Surgery's Blog

While cosmetic surgery can involve major operations, there is also certain skin treatments that are less invasive and most useful for removing scarring and certain types of wrinkles not always caused by age.

Chemical peel is a treatment that uses chemicals to peel the surface layer of the skin. This is not as horrible as it sounds, the amount ‘peeled’ being so minute that it can hardly be seen, but it certainly improves the skin it has been damaged due to certain conditions.

Pre-cancerous keratoses is one condition that may improve with the use of the chemical peel. Irregular skin pigmentation is another. Wrinkles due to age or heredity or sun damage can be smoothed out and the skin’s tolerance to acne and external irritations can be increased.

Chemical peel treatments may be purchased over the counter, but if this course of action is followed, make sure you read the label carefully and start with the weakest mixture first. There is no point treating your skin harshly if it’s not necessary.

Dermabrasion is similar to chemical peeling in the results, but fine diamond tipped rotary instruments are used to ‘sand’ the skin to a certain depth, much like a carpenter sands his new furniture smooth with glasspaper. After the skin is healed, fewer irregularities are found and the surface is much smoother. A surgeon must perform this procedure. A light sedative and local anaesthetic are used.

Sometimes dermabrasion in used in conjunction with chemical peeling in order to treat deeper wrinkles or scarring. Cold packs are often used before the dermabrasion and very little discomfort should be felt during the procedure, though the skin is often swollen and tender afterwards. Some redness may persist for several months, while small white dots can be a side effect, but will disappear shortly. Make-up can be used after about a week. Other side effects of the treatment may be a darkening or lightening of the skin. The darker areas can be successfully treated with special creams, while the lighter area is untreatable, but mostly hardly noticeable.

Laser resurfacing surgery is sometimes used to minimize facial wrinkles. A special beam of light energy can be used to make precise surgical incisions or to significantly improve the lines of the face. It is done under sedation and local anaesthesia and redness persists for several weeks, but make-up may be used to camouflage it seven to ten days.

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LipoDissolve, or the introduction of a chemical formulation by injection to treat spot areas of undesired fat for cosmetic purposes, remains a controversial and non-FDA approved procedure at this point in time. Despite these issues, I have found in the past 3 years in my practice a role for LipoDissolve if it is used judiciously and with good patient selection. I have not experienced any of the complications or problems that I have read about on the internet and I suspect that rigid patient selection, keeping the injections less than 100 per session, and good sterile technique are the reasons why. One application that I have found LipoDissolve injections particularly useful is in the treatment of lipomas.

Lipomas are fatty tumors that can appear anywhere on the body from the scalp to the legs. They are soft, easily moveable (non-adherent) masses beneath the skin that are always round in diameter. They are usually right under the skin and are very slow growing. Most patients seen usually just have one in isolation. There are, however, some patients who have a familial lipomatosis syndrome in which they develop many lipomas throughout their body continously over their lifetime. Lipomas are traditionally treated by excision which removes them in their entirety, establishes their pathology by visual and microscopic examination (if sent to a pathologist) and leaves a residual scar. In some locations, and at the desire of some patients, a scar is not wanted nor is any type of surgical procedure if possible. LipoDissolve offers a non-surgical alternative to traditional excision for some lipomas. If the excision will leave a scar over a prominent area (e.g., the shoulder of a woman) and you are fairly certain that the mass is a lipoma by examination and history, then injection treatment are an option.

I have found that full-strength LipoDissolve injections can work quite well in the nearly 15 lipomas that I have treated thus far in the past two years. The concept is that it is a series of injections, spaced four to six weeks apart, to either reduce the size of the lipoma or completely remove it. In the nine patients (14 lipomas) that I have treated, the average number of injection sessions is nearly 5 (4.8) per patient. This does not take into account that the largest of the lipomas that I have treated (14 x 10 cms) took eight injection sessions while very small ones (2 x 2 cms) may take only one or two injections. Patients will experience a large amount of swelling for the first week and some discomfort which is typical but not lifestyle-limiting.

Since lipomas represent a concentrated nucleus of fat, it is not surprising that LipoDissolve injections can be effective. Its use, however, is not as efficient as surgery (and insurance does not cover the procedure) but it does save a scar and, in large lipomas, the risk of a fluid build-up after surgery or the need for postoperative drains. Before treatment, one has to be fairly certain that the mass is indeed a lipoma. An MRI may be done if necessary to establish the diagnosis in larger lipomas. I have not yet seen a recurrence in any lipomas that I have treated but it is too early to be absolutely certain of that in my present patient series.

About the Author

Dr Barry Eppley, board-certified plastic surgeon of Indianapolis, operates a private practice at Clarian North and West Medical Centers in suburban Indianapolis. He writes a daily blogs on topics and trends in plastic surgery at http://www.exploreplasticsurgery.com

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