Specialities
Plastic Surgery
Facial rejuvenation with radio waves
Performed by means of a high-frequency (4MHz) radio-wave apparatus, this procedure is based on the radio-waves’ potential to convert energy into heat as they pass through the skin and subcutaneous tissue. During the conversion, which occurs as a result of the tissue resistance, the electrodes and the tissue itself remain unheated.
How does it act?
As it passes through the skin layers, a stream of radio-waves exerts its effect only on the collagen and elastic tissues of the dermis, which initially responds by intense contraction. This mechanism best explains the immediate effect of the procedure. The true effect, however, is seen 7 days later, when the tissues relax, with the simultaneous expression of the fibroblastic gene responsible for the intensive synthesis of collagen and elastic fibres in the treated zones.
Course of the procedure:
This procedure does not require the anaesthetization of the treated region and it is performed in outpatient conditions, which means that the patient can leave hospital immediately after the procedure and resume his or her regular activities. The procedure is carried out by means of special electrodes with 5, 10, 15 and 20-mm diameters. In order to protect superficial layers of the skin, special gel is applied prior to the treatment. Apart from sensations of slight tingling and pleasant warmth, no other sensations are felt during or after the procedure. The average duration of the treatment for the face and neck regions is 30 minutes. Rather than a series of sessions, the procedure involves a single-step treatment which is performed once a year in younger patients, or 2-3 times a year in the elderly. This technique significantly reduces the signs of ageing on the face, whereas in the younger patients it prevents the skin from sagging.
Contraindications:
Visible skin diseases call for a previous dermatologist consultation.
Lip Augmentation
The aim of this procedure is to render the lips full and fresh appearance. These highly mobile structures consisting of soft and elastic tissues must not be compromised by a procedure which is intended to establish a harmonious balance on the face.
Before Surgery:
That harmonious balance is achieved using various natural and synthetic materials. Each of them has its advantages and drawbacks. Natural materials include the patient’s own fat, dermis, fascia or processed skin parts of other persons. The advantage of these materials is reflected in their good tolerance and absence of allergic response. However, ultimate results of the use of these materials are hard to predict. The use of natural materials sometimes gives short-lasting effects beacause the body tends to resorb these materials, which may result in the need for repeated procedures. Synthetic materials are available in gel or solid forms. They occasionally cause allergic reactions or intolerance and rejaction by the body. Tendency to allergic reactions may pose an obstacle to the use of this kind of materials.
During Surgery:
The procedure is carried out under local anaesthesia, and its duration depends on the kind of the material used. If the patient’s own fat is used as a filler, it is previously taken from certain parts of the body, then prepared and eventually inserted into the lips through tiny incisions in the lip corners. Synthetic fillers do not require previous preparation.
After Surgery:
Since this is an outpatient procedure, the patient can go home almost immediately after the surgery. The lips are moderately swollen. In order to reduce the swelling, cold dressings are recommended during the first few days following the surgery. The swelling gradually goes down in 5 to 7 days. The procedure involves certain risks of lip asymmetry, scarring or changes in sensation. In some cases, synthetic fillers are felt as tiny knots when the lips are pressed with the fingers. When natural fillers are applied, their excessive resorbtion by the body may indicate a repeated procedure.
Smartlipo
How it works: :
SmartLipo is a short-wave Nd:YAG system used for laser liposculpture (laser-assisted liposculpture). In classical liposculpture or liposuction, excess fat is sucked out through a canula that is commonly inserted in the subcutaneous tissue. Fat cells are removed from the subcutaneous tissue with a canula attached to a vacuum pump.
Interstitial laser lipolysis was introduced in 1999, as an auxiliary procedure in liposculpture techniques. It enables the reduction of localized fat deposits owing to the laser-induced destruction of the fat tissue. Actually, the Nd:YAG laser system has a specific wavelength which causes the rupture of the fat cells (adipocytes) membrane, thereby transforming it into an oily structure which is instantly resorbed and eliminated in a natural way (the process would more correctly be termed as laser adipocytolysis).
Once the treatment has been completed, the fat tissue is more compact, evenly contoured and with fewer lumps. Its shape is improved from day to day, with stable results being achieved within 20-30 days. Moreover, there have been reports that, compared to classical liposuction, the recovery period and undesired side effects (bruises, swelling, bleeding) are reduced by around 50%. Additionally, the final product of laser radiation can be aspired with a tiny canula 3mm in diameter, under a pressure lower than that in standard liposuction procedures, which results in less harm to the tissue. This is better than leaving a lipolysate in situ, since the outcome is thus not affected by the patient’s metabolism and final effects are achieved sooner.
Interstitial laser lipolysis is convenient for the treatment of all forms of fat deposits localized on various parts of the body, and its final result is a smoother contour of lumpy and cellulite-affected surfaces. SmartLipo and Laserlipolysis have a number of advantages, because they:
- Are less traumatic and less invasive;
- Can be done in outpatient conditions;
- Require shorter recovery periods and less bandaging;
- Enable simultaneous coagulation of blood vessels with slighter blood loss;
- Allow for the evasion of the removal of the laser-treated fat, if the patients wishes so;
- Enable simultaneous decontamination of the region treated owing to the laser rays’ sterilizing effect;
- Enable the treatment of regions which have so far been considered inconvenient for standard liposuction, e.g. the face, forearms, upper abdomen and knees.
Some of the most important SmartLipo features are shown in the table below:
| Technical features: | |
| Laser type | pulse Nd:YAG |
| Wavelength | 1064 nm |
| Pulse (wave) energy | up to 150mJ |
| Pulse duration | up to 200 microseconds |
| Frequency | up to 40Hz |
| Focusing (targeting) ray | HeNe laser 1mW (632.8nm) |
| Cooling | Air |
| Electricity supply | 230V singl phase, 50/60 Hz, 4A max |
| Control board | Color Touch LCD screen |
| Dimensions and weight | 68cm (H), 65cm (D), 23cm (W), 38kg |
Where does it work?
SmartLipo can eliminate up to 250 ml of fat in a single session. For volumes up to 500 ml, repeated treatments or mild lysate aspirations are indicated. Volumes above 500 ml call for combined SmartLipo-standard liposuction procedures. Lipolysis can be applied to all parts of the body.
Technique:
The use of SmartLipo involves the following steps:
- Marking of the region that will be treated;
- Injection of an anaesthetic solution into the region due be treated, through tiny openings in the skin;
- Laser emission through a thin canula with optic fibre, through the same openings in the skin. For each body region there is a recommended quantity of energy that should be applied. The recommended energy levels are controlled through an accurate use of known parameters (frequency, duration, energy).
Recommended times of laser emission are the following:
| Total energy (J) |
Treatment duration (min) (settings: 150mJ, 40Hz) |
Treatment duration (min) (setting:150mJ; 20Hz) |
|
| Gluteus | 5040 J | 14 min | 28 min |
| Arm | 4320 J | 12 min | 24 min |
| Abdomen | 2520 J | 7 min | 14 min |
| Hips | 3600 J | 10 min | 20 min |
| Knee | 2880 J | 8 min | 18 min |
| Neck | 1440 J | 4 min | 8 min |
After surgery:
- Elastic compression: moderate elastic compression (70-100DIN) is recommended during 1-2 weeks. Depending on the region that has been treated, different elastic garments are worn – stockings, corsets or bandages.
- Wide-spectrum antibiotics are applied over a brief period following the treatment.
- Lymph drainage is applied during 7-12 days following the treatment (through manual or Triactive massage)
- More aggressive massage (e.g. LPG) should not be applied before the lapse of 4-5 weeks following the treatment.
Scars correction
Any damage to the skin integrity results in scarring. Scars, as inevitable marks left on the body after open injuries, deep burns, skin infections and surgical procedures, can be more or less visible, with or without functional consequences. Not all people are equally prone to scars. Likewise, rough and prominent scars are more likely to be formed on some body regions than on others.
Before surgery:
Scar corrections can be made for aesthetic or functional reasons. It should be noted that there is no surgical technique that can thoroughly eliminate scars. These unsightly marks on the skin have a long period of maturation – between several months and a year – and therefore any corrections should be postponed until the completion of that process. Exceptionally, some scars can be treated before that period for functional reasons (on eyelids after burns, on finger joints etc.). In patients prone to keloids, there are always risks of their recurrence after surgery, even when additional measures are applied (corticosteroid ointments or injections, compressive bandages, radiation).
During surgery:
Several scars correction techniques are applied in plastic surgery. The simplest procedure involves the excision of the scar and joining of the wound edges. This technique can be applied when there is a sufficient amount of the surrounding tissue. In recent times, sticking silicone plaster has been used to cover the wound after the removal of threads, over a period of 3-6 months. However, this plaster is ineffective in the treatment of old scars. In scars which pull back the surrounding tissue thus causing functional limitations, the so-called Z-plastic is most commonly used in order to divert the scar direction and release the tension.
In scars where part of tissue has been lost, the insufficient skin covering can be compensated by the patient’s own skin transplants. The effects of this technique are often unsatisfactory due to the variation in the colouring of the transplanted skin. Prominent skin losses can also be treated using the skin stretching technique, which involves the insertion of a silicone baloon into the healthy tissue beside the scar. As it is periodically filled with a physiological solution, the ballon gradually gets bigger. When the skin has been sufficiently stretched, the baloon is removed, whereas the scar is cut out and substituted by the stretched skin.
After surgery:
Fresh scars should not be directly exposed to the sun over a several months’ period. A range of preparations (ointments and gels) are available for the reduction of scar visibility, yet their effects are uncertain.
Removal of small tumours from the face and body
