Smartlipo, also known as laser lipo, is a relatively new technology which has become popular in recent years.

For clarification, different companies can make the laser machine used for this procedure.  However, since Cynosure (trademarked under the name Smartlipo) was the first company to gain most of the market share, the name has stuck with this procedure.

How is Smartlipo different than traditional liposuction? Well, both procedures can be done under local or general anesthesia.  Both procedures require small stab incisions close to the area to be liposuctioned for access.  Both procedures use tumescent solution (a solution containing a numbing medication and epinephrine, for minimizing bleeding) to “blow up” the area prior to liposuction.  The difference is the next step.  In Smartlipo, a tiny laser fiber (typically 1mm in diameter) is inserted in the area containing the tumescent solution, and the laser is moved back and forth.  The laser generates heat, and will cause some coagulation of the tiny blood vessels.  This may result in less swelling and bruising compared to traditional liposuction.  The main concept behind using the laser, however, is that heat causes contraction and, therefore, may lead to better skin shrinkage after liposuction.  However, to my knowledge, no one has published a randomized, prospective, blinded study showing the final result is better than traditional liposuction.  Also, due to multiple variables, such as patient age, amount of fat, skin quality, etc. it is virtually impossible to design a protocol for the amount of laser energy required to give each patient the best result.

At the end, however, the fat needs to be suctioned out by the surgeon.  Therefore, with ALL liposuction techniques available today, and in the future, the limiting factor is the quality of the surgeon performing the procedure.  An example I frequently use is if I give any one a $7000 top of the line digital camera and a $2000 professional lens, would giving this equipment to someone suddenly make them a photographer? I think you know the answer!

Michael A. Jazayeri, M.D. is a board certified plastic surgeon with over 12 years of experience.  His office is located in Orange County, California.  To schedule a complimentary consultation, please call 714-834-0101.

I am sure many of you have heard of CO2 lasers for treating wrinkles of the face. The traditional CO2 laser causes thermal (heat) damage to the entire area of skin treated. This is a controlled damage and the depth of thermal injury is controlled by the machine and the operator. In effect, a very superficial burn results and after healing newer, more refined skin is the result. When I was doing my burn rotation during residency, I had two patients who sustained flash burns to their face, resulting in superficial burn to the face. After healing, their skin looked much smoother than before. Of course, I do not recommend this method of treatment!

The downside to traditional CO2 laser resurfacing is the longer recovery period (the burn may take 7-10 days to completely heal), slightly higher risk of infection and more importantly, the color of the lasered skin is usually lighter than the non-treated area. In some patients with darker skin, there is also a higher risk of hypo or hyper pigmentation of the skin and or prolonged redness of the skin, which may take months to resolve. However, if the patient has deep, static, facial lines and significant sun damage to the skin, the traditional CO2 laser may be the best option for this patient.

For others who have fine wrinkles, mild hyper pigmentation and or mild acne/acne scars, my choice is the Mixto Laser. The Mixto laser is a CO2 laser and, if the settings are changed, it can act as a traditional CO2 laser. However, in most cases, the laser is used as a Fraxel type laser. This means the laser causes thermal damage to some parts of the skin but leaves small areas of skin intact. This results in even more superficial heat damage than the traditional CO2 laser. The advantage of this method of laser resurfacing is less down-time (typically 4-5 days of swelling and crusting on the skin), and less chance of infection, hypo or hyper pigmentation. Also, the Mixto laser procedure can be performed in the office with topical numbing cream on the skin, whereas the traditional CO2 laser requires either intravenous sedation or general anesthesia. On the other hand, since the level of damage is less, the result is not as dramatic as the traditional CO2 laser. This means patient selection and patient expectation is important.

I recommend this type of laser to patients who have fine wrinkles on the face, mild to moderate sun damage and spotty brown spots on the face. It is also helpful for patients who have scattered actinic keratosis on the face (these are rough spots on the face due to sun damage). The Mixto laser can also be used on the neck, chest, and hands. The indication for treatment is the same in these areas.

The Mixto laser is not a magic bullet. It will cause some shrinkage of the skin, but do not expect a face lift!

The good news is, in almost all patients only one treatment is needed to see improvement, compared to other lasers which may require 3-5 sessions. The patient, of course, can get more than one treatment if required and a maintenance program every 1-3 years may be used, depending on the patient skin type and life style.

Like every thing else, the Mixto laser is only the beginning. The patient must avoid sun (or use sun block with UVA and UVB protection) religiously, avoid tanning beds, smoking, etc. in order to maximize the benefit and longetivity of the treatment.

Michael A. Jazayeri, M.D. is a board certified plastic surgeon with over 10 years of experience in both cosmetic and reconstructive surgery. His office is located in Orange County, California. To schedule a consultation, please call 714-834-0101.

Isn’t it sad the way we age?

For men especially, we lose hair on our heads, and gain it in our nostrils and ears!  We also develop more moles on our bodies as we age (this is true for women as well).

Moles come in two varieties: malignant and non-malignant (benign).

Malignant moles, by definition, are cancerous and will grow and invade the adjacent skin and underlying structures.  Most common skin cancers are squamous cell carcinoma and basal cell carcinoma.  For the most part, these are slow growing and may take years for them to invade adjacent structures or become metastatic (spread to other parts of the body).

Of more concern is melanoma, which is much more aggressive than the above.  Unlike the above cancers, the risk for melanoma increases with occasional excessive sun burn.  Both squamous and basal cell carcinomas arise from chronic exposure to sun.  That once in a while trip to Mexico which gave you a bad sun burn will increase your risk of melanoma more than the other tumors discussed.

The most susceptible person for developing melanoma is fair skin with red hair and freckles.  My advice to any one with fair or light skin living in Southern California is to have an annual skin examination by their family physician or dermatologist.  Any change in size, color or shape of a mole should be investigated.  Itching and bleeding is also of concern.

The only way to make the correct diagnosis is to remove all or part of the mole (depending on the size and location) and have a pathologist examine the lesion under the microscope.  Depending on the diagnosis, additional surgery may be necessary.  The main issue with melanoma is the amount of normal looking skin which has to be removed as part of the treatment.  Even if the melanoma is very thin, a margin of 0.5cm (1/4 of an inch) has to be removed around the melanoma.  If the melanoma is thicker, up to 3cm (slightly more than an inch) of skin has to be removed around the lesion.  This will result in a large wound which typically requires a skin graft from another part of the body.  Lymph node biopsy and removal may also be required.  Therefore, it is critical to minimize exposure to sun and especially avoid sun burn.  Living in Southern California, the only practical solution is to limit outside activities before 3PM and to wear a sun screen with SPF of 30 which has Titanium dioxide and or Zinc dioxide (or both) for maximal protection.  The sun block must be applied 30 minutes before going outside and must be applied every 2 hours or less depending on the amount of perspiration and water contact.

I do not want to minimize the seriousness of squamous and basal cell carcinoma.  These lesions must be addressed and treated sooner rather than later.  However, overall, melanoma is more aggressive and the treatment more drastic than the above.

A non-malignant mole, also called benign, is not cancerous and does not invade adjacent tissue and never metastasize.  The reason for removal is usually cosmetic.  However, sometimes benign moles, because of their location may become problematic.  A good example is a mole in the beard area, which bleeds every time the patient tries to shave.

Most moles can be removed under local anesthesia in the office.  My recommendation is to send any mole excised to pathology for confirmation of clinical diagnosis.  Normal looking moles are rarely cancerous, but only pathology will confirm this.

The advantage of having moles removed by a board certified plastic surgeon is to minimize chance of undesirable scarring.  The plastic surgeon is also able to reconstruct the area if a large amount of tissue has to be removed.  However, please note, the risk of developing a wide and/ or hypertrophic scar increases in areas of excessive motion and tension (shoulder, the chest skin between the breasts are common areas) regardless of technique.

Michael A. Jazayeri, M.D. is a board certified plastic surgeon with over 10 years of experience.  His office is located in Santa Ana, California.  To schedule a complimentary consultation, please call 714-834-0101.

The standard CO2 laser is very effective for deep wrinkles and pigmentation of the facial skin.  Imagine a person between 50-60 years of age, who has spent majority of their time in sun light. May be they smoke as well.  Imagine that thick, leathery skin with deep lines, even when the person is not talking or smiling or raising their eyebrows.  That patient’s skin can only be noticeably improved with standard CO2 resurfacing.

Nothing comes without a price!  Such resurfacing requires general anesthesia or intravenous sedation, thus increasing the cost and risk of procedure.  The patient will have “raw” skin for 7-10 days.  The skin may be red or have areas of light or dark pigmentation for months.

For patients who have finer lines and spotty pigmentation of their skin, the fractional laser is a good option.

Fractional resurfacing “skips” areas of skin with each laser zap.  Therefore, each zap results in areas of normal skin mixed with areas of treated skin.  This results in faster recovery (typically 3-5 days of redness and swelling), less risk of long lasting redness or hyper-pigmentation of the skin, and no need for general anesthesia.

The Mixto laser is a newer generation of fractional lasers.  With this laser, one or two treatments are necessary to obtain the desired result, versus 3-5 treatments for the Fraxel laser.  The treatments are spaced 3-6 months apart, depending on patient healing.

I have attached a before and after photo to illustrate the effectiveness of the procedure.

Michael A. Jazayeri, M.D. is a board certified plastic surgeon.  His office is located centrally in Orange County, in the city of Santa Ana.  To schedule a complimentary consultation, please call 714-834-0101.

There are patients, however, who have finer facial lines and lighter pigmentation.  This population is an ideal candidate for the fractional (typically known as Fraxel) laser resurfacing. 

As opposed to standard laser where the entire skin is “burned” with each zapping of the machine, the fractional laser “skips” areas.  Thus each zap results in areas of normal skin mixed with lasered skin.  This allows the healing process to be quicker, with less chance of redness or discoloration.  In majority of patients, the need for general or intravenous anesthesia is alleviated.

I prefer the Mixto fractional laser since it requires one to two treatments vs. the current Fraxel lasers which require 3-5 treatments.  The treatments are spaced 3-6 months apart, depending on the patient’s healing.  I have performed the procedure with topical anesthesia, with no need for general anesthesia.

Michael A. Jazayeri, M.D. is a board certified plastic surgeon with over 10 years of experience. To schedule a complimentary consultation, please call 714-834-0101.