Lasers and acne?? Most people don’t know about this secret! If you have acne and either have tried many other treatments without success or just want to see results faster consider laser therapy.

I have to admit that I too believed Acne was directly caused by bacteria. As I hope to explain that is not necessarily the truth. What is true is that once the inflammation is present that lasers may give both adolescents and adult a chance for fast improvement minimal discomfort and no downtime.

There is no single factor that alone causes acne. Acne occurs when sebaceous (oil) glands attached to the hair follicles are stimulated. Sebum (oil) is a natural substance which lubricates and protects the skin. When skin cells mature, along with increases in oil production, it predisposes follicular openings or pores to become congested and blocked. This leads to gradual enlargement of the follicle, producing a bump. As the follicle continues to enlarge, the walls may rupture, allowing debris and normal skin bacteria access into the deeper layers of the skin causing inflammation and discomfort.

If the trapped oil gains access to the surface, the result is a “whitehead.” If the oil accumulates pigment (melanin) or becomes oxidized, the oil changes from white to black, and the result is a “blackhead.” Blackheads are not dirt trapped beneath the skin and do not result because of poor skin care. Some other terms that you may hear in regard to acne are:

• a papule which happens when there is a break in the wall of the follicle and white blood cells rush in and the pore becomes inflamed.
• a pustule which forms several days later when white blood cells make their way to the surface of the skin. This is what is generally recognized as a “zit” or a “pimple”.

As I had mentioned there is no direct link between acne and bacteria.

Propionbacterium Acnes (P. Acnes) is present naturally on the skin and usually causes no clinical problems. The problem begins when a follicle becomes blocked and the P. Acnes gets trapped under the skin and begins to multiply. As this occurs it causes inflammation and changes that cause acne eruptions.

As the initial redness and swelling progresses white blood cells enter the area attempting to clear the bacteria resulting in the formation of a pustule.

The treatment of Acne really depends on the stage at which you catch it. The best way to prevent acne is to keep your skin well cleansed and control oil production preventing the follicles from getting blocked. Unfortunately, this is not always possible and acne breakouts occur. Once this happens there are many different methods to try and some work better than others depending on the individual.

For the treatment of mild acne (whiteheads, blackheads, or pimples):

• Gentle cleansing with warm water and a mild soap, such as Dove or Cetaphil
• Applying benzoyl peroxide
• Applying salicylic acid

If these treatments do not work you may need a prescription for a mild Retin-A or a topical antibiotic.

For moderate to severe acne treatments with stronger medicines or a combination of therapies may be required. Deeper blemishes, such as nodules and cysts, are more likely to leave scars. These treatments may include:

• Using benzoyl peroxide
• Applying prescription antibiotic gels, creams, or lotions.
• Applying a stronger strength Retin-A.
• Applying azelaic acid
• Taking prescription oral antibiotics

One method that most people are not aware of is the use of lasers for the treatment of acne. Once the inflammation is present secondary to the trapped bacterial the use of a Pulse Dye Laser can show significant improvement, with minimal discomfort and no downtime, in as little as 48-72 hours. The science of how the laser treats acne is that the laser triggers a photo-porphyrin in the bacteria causing the bacterial to essentially self destruct. Porphyrins are proteins found in all living organisms . Some porphyrins, when exposed to light can act as a photosensitizer by absorbing light or laser energy and transferring that energy to oxygen molecules, creating highly reactive Singlet Oxygen, which is capable of damaging nearby cellular structures including cell membranes, proteins, and DNA causing cell death and in this case destruction of the bacteria. This leads to decreased inflammation and clearing of the acne breakout. This therapy may need to be repeated for optimal results and does not prevent future acne breakouts.

If you would like to learn more about acne treatments using the laser technology please give us a call at (703) 421-6000 to schedule a complimentary consultation.

In the hundreds of breast augmentation consults I have done one of the most common concerns made by patients is either they know someone who’s breast implants have become hard or they have read about it on the internet. The first thing to know is that the implants themselves don’t change from a liquid to a solid state, but a change has occurred in the body surrounding the implant. This could be capsular contracture.

Everyone who has implants placed in their breast, after surgery will form a capsule surrounding the implant. This capsule is scar tissue created as part of your body’s attempt to protect itself from a foreign object. In most cases the capsule surrounding breast implants is usually very thin and soft.

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The problem occurs when a capsule either shrinks or thickens causing the implant to feel hard. It is the surrounding tissue that feels hard, not the implant itself.

It this small percentage of people it may require additional surgery to correct the problem. The older implants had a higher occurrence of this problem. Today’s implants are much more improved and have a very low number of patients that may experience this hardening.

Although there is no one reason attributed to the formation of a capsular contracture, these are some possible reasons for this problem:

• Infection
• Seroma (fluid collection around the implant after surgery)
• Hematoma (blood collection around the implant after surgery)
• Placement of the implant above, rather than below the muscle
• Smoking, as it may decrease oxygen to healing tissues and delay healing or cause inflammation
• Injury
• Trauma

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There is no absolute way of preventing this complication but I strongly feel that breast massage after the surgery decreases its occurrence. I teach these exercises to every patient beginning as soon as their first post operative visit. There is also a medication that a patient can take for prevention.

If you have other questions regarding this topic please call us at (703) 421-6000 or Email us at wherebeautybegins@gmail.com.

When discussing breast augmentation with a perspective patient, I am commonly asked whether I prefer Saline or Silicone breast implants.

My initial answer is that I don’t have a preference except in a few circumstances.

In general I feel that Silicone implants are an advantage in breast
reconstruction and in women, who are thin, possibly never had children, and
have little or none of their own breast tissue. Saline on the other hand is
an advantage in women who have asymmetry in size ( uneven breast size) as
Saline implants can be adjusted at the time of surgery giving me a greater
ability to create a more symmetric appearance( a more even look) to the
breasts.

What is a Saline Implant?

Saline implants are come as empty silicone shells. Saline (salt water) is
used to fill the implant at the time of the surgery. Saline implants are
generally felt to give a firmer, slightly less natural feel compared to
silicone implants. They also have a high incidence of palpable rippling;
wrinkling that can be felt after the procedure. Should the implants leak the
saline is absorbed by the body and is of no danger to the patient. The
patient notices a difference in size and should make an appointment to be
evaluated for replacement of the implant.

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Silicone Implants

There is a long history behind silicone breast implants. Silicone breast
implants were introduced in 1963 and have gone through many changes in
shape, shell, shell texture and chemical make-up of the gel.
The first generation of silicone breast implants were made as a two piece
device glued together to form the implant shape. It came in three sizes,
small, medium and large and had a patch on the back of the implant to
encourage tissue in-growth to prevent unwanted movement of the implant.
These patches were problematic, occasionally causing tearing of the implant
and were subsequently discontinued.

The next changes in silicone breast implants came in the mid 70’s. The
changes included making the shells thinner and the silicone gel thinner to
give a more natural feel. The biggest problem was that the thinner shells
were more fragile and had a high incidence of leak or rupture as they aged.

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To combat these problems the implant shell was made stronger by adding a
coat of diphenyl silicone and the gel was made thicker and more cohesive
decreasing the amount of silicone bleed (the diffusion of silicone molecules
back and forth through interaction with the silicone shell). It has been
postulated that the greater the “bleed” of the silicone the greater the
incidence of capsular contracture.

In 2006 the FDA again approved silicone breast implants for cosmetic use
after an almost 15 year absence. There are only two companies approved to
produce these implants in the United States, Mentor and Allergen. The shell
is still made of two layers (dimethyl siloxane and amorphous silica) and the
gel more cohesive with greater cross linking to decrease gel bleed.

When it comes to safety silicone may be one of the most studied materials
today. There are over 35 studies from both the United States and around the
world documenting the safety of silicone gel. It has been accepted that the
silicone implants do not cause an increased risk of disease. It is well
accepted that the problems associated with breast implants, such as
infection, bleeding, asymmetry, capsule formation are related to the
surgical procedure or the patient’s biologic processes.

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Replacing Breast Implants

The most commonly discussed risks related to the placement of breast
implants include breast pain, changes or loss of nipple sensation,
infection, bleeding, scar tissue causing the breast to feel hard (capsular
contracture), asymmetry, leakage or rupture, and the need for additional
surgery. It is important to realize that all surgical procedures have risk
but that these risks can be decreased by going to a board certified plastic
surgeon and following all of your doctor’s instructions.

To find out more about Breast Augmentation and other types of breast surgery
call our office to schedule your complimentary consultation.

Peter Klainer, M.D., F.A.C.S.
Chrysalis Plastic Surgery, Inc.
46396 Benedict Drive, Suite 330,
Sterling, VA 20164
703.421.6000

www.wherebeautybegins.com
www.breastenhancementvirginia.com

The modern history of breast implants begins in 1962, with the first implantation of a silicone filled implant. For the first time in the history a silicone envelope filled with silicone gel was used in a breast augmentation. Since that time many improvements and changes have made Breast Augmentation one of the most common and safest of the plastic surgery procedures offered.

Saline implants are the most frequently used implants in the U.S. They vary in shell surface (i.e. smooth or textured), volume, shell thickness, profile, and shape (round or anatomical. Most saline implants are single lumen, and are filled at the time of surgery, thereby giving the surgeon more control at symmetry during the operation.

On November 17, 2006, the United States Food and Drug Administration (FDA) re-approved the use of silicone gel-filled implants. The new shells, improved silicone gel and overall structure of the implants make this a safe option for patients. These implants are filled during the manufacturing process and volumes cannot be changed.

The decision on whether to use saline or silicone implants is a personal one. Each has its advantages and disadvantages and these should be reviewed with your surgeon at the time of your consultation.

The time of the consultation should also be used to discuss other important issues related to your potential surgery. Common questions include the placement of the incisions, the position of the implants, and the recovery time needed following the surgery. There are three commonly used incisions for the placement of breast implants, at the base of the areola (under the nipple), in the inframammary crease (under the breast), and in the axilla (under the arm). Although I have used all of the incisions, I personally prefer the incision under the nipple for a number of reasons. First, it is centered on the breast and allows me the greatest access for symmetry and the creation of a natural appearing cleavage. Second, I feel it is the best healing of the three choices and third should there be a problem with the final appearance of the scar it is easily fixed and always hidden in clothing.

In regard to the position of the implant, i.e. above or below the chest wall muscle I strongly recommend the below the muscle placement. The most important reason has to do with mammography. Studies have shown that the submuscular (under the muscle) position of the implant causes significantly less interference with the accuracy of the mammogram. Other benefits include a softer, more natural feel and appearance of the implant, as well as adding some support to the weight of the implant thereby slowing the potential for sagging.

Breast Augmentation can also be done in conjunction with a breast lift. The combining of these procedures can enhance the overall results by improving the upper pole (top of the breast) appearance and often decreasing the amount of scarring required for the lift.

The recovery entails an average of 3-5 days off from work and I recommend no heavy lifting or upper body exercise for three weeks. After that time all activities can be resumed without restrictions.

Finally, when thinking about Plastic Surgery consider the following important factors: 1) is the surgeon board certified, 2) how experienced is the surgeon in the procedure you desire (how many procedures has he/she done) 3) is the surgeon able to answer all of your questions in a way that is easy for you to understand?

If you have addition questions please contact our office at (703) 421-6000 or visit our web site www.wherebeautybegins.com.

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Now let’s discuss SmartLipo vs. SlimLipo. SmartLipo was the first FDA approved laser lipolysis system in the United States. It has gone through 5 generations of improvements since that time to both enhance patient’s results and improve patient safety. The SmartLipo MPX, the laser that I use, is actually a state-of-the-art 2 laser system. One of the lasers melts fat through heat, while coagulating small blood vessels thereby decreasing bruising. The other laser get absorbed by water, 20% of the fat cell is water and 60-70% of the deeper levels of the skin is water. This means that the addition of this laser increases fat cell destruction and stimulates collagen and tightens the skin. This combination therefore not only makes the results of the fat removal more even and more effective but it also make the skin texture better and the skin tighter.

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SlimLipo claims to have a laser that is specific to lipids (fat). This means that the majority of the energy is absorbed by the fat cell and yes causes fat cell destruction. It also means that it is not well absorbed in hemoglobin (blood) or water and therefore is inferior in coagulating blood vessels and improving the skin when compared to SmartLipo.

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What are we really looking for in adding lasers to liposuction? I don’t believe it is to help us, the doctors melt fat so it can be removed more easily, rather it is an instrument that can improve and refine the result, as well as shrink and tighten the skin.

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If you believe in the science SmartLipo is the obvious choice when it comes to the use of lasers and Liposuction.

I have been doing Liposuction and using lasers for almost 15 years. When SmartLipo was introduced in 2006 it was an easy transition in combining these 2 techniques. I have been performing SmartLipo for over 3 years now and believe it is unique in the advantages it offers my patient compared to traditional liposuction methods. Having brought the procedure to the Virginia, Washington, DC metro area, as well as teaching nationally about this procedure I have seen how patients benefit in both results and in speed of recovery.

SmartLipo allows for the permanent removal of unwanted and exercise resistant fat with little if any “downtime”. In my experience it is safer and gentler than traditional liposuction and is done in my office under a local anesthetic. SmartLipo has shown success for areas including the abdomen, ‘love handles’, inner thighs, outer thighs, neck, chin and upper arms.

I was very excited when the SmartLipo MPX was introduced in 2008. It is the next generation of SmartLipo in that it uses 2 small, high-powered lasers to both melt fat and tighten skin from the treatment area. SmartLipo’s thermal (heat) energy produces a tightening effect on the overlying skin, plus coagulates the small blood vessels decreasing postoperative bruising. Skin tightening is a desired improvement seen with SmartLipo MPX which may also reduce the need for more invasive skin reducing procedures. Compared to traditional liposuction, FDA approved SmartLipo MPX results in:

• less bleeding
• less bruising
• less swelling
• less discomfort
• less downtime
• smaller incisions
• no stitches
• minimal scarring
• local anesthesia, not general anesthesia
  
  

My procedures usually take 1-3 hours depending on which areas are being treated. Most of my patients have told me that they are back to work and/or exercise within 2 days and often require minimal pain medication. Patients often resume normal activity, with the exception of strenuous exercise, as early as the same evening.

The SmartLipo MPX® laser is in extremely high demand. In addition, SmartLipo has been featured in People Magazine, Good Morning America, Today Show and Access Hollywood.