"I love you, Dr. Bock"

That is how I was greeted last week by a long time patient. She had undergone a number of noninvasive procedures in the past few years, but two weeks before I saw her I had, for the first time, injected filler in her cheeks. The aging of the mid-face has, with the development of better and linger fillers, become recognized as one of the primary events that makes a person look aged. The young face is full, with smooth, convex surfaces, while the aging face becomes concave, with the loss of deep tissue and other structures. This produces depressions such as the "tear trough", a groove that extends downward and sideways from the inner (medial) part of the eye. It was this area that was filled in my patient. She was smiling as she reported that even her teenage son, without knowing that anything had been done, told her that she looked good.

Laser Fat Destruction & Eyelid Burns

Although many cosmetic surgeons now recognize that lower eyelid bags are more commonly due to tissue loss rather than true fat protrusion, there are many who are still excising lower eyelid fat. Apparently a very small subset of these is attempting to remove this fat by making a small incision in the lateral lower lids, inserting a fiber from the "LaserTight" device and attempting to melt the fat and tighten the skin. This is a procedure that is new to me, and on the surface appears fraught with hazard. There are muscles near the fat that, if injured, could make it difficult for both eyes to move in a coordinated fashion. Furthermore, bleeding from eyelid surgery can rarely result in loss of vision, and this procedure is performed without direct visualization.

The Skinny About Liposuction

Ever since the onset of tumescent liposuction, there have been a number of modifications of the procedure, attempting to produce better results or to speed up the procedure. These approaches include mechanically assisted liposuction, ultrasonic  assisted liposuction and, most recently, laser assisted liposuction.

We have had experience with mechanically assisted liposuction, and have been unimpressed. Although it makes the procedure easier on the physicians, it does not make the procedure any quicker.  Ultrasonic assisted liposuction has never become very popular, due to the relatively high incidence of reported complications. This approach uses ultrasound vibrations to break up the fat cells. Then this is followed by traditional liposuction to withdraw the fluid. one of the associated complications has been the formation of seromas, accumulations of fluid that have a tendency to recur.