Liposuction and obesity

Liposuction is not a procedure to eliminate obesity, it is an operation that effectively removes locally accumulated fat (lower abdomen etc.). Many people misunderstand this as well as the general public, as well as non-professional physicians.

At the American Society of Plastic Surgery, liposuction is not recommended for people with a BMI index of 30 or more. Such a person must first lose weight with diet therapy. As liposuction for patients with a BMI of 30 or more, the risk of complications (deep venous thrombosis and side effects of anesthesia) also increases, so careful response is required.

Breast reduction by liposuction

If the breast is too large and there are symptoms such as shoulder stiffness, it is common practice to cut out the breast tissue by the method called breast reduction method and then sew the skin again.
However, this method has problems in patients who are planning breast-feeding in the future. Another way that can be considered in such a case is to do a method of first reducing fat-portion of the breast by liposuction and then sewing only the skin of the breast. Feeding breastfeeding is possible with this method.

Facelift and type of anesthesia

A facelift is a rejuvenating operation that pulls the slack portion of the face and neck, and excise extra skin etc. Surgery may be a 4-5 hour operation in the case of a full face lift. This operation is generally done in a system where you are hospitalized in a hospital under general anesthesia, but sometimes it is done by local anesthesia as a day surgery outside.
Local anesthesia is not inferior to general anesthesia, and local anesthesia may be safer in some patients. Complications of deep venous thrombosis (so-called economy class syndrome) may occur with long operation surgery. It is said that this is not common in procedures under local anesthesia. The patient is awake and is involuntarily moving his legs.

Breast augmentation and lymphoma

In Europe and the United States, some patients who have undergone breast augmentation in the past have lymphomas in their breasts and are currently monitoring such cases.

ALCL (Anaplastic Large Cell Lymphoma) is called T cell lymphoma in detail. Unlike the same type of lymphoma that occurs in the whole body, what is associated with breast augmentation is localized to the breast and the prognosis is said to be good. It is a phenomenon only seen in cases using breast enlargement bags, especially on the surface called Textured type more commonly found in grainy breast enlarged bags.
The US FDA has instructed plastic surgeons to inform these patients about such information. In France, there is a debate as to whether to prohibit the use of such breast enlargement bags more seriously. However, since it is a very rare phenomenon at frequent times, it seems that discussion has not been done in Japan either.

Liposuction – tumescent technique revisited

Regarding liposuction, our clinic has received various questions from many patients of different nationality.

At this time, we will discuss about slimming surgery using various accompanying devices which are said to be the “latest type” among them. For liposuction, it is famous for its wet method with ordinary cannulas using a tumescent solution that has been widely used in the United States for many years and has established safety. In this method, a local anesthetic or a drug which becomes difficult to bleed is diluted highly, injected so as to inflate the tissue in the target area, and then suctioned. In this method, it is known that bleeding volume is 1% or less of the aspiration volume (very little). Also, depending on the skill of the doctor, it is said that there is little damage to the tissues due to the equipment used, and it is a safe way. In our clinic, using this microcannula method which further evolved this method, effective results with little unevenness are obtained.

Nowadays, in place of the above method, some devices have come up that generate ultrasonic waves and lasers at the tip of the liposuction device. Japanese people are sensitive to new technologies, so treatment using these devices seems to be commonly done in Japan. Then how about in the United States? In the United States, such devices temporarily attracted attention, but it is not being used more often now that it is not used frequently. Why? The biggest problem is the seriousness of complications. Many of these liposuction plus alpha devices emit high energy at the tip, resulting in burns (burns) in the subcutaneous tissue, damage to the nerve, edema due to a delay in the course of healing (water accumulation) etc.

As a result, in the United States and elsewhere, it is true that we have returned to liposuction using a conventional tumescent-based system that does not use lasers or ultrasound.

Migraine headaches and Botox treatment

In our clinic, treatment of migraine is done with botulinum toxin (Botox). This treatment is a treatment method approved by government agencies in Western countries such as the United States, Canada, UK, Australia. Prior to treatment we will check to see if it meets some standards.

First of all, doctors such as neurological department and neurosurgery undergo diagnosis of headaches such as migraine. Then, if possible, receiving image diagnosis such as CT or MRI in the past, it is possible to confirm that there is no abnormality, and so on. At the time of the first visit, if you bring a thing with a history list of medications and a history of treatment up to now, the procedure will be smooth.

Nasal allergy and Botox

For those who are in a season of hay fever or other pollen allergy, although it is unapproved treatment, when improvement is not seen with otolaryngology, taking allergy medicine in ophthalmology, in certain countries a small amount of botulinum toxin is sprayed into the nasal cavity. It has been reported that treatment is effective only by applying to the mucosa.

Breast augmentation and future MRI study

Most patients are in good condition for a while after being subjected to breast augmentation, but when you want to investigate whether there are problems with breast augmentation bags when it becomes stiff or when you feel a change like a streak (rippling), or that my general symptoms are not good , The best test is MRI study.

Although it costs a little, it is possible to detect bag breakage, leak (leak), degree of capsular contracture, peripheral abnormalities (breast cancer, lymphoma etc.). However, someone with metal in somewhere in the body may not be able to do so so it is necessary to check in advance. There may be cases when you have a tattoo (tattoo) in it.
The American FDA recommends MRI examinations every 3 years for people who have performed breast augmentation, but in reality it seems that there is not one who does so frequently.

Use of supplements and filler/Botox

Hyaluronic acid and Botox are rejuvenation methods that can be treated easily without reservation, but there are some conditions.

Those who are regularly using vitamin E, fish oil (EPA, DHA, omega 3, etc.), aspirin and other pain medication called NSAIDs have thin blood, so it is easy to get bruised by stabbing the needle, especially hyaluron near the lower eyelid. It is safer to treat it without taking medication for more than a week when considering such an injection.

Regarding Botox, it is said that it is not recommended if you are currently pregnant, or breastfeeding, but it is also said that it is better not to use it even if there is a possibility of pregnancy within the next 3 months from now. In addition, this is for both sexes.

What is a liquid facelift

Botulinum toxin such as Botox, and dermal fillers such as Restylane and Juvederm have been used for many years to treat facial wrinkles. Botox is usually used to treat lines between the eyebrows, wrinkles on the forehead, wrinkles in the corner of the eye. The most frequently used filler is the same substance as hyaluronic acid which is also present in healthy skin and its deeper layers, and these hyaluronic acid fillers are usually used in combination with legal and marinet wires and longitudinal wrinkles of the upper lip It is used to correct.

Recently, in the United States, long-lasting hyaluronic acid is used to make the upper part of the cheek plump, and by doing so, the wrinkles of all parts of the face pull to the apex of the bulge It is aiming at the effect of being decreased. This method is called Liquid Facelift in English and is also called a liquid face lift in Japanese, is now a very popular treatment.

About troubles after breast augmentation

Breast augmentation surgery is a wonderful operation that makes a very attractive body line. However, after undergoing this operation, there are things that I have to watch over for years. One is encapsulation or capsule contracture, and the breast implants occurring at a rate of 10-15% are in a state of hardening. If the condition gets worse, it will become a streak that you can understand by touching from the top of the skin, or you can understand it even by just looking at it. When such a condition occurs, it is necessary to remove the implant (breast enlargement bag) and also remove the capsule membrane that is completed.

It will be a larger scale surgery than when breast augment surgery was done for the first time. In general, it will be treated as a hospital admission. On the other hand, if you do not remove the capsule stuck to the breast augmentation bag, you can do with simple surgery if you just need to remove the bag, another complication of water accumulation in the capsule (seroma) also can occurs.

Besides this, damage of the bag (rupture) is said to occur at a probability of about 1% per year per one year. It is difficult to detect this by palpation alone, so image diagnosis such as MRI becomes necessary.
In case
It is said that about 25% of patients who have performed breast implants need to undergo surgery in the future if various other complications are added.

Relationship between breast implants and lymphoma

The French government recently warned that it is related to implants used for breast augmentation and specialized lymphomas (undifferentiated large cell lymphoma, Anaplastic large cell lymphoma (abbreviated as ALCL) in English) in breasts became.

Currently it is a very rare tumor and the prognosis is better than the lymphoma that occurs in the whole body so it is not a recommendation for patients who have done breast implants immediately. ALCL is a T cell type tumor called non-Hodgkin’s lymphoma, and there are about 60 cases reported in the world about localized breasts, but it is said that there are more than tens of millions of patients receiving a breast augmentation surgery Because it is so, it is extremely rare.

However, in Europe and the United States there is a system to make information disclosure early and the FDA also keeps monitoring on this subject.

Regarding “Fibroblast” and “PRP”

“Fiblast” (Fibroblast) is a human bFGF material developed in Japan and it is approved by the Ministry of Health, Labor and Welfare for use in the treatment of decubitus ulcers (burn ulcers, lower leg ulcers) in the plastic surgery field.

Recently medical institutions of beauty medical care have used this material out of approval. Even in our clinic, patients receiving a subcutaneous injection of this substance at another clinics come and complain “lumps” of the injected sites. It is difficult to remove a lump caused by subcutaneous injection of fibroblasts and removal is difficult even with invasive treatment. I think whether it is better to pay attention to subcutaneous injection of the fibroblast material that is used for non-approval use.

Regarding PRP, the substances derived from your own blood, it is necessary to submit a third category registration on regenerative medicine by the Ministry of Health, Labor and Welfare, and I think that some approved medical institutions can still do such treatment. However, it is recent general opinion that the sustained effect by subcutaneous infusion as said earlier can not be expected.

We are using only Swedish Restylane and Juvederm made in France, which is approved as a subcutaneous infusion in the Ministry of Health, Labor and Welfare. Even if problems arise, there are degradative enzymes, and it is rare to cause permanent lumps and the like.

About pain during tattoo removal

Many of the tattoo removal is done using laser, but if you do not do some pretreatment (anesthesia) then it will be accompanied by a considerable pain.
In our clinic, pain is relieved by using anesthetic cream or a method of injecting local anesthesia. In the case of anesthesia cream, please think that pain can be reduced in 40-50%. On the other hand, in the case of local anesthesia, it becomes painless. The needle used for local anesthesia uses a very fine needle imported from the United States.
Which anesthetic method is better, you can choose from those two. If you would like to take tattoos but are not good at hurting, please do not hesitate to consult us.

Is hyaluronic acid injection between eyebrows (glabella) dangerous?

The director of our clinic came to Japan from the United States back in 2005. Just ten years ago I gave a lecture on safe hyaluronic acid therapy etc. to the doctors as a lecturer at a seminar on beauty care procedures such as hyaluronic acid. At that time, there was a report that there was already high risk of injection of hyaluronic acid-containing injections into the surroundings of the eyebrows in the United States.

There are few small arteries that are dominant in the vicinity of the eyebrows, and there is no supply of blood flow from the other side with side chains to each other (the end- artery). When injected material enters such a blood vessel, surrounding tissues die (necrosis). Also, since the artery around the eyebrows is located close to the arteriovenous of the orbit (in the dent of the eye), multiple examples in which the injected substance enters the eye artery for reflux to cause blindness It has been reported.

In the case of hyaluronic acid, there is still an enzyme agent that dissolves it, but there are cases where it can not be saved with other injectables, especially those of semi-permanent type.

The same problem may actually occur not only in the glabellar region but also anywhere in the center of the face. There are several technical key points when injecting subcutaneous infusions such as hyaluronic acid, and for those who do not master it, these risks are even higher.

In general terms, I think that treatment of these subcutaneous infusions should be done by specialists (board-certified dermatologists or plastic surgeons) who are familiar with cosmetic medicine (also attending academic societies) doctors. At our clinic, we explain the possible dangers to patients when treating that part, and we are doing the treatment.

Dr. Kure is the only US board-certified plastic surgeon in Japan.

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Dr. Kure