Enhanced results with lipo plus Thermage

As usual, the Hot Topics session at this week's meeting of the American Society of Plastic Surgeons served up a number of issues. I had the opportunity to present the data from our studies proving that Thermage given immediately after liposuction enhances skin tightening. The reason that this is important to prove in a scientific way is that skin shrinks all by itself after lipo, so additional shrinkage can only be claimed if it is demonstrated to be greater than what occurs normally. Patients who benefit from this are those who have some looseness to the skin, such that lipo alone would not give a good result, but not so much that they need something like a tummy tuck. This latter part is important because some plastic surgeons are pitching laser lipo as an alternative to tummy tucks. It's a risky proposition because I am already seeing patients who should have had a tummy tuck but chose laser lipo instead, and the results are not pretty.
To be fair, there was some data presented showing enhanced skin shrinkage with smart lipo (though not as much as with lipo-Thermage) and another suggesting that VASER ultrasound helps too. But each of these has its own risks and benefits, so for now my money is on the one designed to tighten skin in the first place.

Calling all collagen

For all the talk about collagen, the primary structural protein of which we are made, there remains a fair amount of misinformation about it. Here’s a primer: The collagen molecule is composed of long coiled strands, or fibers, which interconnect and weave together to form the matrix of everything from skin to tendons. There are different types, such as elastin, which as the name implies contribute more to flexibility. And like all molecules in the body, collagen is continually broken down and replaced. However, with age and environmental damage, the new collagen has defects, which leads in turn to the visible signs of aging in the skin.

So the real question is how do we encourage new healthier collagen to form? There are several strategies, the primary one being prevention. This involves all the simple things like sunscreen. A healthy diet may be helpful, but only in a general sense. Consuming the tendons rather than the more tender portions of meat, a common practice in Japan, is unlikely to make a difference. Vitamin C is often touted, both in the diet and as an ingredient in skin creams. The logic is that since it is a co-factor for the enzyme that builds collagen (which is why the disease scurvy develops when it is absent from the diet), extra C builds better collagen. But while it is true that collagen can’t be adequately made if it is lacking, extra doesn’t drive the process any faster. The worst idea of all is collagen or elastin in skin creams; skin is a barrier to prevent large molecules like these from entering. So it’s like throwing bricks at a wall and expecting them to somehow be taken in and make the wall stronger.

There is hope though. One sure fire way to encourage new collagen is to recruit the body’s healing processes by essentially creating a controlled injury. This is how chemical peels and lasers work. Thermage functions this way too, and has the advantage of no downtime. And because it works by building new collagen, the results are long-lasting.