How Dr. Salzman Offers Easier Louisville, KY Silent Rupture Detection

Women with silicone gel breast implants are often told MRI is the only option for silent rupture detection. According to FDA recommendations, women should get an MRI three years after receiving silicone gel breast implants, then every two years for the life of the implants. MRIs are expensive and time-consuming, causing many women to put them off or skip them altogether. Dr. Marc Salzman now offers a new option for Louisville, KY silent rupture detection. We spoke with Dr. Salzman to learn more about how he uses high resolution ultrasound to check silicone gel breast implants for rupture at his cosmetic surgery practice.

What Is High Resolution Ultrasound?

High resolution ultrasounds give patients a picture of what is happening inside their bodies, and can be used to check the status of a silicone gel breast implant. At Salzman Cosmetic Surgery and Spa, Dr. Salzman explains, “I use a Clarius device, which is one of the better images that really shows pretty much everything. It’s a wireless device, so we have the patient in the chair where we do a normal exam. I do my physical exam, I look for symmetry and then we lay them back and we type their name on to an iPad and turn the ultrasound on. Within about 45 seconds, you’re ultra sounding. and then I’ll usually do four images left and right, and if there’s anything that’s suspicious, we may do a cine or a movie file. The whole thing, even with talking and presenting it to one of my fellows, takes less than 10 minutes and then you can go back and review later. If you want to annotate the images, we can add it to the patient’s chart just with a click. It’s really been revolutionary.”

How Accurate Is Ultrasound For Louisville, KY Silent Rupture Detection?

Dr. Salzman tells us “I found in my experience with ultrasound that the positive predictive value is as close to 100% as you can get. I haven’t ordered an MRI in seven years. The only scenario that I would ever order an MRI is if the patient says ‘I want to know 100% if my implants are broken. Otherwise, I am not going to the operating room to have them removed.’ And I will look point blank at them and say, ‘There is no 100%, there’s going to be some false positives and false negatives with even MRI.’” 

What Benefits Do Patients Gain From High Resolution Ultrasound?

Dr. Salzman describes several benefits he has seen since introducing high resolution ultrasound to his practice. The first benefits he mentions are reduced costs and ease of scheduling. “MRIs are not inexpensive. And in our town, on the low end, they’re $1,500. On the high end, they’re $2,500. Their insurance usually does not cover it. And it’s not a short thing. It’s a 45 minute to an hour and a half ordeal. You’ve got to go to a center, a physician’s offices like ours don’t usually have MRI machines in the office. 

“If you see a patient that comes in with an Allergan implant and she says, ‘Well, what do I do with this?’ I can say, ‘Well let’s send you for an MRI.’ That’s not as effective as saying, ‘Well, let’s look at it with ultrasound. You have grade one capsules. There’s nothing wrong with your breasts. You’re happy with the way they look. Let’s see if they’re broken. Well, they’re not broken. What do you want to do?’ She can say, ‘Oh, nothing.’ and go on with her life.” 

What if this method of Louisville, KY silent rupture detection does detect a broken implant? In this case Dr. Salzman says, “Well, the right one is broken.” If the right one’s broken, let’s put two new ones in. We’ll put a round, smooth implant. Do you want to go larger? Do you want to lift? All that takes place in one consultation. We don’t have to send somebody away to somebody else, to then read this MRI, and then have the patient come back. That is too long of a waiting period.”

Dr. Salzman says the other major benefit for patients is that he can discover more information with ultrasound than just Louisville, KY silent rupture detection. Recently, the FDA has raised concerns about BIA-ALCL in certain textured surface silicone gel breast implants. Patients who worried about BIA-ALCL, or are unsure if their breast implants are smooth or textured, can get a simple ultrasound to check them. Dr. Salzman tells us, “you can usually tell if an implant is textured or smooth. So if you see a smooth implant on ultrasound, you’re not really as worried about ALCL. If there’s no seroma on ultrasound, the vast majority of patients with ALCL present with a seroma. If there’s no thickening at all, the capsule looks very, very, very thin, it would be super rare for it to be positive for ALCL. So there’s been a vast number of patients that we’ve done exams with ultrasound just in the last couple of months because of this whole Allergan ALCL news that patients have been now sent letters about.”

Visit Dr. Marc Salzman For More Cosmetic Surgery Options

Dr. Salzman has almost 30 years of experience in cosmetic surgery, with his primary focus in breast surgery. In addition to offering high resolution ultrasound, Dr. Salzman offers a wide variety of breast implant options. To explore your options for aesthetic enhancement, visit Dr. Salzman today.

Considering breast implants in Louisville? Contact Dr. Marc Salzman today to discuss your options. Simply call (502) 425-5200, or visit https://www.itbecomesyou.com/. Dr. Salzman’s office is located at 4702 Chamberlain Lane Louisville, KY, 40241.

The Modern Tummy Tuck

A “tummy tuck”, or abdominoplasty, is one of the more frequent procedures done in plastic surgery for women who have lost weight or have had developed laxity of the abdominal wall from childbirth. Over the last year or so, newer techniques have developed that make this procedure better tolerated, less painful, and overall have a speedier recovery. We have been doing drain-less tummy tucks for the last nine months and have found that, whether we place sutures or glue between the skin that’s been lifted and the underlying repaired muscles, we do not need to place a drain tube into the patient. This has allowed for earlier mobility as well as less worry of having to deal with the drain. There’s also no extra hole made for the drain to pass out of the body. Pain reduction with tummy tuck is paramount to a quick recovery. Recently, we have been doing a nerve block, called TAP block, which places the long-lasting numbing medicine called Exparel™ directly into the nerves that supply feeling to the front part of the abdomen under ultrasound guidance. This has had a profound reduction in the pain experienced by our patients during the first few days after surgery. I like to think of this new method as the drain-less, painless tummy tuck. We have also been using ultrasound in our office for over five years now and feel quite competent in being able to assess the amount of fluid that can build up when these drain-less procedures are done. Should there be the necessity of removing this fluid, rather than sending our patients to a radiologist at a hospital, we can simply place a small cannula under the guidance of ultrasound directly into the area of fluid collection and remove it. This has vastly improved our patient’s recovery time compared to drains or to other practices that don’t have the expertise to provide adequate detection and removal of the small fluid collections.

Slim Your Upper Arms with CoolSculpting Petite!

Are you dealing with arm jiggle that causes you to avoid tank tops and arm-baring clothing? Have you been hitting the gym, but are not seeing results in the upper arm area? If this sounds like you, you may be able to benefit from the new CoolSculpting Petite! Read on to learn more about this amazing treatment option.

What is the CoolSculpting Petite?

The CoolSculpting system uses applicators to apply cooling technology to eliminate areas of stubborn fat. The CoolSculpting Petite is the new applicator meant to treat upper arm fat. This FDA-approved applicator is designed to fit smaller areas of fat, and curves to meet the contours of the upper arm.

Treatment with the Petite applicator is quick, taking about 35 minutes to complete. Just like traditional CoolSculpting treatments, CoolSculpting Petite freezes away fat cells for long lasting results. Results are seen after 4-6 weeks, and continue for up to four months.

Benefits of CoolSculpting Petite

There are many benefits associated with the CoolSculpting Petite applicator. These include:

  • Created to specifically treat the upper arm
  • Comes with two interchangeable contours to fit every upper arm shape
  • Non-invasive
  • No stitches or needles
  • Quick treatment
  • No downtime

If you are ready to take the first step towards slimmer, more youthful looking arms, contact Salzman Cosmetic Surgery and Spa today to schedule a consultation. We will work with you to create a customized treatment plan that will address your aesthetic goals. If you are located in the Louisville or Lexington area, call 502-425-5200.

Introducing Vivace!

The Holy Grail it seems in plastic surgery, at least over the last 15 years or so, is skin tightening without surgery. We know that a modern facelift can restore a youthful shape of the face as well as tighten the overlying skin of the face and neck. Because a facelift necessitates making of incisions, some type of anesthesia, as well as the perceived downtime away from work or family, there are a multitude of patients who would opt for a noninvasive or minimally invasive modality to accomplish the same goals. While we do have neurotoxins such as Botox, Dysport and Xeomin, which can paralyze underlying muscles rendering the overlying crease less deep, as well as a plethora of different fillers, either made from hyaluronic acid or other substances, to make the face more youthful, none of these entities will tighten the overlying skin or improve upon fine lines for texture.

For the last 20 years or so we have had ablative lasers using wavelengths of carbon dioxide or Erbium, whether in a fractional or a full field coverage of the face that can produce skin tightening, these lasers need to deliver their energy to the deeper portion of the skin called the dermis and do not have the ability to spare the outer part of the skin called the epidermis. Therefore, when doing ablative laser resurfacing, when the outside layer of skin is removed, some downtime is necessary for healing and, until the outside skin has grown back, make up cannot be used during this healing process. This forced patients scheduling these more aggressive procedures during periods of time in which they could accept these downsides in order to obtain a result of skin tightening, correction of texture and fine lines, as well as the improvement in brownish discolorations.

Some of the newer technology, have used radiofrequency (RF) as a method of tightening skin. These radiofrequency waves, commonly used in telecommunications, have also been used in surgery for over 75 years, mostly in surgical or dermatological applications for both removal of superficial skin blemishes or cutting, and coagulation of blood vessels during surgery. RF works by rapidly stimulating the oscillation of molecules causing internal friction and thereby heat. The heat produced by RF is thought to ‘injure’ the deeper part of the skin causing an inflammatory response by the patient producing new collagen and elastin. Both of these entities, when increased, produce a more elastic and tightened skin appearance.

The first wave of RF devices applied the heat from the outside-in with some type of method of cooling to allow the heat to preferentially be absorbed in the dermis. Because of the human intolerance of outside-in heat of temperatures in excess of 43°C, there was some limitation in how much tightening one could get in a single session. Multiple weekly or biweekly treatments are necessary to produce the desired effect.

The next advancement in the application of RF was to place the heat under the skin using a long insulated needle. Here, using local anesthesia, higher temperatures at the bottom of the skin could be reached and still tolerable by the patient. The technique is called ThermaTyte and we have had this for several years now. It’s very effective for skin laxity around the belly button as well as neck. It does have some downtime, as a fair amount of dilute numbing medicine needs to be placed beneath the skin to make it tolerable.

The latest advancement in the application of RF for the tightening of skin utilizes the placement of this energy through the skin using tiny, hair size needles, known as microneedling. Microneedling involves, either with a roller or piston type stamping method, the insertion of an array of needles into the skin. No skin is removed and the hole simply closes within hours. While open, topical application of serums, that would otherwise not be absorbed, can be placed over the skin allowing them to gain entry to the deeper layers. The improvement in the quality of skin texture is limited only to the length of the linear hole that is made into the skin. Radiofrequency heat energy can be added to the end of the needle so microscopic injuries in the deeper portion of the skin can be made. We can control not only how much energy, but also how long the energy is applied, as well as the exact depth of its placement using a computerized screen. This new device is called Vivace.

 

Vivace uses an array of 36, 1/3000th of an inch wide, goldplated needles attached to a computerized mechanism that when placed on the skin can pierce the skin and deliver the radiofrequency energy in a fraction of a second. The technique does require the topical application of a numbing cream for about 45 minutes prior to the procedure. Because not all of the skin can be treated in one session, a series of treatments is necessary to produce the desired result. Multiple treatment depths can be done in the same session. We are commonly treating skin laxity of the face, stretch marks of the abdomen and legs, active acne as well as acne scarring using this new exciting technology.

So far, we have found this technique to be extremely useful in producing nice results in all the patients. Because the energy bypasses the outside layer of the skin, any skin color or amount of skin tan is amendable to this treatment regimen. After the procedure, we have seen that the skin is merely red or pink for a few hours. Makeup can easily be applied the following day. Some patients have found that there is a gritty feeling texture to their skin but is usually not visible under makeup. We recommend a series of at least four treatments at 4 to 6 week intervals. It seems we finally have a method to treat all patients in all seasons with issues of acne scars, stretch marks, skin laxity of different areas of the body.

Salzman Cosmetic Surgery and Spa featured on WAVE 3 News

September 8th, 2015
WAVE 3 News
Focus On Health

Dr. Salzman was recently featured in a story on WAVE 3 News about the new non-invasive procedure, Vanquish. This procedure is offered at our practice and is getting great reviews from patients! The title of the story on the WAVE 3 News website is, “Melting the fat away: new procedure shaves inches off your midsection.”

Click here to read the full article and watch the video on the story!

http://www.wave3.com/story/29980382/melting-the-fat-away-the-new-procedure-that-shaves-inches-off-your-midsection

shutterstock 465204128

Our New Location

After 22 years in the same location, we have finally moved! Our new location at 4702 Chamberlain Lane, Louisville, KY 40241 with 8,000 square feet was designed around the way our practice has changed over the last two decades. We have added a state-of-the-art operating room, three private pre and post-op recovery suites as well as additional capacity for both our surgical patients and medical spa clients.

Derek Engineering and Barry Wooley Designs have done an exceptional job at constructing and finishing a lush, beautiful office environment that has had very positive first impressions in the few weeks that we have been open. We have added new staff in both nursing and administrative support to streamline our delivery of exceptionally compassionate, caring and skilled services of our surgical spa treatments. In the near future, we will be adding additional appointment times in the early mornings, evenings and Saturdays. All of us at Salzman Cosmetic Surgery and Spa are excited about our new space and we hope to see our established patients as well as new patients in this beautiful new space soon!

Your Fat May Be Your Best Filler

We all have often thought, “If only I could move this stubborn fat around my waist to somewhere else where it might look better.” That concept today in Plastic Surgery is becoming more of a reality. The process is called fat transfer and has exploded in its usefulness in our Plastic Surgery practice. The technique involves removing fat from where it is in excess, like around the midsection and transferring it to where it may help increase the size or fill in areas where fat has been depleted. Common areas to place fat are for increasing breast size, matching size or shape of breasts, making buttocks larger, and filling out of the face that has sagged with weight loss or age. Several rather new modalities have made fat grafting better over the last few years. We now know that the addition of growth factors from platelets, when added to fat grafts make the fat grafts heartier and more likely to gain a blood supply and survive the transfer. In our office, we have used PRP (platelet rich plasma) as a source of these growth factors for over 2 years now and have seen better results with fat grafting since its implementation. Also, it has been recognized that placing fat into muscle which has a better blood supply makes it easier for the fat to survive. We have used ultrasound now to actually see where the fat goes and place in places that will make it more likely to survive. There have also been fair amounts of research into better ways to both harvest the fat and separate out those components that represent the cells most likely to survive.

At the Salzman Institute of Plastic Surgery in Louisville, KY we have been utilizing these advanced techniques with great success in the last few years. One of the new concepts this fat grafting has helped is in High Definition Liposculpting. The fat is removed from the areas where it is in excess and replaced into where accentuation of natural underlying muscle mass is needed. Under ultrasound guidance, these fat grafts can by placed directly into the underlying muscles safely. We also use this same technique in reshaping of the breast. Rather than relying on breast implants alone, fat usually taken from around the belly and hips can be placed into the breast to enlarge and reshape it. Nice contours of natural feel and look can be accomplished in this way.

Fat, it turns out, can be a nice commodity if moved to a more desirable location with newer plastic surgery techniques.

Anatomically Shaped Cohesive Silicone Gel Breast Implants are Back

About 10 years ago, I was chosen to participate in an FDA study utilizing the then new anatomically shaped Inamed 410 silicone breast implant. The trial included initially about 25 surgeons across the USA. There was a short period of time after the initial patients were enrolled that more patients were able to be included. Over 900 patients in the USA were implanted with the shaped cohesive gel implants. Now the implant, although still seeking FDA approval, is again available for use by the initial group of plastic surgeons credentialed to use this new type of silicone gel breast implant. This imlant is different than what is being used presently in the USA, although it is quite popular in Europe where it has been available for some time. This implant is rather than round in shape, shaped like a breast, like a teardrop .Instead of sizing the patient with a volume like a number of cc’s, this implant has three different parameters that need to be adjusted based on the unique needs of each patient. The height, width and projection are all variables that can be adjusted to meet the needs of many different women’s breast shapes. We refer to this implant as a “form stable” implant. This means that if the shell of the impant is removed, the silicone material in the inside would still retain the intended shape of the implant.The lay description of the implant is the “gummy bear implant” relating its feel to that of the gummi bear candies. Having used this novel implant over 10 years now I feel I have a keen understanding of its merits. For the patient with ample breast tissue that has relaxed after childbirth or weight loss and settled to a lower position on the chest wall, this implant has the unique capability to internally replace the missing volume in the upper aspects of the breast and push the nipple and areola back up to a more youthful position on the chest wall.For the women with little overlying breast tissue and never having the skin of the breast being stretched before, the shape of this implant would be too overbearing and a round implant would still give a more flattering look. Since limited numbers of these implants will be available to be implanted, we will select those women who we believe will benefit most from the advantages of a shaped implant. I don’t expect the availability of this implant to last more than a few weeks.

Dr. Salzman as an expert on Exilis

Recently I was interviewed by a trade journal for my thoughts on a relatively new non invasive body shaping modality called Exilis. The holy grail for plastic surgeons is a totally non invasive method of shaping the body by reducing the amount of fat in areas of the body that are disproportionally large. Liposuction of some type, usually utilizing some power assist, presently is the gold standard in fat removal. This new Exilis machine, while not as effective as a surgical result can be used after liposuction to help skin retract and to smoothe out the result. There are those patients that either can not, or will not, opt for an invasive procedure like liposuction and yet still want to reduce some areas of the body. The Exilis treatment is perfect for these patients. You can read more about it and my comments here.

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