Keys to a Long-term Success in Liposuction

After liposuction, patient needs to have a realistic expectation to have a long-term succesful outcome.  There are 4 key elements to have a succesful outcome after liposuction:

1)Exercise - Exercising after liposuction is very important, especially after the initial surgery.  We encourage our patient to start exercising 2 to 4 weeks after their surgery.

2)Proper Diet - It is very important to eat a healthy diet consisting of fruits, vegetables and fish.  We recommend avoiding fatty food, drinking sodas, and eating excessively.  We recommend consulting with a nutritionist if one is having difficulty having a proper healthy diet.

3)Positive Lifestyle Changes

4)Succesful Body Contouring - It is important to choose the right surgeon who would perform your procedure.  Unfortunately, cosmetic surgery is unregulated here in the United States, and we recommend choosing a plastic surgeon who is trained in liposculpture surgery to perform your procedure.

Before & After Photos of VASER Liposuction (6 weeks after surgery) performed by Emmanuel De La Cruz MD, PLLC.

A clinical study conducted by Dr. Rohrich revealed that:

• "Among the 57 percent of patients who did not gain weight, 35 percent report exercising more postoperatively (compared with only 10 percent in the weight gain group, p = 0.002) and 50 percent report eating a healthier diet (22 percent in the weight gain group report eating a healthier diet, p = 0.002). "
• In the weight gain group, 67 percent report no change in their diet regimen and only 17 percent thought their productivity increased (compared with 25 percent among the no weight gain group, p = 0.002). Successful body contouring surgery requires a patient to embrace positive lifestyle habits. "

Thus, the long-term success of a liposuction procedure is dependent on having a healthy proper diet and exercise.  One can still gain weight after your liposuction procedure if one does not exercise and eat a healthy diet.

Reference: Rohrich, et al. The key to long-term success in liposuction: a guide for plastic surgeons and patients. Plast Reconstr Surg. 2004 Dec;114(7):1945-52; discussion 1953.

Emmanuel De La Cruz MD, PLLC

Plastic & Reconstructive Surgeon

Houston, Texas

SmartLipo versus Traditional Tumescent Liposuction - Houston, Texas

A previous randomized clinical trial comparing traditional tumescent liposuction and SmartLipo was performed, and this showed the following findings:

• Less post-operative pain with SmartLipo.
• Cytologic studies showed more damage of the adipocytes (fat cells) in SmartLipo.  Thus, fat harvested from SmartLipo is not suitable for fat grafting, such as in Brazilian Butt Lift.
• No major clinical differences found between SmartLipo versus Traditional Tumescent liposuction.
• Surgical time was longer with the SmartLipo group.
• Higher concentration of free fatty acids were found in the SmartLipo group.
• Lipocrit is lower in the SmartLipo group.

Lower Lipocrit Volume was obtained with the SmartLipo group as compared to the Traditional Tumescent Liposuction group.

In conclusion:  "No major clinical differences for suction-assisted lipoplasty versus laser-assisted lipoplasty were found. Higher concentrations of free-fatty acids after laser-assisted lipoplasty must alert us to possible hepatic and renal toxicity."

Reference:  Prado, et al. A prospective, randomized, double-blind, controlled clinical trial comparing laser-assisted lipoplasty with suction-assisted lipoplasty. Plast Reconstr Surg. 2006 Sep 15;118(4):1032-45.

Emmanuel De La Cruz MD, PLLC

Plastic & Reconstructive Surgeon

Houston, Texas

Reducing Risk of Contour/Skin Irregularities after Liposuction

Patients with poor skin elasticity should be forewarned about the risk for contour irregularities and suboptimal skin contraction. Similarly, pre-existing cellulite, indentations and scars may be present and will not be corrected with liposuction.  

How to Prevent Skin Contour Irregularities after Liposuction

• Intraoperatively, use of micro-cannulae and careful use of the criss-cross technique of liposuction are recommended to prevent waviness
• Using the VASER Liposuction machine may reduce the risk for contour irregularities

Using a smaller cannulae produces less skin contour irregularity as compared to a larger liposuction cannulae.

Before & After Correction of Skin Contour Irregularities.  Patient previously had traditional liposuction from another plastic surgeon and she developed skin contour irregularity.  Dr. De La Cruz performed the VASER liposuction of the thighs with fat transfer to correct the contour irregularity.

Before & After Correction of Skin Contour Irregularities (Frontal View).  Patient previously had traditional liposuction from another plastic surgeon and she developed skin contour irregularity.  Dr. De La Cruz performed the VASER liposuction of the thighs with fat transfer to correct the contour irregularity.

Emmanuel De La Cruz MD, PLLC

Plastic & Reconstructive Surgeon

Tumescent Liposuction - Houston, Texas

What is Tumescent Liposuction?

• The word tumescent refers to anything that is swollen and firm. With tumescent liposuction, a large volume of very dilute solution of local anesthesia (lidocaine, bicarbonate and epinephrine) is injected into the fat beneath the skin, causing the targeted area to become swollen and firm. The local anesthetic lidocaine in the solution used for tumescent liposuction reduces the pain that one would experience after liposuction. The drug epinephrine (adrenalin) provides profound localized vasoconstriction that it reduces surgical bleeding during tumescent liposuction.

• Tumescent liposuction can be combined with other forms of liposuction such as in VASER liposuction.  In fact, the tumescent technique liposuction is essential for VASER liposuction to work since ultrasonic energy used in the VASER liposuction needs "water" to emulsify or liquefy the fat.  The fluid in the tumescent solution also prevents "skin burn injuries" from VASER liposuction.

Before & After Photos:  4D VASER Liposuction 6 weeks after surgery.  Procedure performed by Dr. De La Cruz

Benefits of Tumescent Liposuction

• Less blood is lost.

• Intravenous fluid replacement is not necessary.

• Bacteriostatic lidocaine may decrease the risk of infections.

• Tumescence magnifies defects; therefore, the likelihood of needing a secondary procedure may be less.

• Lipid-soluble lidocaine is somewhat suctioned out with the aspirated fat.

• Vasoconstriction minimizes absorption.

• The epinephrine may increase the cardiac output, which, in turn, hastens the hepatic metabolism of the lidocaine.

• The duration of anesthetic effect may last as long as 24 hours.

• The lidocaine may be given safely up to 45 mg/kg and even higher in certain conditions.

Does VASER Liposuction Employs Tumescent Liposuction Technique?

• It is standard of care to employ the tumescent liposuction technique in most liposuction methods, including the VASER liposelection/liposculpture.
• Infilitrating the area of fat with tumescent solution reduces the risk of burn injuries that may occur in VASER liposuction or Laser-assisted liposuction.

Emmanuel De La Cruz MD, PLLC

Plastic & Reconstructive Surgeon

Skin Retraction After VASER Liposuction

A recent randomized clinical trial had shown that the VASER liposuction produced clinical significant skin retraction. 

• "Regarding skin retraction, the VASER-assisted lipoplasty-treated side resulted in a statistically significant improvement in skin retraction of 53 percent relative to suction-assisted lipoplasty (17 percent per liter versus 11 percent per liter, p = 0.003) with 33 paired sites using a two-tailed t test. "

Figure 1:  Before and After Photos (3 months after surgery) after VASER Hi-Definition Liposuction performed by Dr. De La Cruz.  Note that there was significant skin retraction after surgery.

Reference:

Nagy, et al.. A multicenter, prospective, randomized, single-blind, controlled clinical trial comparing VASER-assisted Lipoplasty and suction-assisted Lipoplasty. Plast Reconstr Surg. 2012 Apr;129(4):681e-9e. doi: 10.1097/PRS.0b013e3182442274.

Emmanuel De La Cruz MD, PLLC

Plastic & Reconstructive Surgeon

Improvement of Diabetes after a VASER Liposuction

Recently, there has been a study conducted to examine the liposuction-induced metabolic changes with regard to release of major adipokines and insulin sensitivity in overweight male patients.

Figure 1:  Before and After Photos (6 weeks after surgery) of 4 D VASER Liposuction performed by Dr. Emmanuel De La Cruz in Houston, Texas.

• "To eliminate the confounding effects of postsurgical inflammation and to evaluate delayed metabolic effects, fasting blood was collected on the day of liposuction, within 1 to 2 months and more than 6 months after surgery."
• "Both treatment groups (diabetic and nondiabetic patients) experienced similar postsurgical weight reduction with concomitant lowering of body mass index value at 1 to 2 months follow-up, which was sustained after 6 months from surgery."
• "Improvement in insulin sensitivity at 1 to 2 months follow-up was observed ( p = .017 and p = .002, for diabetics and nondiabetics, respectively) and this change persisted over the next 4 months."

This study shows that there may be beneficial effects of VASER Liposuction in overweight diabetic and non-diabetic males by improving their insulin sensitivity.

Reference:

Gibas-Dorna, et al.. The Effect of VASER Abdominal Liposuction on Metabolic Profile in Overweight Males.  Am J Mens Health. 2017 Mar;11(2):284-293. doi: 10.1177/1557988316674841. Epub 2016 Oct 22.

Emmanuel De La Cruz MD

Plastic & Reconstructive Surgeon

Abdominal Exercises to Maintain your 6-Pack after 4D VASER Liposuction

After your surgery, it is critical to maintain your new body with exercise and diet. Your results are optimized if you live a healthy lifestyle which includes exercise at least 3 days a week, and a healthy diet with minimal caloric intake.

Here's a video I recommend to maintain your 6-pack after the 4 D VASER liposuction.  Your results will be optimized when you do this exercise.

Emmanuel De La Cruz MD, PLLC

Plastic & Reconstructive Surgeon

Fat Graft Harvested via VASER Liposuction is Viable and Suitable for Fat Transfer in Brazilian Butt Lift Patients

Although there's clinical evidence of successful autologous fat transfer (AFT), such as in Brazilian Butt Lift, using VASER liposuction is readily available, no study has quantified adipocyte viability using standardized methods until recently.

• The UAL system (VASER; Sound Surgical Technologies, Inc, Louisville, Colorado) was set at 60% amplitude in pulsed mode with vacuum aspiration of 15 in Hg or less.
• Laboratory analysis included free lipid volume, viability via lipolysis and propidium iodide staining, and cytological analysis, including cell surface protein examination and hematoxylin and eosin staining.
• The lipolysis assay revealed metabolically active adipocytes with a mean (SD) correlative viability of 85.1%
• Direct measures of acute viability via propidium iodide staining resulted in a mean (SD) viability measure of 88.7%
• Adipose tissue acquired via VASER liposuction is viable at harvest and isa suitable source for autologous fat grafts, especially for Brazilian Butt Lift.
• Adiposed-derived stem cells (fat for fat transfer) obtained via VASER liposuction were of equal quality when directly compared with the current gold standard harvest method according to a study conducted by Duscher.   "UAL- and SAL-derived samples demonstrated equivalent ASC yield and viability, and UAL ASCs were not impaired in their osteogenic, adipogenic, or chondrogenic differentiation capacity."

4D VASER Liposuction performed by Dr. Emmanuel De La Cruz of Houston, Texas

Reference:

Duscher, et al. Ultrasound-Assisted Liposuction Does Not Compromise the Regenerative Potential of Adipose-Derived Stem Cells.  Stem Cells Transl Med. 2016 Feb;5(2):248-57. doi: 10.5966/sctm.2015-0064. Epub 2015 Dec 23.

Schafer, et al.  Acute adipocyte viability after third-generation ultrasound-assisted liposuction. Aesthet Surg J. 2013 Jul;33(5):698-704. doi: 10.1177/1090820X13485239. Epub 2013 May 29.

Harvesting for Fat Transfer in Brazilian Butt Lift

The success of an autologous fat graft depends in part on its total stromal vascular fraction (SVF) and adipose-derived stem cells (ASCs). This is important when it comes to harvesting of fat for fat transfer such as in Brazilian Butt Lift. 

• Subcutaneous fat tissues from the abdomen, flank, or axilla were harvested in the study conducted by Iyyanki from patients of various ages by mechanical liposuction, direct surgical excision, or Coleman's technique with or without centrifugation.
• Compared with Coleman's technique without centrifugation, direct excision yielded significantly more ASCs (P < .001) and total SVF cells (P = .007); liposuction yielded significantly fewer ASCs (P < .001) and total SVF cells (P < .05);
• Coleman's technique with centrifugation yielded significantly more total SVF cells (P < .005), but not ASCs.
• The total number of SVF cells in fat harvested from the abdomen was significantly larger than the number in fat harvested from the flank or axilla (P < .05).
• Adipose tissue harvested from the abdomen through direct excision or Coleman's technique with centrifugation was found to yield the most SVF cells and ASCs.

Reference: 

Iyyanki, et al.  Harvesting technique affects adipose-derived stem cell yield. Aesthetic Surgery J. 2015 May;35(4):467-76. doi: 10.1093/asj/sju055. Epub 2015 Mar 18.

Emmanuel De La Cruz MD, PLLC

Plastic Surgeon, Houston Texas

VASER Liposuction may Improve Diabetes in Overweight patients

It has been of significant interest whether liposuction may have an effect on diabetes in overweight patients.  A prospective study was recently performed showing that VASER liposuction may have a potential beneficial effect on diabetes.

• Overweight male patients aged 37.15 ± 9.60 years (6 with diabetes type 2, 11 without comorbidities) and 10 age-matched healthy lean controls were enrolled in the study.
• Using Vibration Amplification of Sound Energy at Resonance System (VASER Liposuction), ultrasound assisted liposuction was applied onto the deep layers of abdominal subcutaneous adipose tissue. The mean volume supranatant fat was 2208 ± 562 ml.
• Fasting blood was collected on the day of liposuction, within 1 to 2 months and more than 6 months after surgery.
• Both treatment groups (diabetic and nondiabetic patients) experienced similar postsurgical weight reduction with concomitant lowering of body mass index value at 1 to 2 months follow-up, which was sustained after 6 months from surgery.
• Improvement in insulin sensitivity at 1 to 2 months follow-up was observed (p = .017 and p = .002, for diabetics and nondiabetics, respectively) and this change persisted over the next 4 months.

VASER Liposuction (Before and After 6 months of Surgery) performed by Dr. Emmanuel De La Cruz

4D VASER Liposuction performed by Dr. Emmanuel De La Cruz, Houston Plastic Surgeon

With this study, VASER liposuction of the abdomen may have beneficial effects in overweight diabetic and non-diabetic males by improving their insulin sensitivity.

Reference:

Gibas-Dorna, et al. The Effect of VASER Abdominal Liposuction on Metabolic Profile in Overweight Males. Am J Mens Health. 2016 Oct 18. pii: 1557988316674841.

Hand Rejuvenation using Fat Grafting

Apart from the most obvious region (face & neck) where aging can be seen and where most aesthetic surgery for rejuvenation are performed,  the dorsum of the hand is the next obvious area where aging can be seen and is continuously visible in daily life.  What they used to say,"If you want to know a woman's age, look at her hands" still holds true.

The region of the hand exhibits laxity of the skin with subcutaneous atrophy and age-related pigmentations in a comparable manner to the face. Fat transfer to the dorsum of the hand enables subcutaneous regeneration by refilling the subcutaneous space and hence reducing some of the age-related degenerative process.

Areas of Concern of the Aging Hand

• Bony-looking hands due to loss of some of the fat beneath the skin that occurs with age
• Prominent veins
• Brown aging spots (liver spots)

Rejuvenation Treatment for the Aging Hand

•    Chemical peels to improve the overall appearance of the skin on the back of the hand
• Fillers or Fat transfer onto the dorsum or back of the hand to make them appear less bony.  Fat transfer is ideal since this may improve the texture of the skin.

Please consult your plastic surgeon regarding hand rejuvenation.

Emmanuel De La Cruz MD, PLLC

Plastic & Reconstructive Surgeon, and Hand Surgeon

References:   

• Coleman SR.  Hand rejuvenation with structural fat grafting. Plast Reconstr Surg. 2002 Dec;110(7):1731-44; discussion 1745-7. 
• Villanueva, et al.  Technical Refinements in Autologous Hand Rejuvenation.  Plast Reconstr Surg. 2015 Dec;136(6):1175-9.

Lymphatic Massage after Liposuction

One may notice a hardness or lumpiness to the areas treated with liposuction and/or with other body contouring procedures (such as fat injections for what is popularly known as the Brazilian Butt Lift).   This post-surgical lymphedema is caused by inflammation and trauma from the cannula (instrument that sucks out the fat) moving under the skin.  Channels are formed by the cannula that can fill up with fluid and the tissue also becomes swollen.  Manual Lymphatic Massage helps to move the fluid by gently pumping it back into the lymph vessels.  Reducing the swelling can reduce discomfort and may reduce contour irregularities after a   liposuction procedure.  Without Lymph Massage (LDT or MLD) the inflammation can evolve into fibrosis (a permanent hardening of the tissue) or a seroma ( pocket of serum) can form.  It is imperative that one should follow the post-operative protocol of your plastic surgeon to achieve the best possible results and avoid developing fibrosis and even possibly contour irreguarities.

Clinical studies have shown that lymphatic massage also improved the clinical outcome after a cryolipolysis procedure.   The study had shown that post-treatment manual massage resulted in a mean fat layer reduction was 68% greater in the massage side than in the non-massage side as measured by ultrasound at 2 months post-treatment.  At 4 months, mean fat layer reduction was 44% greater in the massage side.   Histological results showed no evidence of necrosis or fibrosis resulting from the massage.

I do NOT recommend receiving a general therapeutic, deep tissue or Swedish Massage in lieu of a lymphatic massage therapy after a liposuction procedure.

Emmanuel De La Cruz MD, PLLC

Plastic & Reconstructive Surgeon, Houston Texas

References:

Boey, et al.  Enhanced clinical outcome with manual massage following cryolipolysis treatment: a 4-month study of safety and efficacy.  Lasers Surg Med. 2014 Jan;46(1):20-6.

A Surgeon's Prayer Before Surgery

As physicians, we interact with patients during some of the most important moments of their lives -- at their births and at their deathbeds, at events bursting with spiritual significance. And yet most of us are afraid to talk about spirituality with our patients, much less discuss religion, out of fear that such conversations would be inappropriate.

I would like to share my prayer to my fellow surgeons who would like to pray for their patients before surgery.  Whether one is Christian, Muslim, Hindi or a Buddhist, I pray this prayer before performing their operation.

A Surgeon’s Prayer Before Surgery

God please guide my hands and all who will assist in the surgery.  Empower us to use our skills to restore our patients health and wholeness.  We ask you to remove any fear or anxiety from our patient and feel him with peace.

May his recovery be swift and his strength renewed and his health restored.

We also ask you to bless his family and friends.  Be with them as they await for the surgery to be finished and give them peace.  

Lord, make me a channel of your peace, that where there is hatred, May i bring love;

Where there is wrong, May i bring the spirit of forgiveness; 

Where there is discord, may I bring harmony; where there is error, May i bring truth;

Where there is doubt, may I bring faith; 

Where there is despair, may I bring hope;  that where there are shadows, I may bring light; 

That where there is sadness, I may bring joy.

We place our patient into your hands, lord, for you are the divine physician.

Emmanuel De La Cruz MD, PLLC
Plastic Surgeon

Removal of Hydrogel using the VASER Liposuction

Hydrogel injection into the buttocks is currently being performed illegally in the United States.  It is fraught with complications which include chronic buttock pain, buttock deformity, hyperpigmentation and even possible loss of limb.

Hydrogel injected into the buttock can either be treated with direct surgical excision and/or using the VASER liposuction method.  An MRI of the buttock is performed to map the areas where the hydrogel was injected.  Hyaluronidase is then injected into the areas where the hydrogel is located 24 hours prior to surgery.  VASER liposuction is then performed to separate the hydrogel from the surrounding fat.   Fat is then transferred to the areas where the hydrogel is removed to correct any deformity that results from removal of the hydrogel. 

Before & After Photos of Hydrogel Removal using the VASER Liposuction with Fat transfer.  Procedure was performed by Dr. Emmanuel De La Cruz, a Houston Plastic Surgeon.

Before & After Photos of Hydrogel Removal using the VASER Liposuction with Fat transfer.  Patient's pain improved after surgery.  Procedure performed by Dr. Emmanuel De La Cruz, a Houston Plastic Surgeon.

Emmanuel De La Cruz MD, PLLC
Plastic & Reconstructive Surgeon,  Houston Texas

VASER Liposuction of The Thighs in Houston, Texas

Localized adiposity of the thighs can be a disfiguring problem to some women.  The inner thigh area is a common area of concern among women who seek liposuction.  Liposuction of the inner thighs can significantly improve the silhouette of the thigh and reduce the rubbing together of the inner thighs which could be cumbersome when walking.  Ideally, there should be no significant lumpiness or irregularity of shape, and no visible evidence of a surgical procedure.

Liposuction of the thighs with or without a medial thigh lift can significantly improve the silhouette of the thighs.  The emergence of the VASER liposuction has improved the results of thigh liposuction since the ultrasonic energy from a VASER liposuction machine causes skin retraction, and thus improve the results after a liposuction.

Before & After Photos (6 Weeks After Surgery) of Circumferential VASER Thigh Liposuction performed by Dr. Emmanuel De La Cruz of Houston, Texas.

Before & After Photos (6 Weeks After Surgery) of Circumferential Thigh Liposuction using the VASER liposuction machine performed by Emmanuel De La Cruz MD, a Houston Plastic Surgeon.

Skin retraction after VASER liposuction continues up to 6 months, and even after one year.  Regarding skin retraction, the VASER-assisted lipoplasty-treated side resulted in a statistically significant improvement in skin retraction of 53 percent relative to suction-assisted lipoplasty based on a randomized-clinical study.

Emmanuel De La Cruz MD, PLLC
Plastic & Reconstructive Surgeon

VASER Liposuction on Gynecomastia for Men

Gynecomastia describes a benign increase of the mammary gland in men.   This could range from a puffiness or localized button of tissue concentrated around the areola to marked, distinct enlargement of the breasts making the breasts looking feminine.  Gynecomastia or the so-called "man-boob" can be secondary to multiple causes such as marijuana usage; certain medications such as Pepcid/Tagamet/cardiac medications; testicular tumors; thyroid abnormalities; pre-pubertal enlargement, etc.  Most cases of gynaecomastia are benign and of cosmetic, rather than clinical, importance.  However, gynecomastia may cause local pain and tenderness, and this could occasionally be the result of a serious underlying illness or a medication, or be inherited.   Most cases of gynecomastia result from deficient androgen action or excessive estrogen action in the breast tissue.  In  pubertal gynecomastia, the breast enlargement may resolve spontaneously and thus may warrant observation for gynecomastia in children.

Before & After Photos of VASER Liposuction of the Breasts for treatment of Gynecomastia.  Note that the patient also underwent the 4D VASER Hi-Definition Liposuction.  Procedure performed by Dr. De La Cruz

When medical treatment fails, the surgical procedure is the treatment of choice.  Numerous surgical techniques exist for gynecomastia treatment.  This could range from using the VASER liposuction or ultrasonic liposuction to direct excision of gynecomastia.  Recent studies have shown that ultrasonic liposuction for the treatment of mild to moderate gynecomastia showed superior results over conventional liposuction methods.

A total of 219 patients (384 breasts) with a mean age of 29 years (range 12-74) were evaluated. UAL was utilised in 24% of breasts (47 patients, 91 breasts). Compared with conventional liposuction, UAL had significantly lower rates of intraoperative conversion to open excision (25% vs. 39%; p<0.05) and postoperative revision (2% vs. 19%; p<0.001) using Fisher's exact test. The haematoma rate for each technique was 1%.

Recently, subcutaneous mastectomy was compared with ultrasonic-liposuction for the treatment of gynecomastia.  The reoperation rates in the mastectomy group and liposuction group were 1.4% and 0.5%, respectively. There were no nipple/areola necrosis and scars in liposuction group.  The ultrasonic-liposuction treatment was associated with superior esthetic results and fewer complications.

The use of ultrasonic-assisted liposuction (UAL) combined with conventional liposuction and partial gland resection without skin excision is an option for moderate cases.  Although a wide range of surgical techniques have been described, the treatment of gynecomastia requires an individualized approach. 

Reference:

Song et al.  Surgical treatment of gynecomastia:  mastectomy compared to liposuction techniques.  Ann Plast Surg. 2014 Sep;73(3):275-8. doi: 10.1097/SAP.0b013e31827c7949.

Wong, et al.. Conventional versus ultrasound-assisted liposuction in gynecomastia surgery:  a 13-year review. J Plast Reconstr Aesthet Surg. 2014 Jul;67(7):921-6. doi: 10.1016/j.bjps.2014.03.004. Epub 2014 Mar 21. 

Emmanuel De La Cruz MD, PLLC

Plastic & Reconstructive Surgeon

Houston, Texas

The Surgeon and his Music in the Operating Room

Scalpel.  Sutures.  iPOD!

Music fills the operating room like a symphony being played at a concert whether your surgeon is performing cardiac surgery or breast augmentation.  Surgery has acquired its own soundtrack, and it can be Mozart, Frank Sinatra, or John Mayer.  Unfortunately, music can become a subtle bone of  contention among the members of the surgical team, but in the end the honcho in the hierarchichal operating room (the surgeon) decides the playlist.  

Musician and guitarist John Mayer playing Free Fallin' in Los Angeles.

Dissecting the Brain of the Surgeon and the Musician

Theodore Bilroth, a 19th century surgeon virtuoso and pioneer of surgical procedures to dissect abdominal tumors, was a very well-talented musician who forged a close friendship with Brahms using his piano and violin.  Rene -Theophille Leannec, the father of chest medicine, was a well-known musician of his  time prior to inventing the stethoscope.

• MRIs have shown that the musicians have a large left planum temple (the area responsible for acoustics and linguistics.)  This explains the great accuracy in performance , excellent hand-to-eye coordination and reaction times, and very good spatial visualization.
• Analysis of surgeons' brains have some similarity to those of musicians which is necessary to have great concentration levels, great anticipation and improvisation skills, and has the capacity to listen.

• A recent study in 2008 revealed that the visuo-spatial abilities of surgeons were  enhanced in those involved in playing musical instruments.  (JSLS. 2008 Jul-Sept; 12(3):292-294.

Music and the Operating Room

The aim of music is to arouse emotions and to provide a state of of satisfaction.    Music is the most powerful of all arts and is the universal language that teaches us on how to listen and express our emotions.  Music is known to reduce anxiety of the surgical team, especially the surgeon, and was found to make surgeons more efficient.

• A recent study published in 2015 showed that a panel of plastic surgeon's performance while "stitching up a wound, found higher quality stitching and 8-10% more efficient when music was played."
• a study in 1994 revealed that "when surgeons select their music in the operating room, the surgeons were less stressed, more accurate and faster in their operations."
• A study in 2010 revealed that surgeon's robotic surgical performance  significantly improved when they listened to music.  (Surgical Innovation. 2010. 17(4) 306-311)

As what Nietzsche would say "Without Music Life Would be a Mistake."

Emmanuel De La Cruz MD, PLLC
Plastic & Reconstructive Surgeon

Dr. De La Cruz  is an avid musician who has a passion in playing his grand piano and guitar.

Treatment of Excessive Sweating or Hyperhydrosis with VASER Liposuction

Current methods to treat excessive sweating of the arm pits or axillary hyperhidrosis are typically palliative.   This may involve the use of topical aluminum chloride or cosmetic injections.  For a more permanent solution of excessive sweating of the arm pits may include excisional surgery, endoscopic transthoracic sympathectomy, and liposuction/curettage.

VASER Liposuction as Treatment for Axillary Hyperhydrosis

• A  prospective study was performed involving 13 patients with hyperhydrosis.  The patients were treated with the VASER liposuction.  11 of 13 patients had "significant reduction in sweat/odor and had no recurrence of significant symptoms at 6 months".
• It is unknown, however, whether the use of the VASER liposuction is permanent or not.
• Axillary liposuction using the VASER liposuction machine promises to be the surgical treatment of choice for those patients refractory to other modalities. 

Emmanuel De La Cruz MD, PLLC

References:

Commons, et al.  Treatment of axillary hyperhidrosis/bromidrosis using VASER ultrasound.Aesthetic Plast Surg. 2009 May;33(3):312-23. doi: 10.1007/s00266-008-9283-y. Epub 2009 Jan 3.

Hydrogel Injections for Buttock Augmentation: Not Recommended

Recently, complications from the illegal use of hydrogel injections for buttock augmentation had been arising.  Unfortunately, there are very few plastic surgeons who would remove these illegally injected products from the buttock.

There are several reasons we don't recommend hydrogel injections for buttock augmentation.

1)It is NOT FDA APPROVED!

• The use of hydrogel injections for buttock augmentation is not FDA approved in the United States as of September 2015.  For the amount of hydrogel injections needed for a proper buttock augmentation, the costs are prohibitive.

2)Complications associated with Hydrogel Injections are SEVERE.

• Complications may include skin hyperpigmentation of the injected area; skin necrosis; chronic infections; granulomas; loss of limb; nerve damage; contour irregularities; scarring; deformity of the area injected; organ failure and possibly death.

This patient had industrial-grade silicone injected into her buttocks.  She had developed complications from this requiring a lifesaving amputation of her limbs.  Article available in Essence.com

3)Typical injectors of hydrogel are NOT LICENSED.

• Since this is not FDA approved in the United States, your plastic surgeon is NOT LIKELY inject a material that could be harmful to your body. Be careful of fraudulent practitioners who are willing to inject hydrogel for buttock augmentation.

Emmanuel De La Cruz MD, PLLC                                                                                                                                                                                                    

Biogel and Hydrogel Removal from the Buttock

Recently, there had been a trend in South America for Hydrogel/Biogel injections for buttock augmentation.  Numerous case reports revealed complications arising from such injections.  These complications include but not limited to:  hyper pigmentation of skin, hardening of tissues, contour irregularities, chronic infections, and buttock deformities.

Management of Unwanted Hydrogel in Buttock

• An MRI of the area involved needs to be obtained prior to surgery.  This will serve as a map for the surgeon prior to removal of the hydrogel/biogel.

Treatment

• Treatment may involve injection of hyaluronidase 24 hours prior to surgical extraction of the hydrogel product. 
• Surgical treatment would involve extraction/removal of the hydrogel either by direct excision of using the VASER liposuction machine.  Fat transfer may be involve to re-contour the deformity.

Emmanuel De La Cruz MD, PLLC