Archive for March, 2009

Active FX and Deep FX: What Medication Will I Need?

Sunday, March 1st, 2009

I routinely give my patients a Vicodin and Prednisone (an oral steroid to help swelling)  immediately before their procedure and send them home with a prescription for 5 more of the Vicodin and 4 days worth of Prednisone. We use a highly effective combination of topical high dose Lidocaine and Tetracaine along with local nerve blocks and forced cold air for anesthesia during the procedure.  The skin may feel hot and uncomfortable for about 2-4 hours after the procedure. For this reason, I also send my patients home with two gel ice packs, which almost completely alleviates this discomfort.

Although swelling can be significant (especially with more aggressive treatments), there is only minor discomfort during the days following the procedure. Patient routinely tell me that they took a single Vicodin to sleep the night after their procedure and have not required anything stronger than ibuprofen after that.  Depending on the amount of swelling, oral steroids such a Prednisone are usually offered to the patients. Patients who have a history of cold sores should also be placed on antiviral medication such as Acyclovir or Valtrex.

SmartLipo: How long does it take to see results?

Sunday, March 1st, 2009

With SmartLipo you must be a little patient.  Swelling will starts to go down after about two weeks. If you start doing massage about twice a week 10-14 days after the procedure, you will likely see the majority of your swelling gone by about 4-6 weeks.  Bruising with the SmartLipo is normally minimal and any bruising that is present will normally resolve within 2-4 weeks.

To help reduce swelling and bruising even faster, try oral arnica (500mg three times a day).  Note that numbness over the treated area also last several months.  Remember, it really takes about 3-4 months to really see something close to final results, and your skin and soft tissue will continue to remodel for over a year. If you are still not happy with the results at 3-4 months, it is time to take to your provider about a possible touch-up.

SmartLipo: better results from wearing compression garment longer?

Sunday, March 1st, 2009

There is very little evidence that compression garments improve final outcome after any type of lipo.  That being said they definitely reduce swelling  if worn for the first couple weeks of surgery (if the surgeon uses open drainage).  They also tend to make patients more comfortable and decrease the likelihood of dizziness during the first few days after the procedure.
After about two weeks you have probably gotten the most use out of your garment that you are going to get.  In fact garments that are too tight can actually prolong healing times because they crush the tiny lymphatic vessels trying to take fluid and damaged tissue out of the wound site.  To get the best results make sure that you have close follow-up and start getting post surgical massage therapy about twice a week starting 10-14 days after your procedure.

Titan vs. Active FX for Skin Tightening?

Sunday, March 1st, 2009

Overall, the Active FX works better for skin tightening but both procedures have their advantages.  The Titan uses a non-ablative infrared light to heat dermal collagen and causes both collagen contraction and new collagen deposition which helps tighten the skin.  The Titan requires three procedures but there is little to no discomfort and zero downtime.  Patients can expect about 5-10% tightening after each procedure which last for 1-2 years.

The Active FX uses a CO2 laser to removal a small core of tissue (about 1 hair thick) which literal decreases the amount of skin. During a face lift approximately 30 square cm of skin are removed, during an Active FX procedure approximately 20-25 square cm of skin are removed.  There is also a significant thermal effect from the Active FX which causes the tissue around the removal site to shrink and also stimulates new collagen deposition. Although there is very little discomfort most patient prefer to take between 5-7 days off before returning to social activities. A single Active FX treatment can tighten tissue from 10-35% depending on the aggressiveness of the treatment. Results last several years.

What should I expect from Active and Deep FX are Milia Common?

Sunday, March 1st, 2009

We were one of the first offices in the country to use the Active and Deep FX lasers and milia are fairly rare if you use the right post care ointment.  Immediately after the procedure the skin will be very hot for about 2-4 hours.  The skin may ooze for about 24 to 48 in any areas that have been treated with the Deep FX. 

You should cover the treated area with an occlusive ointment like Silkses (less milia and acne) or Auqaphor.  You may notice mild to significant swelling, especially around the eyes.  The more aggressive the treatment, the greater the swelling is likely to be.  In many cases we put our patients on prednisone (oral steroids) to help decrease this swelling.  Most swelling starts to significantly improve by about day 3. During this time you can wash your face with Aquanil (cuts the grease of the ointment well) and/or one tbsp plain white vinegar to 1-2 cups cold water.  The water/vinegar combination is weak ascetic acid and will act as an antibiotic and sooth the skin. 

You may also notice some minor itching, if itching is more than mild and not controlled with Benadryl, Claritin or Zyrtec call you doctor as this can be a sign of dermatitis or infections.  If you have a history of cold sores you should be taking an antiviral such as Valtrex or Acyclovir.  Some patients do get breakouts after a few days of having the occlusive ointment on their skin.  This is also were the milia can come into play.
Somewhere between day 5 and 7 you should be able to start back with mineral make-up and stop the topical ointment. After a week or so the Active FX areas will look pretty normal but you will likely be pink in the areas of the Deep FX for at least two or three more weeks depending on how aggressive your provider does the procedure.