LIPOSUCTION ,VASER AND JPLASMA

For fat reduction, liposuction is mandatory associated with VASER and JPlasma as well. VASER are used at the beginning of the surgery to meltdown fat and facilitate the removal of the fat by power assisted devices. Then after the liposuction , Jplasma is used to strengthen the deep fasciae and to retract the skin. Liposuction , even on those areas with sagging and celulites , are done carefully at the level of the fascia , to avoid worsening of the celulites and sagging , and it is important to remove weight from the hanging tissues and to help to decrease the size of the arms and thighs to avoid tension on the scars. A lower tension on the scar leads to a better healing and less visible scars

SAGGING SKIN-How and what to do

Advanced degree of sagging skin has to be dealt with surgery as well , after removing fat and hardening the the deep fascia with J Plasma , we proceed to remove the hanging skin.

There are 2 patterns of removal of the skin.
One that is circumferential ( a more horizontal ) and one vertical. Sometimes , we actually mix both to give a shorter vertical scar (in what we call “T” scar or “7” scar, mainly on the thigh areas ). Prior to surgery, at the consultation , we check the patient to assure that we can locate the scars in the less visible areas of the arms or the thighs and we can then test if the patients need only horizontal or a vertical component must be added , by testing by hands the overall shape that skin pattern removal. However in the case of the thighs , sometimes on those patients with massive weight loss , scars can be located only horizontally at the root of the thighs and do not need to be extended to the thighs and knees. However , if on those patients that have overtly skin tissue projecting forward from the frontal area of thighs , a vertical component is mandatory. But usually patients do not want to have extensive scars so the best alternative would be a “7” shaped scar with a horizontal and vertical components.

WHAT TO DO WITH THOSE PATIENTS THAT HAVE ENLARGED AND VISIBLE SCARS

Patients may develop what we call hypertrophic scars on these regions of the body due to multiple causes. One that is usually misunderstood is the tension that muscles contraction exert on the scar, which is always the weakest point of the skin surface. Muscle contraction, needed for us to move around, increase the size of the area and exert tension on the scars constantly during motion, or when patients are sitting, expanding the skin around the scars. Other factors are more related to the quality of the remaining skin that usually is thin and with stretch marks, and its dermal component is thinner than in normal people. These factors lead to weakness of the scars that enlarge and become visible. Closure of the scars, in our routine is much more time demanding the the skin removal or the liposuction, due to massive weight loss patients propensity to have a very unreliable skin to begin with.

But some treatments that today exist help us to at least fix some of the major problems with scars such as its color. We use Laser to brighten the scars, usually after one month of surgery, to decrease the redness initially and then to brighten the scars if they turn darker than the skin patients. Another procedure is the medical tattoo which works effectively to blend in the scars.

At the end of the day, one must remember that the best option to the scars are to carefully remove tension of the scars during the procedure and to properly suture the scar, with proper technique.