Laser Liposuction & Skin Tightening - Emperor's New Clothes?

Does laser assisted liposuction really provide all of the skin tightening benefits that the manufacturers claim?

We are in pursuit of many Holy Grails in plastic surgery, from scarless post-surgical healing, non-invasive liposuction and implant-free breast augmentation to non-invasive skin tightening. With the advent of laser-assisted liposuction (LAL) came the promise from the manufacturers that we have finally achieved a way of combining "minimally invasive" fat removal with skin tightening, sensationally treating two maladies with one procedure.

I been involved with LAL for many years, and it has been the primary revenue driver in my practice for nearly five years running. I began to perform the procedure when the machines became powerful enough to actually generate enough subdermal heat in a timely fashion to potentially create significant collagen remodeling and hopefully result in skin tightening. My case load quickly became large enough that I was asked to be a national speaker for one of the dominant laser companies educating other physicians on the use of LAL. As such, I delved into every published paper even remotely relating to heat-generated skin tightening and laser assisted liposuction. Over the years, I have been able to merge a huge surgical experience with the science behind the procedure and draw some fairly clear and simple conclusions on the issue of skin tightening.

Setting up a patient for potential skin tightening is fully dependent on generating ample subdermal heat to initiate collagen denaturation and subsequent remodelling. Generally, this temperature is felt to be between 40 to 45 degrees celsius.  At around 47 degrees celsius, skin blistering and burns occur.  With proper time, temperature-monitoring devices, and careful technique, adequate temperatures can be achieved. Getting the skin to this temperature range takes time and significantly prolongs the procedure. Additionally, the risk of seroma escalates the longer you spend with the tissues in this temperature range in my experience.

In about 15% of cases, I see clinically visible skin tightening which I don't feel I would have seen using other techniques. This skin tightening is not the equivalent of excision techniques, but typically limited and subtle. This is obviously purely my subjective opinion to be clear, and I cannot say that these same results may not have occured witht the same frequency had I used other liposuction techniques.

The science of LAL and skin tightening is clear that some tightening does occur and is quantifiable. But this does not predictably translate into clinical relevance. I have now performed nearly 1000 LAL's and no longer educate my patients that LAL is a good method of tightening skin. The limited degree of tightening I credit LAL for is not enough to call it a clinically relevant skin tightening procedure. The majority of new LAL consults in my practice present with the impression that LAL is going to tighten up their loose skin while removing fat. The notion is dominant on the internet and even in print ads. I politely educate them that although there may indeed by some skin tightening, this will be subtle at best. In my opinion, the advantages of LAL lie elsewhere, particularly in a somewhat easier recovery.

I continue to hear from colleagues who also use LAL that they believe in the skin tightening.  I don't know if this is a case of "The Emporers New Clothes" or not. I have pushed the envelope in terms of thoroughly heating up the skin to appropriate temperatures and length of time, but only see minimal tightening and an increase number of seromas. I continue to use LAL heavily but no longer tout skin tightening as being an expected end point.

Interview: Dr. Samir Ibrahim Abu Ghoush, Plastic Surgery In Poland

Plastic surgeon and hair transplant physician Samir Ibrahim Abu Goush who practices in both Poland and the Middle East.

Physician: Dr. Samir Ibrahim Abu Ghoush
Plastic Surgery Clinic: Mandala Beauty Clinic
Location: Poznań, Poland
Website: www.mandalaclinic.pl

That’s interesting: Dr. Ghoush is a trainer for Cool Lipo in the Middle East and Central Europe and a pioneer of LVR (Laser Vaginal Rejuvenation) in the Middle East and Poland.

Profile: Dr. Ibrahim was awarded twice by the International Society of Hair Restoration Surgery for presenting the best clinical case and poster. Aside from that he is recognized worldwide for planting facial hair, moustaches and beards. He is a distinguished Faculty member and Chairperson of many live workshops in HAIRCON and OLSW (Orlando Live Surgery Workshop). Dr. Samir has performed thousands of Aesthetic, Plastic Surgery, Reconstructive and Hair Restoration Procedures in a career spanning for more than 15 years. His patients are women and men from different countries, from all facets of society, many celebrities. Dr. Samir trained and worked with world renowned specialists in their fields.

We hadn't really thought of Poland as a hotbed for cosmetic medicine, until we met plastic surgeon and hair transplant specialist Dr. Samir Ibrahim Abu Goush.

Can you tell us more about your clinic? What are the services available?

Mandala Beauty Clinic is located in the heart of Poznan, Poland. It is very modern, with an integrated operating room with inpatient services. We offer a wide spectrum of innovative methods of treatment, and lasers that include: Vaser Hi def. Liposculpture, Laser Assisted Liposuction, Laser Vaginal Rejuvenation and Aesthetic Gynecology, CTEV Endovenous Laser, Aesthetic Plastic Surgery, Facial Surgery, Breast Surgery, Body Procedures, Hair Transplants, and Dermatology & Aesthetic Medicine 

How is your clinic organized? How do you manage your staff’s salary?

Physicians are working with us as partners on the (win/win) basis. We have at least 25 medical spa staff. The permanent staff is paid a monthly salary while the rest are paid on a per case/per hour basis.

What IPL or laser technologies are you using? What are your thoughts about the technologies you’re using now?

I use a German made IPL (smart plus). I have the Vaser machine from Sound Surgical Technologies, the Cool Lipo Laser and the CTEV Endovenous Laser from Cool Touch, a Laser for LVR (laser vaginal rejuvenation) from Innogyn.

I am very happy and much satisfied with these technologies. I use the Vaser all the time.

How do you market your clinic?

First of all, we have our website that has great medical spa SEO and generates a lot of traffic. We also get featured in both print magazine and TV shows and we always look for ways to make our practice more visible through interviews or PR. However, I still believe that the most important way of spreading word about our clinic is word of mouth. Patients are the most valuable asset you will ever have. If they are happy with your services, there’s a higher probability that they will recommend you to their friends and family and we take every effort to provide both the best medical services, and the best patient care..

What treatments attract the majority of your patients?

The Vaser body sculpturing remains to be the most profitable treatment in my clinic, which delivers amazing results and achieves a high patient satisfaction. Hair transplants are in demand as well. I am always looking into adding new services and innovations to my practice. I am planning to purchase a Fraxel Laser soon.

Can you share your thoughts on what you have learned in the cosmetic industry?

I believe that practicing this profession requires continuous learning. I never stop learning new things, new technologies and how others do the same procedures. If you are in doubt, ask your physician colleagues in the industry and share what you know! Attend workshops, seminars and webinars to keep your self updated.

This interview is part of a series of interviews of physicians running medical spas, laser clinics and cosmetic surgery centers. If you'd like to be considered for an interview, just contact us.