New Technology

Ouchless Needle Makes Worldwide Debut

Last week the medical device I invented called the Ouchless Needle had its official launch with a press release to the media. It has been picked up by news media outlets around the world. The message is that there is a new and better way of administering cosmetic injectables like Botox and Restylane. The Ouchless Needle attaches to standard cosmetic syringe types and allows for the spraying of a freezing gas onto the skin. It acts like instant ice but doesn’t drip or hurt. It also works instantly freeing up the time devoted to numbing creams that may take up to 40 minutes to work. For the active lifestyle of today’s discriminating cosmetic patient, we think it is the way to go. You can read a typical response to the press release here. Learn more

Dr. Salzman Welcomes Exilis Non-Invasive Body Shaping

We as plastic surgeons have been searching for the holy grail of totally non-invasive body contouring modalities. Thus far, everything that I have seen has had major drawbacks that I could not whole-heartedly recommend to my patients. All of the roller-suction machines whether or not they added some heat in the form of laser or RF (radio-frequency) all worked minimally if at all and were for cellulite reduction only on a temporary basis. Similarly, the unipolar RF devices like Thermage hurt so badly no one wanted a second treatment. The high frequency ultrasound devices like LipoSonix and Ultrashape likewise hurt, have limited amounts of fat they can remove in one session and are presently still seeking FDA approval.

Two other new systems have come out in the last year or so and we looked at both. The Zerona system uses very low laser light like that from a laser pointer and aims this laser in a spinning fashion to allow the fat cells to open a hole in their cell wall allowing the fat inside to escape. Some dieting is necessary along with 6 treatments over 6 weeks and the results have not been consistent among all patients. I also looked at Zeltiq. The Zeltiq machine freezes the fat over an hour-long session and causes a programmed slow death of the fat cell. Results are seen in about 3 months. Because the applicators have a fixed size, only that amount of fat that can be squeezed into about a stick of butter can be treated. Presently, it can only treat belly, hip and bra strap fat. Also, no skin tightening is seen with Zeltiq.

The Exilis® method utilizes mono polar RF (heat from radio waves) that can be controlled for depth and intensity with different settings of how cold the delivering hand piece gets. Each 5 by 7 inch rectangular area of the body can be treated for fat or skin tightening in about 4 minutes. So a belly, from belly button to hairline would be 2, 5×7 inch areas at 9 minutes for fat reduction and 9 minutes of skin tightening. The Exilis® technique can treat all areas of the body as well as the face and neck. It requires no anesthesia, no preparation and has no downtime. The treatment is actually quite comfortable and feels like a hot stone massage. The results are best seen after 4 treatments, although some effect can be seen after just one.

I still am a firm believer that the best body contouring modalities are ones that fat cells are actually destroyed and removed from the body. This entails some form of liposuction which we do all the time. Whether under local anesthesia in the office with a laser (Liteshape), or under a general anesthetic using a power assisted cannula (PAL), liposuction will still be the gold standard against which all other non-invasive methods will have to be compared. I appreciate that there is a segment of the population that have a fear of an invasive procedure or feel that the short downtime associated with liposuction is undesirable and will, therefore, never opt for an invasive body contour procedure. Exilis® may likewise be for the patient for whom surgery is contraindicated because of health issues or bleeding problems. For all of these patients, we can now offer them a totally non-invasive body contouring procedure done in the Skin Spa by Salzman in about 30 minutes. All areas of the body and face are treatable. Fat of the area can be reduced and the overlying skin can be tightened in one session.

Exilis® body shaping and skin tightening is the newest, non-invasive plastic surgery treatment to finally offer our patients a truly no downtime alternative to improve the look of skin and reshape the contour of the face and body.

Another “Top Doc” Award

I was recently selected as a 2010 Top Doc for a Trade Magazine for our specialty. The interview really concentrated on what made our practice special and how it all started in Aesthetic Surgery for me. Here is a link: 2010 Top Doc in Plastic Surgery

New Strattice for Breast Implant Revisions

I seem to see a lot of breast implant patients who have had their surgeries done elsewhere who have problems with their breast implants. One of the more common problems is migration of the implant either downward or downward and outward.

Often times simple sewing up of the breast implant capsule is first attempted to remedy the situation. This simple approach often fails due to the thin nature of the capsule tissues. I use to fashion flaps of the capsule and the fascia (thick tissue lining the muscles) to help support the new and more pleasing breast implant position. Lots of times this tissue was very thin and would not support the weight of the implant and breast. Now a new product made of pig skin is being used by our office to help repair these misplaced breast implants.

The pig skin has been specially treated to remove all of the living cells so that the human body sees it as a template of skin and grows its own cells into it. The Strattice can be sewn into the breast capsule as a hammock support or a barrier to separate the breast implants in cases where the implant capsules are touching (breadloafing or uniboob).

Thus far it has been quite successful in our practice. For more information check out the website:

Real life breast implant imaging is here!

Plastic surgery has always been a visual science. Its all about peoples perception of their own visual persona that they feel they represent to those around them. We, as plastic surgeons, provide to our patients the ability to improve that image. We, therefore at consultation for these visual improvements, need to convey to our patients what visual changes they can reasonably expect and provide some information about the risks, benefits as well as other optional treatment choices that exist. We call this process a consultation.

Consults for improvement in breast size, shape, or symmetry issues has been dealt with in the past with photographic aids. Beginning about 1996, 2D imaging of breasts with a “Photoshop” like program in which the photo taken at consultation could be manipulated with software tools to depict the possible result. We, as plastic surgeons were kind of guessing as to what the breast would look like with a certain size implant, but with a fair amount of practice, 14 years or so for me, we got pretty good at it.

However, the best manipulations were only viewed on a side view of the breasts where the blue background of the image was behind the actual photo. Not infrequently, the patient or her husband or boyfriend present at the consultation would say “can I see what that would look like from the front?” I would reply, “It’s hard to show that since we are manipulating pixels and without the blue in the background it is difficult to show a 3D change from the front. Someday we will have a camera software combination that can interpolate the change seen from the side to that seen from the front.”

Well, that is day is finally here. We have just installed the first Vectra 3D imaging system in the state of  Kentucky. I have watched the introduction of this technology grow over the last year or so and felt that it was  finally good enough to incorporate into our practice. There are only some 40 of these systems around the US now. The Vectra 3D camera takes  a single image of the breasts or face from 6 different 6 megapixel images then stitches them together and using a very sophisticated mathematical model creates a 3D image of the patient that can be moved around on a large screen display in any direction. Both the results of breast augmentation as well as the facial procedures like facelift, nose surgery,(rhinoplasty), chin tucks can be visualized in 3D.

For the breast augment patient, the choice of the size of the implant was always challenging. I believe that the best, most natural, and longest lasting results are achieved when the base diameter of the implant best fits into the natural size of the women’s chest wall. This photo system actually measures in real dimensions those parameters and can display them on the screen. The data of size, width and projection for all of the implants made by Mentor and Allergan are stored on the system.

We simply click the type and size of the implant and the software applies that to the breast and shows an enhanced version on the screen. We can then rotate that image sideways, vertical, up and down and compare it to the natural untreated image. The view from the top, as the women sees herself is especially compelling. No more guessing, stuffing implants on top inside a bra or adding baggies of rice to estimate the size of the implant is needed to get the job done. We can even adjust for dissimilar size breasts by using different size implants on each side. The look on the few patients faces that have seen this technological advance has been quite satisfying. No you can really “try on” the different implant sizes to get a feel of how you will look after breast augmentation surgery.

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