Restylane has become the number one trusted dermal filler in the world. With over 20 million treatments worldwide, and numerous publish studies, Restylane’s safety and efficacy is well established. It is composed of hyaluronic acid (HA), a naturally occurring substance that is found in skin and joints. It’s duration of action is about 6-12 months, depending on the location it is placed. (My other blog explains duration in more detail) Crosslinking, a process that joins adjacent strands of the HA, is essential, because the breakdown of the HA would occur in weeks without it.
Restylane is composed of similarly sized HA particles, with a concentration of 100,000 per ml. Perlane, a “cousin” of Restylane, is exactly the same as Restylane, except that it’s concentration is 10,000 particles per ml. Both of these products have been on the US market for years, Restylane since 2005, and Perlane since 2007. Restylane Silk, the newest US FDA approved filler, is composed of 500,000 HA particles per ml.
This means that the Restylane Silk HA particle is 1/5th the size of the regular Restylane HA particle, and that’s the reason behind it’s magic.
Although Restylane Silk was approved in the US in 2014, it has been used under the name Restylane Fine Lines for over 15 years in Canada. There has been a huge experience in Canada using this product to improve superficial fine lines and in LIP ENHANCEMENT. In the US, there are now only 2 FDA approved fillers for the lips, Restylane, and Restylane Silk. Silk is also approved for the perioral area (area around the mouth). It’s the author’s opinion that part of the problem lip enhancement has been disappointing to many patients is that US physicians didn’t have access to the proper filler. Fish lips, sausage lips, uneven lips, overfilled lips have dissuaded many potential patients from ever trying lip enhancement.
The small particle size of Restylane Silk allows the skilled and experienced physician to add product in the very superficial aspect of the lip, in the submucosa. This was impossible with other fillers without lumps being visible. The product spreads in this plane, so only a couple points of injection are needed in each quadrant of the lip. By being so superficial, and with only a couple injection points, the discomfort associated with the injection is markedly decreased. In addition, by staying superficial, and not deep, the risk of a bruise is significantly less. Very precise alloquots of Restylane Silk can be placed along the border of the lip (vermillion), cupids bow and peaks, in the tubercles, and corners of the mouth much easier than the larger particle HA fillers.
The addition of Restylane Silk to the aesthetic physician’s armamentarium fills a necessary niche that was missing in lip enhancement. Patients can now anticipate less bruising, less discomfort, less lumps, with better and more natural results, thanks to the smaller particle size of Restylane Silk.
Move over VBeam, There’s a New Gold Standard for Treating Reds, Rosacea, and Vessels…The Excel V Laser
It was 1986 that the VBeam was originally FDA approved to treat red skin lesions. That’s almost 30 years ago. It’s been a good run, but it’s time to give up the number one spot to the Excel V laser. There are several reasons that the VBeam is inferior to the Excel V which will be elaborated below.
The Excel V is actually 2 lasers, a 532 nm KTP laser and a 1064nm YAG laser. (The Vbeam is a 595nm Pulsed Dye Laser). With the 2 wavelengths, several more possible treatments are available that the VBeam cannot do. Typically, the longer the wavelength, the deeper the laser is capable of going. So basically, by the addition of the 1064 laser, spider veins, and deeper blue vessels of the face and legs can now be treated.
In clinical studies, the 532 wavelength has been shown to have a 5 times higher affinity for oxyhemoglobin than the 595 wavelength. What that means is the Excel V’s laser is much better absorb by the red color (hemoglobin)
in the vessels being treated, resulting in more heat getting into the vessels, and thus, better outcomes. Side by side studies of the 2 lasers confirm this.
Cooling is necessary to protect the skin with both lasers. With the VBeam, a blast of cryogen is sprayed simultaneously with the laser pulse. This technology is called DCD, Dynamic Cooling Device, and is not perfect. If the laser is not held perpendicular to the skin, the cooled area might not correlate to the exact area of the laser pulse and therefore possible complications can result. The Excel V has a sapphire cooling tip that allows for cooling of the exact area that is treated. It also allows for pre, parallel, and post pulse cooling, leading to a safer and more comfortable treatment, with less risk to the skin.
Several user improvements make for a shorter, more time efficient treatment for both the physician and patient. The warm up time for the VBeam can be 20 minutes, but for the Excel V, it is less than 1 minute. Changes during the treatment with either spot size, power, or pulse duration, all require recalibration by the VBeam, but are pretty much done on the fly (Real Time Auto-calibration) with the Excel V. Changes to spot size are frequently done during laser treatments, and with the VBeam, this requires removal and replacement of the handpiece compared to the Excel V which is just done by hitting a button on the computer interface. There are much more spot sizes available with the Excel V vs the VBeam as well, allowing for more accurate treatments.
The following can be treated with the Excel V:
- Generalized redness
- Blue vessels around eye, forehead, temple
- Port wine stains
- Vascular lakes
- Spider Veins
- Reticular Veins
- Skin tags
- Redness associated with acne
- Activation of Levulan
- Hair removal in small areas for all skin types (even type 5 and 6)
- Benign pigmented lesions
The Excel V has now replaced the VBeam as the Gold Standard for treating all vascular lesions. It’s safe, diverse (2 lasers), and gives more effective treatments, making it an easy choice for both patients and physicians.
It happens everyday. Patients ask how long they can count on their dermal filler lasting. The problem is, is that there is no quick and easy answer. There are a number of variables that factor into filler longevity, with the ultimate unknown being that there is no way that a physician can determine how one’s body is going to degrade a particular filler.
In the US, the majority of patients are injected with Hyaluronic Acid (HA) fillers. The commonly known HA fillers are: Juvederm Ultra, Juvederm Ultra Plus, Restylane, Perlane, Voluma, and Belotero. The differences between the HA fillers are their manufacturing process, and the concentration of the HA in the filler. The harder the HA is for the body to break down, the longer it will last. A larger particle of HA has less surface area then multiple smaller particles taking up the same space. Less surface area means there is less area for the cells to “chew up” the HA. In general, larger particles will last a little longer than smaller particles. Another factor in HA fillers is how tightly the particles are bound together. Cross-linking, adding bonds between molecules of HA, has been shown to significantly add longevity. All HA fillers are a combination of cross-linked and non cross-linked HA. Too much cross-linking leads to a filler that is very hard to inject, and has led to more complications (in a filler that is no longer on the market). Non cross-linked fillers last only 3-4 months and are hardly used anymore. One last variable in HA fillers is their ability to attract water, their hydrophylic properties. The more they attract water, the longer the HA filler gives a correction.
The fillers that are collagen stimulators, tend to lead to longer longevity. Fillers in this group are: Radiesse, Sculptra, and Artefill. While studies have shown a very mild collagen response to the HA fillers, the visible volume correction with the HA fillers is the gel, not the collagen. With the collagen stimulators, the body responds to what is injected by creating an inflammatory response and lays down collagen. Until the particle is degraded by the body, collagen will continue to be produced. Radiesse is made of calcium hydroxylapatite, and is the shortest duration in this group. Artefill should be considered a permanent filler, because its component, Poly Methyl Methacrylate (PMMA), does not get broken down by the body. Sculptra has consistently given about 2-3 years duration in studies and in the authors experience.
The location in the face a filler is injected is one of the most important factors to determine longevity. Areas where there is more movement, there is faster breakdown. In order of increasing duration in the face, the order is (in the author’s experience):
- Nasolabial Folds
- Tear Troughs
(Forehead, nose, earlobes are variable)
A couple more very important variables that should be mentioned. The more filler that is injected, the longer it will last. This applies to all the fillers. Also, filler doesn’t stop working all of a sudden. It takes months of gradual loss to notice a difference in volume. In fact, even when the patient believes there is no longer results, biopsies have proven that there is still filler present.
After all the above explanation, the author’s experience with the commonly used fillers is:
- Lips: HA fillers give about 4 months, longer with recurrently injected lips.
- Tear troughs: HA’s – about 9-12 months, Sculptra and Artefill – years. Juvederm could last years and should never be injected in tear troughs.
- Nasolabial: similar to tear troughs
- Temples: HA’s – 12-18 months, Sculptra and Artefill – years
- Cheeks: HA’s – 18 months, perhaps 2 years with Voluma, Sculptra and Artefill – years
Remember that individual results are unpredictable. These are generalizations and offer no guarantee as to how long a patient’s results will last. There are many variables that factor into longevity that are listed above, not to mention how each individual responds, degrades, a certain filler.
This is the golden age for minimally invasive cosmetic procedures. Who would have ever thought 15 years ago, that procedures done in the office in a matter of 20-30 minutes could result in demonstrable improvements in one’s appearance with results lasting, in some cases, a year or more? Without the need for downtime, anesthesia, or significant costs, cosmetic procedures have flourished, with many people who never would consider enhancements, “dipping their toe” in these procedures. The concept of “preventative maintenance” has spurred the younger generation to start earlier, with smaller, less dramatic, but noticeable procedures as well.At the forefront of the wave of cosmetic enhancements are dermal fillers. When Restylane was FDA approved in 2003, a revolution in the field was born. Although the main focus was to improve the nasolabial folds, the “smile” lines, in its inception, the broad “off label” use of it, along with subsequent FDA approval of other fillers, treatments have spread to just about every area of the face. There are now about a dozen dermal fillers on the market, with the majority of them based on hyaluronic acid, a naturally occurring substance that is found in skin and joints. Hyaluronic acid fillers (Restylane, Perlane, Voluma, Juvederm, Belotero) provide a soft, very well tolerated fill, with an extremely safe profile. There is also a level of security knowing that these fillers are generally completely reversible, using the widely available enzyme, hyaluronidase, that can dissolve hyaluronic acid, in minutes to hours.
Although less popular, it must be mentioned that there are other dermal fillers which are FDA approved, each with their own niche market. Radiesse is composed of microspheres of calcium hydroxyapatite, and is known as a very robust filler, that has a very high G prime, a measure of it’s lifting ability. Sculptra is composed of Poly L Lactic Acid (PLLA), also naturally occurring as a sugar in the body, and is known as a collagen stimulator. Its use is for global, long lasting, volumization of the face. The longest duration FDA approved filler is Artefill. It is composed of microspheres of Poly Methyl Methacrylate (PMMA) which is a synthetic molecule. Artefill is considered a permanent filler and works as a collagen stimulator, similar to Sculptra.
The understanding of the aging face has made great strides in the last decade. It is now widely understood that loss of volume is the primary cause of the aging face. Leading this volume loss is the shrinking of the multiple fat pads of face, primarily of the cheek and periorbital area. This is why aging often begins to show around the eyes. Gravity contributes to our aging problems and often manifests itself by the descending of these fat pads. Relegated to a less relevant problem than 15 years ago, is the aging related to excess skin. Plastic Surgeons have tightened loose skin for decades during facelifts, often leaving people appearing skeletonized and hollow, but without wrinkles. It is now understood that most of the redundant skin can be improve with proper volumization of the offending fat pads, and most facelifts incorporate this during surgery presently. (In the author’s opinion, most of the patients undergoing the knife could have had their concerns addressed using a combination of fillers and skin tightening devices.)
The common manifestations of volume loss are:
- Temporal hollows
- Loss of cheek volume
- Tear trough deformity
- Excessive crows feet and forehead lines
- Low hanging eyebrows
- Hollowness of the eye (orbit)
- Poorly defined jawline
- Small lips
- Dropping of nasal tip
- Lip lines (smokers lines)
- Corners of mouth dropping causing sad look
- Saggy neck
- Elongation and narrowing of the face
All the above mentioned aging effects can be improved with dermal fillers. Expertise is required to recognize exactly what areas need to be treated to replenished the lost volume, while still maintaining a natural appearance. It’s been shown that the brain can recognize less than a 1mm change in brow position. When corrections are not done properly, it is very easy for the brain to catch it. Poor corrections of the lips probably stands out in most people’s memory, where they are either too full, out of proper proportion, or there was poor attention to landmarks.
Experienced dermal filler injectors are no longer “chasing lines”, the symptom of aging. The goal is to lift and replenish lost volume by addressing the cause of the aging of the face. Of note, even the neck’s problems can be improved by properly injecting the face. Choosing a doctor that has experience in recognizing the areas affected by volume loss and has the knowledge and expertise to improve those areas is essential for optimal patient outcomes.
Ever since Rox Anderson suggested that treating a portion (fraction) of skin while leaving untreated healthy tissue behind as the basis for the Fraxel Skin resurfacing laser over 10 years ago, patients have been having less downtime, less risk, and less discomfort with their laser procedures. Healing is dramatically improved because the adjacent nontreated dermis is able to provide the needed blood supply, nutrients, and local immune response much faster than the traditional treatments and results have been shown to be very similar in efficacy.
Until recently, all RF devices have applied heat to the skin/dermis in a nonfractionated approach, called “Bulk Heating”. Whether the RF device is Bipolar or Monopolar, if the heating element does not penetrate the skin, the energy is pushed into the deeper layers using this method. The implication of bulk heating is that all precision is lost. Exact placement of the heat is impossible, with large opportunities for errors in depth of penetration and/or temperature control. When treating skin, heat from the RF device using bulk heating can be placed too superficial, leading to burns or pigmentation changes, or too deep, leading to fat loss. The dermis needs to be heated to 42 degrees C for 3 minutes to affect collagen stimulation. Only if skin temperature is measured can the operator be sure that the 42 degrees is reached with bulk heating, which is not the case for most bulk heating devices. One last temperature issue is that bulk heating devices are unable to obtain coagulation of the tissue, which occurs at about 67 degrees C, which is needed for maximal tissue contraction and collagen stimulation.
The Infini uses microneedles to deliver the radiofrequency energy IN A FRACTIONAL manner. Its unique array of needles allows the energy to flow between the needles, creating 49 coagulation points AT A SPECIFIED DEPTH in the dermis. Surrounding tissue is sparred, which makes for very little downtime. The superficial layer of skin is spared (because the needles are insulated), leading to no wound care, and markedly reduced risk of burns and pigmentation issues affecting the epidermis. The temperature created in the areas between the needle is enough to create coagulation, for maximal tissue contraction and collagen stimulation.
(Not all microneedling RF devices are fractional. Fractora uses microneedles, but because the energy is directed from the needles to the skin surface, the heating is in a fashion similar to bulk heating devices. Also, because more tissue is affected using this heating method, discomfort is much higher and local anesthetic needs to be injected in most cases.)
It has taken a long time for RF devices to catch on to the fractional technology revolution. The Infini has created much more precision in the delivery of RF energy to the dermis, allowing for higher degrees of skin tightening, while affording the safety and quick recovery time that fractional technology has created.
Botox injections are the most popular cosmetic procedure performed worldwide. Millions of patients are injected each year with the wrinkle fighting drug. Its popularity is attributed to:
- There is minimal downtime – 15 minutes of bumps from the injection
- The procedure is highly effective in improving wrinkles
- Discomfort is usually minimal
- Side effects are few and rare
- Cost is fairly reasonably, but depends on how many areas are done
- The time it takes to get a treatment is less than 10 minutes
So why is the “Was it Worth It” review on Realself.com for Botox only 69%? This can be attributed to multiple reasons, which be further elaborated upon in this blog. (A large volume practice should have a satisfaction rate in the >95%.)
Although the Botox procedure looks very routine to the observer/client, don’t equate this to being a simple procedure that all injectors can master easily.
All patients will age differently, so what areas need treating for optimal cosmetic results needs to be tailored specifically to each patient. A cookie cutter approach to every patient will not work. There are several areas of the face which can be considered advanced: lips, corners of mouth, neck, gummy smile, under eye, bunny lines, inner eyebrows which require a highly trained and experienced injector, or you will live with a disfiguring facial appearance for 3 months.
The trend is moving away from the frozen, no movement, very obviously treated face to a more natural appearance. Rather than blasting and overwhelming the forehead with Botox, a technique using very small, precisionly placed aliquots that allows for movement but with diminished wrinkles. This is a more difficult technique to master.
Shortcuts are often routine in regards to Botox. A majority of practices will draw up syringes of Botox in the morning, or the day before, by a nurse, medical assistant, or office staff. That means the patient will need to get injected in multiples of what is contained in a syringe, leading to limited customization. Also, errors in dilution and sterile technique are possible when filling the syringes is not done by the same person that is injecting the Botox. (Botox comes in a powder form and needs to have saline added to reconstitute it to become an injectable solution.) Dr. Weiner mixes all his Botox personally, and will draw up the appropriate amounts for each patient in the room, just prior to injection.
Discomfort related to the injection can be minimized using various techniques. Using preserved saline has been shown to result in less pain than using regular saline. Needle size, speed of injection, and using proper needle placement is also a key factor affecting comfort. Dr. Weiner also uses several distraction techniques, capitalizing on the Gate Theory (the brain has difficulty processing more than one sensory input at the same time).
Varying the concentration of Botox is a technique Dr. Weiner has used for years. Certain areas require different dilutions to lead to maximal cosmetic benefits.
Touch ups to correct minor imperfections require an advanced injectors experience. They also need a responsive provider, easily available for a drop in or work in patient.
Getting injected by an unknown provider at someone’s Botox party, is never a good idea, and almost always leads to problems that one has to live with for 3 months. The “savings” never is worth it.
Although Botox is extremely popular, as the Realself.com stats show, there are many people that are not pleased with their experience. This is not the norm for the high volume, experienced injector. As explained above, there are many intricacies which can contribute to better results. Hopefully the public will understand that Botox should not be considered a routine cosmetic procedure, and they need to select their providers carefully.
Realself.com is a public forum for asking questions about cosmetic procedures which patients have had or are thinking of undergoing to the website’s participating physicians. The website allows doctors of the following specialties to respond:
- Plastic Surgeons
- Facial Plastic Surgeons
- Oculoplastic Surgeons
Unfortunately, experience and credentials are not always fully evaluated by the public, and undesired outcomes, often with long term repercussions, can result. Sometimes with only a few weekend courses under their belt, Internists, Family Practitioners, Dentists, ER Physicians or OBGyns hang up a shingle Aesthetic Procedures. An article by Tom Seery, CEO of Realself.com, points out that consumer satisfaction rates are about 30-35% higher when a specialist is performing Botox or Dermal Fillers vs. “all providers”.
Now for the most Botched Cosmetic Procedures:
1. By far, the #1 most botched procedure is tear trough injection with fillers. Complaints range from lumps, prolonged swelling, worsening of appearance, pain, prolonged bruising, vascular injury, numbness, and firm nodules. The skin around the eye is very thin, and there is very little room for error in this procedure. Dr. Weiner is a firm believer that this injection should be performed using blunt cannulas with Restylane. There is less swelling, bruising, and significantly less vascular risk with cannulas. Lesson: Leave this injections to “the pros” for better outcomes and safety.
2. Botox being botched is a close 2nd. Common problems are eyebrow or eyelid droop, uneven smile, ineffectiveness, bruising or swelling, or “Dr. Spock” look. Sometimes a touch up can improve these results, but often one has to wait for the Botox to wear off. This can be 3-4 months. So that deal on Botox that is supposed to improve ones looks becomes a nightmare where one looks abnormal and/or worse. Lesson: Botox deals aren’t usually worth it.
3. Laser hair removal resulting in burns is fairly commonly asked about on Realself. If the laser operator is not using the appropriate laser or settings for one’s skin type, permanent pigmentation problems can result. Fortunately, most superficial burns will reverse over the course of several months. In several states, rules for operating a laser are very lax, allowing techs without significant training to use the laser. Florida is one of the strictest in the country. The operator can only be a nurse practitioner, physicians assistant, doctor, or specially trained electrologist. Lesson: Get the most qualified person to operate the laser, preferably a physician with years of laser experience. Dr. Weiner has over 25 years of laser experience.
4. Lip augmentation with dermal fillers is another highly botched procedure. The most common lip problem is uneveness and lumpiness. These are a direct result of poor technique by the injector. Hyaluronidase to dissolve the filler is usually required, and then you are back to where you started (so 2 procedures to get back to square one). Bruising, swelling, and prolonged downtime is seen when lips are injected using needles in combination with injector inexperience. Dr. Weiner is a huge fan of using blunt cannulas for the lips to minimize the recovery time and bruising. Overfilled, and unnatural lips are also a problem, mainly due to lack of knowledge of the natural anatomy of lips by the provider. Lips should have a ratio of about 40% upper to 60% lower. When the upper lip is larger, or the natural landmarks (tubercle, cupids bow, shape) are not preserved, the lips become obviously “done” and unattractive. The sausage lip is when the lips appear tube like (like a sausage link) which is another common error by the inexperienced injector. Lesson: Lips are another area with several intricacies that require an experienced injector. Cannulas limit bruising, swelling, and downtime so you can enjoy your lips without interrupting your social life.
The take home message is that all providers are not equal. Please do the homework, look at reviews, ask friends, and ask the facility “Who is actually doing my procedure?”. In general, specialty trained physicians will give better outcomes with higher satisfaction rates.
This blog will elucidate that small changes to one’s lifestyle and a small investment in skin products, will lead to significant improvements in one’s skin health and beauty.
- Protect from the sun with daily sunscreen, sun protection, and Heliocare. The number one enemy to skin is sun exposure. The sun’s UVB rays lead to activation of enzymes that destroy the skin’s collagen leading to wrinkling and thinner skin. Skin pigmentation problems (melasma, solar lentigos) are exacerbated by the sun. Skin cancers are almost always related to exposure to the sun’s damaging rays. Studies have shown that just using sunscreen can improve ones looks. Heliocare contains Polypodium leucotomos which is a fern extract that is an antioxidant that reverses and protects against the radiation effects of the sun on skin cells. Heliocare has also been shown to improve melasma, because even indoor artificial light can exacerbate this condition where sunscreens don’t offer protection. Wearing a large brimmed hat, SPF rash guard (if at the beach), and staying under an umbrella/shade should be considered during periods of prolonged outdoor sun exposure.
- Stop smoking. Smoking is probably a close second to the sun as a factor affecting skin health and beauty. The toxins in smoking cause contraction in vessels in the skin, leading to poor oxygenation of the skin cells. Smoking essentially strangulates one’s skin causing loss of elasticity, viability, and thickness. Other side effects include increased wrinkles, a change in the color of the skin, thinning of the hair, halitosis, and dental disease.
- Apply topical Retin A or Retinol. It has been well established with research dating back over 25 years, that Retin A has anti-aging qualities. It has been shown to increase cellular turnover in the skin, thus creating skin cells that are younger and more vibrant. It increases collagen in the skin and improves hydration in the skin by increasing the GAG’s. Pigmentation abnormalities are improved as well. Precancerous changes are reversed and prevented to a certain extent. Wrinkles and photodamage have been shown to improve with just using Retin A. One word of caution. If you choose to use Retinol because it has less peeling, you have to use a strength that is higher than what is found in most OTC cosmetics.
- Maintain hydration, drink plenty of water. This is somewhat controversial, but there are anecdotal reports of improvements in overall looks with just making sure you are fully hydrated. There are obvious other benefits as well including kidney, bladder, blood pressure and circulatory health.
- Topical Growth Factors and Antioxidants. Growth factors stimulate skin cells to become more youthful and recruit stem cells which may lay dormant in the skin. Antioxidants help the skin fight off the environmental stress that attacks the skin, including the sun’s damaging radiation. Products that fall into this category are: TNS Essential Serum, Lifeline Day and Night Cream, and Neocutis Journee.
These recommendations are a good start to improve skin health for all individuals, regardless of budgetary concerns. The younger these are implemented, the less correction that will be needed in the future. Consider following these guidelines as an “investment in the future”.
It seems that women are going to great lengths to try to achieve the elusive “inner thigh gap”. According to Nik Richie, the founder of the website “The Dirty” who claims to be the first to coin the phrase “inner thigh gap”, the space between the thighs needs to ideally be 5 finger breadths. Many people, including physicians, argue that women are genetically predisposed as to whether they have the ability to obtain an ITG. If one’s hips are narrow, the argument is that the legs are too close together and having a gap is not possible. Nik’s reply is that it is possible in all women with harsh dieting and exercise, with particular attention to the thigh abductor weight machine (I think he meant adductor machine). Most women would probably be satisfied with an ITG of any dimension, and feel that Nik’s definition is at the far end of the spectrum.
Coolsculpting has just made it easier for women to improve their inner thighs. Whether or not one achieves the perfect “5 finger breadth” gap is really dependent upon what status the thighs are before starting the procedure, their anatomy (genetics) and how much is related to excessive fat deposits. Each Coolsculpting treatment is able to decrease fat in the treated area by about 25%. Results can be visible at only 5 weeks but take about 3 months to fully appreciate the change. The procedure can be repeated if more fat reduction is desired.
Although Coolsculpting was initially FDA approved in 2009 (2010 approval to treat flanks), the handpieces to treat the thigh area were only recently developed and approved. Both the Coolsmooth and Coolfit handpieces are able to treat the thigh area. Treatments are nearly painless and take approximately 1-2 hours per thigh. There is no downtime and no restrictions on activity after the procedure. Risks are minimal and include bruising, numbness, and need for more treatments. Dr. Weiner feels that Coolsculpting offers a healthy method for reducing thigh fat and does not endorse the alternative, that being extreme dieting. In addition, Dr. Weiner stresses that patients must have realistic expectations as to what the Coolsculpting procedure can achieve, and have an appropriate body image before commencing treatment.
Certainly the “inner thigh gap” is a controversial subject. Dr. Weiner’s stance is that many people will not be able to achieve the gap with the Coolsculpting procedure, but they should expect improvement. There are some people who have an actual physical need to reduce their inner thighs – those who have thighs that rub during exercise or walking – who are particularly good candidates for this treatment. The bottom line is that Coolsculpting is a noninvasive, no downtime, permanent way to improve one’s inner thighs with it’s newly approved handpieces, gap or no gap.