Every new patient that comes into the office presents a unique challenge. What’s the best treatment to create the results that the patient is looking for? Is it skin tightening, spot fat reduction, or liposculpting? Would a transfer of fat from one location to another provide a double benefit? Is the issue a stubborn bulge or loose skin? How aggressive does the patient want to be?

As physicians, our patients rely on us to help them achieve their individual goals. In order to address each patient’s needs, we must offer a suite of treatments, with a range of technologies. VASERlipo™, Liposonix® and Thermage® (Solta Medical, Inc., Hayward, CA) provide the range of treatment options that our patients demand.

VASERlipo: beyond liposuction

The main challenge we have as surgeons is to provide optimal results, but it is important that the tools allow us to achieve these goals. Suction‑assisted liposuction is a widely used procedure that produces excellent outcomes for patients. The advent of VASERlipo provides us with additional capabilities to perform either large volume liposuctions, or sophisticated high-definition procedures.

Building on standard tumescent liposuction techniques, the VASERlipo system uses ultrasound vibration delivered through thin probes. VASERlipo goes beyond what one would expect from a traditional or laser based liposuction procedure. The ultrasound energy gently dislodges fat cells from the tissue matrix while maintaining their viability. The fat is then easily removed using patented atraumatic cannulae and a precision aspiration system, reducing pain and bruising. Clinical and laboratory results have shown that the fat removed using VASERlipo maintains over 80% viability1, and is typically in cell packets of 1 mm in size2, so it is ready for autologous fat transfer. This small packet size is the key to improved revascularization upon re-injection, in most cases producing more predictable, long‑lasting results. With a range of ultrasound probe and cannula designs, the VASERlipo system can handle a broad range of treatment areas, from larger-scale debulking in the hips, waist, thighs, back and buttocks, to more detailed sculpting of the abdomen, ankles, arms, chin and face. Thus, VASERlipo provides us with a superb body sculpting tool.

Figure 1

Figure 1 VaserLipo treatment with VASER Hi Def. (A) Before, (B) 6 months post-treatment, and
(C) 1 year post-treatment (Images courtesy of
Dr Alfredo Hoyos, MD)

VASERlipo Hi Def truly sculpts with fat (liposculpture). The technique allows surgeons to work as artists, creating a sculpted, athletic appearance on almost every region of the anatomy by selectively removing fat around muscle groups to give a more defined appearance. With the proper anatomical and artistic knowledge, any surgeon can reproduce the aesthetic results that both patients and surgeons want.

Liposonix: focusing on problem areas

Figure 2 Treatment with Liposonix (A) before and (B) 12 weeks post-treatment, showing a 4.05 cm reduction (Images courtesy Solta Medical Aesthetic Center)

Figure 2 Treatment with Liposonix (A) before and (B) 12 weeks post-treatment, showing a 4.05 cm reduction (Images courtesy Solta Medical Aesthetic Center)

Trim, fit patients who present with localized stubborn fat pockets that resist diet and exercise, or who prefer a completely non-invasive approach, are candidates for Liposonix. We have found Liposonix to be particularly useful for the lower and mid abdomen and love handles. Those with medium-sized areas of fat tend to do the best, but both small and larger patients can be treated. By using high‑frequency focused ultrasound, energy is transmitted to a very confined region (1.3 cm below the skin’s surface), where the subcutaneous adipose tissue is heated to the point of complete thermal cellular disruption. As an added benefit, heating the collagen in the subcutaneous layer causes it to contract and thicken, which improves the appearance of the overlying skin. Patient discomfort is reduced by using lower fluences with multiple stacked pulses3. The treated adipose tissue is cleared, and the entire treatment zone is resorbed, within 8–12 weeks.

Thermage: the plus factor

Figure 3 Treatment with Thermage (A) before and (B) 3 months post-treatment. (Images courtesy of Solta Medical Aesthetic Center)

Figure 3 Treatment with Thermage (A) before and (B) 3 months post-treatment. (Images courtesy of Solta Medical Aesthetic Center)

If the patient’s concern is mostly with the appearance of wrinkles or loose skin, then we often recommend Thermage. It is a monopolar, capacitively-coupled radiofrequency (RF) system that uses an inverse thermal gradient to non-invasively smooth and contour. The RF energy produces volumetric bulk heating within subdermal tissues, and causes three-dimensional collagen contraction and long-term collagen remodelling. This tightens the skin ‘from the inside’, resulting in a noticeable improvement in appearance. Results often tend to evolve over the first 4 weeks, and continue to improve for up to 6 months.

We have seen efficacy increase dramatically over the past 10 years. The latest generation Thermage CPT incorporates Comfort Pulse Technology and optional vibration, which significantly increase patient comfort4. Pain is a thing of the past with Thermage. Topical anesthesia or other forms of oral/intramuscular sedation are no longer needed. Importantly, recovery is immediate, so patients are able to comfortably return to their normal routine after treatment.

Figure 3 shows how the skin tightening effect from Thermage can dramatically change a patient’s appearance in just one treatment. Patient satisfaction, as well as consistency of results, has been superb with this latest generation of device and tip technology.

Providing solutions for physicians and patients

Patient satisfaction is often driven by how well the treatment and results match goals and expectations. We strive to provide patients with the best and widest range of options. The VASERlipo, Liposonix and Thermage platforms give us choices in meeting patient demands, and the control to craft treatments unique to each case.