Cosmetic Surgery Times - April 2009 - (Page 23) 23 april 2009 Good candidates for this procedure include nonsmokers in good general health, with localized areas of fat in the jowl area and under the chin, and who have good skin integrity. “ ” 57-year-old patient shown (left) pre- and (right) 3 weeks post-laser facelift procedure. the patient is still healing and Dr. mcmenamin notes that she will worsen before the final result. somewhat normal sensation in the area within the first week, Dr. McMenamin says. Good candidates for this procedure include nonsmokers in good general health, with localized areas of fat in the jowl area and under the chin, and who have good skin integrity. “The improvement on the entire jowl (to the oral commissure to the nasolabial line) has been exceptional” Dr. McMenamin notes. Whys and Wherefores Dr. uniform level of trauma. At least, this is our hypothesis.” Whatever the causation, Dr. McMenamin says, “It seems to be a little easier on the patient, and I’m able to get a slightly better result, specifically in the jowl, along the jowl line, and in the oral commissure and moving up nasolabial line.” This is something, he says, that he does not get with a regular facelift because the facial nerve is so superficial. “We are on our fourth generation of laser lipolysis,” but Dr. McMenamin notes that as remarkable as the new lasers are, experience at the helm is of paramount importance to good outcomes. He feels that he and his colleagues need to fine-tune the laser facelift technique, achieving uniform and consistent results, before they can disseminate that technique to their colleagues. toWards an soP There is a learning get a little bit of standardization of technique. Then we’ll design a study where we can test our hypotheses.” There are misconceptions to dispel, as well. For instance, he says, many surgeons ask how much energy to use. There isn’t one right answer, Mr. McMenamin notes. “In the skin on the face, we go to 38 degrees. Is this better than 37 or 39? No. Because it depends on what was done underneath (the skin) before you heat it. How much tumescent liquid you put in, how thick the skin was, how old the patient was, how much sun damage there was, the skin’s elasticity.” Dr. McMenamin and his fellow surgeons are working to define how and why this procedure seems to work so well. ‘hoW’ not ‘hoW much’ For one thing, McMenamin says that the true experts in liposuction, who have done thousands of procedures, all have personal techniques, yet can obtain similar results with the laser facelift. “All of us have our own approaches. Gerhard Sattler, M.D., Ed Lack, M.D., Tom Barnes, M.D., Jeff Klein, M.D., others — we get pretty similar results, even though there are countless confounding variables,” ranging from technique to individual patients’ responses. The limiting factor, he says, is “the template” — the patient. “Why are we using the laser? We think we are getting better skin contraction. We think we’re getting that because we’re inducing another level of trauma — in this case heat — a more curve for the technique, but Dr. McMenamin says, “I feel like I’ve figured a lot of it out. The issue is that most of us have evolved this technique separately — but to a very similar result.” So narrowing down a specific reproducible technique has yet to happen, although he feels that he and his colleagues are close in this collaborative effort. “We’re now trying to get the work codified, Dr. McMenamin says, “it’s not just delivering higher and higher levels of energy. It’s how you deliver the energy that’s important. There’s no magic out there. We’re inducing trauma in a physiologic system. And the question is, how do we apply that energy, and is the trauma that we induce specifically better than the past traumas?” � Disclosure Dr. McMenamin uses the Smartlipo machine. For more information http://www.renewyou.com/ http://www.renewyou.com/
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