Ashley Black and the Fascia Blaster: My Thoughts on the War on Cellulite

Every woman knows what the term cellulite refers to: the cottage cheese certain areas, including your thighs, have with dimpling or waviness. While it doesn’t seem to affect men, it is estimated that 85% of women over the age of 35 years of age have it. It is quite ubiquitous. It is also very genetically-based. I have seen women who run marathons, who are very trim, with cellulite. There are currently two FDA-approved treatments for cellulite: Cellfina and Cellulaze.

Cellulaze is made by Cynosure and was the first FDA- approved treatment for cellulite. It is done in the office under local (in my case, only under local with oral sedation) or general anesthesia. It involves infiltrating the area to be treated with local anesthetic with epinephrine. A fiberoptic laser fiber is inserted under the skin which is used to lyse (cut with the laser) the fascial bands which are pulling the skin inwards. The laser can be directed up into the skin,  to both melt fat to decrease the fullness in the skin rolls (fat in the dermis) and also to laser heat the underside of the skin. This laser of the underside of the skin has been proven to  stimulate collagen and elastic production. The decreased collagen and elastic fibers are thought to be the principle cause for the cellulite. It is a single treatment and the patients will continue to improve for at least 6 months.

Cellfina has been more recently approved by the FDA. Rather than using a laser, it relies solely on cutting the fascial bands under the skin. It is also a single treatment with many advocates.

Ashley Black’s fascial blaster is essentially a roller with spikey projections that is rolled over warm, oiled skin for several minutes. The rolling continues until there is redness and often bruising. It sells online for about $89. She is getting a huge following on the internet and is getting featured in several women’s magazines. She has some very nice before and after pictures on her Facebook page. I’ve been asked if it works what I think about it. 

First, there are some some excellent transformation photos. Of course, if she did not have any pictures, no one would buy it or try it out. It seems that there have been a huge number  Fascia Blasters sold. Assuming these excellent pictures are legitimate, I still have some concerns. It can be difficult to demonstrate cellulite on photos and it is very dependent on lighting. I also wonder how soon after the rolling the pictures were taken. The kind of aggressive rolling that she is recommending will definitely cause swelling. If the skin is swollen, it will absorb water and this will temporarily make the skin look much better since it will mask the uneven surface of the skin. I wonder what these areas look like two weeks later, after the rolling has ceased?

Secondly, there is no question that the Cellulaze  treatment is a very aggressive way to break these adhesions from the skin. It also puts a significant amount of heat into the skin which stimulates collagen production. Even with this, I estimate in my hands only about 80% of women improve somewhat. (I would add that I cannot predict who is going to get a better or a poorer result).  However, even with this very aggressive treatment, it cannot make the cellulite disappear. Most women get a mild to moderate improvement. Almost no one will have their cellulite disappear. It is still worth doing since I don’t believe any treatment is as aggressive. It certainly should accomplish as much as Cellfina, since it incorporates the idea of cutting the fascial bands, and with a laser as opposed to a needle. I find it very hard to believe that rolling the skin can generate enough shearing force to actually tear these fascial bands to the skin – and that they will not simply reform, even if they were torn. If these two minimally-invasive techniques can only give some improvement, I question how likely is it that the Fascial Blaster can give a lasting improvement.

Lastly, even if these photographs are legitimate and not taken in close proximity to the treatment, how many people have photographs that show no difference whatsoever?  If 10,000 women have tried it and there are 30 good photographs, that is not a great ratio of success.

What I do find very interesting is that there are some parallels between this and Thai massage. Thai massage, like acupuncture, follows the thought that there are energy lines that run up and down our bodies. No doubt the Fascial Blaster stimulates these lines. Drinking plenty of water after these treatments, should help to detox the body and make the person feel better over several days. Also the massage of the warm oil will stimulate these lines. I think this accounts for the very positive experience many people are seeing with the Fascial Blaster”.

What would it take to better convince me that the Fascial Blaster works? It is impossible to do a rigorous double-blind medical study. However, it should be possible to get 100 consecutive women to use the Fascial Blaster for some set  period of time. Standardized photographs – with the same distance and lighting – would be done before the study starts. Then after stopping the rolling for 3 weeks, re-photograph the areas. These photos would then be sent to several judges who would not know which photos were taken before and which were taken after treatments and the judges could rate the results. It would be important to have many women who had no treatment but also had “before” and “after” photos to also be sent to the judges, to ensure that they were able to ascertain that the no treatment group did not improve.

Until this happens, I am reserving judgement. I am perhaps showing my years in the beauty world, but there have been endless “miracle treatments” that get rave reviews one year, and then  just 2-3 years later, completely disappear from the world.

Why Laser Hair Removal is Not Ideal in Summer Months

Many people do not consider laser hair removal until the weather gets a little warmer and they start baring more skin. However, by that point, I’d typically recommend against the procedure. The primary reason for this is that you should not be getting laser hair removal on skin that is tanned. You need to use a sunblock in the area for at least 3 weeks and maybe longer. Having said that though, areas such as the bikini area and  axillary area (armpit) are usually not tanned, and laser hair removal on those areas are fine for laser hair removal through the summer. Generally speaking, any area that does not get tanned, even though it is summer, if ok to get treated.

Now you may be wondering if you’ve wasted your money if you’ve already received a few treatments before the summer, and now  you want to hang out at the pool and tan during the summer. Absolutely not! The hair that was destroyed by the treatments (generally 15-20% of the hair treated in one session) remains gone and you can just resume your treatments in the Fall, or when your tan fades – whichever comes first!

Bridal Makeover: Plastic Surgery for the Bride-to-Be

It is almost universal that a woman would like to look her very best on her wedding day. However, from a plastic surgeon’s perspective, it takes careful planning. I’ve seen women who have requested fillers and Botox within a few days of their wedding. I’ve even seen women who have requested an upper lid blepharoplasty within 2 weeks of their wedding. And ditto for a breast augmentation. Quite frankly, all of these are terrible ideas. This topic covers a broad age group: many women are having their first marriages in their 20’s and 30’s and oftentimes a second or third in their 50’s. I’m also discussing others in the wedding party in the information below.  

Of course, each woman and her wedding situation can be different. However, I think as a general principle you should ideally do fillers and Botox six weeks before your wedding. I am being conservative here… 3-4 weeks before is probably fine, but I would lean towards six weeks to be certain. This allows any bruising that may occur to completely resolve and for any fine tuning that needs to be done. Even if you “never bruise,” there is always a first time, so I recommend allowing time for that possibility. A more minor point is to be careful using Botox on your forehead before your wedding. Although getting rid of all lines and wrinkles on your forehead is appealing, those same muscles allow your brow to elevate. Anyone who has Botox injected in their forehead (this does NOT include the glabella area or crows feet), can experience eyebrow descent. This is only correctable with time!

I personally would not do a breast augmentation closer than 4-6 weeks before a wedding, and perhaps much longer if a complicated lift is required at the same time. Three months before the wedding is a better timeframe. As I said previously, I have had women request a breast augmentation the week before their wedding. I’ve told them to enjoy their wedding and honeymoon and then get their augmentation. Remember it takes up to three months for your implants to drop fully into position – and sometimes longer with a vertical mastopexy. I would recommend the same minimum three-month timeframe for a tummy tuck as well. 

SmartLipo is fine three weeks before their wedding, though the more time in advance, the better, as improvements continue to take place over a six month time frame.  

Remember, you are likely your own worst critic. While the thought of looking your very best for your big day is appealing, you want to be sure you allow plenty of time to prevent having any issues or complications on your wedding day. 

Should I Have a Tummy Tuck Before Having Kids?

 

A high percentage of tummy tucks performed are after a woman is done having children. They often aren’t happy with the stretched out look that bearing children has created on their abdomen. There may be loose skin, stretch marks, and decreased muscle and fascial tone, causing the abdomen to bow outwards.

But what about those women who have not yet had children, but feel they could benefit aesthetically from having a tummy tuck? I often see patients who have experienced significant weight loss and have the same concerns that moms may have, with stretched out skin.

This definitely comes up in my practice from time to time. It is really not a problem. They can have a tummy tuck without issue, but if I know that they will likely have children,  I just avoid tightening their fascia, the the thin layer that overlies the abdominal muscle and helps to keep it flat. This allows me to excise the extra skin and fat and give them a tighter look. When and if they get pregnant, the skin and muscle will stretch. How it will look after their pregnancy is impossible to predict, but oftentimes it will be much better than if they did not have the tummy tuck, especially if they are careful to eat in a healthy, controlled fashion and maintain their workouts. I can, of course, still do liposuction to their flanks (love-handles) to help give them a more contoured look. Of course, if they know they are going to have a child soon (in the next 2 years or so), then it makes more sense to wait until after the pregnancy.

What happens to those women who think they will have no more children and have a TT and then find themselves pregnant? Ultimately, the child always wins. The abdominal wall will stretch and the internal sutures will stretch or break. This has obviously happened to women on numerous occasions. However, if i know of these plans in advance, I would simply not tighten the fascia for this reason.

A Day in the Life of a Plastic Surgeon

 

One of the better things about being a plastic surgeon is that no two days are ever alike.

I thought it would be fun to share with you what a day in my life looks like. May 10, 2017 began off with a SmartLipo case for a female client from Baltimore. She had previously came in for a complimentary consultation with her sister. Like many couples who come in to my office for a similar treatment, one will complete theirs first so the other can hear how easy or tough it was. Of course my hope is that they always think of it as easy! As is the case with almost all of my SmartLipo cases, she took some Ativan beforehand to help her feel more relaxed and comfortable (and open). Although some plastic surgeons may be bored while performing SmartLipo, since it is repetitive motions, I really enjoy doing these cases. For me, it is a great chance to chat with my patients and learn about their lives. I have heard incredible stories, both disheartening (sexual abuse, financially helping their families even when they had little money of their own, and so on), as well as truly inspiring (coming to the U.S. with less than $50 in their pockets and succeeding). Whatever the subject matter, it is truly a privilege to be able to connect to people in this way. We are all so busy in this hectic world that this is truly committed time to talk with another person (neither one of us can leave!)

I worked on two of her areas of concern. She currently does not exercise and I had a chance to stress the importance of healthy eating and also exercising. I personally like the Paleo meal replacement product that I currently sell in my office, as it takes most of the planning and thinking out of following a strict diet – and it definitely does work. I also stressed that everyone will get a more dramatic change from SmartLipo if they decrease their total body fat. With both SmartLipo and SculpSure, spot areas of fat are being reduced, but it is still important to decrease the total body fat.

I actually had a second Smartlipo case immediately following this one. This time, it was a former professional athlete who over the last year had found himself super busy with work – to the point where he had stopped all exercising and his diet had gotten worse. The two places guys tend to get fat is in the lower abdomen and flanks. He had already turned around his diet and was starting to exercise. The SmartLipo was to get him jumpstarted so that he could see changes more quickly. He was very, very committed to this and I know he will be successful and will get buff again. It is definitely taking a toll psychologically on him to go from a super-cut 6 pack to his self-proclaimed “doughboy” status.

I followed these procedures with several Botox patients. I like my Botox patients to come back in every 3.5 months. Unlike most plastic surgeons, I do my own injections – and enjoy it! I particularly enjoy hearing if they have any new vacation plans coming up and what is new in their lives. I often have known these patients for years. Some days, I only have a couple of minutes to catch up and other times, I have more time to get into the details – but it is always great to see them again. Two of the women on this day were over 40 years old. It was also an opportunity to tell them about the new Picosure laser that I had just recently purchased for my practice. It is truly an amazing laser, as it allows women to dramatically even out the coloration of their skin and eliminate brown spots and pigmentation on their face, neck, chest and hands – with no downtime. They need to do at least 3 treatments about 1 month apart. We are all amazed by how much improvement the patients are getting already. We are just starting to post some of our results online.

Next up were a few patients wanting fillers. The fillers usually last 12-18 months, so I don’t see them quite as often. However, many of the filler patients also get Botox. Today, as is often the case, I saw a woman who I told should hold off on fillers as she looked great, and that perhaps we should re-evaluate in 4-6 months. Sadly, many doctors will always do something if they can. However, I prefer a more natural look and also personally do not want to encourage treatments that aren’t necessary in my professional opinion.

I then saw a few follow-up patients: a Smartlipo case, a labiaplasty case (done with her breast augmentation) and a breast augmentation case. It is nice to see how they are progressing, and with each visit ,getting a more natural and improved look. After most cosmetic procedures, with time, things look better and better.

I then had a SculpSure consult. I have known this woman for several years, and she has been troubled by stubborn fat that just won’t go away. I was able to offer her insight on both SculpSure and SmartLipo, as they would both be helpful to her. SculpSure is a new laser that I recently purchased which will melt up to 24% of the fat in an area, with no incisions and just 4 small paddles applied to the skin. The treatment only takes 25 minutes, and there is absolutely no downtime. You must do two treatments 4-6 weeks apart to get the best results. It is the only treatment that I have ever had done to myself – so I can tell you with 100% absolute certainty that the results are amazing and what the actual procedure feels like) After explaining both procedures to her and giving her the prices, she left to think about which one makes the most sense for her right now.

My last consult of the day was a woman who wanted a tummy tuck. However, in her case I thought that while a tummy tuck could be beneficial, her skin tone was good enough that if she would work on losing a bit of weight, she would probably do fine with a less invasive procedure such as SmartLipo.

It was a busy day. I never schedule a lunch break. However, I always find time to grab some food that I brought from home between patients and to drink lots of water.

Tomorrow, I will be going the surgicenter to exchange breast implants in a woman who received saline implants over 15 years ago and who now wants to go larger and have silicone implants placed.

Every day brings new patients and former patients back into my world. And every day, i get an opportunity to help boost someone’s self esteem both by what I can do for them and also what I can say to them. If we feel good about ourselves, and feel empowered, then almost anything is possible.

My Experience with the PicoSure Laser Facial

[vc_row type=”in_container” scene_position=”center” text_color=”dark” text_align=”left” overlay_strength=”0.3″][vc_column column_padding=”no-extra-padding” column_padding_position=”all” background_color_opacity=”1″ background_hover_color_opacity=”1″ width=”2/3″][vc_column_text]Written by Jacqueline Seabra, Master Esthetician

As a Master Esthetician, I can truly say that I’m delighted with the results from PicoSure, which is a minimally invasive treatment. As I’m every defensive about what goes on my skin, I wanted to try the facial treatment without any numbing/ I was a little skeptical, but definitely willing to try.

I will note that I do have a high tolerance for pain and discomfort in general, but I found it to be minimally uncomfortable – a heat sensation that I’ll describe as intense but at the same time, it felt good. The PicoSure laser concept is about bringing heat to the skin to induce collagen production and thus resurface the skin. With that thought it mind, I can say it actually felt quite pleasant to me.

It’s a quick procedure, with no  redness or just a small amount, which can be easily covered up with makeup. After each of my two treatments (I will do a third in a months time), I kept working in the office and treating patients, and did not even apply any makeup because I experienced no redness. I found the PicoSure laser facial to truly be a no-downtime procedure with great results.

Even though I wanted to do the PicoSure treatment without applying the numbing cream, most people will want to apply the numbing cream 30 minutes prior to the treatment and cover the area with Saran wrap (for greater absorption), so it will be completely painless.

Remember, you should stop all active ingredients, such as Retin-A or other acids, on your face for 3 days prior to your Picosure laser treatment. You will likely need 3 treatments to see your desired results, each one month apart. You must use a sunblock between treatments when you are in the sun.

 

Jacquline is a Master Esthetician at Berman Cosmetic Surgery & Skincare Center. Learn more about Jacqueline and the rest of the team here.

Want to schedule a skin consultation with Jacqueline? Click here or call 703-406-2444 to schedule now![/vc_column_text][/vc_column][vc_column column_padding=”no-extra-padding” column_padding_position=”all” background_color_opacity=”1″ background_hover_color_opacity=”1″ width=”1/3″][image_with_animation image_url=”4607″ alignment=”” animation=”None” img_link_large=”yes”][vc_column_text]Master Esthetician, Jacqueline, one hour after her PicoSure facial. Notice the absence of redness – she was able to continue to work and see patients immediately! [/vc_column_text][/vc_column][/vc_row]

Are Breast Augmentations Still Taboo?

The quick answer is NO!

In the United States alone, there are literally millions of women who have had a breast augmentation. Based on the sheer number of women getting the procedure, we can clearly concur that it is not taboo. From young women wanting to look a little fuller, to weight loss success stories, mothers and grandmothers looking to get their lift back, there are no limits to age and circumstance of women getting this popular procedure done.

There is also a shift I’m seeing, especially in the past few years. Women are feeling much more comfortable being open about having had this surgery. I suspect that social media has helped to create this culture of authenticity and openness. There have been endless articles written in popular magazines available everywhere. There are a plethora of videos featuring them – both medically and for entertainment purposes. Many models and athletes have augmented their breast size – and have been very open about that fact.

There are also some changes in implants. They are  getting more and more natural to the touch since silicone implants re-entered the market in 2006. Numerous medical studies were done between 1992-2006 confirming that there appear to be no additional medical risks from silicone implants. The public is also realizing that there is no need to change out your breast implants after 10 years, provided they feel and look good. I have seen a large number of women who have had their implants in much longer than 15 years with no problems. I have a number of women I placed breast implants in over 15 years ago who are doing great. I personally have seen two patients who have kept their same implants from the 1970’s! (Note: I did not perform those procedures – I’m not quite that old.)

I also believe that society has finally realized that while you can diet and exercise all you want, if you want larger breasts or a little lift, the only way to get that is with a breast augmentation. As cosmetic procedures have become safer and safer, we are allowing people to fearlessly, and unapologetically, make changes to their bodies as they see fit. We can change our clothes and we can make changes to our bodies – and remain the same person. We have not sold ourselves out- but rather, we have had the strength in our convictions to get what we want, when it has not been handed to us.

If you are considering a breast augmentation yourself, please do not hesitate to call my my office at 703-406-2444 to schedule a private, complimentary consultation or click here to book online.

Who is a Good Candidate for the VI Peel?

VI Peel is a unique chemical solution that uses medical-grade ingredients to remove the damaged surface layer of the skin. This is done essentially by causing a controlled wound to the tissue that stimulates collagen and elastin production.  What happens naturally is the replacement of the damaged skin with new skin cells, providing a brighter, tighter, and more even skin complex.

The VI Peel has one of the finest blends of ingredients available in the Medical Cosmetic industry. It uses a combination of powerful ingredients, including:

  • TRICHLOROACETIC ACID (TCA), which assists with deep scar healing and texture
  • RETIN-A, the most powerful antioxidant available, which helps in the formation of new cells
  • SALICYLIC ACID, a beta hydroxy acid, works in the process of exfoliation allowing better ingredient penetration
  • PHENOL, which includes antiseptic and analgesic properties, works as a anti-inflammatory and reduces excessive discomfort for the patient by allowing the stronger acids to work without causing inflammation in the tissue
  • VITAMIN C (Ascorbic Acid), a powerful antioxidant that assists in healing, as well as preserving the health of new skin cells

So who is a good candidate for a VI Peel? It truly is suitable for all skin types and addresses concerns such as hyperpigmentation, melasma, acne scars, wrinkles, uneven skin tone and overall texture on the skin. One of the best things about it is that it involves minimal discomfort and downtime. During the peeling, which may last from 5 to 7 days, you can cover up with moisturizers and makeup.

The depth of the damage in the tissue is the measurement we use to determine the recommended number of  treatments.

If you have questions about the procedure or would like to schedule a private consultation with me, please call my office at 703-406-2444 or complete the consultation request form on this page – I’m happy to help!

What’s New in Cosmetic Surgery for 2017

 

It’s amazing what advancements take place each year in cosmetic surgery. This part year has brought about two major breakthroughs, PicoSure and SculpSure

The PicoSure laser is a gamechanger in facial procedures. Almost all women over the age of 30 develop irregular areas of increased pigmentation on their face. As they continue to age, this will extend onto the neck and chest area and also the hands. This is often even more pronounced in the Asian population. Traditional laser treatments have included CO2, IPL and Fraxel lasers. These are very helpful with white skin but the problem is these treatments all cause a tremendous amount of redness and inflammation, requiring missing many days from work and other life activities. In addition, on Asian or light brown skin, they can cause hyperpigmentation.

The Picosure laser allows for dramatic improvement in hyperpigmentation on the face, neck, decollete  and hands, regardless of skin tone – and there is very little to NO downtime! I’d recommend planning on three treatments per area, spaces one month apart.

The other huge breakthrough, for the body, is SculpSure. This is the first treatment modality that lets you melt fat in just 25 minutes, using 4 paddles (cell phone size). You should plan at least two treatments, spaced six weeks apart. Studies by Cynosure show that up to 24% of fat can be reduced in the area. This is a very impressive amount, considering no incisions are needed and you can do this on your lunch break or on the way to the gym. I even did this on myself (see my photos here) to show that it really works. By using heat, it avoids many of the problems that occur with freezing (as with CoolSculpt – uneven fat removal, significant pain, ineffective in many patients, significant nerve damage – causalgia).

Another shift we are seeing is the greater recognition that excellent, pharmaceutical-grade skin care is an integral part of looking younger and healthier. These types of products are only going to be available from a physician’s office and can’t be purchased online or at high end stores. Even with the best laser treatments, you will need excellent skin care to maintain this result.

A few predictions:

  • I believe the Brazilian Butt Lift, which is usually achieved by fat transfers, will be found to have a higher complication rate than the public realizes. I have seen fat transfers performed in women with low body fat. The problem is that about 50% of the fat will often not survive (fat needs to acquire a blood supply to live or it just melts away). Therefore, these women will pay a lot of money but will have little to no change in the appearance of their buttocks. I also believe more women experience infections, oil cyst, and fat loss than is presently recognized.
  • I believe that the number of facelifts performed will decrease over time as more women choose to delay their facelifts by using fillers, botox and facial lasers like Picosure. Additionally, procedures like Smartlipo can decrease the fullness and tighten the neck/submental area in many of those women between the ages of 35-55 years old.  Ultimately, they may feel the need for a facelift to to tighten the neck, but this will likely be pushed off in many women to a much older age.