Lipoma treatment with a subdermal Nd:YAG laser technique

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Lipoma treatment with a subdermal Nd:YAG laser technique"

Transcription

1 Dermatologic surgery Lipoma treatment with a subdermal Nd:YAG laser technique Alberto Goldman, MD, and Uwe Wollina, MD From the Clinica Goldman of Plastic Surgery, Porto Alegre, Brazil, and Department of Dermatology and Allergology, Hospital Dresden-Friedrichstadt, Academic Teaching Hospital of the Technical University of Dresden, Dresden, Germany Correspondence Alberto Goldman, MD Av. Augusto Meyer 163 conj Porto Alegre RS Brazil Abstract Background Lipoma is the most common benign mesenchymal tumor composed of mature fat cells. The standard treatment for lipoma is excision. Many treatments have been described in order to minimize the scars produced by surgical excision. The treatment of lipoma using a subdermal laser produces an effective disruption of fat cells and results in a small scar. Objective To evaluate the efficacy of subcutaneous intralesional application of a pulsed Nd:YAG laser as an option for the treatment of lipoma. Methods From January 2001 to November 2007, 20 patients (11 women and nine men) with lipomas were treated using a subdermal, pulsed, 1064-nm Nd:YAG laser. After laser treatment, the oily solution, the product of laser action, was removed with a 2-mm cannula using a negative pressure of 350 mmhg. Histology and cytology of the treated tissue were used to analyze the effects of the laser on the fat cells. Ultrasound was performed in some subjects before and after laser treatment. Results Subdermal lipoma treatment using a 1064-nm Nd:YAG laser resulted in complete or almost complete removal of the tumor in 100% of patients. Four partial relapses were observed that were treated successfully by the same procedure. Adverse effects were mild and temporary. The combination of a 1064-nm Nd:YAG laser and removal of the cell debris by a suction cannula presented an effective therapeutic option for patients with lipoma. Conclusions The treatment of lipoma using a 1064-nm Nd:YAG laser is a minor invasive procedure which does not result in large scars. Laser treatment is an effective and safe option for cellular disruption Introduction Lipomas are benign fatty tumors composed of mature fat cells. They are the most common benign mesenchymal tumor of soft tissue. Solitary lipomas are seen predominantly in women, whereas multiple lipomas occur more frequently in men. The most frequently affected regions are the neck, back, and proximal extremities. 1 Lipomas usually are a few centimeters in size, and can be removed by surgical excision, which still represents the standard treatment. Liposuction has been introduced to achieve superiorcosmeticresultsthroughtheuseofsmallincisions. 2 4 The pulsed 1064-nm Nd:YAG laser offers two modes of action that may be of relevance in the treatment of lipoma: thermal heating (thermal effect) and optomechanical effect, represented by the shock of the laser beam against the fat cell and membrane of the lipoma. Previous studies have shown lipolytic activity, coagulation of small vessels, coagulation of the reticular dermis, and neocollagen formation in the subcutaneous layer and dermal tissue. The action of the laser on the capsular membrane of a lipoma probably involves disruption and fragmentation, in the same manner as in adipocyte membranes. 5 8 In addition, the technique allows a minimally invasive approach as small cannulas are used for subdermal laser irradiation. Materials and Methods Twenty patients with lipomas located in different regions were treated with a subcutaneous, pulsed, 1064-nm Nd:YAG laser procedure at the Clinica Goldman of Plastic Surgery, Porto Alegre, Brazil, between January 2001 and November 2007 (median age, 36.6 years; range, years; 11 women and nine men). Ten patients with lipoma where treated by suction curettage in tumescent anesthesia at the Department of Dermatology and Allergology, Hospital Dresden-Friedrichstadt, Dresden, Germany. The lipomas were photographed and measured before treatment. Nine lesions were located on the back, seven on the neck, six on the extremities, and two on other regions. One patient had undergone previous surgical excision 2 years earlier and the lesion had relapsed. Ultrasound, histologic, and cytologic evaluation were performed in some subjects. Twenty-four lesions were treated (some patients had more than one lesion). In all patients, photographic documentation was performed under the same lighting conditions and using the same photographic equipment.

2 Goldman and Wollina Lipoma laser treatment Dermatologic surgery 1229 Inclusion criteria All subjects provided informed consent. The lipoma size was measured manually. Only tumors with a diameter larger than 3 cm and located in either the subcutaneous tissue or intramuscular layer were included in the study. All patients underwent a pre-operative assessment, including laboratory tests, to determine their general medical condition. Exclusion criteria Pregnant and lactating patients were excluded from the study, as well as patients with clinical changes without control and infection in the area. Lesions located near large nerve branches were not treated. Laser procedure After measurement, each lesion was delimited and marked prior to the procedure. All procedures were performed on an ambulatory basis under aseptic conditions and after adequate subcutaneous infiltration of Klein s solution (lidocaine %; epinephrine 1 : 1000; 10 meq/l of sodium bicarbonate were added to each liter of normal saline). The total volume injected per lipoma ranged from 20 to 1050 ml. The injection may be delivered using syringes, peristaltic pumps, or infusion pumps. We preferred pumps for larger volumes and syringes for smaller volumes. The procedure was initiated following a 20-min delay to allow the diffusion of the solution and appropriate vasoconstriction. After ensuring adequate eye protection for the patient and the entire team, a cannula with an optical fiber was inserted through a 1-mm incision; thus, the Nd:YAG laser acted inside the lesion. The cannula containing the fiber was moved slowly, allowing adequate time for effective laser tissue interaction. The laser system used was a pulsed 1064-nm Nd:YAG laser (Smartlipo; Deka, Italy and Cynosure, USA). The laser energy was delivered to the subcutaneous tissue in direct contact with the lipoma through a 300-lm fiberoptic with a 1-mm-diameter stainless steel microcannula of variable length connected to the tip of the fiber (Fig. 1). In large lipomas (more than 5 cm in diameter), a 600-lm fiberoptic with a 1.2-mm-diameter cannula was used. The equipment worked at 4 10 W in most anatomic regions according to the size, consistency, and location of the lipoma. The distal portion of the fiberoptic was extended 2 mm beyond the distal portion of the cannula. In order to visualize subcutaneous laser action while in operation, an He:Ne laser source was added to the beam path to provide a red guiding beam. This trans-illumination effect offered the surgeon a precise knowledge of where and at what level the Nd:YAG laser was acting, thus decreasing the possibility of cutaneous burns and perforations. The more intense the red light, the more superficial (subdermal) the laser treatment. The total accumulated energy used in each lesion ranged from 5000 to 32,000 J/cm 2. The endpoint to laser action inside the lipoma was the removal of resistance to the small cannula, representing lipolysis and consequent transformation of the fatty tissue into an oily, less dense solution. In large lesions (more than Figure 1 One millimeter cannula containing the laser optical fiber 5 cm in largest diameter), the laser was applied to three layers: deep, medium, and, finally, subdermal. Before, during, and immediately after treatment, a cold gel dressing, or even an air-cooling device, was applied so as to minimize postoperative edema or discomfort and to decrease the possibility of damage or skin burning. The product of laser action was an oily solution containing fragments of cells and membrane, oil, and tumescent solution. This product was removed from the region by aspiration using a 2-mm-diameter cannula and a negative pressure of 0.5 atm (50 kpa or mmhg). In all patients, the aspirated material was sent for histologic analysis and the diagnosis was confirmed as lipoma (not liposarcoma). The treated site was covered with a smooth, nonadherent antimicrobial dressing for 1 week postprocedure. The patients were reviewed and photographed periodically after surgery. The followup ranged from 10 to 43 months. Control group The controls consisted of a group of 10 patients (11 lipomas) treated at the Department of Dermatology and Allergology, Hospital Dresden-Friedrichstadt, Dresden, Germany, during The tumors measured 2 20 cm in diameter (mean, 11 cm). Tumescent anesthesia was performed with ml of a 0.1% prilocarpine solution (epinephrine 1 : 1000, 1 ml; prilocarpine 2%, 50 ml; Ringer s solution, 1000 ml) per patient using an infusion pump with a speed of 100 ml/min. Classical liposuction was performed with the Mentor Contour Genesis device using a blunt 3- mm cannula of the Fatami or Sattler type. The major outcome criteria for both groups were the complete resolution of the tumors and safety of the procedure. Results Histologicevaluationoftheremovedoilytissuedemonstrated and confirmed the clinical diagnosis of lipoma. The major

3 1230 Dermatologic surgery Lipoma laser treatment Goldman and Wollina Figure 2 (a) Lipoma on the back. Observe the scar produced by a previous surgical excision. (b) Five days after subdermal treatment with an Nd:YAG laser. Edema and small scar outcome of the procedure was a reduction or complete disappearance of the lipoma in 83.3% of lesions treated with a single laser session (Figs 2 and 3). Of the 20 patients treated, fourrelapsedpartiallyandrequiredadditionallasertreatment to the same area 2 months after the initial procedure using the same technique. One required a third surgical procedure in order to eliminate the lipoma completely. The adverse effects were mild and temporary, mainly ecchymosis and edema. No burns or skin lesions were observed. The postsurgical period waswelltoleratedinallsubjects. Tissue biopsies taken from some treated areas demonstrated lipomas with mature adipose tissue and disruption of adipocytes (Figs 4 and 5). Cytology demonstrated microfragments of adipose tissue and lipid drops. In 10 patients with 11 lipomas who underwent liposuction, complete remission was achieved in six lesions and partial remission with a reduction in size of more than 50% in five. A single patient was treated in two sessions; all other patients were treated only once. The treatment time was comparable. The adverse effects were generally mild. No infection, severe bleeding, oranyotherseriousadverseeffectwasnoted. Figure 3 (a) Giant lipoma on the back. (b) Two days after treatment using a subdermal, pulsed, 1064-nm Nd:YAG laser Discussion Lipoma represents a growing benign tumor composed of fat cells. Clinically, patients often request lipoma removal as the tumor continues to grow because of aesthetic concerns or compression of local structures, such as nerves. The mechanism for the growth of lipomas remains unclear; however, it has been proposed that, after blunt trauma, rupture of the fibrousseptummayresultintheproliferationofadiposetissue. 9 Surgical excision and liposuction have been used as standard treatment for this condition, which allows the histopathologic examination of the removed tissue. The main disadvantage of surgical excision is the potential presence of visible scars determined by the size of the tumor and the possible recovery time. Liposuction has been proposed as a less invasive and more cosmetically pleasing technique for the treatment of

4 Goldman and Wollina Lipoma laser treatment Dermatologic surgery 1231 Figure 4 Histology showing intramuscular lipoma and lipolysis (hematoxylin and eosin, 100) surgically removed tumors. 16 The opportunity to re-treat lipoma relapse using the same minimally invasive device and technique, avoiding large scars, represents a positive aspect of the use of the pulsed 1064-nm Nd:YAG laser. From a comparison of the various treatment techniques available, surgery is the gold standard, but has the disadvantage of large scars and adverse effects. Liposuction is less invasive, but is limited in fibromatous lipomas as well as very small lesions. Recurrence rates are higher as remnants of the capsule may be left in situ. The use of the pulsed 1064-nm Nd:YAG laser represents a useful option for the treatment of lipomas, which overcomes the limitations of classical tumescent liposuction with minimal invasiveness. Because of excellent cosmetic results, the need for multiple treatments in some patients does not seem to be a major disadvantage. Although the use of the Nd:YAG laser has shown encouraging results in this study, additional studies are necessary to further refine the technique, to demonstrate reproducibility, and to draw final conclusions. The recovery time for patients is lower with subdermal laser lipolysis, although the costs may be higher than with classical surgery or liposuction. Acknowledgments The authors wish to thank Dr Jorge Zanol, André Cartell, and Clarissa Prati for their scientific collaboration. References Figure 5 Detail demonstrating membrane destruction (hematoxylin and eosin, 200) lipomas Although liposuction is usually well accepted, the inherent fibrous anatomic characteristics of lipomas represent a limitation in many cases. Small lipomas are usually difficult to treat with liposuction because of their small dimensions. The rare CD34-positive spindle cell lipoma, which can be fat-free, 13 is not suitable for liposuction therapy. The rate of incomplete removal of lipomas has been reported to be up to 10% of tumors. 12 Without the removal of remnants, the rate may be higher. Using a subdermal Nd:YAG laser technique, 83.3% of lesions were treated effectively with a single session. The adverse effects were mild and temporary. The small 1 2-mm scar was well accepted in all patients. Giant lipomas are therapeutically challenging. 14,15 In our series, four giant lipomas, larger than 10 cm in diameter, were treated. In such situations, the relapse rate is higher, reaching about 18% in 1 Brenn T. Neoplasms of subcutaneous fat. In: Wolff K, Goldsmith LA, Katz SI, et al., eds. Fitzpatrick s Dermatology in General Medicine, 7th edn. New York: McGraw-Hill, 2008: Nichter LS, Gupta BR. Liposuction of giant lipoma. Ann Plast Surg 1990; 24: Berenguer B, de la Cruz L, de la Plaza R. Liposuction in atypical cases. Aesth Plast Surg 2000; 24: Hallock GG. Endoscope-assisted suction extraction of lipomas. Ann Plast Surg 1995; 34: Goldman A, Schavelzon D, Blugerman G. Laser lipolysis: liposuction using Nd:YAG laser. Rev Soc Brasil Cirurg Plást 2002; 17: Badin A, Moraes L, Godek L, et al. Laser lipolysis: flaccidity under control. Aesth Plast Surg 2002; 26: Goldman A. Submentale Laserassistierte Liposuktion: Klinische Erfahrungen und histologische Ergebnisse. Kosmet Med 2005; 26: Goldman A. Submental Nd:YAG laser-assisted liposuction. Lasers Surg Med 2006; 38: Aust MC, Spies M, Kall S, et al. Lipomas after blunt soft tissue trauma: are they real? Analysis of 31 cases. Br J Dermatol 2007; 157: Al-basti HA, El-Khatib HA. The use of suction-assisted surgical extraction of moderate to large lipomas: long term follow-up. Aesth Plast Surg 2002; 26:

5 1232 Dermatologic surgery Lipoma laser treatment Goldman and Wollina 11 Rubenstein R, Roenigk HH Jr, Garden JM, et al. Liposuction for lipoma. J Dermatol Surg Oncol 1985; 11: Choi CW, Kim BJ, Moon SE, et al. Treatment of lipomas assisted with tumescent liposuction. J Eur Acad Dermatol Venereol 2006; 21: Billings SD, Folpe AL. Diagnostically challenging spindle cell lipomas: a report of 34 low-fat and fat-free variants. Am J Dermatopathol 2007; 29: Sanchez MR, Golomb FM, Moy JA, et al. Giant lipoma: case report and review of the literature. J Am Acad Dermatol 1993; 28: Terzioglu A, Tuncali D, Yuksel A, et al. Giant lipomas: a series of 12 consecutive cases and a giant liposarcoma of the thigh. Dermatol Surg 2004; 30: Serpell JW, Chen RY. Review of large deep lipomatous tumours. ANZ J Surg 2007; 77:

A Prospective, Long-Term Follow-Up Study of 1,444 nm Nd:YAG Laser: A New Modality for Treating Axillary Bromhidrosis

A Prospective, Long-Term Follow-Up Study of 1,444 nm Nd:YAG Laser: A New Modality for Treating Axillary Bromhidrosis Ann Dermatol Vol. 26, No. 2, 2014 http://dx.doi.org/10.5021/ad.2014.26.2.184 ORIGINAL ARTICLE A Prospective, Long-Term Follow-Up Study of 1,444 nm Nd:YAG Laser: A New Modality for Treating Axillary Bromhidrosis

More information

F ORUM. Serge Mordon, PhD; Anne Françoise Eymard-Maurin, MD; Benjamin Wassmer, MSc; and Jean Ringot, PhD

F ORUM. Serge Mordon, PhD; Anne Françoise Eymard-Maurin, MD; Benjamin Wassmer, MSc; and Jean Ringot, PhD Histologic Evaluation of Laser Lipolysis: Pulsed 1064-nm Nd:YAG Laser Versus CW 980-nm Diode Laser Serge Mordon, PhD; Anne Françoise Eymard-Maurin, MD; Benjamin Wassmer, MSc; and Jean Ringot, PhD Dr. Mordon

More information

Treatment of Lumpy and Dimpled Skin Using a Next-Generation Laser Technology

Treatment of Lumpy and Dimpled Skin Using a Next-Generation Laser Technology Treatment of Lumpy and Dimpled Skin Using a Next-Generation Laser Technology Marc J. Salzman, MD, FACS INTRODUCTION Lumpy and dimpled skin is a condition that will affect virtually all women at some time

More information

HISTOLOGICAL EVALUATION AFTER RADIOFREQUENCY TREATMENT FOR FACE REJUVENATION AND CELLULITIS

HISTOLOGICAL EVALUATION AFTER RADIOFREQUENCY TREATMENT FOR FACE REJUVENATION AND CELLULITIS HISTOLOGICAL EVALUATION AFTER RADIOFREQUENCY TREATMENT FOR FACE REJUVENATION AND CELLULITIS B. Palmieri 1, V. Rottigni 1 Department of General Surgery and Surgical Specialties, University of Modena and

More information

Tumescent Liposuction

Tumescent Liposuction Standards & Guidelines October 2015 v5 Serving the public by guiding the medical profession Revision date: October 2015 v5 Approval date: September 1999 Originating Committee: Advisory Committee on Non-Hospital

More information

world [2]. One product of such innovative engineering in is the ultrasound-assisted liposuction

world [2]. One product of such innovative engineering in is the ultrasound-assisted liposuction Taewoo Kim Dr. Ramsey WRIT 340 4/12/2013 Sculpting the Human Body with VASER Ultrasound-Assisted Liposuction Abstract Traditional liposuction methods often involved direct mechanical cutting of the fat

More information

Water Jet Assisted Liposuction (WAL) Clinical Study BODY-JET

Water Jet Assisted Liposuction (WAL) Clinical Study BODY-JET Water Jet Assisted Liposuction (WAL) Clinical Study BODY-JET Contents 1. Study Design Page 2 2.1 Summary of Clinical Study Page 3 2.2 Postoperative Outcome Page 11 3. Comparison WAL/UAL Page 13 4. Appendix

More information

Non-Surgical Body Contouring Optimizing Outcomes

Non-Surgical Body Contouring Optimizing Outcomes Non-Surgical Body Contouring Optimizing Outcomes Robert A. Weiss, MD, FAAD, FACPh Past President ASDS, ASLMS, ACP Clinical Associate Professor, Dept Dermatology, U of MD Director, MD Laser Skin & Vein

More information

Arisa Ortiz, MD Director, Laser and Cosmetic Dermatology Assistant Clinical Professor Department of Dermatology UC San Diego

Arisa Ortiz, MD Director, Laser and Cosmetic Dermatology Assistant Clinical Professor Department of Dermatology UC San Diego 1 What s New in Skin Tightening? Arisa Ortiz, MD Director, Laser and Cosmetic Dermatology Assistant Clinical Professor Department of Dermatology UC San Diego 2 Disclosures BTL, InMode, Sciton Equipment

More information

According to the American Society for Aesthetic

According to the American Society for Aesthetic INTERNTIONL ONTRIUTION omparative nalysis of lood Loss in Suction-ssisted Lipoplasty and Third-Generation Internal Ultrasound-ssisted Lipoplasty Onelio Garcia, Jr, MD; and Nirmal Nathan ackground: Lipoplasty

More information

Mommy Makeover

Mommy Makeover Mommy Makeover Many women experience significant physical changes following pregnancy and breast-feeding, many of which can be persistent and difficult to correct with diet and exercise alone. Changes

More information

LIPOPLASTY. About Fat

LIPOPLASTY. About Fat LIPOPLASTY LIPOSUCTION AND FAT REMOVAL Liposuction in all its various guises has always been one of the most popular cosmetic surgical procedures. But before we go into details about how Liposuction is

More information

XF Microlens Optic and XD Microlens Compression Optic for Non-Ablative Fractional Skin Treatment with the Palomar Icon System

XF Microlens Optic and XD Microlens Compression Optic for Non-Ablative Fractional Skin Treatment with the Palomar Icon System Optic and XD Microlens Compression Optic for Non-Ablative Fractional Skin Treatment with the Palomar Icon System Sean Doherty, M.D., 1 Brooke Seckel, M.D., 1 James Childs Ph.D., 2 David Tabatadze Ph.D.,

More information

Scrotum-like protrusion of lipoma arising from the proximal thigh

Scrotum-like protrusion of lipoma arising from the proximal thigh Upsala J Med sci 109: 261 265, 2004 Scrotum-like protrusion of lipoma arising from the proximal thigh Report of two cases Koshi Hattori, 1 Masahito Hatori, 1 Mika Watanabe, 2 Toshihisa Osanai, 3 Shoichi

More information

Additional Information S-55

Additional Information S-55 Additional Information S-55 Network providers are encouraged, but not required to participate in the on-line American Venous Forum Registry (AVR) - The First National Registry for the Treatment of Varicose

More information

Laser Applications in Dermatology & Orthopedics

Laser Applications in Dermatology & Orthopedics 20161205 Laser Applications in Dermatology & Orthopedics Solchan Chung Advisor: prof. Jae Young Lee Biomimetic Materials Lab SMSE, GIST Dermatology 2 - Dermatology is the branch of medicine dealing with

More information

In Vivo Histological Evaluation of a Novel YSGG Ablative Fractional Device for Cutaneous Remodeling

In Vivo Histological Evaluation of a Novel YSGG Ablative Fractional Device for Cutaneous Remodeling In Vivo Histological Evaluation of a Novel YSGG Ablative Fractional Device for Cutaneous Remodeling Walfre Franco, PhD a1, Brian D. Zelickson, MD b, Victor E. Ross, MD c a Cutera Inc., Brisbane, CA b Abbott

More information

Combined Use of Ultrasound-Assisted Liposuction and Limited-Incision Platysmaplasty for Treatment of the Aging Neck

Combined Use of Ultrasound-Assisted Liposuction and Limited-Incision Platysmaplasty for Treatment of the Aging Neck Aesth Plast Surg (2008) 32:790 794 DOI 10.1007/s00266-008-9215-x ORIGINAL ARTICLE Combined Use of Ultrasound-Assisted Liposuction and Limited-Incision Platysmaplasty for Treatment of the Aging Neck Patrick

More information

The PAL System. from MicroAire

The PAL System. from MicroAire The PAL System from MicroAire Proven Cell Viability 2,3,4 Faster Procedure 7 Less Surgeon Fatigue 7 Precision Engineering Patented Technology Made in America Before & After Photo courtesy of Dr. El-Atar

More information

Special Report SmartLipo Laser Body Sculpting

Special Report SmartLipo Laser Body Sculpting Special Report SmartLipo Laser Body Sculpting Rosalind Mitchell, MD Medical Director SanctuaryLasers.com 209-384-7500 Laser-Assisted Smartlipo TM Results in Faster Healing, Tighter, Firmer Skin You can

More information

NONABLATIVE RESURFACING

NONABLATIVE RESURFACING `AESTHETIC LASER SURGERY 0094-1298/00 $15.00 +.00 NONABLATIVE RESURFACING David J. Goldberg, MD TYPES OF LASERS AND THEIR DIFFERENCES Pulsed char-free CO2 laser skin resurfacing has provided a method of

More information

Evaluation of the wound healing response post deep dermal heating by fractional RF: INTRAcel

Evaluation of the wound healing response post deep dermal heating by fractional RF: INTRAcel 12th symposium of the Association of Korean Dermatologists (2009) 1 Evaluation of the wound healing response post deep dermal heating by fractional RF: INTRAcel Un-Cheol.Yeo, M.D. S&U Dermatologic Clinic,

More information

Criteria For Medicare Members. Kaiser Foundation Health Plan of Washington

Criteria For Medicare Members. Kaiser Foundation Health Plan of Washington Clinical Review Criteria Treatment of Varicose Veins Radiofrequency Catheter Closure Sclerotherapy Surgical Stripping Trivex System for Outpatient Varicose Vein Surgery VenaSeal Closure System VNUS Closure

More information

Medicare C/D Medical Coverage Policy

Medicare C/D Medical Coverage Policy Varicose Vein Treatment Medicare C/D Medical Coverage Policy Origination Date: June 1, 1993 Review Date: February 15, 2017 Next Review: February, 2019 DESCRIPTION OF PROCEDURE OR SERVICE Varicose veins

More information

This downloaded PDF Article is supported by LUMENIS the makers of World s renowned LightSheer and Ultrapulse Laser

This downloaded PDF Article is supported by LUMENIS the makers of World s renowned LightSheer and Ultrapulse Laser Review Article Microcannular tumescent liposuction Jayashree Venkataram, Mysore Venkataram* Consultant Gynaecologist and Liposuction Surgeon, *Consultant Dermatologist and Hair Transplant Surgeon, Venkat

More information

How varicose veins occur

How varicose veins occur Varicose veins are a very common problem, generally appearing as twisting, bulging rope-like cords on the legs, anywhere from groin to ankle. Spider veins are smaller, flatter, red or purple veins closer

More information

Treatment of Xanthelasma Palpebrarum by Upper Eyelid Skin Flap Incorporating Blepharoplasty

Treatment of Xanthelasma Palpebrarum by Upper Eyelid Skin Flap Incorporating Blepharoplasty Aesth Plast Surg (2013) 37:882 886 DOI 10.1007/s00266-013-0195-0 INNOVATIVE TECHNIQUES AESTHETIC Treatment of Xanthelasma Palpebrarum by Upper Eyelid Skin Flap Incorporating Blepharoplasty Yanqing Yang

More information

GIANT CELL TUMOR OF TENDON SHEATH IN THE FOOT: CASE STUDIES

GIANT CELL TUMOR OF TENDON SHEATH IN THE FOOT: CASE STUDIES C H A P T E R 3 3 GIANT CELL TUMOR OF TENDON SHEATH IN THE FOOT: CASE STUDIES Annette D. Filiatrault, DPM Joe T. Southerland, DPM William D. Fishco, DPM INTRODUCTION Giant cell tumor of the tendon sheath

More information

EFFECTIVE TREATMENT FOR WRINKLES, STRETCH MARKS AND ACNE SCARS

EFFECTIVE TREATMENT FOR WRINKLES, STRETCH MARKS AND ACNE SCARS EFFECTIVE TREATMENT FOR WRINKLES, STRETCH MARKS AND ACNE SCARS Percutaneous Collagen Induction Therapy (CIT or PCI), more informally known as "skin needling", is not obvious in the market place, but has

More information

EndoRelease ENDOSCOPIC CUBITAL TUNNEL RELEASE SYSTEM

EndoRelease ENDOSCOPIC CUBITAL TUNNEL RELEASE SYSTEM EndoRelease ENDOSCOPIC CUBITAL TUNNEL RELEASE SYSTEM SURGICAL TECHNIQUE Up p e r Ex t r e m i t y So l u t i o n s ENDOSCOPIC CUBITAL TUNNEL RELEASE SYSTEM Description: The EndoRelease Endoscopic Cubital

More information

* I have no disclosures or any

* I have no disclosures or any Howard Rosenthal, M.D. Associate Professor of Orthopedic Surgery University of Kansas Sarcoma Center I have no disclosures or any conflicts related to the content of this presentation. Objectives 1. Describe

More information

Breast Augmentation - Saline Implants

Breast Augmentation - Saline Implants Breast Augmentation - Saline Implants Breast augmentation, or augmentation mammoplasty, is one of the most common plastic surgery procedures performed today. Over time, factors such as age, genetics, pregnancy,

More information

LASERS: CAN THEY TREAT SPIDER VEINS? Steven E. Zimmet, MD

LASERS: CAN THEY TREAT SPIDER VEINS? Steven E. Zimmet, MD LASERS: CAN THEY TREAT SPIDER VEINS? Steven E. Zimmet, MD No conflicts of interest DISCLOSURES YES! WHY USE LASERS FOR LEG VEINS? Patient s Perception Less Painful Newer technology Must be better Needle

More information

Surgical Correction of Crow s Feet Deformity With Radiofrequency Current

Surgical Correction of Crow s Feet Deformity With Radiofrequency Current INTERNATIONAL CONTRIBUTION Oculoplastic Surgery Surgical Correction of Crow s Feet Deformity With Radiofrequency Current Min-Hee Ryu, MD; David Kahng, MD; and Yongho Shin, MD, PhD Aesthetic Surgery Journal

More information

The Tumescent Technique TUMESCENT TECHNIQUE. by itself We strongly recommend that you consult with one of our nutrition and

The Tumescent Technique TUMESCENT TECHNIQUE. by itself We strongly recommend that you consult with one of our nutrition and procedures. Body sculpting can be performed on virtually any area of the body. If there is a body area of concern not mentioned, please ask specifically about these areas at the time of consultation. The

More information

Evaluation of the wound healing response post - deep dermal heating by fractional RF: INTRACEL

Evaluation of the wound healing response post - deep dermal heating by fractional RF: INTRACEL 12th symposium of the Association of Korean Dermatologists (2009) 1 Evaluation of the wound healing response post - deep dermal heating by fractional RF: INTRACEL Un-Cheol.Yeo, MD S&U Dermatologic Clinic,

More information

Coding Companion for Podiatry. A comprehensive illustrated guide to coding and reimbursement

Coding Companion for Podiatry. A comprehensive illustrated guide to coding and reimbursement Coding Companion for Podiatry comprehensive illustrated guide to coding and reimbursement 2016 Contents Contents Foot and Toes 28043-28045 [28039, 28041] 28043 28039 28045 28041 Excision, tumor, soft tissue

More information

posterior interosseous nerve syndrome due to an intramuscular

posterior interosseous nerve syndrome due to an intramuscular Eur Orthop Traumatol (2014) 5:75 79 DOI 10.1007/s12570-013-0203-5 CASE REPORT Posterior interosseous nerve syndrome due to intramuscular lipoma M. Allagui & S. Maghrebi & B. Touati & M. Koubaa & R. Hadhri

More information

Department of Dermatology Faculty of Medicine Siriraj Hospital, Mahidol University Bangkok, THAILAND

Department of Dermatology Faculty of Medicine Siriraj Hospital, Mahidol University Bangkok, THAILAND The efficacy of the treatment of abdominal cellulite and skin tightening with a Venus Freeze (MP) 2 - A pilot study Rungsima Wanitphakdeedecha, MD, MA, MSc Department of Dermatology Faculty of Medicine

More information

Is There an Ideal Donor Site of Fat for Secondary Breast Reconstruction?

Is There an Ideal Donor Site of Fat for Secondary Breast Reconstruction? 526751AESXXX10.1177/1090820X14526751Aesthetic Surgery JournalSmall et al research-article2014 Breast Surgery Is There an Ideal Donor Site of Fat for Secondary Breast Reconstruction? Kevin Small, MD; Mihye

More information

ASPS Recommended Insurance Coverage Criteria for Third- Party Payers

ASPS Recommended Insurance Coverage Criteria for Third- Party Payers ASPS Recommended Insurance Coverage Criteria for Third- Party Payers Breast Implant Associated Anaplastic Large Cell Lymphoma BACKGROUND Anaplastic Large Cell Lymphoma (ALCL) is a rare type of cancer of

More information

Efficacy of botulinum toxin type-a (BT-A) in multiple eccrine hydrocystomas

Efficacy of botulinum toxin type-a (BT-A) in multiple eccrine hydrocystomas ORIGINAL ARTICLE Efficacy of botulinum toxin type-a (BT-A) in multiple eccrine hydrocystomas Hossein Kavoussi, MD Assistant professor, Department of dermatology, Kermanshah University of medical sciences,

More information

Current Management of Varicose Veins

Current Management of Varicose Veins Current Management of Varicose Veins Michael J. Heidenreich, MD St. Joseph Mercy Hospital Ann Arbor, MI March 23, 2013 Nothing to disclose History Prevalence Anatomy Risk factors Clinical manifestations

More information

Nonablative Infrared Skin Tightening in Type IV to V Asian Skin: A Prospective Clinical Study

Nonablative Infrared Skin Tightening in Type IV to V Asian Skin: A Prospective Clinical Study Nonablative Infrared Skin Tightening in Type IV to V Asian Skin: A Prospective Clinical Study SZE-HON CHUA, FRCP (EDIN), POR ANG, MRCP (UK), y LAWRENCE S. W. KHOO, MRCP (UK), y AND CHEE-LEOK GOH, FRCP

More information

Very versatile tool for minor cosmetic procedures High frequency AC radiowaves generate cellular heat Cells vaporised Radiowaves pass through the

Very versatile tool for minor cosmetic procedures High frequency AC radiowaves generate cellular heat Cells vaporised Radiowaves pass through the Dr Hans Raetz, Queenstown. Dr Peter Chapman-Smith, Whangarei. Very versatile tool for minor cosmetic procedures High frequency AC radiowaves generate cellular heat Cells vaporised Radiowaves pass through

More information

MEASUREMENT OF EFFECT SOLID TUMOR EXAMPLES

MEASUREMENT OF EFFECT SOLID TUMOR EXAMPLES MEASUREMENT OF EFFECT SOLID TUMOR EXAMPLES Although response is not the primary endpoint of this trial, subjects with measurable disease will be assessed by standard criteria. For the purposes of this

More information

Pull-Through Subcutaneous Pedicle Flap for an Anterior Auricular Defect

Pull-Through Subcutaneous Pedicle Flap for an Anterior Auricular Defect RECONSTRUCTIVE CONUNDRUM Pull-Through Subcutaneous Pedicle Flap for an Anterior Auricular Defect DENNIS H. NGUYEN, MD, FAAD, AND JEREMY S. BORDEAUX, MD, MPH, FAAD The authors have indicated no significant

More information

Endovenous Laser Ablation

Endovenous Laser Ablation Endovenous Laser Ablation 132 nm Wavelength with Clear Tip Technology vs. 147 nm Wavelength Similarities and Differences 132nm and 147nm Both wavelengths are mid-infrared Water is the primary chromophore

More information

Cryolipolysis Cool-sculpturing Slimming Machine

Cryolipolysis Cool-sculpturing Slimming Machine Cryolipolysis Cool-sculpturing Slimming Machine 1.Principle Cryolipolysis cool-sculpturing technology refers to the treatment gradually reducing the subcutaneous fat. The fat cells are cooled down to zero

More information

GENTLE ABLATION WITH RFITT TECHNOLOGY. For varicose vein treatment

GENTLE ABLATION WITH RFITT TECHNOLOGY. For varicose vein treatment GENTLE ABLATION WITH RFITT TECHNOLOGY For varicose vein treatment CELON RFITT METHOD For healthy and beautiful legs CELON has developed a leading bipolar radiofrequency ablation (RFA) system that can be

More information

Virtually-tracked US-guided Radiofrequency Ablation(RFA) of Benign Thyroid Nodules: Preliminary Results

Virtually-tracked US-guided Radiofrequency Ablation(RFA) of Benign Thyroid Nodules: Preliminary Results Virtually-tracked US-guided Radiofrequency Ablation(RFA) of Benign Thyroid Nodules: Preliminary Results e-poster: 408 Congress: ESHNR 2013 2013 Type: Scientific Poster Presentation Topic: Head and Neck

More information

EXPERIMENTAL THERMAL BURNS I. A study of the immediate and delayed histopathological changes of the skin.

EXPERIMENTAL THERMAL BURNS I. A study of the immediate and delayed histopathological changes of the skin. EXPERIMENTAL THERMAL BURNS I A study of the immediate and delayed histopathological changes of the skin. RJ Brennan, M.D. and B. Rovatti M.D. The purpose of this study was to determine the progressive

More information

Up to date literature at your disposal to discover the benefits of laser dentistry

Up to date literature at your disposal to discover the benefits of laser dentistry Up to date literature at your disposal to discover the benefits of laser dentistry For further information contact info@doctor-smile.com +39-0444-349165 Dipartimento di Scienze e Tecnologie Biofisiche

More information

Lipomodelling/fat grafting/fat transfer/ Colman fat transfer

Lipomodelling/fat grafting/fat transfer/ Colman fat transfer Lipomodelling/fat grafting/fat transfer/ Colman fat transfer Breast Surgery Unit Patient information leaflet Introduction The aim of this leaflet is to provide information to anyone considering undergoing

More information

Reconstruction of Large Facial Defects after Delayed Mohs Surgery for Skin Cancer

Reconstruction of Large Facial Defects after Delayed Mohs Surgery for Skin Cancer 2015;23(4):265-269 CLINICAL ARTICLE Reconstruction of Large Facial Defects after Delayed Mohs Surgery for Skin Cancer Uwe Wollina Department of Dermatology and Allergology, Dresden-Friedrichstadt Academic

More information

JAM ACAD DERMATOL VOLUME 76, NUMBER 2. Research Letters 351

JAM ACAD DERMATOL VOLUME 76, NUMBER 2. Research Letters 351 JAM ACAD DERMATOL Research Letters 351 Standard step sectioning of skin biopsy specimens diagnosed as superficial basal cell carcinoma frequently yields deeper and more aggressive subtypes To the Editor:

More information

Varicose Vein Information Sheet

Varicose Vein Information Sheet Neil Goldstein, MD Joseph Hewett, MD Board- Certified Physicians in Interventional, Diagnostic, and Vascular Radiology, Surgery, Vascular Surgery and Phlebology Varicose Vein Information Sheet PREVALENCE

More information

Supplement 1: an appendix consisting of text documents providing supplemental information for, Maximum safe dosages of tumescent lidocaine

Supplement 1: an appendix consisting of text documents providing supplemental information for, Maximum safe dosages of tumescent lidocaine 1 160114 A&A Supplement Supplement 1: an appendix consisting of text documents providing supplemental information for, Maximum safe dosages of tumescent lidocaine Authors: Jeffrey A Klein, MD MPH & Daniel

More information

Comparison of 635nm Red Light Transmission Through Skin and Subcutaneous Fat

Comparison of 635nm Red Light Transmission Through Skin and Subcutaneous Fat Comparison of 635nm Red Light Transmission Through Skin and Subcutaneous Fat Abstract: This bench testing finds that Photonica Professional delivers 7.8 times more photonic energy to subcutaneous fat cells

More information

2013 MCT CPC-H Quiz #8 Chapters 13 and 14

2013 MCT CPC-H Quiz #8 Chapters 13 and 14 2013 MCT CPC-H Quiz #8 Chapters 13 and 14 Name: Date: Instructor: Score: 1. A female patient presents to the outpatient clinic for excision of a 4.8 cm malignant melanoma of the left inner thigh. A 6 cm

More information

Dr. James B. Lowe Plastic Surgery COMPLEX OPEN WOUND CLOSURE & RECONSTRUCTION INFORMATION SHEET AND INFORMED CONSENT

Dr. James B. Lowe Plastic Surgery COMPLEX OPEN WOUND CLOSURE & RECONSTRUCTION INFORMATION SHEET AND INFORMED CONSENT Dr. James B. Lowe Plastic Surgery COMPLEX OPEN WOUND CLOSURE & RECONSTRUCTION INFORMATION SHEET AND INFORMED CONSENT Instructions This is an informed consent document that has been prepared to assist your

More information

Therapeutic Heating Modalities. Mohammed TA, Omar Mobile : Office number: 2074

Therapeutic Heating Modalities. Mohammed TA, Omar  Mobile : Office number: 2074 Therapeutic Heating Modalities Mohammed TA, Omar momarar@ksu.edu.sa Dr.taher_m@yahoo.com Mobile : 542115404 Office number: 2074 Objectives After studying this lecture, the students must be able to; Define

More information

Takayuki Ohguri 1 Takatoshi Aoki 1 Masanori Hisaoka 2 Hideyuki Watanabe 1 Katsumi Nakamura 1 Hiroshi Hashimoto 2 Toshitaka Nakamura 3 Hajime Nakata 1

Takayuki Ohguri 1 Takatoshi Aoki 1 Masanori Hisaoka 2 Hideyuki Watanabe 1 Katsumi Nakamura 1 Hiroshi Hashimoto 2 Toshitaka Nakamura 3 Hajime Nakata 1 Takayuki Ohguri 1 Takatoshi Aoki 1 Masanori Hisaoka 2 Hideyuki Watanabe 1 Katsumi Nakamura 1 Hiroshi Hashimoto 2 Toshitaka Nakamura 3 Hajime Nakata 1 Received July 1, 2002; accepted after revision November

More information

Satisfaction of Patients After Treatment With Botulinum Toxin for Dynamic Facial Lines

Satisfaction of Patients After Treatment With Botulinum Toxin for Dynamic Facial Lines Satisfaction of Patients After Treatment With Botulinum Toxin for Dynamic Facial Lines BORIS SOMMER, MD, n INA ZSCHOCKE, PHD, w DOROTHEE BERGFELD, MD, n GERHARD SATTLER, MD, n AND MATTHIAS AUGUSTIN, MD,PHD

More information

SmartRelease Endoscopic Carpal Tunnel Release (ECTR)

SmartRelease Endoscopic Carpal Tunnel Release (ECTR) SmartRelease Endoscopic Carpal Tunnel Release (ECTR) Hand Anatomy and Technical Hints Hand Anatomy Hand Topography Hand Anatomical Landmarks 1 SmartRelease Hand Anatomy and Technical Hints Cobb s Line

More information

Augmentation of Atrophic Deprssed Scars Utilizing the Deepithelialized Scar Tissue Itself

Augmentation of Atrophic Deprssed Scars Utilizing the Deepithelialized Scar Tissue Itself Med. J. Cairo Univ., Vol. 82, No. 2, June: 123-127, 2014 www.medicaljournalofcairouniversity.net Augmentation of Atrophic Deprssed Scars Utilizing the Deepithelialized Scar Tissue Itself WAEL SAADELDEEN,

More information

Descending Branch of Lateral Circumflex Femoral Artery Grafting

Descending Branch of Lateral Circumflex Femoral Artery Grafting Chapter 29 Descending Branch of Lateral Circumflex Femoral Artery Grafting 29 T.O. Tatsumi, S. Minohara, K. Kondoh 29.1 Introduction The lateral circumflex femoral artery (LFCA) is one of the branches

More information

INFORMED-CONSENT-SKIN GRAFT SURGERY

INFORMED-CONSENT-SKIN GRAFT SURGERY INFORMED-CONSENT-SKIN GRAFT SURGERY 2000 American Society of Plastic Surgeons. Purchasers of the Patient Consultation Resource Book are given a limited license to modify documents contained herein and

More information

Stage One Stage Two Stages Three and Four

Stage One Stage Two Stages Three and Four Cellulite Few subjects have elicited more debate and controversy amongst the scientific community and professional skin and body therapists than that of cellulite. For years, many in the medical community

More information

Safety and efficacy of endoscopic submucosal dissection for early gastric remnant cancers post-proximal gastrectomy with jejunal interposition

Safety and efficacy of endoscopic submucosal dissection for early gastric remnant cancers post-proximal gastrectomy with jejunal interposition Omori et al. 47 CASE REPORT SERIES PEER REVIEWED OPEN ACCESS Safety and efficacy of endoscopic submucosal dissection for early gastric remnant cancers post-proximal gastrectomy with jejunal interposition

More information

Ultrasound Evaluation of Lumps, Bumps and Small Parts of the Extremities

Ultrasound Evaluation of Lumps, Bumps and Small Parts of the Extremities Ultrasound Evaluation of Lumps, Bumps and Small Parts of the Extremities Michael J. Callahan, M.D. Department of Radiology Boston Children s Hospital No disclosures Learning Objectives Background information

More information

Before Endoscopy? Indications Thermal Coagulation Injection Therapy Combination Therapy Fibrin Sealant Endoclips Argon Plasma Coagulation Lysine -

Before Endoscopy? Indications Thermal Coagulation Injection Therapy Combination Therapy Fibrin Sealant Endoclips Argon Plasma Coagulation Lysine - Dr Simon Smale Before Endoscopy? Indications Thermal Coagulation Injection Therapy Combination Therapy Fibrin Sealant Endoclips Argon Plasma Coagulation Lysine - Haemmostop Variceal Banding Histoacryl

More information

Our Experience with Endoscopic Brow Lifts

Our Experience with Endoscopic Brow Lifts Aesth. Plast. Surg. 24:90 96, 2000 DOI: 10.1007/s002660010017 2000 Springer-Verlag New York Inc. Our Experience with Endoscopic Brow Lifts Ozan Sozer, M.D., and Thomas M. Biggs, M.D. İstanbul, Turkey and

More information

LASERS AND LATTE Richard G. Orlando, M.D., F.A.C.S.

LASERS AND LATTE Richard G. Orlando, M.D., F.A.C.S. LASER LASERS AND LATTE Richard G. Orlando, M.D., F.A.C.S. Light Amplification by Stimulated Emission of Radiation Photons are in phase to produce high intensity polarized light Modification by shutters

More information

Reduction of Lipoplasty Risks and Mortality: An ASAPS Survey

Reduction of Lipoplasty Risks and Mortality: An ASAPS Survey Reduction of Lipoplasty Risks and Mortality: An ASAPS Survey Charles E. Hughes III, MD Background: Previously published articles presenting rates for lipoplasty morbidity and mortality have reported on

More information

Mody. AIS vs. Invasive Adenocarcinoma of the Cervix

Mody. AIS vs. Invasive Adenocarcinoma of the Cervix Common Problems in Gynecologic Pathology Michael T. Deavers, M.D. Houston Methodist Hospital, Houston, Texas Common Problems in Gynecologic Pathology Adenocarcinoma in-situ (AIS) of the Cervix vs. Invasive

More information

Dr. James B. Lowe Plastic Surgery FREE FLAP RECONSTRUCTION WITH POSSIBLE SKIN GRAFT & ADJACENT TISSUE TRANSFER INFORMATION SHEET AND INFORMED CONSENT

Dr. James B. Lowe Plastic Surgery FREE FLAP RECONSTRUCTION WITH POSSIBLE SKIN GRAFT & ADJACENT TISSUE TRANSFER INFORMATION SHEET AND INFORMED CONSENT Dr. James B. Lowe Plastic Surgery FREE FLAP RECONSTRUCTION WITH POSSIBLE SKIN GRAFT & ADJACENT TISSUE TRANSFER INFORMATION SHEET AND INFORMED CONSENT Instructions This is an informed consent document that

More information

Page 1 of 6 Initials Revision American Society of Plastic Surgeons

Page 1 of 6 Initials Revision American Society of Plastic Surgeons Plastic Surgery & Dermatology Associates (PSDA) CLEFT LIP AND/OR PALATE ASSOCIATED NOSE / RHINOPLASTY SURGERY INFORMATION SHEET AND INFORMED CONSENT Instructions This is an informed consent document that

More information

Breast Augmentation - Silicone Implants

Breast Augmentation - Silicone Implants Breast Augmentation - Silicone Implants Breast augmentation, or augmentation mammoplasty, is one of the most common plastic surgery procedures performed today. Over time, factors such as age, genetics,

More information