Mentor Worldwide announced the U.S. launch of the company’s Artoura Breast Tissue Expander on June 8, 2015. For surgeons who do breast reconstruction, the Artoura is the only expander that provides controlled pocket formation, which Mentor says allows for greater control during the first stage of two-stage breast reconstruction.

Brian Thornton, M.D., Ph.D., M.B.A., a plastic surgeon practicing in Louisville, Ky., and Mentor advisory board member, tells Cosmetic Surgery Times the breast tissue expander is an important option in breast reconstruction.

“While the options for breast implants have evolved notably in recent years, tissue expanders have seen limited and incremental design improvements. The [Mentor Artoura] Breast Tissue Expander represents a new level of innovation for breast reconstruction. It is the first and only expander with internal structural elements that provide precise and controlled expansion. This means more control for surgeons to help with achieving better results for patients,” Dr. Thornton says.

Related: Comprehensive breast center boosts process of care for reconstruction patients

Mentor has tested its expander under varying conditions, according to the plastic surgeon.

“A mechanical model was used to simulate anatomical stresses and measure dimensional distortion of the devices. Thorough benchtop testing was also conducted to verify the safety and performance of the device,” he says.

In This Article

Predictable Contours

Dr. Thornton’s Tip for Optimal Results

Predictable Contours

Dr. Thornton says Artoura’s built-in features help surgeons create predictable and desirable contours, while preventing unwanted dimensional distortion. The breast tissue expander simplifies breast implant selection and streamlines the implant exchange.

“A fixed lateral footprint allows surgeons to choose the expander that best aligns to the patient’s chest width, and limited expansion in the upper part of the chest (upper pole) helps to create a naturally contoured shape,” he says.

Related: Study assesses patient satisfaction: Single- vs two-stage breast reconstruction

While it’s a new technology and future use could reveal a subset of patients for which the Artoura provides less predictable results, Dr. Thornton says he is hard-pressed to find drawbacks to this technology as it relates to the breast tissue expanders preceding it.

“Unlike other expanders, the structural design controls expansion and prevents undesired expansion laterally and in the upper pole,” he says. “I cannot imagine any patient population that would not benefit from a tissue expander that minimizes expansion in unwanted areas.”

Dr. Thornton’s Tip for Optimal Results

Dr. Thornton’s Tip for Optimal Results

Dr. Thornton, who has experience using the Artoura, offers colleagues this tip for achieving optimal results. The breast tissue expander is available in two projections, which allows for a full profile at a range of fill volumes.

“When removing the air from the device prior to insertion, [Artoura] deflates in a very predictable way. Typically, when an expander is deflated, we have all seen the multiple folds, creases or ridges. All plastic surgeons have a belief that the fold should be inward or outward, etc, but likely the fold is simply an inconvenience and during expansion the device will unfold via the pathway of least resistance,” he says. “This is not so with [Artoura]. From the very first patient expansion, plastic surgeons might feel an increase resistance to expansion. This resistance is due the preferential lower pole expansion with minimal tissue stretch in unnecessary areas of the breast (i.e., upper pole, lateral or medial pole). Overall, the technique for insertion and use is very similar to currently available tissue expanders.”

Intense pulsed light (IPL) and oral isotretinoin (ISOT) are both effective in treating the effects of facial photoaging — but how does IPL stack up as a solo treatment against a combination of the two?

To find out, a research team led by Enrique Hernández-Pérez, M.D., of the Center for Dermatology and Cosmetic Surgery in San Salvador, El Salvador, conducted an open, randomized, comparative and descriptive trial involving 18 hispanic women with grades II- and III-level cutaneous aging.

Researchers divided the patients into two groups. Those in the first group underwent solo IPL treatment with an Alma Laser Harmony XL machine over five sessions with a two-week interval between each. Starting fluence was 12 J/cm², and was increased to 13 J/cm². The second group received the same number and type of IPL sessions, but the researchers added 20 mg of oral ISOT, three times a week for 10 weeks.

Two 3-mm punch biopsies were taken from the same site: the first just before the initial treatment, the second, three weeks after the study ended. Follow-up occurred six months after the study’s end. Controls were performed by the physician, a nurse (always the same one) and the patient herself. Two dermatopathologists were in charge of microscopic measurements and statistics.

Study Results

Study Results

Researchers found that combination treatment was more effective than IPL alone, clinically, microscopically and statistically.

The idea for the study came about by chance, Dr. Hernández-Pérez tells Cosmetic Surgery Times.

“We noted that patients under ISOT for acne, at the end of the treatment, not only experienced improved acne, but also showed facial rejuvenation, including normalization of skin color, improvement in wrinkles and betterment in skin turgency,” he says. “That took us to assess the use of ISOT in facial rejuvenation.

“A rejuvenated skin has been always the aim in many of the programs looking for facial rejuvenation,” Dr. Hernández-Pérez adds. “It’s possible to get that ‘refreshed’ aspect using a very low dose of ISOT for short periods of time — doses as low as 20 mg three times a week are enough to get it. It is also possible to combine ISOT with, among other procedures, IPL. In other published studies we combined ISOT with invasive and non-invasive surgeries.”

This study was published in the American Journal of Cosmetic Surgery.

Dr. Gary BreslowGary D. Breslow, M.D., was so bothered by inefficiencies of the patient consultation process that he began calling it the consultation conundrum.

The Paramus, N.J., plastic surgeon says he spent precious in-person time with people who were not candidates for procedures, who wanted something they couldn’t afford or who were simply doctor shopping.

“The consultation conundrum… describes the apparently universal yet seemingly unresolvable problem, where, as a cosmetic doctor, I have to waste a significant amount of time going through consultations with unqualified patients or consultations that go nowhere,” Dr. Breslow says. “It’s really just a description of the process, itself. The patients aren’t coming in to waste my time. The patients are coming in because they need information.”

In this Article

The Online Consult

Using Zwivel

But Is It Worth It?

The Online Consult

Today, Dr. Breslow is cofounder and CEO of Zwivel Online Cosmetic Consultations, a consultation tool, which, he says, solves the conundrum.

“This is a prequalification tool for both the doctors and the patients,” Dr. Breslow says.

The online tool Dr. Breslow helped to develop has two consultation-type options. The first is Zwivel Direct. With this options, doctors put the “start your consultation now” widget on their websites. Potential and current patients click on it and anonymously (using a user name) go through the consultation process. It’s much like what happens in the office, according to Dr. Breslow. Patients elect whether to answer questions about their medical histories, areas of cosmetic concern, treatment of choice, budget and more. If they want, they can upload photos — even videos.

“It’s all private and secure. It’s all HIPAA compliant and encrypted software,” Dr. Breslow says. “[It’s] mobile-compatible. You can do it from the iPhone or from the iPad.”

A patient then clicks send, which results in the doctor being notified that he or she has a new request.

“The doctor can reply with his or her recommendations and opinions and estimated fee. Or they can say, ‘I don’t think you’re a candidate at all for this procedure,” Dr. Breslow says.

Doctors can respond with their own procedure videos or before and after photos. The patients then gets a notification email that the doctor has replied to the request.

The result? The preliminary work — determining if what the patient wants and what the doctor is willing to do are a match — is completed before the patient sets foot in the office. 

The second consultation option is Zwivel.com’s Zwivel Search, where potential patients search for doctors, based on a few parameters, such as location and board certification, then go through the consultation process with up to five doctors they choose.

Using Zwivel

Using Zwivel

There is no cost for using Zwivel Direct Basic on individual practice websites, according to Dr. Breslow. The company is getting ready to unveil Zwivel Premium, which will incur a cost. With the basic tool, the patient can send the doctor a request. The doctor can reply, but that’s it. The premium version offers the option of more back and forth communication. Other perks with the premium version include the ability to save replies for future use, creating a library of consultation videos and responses, and allowing doctors to incorporate staff members, such as nurse injectors, into their replies, according to Dr. Breslow.

Zwivel.com hasn’t started charging doctors for listings for the search function. Right now, company administrators are populating the site with doctors who do cosmetic surgery. These doctors may or may not be signed up on Zwivel. If patients go on to Zwivel.com and search, the doctors they choose may not be signed up. But when that patient selects that doctor, the doctor gets a notification about the request and the option to activate a Zwivel account. Without activating the account, doctors can’t consult with potential patients.

“Ultimately, there will be a subscription fee for doctors. The doctors will be listed on Zwivel Search and will be able to see the request that comes in, but they won’t be able to reply to the request unless they’re Zwivel Search subscribed members,” Dr. Breslow says.

But Is It Worth It?

But Is It Worth It?

But the big question is, is it worth it?

Dr. Breslow says doctor feedback has been positive. When he does consults using Zwivel, Dr. Breslow says it takes him about four minutes, versus the 45- to 60-minute in-person consultation.

Not My Thing

Dr. Jonathan BermanJonathan R. Berman, M.D., a plastic surgeon in Boca Raton, Fla., didn’t know about Zwivel and agreed to check it out for Cosmetic Surgery Times. He signed up for a Zwivel account and says he’s unconvinced that the portal can effectively prescreen patients.

“Truly, there are different ways that different people get info about what they want, what surgery they are interested in...  There is a plethora of information on the web. Sure, it would be nice to have a platform that is the… authoritative voice for information. That is not a reasonable expectation. All in all, this platform is another type of ‘capture portal.’ It is entirely dependent on how active the practice website is,” Dr. Berman says.

For physicians to make it work, it’s important to respond to requests in a timely way, Dr. Berman says.

“I personally prefer in-office consultations. Quality plastic surgery is not a commodity. Every person is unique, as is their cosmetic desires,” Dr. Berman says.

Works for Me

Fort Myers, Fla., plastic surgeon Robert Brueck, M.D., uses Zwivel Direct and says the tool saves him time.

“It allows me to give a preliminary consult to a prospective patient pretty much anytime. Patients can send me some preliminary info along with photos, as well as what their needs and desires are. I can look at the info and see if it is reasonable and can at the same time give them a price range,” Dr. Brueck says. “They may soon realize the price is way out of their budget, hence they do not come in [and] spend 30 minutes in a consultation, which will waste their time and mine.”

Rejuvenation of the hand, particularly the dorsum, has garnered increased attention in recent years largely due to its unique aesthetic in the quest to anti-age. Experts have advocated various methods for achieving optimal aesthetic results.

Expanding on the approach to hand rejuvenation, Tommaso Agostini, M.D., and Rafaella Perello, M.D., both of the Department of Plastic and Reconstructive Surgery at Centro Chirurgico San Paolo in Pistoia, Italy, recently report on lipotransfer to the hand as well as the radial and ulnar aspects of the fingers, or what the authors refer to as “global” hand rejuvenation.

Drs. Agostini and Perello conducted a retrospective review of 22 women who had undergone global hand rejuvenation using lipotransfer. Aesthetic outcomes were assessed objectively by serial photography and subjectively by patient self-assessments.

Related: Structural fat grafting fills, rejuvenates hands

The study found that of the 22 patients, 21 indicated that they were “satisfied” or “very satisfied” with the procedure. Other plastic surgeons noted improvements in the aesthetic appearance of the hands after treatment. There were no reported major postoperative complications.

“The findings highlight the importance of structural fat grafting devoted to the rejuvenation of the hand, including the fingers,” Dr. Agostini tells Cosmetic Surgery Times. “We describe a new mini-invasive technique to enhance both the dorsum and the fingers, which have been neglected until now.”

Dr. Agostini says global hand rejuvenation should aim to restore volume and reduce skin laxity to reverse the signs of extrinsic aging.

“The fingers represent almost 50% of the length of the hand and should be included in treatments to achieve optimal aesthetic outcomes,” he says. “Our case series of 22 women who underwent this procedure reported full satisfaction without complications. The most important advantage relies in using tissue harvested from different sites of the  patient’s body, such as the abdomen, thus improving the donor site as well.”

The study was published in the August issue of Aesthetic Surgery Journal.

Using botulinum toxin type A injections for cosmetic purposes has become commonplace over the past couple of decades. According to the author of a new study from Italy, however, objectively measuring the procedure’s effectiveness poses something of a challenge.

Study author Maurizio Cavallini, M.D., a plastic surgeon in Milan, Italy, acknowledges that methods employed to evaluate the treatment’s efficacy are validated and reliable, but notes that they are usually based on subjective factors. He says an objective, quantitative scale is still needed.

Related: Researchers develop, validate lip fullness scale

Dr. Cavallini proposes an objective, fast and reproducible method to evaluate the severity of wrinkles with a three-dimensional imaging and texture analysis. In his study he used Digital Analysis of the Cutaneous Surface (DACS) to analyze cutaneous texture. Measures were taken in the glabellar area before and one month after injecting 15 units of Botox into each of eight female patients.

DACS was able to detect improvement in all cases. On average, static lines decreased by 12.4% and dynamic lines by 41.2%.

“The goal of the study was to offer a precise and objective evaluation of the improvement  of the glabellar lines — and of the texture of the skin — with botulinum toxin type A using a particular three-dimensional camera able to give the percentage of improvement both with a color, 3-D picture and with numerical graphics,” Dr. Cavallini tells Cosmetic Surgery Times. “This is very important in order to overcome the subjective scientific evaluation — which until now used a facial scale that is subject to the different sensitivities of physicians — and to offer a precise study of the onset of the toxin and its efficacy and duration.”

Dr. Cavallini says the results of the study will help surgeons better evaluate post-treatment asymmetry and/or the need to improve clinical results.

“From the patient’s point of view,” he adds, “this study offers the possibility of having a direct comparison between the pre- and post-treatment.”

The study appears in the August issue of Aesthetic Surgery Journal.

Breast augmentation with implants creates a weight imbalance that can cause spinal postural alterations and affect performance of certain simple tasks. Yet according to researchers in Italy, the effects of increased weight of the breasts on static posture after implant breast augmentation have not been investigated.

Thus, a team headed by Giovanni Nicoletti, M.D., of the Department of Clinical Surgical Diagnostic and Paediatric Sciences at the University of Pavia in Italy, recruited 40 healthy woman volunteers. They were asked to wear weighted breast implants — 800 g (1.76 lbs.), 400 g (0.9 lbs.) and 300 g (0.6 lbs.) — in a sports bra for six hours and 30 minutes, one day for each implant size, as they carried out daily life activities. Posture changes were assessed with the association of a physiatric clinical examination and a static-force platform analysis.

What They Found

What They Found

The researchers found that there was a significant increase in cervical lordosis after wearing 400 g implants. The alteration was stable between the 400 g and 800 g implants, indicating that the 400 g implant might be the load threshold that breaks the cervical postural physiologic balance. A significant increase in lumbar lordosis was seen only after the use of the 800 g breast implants. The static-force platform assessment demonstrated a worsening of the balance independent from the visual control with the use of 400 g and 800 g implants.

“Heavy breast implants proved to induce reversible alterations in the spinal curve, and 400 g is the cutoff for functional physiologic compensation in the short term,” the authors write. “Such a weight might be considered the safety limit for the use of breast implants for cosmetic purposes.”

The authors note that their study has “obvious limitations” and write that their findings would be significantly more relevant if they “could be correlated with actual patients to see whether there is adaptation over time.” They suggest that a new prospective study should be carried out on patients undergoing augmentation mammaplasty. “Such a trial would be best conceived in a multicentric setting, but we are afraid that it might not be so easy, as, to our knowledge, the cosmetic surgery units performing implantation with very large breast implants are likely to be outside the academic and research environment.”

The study appears in the August issue of Plastic and Reconstructive Surgery.

When it comes to focusing on the face, the lips take second only to the eyes. Perhaps this is why nearly every patient wants to know, should I have my lips done? Perhaps this is also why the so-called Kylie Jenner Lip Challenge — the act of sucking the air out of a glass cylinder to create fuller lips — made headlines earlier this year.

Crazy at-home attempts aside, there are plenty of ways patient can “preview” lip enhancement results, from mixing in a little cayenne pepper with Vaseline to using a volumizing product such as Dermelect’s new Smooth Lip Volumizer, both of which create temporary, superficial lip swelling.

Once your patients decide to enter the realm of professional lip enhancing treatments, however, the approach and technique are up to you:

• What are the parameters of her ideal lip shape?
• How do you quantify the outcomes?
• What if something goes wrong?

All valid questions, all of which can be explored and answered in content we've recently covered here at CST: 

Researchers define parameters of ideal lip shape

What makes lips attractive? Are there gender-related factors that determine so-called “attractive” lips? Results of a German study suggest that there are certain parameters that define the ideal shape of the lip and lower facial area for men vs women. READ MORE

A validated lip fullness scale

As lip-augmentation procedures become more popular, validated measures of lip fullness become more necessary for quantifying outcomes. LEARN MORE

Are lumpy lips normal after filler injection?

A recent RealSelf.com post described lip nodules and swelling that became painful and noticeable soon after injection. Here’s why this may have happened and why she was right to be concerned. DR. EMER ANSWERS

KISSES — 6 tips for lips

“I spend a lot of time trying to convince patients not to inject their lips. If they really want to do their lips, I tell them we must do the face, or they will look like a skinny, ugly duck." ~Dr. Heidi Waldorf  READ MORE

Can't find the answers you're looking for? Contact me with editorial suggestions. 

Dr. Grant StevensPlastic surgeon Grant Stevens, M.D., says he has tried everything to treat his patients’ cellulite. He estimates the devices (not to mention lotions and potions) have cost him close to $1 million during his 30 years in practice. It wasn’t until the last few years, however, that his money was well spent on a technology that not only works but also offers patients long-term results.

This device that appears to represent the new wave in cellulite treatment is the Ulthera (Merz) Cellfina System. The FDA cleared the technology in early August 2015 for the long-term improvement in the appearance of cellulite on the buttocks and thighs, with no loss of benefit for up to two years. That’s the longest the FDA has cleared any cellulite treatment. Dr. Stevens, who practices in Marina del Rey, Calif., is clinical professor of surgery at the University of Southern California Keck School of Medicine division of plastic surgery and has the first commercial Cellfina installation, says he has seen results lasting nearly four years and counting.

The type of cellulite treatment and results rival everything that Dr. Stevens has had to offer his patients with cellulite, he says.

“I’ve used Endermologie (LPG), VelaShape (Syneron Medical), SmoothShapes (Biocellulase), Velashape I, II and III, and I own two Cellulazes (Cynosure),” Dr. Stevens says. “Cellulaze works, but it costs so much money to run, it’s very hot, it has risks and complications and it doesn’t have longevity. All of my Cellulaze patients came back.”

The FDA’s nod is based on a prospective, multicenter US study of 55 patients who underwent a single treatment with the Cellfina System. According to the results, Cellfina improved the appearance of cellulite in 98% of treated patients at two years. Interestingly, noticeable improvement on the Global Aesthetic Improvement Scale (GAIS) was seen in 100% of treated patients at two years, according to a Merz press release.

“I’ve never seen cellulite improve over time,” Dr. Stevens says.

Photos courtesy Grant Stevens, M.D.

In This Article

Grading System for Patient Selection

Cellfina 101 

Grading System for Patient Selection

Dr. Stevens says proper patient selection for cellulite treatment with Cellfina and other devices is key to patient satisfaction, and he's created a grading system to help standardize the process.

“While using Cellfina and even prior to that with the other technologies I’ve used over the last 30 years …, it became clear to me that there were certain types of cellulite that were more amenable to Cellfina than others. With that in mind, we created a grading system of one through five,” Dr. Stevens says.

According to the plastic surgeon:

• 1 = cellulite-free
• 2 = wavy
• 3 = isolated pits, divots or depressions
• 4 = adjacent pits and depressions
• 5 = overall diffuse cottage cheese.

Patients who are not Cellfina candidates, according to Dr. Stevens, are 1s (they don’t need treatment) and 2s.

“Cellfina really does great when releasing the fibrous bands, so 3s, 4s and 5s have done the best; 3s and 4s (isolated and adjacent depressions) seem to be the absolute best,” he says.

While 5s get improvement from Cellfina, it’s a limited outcome. They might go from a 5 to a 3 or 2 so, it’s important to treat only patients with realistic expectations, Dr. Stevens says.

“I send home about a third of patients because they’re not great candidates or have unrealistic expectations,” he adds.

Photos courtesy Grant Stevens, M.D.

Cellfina 101

Cellfina 101

Cellfina is a novel approach in cellulite treatment.

“It’s a controlled subcision that has a proprietary suction applicator, which sucks the buttocks, skin and the fat into the applicator — stretching the fibrous bands and allowing the subcision blade to precisely divide those bands at either 6 mm or 10 mm,” Dr. Stevens says. The blade, itself, is the same as a 22-gauge needle — like getting a shot of penicillin. There are no stitches.”

While nonsurgeons might have a light learning curve when using Cellfina, use of the technology shouldn’t stress experienced surgeons in the slightest, according to Dr. Stevens.

The FDA clearance covers the buttocks and posterior thighs; however, Dr. Stevens says he has used the technology with success on cellulite on the lateral thighs, as well.

Procedure time ranges from 20 to 60 minutes. Patients need only one treatment. There is no pre-treatment, and post-treatment involves wearing something to compress the area, like yoga pants, according to the plastic surgeon. Dr. Stevens sends patients home with a dressing over the treated area because of potential oozing from the local anesthetic.

Dr. Stevens says he is in the process of publishing a study in which he and colleagues interviewed patients about pain and recovery post-Cellfina treatment.

“Over 90% of the people went out that night or had unrestricted activity the night of the procedure. The majority of them went to work or did their normal activity the next day. No one took narcotics. I have yet to write a prescription for pain meds,” he says.

Dr. Stevens asks patients who are on aspirin, to stop taking it two weeks prior to the procedure. He won’t do Cellfina treatment on patients who have bleeding problems.

One potential drawback is the device requires physicians use an $800 consumable with each treatment. But Dr. Stevens says that’s well covered in what women are willing to pay for a treatment that diminishes their cellulite for the long-term, as the price range is from $3500 to $6500.

The Cellfina System will be available to U.S. physicians in fall 2015.

Disclosure: none

Contact for editorial only: drstevens@hotmail.com

Looking for a patient information resource that addresses aesthetic skin concerns and also provides treatment options? Meet AesthetiPedia, a new website launched by Israeli medical-device firm Lumenis, which claims to provide information about the latest energy-based skincare treatments for common skin conditions such as pigmentation, hair removal and rejuvenation.

AesthetiPedia addresses everything from age and sun spots, acne scars, fine lines and wrinkles to unwanted hair, stretch marks, scars, leg veins and rosacea, among others. The site also offers information about treatment options including intense pulsed light (IPL), non-ablative skin resurfacing and hair reduction, and includes skin-care tips from leading dermatologists on topics such as how to achieve a radiant complexion and the best way to protect skin against damage from the sun’s rays.

But what's in it for you? The site also features Find a Center, which enables patients to select the treatment they’re interested in and find a practice in their area where they can consult with a dermatologist or aesthetician. All you have to do is fill out an online form to request being listed.

“The website is a key information resource that we, as practitioners, can use to refer our patients to so that they can learn more about available treatments,” Sabrina Fabi, M.D., a San Diego dermatologist and cosmetic surgeon, tells Cosmetic Surgery Times. “As a practitioner, the website is very useful, as it really provides an overview of all the treatment options available. For patients, the resource serves as a platform to easily access information about the most suitable procedure for their skin concern.

“Additionally, patients can learn more about actual procedures, the time it takes, factors to consider post-treatment and, most importantly, they can see a range of before-and-after pictures. I encourage all skincare professionals to share this website with their patients.”

EAB Opinion

EAB Opinion

Cosmetic Surgery Times asked Medina, Ohio, dermatologist Helen M. Torok, M.D., a member of sister publication Dermatology Times’ Editorial Advisory Board, for her opinion of the new site.

“The website is user-friendly, informative and patient-oriented,” she says. “However, it is misleading in its statement that it offers information on the latest technologies — they should have stated the latest Lumenis devices. However, they are supporting their website so they can promote their own technologies and devices. But it does not encompass all devices on the market.”

Adam H. Hamawy, M.D., wanted to offer his patients more than a temporary fix to their isolated cosmetic problems. He wanted to create an approach that offered long-lasting and sustainable improvements in beauty and health.

Dr. Hamawy’s solution: a more holistic approach to patient care. One that includes not only a nip or tuck, but also help with diet, exercise and motivation.

The Princeton, N.J., plastic surgeon tells Cosmetic Surgery Times that the components of his proprietary system of care is something others can incorporate in practice. This is why and how Dr. Hamawy does what he does.

In This Article

A Holistic Philosophy

Healthy Guidance

The Payoff

A Holistic Philosophy

Like other physicians who offer patients cosmetic procedures and surgery, Dr. Hamawy’s goal is to help patients look and feel better about themselves. But, he says, he also wants results to last and makes it a point not to present plastic surgery as the only solution to their concerns. His goal is to package diet, exercise and plastic surgery as one patient care service.

“People try diet plans, and they fail, and they do exercise programs… and fail. And they do plastic surgery, which is only one part of the puzzle,” Dr. Hamawy says. “Any one of those by themselves doesn’t do the trick, but, when you combine them all together, you can have long-lasting results, look better and feel better.”

He says there are studies in liposuction that suggest the approach works. One survey of hundreds of liposuction patients by Rohrich et al., published December 2004 in Plastic and Reconstructive Surgery, suggests: “Successful body contouring surgery requires a patient to embrace positive lifestyle habits.”¹

Healthy Guidance

Healthy Guidance

Dr. Hamawy makes diet and exercise recommendations and coaches patients without partnering with other disciplines. It’s just something he does along with plastic surgery and procedures, he says.

He has become educated in other health and wellness aspects of life, in part, through his work in the military. Dr. Hamawy served as a Lt. Colonel in the U.S. Army, doing a tour of duty in Iraq and spending several years in Tacoma, Wash., at the Madigan Army Medical Center. He says his work in diet, exercise and wellness with military personnel and his own efforts at staying healthy help him to guide patients.

But the goal, Dr. Hamawy says, is to incorporate lifestyle changes that are based on individuals and are maintainable for the long-term.

He says he spends time before surgery, asking patients questions that help him to develop holistic approaches to their care. For a liposuction patient, he’ll ask why that person wants liposuction and what else they’ve done to lose weight. He’ll ask what they are eating, if they are exercising and offer pointers (and an ultimate plan) based on what hears.

“Someone … might be already exercising in the gym and I’ll say, ‘Listen, why don’t we add a cycling class a couple of times a week to what you’re already doing?’” Dr. Hamawy says. “[To] someone who is exercising but not dieting, I’ll say, ‘Rather than eating everything that you’re eating now and rather than going on a super diet program, why not just eat 2/3 of your plate or half your plate?’ [Or] ‘Drink a protein shake in the morning and in the afternoon keep doing what you’re doing.’ What I’m trying to do is stimulate is a lifestyle that is maintainable. I tell everyone that if you lose one pound every two weeks, that’s 26 pounds in a year that’s going to stay off.”

There’s a mental, or motivational, component, too. It’s more than a matter of giving patients a blueprint for how they can maintain wellness. Holistic care requires that providers stay in touch with patients. Dr. Hamawy says he already follows up with surgical patients. Why not ask them how they’re doing with the overall plan to stay healthy and beautiful?

The Payoff

The Payoff

This holistic approach takes more time and energy, but Dr. Hamawy does not bill for the extra time or dietary and exercise recommendations. He says he may consider billing for diet plans or selling shakes or other products in the future, but, for now, he thinks the approach leads to greater patient satisfaction and more referrals.

“I just feel like if you take care of patients, they see results that will last a long time. We don’t have to bill for every little component that we do. I think that just that extra touch that we’re currently giving makes us different than some of our other colleagues,” he says.

Reference:

1. Rohrich RJ, Broughton G 2nd, Horton B, Lipschitz A, Kenkel JM, Brown SA. The key to long-term success in liposuction: a guide for plastic surgeons and patients. Plast Reconstr Surg. 2004 Dec;114(7):1945-52; discussion 1953.

Contact for editorial only: drhamawy@gmail.com