RIT with PRP has been in the news as of late as many professional football and baseball players have undergone this treatment with excellent results. This is how it works: when a tissue is injured, platelets rush to the area to form a blood clot (everyone knows this) but additionally platelets release proteins that are directly responsible for the creation of new collagen. If an injured tissue does not fully heal, we are left with a structure that does not fully function and is painful. In order to restore function and reduce pain, we can inject PRP directly into the damaged tissue such as torn muscles, chronic tendonitis, whiplashed neck, arthritic joints, etc. This ‘tricks’ the body into thinking that it has undergone a new injury (but it has not) and this launches the body’s natural healing cascade to grow new collagen. Essentially, we get a second chance at healing. The result is regeneration of new connective tissue, restoration of function, and decrease in pain.

In November of 2008, I gave a lecture on the topic of RIT with PRP for the treatment of pain at an anti-aging medical conference in Dubai, U.A.E. At that same meeting, I saw on the roster a lecture titled “Platelet Rich Plasma for the Rejuvenation of the Skin”. I was fascinated as I had never heard of this but of course, the idea made sense; if PRP heals connective tissue of ligaments, joints and tendons, then it should heal skin as well. I knew I wanted to learn this therapy and offer it to my patients right away.

After the meeting, I spent time in the office of the presenter to learn the procedure. I discovered that the actual injecting technique is identical to French mesotherapy. Because I went to McGill University in Montreal and have lived in France, I speak fluent French. When I first learned of mesotherapy in 2004, I travelled to France to learn mesotherapy directly from the French Society of Mesotherapy (SFM) and since have conducted many training seminars, given lectures, written and translated articles and chapters, and taught for the SFM. All of this to say, learning to perform Dracula Therapy was an easy step for me.

Dracula Therapy’s mechanism of action is identical to RIT using PRP for musculoskeletal disorders. As the skin ages, there is a loss of collagen. This leads to thinning, sagging, and loss of elasticity. Injecting PRP into the skin triggers the growth of new collagen and the hands of time are turned back.

Upon teaching Dracula Therapy to a few of my colleagues, we collaboratively devised an administration method that dramatically reduces the pain involved with the procedure.

WHAT TO EXPECT

Dracula therapy has two main applications:
1. Filling in folds and creases much like a cosmetic filler (but a single treatment is much longer lasting – perhaps years). These injections are deep and leave very little bruising.

2. Rejuvenating thinning, sagging, less elastic skin anywhere on the body. I have found that while anywhere on the body can be treated (including the hands), the greatest improvement is found in the eyelids. These injections are more superficial and cause bruising that lasts a couple of days.

Once a patient has been deemed a good candidate for Dracula Therapy, his or her blood is drawn and placed into a centrifuge for 15 minutes. During this time, a numbing cream is applied to the face. When the blood is spun, the cream is removed, the skin is cleaned, and the PRP is injected into the desired area. Between the cream and my special preparation of the PRP with a very fast-acting and strong local anesthetic, the treatment is minimally painful. The area treated determines the amount of post-treatment bruising (deeper injections = less bruising, superficial injections = more bruising). Patients can then return to normal activities. Patients are advised, just as with PRP for musculoskeletal treatments, to avoid the use of non-steroidal anti-inflammatory medications such as ibuprofen as these agents block the platelet cascade.

After any bruising and swelling goes down after a few days, the patients face returns to normal. Minor if any improvement is seen. Then at about two weeks, minor improvement is noted. At one month to six weeks moderate improvement is present. At two to three months there is generally major improvement. Even at six months, improvement continues. If a second treatment is desired, I recommend a wait of at least three months because it takes that long to see the majority of the treatment. A treatment sooner may not be necessary. No one has been performing Dracula Therapy long enough to determine how long the effect lasts, but I have found that one year out from the treatment, the results do not diminish. Time will tell.

Harry Adelson ND
docereclinics.com

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The impact of scars can be very distressing, particularly if they are on visible parts of the body such as the face, neck, legs or arms. Recent surveys have shown that many people who have had surgery – both cosmetic and routine – were unhappy with the scarring left behind.

However prominent scars could soon be a thing of the past with the advent of several new approaches to minimising scarring.

Scarring is caused when both the top layer of the skin (epidermis) and the lower layer (dermis) are penetrated. However the amount of scarring that happens will depend on how well the skin responds to the issue and how well it copes with healing. The major factor here is collagen, a fibre-like protein which is a sort of glue to help the edges of the wound knit together. When the skin heals well, the edges of the wound are ‘glued’ together by the collagen in the skin helping the skin remain flat and making the scarred area as small as possible.

However, cells called fibroblasts, which are responsible for actually repairing the puncture, can go overboard and setup a new system of blood vessels to the scar area. This then causes too much collagen and this results in rigid lines and lumps and bumps around the wound. The collagen will sometimes ‘overflow’ leaving a rubbery scar over healthy skin tissue.

It is not fully understood why some cuts will heal better than others although good surgical practice, good genes and the location of the wound will all make a different to the way you heal.

So what can be done to help reduce scars?

Juvista is currently in the final phases of development and looks set to be one of the first scar prevention drugs on the market. Juvista is made from a naturally occuring human protein known as the transforming growth factor. Juvista is injected into the edges of the wound after surgery and this technique has so far shown to help reduce the risk of scarring. The injection works by helping the skin heal by weaving the edges together. It is anticipated that this drug will hit the market in the next three years.

Avotermin is another potential scar-reduction drug. Avotermin is made with a synthetic cell-signalling agent. Trials have already been carried out and the results have shown that using the scar prevention drug reduces the chances of scars becoming raised lesions or settling above the skin. This scar reducing drug also reduces the density and thickness of the skin that causes the scarring, helping reduce the appearance of the scar.

If you are going under the knife sometime soon, these developments are too far in the future. After surgery, try and keep your scars moist as this will help prevent scabs from forming. Scabs create a barrier to healing. By keeping the wound moist, you are keeping the collagen away from the surface of the skin and therefore helping to stop collagen overflow. Your cosmetic surgeon is likely to give you a dressing to help keep the wounds moist. Once this dressing has been removed, keep the wound moist by using a moisturising lotion around the scar. Moisturised skin helps wound-healing and ensures the collagen balance is kept even.

There is no need to use expensive creams or lotions either – products such as E45, baby oil, bio-oil or Nivea are all excellent moisturisers although do check you are not allergic to them before your surgery.

It is also worth gently massaging the scar for around a minute several time a day as this will help break the scar up. By massaging the area in a circular motion, you will help make sure the fluid in the skin is moved around and help stop the collagen from becoming lumpy and therefore help to prevent lumpy scarring.

If your scars are particularly prominent or raised, there are several options. Newish scars (scars that have formed within the last 18 months) can be treated with lasers, similar to the way that birthmarks are treated. The lasers target blood vessels that feed the scars, lessening the appearance of the scar. Several treatments are often required and each treatment is likely to cost around $200.

Older scars can be removed by further surgery however there is no guarantee that the resulting scars from the surgery will be any better than your current scars. For UK patients, large, old scars may be removed for free by the NHS, otherwise you will have to seek treatment from a private cosmetic surgeon.

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NewColorIris isn’t just for those who want to change their appearance – this implant can also be used to improve the ocular appearance of patients with partial coloboma (congenital defects of the iris), traumatic irides, ocular albinism and iris heterochromia.

The eye implant itself is a diaphragm that covers the eye’s natural iris. It is made from biocompatible materials that are currently used in cataract surgery, therefore is very safe. The implants themselves are manufactured in the US and are FDA approved, although the procedure is not yet licensed in Europe.

The iris implants are inserted under local anaesthetic and the whole process should be painless and only take a few minutes to complete. The implants do not correct eyesight therefore pre-operation eyesight will be the same as post-op and if you require glasses before the operation, you will require them after. The surgery can be performed on those who have astigmatism. Vision will be blurry for up to four days after the operation and during this period, antibiotics and anti-inflammatory eyedrops must be used.

Side effects can be severe though. A recent case highlighted in British newspaper the Daily Mail showed the story of the first person in the UK to undergo the coloured lens transplant.

After the cosmetic surgery, her eyesight remained bad and over a week later, she was barely able to read the top line of an optician’s eye chart – her sight was so bad that she officially could have been registered as blind. Fortunately, her eyesight was saved by a British surgeon however she now has a greater risk of cataracts and glaucoma later in life.

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Much of the trend is said to stem from Victoria Beckham. Pictures of her recently have seen her in tight black t-shirts with her nipples outlined in the top. The pictures have sparked debate over whether they are real or fake, and some people have chosen to have cosmetic surgery to get nipples like her.

Many women who are looking for nipple cosmetic surgery cite reasons that they want to improve their shape and appearance, particularly for occasions when they want to wear a t-shirt without a bra.

The term ‘nipple cosmetic surgery’ actually encompasses quite a range of different plastic surgery techniques. Some of the techniques available are:

• Nipple Lifts: Small flaps of skin around the nipple are made which then helps push it up and out
• Symmetry Surgery: Cosmetic surgery to ensure the nipples on each breast look the same
• Nipple Colour: The areola (the pigmented area around the nipple) can be evened out. The area can also be tattooed to even the colour or to change the colour.
• Inverted Nipple Correction: Some nipples can be flat or concave and refuse to protrude. This condition can interfere with breastfeeding. Cosmetic surgery can be done to correct this issue.

Naturally there are side effects associated with each of the nipple cosmetic surgery procedures. Any incisions are, of course, at a small risk of infection. The surgery can also cause the nipples to lose physical sensitivity if nerve endings are removed or damaged. A small number of women may also lose the ability to breastfeed.

The success rate of each of the cosmetic procedures will also vary. Inverted nipple surgery has quite a low long-term success rate with up to 50% of women saying that the nipples retract again within 2 months of having nipple cosmetic surgery. Weight loss or weight gain can also have a profound effect on the long-term effectiveness of the surgery.

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Both hydradermabrasion and microdermabrasion are aesthetic non-invasive techniques designed to help polish the skin, buffing away fine lines and wrinkles and helping the skin have a more youthful glow about it. Hydradermabrasion combines microdermabrasion with hydration techniques to help improve the skin tone even further.

Hydradermabrasion firstly helps to exfoliate the skin to help the skin become more smooth and uniform. A serum will be applied during the session so that it is absorbed deep into the skin to help the skin tone improve. Different serums may be used depending on the patient – some may use anti-ageing creams whilst others may plump for a skin rejuvenating serum. Those with acne-prone skin may opt for a Beta-HD serum, or perhaps an acid peel.

At just 20 minutes per session, it is possible to have hydradermabrasion during your lunch break. The treatment should have immediate benefits with fine lines and wrinkles looking reduced directly after the procedure has been completed. Hydradermabrasion also helps to remove dead skin cells and stimulate collagen production, whilst the serum aspect of the treatment ensures that the skin is fully hydrated.

After a session, patients should notice that any pigmented patches have lightened, the skin ton is more even, and the skin in general looks healthier, tighter and more toned.

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SmartLipo was launched in the UK in June 2006 and is a revolutionary evolution of the standard cosmetic surgery procedure, liposuction.

Often marketed as Laser Lipolysis or Laseripolisi (often misspelled Lipolisis) , the procedure works by using a laser to target fatty areas. The laser helps to break down the membranes of the fat cells, turning them into an oily liquid. This liquid is then either removed by suction, or through the body’s natural processes.

It is said that SmartLipo is far less traumatic on the body than the more traditional liposuction procedure with the operation involving almost no loss of blood. The heating action of the laser used in the cosmetic surgery is also thought to help tighten the skin by stimulating collagen production. SmartLipo is also said to cause less swelling and bruising than standard liposuction, ensuring a quicker recovery time for the patient.

How Does SmartLipo Work?

SmartLipo uses a 1064nm Nd: YAG pulsed laser. An anaesthetic is first given the patient – often, just a local anaesthetic is needed thanks to the small cannula that is used and the fact that the laser causes small blood vessels to coagulate on contact meaning almost no loss of blood during the operation.

A small incision is made in the skin around the area that the patient wished to have the fat removed from. A small cannula (tube) which contains a laser fibre is inserted into this incision. The cannula is then moved backwards and forwards to deliver the laser pulse to the fat cells. The laser causes the fat cells to rupture, and the fat can then either be drained via low level suction or with a syringe, or can be left for the body to dispose of naturally.

The results of SmartLipo will become apparent after a couple of weeks. If the surgeon has chosen to allow the body to dispose of the excess fat naturally, it may be several months before you see the full results of this cosmetic procedure. As long a sensible diet is maintained in the future, the results of the operation are permanent.

What Areas Can SmartLipo Treat?

Because the cannula used in the procedure is so small, many focused areas of the body can be targeted. As well as the ‘normal’ areas that liposuction can treat such as the stomach, thighs and hips, SmartLipo is also popular for treating:
- double chins
- under the arms (‘bingo wings’)
- knees
- calves
- hips
- outer thighs (‘saddlebags’)
- waist (‘love handles’)
- back
- bra strap area

What Are SmartLipo’s Side Effects?

Any operation has it’s risks, however because SmartLipo does not require general anaesthetic and because blood loss is kept to a minimum, it is generally seen as less risky than liposuction.

Some of the potential side effects of having SmartLipo include:
- Minor swelling, bruising and tenderness for a couple of weeks after surgery
- Infection and haematoma (where blood collects under the skin)
- Lop-sided results

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The surgery
Vaginal tightening surgery normally takes around an hour. Some patients will be given the full general anaesthetic whereas other will be give a local anaesthetic, sometimes also with sedation. This means that normally the patient will require an overnight stay in hospital.

There are several different methods that are used – some operations will use traditional surgical methods whereas others will use a laser. The actual operation normally involves joining the stretched muscle at the back of the vagina together and shortening it before removing any excess or unwanted skin. This reduces the amount of excess vaginal lining and tightens the vaginal muscles. All the scarring from the operation is in the vagina itself and should therefore not be visible.

After surgery, the patient may experience some discomfort and swelling for around a fortnight. Most patients will be allowed back to work within a week of surgery, although patients should avoid heavy lifting or physical activity for around six weeks. Sexual intercourse can normally be resumed around 6 to 8 weeks after the surgery.

As with any cosmetic surgery, there are risks involved. One of the main risks associated with vaginoplasty operations is that of the vagina being overtightened which can lead to urine retention.

It is important that you are completely happy with both your surgeon and the operation itself. Click here to see our free guide to choosing a good surgeon. If you have any concerns about either your surgeon or the operation itself, it may be worth exploring other options such as pelvic floor exercises that may boost your vaginal tightness without the need for an operation.

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Am I suitable for a nose job?
Most surgeons will not operate on people under 16 if it is ‘elective’ surgery because they want to allow the nasal bone growth to complete before intefering with the nose. For those with medical purposes such as breathing problems or injurires, age is not really a factor.

Scars
After the surgery, small burst blood vessels might appear on the skin’s surface. These will be permanent. If the rhinoplasty is done using incisions inside the nostrils, no scarring will be visible. Some rhinoplasty surgery will leave small scars at the base of the nose, particularly for surgery to reduce the opening of the nostrils. Sometimes a second procedure will be necessary to correct minor problems.

The surgery itself
Rhinoplasty can be performed under either general anesthetic or local – it depends on both the patience preference and the severity of the surgery. Some people will be able to go home the same day. More complex procedures will require an overnight stay in hospital. The surgery should only take a maximum of 2-3 hours. Most surgery will be done via an incision inside of the nostrils.

Post-Surgery
You will be able to go back to work after a week of rest. Any activity that increases blood pressure such as exercise should be avoided for a month. Direct sunlight should be avoided to help the skin heal. If you wear glasses, these will have to be taped to your face for about 2 months to allow the nose to heal fully. Full results may not be apparent for up to a year.

What are the risks?
- Reactions to the medications
- Problems breathing
- Bleeding
- Infection of the incision sites
- Bruising

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How does it work?
In the 1950s, researchers discovered that injecting overactive muscles with minute quantities of the botulinium toxin (type A) decreased muscle activity by blocking the release of a chemical, thereby rendering the muscle unable to contract for anything up to 6 months.

Why is it so popular?
Botox injections are one of the most popular cosmetic surgery procedures available today. In western culture, there is a quest by many to remain as youthful looking as possible. The appearance of wrinkles, which age the face, are a source of anxiety to many. By freezing the muscles responsible for these wrinkles, Botox eliminates or reduces these wrinkles without the need for cosmetic surgery. It is relatively painless, requires no lenghty hospital stay, is not an invasive procedure, and lasts for up to 6 months at a time.

What are the risks?
Botox is a poison. Botox may cause more muscles than the ones you want to freeze causing a portion of your face to ‘droop’. You may notice a tightness in your face or an inability to make certain facial expressions. You speech may seem tighter than normal.

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However, it will not be able to remove stretch marks on the mid or upper abdomen. If you have a thick layer of fat on your upper abdomen, a tummy tuck will not remove this.

Am I suitable for abdominoplasty?
If you have a lot of fat around your middle, your surgeon may not do a full tummy tuck because of the high risk of healing problems. Instead, he will probably perform a panniculectomy which removes skin and fat, but doesn’t tighten the girdle. If you have a smallish layer of fat around your lower abdomen, and you want your stomach flattened and excess skin removed, you are a good candidate for a tummy tuck. It is advisable to only have a tummy tuck when you have decided not to have any more children – more pregnancies may undo all the surgery work.

Is a tummy tuck better than liposuction?
If your skin tone is fairly poor, you have cellulite, and you need excess skin removed as well as fat, a tummy tuck would be the better procedure. If you just need fat removed, and your skin tone is good (so the skin will retract back with no excess skin visible), liposuction is the option you should go for.

Scars
You will have one scar which will extend across the lowest part of the abdomen and another scar which runs around the belly button. These scars should be hidden by a swimming costume. Most scars should heal fairly discretely.

The surgery itself
During pregnancy, the inner girdle – which extends from the rib cage down to the pubic bone and either side of the abdomen – is stretched. After pregnancy, the girdle may not regain its former shape, even though the stomach muscles are well toned. During surgery, the surgeon will tighten the inner girdle to make it flatter. Note that he will not touch the stomach muscles – these are below the inner girdle and will not be touched during the operation.

Post-surgery
Most surgery will be performed under general anesthetics but sometimes, it can be performed under heavy sedation. Surgery will take 1-3 hours and you will probably have to stay in hospital overnight. Depending on the extent of the tightening of the girdle, the pain will be moderate to severe so you will probably be prescribed anything up to one week of pain medications. You should not have any bruising, however your abdomen may be numb in places for anything up to 6 months. You will be able to return to work within one to two weeks, and you will also be able to start driving again. After a month, light exercise can be taken.

What are the risks?
Leg Blood Clots:This is more common in longer operations, and can happen in any surgery. You can reduce the risk of this my asking your surgeon to give you some compression stockings to wear if your surgery is going to last over 2 hours.
Skin death (necrosis): This occurs when then is poor circulation to the skin around the abdomen. This happens because the skin/fat layer must be separated from your girdle. Usually, there is enough circulation to the area to allow healing, but sometimes (particularly if you are a smoker or suffer from diabetes), the circulation is too poor to allow healing which leads to the skin dying.
Hematoma: This is a collection of blood underneath the skin. This occurs because of bleeding after the surgery. Most will clear up of their own accord, but if it is a large hematoma, more surgery may be required.
Seroma: This is a collection of fluid underneath the skin. Most surgeons will put drains underneath the skin at the time of surgery to prevent this. Sometimes, seromas will still occur. The fluid will be drained using a needle and syringe.
‘Dog ears’: These are puckers of skin on each end of your scars. The looser the skin, the more likely you will get dog ears on your scars. The dog ears can be removed under local anesthetic at a later date.

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