The best answer that every doctor is told to tell his or her patients is that about 50% of fat can be removed with liposuction. But with CoolSculpting, we know that ONE treatment can remove up to 30% of fat. Want more gone? Add another treatment. Some with more to lose do three treatments. It’s great because there’s no downtime, it’s permanent, and it’s comfortable.

Question: How do I know if I am a good patient for CoolSculpting?
Answer: If you are healthy, close to your ideal weight, and the fat you want to get rid of looks “poochy,” then you may be a good candidate for CoolSculpting.

Question: Will I get tightening with CoolSculpting?
Answer: The direct answer is that the FDA clearance for CoolSculpting does not list the treatment as a way of tightening the skin. However, if you look at the CoolSculpting treatment photos on the Web, the patients’ skin looks tighter. What’s happening is that the body responds to treatment with some natural tightening of skin anyway over several months after treatment.

Question: Are there other treatments I can do with my CoolSculpting to get better skin tightening?
Answer: Yes. Lasers and Thermage® can tighten, and Ultherapy® can tighten and lift. The great news that makes CoolSculpting so unique to Key Laser Institute is that we have all of the choices for you to choose from to make for a better treatment for you.

Question: Which is the best treatment for me, CoolSculpting or Layered LaserLipo?
Answer: The simple answer is if you simply want less fat and want to slim without surgery, then CoolSculpting is the choice for you; you can achieve this with one, two or three or more sessions. The great thing about the Key Laser Institute for Aesthetic Medicine is you really have two great choices with CoolSculpting and LaserLipo. Let us help you find the best choice for you.

Questions: How much will I feel during treatment?
Answer: The applications of the cooling chambers to the skin and fat are really quite comfortable. You will feel something to begin with, mostly the suction of your fat into the cooling chamber. During the treatment, you won’t feel much because the cooling numbs as it is applied. In the first few minutes and at the end of treatment, you feel this “waking up” tingling, when the unwanted fat begins to thaw and natural body heat returns to the fat.

Question: Well, if treatment doesn’t hurt that much, how much will I feel after?
Answer: Most patients say that there wasn’t much discomfort after treatment; their skin felt a bit numb, there was some sensitivity, and maybe there was some bruising, but that all went away quickly. There are some patients who have had discomfort afterward, almost a nerve pain like-feeling, but it has resolved in all patients. Typically, after traditional liposuction in Portland, Oregon, patients have been instructed to wear a form-fitting compression garments after their procedure to avoid this kind of swelling, bruising, and discomfort, and achieve the “best results.” So the big question with CoolSculpting is: why not use a compression garment, just like after liposuction? It has worked so well for all of these years, so we recommend that CoolSculpting patients should wear them for a few days, maybe a week, (not the weeks needed after lasers and liposuction). What have we found? Wow, what a big difference for comfort after CoolSculpting, with a few days use of a compression garment.

Question: Do I have too much fat to have CoolSculpting?
Answer: The answer lies in the plan: larger areas with more fat will take more treatment sessions, smaller areas with less fat will take fewer. If you want to enhance your tummy but you have only a small amount of fat, we’ll set a plan for your first treatment to be two cooling applicators, maybe a smaller one for the upper tummy, and maybe a medium or larger one for the lower tummy. You can lose up to 30% of your fat in the first treatment. Want to lose more? The second treatment can be performed in the same area (i.e. tummy) as soon as 2 months later. Let’s just see where the most amount of fat is left to lose. For example, if the sides of the tummy need more treatment, the cooling applicators would then be applied where the fat remains, and the same can be done for a third session, letting the body decide where we need to place the next session of cooling applicators.

Question: Can I do my tummy and muffin top the same day?
Answer: Yes, you can treat one area right after the other the same day. If the tummy needs two cool applicators, i.e. one for the upper tummy and one for the lower tummy, then you can always come back the next day and treat the right muffin top, and the left muffin top.

Question: What does Cooling Cycles mean?
Answer: Each cooling cycle is the application of one cooling chamber, which takes about an hour for each application. So, for example the right and left love handles treatment takes about two and a half hours from start to finish.

The secret with Portland Lipo procedures is that they take a lot of laser heat energy to break apart fat cells. After they are heated, you still need to suction those cells out of the body to get rid of them. But there is another way. Fat cells are really quite susceptible to dying off with cold too. CoolSculpting uses intense cold to destroy fat cells. Yes, you can just freeze those unwanted fat cells (the right way) and your body just naturally gets rid of them. With CoolSculpting you can lose up to 30% of the treated fat with one session.

So how does it work? While you comfortably recline, check your email or read a book, a cooling chamber is applied to the unwanted area of fat (muffin top / back fat / flabby abs / love handles). Gentle suction is turned on and the bulge of skin and fat is drawn into the cooling chamber. Gentle cooling continues for about 50 minutes. Heat is drawn out of the unwanted fat, and microscopic ice crystals form within the fat cells (no, you can’t see them, they’re invisible). The cooling is then released, and the ice crystals that were within those cells disappear. The targeted fat cells that are part of that unwanted bulge are damaged just enough that the body decides to just get rid of them. Not just for a summer, but for all summers to come, just like liposuction, but with no liposuction. It’s totally non-invasive and there’s no downtime at all.

CoolSculpting uses your body’s natural waste-removal processes to get rid of unwanted or damaged cells; this natural process is actually happening every day of our lives. Our bodies are getting rid of this-or-that cells – ones that are older or damaged – it’s natural. No, that fat doesn’t go into the blood stream, but is metabolized, slowly, gradually, naturally over several months for that unwanted bulge to slim down.

Let’s talk about Ultherapy. First of all, I am excited about the results we are seeing with our patients – this treatment is all about skin lifting and tightening. I was an early investigator for Thermage®, and while this treatment works for many people, not all patients will see the result they want and the treatment can be uncomfortable. Real Self has a polled survey suggesting that 39% of patients with Thermage were happy with their gains, and I would say that is about right. I think the percentage of Ultherapy patients who are happy will be much higher.

Very simply, gravity is what makes the face look tired. Sure we can fill or plump up those marionette lines with injectables, but a big part of the cause for those folds is the loss of skin tightness. That’s where Ultherapy comes in it’s all about lifting the skin naturally.

So how does it work?

Imagine microbeams of ultrasound energy that focus together, under the skin. These beams converge in the collagen layer, where thousands of microbeads of energy create “droplets” of collagen repair and regeneration. It’s pretty exciting just to talk about, but really exciting for us to see.

What is treatment like?

Treatment can be uncomfortable, and that’s why I ask each patient what they use in their daily lives to make discomfort manageable. Many of our patients are using just ibuprofen (Advil), but there’s a good half at least that will want something stronger. With all of our patients we are using the Zimmer Air Cool, and this may be why we just aren’t seeing much in the way of swelling. In my office Ultherapy treatments are given by our RN’s with huge laser experience. I simply don’t believe that for your safety this treatment should be in the hands of laser technicians or anyone less experienced.

What is recovery like?

After treatment our patients leave our Portland, Oregon dermatology office and they already can see some of their results, with the best still to come over the next 4 to 6 months. Bruising is uncommon, but we have a few patients who have bruised, so I would also talk with your doctor about how you can minimize bruising. As a general rule, our patients finish treatment and can return to work later that day, if not fully by the next day.

How many treatments do you need?

The before and afters with just one treatment are impressive. We’re also seeing people who need a lot more lifting, and some of them have even had facial surgery maybe a decade ago. In their words, they say things like “it’s all gone” and “I heard about Ultherapy.” For certain patients we are saying “think about two treatment sessions, maybe three to four months apart.” This way, you can gain your improvement by allowing two steps of regenerative repair.

Skin Rejuvenation

Your choices for improvement have really come a long way. First there are all of the brown spots (from all of those great summers in the sunshine). A breakthrough treatment is the brand new Fraxel Dual. This is gentle for our patients and extremely effective. This new use of light at the 1927 wavelength band is great for removing unwanted pigmentation as well as improving those fine lines on the backs of hands. This laser treatment seems to bring the pigment to the surface, with a fine shedding that follows, with some redness and recovery over 1 to 2 weeks. Our patients are doing well in as few as 1 to 2 treatments. Treatment doesn’t have to stop at the wrist, but can go all the way up the arms as well. Layered Light can combine both selective other lasers for pigmentation and Fraxel 1927 for even greater gain in each treatment session.

A Plump, Youthful Appearance

I hear from my patients, “my hands just look so thin, so bony.” Here is where injectable fillers can be extremely effective. My favorite filler at this time is RADIESSE. What a great filler for the backs of the hands! RADIESSE is a filler that is both natural and a collagen stimulator, so results can last as well.

Your hands and arms can look great if we give back some fullness to the hands, lessen the size of veins, improve and regenerate the skin roughness and even out color. Welcome to the world of laser medicine and Layered Light™.

First the chest and neck get a tremendous beating from sunlight, so why not use lasers to help regenerate the skin after sun damage? My favorite lasers to use on the neck and chest are one of two choices.

1. DOT resurfacing. DOT is an acronym for Dermal Optical Thermolysis. DOT treatments scan micro pixels of carbon dioxide laser energy into the skin surface, stimulating collagen regeneration and skin surface collagen tightening. We use numbing creams that make this treatment comfortable. But remember, this is not a laser treatment for a medispa, or anyone else other than a highly trained and experienced laser physician within the specialties of dermatology and plastic surgery.
2. Fraxel. Fraxel Dual 1927 wavelength laser is a great choice for the brown and red blotchiness that comes with too much sun.

These are choices in laser selection that can be used to complement each other. So often we hear after treatment, “My chest is so smooth, and the color looks great!”

Even More Options

For loose skin and crepyness under the chin, let’s talk about combining Layered Light tightening with Ultherapy for deeper skin-focused ultrasound tightening. These treatments are noninvasive and gain you tightening and lift, without the need for surgery.

Then there is Layered Light for Body Shaping, and why not use lasers to dissolve excess fat under the chin with laser assisted lipolysis?

These treatments can easily be combined in a single office visit. Ready to look younger? Give us a call today for a personal assessment of your cosmetic needs.

The Fourth Layer: Excess Facial Fat

To address fullness of the neck or jowls, lasers can be used, dissolving fat from under the skin. This is actually an effective method of fat reduction anywhere on the body including the tummy, hips, thighs and arms. I use Layered Light for LipoShaping.

• First, the treatment area is numbed, important for both your safety and your comfort.
• A laser fiber is passed under the skin to target unwanted fat. These laser fibers can be small – imagine a laser fiber less than half of one millimeter in size. As laser energy flows out of this fiber, unwanted fat is dissolved, and skin begins to tighten as well because of the laser energy.
• There still may be a need for small volume microcannula lipoaspiration, to remove fat excess.

If treatment is just to the face and neck, my patients will most often be able to safely drive themselves home. Initial results can be seen right after treatment but it’s usually several months before the best results are achieved, since the body needs time to rid itself of treated fat. Do remember that this is still a procedure, and the amount your skin may tighten and what you will gain still depends as well on the biologic response of your skin to tightening and to the laser energies of treatment. The newest use of this laser is not just the jowl or underchin fullness, but the nasolabial cheek fold. With the laser, I can actually flatten and smooth out the fold, rather than just using fillers which are of course more temporary.

Other related posts:

• The First Layer of Aging: Gravity
• The Second Layer of Aging: Volume Loss
• The Third Layer of Aging: Sun and Environmental Damage

The Third Layer: Sun and Environmental Damage

All of the changes to your skin, from silky softness to all of those lines and wrinkles – not to mention brown spots and broken blood vessels – are all about a layer of aging that is the skin. We are talking not just about skin surface cells, but the full collagen thickness of the skin as well, giving back the health of the whole skin surface. Regeneration of skin cells and skin collagen is all of what treatment is about.

So let’s talk a bit about Layered Light for Lines and Wrinkles. The biggest breakthrough here was probably over 20 years in the making, it did begin with sanding, then chemical peels, and then laser peels of all kinds, and then how to do treatment with pixels of laser energy was discovered, and what a difference that has made. We are not talking about just waving a laser over the skin and you are “recovered,” but we are talking about using higher energy pixels of laser energy to remodel and regenerate deeper skin collagen and skin surface cells.

Your appearance after treatment is one of redness, and some swelling and shedding that takes about a week to 10 days to recover from. I would ask you as the patient to choose your physician wisely because skill does matter. As a board-certified dermatologist in Portland myself, and I would certainly only choose a physician board certified only in dermatology or plastic surgery. A “weekend course” trains no one for this procedure, and remember the laser is not doing the treatment – it is very much still your choice of physician. The combinations of lasers that are possible with our Layered Light for Lines, Wrinkles, and Sun Aging, are almost endless: IPL, Cool Breeze, Fraxel Dual 1550 and 1927 and Photodynamic Therapy (PDT).

The Second Layer: Volume Loss

As we age, our faces sink inward. It’s a natural process, but that doesn’t mean it’s inevitable. Structure is what holds up the face – think of the bones, muscles and even fat that combine to create your facial contour. When facial fat begins to diminish, injectable fillers can help keep the skin looking youthful.

First there is fat transfer injection – yes, fat from your tummy or thighs can be used to help the thinning face. Lipotransfer works by using the mature adult stem cells that are in all fat and transferring them into the deep fatty tissue and muscle structure of the face. There are many other injectables to give back volume and structure, lift the cheeks and fill in folds around the mouth. These hyaluronic acid injectable fillers include Restylane and Juvederm Ultra Plus. For adding deep tissue volume, I often use Radiesse or Sculptra. These products a very popular and deliver results that can last for years. But remember, it’s not the product, it’s all about which procedure to choose, which product to use that’s best for you, and most importantly the artistry with which the treatment is given.