The Lipodissolve Clinic Blog

Be careful what you wish for.

I've had more than a few patients walk in my Chicago area office with silicone filled lips or problematic bumps on their face from Sculptra that were unhappy with their outcome but could not do anything about it.

One of the unhappy patients had silicone enhanced lips and had never even had a temporary filler prior to the silicone. This, I believe is absurd, as it is always helpful for a patient to see how they will look like prior to a permanent change. Her doctor suggested a permanent implant the first time she asked for lip enhancement. This is a doctor to run from. The patient turned out looking like a pair of walking lips. She can have the implants removed, but this is not a simple procedure like injecting hyaluronidase into an area that was over filled.

While a patient might look good and be happy with a permanent implant down the road, one should always recommend trying the look temporarily at first to make sure it works.

Sculptra and some of the other fillers that stimulate lots of collagen production deep in the dermis, can achieve phenomenal results, they can also create lumps and bumps that are often visible. Even in the hands of a skilled doctor, there is a risk.

Sculptra seems to be the best for HIV related facial lipodystrophy. These patients have lost so much volume in their faces that they really can't look over filled compared to how abnormal they looked prior.

The over filled look, or even filling to perfection, can often look obviously abnormal. The planes of the face can become distorted. So if you think you want to fill to perfection, do it at first with a short acting filler. If you don't love the look, it will be gone in few months. If you love the look, repeat it the next time with a longer acting filler. Just remember, it is normal to have some amount of smile lines starting in your twenties. Smile lines can actually add more dimension to your face which is usually more visually appealing and interesting.

Growth factors are naturally occurring proteins that promote tissue growth. They are the hottest trend in upscale skin care lines.

The growth factors that are being used have been shown in the lab to promote collagen generation and to decrease collagen degeneration.

Skin is a wonderful impermeable protective organ. Water soluble topical applications to not absorb well.

Mesotherapy with needles or with an electric current greatly improve delivery of product.

The newest form of mesotherapy to hit the medical spa market is the microneedle derm roller. This is typically accompanied by pharmaceutical growth factors EGF and TGF, often with copper peptides.

In my Chicago area office in Evanston, I employ the use of full needle mesotherapy, electric mesotherapy which has the added benefit of an electrical current that contracts the muscles and tightens them, and microneedle derm rollers.

All the above methods greatly improve delivery of often expensive products that one would not want to waste by just applying them topically.

I can achieve lightening of dark skin spots while avoiding the use of hydroquinone by applying safer water soluble products.

By placing patients on oral astaxanthin which reduces collagen breakdown by 30%This accompanied by pharmaceutical EGF and TGF used with dermal rolling can not only prevent collagen loss, but can actually promote new collagen growth to the point of filling in small vertical lines.

Mesotherapy is not well known or frequently practiced in the states. However, it is a popular procedure in Europe where aesthetic medicine is a medical specialty. And, it is popular in my Chicago area office.

Typically mesotherapy is performed with small needles attached to a syringe in order to inject growth factors and vitamins just under the top layer of skin. This is performed to either enhance the collagen growth, reduce wrinkles or lighten dark spots.

Needleless machines which use a microcurrent to pulse the product under the skin have become popular as have meso guns and dermal rollers. The products that are used to encourage dermal growth and reduction of wrinkles have grown into a large list based upon ongoing research in skin repair and clinical outcomes.

Very fine needles are used as a method of getting product into the skin, but needles also stimulate the growth and repair cycle of skin as well as encourage tightening. Needleless machines use a current to open micropores in the skin in order to achieve similar results.

One of the benefits of mesotherapy on the face and neck, is a reduction in fine lines and an increase in the glow of the skin. The fibroblasts or cells responsible for the growth of collagen, become bathed in vitamins, minerals and growth factors. Micro trauma promotes new collagen growth even on its' own.

The mesotherapy technique can be used for cellulite reduction very effectively by using collagenase, a naturally occuring enzyme. The collagenase is injected into the abnormal collagen fibers that trap the fat cells, creating a smoother surface.

This technique can also be used for pain management by injecting lidocaine or traumheel or even just sterile saline as the needling itself often breaks an abnormal pain cycle.

There are two types of abdominal fat; visceral and subcutaneous.

While many studies cite the dangers of visceral fat because of it's association with heart disease and diabetes type two, subcutaneous fat can also pose some dangers.

All fat cells have the capability to transform cholesterol into hormones, particularly estrogen, and large amounts of subcutaneous fat can translate in to excessive estrogen.

Many patients visit my Chicago area office for lipodissolve but this can only eliminate subcutaneous fat. If they have visceral fat which is never good, I recommend dietary changes and either conjugated linoleic acid (CLA), or DHEA.

The studies on both of these supplements are very promising in reducing fat and increasing lean body mass.

The November 10 issue of The Journal of the American Medical Association (JAMA) published a study on the effects of DHEA on visceral and subcutaneous fat.

The study included the non-control group of elderly subjects taking 50mg per day of DHEA for six months.

The conclusion was that DHEA supplementation significantly reduced not only visceral fat, but subcutaneous fat as well. And, previous studies have shown an increase in bone density in subjects taking DHEA.

CLA has been studied and is associated with an increase in lean body mass and decrease in visceral fat. However, the studies were not as impressive as with DHEA. Non the less, many weight trainers body sculptors swear by CLA.

Lipodissolve is only good for someone with a medium to lean body weight who has stubborn fatty tissue in spot areas, like a mushy lower abdomen (women) and love handles (men and women).

Many patients that walk into my Chicago area clinic want to go on a cleanse. While it can be very beneficial to go on a cleanse, what you do after you've finished, is more predictive of the longterm gains you'll have made from doing it in the first place.

We all know someone who is a "yo-yo" dieter. There are "yo-yo" health eaters as well.

"Diets" in general do not work, no matter what the reason. It is imperative to learn to eat in a way that is the most beneficial to you. So if you need to shrink your shadow, this requires a change in your habits. Likewise, if you want to improve your health status and reduce toxins, this also requires lifestyle changes and not just a month of raw fooding or cleansing.

I highly recommend adding a low glycemic protein drink with great prebiotics such as inulin while starting to make lifestyle and dietary changes. The reason is that these drinks help you feel satisfied and if they contain inulin and low sugars, they can actually alter your bowel flora (the beneficial gut bacteria).

Recent research in obesity has revealed that many obese individuals harbor different bowel flora than thin individuals. The flora of obese individuals actually breakdown what is otherwise undigestible cellulose and obtain sugars and calories from it. And, rats fed a high sugar and fried food diet, actually change their bowel flora to those of obese individuals. This means, if you a eat high sugar, high bad fat diet, you are slammed with a double whammy as the bowel bacteria will be altered to grab even more calories from your food than if you didn't eat this way.

We all know that once we get on a carbohydrate binge, it is very difficult to stop the inertia. The best way I have found to stop the inertia is with a high quality low glycemic index protein drink. Occasionally, I'll add some herbs to help quell intense cravings.

Once a patient is off the carbohydrate merry-go-round, I find it is easier for them to make permanent changes in their eating habits.

There are so many products out there professing to turn back the clock. And, the barrage of supplements you "must" take lest you fall apart is mind boggling. However, for improved collagen and young looking skin, there are not many supplements that compare to red micro algae or "astaxanthin".

This is a naturally occurring plant called hematococcus pluvialis. It creates a red pigment which turns out to be the most potent of all carotenoids on the planet. It has many effects on the body.

When taken orally, it is one of the most potent antioxidants known to man, without any pro-oxidant state. It is one of the most known potent anti-inflamatory agents that has no negative side effects such as gastrointestinal bleeding. It stimulates collagen production in skin and joints.

When used topically, It slows down collagen breakdown and decreases wrinkle formation by its' prevention of reactive oxygen species (ROS) from damaging the top layer of skin and its' reduction of inflammation from UVB light.

Astaxanthin is one of the key supplements I recommend to patients in my Chicago area office who either want younger skin, have elevated inflammatory markers, or have known decrease of collagen in their joints.

I also add this ingredient to the natural skin care and sunscreens that my patients buy.
Many of the commercial products on the market that claim to have astaxanthin as an ingredient, have too little to make a real difference.

Many patients come to my Evanston office expecting me to perform repeated sessions of lipodissolve for their weight problem. I won't and I don't. Lipodissolve is a localized fat loss procedure, not a weight loss procedure and is inappropriate as a treatment for obesity.

The exceptions are that I will treat a buffalo hump, double chin, or droopy jowls on an obese person, I just won't treat the body.

In these instances, I have the patient return for a one to two hour medical and nutritional evaluation. I examine closely the patients behaviors around food and choices. For patients with eating addiction, I recommend attending overeaters anonymous (OA). for patients making bad choices, I teach them how to reduce insulin levels.

Historically, we were all told that in order to lose weight, calories in had to be less than calories expended. and vice versa. now we know that not all calories are created equal.

When we eat something that turns to glucose quickly, we produce insulin. and if we don't utilize the glucose, we create storage fat via the insulin. the more carbs we eat, the more insulin we need. over time we become resistant to insulin and keep requiring more to deal with our glucose. This process creates more and more storage fat, or triglycerides.

If we eat half an avocado vs half of a bagel, we have no insulin stimulation although we've eaten the same amount of calories that the bagel might have. Over time, when we make smart choices, we become less insulin resistant, or more insulin sensitive. This enables us to feel more stable, less starved prior to meals and our triglyceride production is greatly reduced.

So remember, it's not the calories that ruin us, but our hormonal response to the calories.

Many prospective patients come to my Chicago area clinic asking for botox and fillers in the hope that their skin will look younger. The truth is that botox and filler can make a huge difference but not in enhancing the look of one's skin.

As we age, our skin becomes less reflective to light due to enlargement of pores and hyper-pigmentation in the deeper layers of skin. Both of these events happen secondary to damage. The abnormal pigmentation can be either red or brown.

I have found that the best way to brighten up the skin is to use intense pulsed light or IPL, and bipolar radio frequency (ELOS technology). I can get very good results using LED light, facial ultrasound and mesotherapy but it would take more treatments to get the same results as compared with ELOS technology. Occasionally, I might choose to use one of the other technologies if I need to achieve a specific goal.

There are many med spas offering "fotofacial" but only ELOS technology is "fotofacial". The other machines or lasers are not IPL coupled with bipolar radio frequency and therefore are either uncomfortable or not as potent.

While filler and botox are temporary, facial rejuvenation is not. Once the damage is removed and the pore size corrected, this is permanent until the skin might get damaged again. I always council my patients on what supplements to take and what to avoid on the skin in order to protect it in the future.

Fraud of any kind is never a good thing, especially when it taints a whole community.
This past month, Lisa Madigan, the attorney general of Illinois filed a lawsuit against the Chicago area Nu U spas. This could actually be a very good thing as they had allegedly been practicing medical aesthetics without a physician.

They were presumably giving very "hard sells" to their clients by having them sign documents committing them to several treatments at thousands of dollars per contract.

I had heard a few times from patients coming to my office that they had seen an aesthetician at a NU U spa claiming she was going to be delivering the treatments herself. And, they reported feeling pressured into signing paperwork committing them to many treatments. So, I was very glad to hear that they were finally being called on suspicious behavior. However, I was very concerned to read the press release out of Madigan's office. It implied that lipodissolve itself was dangerous and illegal. They stated that the treatment was not FDA approved.

While technically, this is true, it is very misleading. The FDA has no jurisdiction over procedures, only drugs and medical devices.

It is true that phosphatidyl choline (lecithin) and deoxycholate (bile salts) are not FDA approved drugs. They are both naturally occurring and not patentable, just like a vitamin b 12 injection. It would be illegal to market them to the public as drugs.

Physicians that are trained and certified in lipodissolve perform the procedure with the aforementioned agents. This is not illegal. Nor is it dangerous. There has never been a single death, hospitalization or a serious side effect from the procedure being performed by a physician. There has a reported case of uneven fat removal under the eyes by a physician who was not trained in the procedure.

That is an amazing record. Compare that to allergy shots, which cause death by anaphylactic reaction in a handful of patients each year in the US, or to liposuction, that has the highest death rate among elective procedures.

Physicians in the plastic surgery department at UCLA performed an extensive study of outcomes and side effects of lipodissolve. The results and conclusions were overwhelmingly positive.

Both American Academies of Plastic Surgeons, view lipodissolve as an economic threat. Liposuction bookings have fallen drastically since news surfaced that liposuction has the highest death rate of any elective procedure. Lipodissolve's emergence as a safer, less expensive alternative to liposuction has made many plastic surgeons nervous.

In reality, many plastic surgery offices are now offering lipodissolve, and you can bet that the surgeons have the nurses performing the procedure, as it is not worth the surgeon's time in dollars.

Is it necessary to look like a kissing trout or a parading duck after having your lips augmented and having the lines of your top lip filled in?

I think not. I notice in my Chicago practice, many women walking around with lips like Daffy Duck. It has become a look that has been accepted and even revered.

This 'look' occurs because the vermillion border of the lip gets overfilled along with some of the vertical lines. And, If the nasolabial lines are filled completely, the top lip is driven inside causing the physician to then over fill the top lip.

From the doctors perspective, the more filler they sell, the more money they make.
The plastic surgeons have created this extreme look and women flock to it.

Often this Daffy Duck look goes along with huge breast implants and 6-inch high heels.
I believe that hyaluronic filler for facial enhancement should be applied in order to turn the clock back, not to create the look of another species.

Less is more. The results of having filler applied in wrinkles, and in an ever-disappearing mouth should simply be a return to a more youthful look of the person: shallower wrinkles and a neutral position of the corners of the mouth.

There are many techniques when filling in lines, some of the techniques just fill in lines and some techniques actually stimulate collagen production.

When I teach "filler technique" I encourage my students to use techniques that stimulate collagen production and not to overfill lines and wrinkles. In essence, I try to encourage a return to a more youthful look as the doctor-patient goal.

In my Chicago area office, I see many women who have used botox repeatedly over the years. They often have flat foreheads and abnormally shiny skin from muscular atrophy.
Often their eyebrows are too high on the foreheads giving them a look I affectionately call "Mrs. Surprise".

The question is; is this the necessary outcome after using years of botox? And the answer is; it doesn't have to be.

Training courses for physicians often focus on the marketing and financial aspects of learning a new technique. The plastic surgeon I initially heard speak about botox had a frozen expression and stated he used a whole vial (100 units) in each of his patients face. He was supposedly excited about the topic but I couldn't tell. He spoke about getting the patients "hooked" on their freshly ironed face and returning every three months for their eight hundred to twelve hundred dollar treatment.

I don't love my "elevens" but I can tell you that weakening the muscles (by using less botox per area) as opposed to paralyzing them is a better way to go in the longterm. This isn't the norm as it is not how we're taught in training courses, and it's not a good business model, since we charge per unit of botox. And, to be fair, there are many patients who want their face immobilized.

I encourage my patients to sit down with me and talk about expectations, short and longterm. This way I can explain that weakening the musculature that causes excessive wrinkling is often a better option than completely paralyzing facial expressions. Besides, next time you're feeling something, don't you want others to know it.