drug delivery to the deeper levels of the skin.

Microneedling with PRP

To speed and boost the effects of microneedling, it is sometimes paired with platelet-rich plasma treatment (PRP). This cosmetic procedure is also known as “vampire facelift” and has been popularized by celebrities such as Kim Kardashian and Bar Rafaeli.

source: Instagram.com

Microneedling with RF

Fractional radiofrequency microneedling (RFM) is a treatment performed with a special tool: an array of insulated microneedles delivers the radiofrequency energy directly into the dermal layer.

Radiofrequency works by producing RF energy that is converted into heat in the tissues. Heating starts from the epidermis, the outermost layer of the skin, and gets to the dermis, a deeper layer, with less energy. For optimal effects, the dermis should be heated to 65-70 °C (149-158 F°) but doing this with a classic radiofrequency device would cause burns and damage to the superficial skin. Radiofrequency microneedling delivers the energy directly into the dermal layer, allowing for the optimal heating temperature to be reached while sparing the superficial tissues.

The treatment is safe and minimally invasive with no downtime. It seems to be effective in the treatment of scars, acne and for skin rejuvenation.

Pen microneedling for the skin (Dermapen)

Pen microneedling works the same way as dermarolling, but it employs a different instrument. Instead of the rolling cylinder with needles, the practitioner uses a pen-shaped electronic instrument with fine needles on the tip side which are capable of moving vertically. The speed or frequency of the puncturing vertical motion as well as the depth can be set on the instrument.

Difference between devices: dermapen vs dermaroller

There are a few differences between pen microneedling and dermarolling:

1. Dermapen needles enter the skin perpendicularly while Dermaroller needles enter at an angle and exit at a different one, causing more trauma.
2. Dermapen makes more holes with a smaller diameter, while Dermaroller makes fewer larger holes.
3. Dermapen seems to heal faster and cause less pain and discomfort.

In the end the choice of tool depends upon the preference and experience of the doctor performing the treatment as well as the location of the area to be treated and the indication for the treatment.

Microneedling at home

Microneedling devices sold to be used at home or at nonmedical SPAs are different than those used by certified physicians. They are duller and with shorter needles and do not puncture the skin deep enough to produce the desired effects like stimulating collagen production. They may be able to produce minimal and often temporary effects by stimulating the blood flow in the treated area.

Moreover, at home devices tend to be reused, but the needles become duller and duller after each treatment. They should also be thoroughly cleaned between uses and kept sterile to avoid the risk of infection and complications. For all these reasons, it is advised to seek this type of treatment only at clinics with qualified practitioners.

Microneedling for Acne and Acne scars

Nonablative radiofrequency microneedling or RF microneedling is a novel type of treatment for acne lesions and acne scars. This technique is thought to reduce the activity of the sebaceous glands while also remodeling the dermis thanks to the deep heating produced by the RF device. Microneedling for acne seems to be safer than other treatment modalities such as lasers, in particular for Fitzpatrick’s skin types IV-VI, and is able to achieve a reduction in both inflammatory and non-inflammatory lesions as well as a reduction in sebum production according to several studies.

When it comes to treating acne scars, microneedling may be also combined with PRP, radiofrequency, vitamin C, or glycolic acid peels.

Pre-treatment instructions for skin needling therapy

Generally, it is advised to not use certain topical products such as isotretinoin and other retinoids, chemical peeling agents, and exfoliants for a period of time preceding the microneedling treatment: this is done to avoid increased sensitivity. You may be asked to not use certain anti-inflammatory medications or to not use blood thinning medications as well.

Sun exposure should be avoided both before and after treatment. Laser, IPL, dermabrasion, waxing and other procedures should also be avoided.

Active infections, open wounds, inflammatory rosacea are a contraindication for treatment.

On the day of treatment your skin should be clean so do not wear make-up, sunscreen, creams or lotions or you should clean your face at the clinic once you arrive.

The doctor will apply a topical anesthetic and disinfect the skin before starting the treatment.

Ask your treatment provider for detailed instructions and pre-treatment tips.

Microneedling after care, risks and side effects

Microneedling is a safe procedure with no down time. Some redness is to be expected for a couple of days. Minimal bleeding during the treatment is also normal.

You may be asked to not use anti-inflammatory medications after the procedure as they may interfere with the healing process which is triggered on purpose by the procedure.

You may apply make-up from the day after the procedure, but you may be asked to avoid using some of the products in your usual skincare regimen. Other cosmeceutical ingredients such as vitamin A and vitamin C may be advised as they may help with healing and collagen production.

You should avoid sun exposure for about 4 weeks, and you should wear your sunscreen starting from the day after the procedure.

Due to the bleeding caused by the procedure, there may be some bruising as well. Some peeling or flaking of the skin may be normal for the first few days.

Your specialist will advise you more in detail.

Cost of microneedling

Price varies depending on the chosen doctor and clinic, the country where you are being treated and on how large the area to be treated is. Usually, clinics offer packages of 3-6 sessions at a discount.

• In the USA the cost of microneedling is 100-700 USD per session
• In Australia the price is 175-600 AUD (135-465 USD) per session.
• In Thailand treatments start from 2-3,000 THB up to 20,000 THB per session (70-670 USD).

Sources

• Fitzpatrick’s Dermatology, 9th Edition
  S Kang – McGraw-Hill, 2019
  ISBN 978-0-07-183779-8
  https://dermatology.mhmedical.com/book.aspx?bookid=2570
• Cosmetic Medicine and Surgery.
  P André – CRC Press, 2016
  ISBN 978-1-4822-0809-2
• International Textbook of Aesthetic Surgery
  N Scuderi – Springer, 2016
  ISBN 978-3-662-46599-8
  DOI:  https://doi.org/10.1007/978-3-662-46599-8
• Microneedling: Where do we stand now? A systematic review of the literature.
  L Ramaut – Journal of Plastic Reconstructive and Aesthetic Surgery, Jan 2018
  DOI: https://doi.org/10.1016/j.bjps.2017.06.006
• Microneedling: A Comprehensive Review.
  A Hou – Dermatologic Surgery, Mar 2017
  DOI: https://doi.org/10.1097/dss.0000000000000924
• Treatment of acne vulgaris with fractional radiofrequency microneedling.
  ST Kim – The Journal of Dermatology, Jul 2014
  DOI: https://doi.org/10.1111/1346-8138.12471
• Microneedling with Dermaroller.
  S Doddaballapur – Journal of Cutaneous and Aesthetic Surgery, Jul 2009
  DOI: https://dx.doi.org/10.4103%2F0974-2077.58529
• Fractional radiofrequency microneedling for skin rejuvenation.
  JN Mehrabi – Dermatological Reviews, Feb 2020
  DOI: https://doi.org/10.1002/der2.8
• Radiofrequency Microneedling: Overview of Technology, Advantages, Differences in Devices, Studies, and Indications.
  SF Weiner – Facial Plastic Surgery Clinics of North America, Aug 2019
  DOI: https://doi.org/10.1016/j.fsc.2019.03.002
• American Academy of Dermatology (AAD)

Richard Troy

Medical Blogger committed to accuracy, I am passionate about delivering my readers critical insights into the medical field.
Former paramedic, instructor and medical school student.
You can read more about me in the dedicated section of the website.

www.medtravel.asia/about-richard-troy-medical-blogger/

The post What is microneedling? Skin needling therapy guide appeared first on MedTravel Asia.

What causes the wide or droopy nose when smiling?

Everyone experiences at least a subtle modification in their nose appearance when smiling: you can feel it by yourself by placing your index finger on the side of your nose right where the opening of the nostril and the cheek meet and then forcing a smile; you will feel your finger being slightly pulled to the side of your face. Likewise, when placing the index finger at the base of the septum (base of the columella) and smiling you will feel it being pulled down towards your lips. In some individuals this may become more evident: not all smiles are the same and we all have slight anatomical differences.

• We activate the mimic (expression) muscles to a different extent.
• We also may use different muscles
• We have different muscle anatomy
• We have different nose and face anatomy.

Moreover, not everyone is self-conscious and bothered by this slight movements hence only some seek a solution to this.

In some cases, the unwanted nostril flare may also be due to a rhinoplasty. If the surgeon modifies the size of the nose, making it smaller, without reshaping the nostrils as well to make them proportionate to the new nose, you may have flared nostrils as a result. This can also happen if the rhinoplasty modifies the position of the tip of the nose in relation to the base of the septum: if pulled back it could modify the look of the alar base which then gets exacerbated by the smiling motion.

How to fix nostril flaring when smiling?

There are both surgical and nonsurgical options to fix the widened nose or the elongated nose with droopy tip when smiling.

Non-surgical option: Botox or Dysport

Botulinum toxin is the only non-surgical option available to address this issue. Being caused by muscle contraction, injecting a few units in strategic points of the face will reduce both the widening of the nose and the droopy tip when smiling. It is very important to have the injections performed by an experienced provider as if done wrong this could temporarily compromise your smile and expressivity in general. Injection site and volume have to be carefully planned after analyzing your face and smile.

This is a temporary fix, and the treatment will have to be repeated 2-4 times a year to be effective all year round. It won’t be very expensive as only few units are required to obtain the results and there will be no downtime from this procedure.

Botox won’t work if the nostrils are flared or if the tip is droopy also when not smiling: in this cases the only way to address the issue is with surgery.

Surgical options for wide nose when smiling and droopy nasal tip

There are several different surgical procedures that may help address the wide nose and the droopy nasal tip when smiling. You should discuss the following options with an experienced facial plastic surgeon.

Flared Nostril Rhinoplasty

Flared nostril rhinoplasty is a procedure that surgically weakens the muscles that pull the tip of the nose downwards and the nostrils laterally when we smile. The muscles are accessed through a small incision at the base of the columella and are slightly trimmed to reduce their pulling force. Unlike Botox, the effects of this surgery are permanent. Flared nostril rhinoplasty in some cases may also improve the look of flared nostrils at rest.

Tip Rhinoplasty

Reshaping or shortening the tip of the nose may fix both the widening and droopy nose when smiling. The tip may be responsible for curved round nostrils that can be straightened surgically or may present excess cartilage causing the droopy look. For this reason, addressing the tip may improve the look both at rest and when you smile.

Alar Base Reduction

Alar base reduction reduces the size of the nostrils by removing a small wedge of tissue. Surgery is performed by making a small incision inside the nostrils, known as Weir incision. This surgery addresses the size of the nostrils both at rest and when smiling. The scar resulting from the incision is usually unnoticeable.

Takeaway

Flared nostrils, widened nose and droopy tip when smiling are all issues that can be fixed.

With the nonsurgical option, costs are lower than a traditional Botox treatment as only few units are required, and the benefit is that it is reversible and there is no downtime.

With the surgical options there is little downtime, and they are often performed as outpatient procedures. Costs are lower than a traditional rhinoplasty.

It is very important to have a consultation with an experienced facial plastic surgeon to avoid complications, botched results and dissatisfaction.

Sources

• Multifactorial approaches for correction of the drooping tip of a long nose in East asians.
  SG Park, H Jeong – Archives of Plastic Surgery, Nov 2014
• Nostril Surgery: Indications, Surgical Procedures and Outcomes-A Systematic Review of Published Cases.
  S Gandolfi, J Laloze – Aesthetic Plastic Sugery, Dec 2020
• Global 3-dimensional approach to natural rejuvenation: recommendations for perioral, nose, and ear rejuvenation.
  V Gassia, H Raspaldo – Journal of Cosmetic Dermatology, Jun 2013
• Non-surgical rhinoplasty using filler, Botox, and thread remodeling: Retro analysis of 332 cases.
  Y Helmi – Journal of Cosmetic and Laser Therapy, Mar 2018

Richard Troy

Medical Blogger committed to accuracy, I am passionate about delivering my readers critical insights into the medical field.
Former paramedic, instructor and medical school student.
You can read more about me in the dedicated section of the website.

www.medtravel.asia/about-richard-troy-medical-blogger/

The post Wide nose when smiling: causes and remedies. appeared first on MedTravel Asia.

Woman photo created by wavebreakmedia_micro – www.freepik.com

How does the plasma pen work?

The plasma pen is a small handheld battery-operated device with a metal tip; this shape led to the “pen” denomination. The energy released from the tip of the device ionizes the air surrounding it and generates plasma, the fourth state of matter constituted by ionized gas, which forms an arch from the tip of the device to the surface of the skin, which are kept about 1 mm apart, releasing its high energy. The heat damage generated by the plasma on the skin surface stimulates the fibroblasts into producing more proteins and other components of the extracellular matrix, like hyaluronic acid, producing a skin rejuvenating effect.

The principle of action is similar to that of lasers for which the indications are similar, but with a key difference: lasers work following the selective photothermolysis principle; this means that the high energy light beam from the laser device produces thermal damage only on specific targets which absorb the specific wavelength emitted by the laser. This target or chromophore could be the melanin in the hair and in hyperpigmented spots, the water in the skin cells, or the red pigment in blood when treating vascular lesions. The surrounding tissues don’t suffer from the thermal damage since the energy is almost entirely absorbed by the specific target. With plasma the energy is delivered on the skin surface, with no specific target, creating a generalized thermal damage. By increasing the energy generated by the device, the energy is delivered deeper into the skin.

Usually some results can be seen already after the first treatment, but for more apparent changes at least 3 treatments are needed. Each session lasts 15-45 minutes depending on how large the area to be treated is. A local anesthetic gel or cream may be applied before the treatment and sessions are performed 3 to 8 weeks apart.

What are the indications for the plasma pen?

The plasma pen has been marketed and used by cosmetic dermatologist and aesthetic medicine practitioners in the past few years for:

• treatment of fine lines and wrinkles of the face and in particular the periorbital wrinkles and the lines that form above the upper lip
• photodamaged skin
• skin laxity
• brighten the skin and improving the texture
• skin rejuvenation in general.

Treatment is generally only advised on Fitzpatrick skin types I, II, and III.

Is the plasma pen FDA approved?

Some brands have been approved by the FDA, but the cosmetic application is an off-label use of such devices. The plasma pens are FDA-approved for the “removal and destruction of skin

lesions and the coagulation of tissue”. The devices are intended for use by a physician, not to be used in SPAs by untrained aestheticians or at home.

There are plenty of “plasma pens” selling online for a limited budget and for home use: such devices should be absolutely avoided! The difference between the approved devices and the ones sold online is the reliability of the instrument and the controlled energy emission. Cheap devices lack control and have inconsistent amounts of energy delivered to the skin; there is no control or consistency in spot size and depth of treatment either. All these factors increase the risk of permanent hyperpigmentation and scarring, and longer recovery.

What are the risks and possible complications of the plasma pen treatment?

Among the risks and possible complications there are: redness, swelling, hyperpigmentation, scarring, infection, dissatisfaction with the treatment, burns and blisters. Some of these complications are mild, temporary and to be expected, but if the treatment is not properly executed there may be permanent damage as well.

For this reason, it is important to be treated by a medical professional trained in the use of this specific device as unproper treatment is more like to lead to unwanted damage and possibly to scarring and permanent hyperpigmentation.

How is the recovery from the plasma pen fibroblast therapy like?

Plasma pen treatment is delivered in tiny spots and essentially burns the skin, leaving brown dots which form small scabs. Spot sized scabs following a grid pattern usually last up to 1 week. There may be some redness and minor swelling for a few days as well. Some creams may help the healing process and their use will be advised by your treating physician. Sun protection will be very important for the first few weeks following treatment to avoid the risk of hyperpigmentation. Make-up is better avoided until the skin has healed completely.

Applying icepacks (15 minutes on, 15 minutes off) a couple of times per day may help with the discomfort, redness and swelling which are common and expected the first 1-2 days. 

How much does the plasma pen treatment cost?

Depending on how big the treated area is, on the chosen clinic and surgeon, and on the geographical location, the price of plasma pen treatment is:

• 300-1,700 USD in the United States
• 150-1,200 GBP in the UK
• 200-2,000 AUD in Australia

Sources

• Plasma Energy Skin Rejuvenation.
  JD Holcomb – Facial Plastic Surgery Clinics of North America, Feb 2020
• Nitrogen plasma skin regeneration for the treatment of mild-to-moderate periorbital wrinkles: A prospective, randomized, controlled evaluator-blinded trial.
  N Theppornpitak, M Udompataikul – Journal of Cosmetic Dermatology, Feb 2019
• Nitrogen plasma skin regeneration and aesthetic facial surgery: multicenter evaluation of concurrent treatment.
  JD Holcomb, KJ Kent – Archives of Facial Plastic Surgery, May 2009
• Plasma Skin Resurfacing: Personal Experience and Long-Term Results.
  SH Bentkover – Facial Plastic Surgery Clinics of North America, May 2012
• Evaluation of plasma skin regeneration technology in low-energy full-facial rejuvenation.
  MA Bogle, KA Arndt – Archives of Dermatology, Feb 2007
• Evaluation of plasma skin regeneration technology for cutaneous remodeling.
  ML Elsaie, JN Kammer – Journal of Cosmetic Dermatology, Dec 2008
• U.S. Food and Drug Administration (FDA)

Richard Troy

Medical Blogger committed to accuracy, I am passionate about delivering my readers critical insights into the medical field.
Former paramedic, instructor and medical school student.
You can read more about me in the dedicated section of the website.

www.medtravel.asia/about-richard-troy-medical-blogger/

The post Plasma Pen: fibroblast therapy skin rejuvenation appeared first on MedTravel Asia.

Hair loss is very common among men because of androgenetic alopecia, a condition that leads to progressively thinning hair and baldness. It affects the crown of the scalp and the hairline above the temples which recedes; because of this typical presentation it is also called male pattern hair loss. While hair thinning is in progress there are some things you can still do to reverse, stop, or at least slow down this process, but once the hair is lost the hair transplant is the only possible treatment.

There are many different techniques performed in Thailand to restore the hair:

• FUT transplant. This technique involves the harvesting of a strip of hair from the back of the head the size of which will be based on the number of grafts needed for your specific case. Stitches will be used to close the surgical wound and then the hair grafts (follicular units) will be harvested from the strip and reimplanted where needed in the scalp. This method leaves a scar which will be hidden by the hair surrounding it in a couple of months.
• FUE transplant. This technique requires more skill from the surgeon. The follicular units are harvested manually one by one by the doctor and after some processing they are implanted where needed in the recipient area during the second stage of the surgery. It is labor intensive, requires expertise, but leads to great natural looking results and it is minimally invasive.
• ARTAS – Robotic Hair Restoration. This is the most advanced technique. A robot will perform the harvesting part according to the surgeon’s parameters making it much quicker, less traumatic, and more precise. The follicular units are extracted precisely at the right angle that varies for each hair and always leaving the same space between units extracted, for the best possible outcome post-procedure for the donor area as well. The surgeon will then have to manually perform the implant procedure like the FUE or FUT transplant.
• Scalp advancement – Hairline lowering. An incision is performed along the front of the hairline and the scalp is pulled forward; the excess skin on the forehead is excised and the new hairline is stitched in place. This technique allows to shorten the forehead by 2-5 cm and regain a younger looking hairline.

The transplanted follicular units in FUT, FUE and ARTAS techniques are harvested from areas of the scalp not affected by androgenetic alopecia and for this reason they will maintain their “immunity” to this condition and stay in the recipient area permanently.

Why a hair transplant in Bangkok, Thailand?

For a procedure such as the hair transplant, there are many benefits in choosing a clinic in Bangkok or Thailand in general for your surgery.

You can save a lot of money, up to 75% of the total cost of treatment depending upon the country you come from and the chosen treatment.

Saving money doesn’t mean you’ll receive substandard care: actually, the quality of the facilities, the expertise of the doctors, the technologies employed for your surgery are among the best in the world, which is another great reason to choose Bangkok for the hair transplant procedure.

Medical tourism is not just about the medical treatment. By undergoing a minimally invasive procedure such as the hair transplant, you will still be able to enjoy Bangkok and Thailand as a tourist with minimal limitations. This means you can have an amazing holiday and experience the many beauties of Thailand, from sightseeing, to SPAs, to Resorts, to the night life and much more.

Moreover, another reason why people choose to travel for their medical treatment is the privacy. By undergoing the hair transplant in Bangkok, nobody will know you had surgery unless you tell them so. The initial swelling, the scabs that form in the first few days, the redness that may be present on your scalp are unequivocable signs you had surgery. By spending some time in Thailand after your hair transplant, by the time you go back home you’ll have recovered, and nobody will know what you did.

How long do I need to stay in Bangkok for a hair transplant?

A hair transplant procedure takes normally between 4 to 8 hours depending on how many grafts are harvested and reimplanted. You will need to be in Bangkok one day before the surgery takes place to meet your surgeon and have a consultation with him. The day after the surgery you will go back to the clinic for a follow-up appointment and after that you will be free to enjoy your holiday in Thailand.

How is the recovery like for a hair transplant?

Recovery varies based on the technique used for your hair restoration.

With FUE and robotic hair transplant there will be some swelling, bruising and scabs which usually fade within 1 week. The scabs and the newly implanted hair will fall off and after about 3 months the new hair will start growing naturally again, which is when you will begin to see the results of your surgery.

You will have to use an antiseptic shampoo for a while, protect your head from the sun wearing a hat, wear a head band to limit the swelling. By duly following your surgeon’s advice the recovery will be quick and with minimal to no risk of any complication.

What is the cost of a hair transplant in Bangkok, Thailand?

The price varies depending upon the chosen clinic and technique.

For FUE-ARTAS hair transplant the cost per graft is about 30 to 80 THB (1.00-2.65 USD).

Contact us to know about the latest exclusive offers and promotions from the clinics.

What are the best clinics for a hair transplant in Bangkok?

Depending upon the technique you are interested in, there are many great clinics in Bangkok and in Thailand in general for hair restoration surgery.

Send us an email for a free quotation with no added costs to your surgery.

• Kamol Cosmetic Hospital
• Apex Medical Center
• Yanhee Hospital
• Million Hair Transplant Center
• Jungceylon Plastic Surgery Clinic – Phuket

Richard Troy

Medical Blogger committed to accuracy, I am passionate about delivering my readers critical insights into the medical field.
Former paramedic, instructor and medical school student.
You can read more about me in the dedicated section of the website.

www.medtravel.asia/about-richard-troy-medical-blogger/

The post Hair transplant in Bangkok, Thailand: cost and best clinics appeared first on MedTravel Asia.

Although no definitive standards exist for the perfect designer vagina, when it comes to the labia majora most people consider smooth plump labia as the gold standard.

Due to aging, genetics or massive weight loss the labia majora may look deflated, sagging and wrinkled, which results from the loss of subcutaneous fat and collagen, the same process that affects the face, the hands and the whole body in general. This vulvar atrophy may also result in the protrusion of the labia minora and clitoral hood, which become over exposed.

To address the atrophy of the labia majora many different approaches have been developed since 2007, with growing interest especially among women in their 40s and 50s and a steep increase in procedures; labia majora augmentation is considered both an antiaging and a cosmetic procedure for the female genitalia.

Labia Majora Augmentation with fat transfer

Fat grafting for labia majora augmentation is the most commonly performed technique. Satisfactory results may be achieved with a single session, but sometime a second session is needed after 4 to 6 months. It is a minimally invasive technique and it requires some fat to be harvested via liposuction from other areas of the body, such as the abdomen or the thighs, and after processing it with a centrifuge, the fat is reinjected into the labia in multiple layers; usually about 10ml of fat are injected on each side and sometimes Platelet Rich Plasma (PRP) may be injected as well to increase the survival rate of the adipocytes. The augmentation with fat graft leads to permanent results, with 50-70% of the fat transferred in each session lasting permanently.

Labia Majora Augmentation with fillers

Labia majora augmentation using dermal fillers is the second most performed technique. Unlike fat grafting, the use of hyaluronic acid fillers requires recurrent treatment sessions, every 4-12 months. 2 to 6 ml of hyaluronic acid fillers are required for satisfactory results; when more than 2-3 ml are required, the remaining volume may be injected in a second treatment session 2 to 4 months later in order to achieve optimal aesthetics.

Labia Majora Augmentation with dermal flap or dermal graft

Another option for labia majora augmentation is the use of a dermal flap or graft derived from other surgical procedures. This technique is rarely used and may have higher risks and complication rates. During a thigh lift or during a labia minora reduction surgery, a flap may be transposed and used to augment the labia majora; similarly, a dermal graft may be harvested while performing an abdominoplasty or other procedure and inserted into the labia majora.

Risks and complications of labia majora augmentation

As any other medical or surgical procedure, labia majora augmentation carries some risks.

Transient pain, pruritus, discomfort following the procedure are not uncommon. Hematoma, infection, flap or graft necrosis, asymmetry, fat cysts are among other possible complications.

Some swelling is expected for up to 4 weeks after the procedure and strenuous exercise and sexual intercourse may have to be avoided for up to 4 weeks depending on the type of augmentation performed.

Sources

• Labia Majora Augmentation: A Systematic Review of the Literature.
  S jabbour, E Kechichian – Aesthetic Surgery Journal, Oct 2017
• Commentary on: Labia Majora Augmentation: A Systematic Review of the Literature.
  CA Hamori – Aesthetic Surgery Journal, Oct 2017
• Aesthetic Vaginal Plastic Surgery
  L Triana – Springer, 2020

Richard Troy

Medical Blogger committed to accuracy, I am passionate about delivering my readers critical insights into the medical field.
Former paramedic, instructor and medical school student.
You can read more about me in the dedicated section of the website.

www.medtravel.asia/about-richard-troy-medical-blogger/

The post Labia majora augmentation: fat grafting and fillers appeared first on MedTravel Asia.

What is the G spot?

The G-Spot, also known as Gräfenberg spot from the name of the German gynecologist who described it, is an erogenous area on the anterior wall of the vagina, 5-8 cm from the vaginal opening. When stimulated, the G-Spot leads to strong sexual arousal, powerful orgasm and potential female ejaculation.

G spot amplification is one of the many designer vagina procedures available in female cosmetic genital surgery.

About the g-shot procedure

G-Shot is a quick and painless procedure that takes less than 15 minutes to be performed. The actual injection for G-Spot amplification takes just a couple of seconds and most of the time is used for the preparation to the procedure. G spot amplification is performed in the doctor’s office and a local anesthetic injected through a very tiny needle is used to avoid any discomfort or pain.

Finding the G-Spot and taking notes on its location is what takes most of the time: after the patient finds the most sensitive area on the anterior vaginal wall by palpation, the physician uses a specially designed speculum that allows to take measurements of its exact location. By taking measurements, the second time the procedure will be performed it will only take a few minutes, as the injection site will be known already. After administering the local anesthetic, a dermal filler is injected in the G-Spot area.

About the O-shot amplification procedure

O shot is known also as orgasm shot. The procedure involves the injection of PRP (platelet rich plasma) around the clitoris, in the g-spot area of the anterior vaginal wall and in the labia. PRP is obtained by drawing a small amount of blood from the patient’s arm and then processing it with a centrifuge. PRP contains a concentrate of growth factors that are being used lately for a great variety of applications, mainly for tissue rejuvenation and regeneration purposes. By stimulating tissue growth and the creation of new blood vessels and nerves for better blood flow and sensitivity in the target areas, the providers of this treatment claim it may help women suffering with sexual dysfunction, it may help with lubrication, urinary incontinence as well as increase sexual pleasure and sexual arousal and enhance the overall sexual experience.

There is very little and questionable research on this procedure, more high-quality data is needed to assess the benefits as well as the risks and potential complications of O-Shot amplification.

How long does G-Spot amplification last?

G-spot amplification is effective on average for 4 months. Duration varies depending on the specific substance injected and on the physiology of the patient: collagen or hyaluronic acid are generally used for this procedure; in some patients the active ingredient is resorbed more quickly while in others it lasts for longer. Autologous fat may be used as well and in this case the effects will be long lasting.

Does g-spot amplification work?

The existence of the g-spot itself has actually never been scientifically proven. Not all women can reach an orgasm just through vaginal stimulation.

Women who can reach a vaginal orgasm or who can feel the existence of an erogenous area on their anterior vaginal wall may benefit from g spot amplification. Results vary among women and there is still limited data on this procedure. In a pilot study by Dr. David Matlock, the inventor of the G-Shot procedure, 87% of women receiving the G-Shot reported enhanced sexual arousal/gratification.

What are the risks of g-spot amplification?

Due to the lack of studies there is limited knowledge on the possible risks and complications of g-spot amplification. By using resorbable dermal fillers the effects of this procedure are temporary, this means also that the possible complications, if any should arise, will be temporary as well. For this reason, permanent fillers should be avoided as they are difficult to remove completely and may result in permanent complications as well.

The treatment is not FDA-approved for this purpose, but fillers are injected and approved for use in the vagina for other medical conditions. The majority of studies on such conditions report that the injection of fillers into the vagina is safe and rarely leads to complications.

The possible risks associated with this procedure are:

• Infection of the injection site
• Bleeding from the injection site
• Scarring
• Necrosis
• Allergic reaction to the filler or anesthetic
• Dyspareunia (Painful sexual intercourse)
• Constant awareness of the G-Spot
• Constant sexual arousal

For more information on possible risks and complication ask your physician.

How much does the G-Spot injection cost?

Prices vary based on the substance injected, the country where you undergo treatment and

the chosen clinic and doctor. On average the g-spot augmentation procedure costs:

• 1,200-2,200 EUR (1,400-2,550 USD) in Germany
• 1,000-2,500 USD in the USA
• Around 40,000 THB (1,200 USD) in Thailand.

If you want to know more about g-spot augmentation in Thailand, send us a message for a free quotation.

References

• Aesthetic Surgery of the Female Genitalia.
  JMLCL Dobbeleir, K Van Landuyt – Seminars in Plastic Surgery, May 2011
• Female Cosmetic Genital Surgery – Concepts, Classifications and Techniques
  CA Hamori, PE Banwell, R Alinsod – Thieme, 2017
• International Society for the Study of Vulvovaginal Disease Recommendations Regarding Female Cosmetic Genital Surgery.
  P Vieira-Baptista et al. – Journal of Lower Genital Tract Disease, Oct 2018
• G-Shot consent form retrieved from thegshot.com
• American Society of Plastic Surgeons (ASPS)

Richard Troy

Medical Blogger committed to accuracy, I am passionate about delivering my readers critical insights into the medical field.
Former paramedic, instructor and medical school student.
You can read more about me in the dedicated section of the website.

www.medtravel.asia/about-richard-troy-medical-blogger/

The post G-shot and O-shot: G-spot amplification procedure appeared first on MedTravel Asia.

A droopy eyelid or eyebrow is one of the most common side effects of botulinum toxin type A injection (Botox®, Dysport®, Azzalure®, Xeomin®, Bocouture®, etc.). It occurs in up to 5% of patients when Botox treatment is performed by an inexperienced injector. When an experienced provider injects with the proper technique, eyebrow or eyelid ptosis occurrence can be reduced below 1% of cases.

Botox is a neuromodulator drug widely used in the treatment of dynamic (expression) wrinkles, with over 7.7 million treatments performed in 2019 in the USA alone. When properly injected, Botox relaxes the muscles in the treated area, reducing wrinkles and preventing their formation while also preserving some movement of the muscles.

Woman photo created by valuavitaly – www.freepik.com

Botched botox treatment – Bad cosmetic outcome

When poorly injected, Botox can cause:

• facial asymmetries, when units of Botox are unevenly distributed on the two symmetrical halves of the face.
• total paralysis of the muscles, when too many units are injected in an area leading to an unnatural look and lack of facial expressiveness (frozen appearance and apparent lack of emotions).
• Failure to treat wrinkles, when too little is injected or when it is injected in the wrong spots.
• Increase in wrinkles, due to overcompensation when the muscle is treated unevenly in its upper and lower part
• Other bad cosmetic outcome such as the “Spock eyebrow” or “Joker eyebrow” look when Botox units are unevenly distributed in an area.

Droopy eyelid or eyebrow after Botox

Another potential bad Botox side effect is the droopy eyelid or eyebrow, known as ptosis of the eyelid or eyebrow. This side effect is seen between 5- and 14-days following Botox treatment. There are many reasons why this could happen, including when:

• too many units are injected or when Botox is improperly diluted with normal saline and/or adrenalin, or when a syringe that does not allow for precise dose visualization is used
• wrong site of injection
• when there is migration of the drug from one area to another
• when forehead is improperly evaluated during consultation. Some patients have excess eyelid skin and unconsciously tend to keep their eyebrows raised to have the eyes more open. Forcing the muscles to relax with Botox, doesn’t allow for this compensation, causing the tired look or heavy eyelid feeling. Other patients have stronger or weaker facial muscles than others, so using a standard dose would result in overtreating or undertreating a muscle.
• when patients did not follow the post-procedure advice from their treating physician, causing Botox to spread to other areas.
• when previous periorbital procedures where performed, altering the anatomy of the tissues around the eyes.
• Botox may in rare cases cause eyelid edema. This usually resolves in about 2 weeks, and the causes for this are not fully understood.

It is not always the physician’s fault for Botox side effects; sometimes they may be due to the individual anatomy of the patient (we are not made exactly the same), the individual response to the drug or due to other circumstances. Choosing an experienced Botox provider will lower the chances to a minimum, but like any other medical or surgical procedure there is always the possibility of something going wrong.

How to fix droopy eyelid or eyebrow after Botox?

The good news with Botox is that it wears off and its effects are not permanent. Depending on the patient, many who experienced a side effect reported improvement within 6-8 weeks as the drug starts wearing off.

There are some ways to fix, at least partially, the issue. First thing you should do is refer to your doctor for an evaluation:

• If the droopy eyelid is the result of an uneven application of Botox, this can be easily corrected with further injections.
• The doctor may also perform a non-surgical brow lift using dermal fillers to correct the ptosis.
• The doctor may prescribe some Apraclonidine 0,5% eyedrops. These eyedrops may be used up to three times per day and stimulate the muscles to raise the upper eyelid, providing temporary relief.
• Massaging the muscles. You can try and use something like the back of an electric toothbrush for a couple of minutes 2-3 times a day to massage the affected area. Although there is not much evidence supporting this practice, some people have anecdotally found it helpful in speeding up the recovery.
• Using make-up or changing the hairstyle may also help in disguising the issue if you feel uncomfortable while in public.

How to prevent droopy eyelid or eyebrow after Botox injection?

The first and most important advice in preventing droopy eyelids or any other bad outcome from Botox, as well as from other medical treatments, is to refer to a properly trained and experienced practitioner. You may want to have a second opinion too, to compare the two consultations. If you want to avoid this hassle you can refer to us: at MedTravel Asia we take care of vetting doctors and clinics, checking qualifications, knowledge and experience for your convenience.

After choosing the right provider, you should let the doctor know of any medication taken in the previous few weeks, as they can interact with Botox treatment. You should also tell if you had Botox treatment in the previous months or if you had facial surgeries in the past.

After treatment you should follow your doctor’s advice including:

• Avoid rubbing or massaging your face for 24 hours and avoid facials, beauty treatments and professional face massages for a couple of days
• Avoid lying down for at least 4 hours
• Avoid make-up for 24 hours
• Avoid tight headwear for 24 hours
• Avoid sleeping on your face the first night
• Avoid alcohol consumption for at least 24 hours
• Avoid sun exposure or hot bath, saunas, steam rooms for a couple of days
• Avoid strenuous physical activity for 24 hours
• Avoid some medications, such as blood thinners (aspirin included) for a couple of days. Ask your treating physician before taking any.

How to fix a droopy eyelid with Botox?

Sometimes a droopy eyelid is not the result of a botched procedure, but it is caused physiologically by the aging process. Both males and females are affected by this issue and they often complain to their doctor that they look tired when they look at themselves in the mirror as well as they receive comments from friends and acquaintances that they have a tired look. In some cases, the droopy eyelid affects their field of vision too. Many surgical and non-surgical options are available for these patients one of which is using neuromodulators: Botox may be used to create a brow lift effect, pulling the proper muscles and restoring a normal and rested appearance to these patients.

Sources

• How to avoid brow ptosis after forehead treatment with botulinum toxin.
  A Redaelli, R Forte – Journal of Cosmetic & Laser Therapy, Dec 2003
• Management of Ptosis.
  M King – Journal of Clinical and Aesthetic Dermatology, Dec 2016
• Nonallergic Eyelid Edema After Botulinum Toxin Type A Injection.
  YS Chang, CC Chang – Medicine, Sep 2015
• Apraclonidine: A Real Eye Opener in Botox-Induced Ptosis.
  M Crist – American Academy of Optometry, 2011
• Intradermal Injection of Botulinum Toxin: A Safer Treatment Modality for Forehead Wrinkles.
  JY Jun, JH Park – Annals of Dermatology, Aug 2018
• Botulinum Toxin to Treat Horizontal Forehead Lines: A Refined Injection Pattern Accommodating the Lower Frontalis.
  XY Zhang, L Cai, MX Yang – Aesthetic Surgery Journal, 2019
• American Society of Plastic Surgery (ASPS)

Richard Troy

Medical Blogger committed to accuracy, I am passionate about delivering my readers critical insights into the medical field.
Former paramedic, instructor and medical school student.
You can read more about me in the dedicated section of the website.

www.medtravel.asia/about-richard-troy-medical-blogger/

The post How to fix droopy eyelid or eyebrow due to Botox? appeared first on MedTravel Asia.

There are several options to get rid of stubborn belly fat that do not involve surgery, inpatient hospital stays, scars, pain and downtime. These nonsurgical fat reduction technologies use heat, cold, ultrasounds or an injected medication to remove stubborn fat deposits.

They are also known as non-invasive body contouring procedures, a broad category that comprises also skin tightening procedures and muscle tightening and enhancement treatments.

What is stubborn fat?

Stubborn fat refers to the localized fat deposits that do not respond to diet and exercise.

Due to genetics, stress with risen cortisol levels or adaptation to the hypocaloric diet and exercise regimen, it may be difficult to lose the last few pounds that separate our current shape to our desired shape or, for fitter individuals, to their dream beach body ready for summer.

Indications for nonsurgical fat reduction

Noninvasive body contouring is indicated to target the stubborn fat deposit in most areas of the body such as the belly, flanks (love handles), thighs, chin (double chin), neck, back, upper arms, and knees.

These treatments are effective in reducing a localized fat bulge, but they are not a substitute to diet and exercise or to other medical procedures such as gastric bypass surgery or abdominoplasty when the goal is overall weight loss or the removal of a great amount of fat tissue.

Options for noninvasive fat reduction

All nonsurgical options for fat reduction rely on handheld devices that are placed in contact with the skin in the target area, or just above the skin, to target and permanently destroy the adipocytes (fat cells) without causing harm to the skin, nerves, muscles or any other tissue. Injection lipolysis does the same, but instead of a handheld device it consists of a drug being injected directly into the subcutaneous fat layer.

Cryolipolysis – CoolSculpting®

Cryolipolysis is most commonly known by patients as “fat freezing” or as CoolSculpting, the name of the patented device used to perform the treatment. A hollow applicator of the appropriate size is placed on the fat bulge to be treated. The applicator creates a vacuum, suctioning the fat bulge into its hollow opening. Cooling panels make the temperature drop inside the applicator, cooling the target area. You may feel cold, tingling and slight discomfort during the first few minutes of treatment, but this resolves quickly as the cold has also an anesthetic effect numbing the area.

A treatment session lasts up to 1 hour during which the patient can read, use the smartphone or watch tv.

Cryolipolysis works by cooling the adipocytes (fat cells) between 0-4 °C. Fat cells are susceptible to cold temperatures unlike other cells and tissues like the skin. The cold injures the fat cells causing their death and an inflammatory response that results in a gradual reduction of the fat layer over the course of several weeks.

Injection Lipolysis – Kybella®, Lipostabil®, LipoDissolve®

Injection lipolysis is also known as intralipotherapy and is commonly referred to as fat dissolving injections. The treatment is performed by injecting a medication in a grid pattern in the target area. The medication used is deoxycholic acid as in the case of Kybella and Belkyra, phosphatidylcholine as in the case of Lipostabil or a combination of the two as in the case of LipoDissolve. These substances cause the disruption of the fat cell membrane and its death, causing it to be metabolized and permanently eliminated from the body.

Radiofrequency Lipolysis – Vanquish®

Radiofrequency lipolysis is also known as Vanquish, the name of one of the patented devices used to deliver this treatment. Adjustable panels are placed around the target area without touching the body. The device emits radiofrequency, an electromagnetic wave capable of heating the deeper skin layers without causing harm to the skin. The energy emitted heats the subcutaneous fat layer causing the death of the adipocytes resulting in permanent fat loss. The patient feels a gentle heating without discomfort during the 30 minutes long treatment. Treatment causes no damage to the skin, nerves, muscles or the internal organs.

Laser Lipolysis – SculpSure®, Zerona®

Laser lipolysis commonly known by the name of the patented devices used to perform the treatment such as SculpSure and Zerona, is another heat-based treatment. In this case, heat is generated by a laser. The energy emitted by the laser is absorbed by the adipocytes, leaving other cells and tissues unharmed, and causing them to heat up during the 25 minutes long treatment. Heating results in the death of the fat cells, which will be then eliminated by the body over the course of several weeks.

Ultrasound Lipolysis – Ultrashape®, Liposonix®

Ultrasound lipolysis uses another type of electromagnetic waves: Ultrashape uses pulsed ultrasound technology while Liposonix uses high intensity focused ultrasound. The energy emitted by these devices on the target area cause the fat cells to vibrate and heat up. The heat causes the death of the adipocytes resulting in permanent fat loss.

Are non-invasive fat reduction results permanent?

Scientific Animations [CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0)]

All of the above treatments lead to permanent results.

Fat is not stored freely in tissues. It is stored within the cell membrane of specialized cells known as adipocytes. The number of adipocytes in adults doesn’t normally change. When we gain or lose weight, what changes is the volume of each cell which gets larger or smaller. By resulting in the death of the fat cells in the target area, the above treatments decrease the ability of that area to store fat resulting in permanent fat loss in the target area. This doesn’t mean it is impossible to regain fat in the treated area: not all the adipocytes are killed by the treatment and the surviving ones still retain the ability to store fat so in case of a significant gain of bodyweight and fat mass you may see the fat come back.

How long before I can see the results of targeted fat reduction?

All of the above procedures require multiple sessions and the results become evident weeks or months after the treatment due to the long time the body needs to metabolize and remove the dead and damaged fat cells from the body.

• Cryolipolysis – CoolSculpting®: this treatment generally requires between 1 and 3 sessions for each area. Each session lasts up to 1 hour and initial results may be seen as early as 3 weeks after the treatment. After 4 to 6 months you can see the final results with an average fat reduction of about 20%.
• Injection Lipolysis – Kybella®, Lipostabil®, LipoDissolve®: this treatment usually requires 2-4 sessions for each area in order to have satisfactory results. It takes 4-8 weeks for the results to be visible with further improvements up to 3 months after the treatment.
• Radiofrequency Lipolysis – Vanquish®: this treatment usually requires 4 to 6 sessions for each area, spaced 1 week apart. Initial results are visible after 6 weeks and as little as 2-3 treatments, while full results may be seen 2-4 months after the last treatment session. From studies, after 6 sessions patients lost on average 5 cm (2 inches) around the abdomen.
• Laser Lipolysis – SculpSure®, Zerona®: this treatment usually requires 1-4 sessions with 2 sessions minimum usually recommended by physicians for better results. Each session lasts about 25 minutes and the results may be visible after 6 weeks with further improvements up to 3-4 months after the last treatment session.
• Ultrasound Lipolysis – Ultrashape®, Liposonix®: this treatment is usually recommended for a minimum of 3 sessions, each one 30 to 60 minutes long. Results are visible about 2 weeks after the treatment with further improvements up to 6-8 weeks after each session.

What is the cost of non-invasive body contouring?

Price varies greatly depending on the chosen clinic and doctor, the type of treatment, the device used for the treatment, the number of sessions required and the country where you’re being treated. Here are the average costs:

• Cryolipolysis costs between 2,000 and 4,000 USD per area.
• Injection Lipolysis costs between 1,200 and 2,000 USD per area.
• Radiofrequency Lipolysis costs between 2,000 and 4,000 USD per area.
• Laser Lipolysis costs between 1,200-2,200 USD per area.
• Ultrasound Lipolysis costs between 2,000-4,200 USD per area.

You should expect to save about 30-70% on the overall costs by undergoing treatment at a plastic surgery clinic in Thailand.

For more information on each specific treatment check out the dedicated articles. 

Sources

• Review of the Mechanisms and Effects of Noninvasive Body Contouring Devices on Cellulite and Subcutaneous Fat.
  Z Alizadeh, F Halabchi – International Journal of Endocrinology and Metabolism, Oct 2016
• Cryolipolysis for noninvasive body contouring: clinical efficacy and patient satisfaction.
  N Krueger, SV Mai, S Luebberding – Clinical, Cosmetic and Investigational Dermatology, Jun 2014
• Non-invasive Subcutaneous Fat Reduction: A Review.
  J Kennedy, S Verne, R Griffith – Journal of the European Academy of Dermatology and Venereology, Feb 2015
• Noninvasive Body Sculpting Technologies With an Emphasis on High-Intensity Focused Ultrasound.
  ML Jewell, NJ Solish, CS Desilets – Aesthetic Plastic Surgery, Oct 2011
• American Society of Plastic Surgeons (ASPS)
• American Society for Dermatologic Surgery (ASDS)
• International Society of Aesthetic Plastic Surgery (ISAPS)
• American Academy of Dermatology Association (AAD)

Richard Troy

Medical Blogger committed to accuracy, I am passionate about delivering my readers critical insights into the medical field.
Former paramedic, instructor and medical school student.
You can read more about me in the dedicated section of the website.

www.medtravel.asia/about-richard-troy-medical-blogger/

The post Non-surgical fat reduction to get rid of stubborn belly fat appeared first on MedTravel Asia.

Injection lipolysis, also known as intralipotherapy, is a minimally invasive medical procedure for targeted fat reduction. Commonly referred to as fat dissolving injections, intralipotherapy is a form of mesotherapy and one of the nonsurgical fat reduction options available in cosmetic medicine.

What is injection lipolysis?

Intralipotherapy refers to the injection of a broad range of different substances directly in the fat layer below the skin known as the hypodermis; after the injection, the fat cells are destroyed and are unable to store or accumulate fat anymore, consequently their debris are metabolized and eliminated permanently from the body.

Indications of fat dissolving injections

In the US and in Canada the only FDA-approved fat dissolving injection is deoxycholic acid and it is indicated only for the treatment of submental fat known as the double chin. This drug is marketed as Kybella® in the US and Belkyra® in Canada and in Europe.

This and other substances are also used on-label or off-label, depending on each country’s approval, for the treatment of other localized fat deposits. You should ask your treating physician for information specific to the country where you are receiving treatment. Common treatment areas are:

• Submental fat a.k.a. double chin
• Infraorbital fat pads a.k.a. eye bags
• Jowls
• Other facial fat deposits such as cheeks and jaw fat
• Axillary fat pads a.k.a. armpit fat
• Male gynecomastia
• Upper back fat rolls
• Bra fat rolls
• Upper arm fat
• Waistline fat
• Abs and six pack definition
• Male and female abdominal fat
• Male and female flanks
• Buttock fat and cellulite
• Thighs fat and cellulite
• Knee fat
• Upper calf fat
• Lipoma (benign fat tumor)

Types of fat dissolving injections

The main substances used for injection lipolysis are the following:

• Deoxycholic acid – Kybella®, Belkyra®, GeoLysis®
• Phosphatidylcholine – Lipostabil®

The main combinations of substances used for injection lipolysis are the following:

• LipoDissolve®, Dermastabilon®, Aqualyx®

How does injection lipolysis work?

Deoxycholic acid – Kybella®, Belkyra®, GeoLysis®

Deoxycholic acid is a component of human bile, which is a fluid secreted by the liver and stored in the gallbladder to digest the lipids transiting in the small intestine. Deoxycholic acid disrupts the fat cell membrane causing the death of the fat cell which is then metabolized and eliminated from the body. 

Phosphatidylcholine – Lipostabil®

Phosphatidylcholine mechanism of action as fat dissolving injection is not yet well understood. Phosphatidylcholine is naturally found in the human body where it is involved in different body functions, such as being a component of the cellular membrane or metabolizing cholesterol. It is thought to cause the lysis of fat cell membranes. Phosphatidylcholine is extracted from soybean where it is abundant.

LipoDissolve®, Dermastabilon®, Aqualyx®

There are many mixes of substances, some of which have been registered as trademark, that are used for injection lipolysis.

LipoDissolve®, Dermastabilon®, Aqualyx® all contain a mix of two active ingredients: sodium deoxycholate (DC) and phosphatidylcholine (PC). Sodium deoxycholate is the sodium salt of deoxycholic acid and works similarly by disrupting the fat cell membrane causing its death. They are thought to work well in combination with DC breaking the fat cells and PC helping to metabolize them.

Other substances for injection lipolysis

Some clinics promote mesotherapy for facial rejuvenation, skin tightening, improving the tone and color of the skin and also for localized fat reduction. Mesotherapy is the injection of substances into the hypodermis, which is the layer of fat and connective tissue under the skin. There is scarce if not nonexistent evidence on both the efficacy and the safety of such treatments. Although most of the substances are FDA approved, they are used in mesotherapy for non-approved indications.

Many physicians and physician’s organizations such as the American Society of Plastic Surgeons (ASPS) advise against mesotherapy employing substances that have not been studied with safety and efficacy still not proven; they encourage further testing and research before recommending these treatments. Among the many substances advertised in mesotherapy for fat reduction there are:

• L-Carnitine
• Lecithin
• Choline
• Aminophyline
• Isoproterenol
• Vitamins
• Collagenase
• Hyaluronidase
• And many more…

How long do fat dissolving injections last?

Fat is not stored in the body freely as a fat molecule in tissues. Fat is stored within specialized cells known as adipocytes which absorb triglycerides from the bloodstream and store them within their cell membrane. When fat is needed for energy or other body functions, fat cells can release their content back into the bloodstream.

As adults, when we gain weight, we don’t increase the number of fat cells, we just increase their size as they get bigger by storing more triglycerides. In the same way, when we lose weight, we don’t reduce the number of adipocytes, we just reduce their volume.

Fat dissolving injections break down fat cells. The destroyed fat cells will not grow back and will be gone forever. Only the remaining adipocytes in the treated area will still be able to store fat and increase in size, but this will happen only if you gain weight which will anyway be redistributed among all fat cells in the body (depending also on genetics and other factors some areas are privileged for fat storage). The treated area will have less capacity for fat storage which will result in long-term efficacy of the treatment.

This means that once you reach the desired results, treatment is expected to last indefinitely unless there is a great increase in bodyweight and fat mass.

How much does injection lipolysis cost?

Depending on the country where you receive treatment, the chosen clinic and doctor administering the treatment, the area to be treated and the number of sessions required to achieve the desired result, the cost of injection lipolysis varies greatly.

• Kybella® and Belkyra® on average costs about 600-750 USD per vial.
• LipoDissolve®, Dermastabilon®, Aqualyx® and Lipostabil® on average are cheaper treatments starting from 150 USD.

You should expect to save about 30-70% on the overall costs by undergoing treatment in a plastic surgery clinic in Thailand.

Risks and side effects of intralipotherapy

Fat dissolving injections are a minimally invasive and non-surgical option for targeted fat reduction. As any other medical or surgical procedure, injections lipolysis carries some risks and has possible side effects.

The most common side effects concern the treated area:

• Swelling
• Bruising
• Pain or discomfort
• Numbness
• Redness
• Hardness

These side effects last from a couple of hours to a couple of weeks.

The possible serious complications reported are:

• Marginal mandibular nerve injury (with asymmetric smile or facial muscle weakness)
• Dysphagia (trouble swallowing)

Both these complications resolved spontaneously, without medical treatment, in clinical trials.

Other serious but rare complications are:

• Injection-site infection
• Injection-site ulceration
• Tissue necrosis
• Alopecia

An expert and knowledgeable physician can minimize all the risks by following protocols such as using the proper injection technique, targeting the right areas, injecting the right amount of product, observing aseptic techniques, etc.

Ask your treating doctor for the specific risks, side effects and contraindications of the specific product you are interested in.

How long after treatment with fat dissolving injections to see results?

It takes about 4-8 weeks for results to be fully visible and sometimes further improvement is possible up to 12 weeks post-treatment.

On average, at least 2-4 treatment sessions are needed for satisfactory results, spaced at least 4 weeks apart.

Sources

• Metabolic and Structural Effects of Phosphatidylcholine and Deoxycholate Injections on Subcutaneous Fat: A Randomized, Controlled Trial.
  DN Reeds, BS Mohammed, S Klein – Aesthetic Surgery Journal, Mar 2013
• Injectable Treatments for Adipose Tissue: Terminology, Mechanism, and Tissue Interaction.
  AM Rotunda – Lasers in Surgery and Medicine, 2009
• Injection Adipolysis: Mechanisms, Agents, and Future Directions.
  S Kamalpour, K Leblanc – Journal of Clinical and Aesthetic Dermatology, Dec 2016
• Mesotherapy – The french connection
  G Sivagnanam – Journal of Pharmacology and Pharmacotherapeutics, 2010
• Lipodissolve for Subcutaneous Fat Reduction and Skin Retraction.
  DI Duncan – Aesthetic Surgery Journal, Sep 2005
• International Textbook of Aesthetic Surgery.
  N Scuderi, BA Toth – Springer 2016
• Detergent Effects of Sodium Deoxycholate Are a Major Feature of an Injectable Phosphatidylcholine Formulation Used for Localized Fat Dissolution.
  AM Rotunda, H Suzuki, RL Moy – Dermatologic Surgery, Jul 2004
• Injection Lipolysis: A Systematic Review of Literature and Our Experience with a Combination of Phosphatidylcholine and Deoxycholate over a Period of 14 Years in 1269 Patients of Indian and South East Asian Origin.
  MK Thomas, JA D’Silva, AJ Borole – Journal of Cutaneous and Aesthetic Surgery, Oct 2018
• Lipostabil: The Effect of Phosphatidylcholine on Subcutaneous Fat.
  VL Young – Aesthetic Surgery Journal, Sep 2003
  K Mahmud, CE Crutchfield – The Journal of Clinical and Aesthetic Dermatology, Oct 2012
• Effectiveness of Local Fat-Dissolving Solution Injection
  GS Jung – Aesthetic Surgery Journal, Mar 2019
• Efficacy of mesotherapy in facial rejuvenation: a histological and immunohistochemical evaluation.
  M El-Domyati, TS El-Ammawi, O Moawad – International Journal of Dermatology, Aug 2012
• Dynamics of Fat Cell Turnover in Humans.
  KL Spalding, E Arner PO Westermark – Nature, Jun 2008
• Evaluation of the Efficacy of Injection Lipolysis using Phosphatidylcholine/Deoxycholate Versus Deoxycholate Alone in Treatment of Localized Fat Deposits.
  A El Kamshoushy, RA Maksoud, N El Mahdy – Journal of Clinical & Experimental Dermatology Research, 2012
• American Society of Plastic Surgeons (ASPS)

Richard Troy

Medical Blogger committed to accuracy, I am passionate about delivering my readers critical insights into the medical field.
Former paramedic, instructor and medical school student.
You can read more about me in the dedicated section of the website.

www.medtravel.asia/about-richard-troy-medical-blogger/

The post Injection lipolysis: fat dissolving injections appeared first on MedTravel Asia.

Dermal fillers, also known as injectable soft tissue fillers, are the second most popular minimally invasive procedure in the field of cosmetic medicine and surgery, the first one being botulinum toxin injections (Botox). Dermal fillers are mainly used for facial rejuvenating purposes to fight the signs of aging, such as lines and wrinkles, but are also often used to enhance facial features, to replace lost volume both in the face and in the hands and to overall restore a youthful appearance.

What are dermal fillers?

Dermal filler is a broad term that includes many different substances used to achieve the same goal. These substances can be natural, such as hyaluronic acid, derived from our own bodies such as PRP and autologous fat, or synthetic like PLLA and PMMA. They can be temporary treatment, long lasting biodegradable treatments or permanent non-biodegradable substances. They work in different ways and not all of them are right for each indication and injection area; for this reason, a plastic surgeon may prefer using one over another to provide the results that meet the expectations of the patient. 

Indications of dermal fillers

Injectable soft tissue fillers have many different cosmetic indications and are used to improve the look and appearance in several different ways. Dermal fillers can:

• Smooth fine lines on the face, like crow’s feet and vertical lip lines (smoker’s lines).
• Fill wrinkles, like the horizontal forehead lines and the frown lines.
• Soften creases and skin folds on the face, like the nasolabial fold and marionette lines.
• Fill hollows, such as the under-eye hollows that cause black circles and a tired appearance or the submalar hollow when cheek volume is loss due to aging.
• Reshape features, such as the chin and the nose
• Augment features, such as lips and cheeks
• Restore lost volume, in many facial areas but also in the aging hands
• Improve the look of scars, such as acne scars and other depressed scars

Types of dermal fillers

The main types of dermal fillers are:

1. Hyaluronic acid fillers (HA)
2. Collagen fillers
3. Autologous Fat
4. Platelet-rich plasma (PRP)
5. Poly-L-lactic acid fillers (PLLA)
6. Calcium Hydroxylapatite (CaHA)
7. Polymethylmethacrylate (PMMA)
8. Polycaprolactone (PCL)

Beware of black-market substances, unlicensed providers and non-FDA approved products.

There are reports of patients who received all kind of dangerous injections for cosmetic purposes: from silicone, to animal fat, glycerin, non-medical-grade products to even cement and motor oil.

How do dermal fillers work?

Depending on the specific substance injected, dermal fillers work in different ways.

Hyaluronic acid fillers

Hyaluronic acid (HA) is a natural occurring molecule in the human body. It is also found in the skin where it keeps it plump and hydrated. HA has the ability to bind 1000 times its weight in water, helping to retain it in the skin. Photodamaged and aging skin in general see a decrease in concentration of hyaluronic acid due to its degradation and reduced synthesis resulting in loss of volume, wrinkling and altered elasticity. Hyaluronic acid as an injectable filler may be chemically modified (crosslinked) to make it last longer in the body.

There are several different brands marketing different hyaluronic acid products each with its own slightly different formulation, characteristics and applications. The main ones are:

• Belotero®: Balance.
• Captique®
• Esthélis®
• Elevess®
• Hylaform®
• Juvederm®: Ultra, Ultra Plus, XC, Ultra XC, Volbella XC, Vollure XC, Voluma XC
• Perlane®
• Prevelle®: Silk
• Puragen®
• Restylane®: L, Lyft, Silk, Refyne, Defyne
• Teoxane Teosyal®: RH1, RH2, RH3, RH4, Kiss

Collagen fillers

Collagen is a naturally occurring and most abundant protein found in the human body. Collagen is a major component of the skin giving it strength and support. Collagen deteriorates over time and is easily damaged and degrades when hit by UV rays. There are different collagen products on the market, some are derived from animal sources (bovine and porcine) and other are derived from human sources (cadaveric skin or lab cell cultures). The main ones are:

• Alloderm®
• Cosmoderm®
• Cosmoplast®
• Cymetra®
• Evolence®
• Fibrel®
• Zyderm®
• Zyplast®

Autologous Fat Graft

Fat grafting is a procedure that utilizes autologous fat as filling material. Fat grafting is also known as fat transfer, fat transplant or lipofilling. Fat is another component of the subcutaneous tissue that is loss due to the aging process and its loss contributes to sagging and wrinkling skin as we age; this loss happens in the face and hands mainly while fat storage is increased in other areas of the body such as the waist in women and the abdomen in men. Fat is usually obtained through liposuction of the lower abdomen and after centrifugation and processing it is ready for reinjection. Not all transplanted fat cells will survive, and the survival rate varies greatly depending on the surgical techniques used and the ability of the surgeon. The damaged cells and those that can’t receive blood and nutrient supply in the recipient area will be resorbed with time. The survival rate ranges 10-90% and the use of PRP in conjunction with fat grafting seems to be promising in guaranteeing a higher survival rate of the fat cells.

Platelet-rich plasma (PRP)

PRP injections to the face are also known as “vampire lift”. Blood is drawn from the arm and after centrifugation and processing the PRP is separated from the other blood components and is ready for reinjection. PRP is rich in growth factors which increase fibroblast proliferation; fibroblasts are cells that synthetize the extracellular matrix (ECM) which is composed by proteins such as collagen and elastin, and by other molecules such as hyaluronic acid, all of which are lost due to the aging process. By increasing fibroblast and their production of ECM components, PRP effectively rejuvenates the skin, decreasing the signs of aging and increasing elasticity and volume.

Poly-L-lactic acid (PLLA)

Polylactic acid is a synthetic but resorbable dermal filler used for many years in the medical field such as in dissolvable stitches. PLLA works by stimulating the tissue to synthetize new collagen over several weeks while slowly being resorbed. It is marketed under the following brand names:

• Sculptra®
• Sculptra Aesthetics®

Calcium Hydroxylapatite (CaHA)

Calcium hydroxylapatite is a biodegradable substance naturally found in human bones and teeth. As a filler, CaHA is made in the lab as microspheres suspended in a soluble gel which is resorbed and helps in the dispersion of the microspheres. Calcium hydroxylapatite stimulates collagen production, increasing volume over several months in the areas where it was injected, and it is eventually resorbed. It is marketed under the following brand name:

• Radiesse®

Polymethylmethacrylate (PMMA)

PMMA is a biocompatible but permanent filler. Microspheres of PMMA are suspended in a collagen gel which helps for an even distribution of the product. While collagen is quickly resorbed, PMMA microspheres stimulate our own collagen production providing volume in the treated areas. It is marketed under the following brand names:

• Artefill®
• Bellafill®

Polycaprolactone (PCL)

PCL is a biocompatible and biodegradable polymer. Microspheres of PCL are suspended in an aqueous gel and injected in the desired area. The aqueous gel provides immediate volume restoration and is then resorbed over 2 to 3 months. The PCL microspheres stimulate collagen production overtime providing a longer lasting effect. It is marketed under the following brand name:

• Ellansé®

How long do dermal filler lasts?

Different classes of fillers have different duration of the effects. Different formulations of the same class of fillers also have different duration. Duration is also affected by the site of injection, technique used for the injection, amount of product injected, patient’s metabolism and individual characteristics, and if it is the first treatment or a follow-up treatment.

This is how long, on average, dermal filler last:

• Hyaluronic acid fillers HA (Juvederm®, Restylane®, …): effects lasting 6-18 months
• Collagen fillers (Cosmoderm®, Zyplast®, …): effects lasting 1-4 months
• Autologous Fat: some fat cells will be resorbed during the first few months, after about 6 months the effects should be stable and last several years (5-15 years).
• Platelet-rich plasma (PRP): full effects visible in 2-3 months and lasting up to 12-18 months
• Poly-L-lactic acid fillers PLLA (Sculptra®): full effects visible in 2-3 months and lasting about 2 years.
• Calcium Hydroxylapatite CaHA (Radiesse®): effects lasting 12-18 months
• Polymethylmethacrylate PMMA (Bellafill®): full effects seen after 3-6 months and lasting over 5 years.
• Polycaprolactone PCL (Ellansé®): Effects from the water gel carrier are immediate and fade in 6-12 weeks, while full effects of PCL are seen after about 12 weeks and last 12-48 months depending on the formulation used.

Facial dermal fillers cost

As per the duration, there are many variables influencing the cost of dermal fillers: it will depend on the surgeon and clinic where the treatment is performed, the country, the formulation, the brand, …

On average, the cost of face dermal filler treatment is:

• Hyaluronic acid fillers HA (Juvederm®, Restylane®, …): 500-1,500 USD per syringe
• Collagen fillers (Cosmoderm®, Zyplast®, …): 300-450 USD per syringe
• Autologous Fat: 2,500-8,000 USD per treatment
• Platelet-rich plasma (PRP): 500-2,500 USD per treatment
• Poly-L-lactic acid fillers PLLA (Sculptra®): 800-1,000 USD per syringe
• Calcium Hydroxylapatite CaHA (Radiesse®): 800-1,000 USD per syringe
• Polymethylmethacrylate PMMA (Bellafill®): 1,000 USD per syringe
• Polycaprolactone PCL (Ellansé®): 450-650 USD per syringe

You may expect to save about 30-70% by undergoing treatment in plastic and cosmetic surgery clinics in Bangkok, Thailand.

Risks and side effects of dermal fillers

Dermal filler injections are generally a safe treatment but do carry some risks, like any other medical or surgical procedure.

To minimize such risks, it is of utmost importance to have the procedure carried out in a medical setting by a qualified and experienced professional using products purchased from a reputable source.

The face has a great number of blood vessels and nerves and if a filler is injected in the wrong spot or in the wrong amount or with the wrong technique it can cause complications, sometimes irreversible and potentially even death.

Over the years, due to dermal fillers being a very remunerative industry, doctors from all specialties and background started providing dermal filler injections. While a plastic surgeon, or dermatologist, or cranio-facial surgeon has extensive knowledge of the facial and soft tissues anatomy, a dentist, a GP, or a nurse are not as trained as them. Sometimes doctors qualify themselves as aesthetic doctors. Aesthetic medicine is not a recognized medical specialty and it is a title often awarded after attending a 1-2 days course on how to perform injections or how to use a medical (cosmetic) device such as lasers.

Moreover, cosmetic surgery is also an art. To achieve a harmonious, pleasing, natural looking result doesn’t just require medical knowledge but also artistic sense.

Each filler has a different risk profile, which also depends on the area treated and on the characteristics of the patient. Your provider will inform you of the specific risks related to the procedure you want performed.

In general, these are the potential risks and side effects of dermal filler treatment to the face

Common risks of dermal fillers include

• Bruising
• Swelling
• Minor bleeding
• Redness
• Itching
• Discomfort or pain for a few days

Uncommon risks of dermal fillers include

• Asymmetry of the face
• Infection at the injection site
• Scarring
• Lumps
• Redness of the skin and itching
• Skin discoloration
• Numbness
• Allergic reactions
• Systemic infection
• Blisters
• Migration of the filler to another area
• Skin necrosis
• Blindness and cardiovascular complications if injected into a blood vessel

It is generally better to start with hyaluronic acid injections before committing to a long-lasting or permanent filler injection. Hyaluronic acid is also the only type of filler than can be reversed by injecting an enzyme known as hyaluronidase which dissolves the filler if you are unhappy with the results.

We advise against the use of permanent PMMA fillers (Bellafill®) and Polyacrylamide fillers (Aquamid®).

Best Bangkok Clinics for dermal filler injections to the face

• Refine Dermatology Clinic
• Dermaster Wellness and Aesthetic Institute
• Preecha Aesthetic Institute (PAI)
• Kamol Cosmetic Hospital
• Apex Medical Center
• Panacee Medical Center

Sources

• Skin ageing and its treatment.
  L Baumann – Journal of Pathology, 2007
• “Saving Face”: An Online Study of the Injecting Use of DIY Botox and Dermal Filler Kits.
  R Brennan, JSG Wells, M Van Hout – Plastic Surgery, 2018
• A Review of Dermal Fillers in Facial Plastic Surgery.
  D Bray, C Hopkins, DN Roberts – Current Opinion in Otolaryngology & Head and Neck Surgery, Aug 2010
• Fat, Stem Cells, and Platelet-Rich Plasma.
  IB James, SR Coleman, JP Rubin – Clinics in Plastic Surgery, 2016
• Update in minimally invasive periorbital rejuvenation with a focus on platelet-rich plasma: A narrative review.
  M Kassir, G Kroumpouzos, P Puja – Journal of Cosmetic Dermatology, Mar 2020
• ArteFill® Permanent Injectable for Soft Tissue Augmentation: I. Mechanism of Action and Injection Techniques.
  G Lemperle, TR KNAPP, NS Sadick – Aesthetic Plastic Surgery, Jun 2010
• Polycaprolactone: How a Well-Known and Futuristic Polymer Has Become an Innovative Collagen-Stimulator in Esthetics.
  MO Christen, F Vercesi – Clinical Cosmetic and Investigational Dermatology, Jan 2020
• Managing Complications of Fillers: Rare and Not-So-Rare.
  E Haneke – Journal of Cutaneous and Aesthetic Surgery, Oct 2015
• Overview of Deep Dermal Fillers.
  MH Liu, DP Beynet, NM Gharavi – Facial Plastic Surgery, Jun 2019
• U.S. Food & Drug Administration (FDA)
• American Society of Plastic Surgeons (ASPS)
• American Academy of Dermatology (AAD)

Richard Troy

Medical Blogger committed to accuracy, I am passionate about delivering my readers critical insights into the medical field.
Former paramedic, instructor and medical school student.
You can read more about me in the dedicated section of the website.

www.medtravel.asia/about-richard-troy-medical-blogger/

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