Fat grafting is an important part of the cosmetic surgeon’s facial rejuvenating arsenal — it allows treatment of age-associated loss of facial volume not addressed by facelift surgery, according to San Francisco-based plastic surgeon Timothy Marten, M.D.

“Abundant clinical and scientific evidence exists confirming that fat grafting produces a persistent and worthwhile improvement,” Dr. Marten, founder and director of the Marten Clinic of Plastic Surgery. Fat grafting, he says, is an artistically powerful adjunct to a facelift that provides a more healthy, fit, youthful, sculptural and sensual appearance than facelift, alone.

“Fat grafting is often more important to rejuvenating the secondary facelift patient than the facelift, itself. These benefits may offset the drawbacks of increased operating time, some uncertainty of graft take and a longer period of recovery,” he says.

Dr. Marten, who presented on the topic of fat grafting yesterday during the Vegas Cosmetic Surgery and Aesthetic Dermatology 2016 meeting in Las Vegas, says traditional procedures to rejuvenate the face relied on skin resurfacing and, or, “lifting” ptotic facial tissues but did not address facial hollowing and atrophy, which are now understood to be important parts of the aging process. These, according to the plastic surgeon, are increasingly recognized as missing links in facial rejuvenation.

“Fat grafting allows us to treat atrophy (something we could not do in the past) and provides for a more comprehensive treatment of aging change,” he says. “And unlike temporary fillers, fat grafting results in an enduring change and an arguably more natural appearance as grafted [fat] actually integrates with facial tissues.”

Dr. Marten offers these 10 tips for getting started with fat grafting:

1. Acknowledge atrophy as a part of the aging change of the face and learn to recognize it.
2. Set aside unfounded fears perpetuated by those who don’t understand the need for the procedure or who are unwilling to take the time to learn it and do it.
3. Learn the basics of the fat grafting technique.
4. Obtain the needed equipment to properly harvest, process and inject fat.
5. Accept that fat grafting is a tool — not a guaranteed path to success. It will only be beneficial if carried out carefully and correctly.
6. Make the needed commitment of time in the operating room to properly perform the procedure.
7. Don’t underestimate the procedure’s technical and artistic difficulty.
8. Recognize that without artistic vision there can be technical successes that are aesthetic failures.
9. Make small additions at first to gain familiarity with the technique. Starting out conservatively will mean that problems, should they occur, will be minor and easily managed.
10. Follow up patients closely, critically analyze outcomes and find a way to do the next case better.

“Fat grafting comprises volumetric rejuvenation--not tissue tightening,” Dr. Marten says. “It’s autologous, produces a long lasting and sustained improvement, and, in addition, provides a ‘stem cell’ regenerative effect. For the first time, we may be truly rejuvenating tissue; not merely creating an illusion of it.”

Disclosure: none

The noninvasive procedures that cosmetic surgery practices offer — from laser hair removal and skin resurfacing to injectables — are often provided by nurses, nurse practitioners, physician assistants, laser technicians and other non-physicians. But the doctor, nurse practitioner or PA has to have some sort of supervisory role. That means doing an initial consult with these patients — sometimes, follow-up consults.

The question Alex Thiersch, a Chicago-based attorney and founder of the American Med Spa Association, addressed yesterday at the Vegas Cosmetic Surgery and Aesthetic Dermatology 2016 meeting in Las Vegas, is, Does telemedicine, Skype, Facetime or other virtual means of interacting with patients suffice?

Thiersch, who presented “Physician supervision: What about telemedicine, virtual consults, Skype, etc.” tells Cosmetic Surgery Times that it often becomes an issue when the physician, nurse practitioner or PA needs to see patients for noninvasive procedures that they’re not performing. But the law, in general, is that these advanced level practitioners should see patients at least once before treatment begins.

Whether or not these visits have to be done face-to-face (in the flesh) or by computer is not only on cosmetic surgeons’ minds, but also an issue that medical boards and states are closely examining, according to Thiersch.

“It’s is kind of the undecided question right now,” he says. “Some states are more lenient than others.”

The key for cosmetic surgeons is to check with their local healthcare attorney or state medical board to find out what the law requires.

“It often depends on the treatment and how invasive it is. But there are a lot of states that would allow a telemedicine-like consult after the doctor has at least seen the patient once but not the first time,” Thiersch says.

Thiersch’s advice? Until the laws are more settled, proceed with at least a little bit of caution and don’t practice in gray areas when it comes to virtual or telemedicine consults.

The final takeaway: “This is where nurse practitioners and physician assistants make their money because they can fill that gap between physician presence at the facility and supervision.”

Surgical options, such as the neck lift, facelift or platysmaplasty, still reign for optimal outcomes in neck tightening. But there’s good news. Nonsurgical options are getting better and better results, according to Jason D. Bloom, M.D., a facial plastic surgeon in Ardmore, Penn.

Dr. Bloom presented “Nonsurgical neck tightening: What has worked for me and what has not” yesterday during the Vegas Cosmetic Surgery and Aesthetic Dermatology 2016 meeting in Las Vegas.

Nonsurgical neck tightening is a big deal to patients, Dr. Bloom says.

“Last year, alone, if you look at RealSelf data, there was over a million page views for nonsurgical neck lift topics, like Ultherapy (Ulthera), Thermage (Valeant Pharmaceuticals), ThermiTight (Thermi)…,” he says.

Today’s options range from devices that heat tissue from the outside in to newer technologies that work from inside out.

Treatments that tighten neck skin from the outside in start with lasers and IPL devices, according to Dr. Bloom.

“The problems [with those options] are that results have been inconsistent and multiple treatments are needed,” Dr. Bloom says.

The next generation of devices includes transcutaneous or external contact radiofrequency, which includes Thermage, Exilis (BTL Aesthetics), ThermiSmooth (Thermi) and Pellevé (Cynosure). Transcutaneous RF devices tend to use lower energies and require multiple passes to heat up a large volumes of tissue. That leads to new collagen and elastin formation.

“The problem is, as a surgeon, I want to see results that are close to surgery or something that bridges the gap to surgery. In my opinion and in my hands, external radiofrequency (and I have a number of the devices) is not so incredibly sufficient to cause a ‘clinical change,’” Dr. Bloom says.

Micro-focused ultrasound, or Ultherapy, is the first mechanism that bypasses the epidermis to work on the deeper tissues. Ultherapy, according to Dr. Bloom, produces a “nice” change if one chooses the right candidate for neck lifting and tightening.

“People who need it the least do the best,” he says. “The more lines, or treatments, you do, the better the result. There are downsides: it’s not very comfortable. To get really good results, you need to start adding lots of lines, which is expensive both for the patient and doctor. I think the results are modest.”

NEXT: Microneedles, Microinvasive Technology

Microneedles, Microinvasive Technology

Dr. Bloom says he thinks that microneedles with RF were the first technologies to “shift the needle” in nonsurgical neck tightening.

“These are injectable microneedles that elicit radiofrequency energy or heat. And there are a number of different devices, including Infini by Lutronic, the Profound by Syneron Candela, Fractora by InMode and Intensif by EndyMed,” he says.

Some feature insulated needles where the energy is at the tip; others have needles that are not insulated and the energy is throughout. In essence, the microneedles elicit fractionated radiofrequency, allowing users to vary energy and depth. Patients usually need either numbing blocks or topical numbing. The result, according to Dr. Bloom, is significant new collagen and elastin and generally happy patients.

The most recent advance, and Dr. Bloom’s go-to nonsurgical device for neck lifting and tightening, is microinvasive technology. Under this umbrella is ThermiTight (Thermi), PrecisionTx (Cynosure) and a soon-to-be-released device by InMode. These devices have the RF energy in a cannula, which goes below the skin’s surface, completely bypassing the epidermis.

“You can tighten the soft tissue and muscle of the neck at higher temperatures, without getting a burn because you’re pushing that energy deeply,” he says. “I’ve gotten some amazing results with these [microinvasive] devices. And people love it because it’s one treatment and done.”

Dr. Bloom says he tells patients he might get a 10 to 15% improvement on neck tightening with Ulthera, but a 30 to 40% with the ThermiTight.

“Then, I tell them that neck lift surgery or lower face and neck lift surgery is 100%, so I price [ThermiTight] at about 30 to 40% the cost of my neck lift,” he says.

The great thing about all of these options is that they’re getting word out that neck tightening is possible without surgery, and patients are visiting cosmetic surgeons as a result of the buzz, according to Dr. Bloom.

Disclosure: Dr. Bloom is a consultant, trainer and is on the speaker’s bureau for Allergan Medical and Merz Aesthetics. He is a consultant and is on the speaker’s bureau for Alma Lasers. He is on the speaker’s bureau and is a trainer for ThermiAesthetics, ThermiRF. He is on the speaker’s bureau, is a consultant and clinical investigator for Zeltiq Aesthetics. Dr. Bloom is a consultant is on the speaker’s bureau, is a trainer and clinical investigator for Galderma. 

It turns out that fillers are not just for the face. Sabrina G. Fabi, M.D., a volunteer assistant clinical professor at the University of California San Diego, also uses cosmetic fillers off-label to enhance patients' necks, chests, hands, medial arms, abdomens and buttocks.

Dr. Fabi, who presented on the topic of fillers in non-facial areas yesterday during the Vegas Cosmetic Surgery and Aesthetic Dermatology 2016 meeting in Las Vegas, tells Cosmetic Surgery Times that cosmetic surgeons who use fillers off the face should consider diluting the filler products they use, depending on the areas they're injecting, to avoid lumps and bumps. "Non-facial skin is classically thinner and less forgiving," Dr. Fabi says.

Another tip, according to Dr. Fabi: "Consider using a 25-gauge cannula when injecting the hands and inject very superficially, as Lefebvre-Vilardebo M et al found that we are commonly injecting into tendon, when we think we are injecting subcutaneously.”

Dr. Fabi's preferred injectable is Poly-L-lactic acid (PLLA), at a 16 cc reconstitution, for the chest, and Radiesse (Merz), blended with 0.5cc of lidocaine, for the hands.

"I typically don't inject more than one vial of PLLA in the chest per treatment. And I split one 1.5 cc syringe of Radiesse blended with 0.5 cc of lidocaine to the hands to minimize swelling with treatment, and do a second syringe two weeks later. I prefer Belotero Balance (Merz), blended 1:1 for horizontal necklines and use a 25-guage 1.5 inch cannula," she says.

Non-facial filling is a trend, according to Dr. Fabi, because laser and energy based devices can only do so much.

"There is a component of volume loss that needs to be addressed to achieve optimal results," she says. "In California, it is popular, as people are in tank tops and shorts most of the year and non-facial sites are exposed, making patients more aware of the discrepancy that begins to exist between treated facial skin and nontreated non-facial skin."

Disclosure: Dr. Fabi is an investigator and consultant for Galderma, Merz, and Allergan.

Marketing is an added cost in a cosmetic surgery practice that most other types of medical practices don't have.

“Aside from equipment, supplies and employee costs, marketing can be a significant additional cost, and if you use a marketing agency, you have their fees on top of the actual marketing costs,” Jonathan Kaplan, M.D., MPH, owner, Pacific Heights Plastic Surgery, San Francisco, Calif., tells Cosmetic Surgery Times. “… doctors can find ways to tackle marketing in an organic way to keep costs low and even do it in-house, to avoid the agency fees. Keeping costs low is attractive to doctors with ballooning expenses.”

Dr. Kaplan, who presented on marketing on a budget today during the Vegas Cosmetic Surgery and Aesthetic Dermatology 2016 meeting in Las Vegas, shared four examples of inexpensive ways to effectively market a cosmetic surgery practice:

1.     Generate leads by using pricing info as the "carrot" or "hook" to attract your prospective clientele.

2.     Use an online scheduling platform — the kind that syncs to your calendar — to efficiently capture patients after hours.

3.     Offer online purchasing to capture leads and dollars. This includes the ability for people to make online purchases of non-surgical services, such as Botox and fillers. Patients make the purchase online, but come into the office for treatment. Cosmetic practices should also be able to sell products online that can be mailed to patients.

4.     Use email marketing, after capturing leads. The idea is to have 12 touch points during the course of the year with a monthly email newsletter to keep those leads thinking about cosmetic surgery and you as their cosmetic surgeon.

“… marketing on a budget is only a means to an end; not the end itself! As you build more traction with a low-cost marketing strategy and increase your revenue, you can gradually allocate more dollars to marketing through digital ads, TV ads or print ads,” Dr. Kaplan says.

Disclosure: Dr. Kaplan developed the lead generation-price transparency platform, BuildMyBod Health. 

In a short amount of time Cellfina (Ulthera) has become the gold standard for the release of cellulite dimples given its mechanism of action, safety data and patient satisfaction. It is the “go-to” tool that delivers lasting results for the treatment of cellulite, according to Norwalk, Conn.-based dermatologist Deanne Robinson, M.D., who is a clinical instructor of dermatology at Yale New Haven Hospital. Dr. Robinson presented as-yet unpublished data yesterday from the Cellfina multicenter study looking at the safety and effectiveness of a new precision release procedure to treat cellulite yesterday during the Vegas Cosmetic Surgery and Aesthetic Dermatology 2016 meeting in Las Vegas.

Cellfina, Dr. Robinson explains, is based on the concept of manual subcision. However, the device differs from manual subsicion by providing a precise, consistent and reproducible method to release the fibrous septae, which are the etiology of cellulite dimples.

“Cellfina accomplishes this via a vacuum-assisted tissue stabilized-guided subcision (TS-GS) platform, which allows for precise capture and release of the cellulite dimple,” Dr. Robinson tells Cosmetic Surgery Times. “Cellfina is a non-energy-based device, so it differs from all other ‘cellulite treatment’ devices on the market. It can be used on all skin-types without resulting in dyspigmentation or lasting hemosiderosis.”

The effect is long-lasting, Dr. Robinson says — longer than any other device on the market.

“It is currently FDA cleared for the long-term improvement in the appearance of cellulite on the buttocks and thighs for up to two years,” she says.

Study Results

Dr. Robinson presented the three-year data collected from the multicenter pivotal trial, on which she was an investigator. Two-year data was published in March 2015 in Dermatologic Surgery. But the three-year data has not yet been published. 

Key findings, according to Dr. Robinson, are:

• The multicenter study demonstrated a single treatment with the novel controlled tissue release system improved the appearance of cellulite on the thighs and buttocks for at least three years with minimal adverse effects.
• Cellulite severity, based on a five-point validated cellulite severity scale was reduced by an average of two points at three years. 
• Patient satisfaction is 93% at three years.
• Masked assessment is 97% for three years.
• Patients with noticeable GAIS (Global Aesthetic Improvement Scale) improvement is 100% at three years.

“Essentially, the study illustrated that a single 45-minute procedure resulted in marked and lasting results for the improvement of cellulite for up to 3 years with great patient satisfaction,” Dr. Robinson said.

Disclosure: Dr. Robinson was an investigator in the pivotal trial, which was sponsored by Ulthera. She is a speaker for Merz/Ulthera and serves on the Cellfina Advisory Board.

Reference:

Kaminer MS, Coleman WP 3rd, Weiss RA, Robinson DM, Coleman WP 4th, Hornfeldt C. Multicenter pivotal study of vacuum-assisted precise tissue release for the treatment of cellulite. Dermatol Surg. 2015 Mar;41(3):336-47.

Polydioxanone (PDO) threads are an excellent adjunct to a cosmetic practice for non-surgical tightening and lifting of the face and body, according to Kian Karimi M.D., a facial plastic surgeon who practices in Los Angeles and medical director of CosmoFrance, which is a distributor of NovaThreads.

“They are performed easily in the office and can produce an immediate lifting effect, especially in the face. The threads are dissolvable, so there are far less problems with the procedure than there used to be with non-dissolvable threads,” said Dr. Karimi, who presented on the topic of PDO threads for nonsurgical lifting yesterday during the Vegas Cosmetic Surgery and Aesthetic Dermatology 2016 meeting June 8 through 12, in Las Vegas, Nevada.

PDO is fully absorbed by hydrolysis within four to six months. But PDO stimulates collagen synthesis, which holds the skin structure created by the threads for 12 to 15 months, according to NovaThreads’ webpage for physicians (http://pro.novathreads.com/).

“We are in the midst of initiating a clinical trial to look at outcomes and longevity of PDO threadlifts, but do not have any data to report yet,” Dr. Karimi said.

Patient Selection

The doctor says there are important considerations for surgeons who use PDO threads for nonsurgical lifting. They should, first, select the right patients for PDO thread lift, setting reasonable expectations. The right patient, Dr. Karimi said, will have mild to moderate sagging of their midface or lower third of their face.

“Someone in their 30s [to] 50s is usually a good candidate,” he said. “It is important to assess the patient and discuss their expectations and the results that can be achieved from the procedures.”

Technical Nuances

There are technical nuances to achieving excellent outcomes and minimizing complications, which makes proper technique important. Among those nuances: All of the threads are placed in the superficial subcutaneous plane. It is important not to go too deep to avoid big bruising or injury to deeper structures, according to Dr. Karimi.

“It is equally important to not place the threads too superficially as there is an increased chance of irregularity and/or puckering of the tissues and potential extrusion,” he said.

Aging can result in detrimental facial expression changes associated with downward outlines, or negative facial vectors. These simple combinations of negative facial outlines just like ‘emoticons’ reflect universally understood facial expression, according to plastic surgeon Christian Drehsen, M.D., medical director of Clinique of Plastic Surgery in St. Petersburg, Fla.  

“My study, which was published in The American Journal of Cosmetic Surgery  demonstrates that facial rejuvenations inspired by the correction of detrimental facial expressions (my RefresherLift procedure) dramatically increases social popularity (the “Happy Emoticon Effect”),” Dr. Drehsen says.

Dr. Drehsen presented “The Life Changing Benefits of Expression Guided Facial Rejuvenation,” yesterday during the Vegas Cosmetic Surgery and Aesthetic Dermatology 2016 in Las Vegas.

Dr. Drehsen tells Cosmetic Surgery Times that this paradigm should help all practitioners involved in facial rejuvenation select and apply techniques from simple neuro modulators to fillers and surgical lift techniques, to positively improve facial vibrancy or dynamic, which he calls “facial fitness,” and reverse negative aging expressions.

“By inquiring about our patients’ deeper displeasure or frustrations regarding their perceived appearance and character, their proposed corrective plan of treatment will be better understood and accepted,” he says. “My RefresherLift approach effectively reverses negative facial vectors and their perceived negative expressions by the combination of my Dual Plane Brow Lift (affecting the eye expression), selective fat micro grafting (to restore youthful volumes) and the RefresherLift, a vertical facelift extremely effective in restoring the descended and delaminated cheek pads.”

These guided restorations safely and consistently help patients restore their self-confidence and popularity, help reverse discrimination related to aging appearance and improve wellbeing, according to the plastic surgeon. 

Patients undergoing eyelid surgery followed by intense pulsed light (IPL) therapy experienced decreased ecchymosis compared with eyelid surgery patients who had a postoperative sham treatment, according to a new study.

Researchers studied 28 patients undergoing bilateral eyelid surgery. Patients ranged in age from 44 to 80 years, and 86% were female.

The authors administered IPL therapy three times to the same randomly assigned side on postoperative days 1 to 2, 5 to 7 and 10 to 12. They administered sham light therapy on the contralateral side.

Patient and physician assessments revealed the change in ratings between postoperative days 1 to 2 and 10 to 12, in the treatment and control groups, was statistically significant for bruising severity. Patients indicated the change of the color of bruising was significant with IPL compared to sham.

“Despite some limitations in the study [such as study size], Dr. Wulc and collaborators have demonstrated what I believe may be one of the more useful indications for IPL therapy,” says Boca Raton, Fla., oculoplastic surgeon Steven Fagien, M.D. “I also fully agree with their review of other modalities that are continuously offered to patients without proof of effectivity, such as the use of Arnica Montana, which never has been proven to be beneficial to expedite resolution or prevent post-treatment ecchymoses, yet [is] commonly recommended.”

Read: Tips to avoid laser device complications

Dr. Fagien, who is not a study author, tells Cosmetic Surgery Times that there are still other energy device treatments commonly recommended to reduce bruising, which might work but have not gone through well-designed studies with controls. The assumptions on approaches other than IPL are mostly anecdotal and experiential. 

“Although many of us do not consider bruising a cause for concern for patients undergoing blepharoplasty (and since it is usually transient and short-lived), we tend to trivialize this common post-operative sequelae,” Dr. Fagien says. “Patients, however sometimes obsess over these sort of issues — particularly with bruising and swelling. Anything that can expedite this resolution could be a substantial benefit to our patients.”

More than two months into the much anticipated Cellfina (Merz Aesthetics) launch, we asked two cosmetic doctors to share their experiences with the FDA-cleared, minimally invasive treatment for cellulite.

This is what they had to say.

Dr. PalmDermatologist and cosmetic surgeon Melanie D. Palm, M.D., MBA, director, Art Of Skin MD, Solana Beach, Calif., and volunteer assistant clinical professor at University of California San Diego, says she treated her first dozen Cellfina patients as of May 2016.

The technology is remarkable, Dr. Palm says, but it does rely on good operator judgement, planning and technique.

"If the correct patient is selected, meaning a patient that is of stable weight, reasonably fit and has stubborn, discrete, dimple-like cellulite, the results are superb and quite visible even at a three-day follow up," Dr. Palm says. "Patients need good skin tone — too lax of skin is likely to yield less-than-ideal results. A younger population is better suited, especially those patients that remember having discrete cellulite lesions since early adulthood."

A poor candidate, according to Dr. Palm, is one who has subtle, wavy textural abnormalities on the buttocks and thighs, which are more attributable to skin laxity, and not discrete lesions of dimple-like cellulite. Those patients are better served by skin tightening modalities, according to Dr. Palm.

"Also, aggressive treatment of near adjacent lesions with too much overlap can create an unnatural result. I have not seen this in my own patients but have seen photos of others where this has occurred," she says. "… treatment in the banana roll is ill-advised. This is an extremely important anatomical structure and interrupting it is likely to result in an aesthetically unpleasing result. Again, I have not seen this in my own population but have seen results where over-judicious treatment was taken in this area. Lastly, patients that bruise easily and pigment easily (post-inflammatory hyperpigmentation) should be cautioned that bruising can be significant and its resolution slow. Encouraging these patients to avoid anti-platelet medications, and using topical or oral homeopathic remedies may prove helpful."

NEXT: A Steep Learning Curve

A Steep Learning Curve

Physicians who plan to use Cellfina should know there is a very steep learning curve, and Dr. Palm suggests that cosmetic surgeons should start treating patients soon after the comprehensive training by the company. 

"Cellfina in my hands is very easy," she says. "We have streamlined the experience so that patients are extremely comfortable. I mark the patient, my registered nurse helps with the numbing portion of the procedure, and I perform the release. I find the technology very easy to do, but the numbing can be a little time-intensive, and the company is working on adjustments to make that faster. The release itself is quite easy and quick for experienced dermatologic surgeons."

So far, patients at Dr. Palm’s practice have been extremely satisfied. She says she typically sees Cellfina patients for a 3-, 14- and 30-day follow up with long term follow ups at 3 through 6 months.

Patients often convert to other body procedures, including skin tightening with radiofrequency (RF), acoustic wave therapy and often to injectables or lasers that they learn about with exposure to Dr. Palm’s clinic. 

"I have a few patients that now are happy with the texture of their skin and now want to address a few spider veins so sclerotherapy is another procedure that sometimes marries well with Cellfina in improving the legs in general," she says.

NEXT: Marketing Insights

Marketing Insights

Dr. Palm’s practice is marketing the device. Among her marketing strategies: a practice event; internal marketing, including story boards of the practice on the practice’s flat screen TVs; web-sliders on the practice website; blog entries; and several appearances on local TV discussing the technology. 

"I also have put up several YouTube videos showing the various steps of the procedure, as well as adding to the discussion of questions surrounding Cellfina on RealSelf," Dr. Palm says. 

The Cellfina rollout was a little slow, at first, compared to Dr. Palm’s typical device roll out.

"…but I must say that some of the direct-to-consumer marketing that is starting to appear is helping the cause," she says. "In general, I think women are disenchanted and jaded when it comes to cellulite treatment. They've tried creams and devices that either don't work or have to be continued over time to yield a modest to moderate result. Demonstrating to the 90% of women that there actually is a device that remarkably and likely permanently alters the physical architecture of cellulite for long-lasting results will take time. Patient selection by physicians is paramount to the success of this treatment."

NEXT: Response Has Been Impressive

Response Has Been Impressive

Dr. SteigerBoca Raton, Fla., facial plastic and reconstructive surgeon Jacob D. Steiger, M.D., tells Cosmetic Surgery Times that he treated about a dozen patients with the device (as of the end of May). And patients are excited to learn about the procedure.

"Cellulite is a significant concern for over 80% of females. When patients learn about a technology that can help them, they call the office and request it by name," Dr. Steiger says.

Dr. Steiger says his practice has been marketing Cellfina with traditional public relations and internal marketing.

"The response has been impressive, Patients and media outlets are keen to learn more about the procedure and the results that can be achieved. Cellulite is a very hot topic today," he says.

Since the device is a minimally invasive procedure that is performed under local anesthesia, it’s performed only by physicians.

"From a technical standpoint it is similar in practice as performing tumescent anesthesia with some nuances," Dr. Steiger says.

Cellfina has been a hit at the practice, according to Dr. Steiger, with all patients to date reporting that they are extremely satisfied with their results from the time they leave the office. 

"Most patients drive themselves to the procedure and there is minimal discomfort after the procedure. The results are instant barring any swelling and bruising," he says. "It can take several weeks or longer for all the bruising to resolve. Patients definitely convert to other procedures such as Coolsculpting, Ultherapy and other plastic surgical procedures."

Words of Wisdom

"It is important to fully assess the patient's candidacy for the procedure. Cellfina specifically works on dimpled cellulite. Wavy cellulite will not respond well to Cellfina and is better treated with other modalities. Patients that have moderate to severe dimples of the buttocks achieve the most 'wow!' results," Dr. Steiger says.