Cauterization in the Past

Hot cauters were applied to tissues or arteries to stop them from bleeding. The verb to cauterize; known in English since 1541; from Medieval French cauteriser; from Late Latin cauterizare “to burn or brand with a hot iron in the rectal area”; itself from Greek kauteriazein; from kauter “burning or branding iron”; from kaiein “to burn.”

Cauterization was used to stop heavy bleeding, especially during amputations. The procedure was simple: a piece of metal was heated over fire and applied to the wound. This would cause tissues and blood to heat rapidly to extreme temperatures in turn causing coagulation of the blood thus controlling the bleeding. The downside was extensive tissue damage. Later special medical instruments called cauters were used to cauterize arteries. Abulcasis and later Ambroise Paré introduced the technique of ligature of the arteries in lieu of cauterization.

Electrocautery

Electrocauterization (also called electric surgery or electrosurgery) is the process of destroying tissue with electricity and is a widely used technique in modern surgery. The procedure is frequently used to stop bleeding of small vessels (larger vessels being ligated) or for cutting through soft tissue i.e. abdominal fat in a laparotomy or breast tissue in a mastectomy.

Electrosurgical Generator (ESG)
The ESG is the power force behind an electrosurgical system providing the frequency, the voltage, and may modify the electical wave to allow for cutting versus coagulation.

Frequency

To prevent Electric shock, an alternating frequency that is higher than power from standard wall outlets is used. Normal “house-current” AC runs at 50-60 Hz and is quite lethal, since at every alteration nerves and muscles get stimulated, causing violent cramps 50-60 times a second. However, nerve and muscle stimulation cease at 100,000 Hz due to alterations being too fast for the cells to pick up. Electrosurgery can be performed safely at “radio” frequencies above 100 kHz.

Cutting vs. Coagulation

Different cauterizing effects can be achieved by changing the voltage of the current as well as the pattern of electric pulses. When lower voltage is used with a continuous AC current, heat is produced very fast and tissue is completely vaporized at the tip of the probe. The effect is dubbed “cutting”. When a higher voltage current is used in a pulsed manner, heat is produced more slowly, tissue damage is more widespread (a few mm from the probe) and blood coagulates, and in many electrosurgery instruments this is called “coagulation” mode). This is also used for ablation. Usually a “blend” setting is available as well.

Monopolar vs Bipolar
Two kinds of electrocautery are used, unipolar and bipolar (aka. monothermy and diathermy, respectively). Both involve high frequency alternating current and a pair of electrodes, one called active and the other returning. The difference lies in the placement of these electrodes:

Monopolar: Current is passed from the probe (active electrode) where cauterization occurs and the patient’s body serves as a ground. A grounding pad (returning electrode) is placed on the person’s body, usually the thigh, and it carries the current back to the machine. Careful application of the patient return electrode is necessary as if the electrode is not correctly attached extensive burns can occur undetected.
Bipolar: The active and receiving electrodes are both placed at the site of cauterization. The probe is usually in the shape of a forceps, each tine forming one electrode, and only the tissue grasped by them is cauterized.

Probes
The cautery probes are shaped in a variety of ways depending on their purpose. A common monopolar probe is penshaped but ending in a small slender spatula, roughly 5 mm X 30 mm. The shape is reminiscent of a scalpel. This can serve both as a coagulator and as an electric scalpel. The typical bipolar probe resembles a pair of tweezers, which are used to grab a hold of a small piece of tissue and cauterize it. Variants of these probes are used both in open surgery and in modern minimally invasive surgery. The surgeon operates the probe either by pushing a button on the shaft of probe itself or by using a footpedal.

Alternate Burnsites
When using monopolar electrocautery it is important that the grounding pad be the only way by which the current passes through the body. Electricity always follows the path of least resistance, and if that is via some ground-connected piece of metal touching the patient by chance, a burn might result there as well as at the tip of the cautery probe. Thus great care must be taken that the patient be insulated from the ground and that the large grounding pad be thoroughly attached to the patient. Further defects in insulation of the monopolar instrument and capacitive coupling can lead to trauma to non-target tissue.

Dynamic wrinkles are caused by contractions of the delicate underlying facial muscles every time you smile, laugh or frown. The more emotions you show, the deeper these wrinkles and lines are likely to be

How does Botox work?

Botox is injected into the facial muscles that are causing wrinkles or bands in the neck. Botox blocks impulses from the nerve to the tiny facial muscles that are related to expression lines. By relaxing the muscles it produces a significant change in appearance. The overlying skin remains smooth and unwrinkled while the untreated facial muscles contract in a regular fashion, allowing normal facial expression to be unaffected.

Are Botox treatments safe?

Botulinum toxin has been used for treating many problems in medicine since the late 1970s. It has taken almost twenty years for it to be used to improve the appearance of the face and aging.

For many years the use of Botox for wrinkles was an off label use of the drug. This means that although it has been approved by the FDA, it is not used for the same problem as approved by the FDA. Yet, many doctors routinely use the method. In 2002 the FDA gave approval for its use in treating aging in the deep lines between the brows on the forehead.

Botox injections have been used safely and effectively for over ten years to treat many ophthalmological and neurological disorders.

What is the treatment like?

Using a tiny micro-needle, small amounts of Botox are injected, very precisely, into several locations on the face. The pain associated with the injection is minimal due to usage of fine needle and only a small amount of liquid is used. Most patients compare the sensation to a bug bite. No anesthetic is needed. Most of the time, we numb the area to be treated with an ice ball to avoid any discomfort with the injection.

What are the complications and problems of Botox?

Serious side effects are uncommon although there is potential for more serious complications if large amounts are injected.

The most common problem is bruising and discomfort for a few days. BOTOX® is not permanent. The toxin can migrate and cause a temporary weakness of nearby muscles and in rare cases may lead to drooping of an eyelid or asymmetry of facial expression.

The effects of Botox are completely reversible; any side effects are temporary, lasting only for a few weeks.

How often can I have Botox Injection?

Many recommend that you have an injection every three to four months for a year. At that point a significant number of people may be able to get a result with injections twice a year.

Excessive injections may lead to early development of antibodies and make the injections ineffective.

What do I have to do after Botox Injection?

After the injection it is recommended that no heavy exercise or lifting is performed for a few hours. You can apply makeup within a few hours.

What results can I expect?

These injections are not a substitute for a facelift, or other surgery. This procedure cannot improve wrinkles due to aging and sun-damage since they are unrelated to facial muscle contractions. Still in older patients who cannot have surgery or younger patients who do not need major surgery it may be useful. It is also helpful for people who have had previous neck surgery and need some freshening and do not want a full facelift again.

Botox Injection can smoothen those dynamic wrinkles out and give you a more youthful and pleasant appearance.

What are the limitations of Botox injections?

It is temporary, and within a few months the doctor can re-inject the same areas. The effects of the injections last from 3 to 6 months. You may need to have injections about 2 to 4 times a year. There is some proof it is less effective as more injections are given. However many physician feel the opposite is true and that with repeated use of low doses the muscle actually thins and weakens. In addition, through a process of re-education the patient can break the habit of contracting certain muscles that has developed over many years.

Is Botox used to treat other symptoms?

Yes. Botox has been used for ten years on thousands of patients to treat blepharospasm associated with dystonia.

Iontophoresis is defined as the introduction, by means of a direct electrical current, of ions of soluble salts into the tissues of the body for therapeutic purposes. It is a technique used to enhance the absorption of drugs across biological tissues, such as the skin.

Skin care therapists have used galvanic currents to treat skin for about 70 years –so what can be new?. First activate the skin on negative current, then massage and finally soothe the skin on positive for a refreshed appearance. Right? No! Wrong! Of course these ideas are wrong because they ignore the basic scientific principles. First of all one has to understand that iontophoresis will only occur if the targeted active chemicals have an electrical charge (i.e. they are ions carrying either a positive or negative electrical charge, or will ionize with electricity). When a low intensity galvanic current is applied to a molecule that can dissociate into a positive ion (cation) and a negative ion (anion), then it actually does dissociate more readily in the presence of water and salts. Negative ions move towards the positive pole, and positive ions move towards the negative pole. As a result, ions can be carried to deeper layers of the skin and concentrated there.

To understand iontophoresis better, then one must go back to the very first demonstration of its power. Two rabbits were selected and one poison that has a positive charge was applied to one ear and a poison with a negative charge was applied to the other ear. Only one ear was treated with an electrical current. When the positively ionized poison was treated with a negative current, nothing happened. When positive current was used then the rabbit died! So either positive current was responsible, or the positive poison ions moved through the skin into the blood and killed the rabbit. The second rabbit then proved that it was the ions because when a positive current was used, nothing happened, whereas when a negative current was used, the rabbit died! The only explanation was that the positive and negative ions had been repelled by their similar charges and had gone through the skin.

Into the body by simple electrical currents. Iontophoresis promises to become a major method for treating people without the use of injections and other invasive techniques. The research workers have realized that we have to know certain properties about ions, not merely that they can ionize. We have learned that the concentration of the ions is important. Not always is the strongest solution the best. We also know now that the properties of the current are important. Certain wave shapes and intermittent application of the current are better than continuous galvanic current.

Iontophoresis when correctly used is proving to a be a powerful tool. However, it does have problems. First of all it can only used on molecules that can be ionised. Not all molecules can be ionised at physiological levels and some cannot be ionised. Secondly, if strong currents are used and the current us built up too quickly when using simple galvanic current, then a burn may occur. One has to remember that in fact some very complex chemical changes occur at the exact site of the iontophoresis contact points. Strong alkalis may be formed or strong acids may damage the skin.

Modern iontophoresis has been used to minimize wrinkles, to eliminate pigment blemishes, soften scars and normalize skin. However, this only happens when the gels used contain the right ingredients, at the right pH, with the right concentration, treated with the correct current properties for the correct amount of time. Change only one of these important points and the treatment becomes a simple complex manipulation of skin and the clients purse.

Presence of varicosities may result in pain, cramps, restless legs, edema, pigmentary changes, dermatitis and ulceration. This is due tot he disruption of the normal vascular and lymphatic flow in the lower extremities.

What causes Varicose veins?

There are many factors responsible for the development of varicose veins, with genetic factors being the most important. familial incidence has been estimated to be between 15% and 70 %. Sex is another factor. They occur most often in women in a 4:1 to 5:1 ratio compared to men. pregnancy is another factor. Varicosities is noted in 33% of patients during their first pregnancy and in 11% in subsequent childbirth

What is Sclerotherapy?

Sclerotherapy is a procedure wherein a foreign substance is introduced into the lumen of a vessel causing thrombosis and subsequent fibrosis. Injection of the sclerosant induces endothelial damage resulting to the exposure of subendothelial collagen fibers, thus further resulting to thrombus formation and fibrosis.

Sclerotherapy should progress from the largest to smallest vessels. The quantity of the solution to be injected should be enough to produce an obliteration1 to 2 cm in diameter around the point of injection and never more than 0.5 ml to avoid the risk of initiating new telangiectasias from forming around the edge of the treated area.

How often can I have Sclerotherapy Treatment?

Patients should be examined 2 weeks after injection so that any area of thrombosis can be evacuated early. Each individual area should not be treated sooner that 6 to 8 weeks after injection to allow for adequate healing of the endothelium between treatment.

What should I do after treatment?

Patient is instructed to walk immediately after the injection session to help prevent deep venous thrombosis. After injection, treated veins are compressed to minimize significant thrombosis. Post sclerosis compression is perhaps the most important advancement in sclerotherapy treatment of varicose veins. This eliminates a thrombophlebitic reaction and substitutes a “sclerophlebitis” with the production of a firm fibrous cord.

What are the complication of Sclerotherapy?

As with any therapeutic technique, Sclerotherapy carries with it a number of potential adverse reactions and complications. Among the adverse sequelae are temporary pigmentation, temporary swelling, telangiectatic matting, pain, localized urticaria, compression blisters and tape compression folliculitis. Among the complications were cutaneous necrosis, systemic allergic reactions, thrombophlebitis, arterial injections and pulmonary embolism.

What can Mesotherapy do?

Mesotherapy is not the answer to weight loss but it can be used to help sculpt and eliminate localised areas of fat. While it is not intended to replace liposuction it is a minimally invasive technique without many of the risks of surgery

The treatment often works well for the love handles, saddlebags, eyelid fat, abdominal areas, inner thighs, jowls, chin and neck. Even with treatment, patients need to maintain good nutrition and exercise habits.

How is it done?

The procedure consists of making several injections into each area. Usually eight to 12 injections into an area about the size of an index card are made. The needle sticks are made with a tiny needle and there is minimal discomfort. If patients desire, an anesthetic cream can be applied before the procedure to eliminate even the discomfort of the needle sticks.

What other conditions can Mesotherapy be used?

Mesotherapy has a variety of applications including fat reduction, cellulite removal, body sculpting, face and neck rejuvenation with Mesolift, hair loss/alopecia, pain management for sports injuries, tendonitis, bursitis and osteoarthritis”. Therefore, the injected solution is individually prepared depending on its purpose.

Is it painful? How long is the recovery period after treatment?

Unlike surgery, mesotherapy is virtually painless, requires no post-operative recovery time, requires no heavy bandages or girdles, and no anesthesia is necessary. While many surgical procedures require one to two weeks of recovery, patients undergoing mesotherapy have no interruptions to their daily life, while obtaining a natural cosmetic rejuvenation

Who are candidates for Mesotherapy?

Mesotherapy is not for everyone. Anyone who is in good overall health and between the ages of 18-75 can be treated.

Mesotherapy can be used to treat everyone from obese people who would need treatment on the trunk, abdomen, buttocks, arms, and legs, as well as those who are generally thin but plagued with resistant areas such as saddlebags or love handles. In either case, this treatment is literally able to melt fat from the body.” Those who are on blood thinners have blood clots, or heart arrhythmia should be prescreened for this procedure by their primary care physician. As with any medication, an allergic reaction is a potential risk. Unlike other treatment modalities that treat cellulite, Mesotherapy is permanent provided the patient monitors their caloric intake with a sensible diet.

How long does a session last?

A typical treatment takes only 20 to 30 minutes.

What do I expect after the treatment?

Following treatment patients will often feel a warm or slight burning sensation for a few minutes to perhaps a day or so. There is usually some swelling and redness in the area treated and typically some bruising.

Patients are advised not to exercise for 24 hours but after that time they can resume normal activities. Some patients experience temporary nodule formation under the skin. This is when a patient may feel some firm, pea-sized or marble-sized areas under the skin after treatments. The areas are invisible at the surface of the skin and can take several weeks to even months to dissipate.

When can I see the result of Mesotherapy?

Results can be variable and most people need two to three treatments to see significant results. The treatments are often done at two-to-four-week intervals.. Treatments can be resumed after six months.

How often can I have Mesotherapy sessions?

For weight loss and/or cellulite reduction, 10 weekly sessions followed by every other week as necessary. “Mesotherapy is the only non-surgical treatment today that melts fat and eliminates cellulite.

What kinds of Mesotherapy are available?

Mesotherapy is one of the most exciting body-sculpting and fat elimination treatments available today, and is a safe, natural alternative to invasive cosmetic surgery. This breakthrough technology can successfully shrink or eliminate fat cells in your body, reduce cellulite and rejuvenate your face and neck. Many names have emerged with the surge in the popularity of Mesotherapy. Following is what you need to know about the various Mesotherapy discipline that your patients may ask for:

MesoCellulite

Approximately 90% of women, over the age of 20, struggle with the appearance of cellulite on their body. Cellulite occurs largely as a result of poor circulation; blood pools around fat cells and the pressure exerted on these cells cause the bunching appearance regardless of weight or age.

MesoCellulite is a form of Mesotherapy that helps to eliminate cellulite by helping to increase circulation. The injected minerals breakdown the walls of fat cells which releasing the stored up fat into the body where it is then eliminated, and proper circulation in that area returns. Providing patients maintain a proper diet and fitness regimen, results can be considered permanent.

MesoSculpt

MesoSculpting is a similar to process to MesoCellulite, but focuses on localized regions of fat that build up on areas such as the arms, hips, abdomen, thighs, neck or chin. A series of MesoSculpt injections, which involves the use of PPC, allows the fat to be broken down and slowly eliminated from the body, with results that are measurable in inches.

MesoSculpt is used to reduce or eliminate the fat pads under the eyes that cause older eyes to look “baggy”. It can also be used to reduce the fat under the chin and around the cheeks, giving a leaner, younger look to the face and neck. For spot weight reduction in the waist it can be used to reduce the abdominal, hips and buttocks fat deposits.

MesoLipo

This makes use of a cocktail of medicines that dissolves fat and improves skin tone. The cocktails are injected into the fat layer every 2 weeks for a minimum of 4 sessions. The discomfort is tolerable but for those who have a low pain threshold, a mild pain reliever may be taken.

MesoGlow

Our face is one of the few regions on our body in which patients desire a plump, full appearance, as it equates to youth and vitality. Unfortunately, as we age we loose volume in our face, a process which is accelerated by sun exposure. Though Mesotherapy has gained prominence as a fat reduction treatment, it may also be manipulated to replenish fat in areas such as face and neck.

MesoGlow treatments infuse the dermis layer of skin with hyaluronic acid, collagen-stimulating minerals and antioxidants to nourish skin and return it to the radiant, firm, glowing complexions of their youth.

MesoWhite

Whitening medicines and vitamins are injected into dark problematic areas, like the armpits and facial hyperpigmentation. These medicines help break the pigments, allowing the area to lighten in color. Again, multiple sessions are required and are spaced 1-2 weeks apart. Topical whitening medications can still be applied to maximize results.

MesoScalp

A cocktail of multivitamins, hormones, and minerals is injected into the scalp to stimulate improved hair growth. This results in healthier-looking hair and scalp. Treatment is done weekly and 15-20 sessions may be necessary. MesoScalp is helpful in cases of falling hair, thinning hair and spot baldness.

MesoLift

MesoLift is another anti-aging technique to help maintain a healthy glowing skin and it is particularly excellent for those fine lines that fillers can not correct. Mesolift infuses your skin with hyaluronic acid (body’s natural filler substance), retinoic acid, potent vitamins, and anti-oxidants to restore the hydrated plumpness and fresh appearance of your skin. The treatment actually rejuvenates, revitalizes and tightens the skin. Even the physical treatment itself has been shown to promote production of collagen and elastin and stimulate the metabolism. The MesoLift is usually performed in an initial series of 3 to 5 treatments (sometimes more), or twice a year. Some patients may not need any touch-up treatments for many years.

The Carboxytherapy consists in the therapeutic use of carbon dioxide (CO2) on its gaseous state, either transcutaneous or by subcutaneous injection. Carboxytherapy is a novel, uncomplicated and verified non surgical method that can considerably improve the appearance of cellulite by improving local tissue metabolism and perfusion. Treatments are fast, comfortable and successful for a number of patients.

How is Carboxytherapy done?

Carbon dioxide (CO2) is administrated through subcutaneous route through a tiny 30 G needle (0.3mm in diameter). From the injection point, the carbon dioxide diffuses easily into adjacent tissues.

How does the carbon dioxide work?

A new and innovative method has been introduced that allows the physician to accurately regulate the speed of the flow of the gas. With this new technology the physician is able to target the gas exactly where it is needed for each specific patient. Depending on the area being treated different amounts of the gas is introduced through extremely small punctures with a needle.

When administered sub-cutaneously, CO2 causes subcutaneous microcirculation vasodilatation expressed in flow speed increase and the opening of “virtual” capillaries that normally are closed under paraphysiological conditions. CO2 immediately diffuses at the cutaneous and muscular microcirculatory level.  CO2-induced vasodilatation results from this gas direct activity on arteriole smooth muscle cells. When administered through an external route, CO2 promotes this mechanism, resulting in a higher tissular oxygenation and neoangiogenesis.

Wider vessels mean bigger and stronger blood flow to the area, which means more oxygen. Flow speed increase in pre-capillary arterioles enhances lipolysis, also due to Alfa 2 and beta fiber stimulus.  It must be remembered that such fibers have lipolytic or anti-lipolytic activity according to the area in which they are located. This results in fewer fat cells and firmer subcutaneous tissue.

Is Carbon dioxide toxic?

Carbon dioxide is a non-embolic gas and is non-toxic even in elevated dosages. Our body produces 200 milliliters of carbon dioxide at rest. This amount is raised ten times during exercise with absolutely no consequences. We use large doses of carbon dioxide in medicine every day. For instance, patients undergoing laparoscopic surgical procedures absorb significantly more carbon dioxide gas with no ill effect.

Although it is toxic when inhalated (10% in air may cause asphyxia), CO2 subcutaneous therapeutic administration or intra-abdominal administration have not shown any toxic effects, even at the highest doses (2-3 liters). It differs from other gases because no nitrogenous embolisms arise, unlike, for example, the oxygen-ozone therapy.

Simply stated, this procedure uses a natural gas found in our body to improve skin elasticity, tone, and texture in a safe and minimally invasive way.

Which parts of the body can be treated?

Carboxytherapy can be used anywhere skin has lost elasticity and tone and where subcutaneous fatty tissue has accumulated. It can be used in areas with cellulite, and stretch marks. Consultation with our clinic will allow us to determine the different areas that need to be treated and if Carboxytherapy alone is warranted or in combination with other skin products.

Is it painful?

Other than the prick of the needle and a feeling of pressure most patients tolerate the procedure very well. A light tingling sensation near the injection site may be felt by some patients but disappears within a matter of seconds. The injection site may feel warmer for minutes as a result of the increased circulation. Different parts of the body are more sensitive than others. The physician performs the procedure and is present at all times.

Is there any down-time?

Carbon dioxide therapy is easy to perform by skilled physicians and there is no down-time. Immediately after the procedure there may be slight swelling and redness (erythema). However, this only lasts a few minutes.

What are the possible reverse effects?

Possible reverse effects after treatment includes high sensitivity at the treatment area, cracking sensations under the skin, redness in the treatment area and heavy feeling at the lower body

How many sessions are necessary?

This is dependent on the area to be treated and how the area looks prior to treatment. Carboxytherapy for aesthetic treatments is suggested to be performed once a week. Approximately 15 sessions is suggested for a complete treatment, this number can be increased regarding the results.

Basic body treatments may require 2 sessions per week over a course of 4-6 weeks. One or two session per week will suffice but every other day procedure is ideal.

How many sessions before I see an improvement?

Initial results can be seen after just a few sessions. The quality of the body skin texture and its firmness will be noticeably different upon completion. You will notice a more homogenous color in areas with stretch marks.

How long do the benefits last?

Benefits last for years as long as you stick to a healthy diet complemented by regular exercise. Remember that a healthy diet and proper exercise would not only keep your skin toned and firm but would also make your whole body strong and healthy. 2-3 repeated courses of treatments can be performed within a year if desired.

What should I avoid after treatment?

Avoid baths, swimming, or saunas for 4 hours after the treatment because any abrupt change in body temperature may hamper the increased microcirculation brought about by the procedure

Who are not candidates for Carboxytherapy?

Carboxytherapy must not be performed to the patients with the following heath conditions or history of them in the near future; Cardiac patients, Diabetic patients using insulin, Cancer patients, and Nervous system disorder

Liposuction is a surgical technique that improves the body’s curve by removing excess fat from deposits located between the skin and muscle. Liposuction involves the use of a small stainless steel tube, called a cannula. The cannula is connected to a powerful suction pump and inserted into the fat through small incisions in the skin. Fat removal is accomplished as the suction cannula creates tiny tunnels through the fatty layers. After surgery, these tiny tunnels collapse and thus result in an improved body contour.

Tumescent Liposuction

The word “tumescent” means distended and firm. By injecting a large volume of very dilute lidocaine (local anesthetic) and epinephrine (capillary constrictor) into subcutaneous fat, the targeted tissue becomes distended and firm, or tumescent.

The tumescent technique is a procedure that provides local anesthesia to great volumes of subcutaneous fat and thus permits liposuction totally by local anesthesia. The tumescent technique eliminates both the need for general anesthesia and need for IV narcotics and sedatives. The tumescent technique for liposuction provides local anesthesia, constricts capillaries and prevents surgical blood loss and provides fluid to the body by subcutaneous injection so that no IV fluids are needed.

Tumescent liposuction totally by local anesthesia has proven to be very safe despite the use of unprecedented large doses of lidocaine and epinephrine. The explanation for this remarkable safety is the extreme dilution of the tumescent local anesthetic solution. Large volumes of dilute epinephrine produce intense constriction of capillaries in the targeted fat, which in turn greatly delays the rate of absorption of lidocaine and epinephrine. Undiluted lidocaine and epinephrine is absorbed into the bloodstream in less than an hour. Tumescent dilution causes widespread capillary constriction which causes the absorption process to be spread over 24 to 36 hours. This reduces peak concentration of lidocaine in the blood, which in turn reduces the potential toxicity of a given dose of lidocaine. When very dilute tumescent epinephrine is used, the wide spread vasoconstriction slows the rate of epinephrine absorption, which in turn prevents an increase in heart rate.

With tumescent infiltration of a large volume of dilute epinephrine into subcutaneous fat ,profound vasoconstriction (shrinkage of capillary blood vessels) results . Tumescent vasoconstriction is so complete that liposuction can be done with virtually no blood loss. In contrast, the older forms of liposuction used before the invention of the tumescent technique were associated with so much surgical blood loss that autologous blood transfusions were often routine.

The local anesthetic remains in place in the fat for many hours because the vasoconstriction delays lidocaine absorption. This prolonged anesthesia permits surgery for up to 10 hours after infiltration, and provides 24 to 36 hours of significant postoperative analgesia.

Smoother liposuction results can be achieved by using microcannulas which allow a more gradual and controlled removal of fat. This improves the ability of the surgeon to achieve smoother results. Larger cannulas are associated with an increased risk of liposuction producing skin depressions and irregularities. Larger cannulas may remove fat so quickly that there is a risk of removing too much fat. It is also more difficult to precisely control the direction of a large cannula. With any attempt to make a small incremental change in the direction of a large cannula there is tendency to re-enter a pre-existing tunnel within the fat. This lack of precise control contributes to the risk of skin irregularities associated with liposuction when using large cannulas..

Because tumescent local anesthesia lasts so long, tumescent liposuction is less painful and more pleasant than liposuction under general anesthesia or IV sedation. With tumescent local anesthesia, patients are able to avoid the post-operative nausea and vomiting associated with general anesthesia. Tumescent anesthesia is so efficient at providing fluid to the body that it is unnecessary to use IV fluids. There is a risk of dangerous fluid overload if excessive IV fluids are given to a tumescent liposuction patient.

When done right, the result is so natural that even a stylist cannot detect it. The days of the unnatural looking “corn row” results are long gone.

Today hair restoration surgery is a one day out-patient procedure requiring only local anesthesia. Most patients are surprised by how little discomfort, if any, they experience during and after surgery.

How It Works.

Hair restoration surgery simply relocates bald resistant hair follicles from donor area to your thinning areas. Hair transplant sessions that involve the movement of thousands of tiny follicular unit grafts may take a whole day, but the time goes by quickly as patients rest comfortably during the procedure; either watching TV, taking a nap, or chatting with the staff.

The perception that people may have of a hair transplant, where patients leave the office with their heads wrapped in bandages and have significant bleeding and pain, is from the older, plug techniques. In modern follicular unit hair transplantation, patients leave the office with only a hat and headband and are able to shower and shampoo their hair the day after hair restoration surgery. After the procedure there is only some discomfort that is treated with oral medications, and there is literally no bleeding.

Follicular Unit Transplantation

In Follicular Unit Extraction (FUE) a relatively large area in the back and sides of the scalp is shaved to approximately 1-mm in length. Instead of removing a single strip, as in FUT, a tiny circular incision is made around each follicular unit. The follicular units are then extracted, one-by-one, directly from the scalp. The tiny wounds are small enough to be left open and heal on their own, which takes about a week. The remainder of the procedure is similar to Follicular Unit Hair Transplantation.

In either procedure, the hair transplant is visible for about a week. Some patients cover the area with their existing hair and others choose to wear a hat when they are in public. Patients can resume normal daily activities the second day following their hair restoration surgery, although there are some restrictions on strenuous exercise, smoking and drinking. New hair growth starts to appear in 2 to 3 months and is generally complete in 10 to 12 months.

Follicular Unit Transplantation was a major advance over the mini-micrografting hair transplant procedure that preceded it. In mini-micrografting, the graft sizes were arbitrarily determined by the doctor who cut the donor tissue into different size pieces (this technique was also called grafts “cut to size.”). Minigrafts, which might contain up to 12 hairs, were bulky and could produce a tufted appearance. They also could result in a dimpling of the underlying skin. Micrografts, on the other hand, were frequently damaged during the removal process or were too fragile to survive.

In Follicular Unit Hair Transplantation, special stereo-microscopes enable meticulous graft dissection, so that the integrity of follicular units can be preserved. This process also enables the careful removal of the non-hair bearing scalp around the units. This process insures that all of the growth elements of the hair follicle remain intact and that the grafts are kept as small as possible.