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« Med Spa & Laser Clinic News | Main | Free 5 Credit CME Workshop in Phoenix, AZ Saturday May 2nd »
Thursday
Apr232009

Laser Lipo ~ One Lump, or Two?

I like to regularly read through various self-help forums to understand the patient’s point of view on the types of procedures we perform. (Laser Lipo, SmartLipo) I believe in doing so, it can help fine tune our procedures, prepare us better for responses to patients with similar experiences, and help us perform overall better customer service.

One of the common complaints I have continually come across was lumps and bumps patients have experienced post laser lipolysis. Many seem somewhat traumatized by the bumps, others state their physicians have given them no explanation or even treatment for the lumps.

Let me first preface that this is in no way comparable to the lumps and tracts after traditional liposuction for reasons we’re all well aware of. In fact, many of our patients are coming in to have those lumps and tracts removed with laser lipo. Patients need to be well educated about the healing process of the lymphatic system, underlying tissue layers, the remaining layer of fat post laser lipolysis, and that lumps can be part of that process for some. How many lumps remain visible after the healing process has been completed (6 months or more) is dependent upon how much fat was left underneath the skin from the procedure, how aggressive the procedure was (amount of fat removed and severity of manipulation), and how the area was treated during the healing process. These lumps can be pockets of just fat, or consolidation of scar tissue and body fluid, even seromas that require regular draining until gone.

It doesn’t matter if the device used was a lipo lysing laser or the ultrasound Vaser, lumps can occur and tend to be more operator dependent than anything. No surprise to any of us, I noticed with many physicians I talked with experienced more lumps at the beginning of their training and had to bring many patients back for touch-ups. These physicians tell me that as their experience level increased they began to see fewer lumps and attributed the reduction to technique enhancements from training with more experienced physicians, choices of suction devices and cannulas, aggressiveness of suction post lysing, and post treatment regimens.

Because you can’t rush a physician’s level of experience, what you can do is offer your patients methods to help keep the lumpy bumpies away. These treatments can be started as early as 2 weeks post-procedure or as early as tolerated by your patient.

Here are some of the laser lipo remedies that we currently use or have been suggested to me by others.

  • Proper garment fitting
  • Placement of large foam surgical pad across abdomen under garment to disperse pressure evenly
  • Lymphatic massage, or deep tissue massage, by an experienced massage therapist
  • Use of a roller ball. We like the Omni roller ball suggested to us by our dear friend Dr. Richard Goldfarb (thanks Rich!)
  • Ultrasound therapy
  • VelaShape, or comparable device. We give our patients 2 free sessions with every laser lipo procedure. We like the blending of the infrared, radio frequency, roller motion and suction to help our patients smooth out and tighten the skin.
  • Endermologie
  • Use of a small cannula to excise the areas of fat (plastic surgeon suggested)

More theories and suggestions are welcome!

Author: Paula D. Young RN runs internal operations and training at Young Medical Spa and is the author of the Medical Spa Aesthetics Course, Study Guide, and Advanced IPL & Laser Training course for medical estheticians and laser technicians.

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Reader Comments (11)

Thank you for the advice. I have read the complaints about lumps and bumps on forums as well which always scared me away from performing lipo lysis as I don't know how to prevent or treat them. This type of advice is needed and appreciated.

04.27 | Unregistered CommenterDr DO

Paula,

I appreciate the article but there are a few things that need to be looked at. I was trained by Dr. Jeffrey Klein. He invented tumescent liposuction. He would argue against the use of surgical foam pads as they may be linked to a higher incidence of infection as well as skin ulceration from pressure.

You also recommended to have small cannulas then recommend a plastic surgeon. The problem with that is that most plastic surgeons do not use small cannulas. Dr. Klein teaches only the microcannula technique.

Just my two cents. If things are done correctly you really do not need the other stuff either.

04.27 | Unregistered CommenterLH

I suspect that Dr. Klein would argue that you don't need laser liposuction at all!

04.28 | Unregistered CommenterTF

LH,

You make a good point, but let me clarify myself a bit more. Last year at The Aesthetic Show in Vegas, Dr. Millard and other tumescent lipo physicians made a clear point that improper garment fitting, or brands, can lead to an undesirable outcome of uneveness and lumps. In fact, some physicians suggest not using a garment at all! In the case of abdomens that underwent a significant amount of work, some physicians believed lines were being caused by uneven pressure from the garment or at the seams. The foam pad they suggest using has a firmer, non-absorbent backside which is placed over the ABDs covering the puncture sites, but underneath the garment to exert an even pressure over the treated area from the firmer side. Of course, the pad would have to be sized accordingly.

I agree with you on Dr. Klein's technique with the microcannula. The small cannula technique was suggested by a plastic surgeon in a discussion at ASLMS (I apologize I do not know his name, it was a large group). He stated he felt more comfortable going in with a small standard liposuction cannula to repair areas rather than the laser lipo device. He said many of his colleagues treated lumps the same way.

Your last point about if things are "done correctly" you don't need other treatments (like roller balls, massage etc.), are there any technique suggestion you may have for others who could learn from your experience? You can see Dr. DO's comment above that they are a little apprehensive to perform laser lipo. While you can't rush experience, this is an excellent forum to discuss training and technique!

Respectfully yours, Paula

TF,

You are 100% correct. Dr. Klein does not feel that laser adds anything to the procedure but he is looking at it but definitely not sold that it helps.

Dr. Klein also feels that US assisted lipo increases the risks of complications.

04.28 | Unregistered CommenterLH

Paula,

I agree that improperly fitting garments can cause problems. It is extremely important to make sure of fit as well as alignment of the garments.

As far as the foam (reston), has been shown to increase the risk of infection, ulceration and skin necrosis.

As we all know, lumps and bumps will decrease as the physician gains experience. When you are first learning you will have a higher touchup rate than you will after you have done 30 to 40 cases.

I took a class form Dr. Millards clinic and did not feel as though I was anywhere near ready to do cases on my own. They only did one live case and none of the physicians were able to assist. I then took Dr. Kleins course which was excellent. We did 12 cases and every physician got hands on for every patient. I then felt I was ready to do my first solo case (I had done some cases with other more local physicians). Dr. Klein is very conservative with lipo. He has never had a case of skin ulceration or skin necrosis. He has only had one case with a slight infection to a patients inner thigh that he drained and she has about a 1cm scar.

So, if I were thinking about starting to do lipo like Dr. Do I would try to get in Dr. Klein's course (liposuction101.com). Then when you are done make sure to have someone come in and observe your technique in your clinic.

04.28 | Unregistered CommenterLH

If you like to use foam dressings post-lipo, don't use Reston. It's designed for pipes, not people.

Epi-foam - which is silicone backed - is much better, and no blisters!

04.28 | Unregistered CommenterTF

I was thinking of getting body contouring from Sona MedSpa of Charlotte Has anyone had an experience with their procedures?

04.28 | Unregistered CommenterLH

Fashion Shop,
This is nice isn't it! Paula is always generous with her knowledge and her experience. This is called "Clinical Exchange". I bet the laser company that makes SmartLipo (Cynosure) does not talk about lumps and bumps. This is precisely the reason we need to advocate strongly for company promoted and facilitated clinical exchange. Most providers who do SmartLipo are not told about lumps and bumps and do not know how to prevent and treat them. Most providers get blind sided when their patients come back to them upset about the lumps and bumps. Cynosure probably does not care because they already sold you their $150,000 laser plus upgrades when they went from 10 watts to 11 watts to 12 watts, etc. Clinical Exchange is the answer and we (providers) must press and annoy and insist that the laser companies (go after their top executives) offer and promote this to all their users. It is the only way we are going to advance the field more swiftly getting better results with fewer complications. See Solta (Steven Fanning). Lumenis (Robert Mann), and search for "clinical Exchange" to find out more about Clinical Exchange. You can also look into MAPA for an organzation dedicated to clincical exchange www.mapaskin.com.

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I have also been hesitant to learn and perform tumescent lipo for reasons Dr DO mentioned (fear of complications and lack of knowledge on how to manage them, especially lumps and bumps that I've heard about on forums from patients). Please keep the discussion alive so that we can all learn. Are there any other courses that you would recommend besides Dr Klein? Thanks

05.8 | Unregistered CommenterLA Doc

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