The Smartlipo MPX system is used to tighten and lift the neck.

HOW DOES IT WORK?

A small incision is made under the chin and a combination of lasers is inserted under the skin. This breaks down fat celss, dissolving them into a liquid which is then sucked away. Smartlipo helps reduce a double chin and makes your neck look more taut.

IT COSTS from £2000.

For more details contact Dr Al-Ayoubi at the London Medical & Aesthetic Clinic ( 020 8342 1100; www.Lmaclinic.com).

After years ofworrying about her 'turkey neck', Karen Morgan wanted a permanent solution

I became very conscious of my neck in my early thirties because  I had what looked like a fat bulge under my chin. When I found an ad in the paper for chin lifts, I thought I'd book myself in, but the doctor said my neck was beautiful and to come back in five years' time. He said it wouldn't make that much difference.

Gradually, though, as I suspected, I got a turkey neck. The skin began to sag and I lost all definition around my jawline. When I spoke, I'd keep my chin down, and I'd look at the ground when I walked because I was so conscious of everyone staring at it.

Every morning I'd give myself a five-minute chin massage with the backs of my fingers, which worked to some extent. I spent thousands on neck creams, but they didn't have much effect, and I would always ask my beautician to work on my neck -this did tighten it slightly, but then it would relax the following day. I also went for a non-surgical treatment every month using a CACI machine, which uses microcurrents to lift the muscles. The lift would last two days, then drop again.

In the end, I decided I might as well have surgery to remove the fat and tighten up the excess skin. So, five years to the day when I first saw the doctor, I borrowed £2,500 and went back to see him.

The procedure was painless. After having a local anaesthetic, the laser went in through a tiny incision. I didn't experience any trauma or scarring and the treatment only lasted about 20 minutes.

In less than half an hour, I came out a new woman. Now my neck is taut, tight and I actually have a jawline. I'd have paid ten times the amount for this, without a doubt.

Two months on and I still have a laser treatment called VelaShape that tightens the skin on my neck even more. Six ofthese sessions should do the trick for good.

I talk to people with confidence now, and I don't hold my head down. I would never actually go under the knife, but this is certainly the best thing I've ever done.

Laser neck lifts: the facts

WHAT The neck is resistant to diet and exercise, so people are increasingly turning to the Scarless Laser Neck Lift . Rather than using the Smartlipo MPX system for fat reduction, which is its traditional purpose, laser surgeon Dr Ayham AI-Ayoubi  uses it as a tightening and  lifting treatment for the neck.

HOW A small incision is made under the chin and the laser inserted. The thermal energy produced by the laser melts the fat, which is sucked away. The process stimulates the patient's own collagen to tighten and tone the area. The heat causes the skin to tighten and contract, which then gives the lifting effect.

RESULT An instantly smoother, toned jawline and neck area, giving a more youthful appearance, with little or no pain or bruising.

COST From £2,000.

Contact Dr AI-Ayoubi at the London Medical and Aesthetic Clinic on 020 8342 1100 or visit www.Lmaclinic.com.

LASER LIPOLYSIS

The advent of loser lipolysis enabled non-surgically trained practitioners, such as cosmetic doctors, to start performing fat reducing treatments in their cliniCS under local anaesthetic, offering patients on alternative to more invasive surgical liposuction for the Arst time. Deka's Smartlipo system was the first on the market and has since been followed by a plethora of other devices including: Smartlipo MPX (Cynosure). Slim Lipa (Eden). ProLipo Plus(Scrton), OSYRIS Phoraon Loser Lipolysis System and the Fotona XP2 (AMBETech).

Loser lipolysis works by using loser energy (delivered by inserting a Fibre-optic probe under the skin) to break up and liquety the fat cells. The liquefied fat can be left to be naturally eliminated by the body however experience has shown that for superior results are gained by also using aspiration.

Dr Ayham AI-Ayoubi comments, "The most important thing to remember is that for loser lipolysiS treatments, such as Smartlipo MPX to be effective in a weight loss patient. they must use all medical, surgical and wellness tools available to them, which includes strict help from a dietiCian. The Smartlipo MPX will get rid of excess fat from the problem areas however the patient must also accompany this with a strict diet ond exercise regime. The benefit of Smartlipo MPX for weight loss is that it gives on immediate boost to patients to continue to keep the weight off as you can see immediate results. Combined with a good healthy diet from a dietician it's a healthy woy to lose weight but it can't be used alone and the patient must understand this. They must work hard with medical team and be sent to a specialised doctor to make sure any underlying medical problems are under good control. e.g diabetes. To summarise, make sure ony underlying health problem is under control before using Smartlipo MPX os a treatment for weight loss and it needs to be combined with all tools available -medical. surgical and diet. wellness to be effective."

SMARTLIPO MPX

Smartlipo MPX (Cynosure) is the first and only FDA approved dual wavelength laserlipolysis workstation on the market. The Smartlipo MPX allows the physician to customise treallment protocols based on the patients needs. It allows each wavelength to be used individually and sequentially in a 'blended fashion ' for optimal results. The Smartlipo MPX utilises beth the 1 064nm and 1 320nm wavelengths. Each of these wavelengths brings unique haracteristics to the laser lipolysis procedure. One is better suited for liquefying and coagulating and the other is more aggressive and suited for targeted tightening. The l064nm wavelength has a greater affinity toward oxyhemoglobin, but demonstrates less abserption in water, which produces a larger scattering effect than the 1320nm wavelength. Due to this strong scattering effect with the 1 064nm wavelength, the laser energy would be distributed in a more homogenous manner (broader region)  in fat tissue. The l064nm wavelength alse has a more diffused distribution of the laser energy which will help to safely heat the collagen bundles in dermis, resulting in tissue tightening.

The 1320nm wavelength has strong abserption and less scattering in fat tissue: therefore, most of the laser energy is deposited into a small 0ocalised) region near the laser fiber tip in the subcutaneous layer. This results a high efficiency toward heating the subcutaneous layer and disrupting fat cells with the 1320nm wavelength. This blending of wavelengths is actually called Multiplexing (MPX). Multiplexing or blending wavelengths gives you the ability to maximise safety, effectiveness and overall patient outcomes and satisfaction. It allows the physician the option to blend these wavelengths to achieve optimal results.

I've got a new body and face

Lisa Turner, 34, is a businesswoman and mum to eight‑year-old Samuel. They live in Beaconsfield, Bucks. Lisa had a breast lift and facelift after her fiancé left her for another woman last Christmas. She says:

About two weeks before last Christmas I discovered that Samuel’s father, my fiancé, had been having an affair with a 24-year-old woman. It made me feel doubly awful that she was nine years younger than me.

Christmas Day was horrible. I’d got a houseful of family and friends, my oven decided to stop working and I was so upset about facing the new year as a singleton again at 33.

My little boy caught me in tears in the kitchen preparing the turkey and when he asked why I was crying I had to
tell him it was because I’d been chopping onions.

But somewhere amid my misery I decided to take action – there was no way I was going to have another Christmas as sad as that one.

For starters I sold the house because I wanted to get away from the bad memories. Then I turned my attention
to my appearance.

While I was breastfeeding Samuel my breasts had gone up to a GG-cup.

Eventually they settled down to a D-cup but they were never as pert and I always said that one day I’d get them lifted. So this year I did. I went to the London Medical and Aesthetic Clinic (www.lmaclinic.com) where cosmetic surgeon Dr Ayham Ayoubi told me the most effective way to get the breast lift I wanted was to have Smart Lipo, where a tiny laser is inserted into fatty tissue to melt it before it is sucked out.

He performed this just around the sides under my armpits where there was a little bulge over my bra strap. Then as the area healed and contracted the breasts lifted. I was absolutely stunned when they lifted an entire 12 centimetres in the weeks after the procedure which cost around £2,500.

I now have fantastically pert breasts. I had it done under local anaesthetic on August 16 and went out the same night to celebrate a friend’s birthday.

Next I was on a mission to sort out my face. Dr Ayoubi suggested the Double V Knifeless Facelift at a total
cost of £1,800. He injected Sculptra, a filler that stimulates natural collagen production, into the jowl lines and
in the V-shape that covers the eyebags and upper cheekbones. I had three lots of treatment four weeks apart, the last one just a few days ago. Even though the effects will increase as more collagen is produced already so many people keep telling me I look great. The Double V Facelift should last up to five years. This Christmas I feel transformed.

I’ve got rid of my eye bags

Lesley Walsh, 60, is a retired hairdresser and lives alone near Manchester. She has had her eye bags removed, an eyebrow lift and a full facelift. She says: I look younger now than I did in photos taken at Christmas 20 years ago. Last Christmas I didn’t go out as I looked so old. I’d got these awful eye bags and my neck had begun to sag.
I’ve always been a sun worshipper so my skin suffered.

I turned 60 in January this year, too, so I thought it was a good time to think about having some surgery.

I had a consultation at Surgicare (www.surgicare.co.uk) in Manchester which recommended an eyebrow lift, blepharoplasty (eyebag removal) and a full facelift. I had the eyebrow lift first which was painful – the surgeon made tiny holes at either edge of my eyebrows into which he inserted a metal rod then literally pulled the muscle up and
secured it into place. I had to allow my face to settle and recover from that before having any more work done.

My family said I was mad and my children told me I looked fine as I was. But I didn’t feel good about myself. Two months later I went back to the clinic for the facelift and eyebag removal. I also had the hoods of skin removed from the tops of my eyelids to open up my eyes again. I was in theatre for about three or four hours but I didn’t have any pain afterwards, only a bit of discomfort and swelling. The whole lot cost £8,000 but it was worth it. Even my children agree I look great.

I look and feel younger than I did 20 years ago. The trouble with surgery is that it makes you scrutinise other parts of your body. At the moment I’m having the preparatory work for teeth implants in the new year so that my smile is as
youthful as my new face.

This Christmas I intend to find all the parties I can. I want to make the most of my new confidence instead of feeling that people would point and say: “Look at that old woman over there!”

Singing a solo in front of her peers and parents at her school Christmas concert, aged 16, should have been a wonderful treat for Emma Hardy.
However, rather than enjoying her moment in the limelight, she gritted her teeth and counted down the minutes until it was over.

Wearing a white blouse and with all eyes on her, she couldn't hide the fact she was drenched with sweat.

'It was vile,' says Emma, now 43. 'I was sweating so much it looked as if I was taking part in a wet T-shirt competition.'

Unfortunately for Emma, this was not a one-off; it happened because she suffers from hyperhidrosis, or excessive sweating. And she isn't alone. Indeed, it's estimated that around 1.5 million people in the UK are affected by the condition.

Sweating is the body's natural way of cooling itself down. But not only do we sweat when we're hot, we also sweat in response to certain emotions, such as stress or anxiety.

In those with hyperhidrosis, it's believed that for some reason the sympathetic nervous system, which controls sweating by stimulating the sweat glands, is overactive or more sensitive than normal, says Dr Ayham Al-Ayoubi of the London Medical & Aesthetic Clinic.

Dr Ayoubi is pioneering the use of the Cynosure Smartlipo MPX system to treat hyperhidrosis in the UK. It is a laser treatment usually used to remove fat. In this case, though, the laser is used to destroy the fat cells just beneath the layer of skin in the armpit, destroying the sweat glands.

According to Dr Ayoubi, there are three types of hyperhidrosis. The most common is primary idiopathic focal hyperhidrosis, which means that excessive sweating occurs in a 'focal' place such as the armpits, palms of the hands, soles of the feet, or face. It is believed there may be a genetic factor involved and it typically develops under the age of 25.

Secondary focal hyperhidrosis, which isn't common, again means that the excessive sweating occurs in a particular part of the body. But it is generally because of an underlying illness or condition.

 No sweat: The laser machine
Finally, there is generalised hyperhidrosis, where you sweat more than normal all over. It is uncommon and usually caused by an underlying medical condition, such as anxiety disorders, heart problems, overactive thyroid gland or an infection.

'There are various treatments for axillary [underarm] hyperhidrosis, including surgery to cut the nerves in the chest that lead to the affected sweat glands.

'It is a permanent solution and has been proven effective, but it's a very invasive procedure and carries the usual risks of going under general anaesthetic,' says Dr Ayoubi.

'Also, patients will be left with scarring and bruising and often have to take time off work. The beauty of the Smartlipo MPX treatment - the first dual-wavelength laser system - is that it is quick, is performed under local anaesthetic, and recovery times are short.

'Working together, the light and energy from the lasers liquefy the fat cells and targets sweat glands. At the same time, the laser energy seals the small blood vessels, thereby preventing bleeding, and it also stimulates collagen to tighten the skin.

Dr Ayoubi will make a 1 to 2mm incision under a patient's arm, in which local anaesthetic is injected. The optical fibre of the laser is then inserted through a fine cannula (a small tube) into the same incision at a precise angle, directly reaching the sweat glands beneath the skin.

Afterwards the damaged tissue is sucked out through a fine tube. The whole procedure takes around 30 minutes.

'Patients have no bleeding or bruising, no damage to the nerve endings and no scarring,' says Dr Ayoubi. 'They can go back to work the next day and results are instant.

'I've carried out the procedure on 13 patients and, in theory, it should last forever. It's a revolutionary breakthrough.'

Emma, who runs an online beauty business and lives with her husband and two children in South-West London, has suffered from the embarrassing condition for 30 years.

'After puberty I was sweating all the time,' she says. 'I'm a confident person so it really knocked me. It made me miserable, so I talked to my mum about it and we bought every antiperspirant we could. But nothing worked. I had to accept I was going to have to live with it. Luckily I didn't have odour problems too.

'It was a pain because I had to think about it all the time. I always made sure I carried antiperspirant and a couple of spare tops and I could never wear anything tight or pale in colour.'

Emma even spent £1,000 having Botox injected under her arms to freeze the nerves that stimulate the sweat glands. While initially effective, the results lasted only a couple of months before she needed a top-up treatment. Emma had the laser procedure in September this year and is delighted with the results.

'The treatment was really quick. I was a little tender afterwards, but it was not painful,' she says.
'The results are amazing. It's so liberating not having to think about my armpits. I bought a boob tube to wear to a Christmas party - something I never would have been able to wear before.'

www.lmaclinic.com

Hyperhidrosis, or excessive sweating, is a serious medical condition that affects millions of people around the world -approximately three per cent of the population. Dr Ayoubi of the London Medical & Aesthetic Clinic explains how Smartlipo MPX from Cynosure could be the answer

When your body heats up — from weather, exercise or stress — your brain sends the message that your system is overheating. The message travels to nerves that lead to the more than 2 million sweat glands that lie under your skin. And that's when they send moisture through the sweat ducts to your skin's surface.

In some people, the body's mechanism for cooling itself is overactive — so overactive that they may sweat four or five times more than is necessary, or normal. When sweating is this extreme it can be embarrassing, uncomfortable, anxiety-inducing, and disabling. It can ruin relationships, affect career choices and damage your self-esteem.

Options to treat this condition

Traditionally, people would apply perfume or products to disguise the problem but this is a superficial treatment that doesn't affect the production of sweat.

The surgical solution was to make an incision under the arm, lift the skin and then damage or destroy the glands. The problems with this procedure are that it obviously leaves a large scar and there is a long recovery time. Also this is a very sensitive area with a strong nerve supply so you can risk doing unnecessary damage. The sweat glands are so small that it is hard just to tackle them and not damage other important tissue or muscles.

Botox is a more well known treatment for hyperhidrosis. A starch test is performed to locate the sweat glands and then a small amount of Botox is injected into approximately 12 to 15 places under each arm. The poison blocks the action of the nerves in the sweat glands - sweat slowly returns as nerve ending grow back in six to 12 weeks and a new treatment is usually required after seven months. This is the main disadvantage of Botox; it is only a temporary solution so can be expensive if you're having regular top ups.

The focus then turned to other various non-surgical procedures to see if one of them was suitable for dealing with hyperhidrosis in a permanent way.

The search for a solution

Radiofrequency was explored but this didn't work well for a very simple reason. Radiofrequency works by applying heat to the surface of the skin, so you risk damaging or scarring the surface of the skin before you even reach the glands. You're also working blind and have to go through vascular and fat tissue before reaching your target so you risk overheating this tissue on the way through.

This is where laser came into the spotlight. SmartLipo's main function is for body contouring because it damages the fat cells but what sets it aside from other treatments and why it is so good at removing superficial, vascular fat is that it also cauterises the blood vessels at the same time. And it is this function that we bring to use in the dealing with hyperhidrosis.

How SmartLipo works

The glands in the armpit that produce sweat are all dependent on a blood supply. The SmartLipo cuts the supply of blood to the glands and, like any tissue, it dies. The procedure is very simple. We make a small 1mm incision, which you will not see after the procedure, and through this incision we insert the local anaesthetic. I use a small spinal needle which is very precise and delicate so the patient doesn't feel the injection. We use extremely diluted local anaesthetic as you don't want to numb the area too much or otherwise the patient will feel that numbness in their hands.

Then we insert the laser through the same incision under the skin and laser the sweat glands. The structure under the arms is skin, a layer of fat, the sweat glands, another layer of fat, then muscle. The only downside to this procedure is that you may laser some fat cells which is not a bad thing in itself. Then I use very gentle suction to suck out the local anaesthetic, the damaged gland and any little bit of fat.

The results

We have had great permanent results with this procedure. I have been offering it for over two years and patients see a significant improvement in their condition. Some of my earlier patients had a reoccurrence of the problem but at a much lesser level than before - at the beginning I was more conservative as this was such a new procedure. Over time I have gained in experience and I know how much local anaesthetics and laser energy to apply.

So, if excessive sweating is ruining your life then there is a way to deal with the problem, permanently.

Available from: For more information on Cynosure and their lasers visit www. cynosureuk.com or call 01628 522252.

For a full list of all the procedures that Dr Ayoubi performs and to book a consultation with the London Medical & Aesthetic Clinic visit www.lmaclinic.com or call 020 8342 1100

I have a fat face. There's no polite way to put it. I don't possess the kind of bone structure the sculpted cheekbone sweeping lines — that has traditionally added up to true beauty. It's always been the way. But then, a year or so ago, something odd happened. Suddenly, somehow, countless a, celebrities seemed to share my plump, pillowy features. Their bodies were as taut and toned as ever, but their faces were puffed out, filled in. It was quite hard to figure out what they'd done. Frankly, I didn't care. Finally, I had a fashionable face. The thing is, my fat face is genetically inherited. But these women paid for theirs.

It has become known as `Pillow Face' — a derisory term for the over-stuffed cheeks and plumped-up skin and plush lips that, after a certain age, can only be achieved with the help of a syringe. In the beauty industry, it's called 'volumising'. If cosmetic surgery is about the battle to outwit time, then this is its latest weapon: the fullness of a youthful face, literally and liberally injected into an older one.

It's a slippery slope: some Botox to stop the wrinkles developing and smooth things out, some filler to hide the lines that are already sliding in. Then more filler to reshape and define. And, before you know it, the face you see in the mirror, or splashed across the pages of Us Weekly, isn't what it was. It's not younger looking, really; although it doesn't have any of the signs associated with ageing. It's mostly just... fatter.

`I would be astonished if there was a single Hollywood celebrity over the age of 30 who wasn't having filler injected into her face,' says Dr Marc Armangue, who works as an aesthetic physician at south-west London's Hurlingham Clinic. `It's a standard procedure nowadays.'

Cosmetic surgery once meant using a scalpel to tighten a sagging face — cutting and hauling up the skin and, by doing so, making the face smaller. Now doctors understand that what makes us look old is the loss of volume, and the way to reverse that is to actually make the face fatter. This is where filler comes in.

From the patient's own body fat to bovine-derived collagen, from permanent silicone to synthetic hyaluronic acid, there's an ever-growing array of substances that can be stuffed into a face. Some of them are household names: Restylane, Perlane, and Juvederm. Injected almost painlessly by the syringeful, these wrinkle-fillers provide instant gratification, have few side-effects and gently deflate in less than a year. `If it's done well, nobody should notice,' says Dr Armangue. `Not even your husband.'

The trouble for me is that even a fat face ages. By the time we're 21, our collagen has started to disappear. By the early thirties, nasolabial lines have appeared. These are the chasms that yawn between the mouth and nose, and are the first thing most of us notice as we grow older. Getting rid of them is a simple and unobtrusive job. That is, if you can resist also adding filler to the cheeks andjawline while sitting in the surgeon's chair.

Over the past few months, I've talked with several cosmetic doctors for various articles I've been researching. At the end, just before I leave, I always ask what they would do to my face. It's partly professional curiosity, partly personal vanity, but mostly it's window-shopping. I now think I see the slow creep of those nasolabial lines. Could I get rid of them? Could I be improved? And in what way?

Although all these doctors are eminent professionals within their field, their recommendations differ. One wants to inject my cheeks, my nasolabial lines and my lower lip; another refuses to touch my face, bar a bit of Botox; the last tells me he'd laugh me out of the office if I asked him for anything at all.

I'm neither flattered nor horrified by these assessments: it's only personal opinion, after all. This is the issue, of course: advances in dermatology and cosmetology allow us to erase every imperfection, real or perceived. A cocktail of treatments are on offer: from plumpers to freezers, there are numerous non-invasive procedures to choose from. Which do you want? What does your doctor suggest? There's no right or wrong answer — it's all about aesthetic judgement. That's the trouble with fillers. The danger lies with your own personal taste.

And for some, that personal taste is somewhat questionable. Dr Ayham Al-Ayoubi, from the London Medical & Aesthetic Clinic, sees many women who want something `extreme — they aspire to something which is completely artificial. I say no, of course. But often doctors won't say no to a celebrity or, if they do, the celebrity then goes to a different doctor.'

Dr Ayoubi doesn't just attend to the rich and vain; he also works for the NHS as a plastic surgeon, carefully reconstructing the faces of cancer patients. Born in Syria, he spends his days in the operating theatre and his evenings in Harley Street, wielding a syringe. He is charming but straightforward; the kind of doctor who understands that, despite its frivolous nature, cosmetic surgery is still a very serious business indeed. `It's my professional responsibility to make you look like a better version of yourself,' he explains. `That doesn't necessarily mean younger.'

Dr Ayoubi laughs when I talk about my fat face, telling me that it's actually round, which is something entirely different. He says that I have good skin and am ageing well, but he doesn't send me home with this happy news. Instead, he suggests I try Sculptra: an injectable volumising treatment that gradually stimulates the skin to produce more of its own collagen. It takes several sessions over a period of three to six months to see the results, which would then last for three or four years. In the meantime, he recommends some filler.

I've had filler before: fat syringes of the hyaluronic acids Restylane and Perlane injected in my nasolabial lines and lips. I didn't need it then, but I was curious. After one session, I let it dissolve, as it does, and never repeated the experience again. Now, at the age of 35, I notice little creases developing between the nose and mouth where my fat face has lost its natural stuffing. This is what Dr Ayoubi will restore. Nothing more.

Having filler isn't painful. It's course. But after a liberal unpleasant, of course — I mean, who likes injections in their face? But after a liberal smear of anaesthetic cream and dfurther numbing needle with ice packs, I hardy feel the needle as it slides in.

Again and again. Two syringefuls of something called Teosyal disappear into the flesh between my nose and mouth with startling ease. It takes five minutes, during which time I shut my eyes and hold my breath, expecting some pain. None comes. I feel pressure but nothing else. The whole procedure is over while I'm still waiting for the bad stuff to happen. `Now look at your beautiful face!' exclaims Dr Ayoubi, handing me a mirror. I hold my breath again. There's a tiny bloody pinprick above my lip but no bruising, no swelling, nothing to show what's happened. Nothing... except my face seems smoother. The slight creases have softened out. It's probably too subtle for anyone but me and Dr Ayoubi to notice.

I don't look as though I've been plumped out into someone else. I look like me — but on a good day. I still have a fat face, of course, but without the puffy cheeks and over-ripe lips of current celebrity. I would be out of place in a gossip magazine.

I like it. I like it a lot. So much, in fact, that I've signed up for Sculptra. Like I said, it's a slippery slope.

SAGGY BOOBS:

SCARLESS LASER BREAST LIFT

It's an unavoidable fact pesky gravity causes body parts to droop. As they're one-third fat, breasts are the area most affected. If you dream of perkier boobs but going under the knife seems too extreme, the Scarless Laser Breast Lift could be the answer. The first of its kind, it uses a combination of two lasers. One to melt the fat on the sides of the upper back and in the armpit (this fat is then sucked out through a small incision). The other works to stimulate the production of collagen to tighten and tone the skin.

RECOVERY TIME: After the procedure, which takes 1 hour, you can go straight back to work, but are advised to take things easy for a few days. The only discomfort you'll feel resembles a post-gym ache. A week later, once the small incisions heal, you'll be scar-free.

COST: From £2,000. For more information contact www.Lmaclinic.com / 0208 342 1100

LIPO IS THIGH-HIGH

The trend for wearing designer thigh-high boots has prompted Smartlipo MPX™ manufacturers Cynosure, to promote a new treatment, 'Thigh-High Boot Lipo'.

Tackling the calves, fat ankles or chubby thighs, Thigh-High Boot Lipo can sculpt problem areas permanently in just one session. It works by introducing pulsed laser energy through a cannula to liquefy fat, which is then removed from the body. The laser energy also coagulates the tissue, thereby sculpting body contours and tightening the skin. The procedure generally causes less bleeding, swelling and bruising than traditional liposuction, resulting in fewer complications and faster recovery,

Taking around one hour for each targeted area, the treatment takes place under a local anesthetic which results in minimal downtime for the client. The Cynosure Smartlipo MPX™ is the first and only FDA approved dual wavelengthlaser lipolysis workstation on the market it allows the physician to customise treatment protocols based on the patients needs. It allows each wavelength to be used individually and sequentially in a 'blended fashion' for optimal results.

Knee High

It is rumoured that Demi Moore had her knees done and now it is possible to resolve the problem of lumpy, bumpy and dimply knees with laser knee sculpting. Dr Ayoubi of the London Medical & Aesthetic Clinic, who was the first person in the UK to perform this procedure, explains

“The challenge we faced has been how to deal with fat removal because we have two different we have two types of fat under the skin”

The challenge we faced as -  plastic surgeons over the years has been how to deal with fat removal because we have two different types of fat under the skin, We have deep fat (or loose fat) and superficial fat which is just under the skin layer; from a structural point of view these two fats are very different.

Initially, we used a surgical technique for fat removal, where we would lift the skin, remove the fat and then replace the skin. The advantage of that technique was that you could see what you were doing, could remove a lot of fat and could tighten the skin as it was replaced. The problem was that you would end up with scarring. This might be acceptable in a tummy tuck but doesn't work if you're doing the inner or outer thigh or the knee as there was nowhere to hide the scar.

As a result, liposuction was introduced about 30 years ago and this became the accepted technique. A small incision is made and the fat sucked out through this incision, the challenge is that you can only suck out the deep fat because it is not possible to suck out the superficial fat with traditional liposuction for two reasons.

Unlike the deep fat, the superficial fat is extremely vascular which means it has a strong blood supply and the patient would bleed significantly if you tried to tackle it. Also you could risk damaging the skin from the inside which could result in cellulite or a collapsed effect in the skin.

So there were a number of techniques developed that tried to deal with superficial fat such as radiofrequency. These techniques were combined with traditional liposuction but they didn't have the desired result because the energy was aimed at the surface of the skin and you risked damaging the skin before you reached the target.

So SmartLipo was developed; there are two lasers - one targets the fat membrane and the other laser targets the water and blood vessels. This laser cauterises the blood vessels and also targets water so it dehydrates the area which helps with the tightening effect. Another effect of the laser energy is to create an inflammation which will give you further skin tightening effect.

How it works

The laser sculpting is done under local anaesthetic, so there is no need for a general anaesthetic or overnight stay. A very small incision of one or two millimetres is made which will fade away completely and local anaesthetic is injected into the incision. Then in the same place we insert a needle containing the laser fibre and tackle the deep fat. The laser doesn't destroy the fat cell; it works by disturbing the structure of the cell and the fat leaks away as a liquid.

Then we change the setting on the machine and, using the same two lasers, we tackle the superficial fat. This is where the revolution comes as this is the first time we can remove the fat under the skin without causing any of the associated problems.

The laser energy fractures the fat cells and then we suction away most of the fat. We don't need to do the aggressive suction associated with traditional liposuction because the fat is very liquid and has been heated up.

We used to leave the fat in the areas such as the knees to vacate the body naturally through the lymphatic system, but I now suction most of it out. Otherwise you are relying on the patient to follow up the procedure with exercise and a healthy diet and not all patients do this. They also don't want to wait for three to four months to see the results. It is possible for them to see the results straightaway and feel the skin tightening effect working as they are lying there.

About 50 to 60 per cent of the fat is removed at the time of the procedure and the rest is left to drain out through the lymphatic system. There are two reasons for this. If I took it out all at once then you risking leave the patient with a big dip under the skin. The second reason is that we are doing it under local anaesthetic and it would be very painful if I went too close to the muscle and can also cause bruising. There is no need to be aggressive because the rest will clear out of the system naturally - within four weeks time you'll have amazing results.

It is important to emphasise how little downtime there is associated with this procedure. Patients can go to work the next day and can start going to the gym within a week whereas traditional liposuction can mean a week off work and a lot of discomfort.

Available from: For more information on Cynosure and their lasers visit www.cynosureuk.com or call 01628 522252. For a full list of all the procedures that Dr Ayoubi performs and to book a consultation with the London Medical & Aesthetic Clinic visit www.Lmaclinic.com or call 020 8342 1100

“It is important to emphasise how little downtime there is associated with this procedure”

Natural Beauty

Mr Ayham AI-Ayoubi MD. MS. DLORSC (London). ENT, Facial Plastic and Laser Surgeon. The leading SmartLipo and Sulptra surgeon in the UK.

Mr Ayoubi has developed his own advanced techniques in various aspects of laser surgery including SmartLipo with suction. Patients travel from all over the UK and the world to have Mr Ayoubi perform SmartLipo.

“My philosophy is to enhance but also to preserve our natural beauty”

Q: What attracted you to aesthetics?
A: I enjoy sculpture and art as a hobby and I try to bring that artist eye to my work.

Q: What is the most important thing you've learned from your patients?
A: The surgeon has to deliver what the patient wants. Even if I consider it a successful result, if it doesn't fulfil what they want then I have failed.

Q: What is your best anti-ageing advice?
A: Have a healthy lifestyle and good skincare and definitely avoid smoking.

Medical Qualifications

Surgical training at The Royal College of Surgeons of England in 1998. MD. MS. DLORCS (London)

Associations

·         The European Academy of Facial Plastic Surgery

·         The European Society of Aesthetic Surgery

·         The British Association of Cosmetic Doctors

·         The British Association of Otolaryngologists, Head & Neck Surgeons

Areas of Expertise

·         ENT, Head and Neck Surgery

·         Facial Plastic Surgery

·         Non-surgical cosmetic procedures especially
Sculptra

·         SmartLipo Laser Body Sculpting

·         All aspects of laser treatments

Contact Details

London Medical & Aesthetic Clinic
1 Harley Street, London, W1G 9QD

Tel: 0208342 1100

Email: info@lmaclinic.com

Web: www.Lmaclinic.com

A recent survey of Cynosure clinics nationwide has confirmed that there has been an increase in men seeking laser therapy for their health and grooming needs. This crosses a number of procedures and is demonstrated right across the UK.  

Men account for 25% of the business in Cynosure clinics nationwide and this has been steadily increasing over the past five years. In the past 12 months, laser hair removal has proved to be the most popular treatment for men across all of the Cynosure clinics with 100% of the clinics surveyed reporting this as the most popular treatment for their male clients. Additionally, men are also seeking laser therapy for anti-ageing, tattoo removal and thread vein removal. This typically occurs when they have successfully treated excessive hair growth using lasers. Cynosure clinics are reporting that over the past 12 months they have seen an increase in men enquiring about the following treatments: Thread vein removal -41 %increase in enquiries Tattoo removal -16%increase in enquiries Anfi.ageing -8% increase in enquiries In the survey, clinics attribute the increase in business from male clients to their increasing understanding of laser treatments and this in turn is attributed to both television programmes and the fact that there is often no other alternative treatment available. Karen Tipping, marketing manager for Cynosure said, "The increase in men seeking laser therapy mirrors the overall increase in people seeking more permanent solutions to their beauty and health problems. Cynosure clinics nationwide are continuing to show a steady rate of growth and the men's sector is a shining example of this."

Standing firm on its continued development of innovative solutions in the rapidly evolving field of medicine, Cynosure, Inc. (Westford, Massachusetts, U.S.) remains committed to the science of aesthetic medicine. The company’s emergence as a world leader in aesthetics is heralded by the international launch of three premier aesthetic medical devices, as well as the creation of the International Academy for Body Contouring and Laser Lipolysis (The Academy).

“Education is The Academy’s first and foremost role. We will foster a firm grounding in basic knowledge without which these procedures cannot be successfully applied.”

Currently, Cynosure is the sole contributor to The academy, which was founded by internationally renowned physician Gerhard Sattler, M.D., cosmetic surgeon and director of the Rosenpark Klinik in Darmstadt, Germany. “The body of empirical research in liposuction and body contouring technology has advanced considerably since the early days and has fostered key developments in technology and refinements in technique,” he explained. “While the growing variety of available technical options has led to a new understanding of the subject, subsequently there is a greater need for proper training and education, which patients increasingly demand from their physicians. What’s more, the standards of safety and efficacy we achieved even ten years ago with liposuction are no longer acceptable to today’s patient.”

According to Dr. Sattler, The Academy was formed to address the need for superior body contouring results through better training and education of practitioners. “Education is The Academy’s first and foremost role. We will foster a firm grounding in basic knowledge without which these procedures cannot be successfully applied. From that foundation we present new methods and procedures as well.” The exchange of ideas and experience will further drive innovation and propel the state of the industry forward. “The aim is to establish requisite conditions so that we can share knowledge, increase our qualifications and then treat patients independently at a superior skill level.”

In addition to providing a forum for the exchange of ideas from world leaders in body contouring science, The Academy’s educational goals will be accomplished through workshops and hands-on training in several international cities, added Dr. Sattler. The foundation course will be comprised of anatomical theory, principles of tumescent anesthesia and relevant pharmacology, tissue physiology and post-operative wound healing, principles of diagnostics, how to choose the best technique for the task and basic operating techniques, among other subjects. Other, less technical, but important topics such as patient selection, patient psychology and counseling issues will also be covered.

Dr. Sattler was also a key researcher in the development of Cynosure’s laser lipolysis offering, Smartlipo MPX, which is arguably one of the most recognizable names in laser lipolysis. Smartlipo MPX is one of three Cynosure devices scheduled to be launched internationally in the coming months – the Elite MPX Aesthetic Workstation and the Performa micro ablative CO2 system are the other two.

SMARTLIPO MPX

The original six watt Smartlipo 1064 nm Nd:YAG may be considered the forerunner toother laser lipolysis devices. Compared to the original system, the latest generation platform, Smartlipo MPX (MultiPlex), is a more powerful and effective version, utilizing 46 watts of power in two wavelengths, 1064 nm and 1320 nm, and features two intelligent delivery systems for increased safety and efficacy.

Alberto Goldman, M.D., a plastic surgeon in private practice in Porte Alegre, Brazil, observed that liposuction is the most frequently performed surgical procedure in Brazil.

“We performed liposuction on about 300,000 patients last year. Smartlipo is also very popular in Brazil because downtime is reduced and results are high quality. Our study results with this new device are very impressive in terms of cellulite improvement.”

“In the case of Smartlipo MPX a lot of energy can be applied, delivered in pulses rather than a continuous wave. This is preferable because it better conforms to the principle of selective photothermolysis.”

Ayham Ayoubi, M.D., an ear, nose and throat surgeon and cosmetic consultant in London, U.K. has noticed even more growth in overall aesthetic procedures. “The popularity of aesthetic procedures continues to increase by about 30% per year. I’ve also noticed a 40% increase in the number of men who have aesthetic treatments.” In 2006, Dr. Ayoubi introduced the original Smartlipo in the U.K. and has since treated more than 650 patients with it. “I used to perform 10 or 15 Smartlipo procedures a month, now it’s about 40.”

Smartlipo MPX utilizes Cynosure’s patented MultiPlex technology to combine the benefits of the 1064 nm and 1320 nm wavelengths in one laser output, enabling them to be blended, or fired sequentially, for optimal fat liquefaction and skin tightening results through tissue coagulation. “The use of the 30 watt, 1064 nm laser and the 16 watt, 1320 nm laser together translates into higher peak power for better outcomes and skin tightening benefits,” said Bruce Katz, M.D., medical director of the Juva Skin and Laser Center in New York City, New York, U.S.

According to Dr. Katz, treatment is performed under tumescent anesthesia. The laser energy is delivered through a fiber inside a small cannula. It is inserted into the treatment area to liquefy the fat, which is then expressed or suctioned out. The laser energy carves a path for the cannula which reduces tissue trauma. The cannula size and ease with which it moves through even heavily fibrotic tissue allows the procedure to be performed in-office, with much less downtime compared to traditional liposuction. Scarring is not a problem because the tiny incisions do not require sutures. The technique is similar to ultrasound-assisted lipolysis, but with a few key differences: less pain, improved hemostasis and the ability to direct treatment energy. “With the 1 mm cannula, which is the smallest in the business right now, you can treat anywhere on the body. Facial plastic surgeons can use this to enhance face-lifts or achieve fat reduction and facial tissue coagulation leading to skin tightening without surgery.”

Gordon Sasaki, M.D., a plastic surgeon in Pasadena, California, U.S., believes in power over wavelength. “There is less discussion about the photoacoustic properties of the laser beam, so what ultimately differentiates these devices is how much power they can safely deliver. In the case of Smartlipo MPX, where a blended beam is used, a lot of energy can be applied, delivered in pulses rather than a continuous wave. This is preferable because it better conforms to the principle of selective photo thermolysis, where thermal relaxation time is going to be less than the pulse duration.”

“With the combined wavelengths you optimize deep tissue absorption by fat and water, but as you move toward the surface you get tissue contraction by heating water and collagen.”

According to Barry DiBernardo, M.D., F.A.C.S., founder of New Jersey Plastic Surgery in Montclair, N.J., U.S., there are three targets: fat cells, hemoglobin and water. “With the dual wavelength Smartlipo MPX, the job of the 1064 nm wavelength provides greater distribution of energy which coagulates small blood vessels in the treatment area to control bleeding within a few millimeters of the cannula tip. The 1320 nm wavelength is more efficient at heating the water as well as adipose tissue, and is directed much closer to the cannula tip in a sort of bubble-shape. Therefore, the device efficiently moves through fat with the 1320 nm wavelength, enhanced by the useful properties of the 1064 nm laser for a better result overall.”

“People tend to forget that the dermis is about 70% water and 20% collagen, while adipose tissue is about 75% lipids and 20% water,” Dr. Sasaki added. “With the combined wavelengths you optimize deep tissue absorption by fat and water, but as you move toward the surface you get tissue contraction by heating water and collagen.”

Most other lipolysis lasers are single wavelength. However, when combined and blended, an exponential amount of energy absorption by the target tissues is seen. Each wavelength is fired sequentially at about 40 Hz, according to Dr. Sasaki, to promote these effects. “The appropriate photoabsorption of the 1064 nm and 1320 nm wavelengths’ blended mode in fatty tissue, in the water within the fat cells, and in water within the tissue environment, whether it was brought in by the tumescent anesthesia or is naturally occurring tissue fluid, hemoglobin and collagen, is better tuned than with any other available single-wavelength in the market. If you blend properly, your absorption coefficient is more appropriate than what you would expect from any single wavelength.”

Smartlipo MPX offers three blend ratios. Blend 1, providing equal delivery of energy from both wavelengths, is good for superficial work, according to Dr. Sasaki. Blend 3, which is for the deeper treatment, maximizes the 1064 nm contribution for more diffuse, uniform delivery of energy at depth. Blend 2 is right in-between.

To maximize safe energy delivery, Cynosure engineers developed SmartSense, the company’s first intelligent delivery system, which employs accelerometer technology as used in video game controllers and automotive air bags. SmartSense is designed to regulate the amount of energy delivered based on the motion of the handpiece. Once the desired energy level has been set, the device will increase or decrease the energy delivered by raising or lowering the pulse rate during the treatment, based on the speed in which the handpiece is moved. When the target energy level is reached the device shuts off, making it easier for physicians to treat with more energy safely.

Cynosure recently unveiled ThermaGuide, a thermistor-driven technology in the cannula tip which monitors internal temperature. As the operator approaches the target temperature, ThermaGuide provides an audible warning. When the target temperature is achieved, the device stops delivering laser energy. If you move to a cooler treatment area, Smartlipo MPX will resume energy delivery. “This ensures a certain measure of comfort during treatment, like SmartSense, but also allows us to maximize energy delivery for the best fat removal and/or skin tightening outcomes,” explained Dr. Katz.

“All of my first fifty patients were highly satisfied with their body contour change and degree of contraction, and there was only minimal bruising, pain and swelling.”

According to Dr. DiBernardo, reaching temperature goals in a precise manner is harder and more essential than one might think. “The temperature increases exponentially,” he explained. “It may take 40 seconds for the subsurface temperature to go from 28° C to 32° C, but the next four degrees may take half as long, with the last four coming at almost one degree per two seconds. If the target for maximum skin tightening, for example, is 42° C, with the magic number at depth being about five degrees higher, it’s easy to see how critical this technology can be.”

Smartlipo MPX’s intelligent safety features also speed up treatment, according to Dr. Sasaki. “We work in five centimeter squares, and as you deliver energy to each treatment square, the safety features will govern the uniformity of your result. This not only optimizes energy delivery, it saves time.” In the past the slower treatment with laser lipolysis has been an issue because two-stage laser lipolysis, followed by aspiration, adds up to 45 minutes of additional surgery time per zone.

Dr. DiBernardo recently presented the results of a soon to be published landmark clinical trial with Smartlipo MPX which closely examined the tightening effect. “We were looking for clinical evidence of skin contraction that’s been talked about since the beginning of laser lipolysis because traditional liposuction doesn’t tighten skin,” he began. “You may have natural retraction but this is different. We spent a long time testing and choosing how to effectively measure this. We ended up using tattoos on the abdomen captured in threedimensional digital photography to account for curvature of the area. Skin elasticity was also measured. Evaluations were performed at one and three months after treatment.”

In the first study, five patients were treated, each with four tattooed squares on their abdomen, for a total of 20 squares. Results showed obvious visible shrinkage nearing 20% and significant increases in elasticity. A second study that evaluated Smartlipo MPX versus traditional liposuction was conducted on a blinded basis with ten patients.

This blinded study showed abdominal skin contraction with Smartlipo MPX to be approximately 54% greater at three months than traditional liposuction. In an informal survey of patients, Dr. Sasaki observed patient satisfaction, which was very high. “All of my first fifty patients were highly satisfied with their body contour change and degree of contraction, and there was only minimal bruising, pain and swelling. Average suction volume was between 1,000 cc and 1,500 cc. On a ten point analog pain scale, the intraoperative pain level averaged 1.5, versus 3.5 for traditional liposuction when removing the same volume, which is a significant difference. After a week of recovery, patients reported an average pain level of 0.5, compared to 2.5 with traditional liposuction. Smartlipo MPX patients required no pain medication.”

Dr. Sasaki also treats cellulite, which he highlighted as a major emerging indication for Smartlipo MPX. “Axillary hyperhidrosis is another potential indication,” he said. “Subdermal heating with Smartlipo MPX destroys the offending sweat glands. We’re also seeing impressive results for gynecomastia in our study.”

Dr. Ayoubi noted that patients who would not consider liposuction would definitely consider Smartlipo, presenting practitioners with potential for broadening their patient base. “There’s no question about it, patients avoid liposuction because it leaves a noticeable scar, involves hospitalization, requires at least ten days of downtime and can leave saggy skin. You don’t have these problems with Smartlipo.”

“Increasingly, when people search the Internet for liposuction they find information on Smartlipo and decide on this procedure instead. Smartlipo is not a replacement for liposuction.”

From an economic standpoint, experts agree that as the top invasive treatment in plastic surgery, there is a strong, growing market for laser lipolysis. Since the device can treat larger or smaller volumes it is versatile and further expands the small-sculpture market.

“Additionally, liposuction is limited to large anatomical areas,” Dr. Ayoubi continued. “Reports in medical journals demonstrated that liposuction on small areas under the arms resulted in numbness. Increasingly, when people search the Internet for liposuction they find information on Smartlipo and decide on this procedure instead. Smartlipo is not a replacement for liposuction yet.”

ELITE MPX

Cynosure’s versatile Elite MPX Aesthetic Workstation allows users to perform multiple laser applications quickly and efficiently for patients of any skin type. As with Smartlipo MPX, the device incorporates MultiPlex technology – in this case blending 755 nm alexandrite and 1064 nm Nd:YAG laser wavelengths. Additionally there is the option of using only Xenon Pulsed Light (XPL2) technology, thus creating one of the industry’s most innovative workstations for long-term hair removal, skin rejuvenation and the treatment of vascular and pigmented lesions.

The ability to blend these two gold standard wavelengths translates into greater control of outcomes for practitioners, and greater satisfaction for patients. This is especially true for achieving long-term hair removal, according to Emil Tanghetti, M.D., clinical professor of dermatology at the University of California, Davis (Davis, California, U.S.) and Director of The Center for Dermatology and Laser Surgery (Sacramento, California, U.S.). “The way MultiPlex technology blends the alexandrite and Nd:YAG wavelengths is what makes Elite MPX effective for treatment of different skin types. The value of this benefit increases as the ethnic diversity of our patient base continues to grow.”

“With Elite MPX hair removal, for example,” he said, “we want to maximize efficacy and minimize treatment discomfort. With MultiPlex technology we can control the blend of the wavelengths so it’s either heavy on the alexandrite, heavy on the Nd:YAG, or an appropriate combination of both. We don’t have much choice with the interval between pulses but from a practical standpoint, it offers users a lot of leeway to tailor treatment to the individual patient.”

“The alexandrite laser allows for optimal heating,” Dr. Tanghetti continued. “It is better absorbed by melanin and it reaches deep, which is why it’s a great laser for hair removal. The problem with it is that you can’t use the alexandrite for darker skin types due to the prevalence of competing melanin in the skin. For those patients, we’ve traditionally used the Nd:YAG laser, which is less absorbed by the melanin, but more painful since it travels deeper. For patients with less chromophore you can’t obtain enough fluence through the Nd:YAG without it being overly painful. In some situations you may simply wish to add some Nd:YAG to an alexandrite treatment, thereby raising the fluence without as much epidermal heating, or reaching deeper to increase efficacy without increasing pain.”

Elite MPX’s ability to treat ethnic skin effectively is a big plus. “If you look at the demographics of many urban populations, maybe 30% to 35% are white and the rest comprise all other ethnicities. The African-American and Hispanic populations can be treated, you just have to add more Nd:YAG to raise the fluence to an efficacious level.”

“The Performa CO2 is also good for lentigines. If you want to go even deeper to target acne scars or wrinkles, you have greater flexibility to customize your parameters, allowing users to be as aggressive as needed.”

The addition of XPL2 technology allows for more effective treatment of photodamage, dyschromia, pigmented lesions, and diffuse redness or rosacea. The technology is more powerful than its intense pulsed light (IPL) predecessors and features interchangeable filters, along with an integrated cooling technology that reduces treatment time.“Reducing treatment time is one of the simplest ways to make any treatment more tolerable to the patient,” said Dr. Tanghetti.

Elite MPX features eight different spot sizes, including an 18 mm that treats 44% more treatment area per pulse than the standard 15 mm spot size. This further enhances the user’s ability to tailor treatment to individual cases. The device also integrates SmartCool – Cynosure’s proprietary Zimmer cooling system – into the treatment module to reduce treatment time and conserve office space.

Additionally, the Elite MPX workstation features a new, sophisticated software package which allows users to best harness the platform’s capabilities, as shown in its redesigned, easy-to-use graphic touch screen interface. “Overall the platform allows for future upgrades and software changes that will prevent it from becoming obsolete in a short period of time, which is a growing problem in this constantly evolving industry,” said Dr. Tanghetti. “The ability of this device to grow with the practitioner is critical in this era of aesthetic medicine.”

There is a further economic advantage to the device, according to Dr. Tanghetti. “You cannot have a hair removal practice, for example, without an Nd:YAG and either an alexandrite or diode laser. You can’t treat lighter skin types with the Nd:YAG and you can’t treat darker skin types with the diode or alexandrite. A device that allows you to harness the two prominent wavelengths with a single system makes more sense than having two devices.

PERFORMA CO2

Performa CO2 is Cynosure’s upcoming entry into the micro ablative fractional resurfacing arena. “The time is coming when you’re not going to be able to succeed in this business without an ablative fractional CO2 device that you can rely on,” noted Raminder Saluja, M.D., medical director of the Presbyterian Cosmetic and Laser Center in Cornelius, North Carolina, U.S. “The increased efficacy over non-ablative fractional devices, plus the reduced downtime and increased safety over traditional CO2 laser resurfacing, equal a winning combination. Patients come through the door asking for a laser that targets dyschromia and tightens skin at the same time, Performa CO2 does that.”

The versatility of the Performa CO2 is unquestionable, according to Dr. Saluja, who is involved in clinical trials of this device. “Since you cause ablation from the epidermis down, you can target dyschromia or melasma that’s otherwise too deep down to be successfully handled with IPL type therapy. The Performa CO2 is also good for lentigines. If you want to go even deeper to target acne scars or wrinkles, you have greater flexibility to customize your parameters (power, dwell time, density, scan size and shape), allowing users to be as aggressive as needed. Furthermore, you get the non-specific thermal component that you lack with erbium fractional systems.”

“Despite the down economy we’re continuing to invest in the kind of innovation that covers more treatment applications, creates new aesthetic categories and drives market growth.”

Nine scan patterns (three different shapes and three different sizes) are offered by the Performa CO2 and these are adjustable on the fly with the push of a button on the handpiece. “This helps to save time, so I can treat a complete face in about 30 minutes,” said Dr. Saluja. Users can also choose between microwound densities (pitch) of 100, 200, or 500 spots per centimeter in a square, rectangular or trapezoidal pattern.

“While the square is probably the most useful, the other patterns are good for some facial zones such as the perioral area, and it is very helpful to be able to adjust with the fingertip controls.”

Power and pulse duration are also adjustable, allowing aggressiveness up to surgical ablation. “As we learn more and more about this technology I think you’ll see experienced physicians obtaining great results using very aggressive settings,” Dr. Saluja continued.

In addition to its regular scanning handpiece, Performa CO2 features two additional pinpoint handpieces for finesse work, one at 200 microns and the other at 400 microns in diameter. “These should be great for icepick scars or scarring in general and other work of that nature,” she added.

The platform itself, with its easy-to-learn touch screen interface, is on wheels and can be easily moved from room to room. “Performa CO2 is small and portable as far as this type of equipment goes, which is a great advantage,” said Dr. Saluja.

Clinical trials are going very well, according to Dr. Saluja. “In addition to overall results and evaluation of patient satisfaction, we’re varying parameters and checking histology to see what’s going on at the cellular level. So far patients have been thrilled with results, and we’re coming up on one month follow-up.”

In addition to the potential financial benefit that comes with the worldwide launch of three proven products, this move makes a statement about Cynosure’s commitment to global industry leadership. “We took the company public in 2005, and today we have a presence in more than 60 countries around the globe,” said Mike Davin, CEO of Cynosure. “We have expertise that allows us to smoothly navigate the regulatory waters worldwide. Despite the down economy we’re continuing to invest in the kind of innovation that covers more treatment applications, creates new aesthetic categories and drives market growth.”

Two studies of long-lasting injectables have provided further data of their efficacy and safety. One study tested the longevity and quality of the aesthetic results up to three years of using a poly-L-lactic acid (PLLA) and the other study recorded the re­sults over two years with a hyaluronic acid.

Dr Ayham Al-Ayoubi, an ENT surgeon and aesthetics practitioner, conducted the PLLA study, assessing the ef­ficacy, safety and durability of Sculptra to return volume to facial areas over 150 weeks over which 400 patients were treated. The mean age was 39 years: 70% were Caucasian and 90% were female. Eighty per cent of the group received three to four sets of PLLA injections around four to six weeks apart.

The PPLA was injected into the mid-face and tempo­ral fossa regions using a criss­cross and tunnelling tech­nique, depositing the material deep into the dermis followed by a firm massage. The mas­sage was continued twice a day for the following five to seven days after treatment.

No interruptions in PLLA treatment were noted due to adverse events. Injections were associated with nominal, localised edema that resolved within an average of three days. Small haematoma were noted in eight patients fol­lowing injection and resolved within 10 days. The study notes that palpable, but non-visible and non-bothersome subcutaneous papules were observed in 22 of patients, with a mean onset of six to nine months after initial injection, 85% of which were "spontaneously resolved".

Based on clinical exami­nation and photography per­formed at each session at six months and three years after the second and third session, Dr Ayoubi concludes Sculptra provides more lasting results than absorbable fillers com­monly use in clinical practice, such as hyaluronic acid.

"We achieved a significant improvement with collagen stimulation and plumping up of the face, also with a faster response than the older group of 41-70," Dr Ayoubi says.

Sculptra falls in the class of a stimulatory product that creates its effect through en­couraging neocollagenesis when injected. It is intended for deep tissue filling or in the dermal subcutaneous junc­tion to firm under the skin and soften lines and wrinkles.

Injections per session and total volume of product are adjusted according to the size of the correction; however, it is recommended injections should be spaced 0.5—1.0cm apart (a cheek may, therefore, require 20 injections), with 0.1—0.2ml of product placed with each injection using a 26-gauge needle. A depot of 0.05ml per injection is prefer­ential in the temples and up­per zygoma.

Hyaluronic acid

Dr Aref Alsoufi, a plastic surgeon and aesthetic prac­titioner based in Germany, tested Varioderm Subdermal for facial indications on 42 patients over two years from April 2007 to August 2009. Varioderm Subdermal was in­jected in subcutaneous tissue and the deep dermis, using a 26-gauge needle. Deep naso-labial and marionette folds, cheeks and cheek bones were treated mainly with subcuta­neous injections.

Acute reactions such as swelling, reddening and pain were either minimal or did not occur. A pronounced volume effect and good ad­aptation to the tissue were observed, so that even pro­nounced folds could be aug­mented. No complications were noticed either in the short term or during check­ups after three, six, nine and 12 months, with treatment effects lasting 12—18 months.

"This hyaluronic acid has proven to be effective for 12—18 months after a single injection. The only disadvan­tage was a slightly increased swelling tendency during the initial phase. There were no subsequent complications. In our view, this substance represents an interesting new development in the field of fillers," Dr Alsoufi says.

There are three tech­nologies for manufacturing hyaluronic acids. One uses a partly cross-linked por­tion of hyaluronic acid sus­pended in a non-cross-linked hyaluronic acid (bi-phasic products) to make the sub­stance injectable. Another uses hyaluronic acid partly cross-linked (around 1—20%), of which the final product (mono-phasic) is filled into a syringe. The third uses a highly cross-linked hyaluron­ic acid (70-90%), which has no suspension. This is subse­quently made into particles (monophasic particle technol­ogy) and stabilised to facili­tate the filling of the syringes without the need for dilution.

Cynosure has been a surge of enquiries for laser knee sculpting, reporting a staggering 100% increase in the number of treatments being performed with their Smartlipo MPX system in North America.

The popularity of the treatment is also on the rise on the UK. Dr Ayoubi, the first surgeon in the UK to perform this procedure using the Smartlipo MPX system has seen a corresponding increase in enquiries about the use of Smartlipo for knees, since the beginning of the year.

He has completed more than 40 laser knee sculpting procedures on clients since the launch of Smartlipo MPX in September 2008.

The treatment is performed under local anaesthetic and takes around one hour for both knees. On average, around 100-150 ml of fat is removed from each knee. Many clients are advised to wear a support garment for up to 10 days after the procedure to ensure maximum results. Clients can return to work within a few days and can resume exercise after a week to 10 days.

It's the latest flab jab to hit a surgeon's clinic near you, but would you pay £2,000 for prettier knees?

I’VE HATED MY KNEES SINCE MY TEENS.

No matter how much I dieted or exercised, the areas above my kneecaps were still flabby and puffy, making my legs look shapeless, even in tights and leggings. Holidays were the worst. I felt insecure, self-conscious and paranoid, and I never wore abikiniwithout a sarong.

At university I thought about blowing my student loan to get them done, but my only option back then was a scary-looking and expensive form of liposuction, so I chickened out. Finally, at 33, I decided to take action. Liposuction is less expensive now and readily available, but I decided to go with Cynosure Smartlipo, which seemed a lot less harsh. Before booking myself in, I watched the procedure on YouTube, so I knew what to expect.

The whole thing took about three quarters of an hour, dur­ing which I was awake with my legs numb from a local anae­sethic. So as not to get into a state, I focused on all those tight leggings that I could never wear or the prospect of a new bikini. The probe is about as thick as a knitting needle, with a laser on the end, and was in­serted into each knee. The la­ser melted the fat, then about half of it was sucked out, so my knees shrank immediately. The rest of the fat gradually disappeared over the next few weeks through my lymphatic drainage system, leaving them even slimmer. The skin was also more taut. Apparently, about 100ml of fat is removed from each knee. That's about two shot glasses!

There was no real pain after the op, just light bruising. Two months later, the four scars from the incisions are so small. I now wear clothes that I would never have dreamed of wearing before. I bought a pair of leg­ gings a month ago and got three compli­ments from girls in the office. A guy even came up to me at the gym and said, `You have the best legs.' It's changed my life.

I can't believe that I've become such a cheerleader for this op. I used to look at celebrities trying to change their bodies in all kinds of ways and think they were crazy. I still wouldn't agree with most of that, but just 45 minutes on the operating table, for a problem that seemed to others like such a small thing, have made a huge difference to my self-confidence.

The new knee jab at a glance

WHAT - According to plastic and laser surgeon Dr Ayham AI-Ayoubi, celebs have been having Cynosure Smartlipo treatments in the US since October 2006, when it was rumoured that Nicole Kidman, Geri Halliwell and Demi Moore had had it after they were each papped with a tiny plaster on each knee.

HOW - The laser literally melts the fat away (using energy, not heat) and, at the same time, it tightens the surrounding skin.

RESULTS - It can take up to four weeks to notice the full effects, but both tightening and toning can usually be seen instantly. The laser encourages your body to break down fat stores and dispose of them through the lymphatic system.

RESEARCH - Always go to an experienced doctor who is fully licensed with the Medical Research Council (check at mrc.ac.uk). Ask to fee before and after photographs of previous, similar procedures the surgeon has performed.

COST - From £1,700 to £2,000 for one area, depending on area treated. Contact Dr Ayham Al-Ayoubi at the London Medical and Aesthetic Clinic on 020 8342 1100 or visit www.Lmaclinic.com.

Dr Ayham Al-Ayoubi from the LMA Clinic has created a brand-new breast lift that doesn't involve knives or needles. Instead, it uses a combination of laser-lipo and lasers to lift and tighten. Dr Ayoubi reduces excess fat and tightens tissue and skin with SmartLipo MPX (the strongest type of laser lipo, as reported in Grazia recently).

It's not suitable for very large breasts, though: 'It's perfect for women who have slightly droopy breasts caused by children, ageing or weight loss. It's like a facelift for breasts,' says Dr Ayoubi. He also melts away the fatty deposits around the armpit area, and the treatment boosts collagen production, so you end up with pert, springier boobs.

Details: Dr Ayoubi at the London Medical & Aesthetic Clinic, 1 Harley Street, 020 8342 1100, www.lmaclinic.com.

I want a breast lift for my sagging boobs, but I don't want a big scar. Help!
AMANDA, 30, PORTSMOUTH

There's now a breast lift that won't leave a scar Smart Lipo uses a laser to melt fat beneath the skin and vacuum it away. It also stimulates collagen production to tighten and tone skin, lifting the breasts. It's minimally invasive and you'll be able to go back to work after a few days.

It costs around £2,000 - check out Dr Ayoubi at wwwlmaclinic.com.

VelaShape

Best for: Smoothing bumpy thighs.

The treatment: A hose sucks at my thighs, breaking up the fat cells near the surface of the skin while a laser heats them up and breaks them down. The heat helps my body absorb and excrete the waste.

The results: The first treatment left marks on my thighs (so don’t go for the treatment too near your holiday) but after the second, my cellulite improved. It wasn’t gone completely but my legs were smoother.

Price: £250 for 60 minutes or £1,200 for ten sessions.

London Medical & Aesthetic Clinic.

Tel: 020 8342 1100.

www.Lmaclinic.com

LIPOSUCTION HAS LONG BEEN ONE OF THE TOP COSMETIC SURGERY PROCEDURES. WE LOOK AT HOW TECHNIQUES HAVE EVOLVED TO MAKE THE PROCEDURE QUICKER AND SAFER AND ASK WHAT IMPACT THE INTRODUCTION OF LESS INVASIVE LASER AND ULTRASOUND-ASSISTED PROCEURES HAS HAD ON THE MARKET

Liposuction has traditionally been one of the most popular cosmetic surgery procedure, especially in the States where it has ranked number one in the American Society for Aesthetic Plastic Surgery’s (ASAPS) statictics almost every year. Its popularity also seemed to be on the rise in the UK with The British Association of Aesthetic Plastic Surgon’s (BAAPS) reporting an 18% increase in liposuction for men, as well as a 15% increase in the number of women undergoing the treament in 2007, however last year the statistics from both countries told a different story.

While other cosmetic surgery procedures in he UK had seen a slight increase on the previous year, the downturn in the number of liposuction procedures being performed was significant (29%). Across the Atlantic the procedure was also knocked off the top spot for the first time in the ASAPS hsitory.

But is this just because the global credit crunch is making consumers more cautious with their cash and encouraging them to hold off on more dramatic surgical procedures or has the influx of non-surgical liposcution techniques had an impact on the market?

A BRIEF HISTORY

Liposuction has been used to remove stubborn areas of fat from the body in order to enhance aesthetic appearance since the 1970s, when it was first used by Italian gynaecologist Dr Giorgio Fisher. The procedure soon became popular in France and the States in the early 1980s, but the techniques used carried high risks and even lead to the death of some patients. However in the mid 80s the introduction of a technique using tumescent anaesthesia by Californian dermatologist Dr Jeffrey Klein made liposuction a much safer and more viable option for people wanting to get rid of excess fat that was resistant to diet and exercise.

Surgeon Bryan Mayou, who first introduced the technique to the UK, remembers, "Liposuction was something that I was aware they were using in Paris. I went over to find out what it was and was very impressed. I have used it ever since." In recent years additional improvements in technique have further increased the success of this treatment, enabling it to be done in outpatient clinics and under local anaesthetic.

"In 1986 I attended a symposium in LA at which there was a talk on liposuction under local anaesthetic", says Dr Alan Kingdon. "Until then it had been thought that the amount of local anaesthetic necessary to do liposuction would be toxic, but they showed that a dilute solution could be used quite safely. In order to distinguish it from the original liposuction the technique was referred to as 'liposculpture'. I have performed many thousands of cases in this way without there ever being any adverse incident."

The use of finer instruments has also enabled surgeons to have more control and has lessened the risk of post-surgical 'lumps and bumps'.

"Years ago the suction cannulas used for liposuction were really big so you didn't have much control over the amount of fat you were removing", explains Dr Kingdon. "If you remove too much fat you can get depressions on the skin, but this problem has been alleviated by the introduction of finer instruments."

 LIPOSUCTION TECHNIQUES

There are a variety of techniques favoured by different surgeons. All involve an incision being made into the skin and a tube or cannula being inserted to facilitate the removal of the fat. This can either be removed by suction or via a large syringe.

FLUID INJECTION

A fluid containing lidocaine and adrenaline is injected into the fatty areas before liposuction is performed. This helps reduce blood loss and bruising and enables the surgeon to remove the fat more easily. The local anaesthetic means less downtime for the patient and reduces any pain or discomfort they may feel during treatment.

TUMESCENT LIPOSUCTION

Large amounts of fluid are injected into the fat before the liposuction is performed. The amount of fluid used can be up to three times more than the amount of fat that is being removed. This technique can take a lot longer than other forms of liposuction, but enables the procedure to be done under local rather than general anaesthetic.

THE SUPER-WET TECHNIQUE

Similar to the tumescent technique, this technique uses less fluid and can be carried out in less time. It can be performed under a sedative or via a general anaesthetic.

BODY JET LIPOSUCTION

A fluid containing lidocaine and epinephrine, to constrict the vessels and reduce bleeding and bruising, is instilled into the areas via cannulas specifically designed to simultaneously gently suck out the fat while it is broken apart with the high-pressure spray.

This water-jet process makes the removal of the fat easier with less destruction of the surrounding tissues.

“NON-SURGICAL OPTIONS”

In recent years the introdustion of so-called ‘non-surgical’ alternatives to liposuction has undoubtedly seen the fat reduction market change direction.

In 2006 Deka introduced Smartlipo to the UK. The treatment caused a media storm and was dubbed ‘lunchtime lipo’ in the press. The advent of laser lipolysis enabled non-surgically trained practitioners, such as cosmetic doctors, to start performing fat reducing treatments in their clinics under local anaesthetic, offering patients an alternative to more invasive surgical liposuction for the first time.

"The whole industry is moving toward treatments that are safer, have less downtime, are more convenient for patients and don't involve overnight stays in hospitals or general anaesthetic", says Dr Ravi Jain. "With new technologies most people can now be treated with some form of lipo without having to go through prolonged downtime. That's really good for the patient."

Laser lipolysis was touted as a revolution, it worked by using laser energy (delivered by inserting a fibre-optic probe under the skin) to break up and liquefy the fat cells. The liquefied fat was left to be naturally eliminated by the body but it soon became apparent that, without aspiration, the results were not good enough for many patients.

"A lot of Smartlipo users were generally very dissatisfied", said Dr Jain. "Without aspiration it was virtually ineffective and we were getting a lot of unhappy patients which consumed a lot of time."

Mr Mayou agrees but believes the introduction of aspiration, as well as the emergence of more sophisticated systems, has made laser lipolysis a viable option for many patients. Unfortunately the original Smartlipo didn't do very much", he says. "However the Smartlipo MPX (Cynosure) is much more powerful and has an extra laser in it to simultaneously tighten the skin. You can't get as much fat out as you can with surgery but for smaller areas and certain patients it can be very good."

VASER DAYS

Recently it has been Vaser that has been causing a stir in the liposuction arena. Launched in the US in 2002, the product uses ultrasound to break up fat cells.

This concept is nothing new, Ultrasound —Assisted Lipoplasty (UAL) had been used in surgery for years however, although some surgeons favoured the technique for areas such as the back, where the fatty tissue is more fibrous, or as a secondary procedure to refine results after the initial liposuction procedure, it had never really took off as a surgical technique and there were concerns over the development of skin necrosis in patients.

The Vaser technique differs from traditional UAL procedures however. Using a patented device/ probe, which delivers ultrasound energy from all sides, as well as from the tip, it allows the practitioner to sculpt more precisely. This also means that there is less risk of damaging the surrounding structures, such as blood vessels or nerves, as with traditional UAL.

Like many forms of surgical liposuction, a saline solution containing adrenaline and lidocaine is also introduced through a small incision in order to numb the area and loosen up the fatty tissue before the fat is liquefied and sucked out.

Dr Jain is a big fan. "We got the Vaser in February and since then I have been doing three or four a week", he says. "It provides great results for patients thighs, tummies and love handles - pretty much all over. It is quite a wet procedure and can be uncomfortable but is very well tolerated. Patients can get swelling for few days or even weeks but the downtime is a lot less than with liposuction."

But can these less invasive machine-assisted procedures ever be as good as surgical liposuction?

"All the techniques available have their advantages", says Mr Mayou. "I believe, as a surgeon, you will get the best results when you have a variety of techniques at hand so you can chose what is appropriate for individual patients. Although I favour certain methods other surgeons will get better results with different methods — there is no right or wrong way. I believe laser lipolysis can give excellent results for smaller areas in the right patient. If you want to do bigger areas however, more conventional liposuction may be more appropriate. While I prefer to do it under local anaesthetic when possible, I don't think people should rule out doing it under general anaesthetic. The advantage of general anaesthetic is you know it is not going to be painful and, as a surgeon, you do not feel as inhibited as when someone is awake and you think you may be hurting them."

Plastic surgeon Rajiv Grover agrees. "All of these procedures can be good or bad depending

on whether they are in the right hands or not. Someone could be doing laser or Vaser procedures and get good results, similarly a surgeon who is experienced in traditional liposuction techniques can get good results, but anybody who is inexperienced or pushes the recommended boundaries could run into trouble."

Mr Grover also has his own theories as to why liposuction has seen a bit of a decline. "Undoubtedly these sort of procedures which offer less downtime have had an impact on surgical liposuction, but I think there area number of factors that have played a part.

"People's decision to have any kind of body contouring procedure is often influenced by what is in the media about body size and body image. Last year we saw a bit of a backlash to the whole size zero trend as well as programmes such as How to Look Good Naked and the Dove advertising campaign promoting healthier body image. There is also a lot of research coming out now about preserving weight as you age to keep fat in your face.

"This isn't just a freak statistic. Liposuction has been the top procedure in the US since ASAPS started compiling their stats for the first time ever this year it wasn't number one. I think more people are either going to the gym or eating healthily to reduce their weight or going for more non-surgical procedures with less downtime."

The only problem most of us face with our chins is the occasional hormonal spot, or - whisper it - the odd pesky whisker. Nothing a dab of tea tree oil, a pair of tweezers and a magnifying mirror can’t solve.

But what about the double chin? When no amount of cream, facial exercises or dieting helps, cosmetic surgeons come to the rescue.

For a decade, whenever property consultant Jamela Ahmed, 30, caught sight of her reflection she saw only one thing: her double chin.

'Once you notice something like a double chin, it becomes the bane of your life,’ says Jamela, who lives in London with her husband and two children.
‘I was 20 when I became aware of it. They run in the family. My mother and grandmother have them, too. ‘Nobody else commented on it but, gradually, my double chin depleted my confidence and made me feel and look older.’ Jamela spent a decade trying everything to make her double chin disappear.

‘I massaged it, did facial exercises, used firming lotions and even dieted,’ she recalls. ‘But nothing made any difference.

‘Then I read a newspaper article last summer about a laser-assist­ed liposuction procedure called Smartlipo, for double chins.

‘Even though I’d been having Botox and fillers in my face, surgery frightened me. But I began researching the procedure.’

Jamela’s saving grace came in the form of Dr Ayham Ayoubi, a cos­metic and plastic surgeon at the London Medical & Aesthetic Clinic (LMA), who pioneered the treatment in the UK. In October she had a consultation at his Harley Street clinic.

‘The process uses technology designed to reduce fat and tighten the skin in delicate areas like the chin because it is non-aggressive unlike traditional methods of liposuction,’ says Dr Ayoubi.

‘Smartlipo can be used nearly anywhere - face, Jamela before, left, and after neck, chin, arms, hips and lovehandles, and the chest on men.’

 Jamela returned to the clinic in November for the procedure. ‘The only uncomfortable bit was when Dr Ayoubi injected the anaesthetic,’ she says.

 Amazingly, half an hour later the doctor announced he had removed 100 ml of fat. There was no bruising or stitches, just a little discomfort.

‘Although I felt well enough to go to work, the logical thing was to go home. ‘Initially, I couldn’t see much difference but, a week later, my chin had tightened significantly.

After a month, it was gone. I was over the moon. I didn’t tell anyone about the liposuction until after I’d had it done. I approached it as a beauty treatment rather than surgery, even though £2,000 isn’t what you’d pay in your average salon!’

Eight months on, Jamela says she’s the most confident she’s ever been, and even wears tops with low-cut necklines and jewellery that draws attention to her neck area.

‘Would I consider other surgery? Oh, yes!’ she exclaims.

For further information about laser-assisted liposuction, contact The London Medical & Aesthetic Clinic,

020 8342 1100; www.lmaclinic.co.uk

My backside has been a source of distress to me for my whole post-adolescent life.

I've put a lot of effort into rectifying its disproportionately large size and as a competitive City girl have battled with a string of unbearable diets.

Over the past six years I've attempted Atkins, low GI, low calorie (well, starvation really), the cabbage soup diet and even Beyoncé's maple syrup concoction.

I've tried personal trainers, yoga, Pilates, power plates and Brazilian boot camps, yet I still look dreadful in jeans.

So when I recently heard whispers around the City about a new form of "lunchtime lipo", my ears pricked up.

Rumour had it that the newest form of fat removal caused only minimal bruising and downtime - so virtually no time off work - and was taking London by storm.

After five minutes on Google I'd located Dr Ayoubi, the man credited with introducing the treatment to the UK, and had booked myself a consultation session at the London Medical and Aesthetic Clinic in Harley Street.

Dr Ayoubi, a charming and softly spoken Syrian, first explained the philosophy of his clinic, which is that any surgery is aimed at "enhancing" rather than "altering" looks. I had been hoping for more shrinkage than "enhancement".

The treatment can be applied to any part of the body though the most popular areas are post-natal tummies, saddlebags, double chins and bingo wings.

Not surprisingly, 80 per cent of Dr Ayoubi's clients are women but he noted, "We do get men. Most of them are looking to remove 'man breasts'." I don't blame them.

The treatment is not a cure for obesity. It's designed for patients with areas of "stubborn fat".

After granting that the fat around my rear was suitably stubborn, I contemplated an appointment the following week, which would make me "bikini-ready" three weeks after that.

With a holiday to Europe looming and a beach full of sun-kissed supermodels on my mind, I handed over my credit card.

On my way to the treatment, my optimism faded and I was instead questioning my own sanity. Fortunately my fears were allayed on arrival at the fantastically chic Hurlingham Clinic (and spa, incidentally) in Parsons Green.

The atmosphere was calming - it felt like I was just swinging by for a facial - and the staff couldn't have been more friendly.

As the appointment loomed, however, the luxurious surroundings weren't enough to appease my fears - in my nervous state I embarrassingly put on my surgical gown backwards and forgot my operating knickers.

A couple of Valiums later, and with two motherly nurses holding each hand, I found myself on the operating table.

After the application of local anaesthetic, it was time for the laser treatment, an odd sensation to say the least.

Having made a very small incision, the surgeon inserted a two-milimetre-wide laser under the skin, and melted the fat cells that had been causing me so much distress.

Ice packs were applied after each zap to ensure that the skin wasn't burnt.

The first version of SmartLipo would leave it at that, but this new generation treatment (SmartLipo MPX) uses a little suction to remove some of the fat there and then, so that a partial result may be seen immediately and the end result is more effective.

"I have found that patients are anything but patient," Dr Ayoubi joked. I knew that my surgeon and I were on the same wavelength.

When I gently sat up, trying not to look too carefully at my mangled body, I noticed the sponge-like texture of my thighs before I was quickly manoeuvered into the garment I was to wear for the next 10 days.

These were like a slightly tighter, nude pair of Bridget Jones style "magic knickers", with a strategically placed hole.

Although the bruising is dramatic, the procedure and recovery period has been uncomfortable rather than painful.

What's more concerning is that two weeks later my backside is still more Kerry Katona than the Carla Bruni bottom I had envisaged.

Reassuringly, Gillie Turner, the helpful managing director of the Hurlingham Clinic, reminded me that "the treatment was not a miracle cure, that I should continue to eat sensibly and take exercise and that the full effects would become apparent in "about three months' time".

Providing my thighs no longer "kiss" and I'm happily wearing my skinny jeans by October, that's enough of a miracle for me.

London Medical & Aesthetic Clinic 020 8342 1100, www.lmaclinic.com/ Prices start from £2,200.

WHAT IS IT? The new SmartLipo MPX tummy tuck, which originated In Beverly Hills, was launched in the UK last September, Unlike the traditional muscle-cutting tummy tuck (which gives patients a hip-to-hip scar and a £6,000 bill), this leaves a scar smaller than a centimetre and costs a more moderate £2,000, 'It's not recommended for women with several stone to lose, but It's ideal forthose with a bit of a tummy; says US surgeon Dr Mulholland.

WHAT HAPPENS? After a local anaesthetic, a 1mm tube with a laser fibre inside is inserted into a 1mm to 2mm incision and directed into pockets of fat. The tube, with the tip of the laser fibre pointing out of the end, is then fanned back and forth through the fat, melting any fat cells it comes into contact with. The end product is a yellow, oily substance (the destroyed fat cells), which is sucked out by the tube, or naturally expelled by the body.

PROS

• Speedy treatment time — this procedure takes one or two hours.

• Quick recovery, but one or two days of downtime is advised.

• Not too expensive in relation to the traditional tummy tuck.

CONS

• Some people feel a sensation of tugging and stinging during the treatment, and some temporary bruising of surrounding skin and discomfort afterwards,

• You must eat sensibly - otherwise your tummy won't stay tucked for long.

WHERETO FIND IT

The Hudingham Clinic (www.thehurlinghamclinic. co.uk, 020 7348 6380);
The London Medical & Aesthetic Clinic (www.Lmaclinic.com, 020 8342 1100)

Surgery aside, what’s the best way to tackle stretchmarks?

Julia Roberts: most famous actress on the planet; and now also its most popular inhabitant – at least with other mothers. After being photographed on the beach in Hawaii wearing nothing but a bikini and a wrinkly tummy, her approval rating must surely rival even that of Saint Joanna of Lumley.

What makes Roberts’s chutzpah even more exceptional is that, in an industry obsessed with youth and eternal perfection, she is a lone voice of reason. In recent months those of us with less than optimal abdominal arrangements have had to endure a succession of increasingly taut middle-aged bodies disporting themselves in various stages of undress. Madonna, Demi Moore et al: the middle-aged woman with a better body than her teenage daughter is a perversion of our post-surgical times, and Ms Roberts (41) has just put two fingers up to the lot of them.

Roberts looks exactly the way a woman who has had three children – two of them twins – should look. One baby on its own is bad enough when it comes to stretchmarks and jelly belly; two in one go is an absolute nightmare. Much can be done through diet and exercise, and of course genes play a huge part. But ultimately, the stomach of a mother-of-three will never really be able to compete with that of a childless woman half her age – unless, of course, she resorts to surgery.

Such is the nature of the female psyche that it’s unlikely Roberts will be thanking the photographer who took that picture. And given her profession, it is almost inevitable that she will come under pressure to have a little “work” done to alleviate the problem.

So, if plastic perfection is not your ultimate goal but you would like to give nature a little leg-up, what are the non-invasive options? The only one I have actually witnessed in action (and therefore feel qualified to recommend) is Velashape (www.velashape.com). It’s basically a vigorous heated vacuum massage (described by a friend who had it as “like getting into a bad fight with a Dyson”) that sort of shrink-wraps the skin and underlying tissue to make it look smoother and tighter. It works very well on stomachs, but is also suitable for cellulite on the thighs and underarms.

You need four or five sessions to really see results, but from what I saw it does make a noticeable difference. You can have it as little as four weeks after giving birth, and also while breastfeeding. I saw it being done at the London Medical and Aesthetic Clinic (020-8342 1100), where they charge around £100 per session (depending on the size of the area to be treated), but less if you block-book. If you visit the website you’ll find a list of other accredited practitioners.

WHEN SMARTLIPO HIT THE UK MARKET BACK IN 2006, IT CAUSED QUITEA STIR. THREE YEARS ON, DR AYHAM AL AYOUBI, THE SURGEON WHO BROUGHT IT HERE, TELLS US HOW IT HAS EVOLVED AND HOW TO SUCCESSFULLY COMBINE IT WITH OTHER TECHNIQUES

The-first time! heard about the pos­sibility of using lasers for lipalysis was when I read an article on SrnartLipo In 2002 by Dr Alberto Goldman a plastic surgeon in Brazil, As an ENT, facial plastic and laser surgeon, it fascinated me and I tried to get SmartLipo into the UK. Back then, however, there weren't enough clinical studies available for it to be approved in this country. Four years later, approval was finally given and I was the first surgeon to introduce the new laser technique from Italy into the UK in 2006.

Prior to SmartLipo, I was using traditional liposuction for fat reduction by making an incision in the skin to suction out.the deep fat very safety, with good results in the majority of cases. But it was not possible to suck out the supetrficialfat because of the high risk of bleeding and the damage that could occur to the skin. This superficial fat is extremely vascular and the fat cells are positioned very closely together.

In about 20% of patients, traditional liposuc­tion would result in a sagging effect where the skin is no longer supported. Another problem was that I was restricted in the areas I could operate on. For example, performing liposue­lion under the arms could result in numbness in the hands if the nerves are damaged by the powerful suction. Similarly, under the chin, which is an extremely vascular area, bleeding could be severe during surgery.

BREAKING POINT

Instead of only sucking fat out, in SmartLipo treatments the laser targets the fat cell's mem­brane and punctures It. So we pierce the cell, the fat leaks out and is absorbed and drained through the lymphatic system.

I started doing SmartLipo procedures with the first generation machine (Deka system), which had great results in small areas, particu­larly in terms of skin tightening, caused by the laser's heat, which reaches 38-40°C, producing an inflammation to tighten skin.

The difficulty with the early model was that patients were asking us to remove areas of fat that were too large for the machine to tackle. They were not keen to have traditional liposuc­tion because they see it performed on television and think it seems a very aggressive procedure, which it is not. Also, patients often don't want, or are not able, to have a general anaesthetic,

So I knew back then, from a clinical point of view, that we needed a stronger laser. The original SmartLipo machine I was working with had a power of 6W. The next version had 10W and the current machine has evolved to 18W.

I've being using the current SmartLipo MPX since September 2008, when I introduced it from the US into the UK and Europe. Like its predecessors, the MPX enhances the break­down of fat, reduces bruising through the coagulation of blood vessels and promotes skin tightening by stimulating fibrobtasts.The dif­ference is, speed and efficacy are enhanced.

It has a different platform, featuring 20W for the 1,064nm wavelength laser and 12W for the 1320nm wavelength. The 1,064nm wavelength concentrates on blood vessels and fat cells, firing under the skin to act on collagen fibres, without causing much damage, whereas the 1320 nm wavelength hasa higher affinity for tat and the laser energy bursts the cells.

This increases the efficiency of the heating and of the overall process. It means we can destroy more fat cells in a shorter time, allow­ing us to target bigger areas and to do multiple areas within the same treatment.

SmartLipo MPX also features what they call the "SmartSense" safety feature, which regu­lates the level of laser energy being delivered in relation to the speed at which the handpiece is moved, providing uniform energy delivery throughout a treatment. This prevents laser discharges if the handpiece stops moving but allows them to resume when it moves again.

The most commonly requested areas for women are abdomen and hips. However, a lot of patients have inner and outer thighs done, I have also performed .a large number of SmartLipo procedures on the thin and neck area, where the skin tightening effect can be particularly significant.

In men, the hereditary tat in the chest and hip areas is usually stubborn and difficult to shift via exercise and dieting alone. These small areas of stubborn fat respond well to Smart­Lipo in a short period of time and patients can see about 40-50% of fat reduction immediately after treatment with some noticeable skin tightening effect. Within 2-3 months they can see a significant result with fat reduction and tightened skin. These areas respond better than the abdomen, where it usually takes up to four months to see the final result.

COMBINATION INVASION

As well as a standalone treatment, Smartlipo has been used as an adjunctive procedure to enhance the results of traditional liposuction. Conversely, liposuction can also supplement SmartLipo.

Over the last two years I have taken the SmartLipo treatment further and developed my own technique for patients with much larger areas of fat. This combines SmartLipo and gentle suction at the same time. We laser the deep fat first, then the superficial fat, and than suction it out.

This is producing great results and is relatively painless. I have noticed that patients who would not consider liposuction will consider laser lipotysis. There's no question about it, patients avoid liposuction because it involves hospitalisation, at least seven days of downtime and can leave saggy skin and a noticeable scar.

Traditional liposuction is an imprecise toot because it's limited to the deep fatty layers around the muscle. With Smartlipo MPX, we can treat the superficial fatty layer and get underneath the dermis with a very small (2mm) cannula. When we do this we can get the skin to shrink because we release it from the fatty Layer. Then, if we heat the skin to about 38-­40°C we can achieve additional shrinkage from reticular collagen stimulation and reformation.

With the original SmartLipo or with ultra­sound the surgery would be very time consum­ing. The two wavelengths of the MPX model also provide the capacity for debunking, unlike single wavelength devices. Also with this new device we are very having impressive results in terms of cellulite improvement.

The skin tightening is immediate – patients like to see results straightaway. It is also done under local anaesthetic so there is no need fora general anaesthetic or to stay overnight, which also- means it can be done on patients who aren't suitable for a general. There are no stitches, just a small incision that heats welt.

As a surgeon who specialises in laser surgery, I find that I am increasingly doing Less aggressive procedures and I am getting very good results by combining SmartLipo with gentle suction.

INFORMED CHOICE

Not every patient is suitable for SmartLipo treatment. Those who are overweight and don't have a healthy lifestyle or don't exercise enough are not ideal, I usually refer those patients to dieticians or nutritionists to improve their lifestyle and eating habits. In some cases we recommend alternative treatments, such as traditional liposuction or other surgical techniques for fat reduction.

An equally important segment who are unsiuitaate for SmartUpo is patients who don't have realistic expectations of the improve­ments they can achieve and the time it will take before they see the full result Therefore, patient selection is, extremely important during the initial consultation Also, I strongly believe consultation should be carried out by the same physician who will do the SmartLipo treatment.

To help ensure patients remain realistic about the results they will achieve I devised a chart where we measure each area to be treated in centimetres then measure those same areas again in each follow up visit to see how much objective reduction we have.

I have to stress to patients that SmartUpo is not a lunchtime treatment. Laser-guided liposuction is an exacting and time-consuming process that requires attention to detail and consistency throughout the operating area.

We're talking about the delivery of a signifi­cant amount of energy to the deep layer and a complete heating of the dermal layer to a temperature at or close to 40°C. A typical tower abdomen requires between 50 and 80 thousand joules of energy to achieve the desired results of fat reduction.

Any technique, be it surgery, traditional liposuction, or SmartLipo, will only have the optimum outcome if the patient is committed to a healthy lifestyle to maintain the results and has realistic expectations of the final result, which takes up to four months to see.

Dr Ayoubi of the London Medical & Aesthetic Clinic speaks to Cosmetic Surgery & Aesthetics Magazine about SmartLipo, the groundbreaking treatment he introduced to the UK

The most important thing to understand is that we have two different types of fat in the body: deep fat and the superficial fat which sits just beneath the skin. This superficial fat is extremely vascular and the fat cells are ositioned very closely together.

Prior to launching SmartLipo into the UK I was using traditional liposuction to achieve fat reduction. When you do traditional liposuction you make an incision in the skin to suction out the fat and you can very safely suck out the deep fat but it is not possible to suck out the superficial fat because of the high risk of bleeding and the damage that you can do to the skin from the inside when you remove that fat. With some patients – in about 20 per cent of cases – it can result in a ‘collapsed banana skin’ effect as the skin isn’t supported.

As a surgeon, another problem I found with traditional liposuction is that you are restricted in the areas that you can do the procedure. The under the arms procedure could result in numbness in the hands if you damage the nerves and under the chin it is extremely vascular so can cause bleeding during the surgery.

I had read an article in 2002 from a plastic surgeon in Brazil, Alberto Goldman, about SmartLipo which fascinated me as a Laser Surgeon but at first I did think it sounded too good to be true.The principle is that instead of only sucking the fat out, the laser targets the fat cell membrane and punctures it.

Like a balloon filled with water, you pierce the fat cell and the fat drains out through the lymphatic system. The structure of the fat cell is then disturbed so it won’t continue working in the same way.

I tried to get SmartLipo into UK from 2003 but there weren’t enough clinical studies available for it to be approved in the country at that stage. Approval was finally given in 2006 in the UK. I started doing procedures with the first generation SmartLipo machine which had great results in small areas, particularly in terms of skin tightening. The skin tightening effect is because the heat of the laser goes up to 38-40° and it produces an inflammation which tightens the skin.

The difficulty we found was that patients were coming to us who had much larger areas of fat to remove. They were not keen to have traditional liposuction because it is often shown being performed on TV and patients think it looks a very aggressive procedure. Also, patients often don’t want to have a general anaesthetic or are not able to because of medical reasons.

So we knew from a clinical point of view that we needed a stronger laser. The first machine I was working with  had a power of 6 watts then later 10 watts.

Cynosure then produced the next generation machine, SmartLipo MPX. This was much more powerful – the laser produces 32 watts. This meant we could destroy more fat cells in a shorter period of time so not only is the  patient having a much faster treatment but you can do much bigger areas and also do multiple areas within the same treatment.

More importantly it has two lasers. One which targets the fat cells with a laser power of 20 watts and one which targets the water and the blood vessels which is 12 watts. The two lasers work both at the same time but the other great thing with this machine is that you can change the settings which gives you a greater degree of flexibility in what you can offer patients.

I then took this further and developed my own technique for patients with much larger areas of fat. This combined SmartLipo and gentle suction at the same time. We laser the deep fat first and then the superficial fat and then suction out the fat.

This is producing great results and is relatively painless. I always remind patients that it is not possible to have any procedure without some discomfort but this is very good and safe.

The skin tightening is immediate – patients often like to see results straightaway, they don’t like to be told that it can take a few months. It is also done under local anaesthetic so there is no need for a general anaesthetic or to stay overnight which also means that it can be done on patients who aren’t suitable for a general. There are no stitches, just a very small incision that heals very well. By three or so months the patients can see the final result.

What is important to remember is that this procedure is not designed to lose weight. We can take out a litre or more of fat but this is about body reshaping and sculpting. Any technique, whether it be surgery, traditional liposuction, or SmartLipo, will only have the optimum outcome if the patient is committed to being fit and healthy to maintain the results.

As a surgeon who specialises in laser surgery, I find that I am increasingly doing less aggressive procedures and  am getting fantastic results by combining SmartLipo with gentle suction. That is the wonderful thing with the continuing advances in technology; we can get the results without aggressive invasive surgery.

Treatment: SmartLipo

Price: £1800–£4000

Time Taken: 1–3 Hours

Anaesthetic Type: Local

Hospital stay: No

Available from: For more information on Cynosure’s MPX visit www.cynosureuk. com.

 To contact Dr Ayham Ayoubi please visit www.lmaclinic.com or phone 0208342 1100

Best for: Effective fat reduction at a price. At its launch Cynosure Smartlipo MPX was touted in the beauty pages as a lunchtime treatment and the non-evasive alternative to Liposuction - the jury is still out on this relatively new to the U.K procedure.

How it works:

Stubborn areas of fat and cellulite that don’t budge even after dieting and exercise plague most women, Cynosure Smartlipo MPX which works with laser technology, is designed specifically for these areas of fat and is reported to work particularly well on love handles, thighs, stomachs and fat ankles.

The area to be treated is anaesthetised (by flooding the area with liquid anaesthetic which is inserted by a cannula needle) and a laser is then used – again this involves a rather needle – to poke around the area, ‘zapping’ fat cells and liquefying them. The laser is hot enough to break the cell walls and liquidise fat but not hot enough to be harmful in any other way and the procedure is painless. The liquid fat is then sucked out, exiting the body gradually over the following 3- 6 months because the fat is broken down in the lymphatic system.

As the body cannot renew fat cells - after adolescence we stop acquiring them – the fat should not return to this area. However this is not a licence to go out and gorge yourself on junk food – you can still gain weight if you don’t stick to sensible eating, it will simply get stored somewhere else in the body.

The verdict:

Cynosure Smartlipo MPX does remove fat – we tested it on the inner and back of thighs. It also has less downtime than liposuction as it only requires a local anaesthetic and there is absolutely no bruising or scarring. But it’s still a fairly brutal procedure that leaves you groggy and wobbly for a few days, not to mention a little low from the drugs and anaesthetic (in addition to anaesthetic you’ll be given sedative tranquilisers like Temazepan/ Xanax).

Always go to a recommended surgeon. Elle tested Smartlipo with Dr Ayoubi at the Hurlingham Clinic, from £2000

 I rather over-indulged during the festive season and all the excess food seems to have settled around my middle into an unattractive muffin top. I am hopeless at dieting and hate the gym, so would love a quick-fix solution to shed the extra pounds. Can you give me any suggestions for effective, speedy ways to whittle my waist?

How I did it!

Emma Morris, 26, had SmartLipo MPX on her abdomen to give her a more shapely silhouette

'I am generally happy with my body but I wanted to remove the stubborn fat around my stomach to get a flatter shape and more definition around my waist. Dr Ayoubi at the Hudingham Clinic suggested Smartupo as it would reduce the fat, while tightening any loose skin. I opted for the procedure because its a quick solution with no time off work. I had considered liposuction but felt that the downtime was too long and that it seemed more radical than I wanted.

'On the day, Dr Ayoubi marked and measured the treatment area. I was given loci anaesthetic so the procedure was uncomfortable but not painful. Afterwards I was fitted with a garment rather like a body shaper that I wore for almost two weeks. I returned to work the next day.

'My stomach was a bit tender and swollen for a couple of weeks but I could see an instant improvement and the results have continued to improve over time. My clothes feel looser and fit better, and I've last 9in from around my middle!

Expect to pay: Around £2,000

Contact: The Huriingham Clinic, London, on 020 7348 6380; hurlinghamclinic.co.uk

Further research from Medical Insight also reports that globally 1.4 million liposuction procedures were performed in 2007, making it a $4 billion business for aesthetic surgeons. Alberto Goldman, M.D., a plastic surgeon in private practice in Porte Alegre, Brazil, observed that liposuction is the most frequently performed surgical procedure in Brazil. “We performed liposuction on about 300,000 patients last year.

Smartlipo is also very popular in Brazil because downtime is reduced and results are high quality.” Dr. Goldman expects improved results and the ability to treat difficult cases, as well as both large and small anatomical areas, with the Smartlipo MPX.

“Our studies using this new device are very impressive in terms of cellulite improvement.” According to Ali Juma, M.B., B.S., a consultant plastic, reconstructive and cosmetic surgeon in Liverpool, U.K., “there is a 15% annual growth in body shaping treatments, even with the global recession. Consumers today are more aware of the increasing number of non-invasive, semi-invasive and combination procedures due to the media and Internet. Per capita income has also increased over the past five years.” Mr. Juma also added that medical groups have reported an increase in annual income as a result of cosmetic surgery, in some cases doubling income by performing just one or two types of procedures. “Patients are still willing to spend money to look and feel better.”

Ayham Ayoubi, M.D., an ear, nose and throat surgeon and cosmetic consultant in London, U.K. has noticed even more growth in aesthetic procedures. “The popularity of aesthetic procedures continues to increase by about 30% per year. I’ve also noticed a 40% increase in the number of men who have aesthetic treatments.” In 2006, Dr. Ayoubi – who will acquire his Smartlipo MPX soon – introduced the original Smartlipo in the U.K. and has since treated more than 650 patients with it. “I used to perform 10 or 15 Smartlipo procedures a month, now it’s about 40.”

According to Barry DiBernardo, M.D., a plastic surgeon currently treating patients with the Smartlipo MPX at his  practice in Montclair, New Jersey, U.S., the increase in the number of procedures performed on men is a  contributing factor to the growth of the aesthetic market. “Men are interested in their necks, abdomens and flanks.”

However, Dr. Goldman feels that the “increasing number of cosmetic treatments being performed is directly related to new technologies and less invasive procedures.”

Unlike the Smartlipo, which dissolves fat and tightens skin with one wavelength, the Smartlipo MPX uses two wavelengths – 1064 nm and 1320 nm – released in sequence to improve efficacy, speed and safety. For this reason Mr. Juma, who has extensive Smartlipo experience, is eager to obtain the Smartlipo MPX. “The 1064 nm beam fires under the skin to improve skin tone and act on collagen fibers, all without causing much damage – whereas the 1320 nm energy melts the fat by bursting the cells, making the fat easier to suck out.”

According to Dr. DiBernardo, the original Smartlipo device had 6 watts of power and was used internationally for seven years. “Since its U.S. introduction in 2006, the Smartlipo evolved to 10Wand then to 18 W. With its entirely different platform, Smartlipo MPX features 20 W for the 1064 nm wavelength and 12 W for the 1320 nm wavelength.” The 1064 nm wavelength concentrates on the blood vessels and fat cells, whereas the 1320 nm wavelength has a higher affinity for fat.

This increases the efficiency of not only the heating, but the entire process. “When you look at the temperature curves for the two wavelengths, you see that the 1064 nm curve goes up gradually while the 1320 nm curve is steep. This means that the 1064 nm energy provides gradual heating while the 1320 heats the skin quickly,” Dr. DiBernardo continued.

“The 1320 nm energy alone might heat the skin too quickly, so when you combine the two wavelengths you have a very nice temperature curve for heating the target tissue.”

Smartlipo MPX also utilizes Cynosure’s SmartSense safety feature which regulates the level of laser energy being delivered in relation to the speed at which the handpiece is being moved, thus providing constant and uniform energy delivery throughout treatment. SmartSense prevents laser discharges if the handpiece stops moving but resumes when it starts to move again.

In terms of practice positioning, Smartlipo has been used as a stand-alone treatment as well as an adjunctive procedure to enhance the results of traditional liposuction. “Smartlipo can be used on any body part but performs best in smaller areas such as the knees, upper abdomen and male breasts,” Mr. Juma advised. “Conversely, traditional liposuction can supplement Smartlipo. You melt the fat, the fat stays behind and then you remove the fat with small cannulas.”

Dr. Ayoubi noted that patients who would not consider liposuction would definitely consider Smartlipo. “There’s no question about it, patients avoid liposuction because it leaves a noticeable scar, involves hospitalization, requires at least ten days of downtime and can leave saggy skin. You don’t have these problems with Smartlipo.”

“Additionally, liposuction is limited to large anatomical areas. Reports in medical journals demonstrated that liposuction on small areas under the arms resulted in numbness.

Increasingly, when people search the Internet for liposuction they find information on Smartlipo and decide on this procedure instead. Smartlipo is not a replacement for liposuction yet, but it will be in the next four to five years,” Dr. Ayoubi predicted.

Dr. DiBernardo has used the Smartlipo MPX for six months. “Like its predecessors, the Smartlipo MPX enhances the breakdown of fat, reduces bruising through the coagulation of blood vessels and enhances the skin tightening effect by stimulating fibroblasts and collagen production. The difference is that the speed and efficacy are enhanced in the new Smartlipo MPX.”

John Millard, M.D., a plastic surgeon who currently uses the Smartlipo MPX in his private practice in Lone Tree,,Colorado, U.S., has used the Smartlipo MPX for eight weeks and considers it a core instrument in his practice. “I had five patients my first week. I got my first great result when I treated a woman with floppy saddle bags.  

Traditional liposuction would have removed the fat but she would be left with thin, floppy thighs. When I,treated her with the Smartlipo MPX, the result was thin, nonfloppy thighs.”

Dr. Millard also explained Smartlipo MPX’s effective skin tightening: “Traditional liposuction is an imprecise tool because it’s limited to the deep fatty layers around the muscle.

With the Smartlipo you can treat the superficial fatty layer and get underneath the dermis with the very small (2 mm) cannula.

When you do this in vivo you can get the skin to shrink because you’ve released it from the fatty layer. Then, if you heat the skin to about 40°, you can achieve additional shrinkage from reticular collagen stimulation and reformation. This can be done more quickly and precisely with Smartlipo MPX’s two wavelengths.”

“With the previous Smartlipo or ultrasound, the surgery would be very timeconsuming. The two wavelengths of the MPX model also provide the capacity for debulking, unlike single wavelength devices. These two wavelengths act synergistically,” Dr. Millard noted. “The physician must use the device properly, but its design makes it easier to attain good results.”

Patients are very satisfied with the Smartlipo MPX procedure, according to Dr. DiBernardo. “They see the fat reduction fairly soon after a single treatment.

When they see the skin tightening effect several months later, they’re even happier than they were initially.”

Dr. Millard has also experienced high patient satisfaction, “On a scale of one to ten, satisfaction in my patients approaches ten. In my hands, the Smartlipo MPX provides a significant benefit after a single treatment. It’s a very powerful tool if you want to add a second round as well.”

Dr. DiBernardo trains physicians on the use of the Smartlipo MPX. “Laser-guided liposuction is not just placing a cannula under the skin for a short time and then saying you did the procedure. Physicians can spend a whole day just learning how to enhance the results of liposuction. It’s an exacting and time-consuming process that requires attention to detail and consistency throughout the operating area. Most importantly, it’s the delivery of a significant amount of energy to the deep layer and a complete heating of the dermal layer to a temperature at or close to 42° C. A typical lower abdomen would require between 50 and 80 thousand joules of energy.”

According to Dr. Ayoubi, SmartlipoMPX’s 1064 nm wavelength at 20 W, the increased skin tightening effect and the SmartSense device raise it to a different level. “The SmartlipoMPX has a huge future. The success we’ve experienced with the traditional Smartlipo device was greater than I thought it would be.” He also suggested that plastic surgeons recognize the demand for less invasive cosmetic procedures. “You can no longer have a clinic based only on plastic surgery. Patients are going to clinics offering Smartlipo MPX because it provides good results and is less invasive. It is not a lunch break fat removal treatment. Proper technique is required, but if you don’t recognize the demand for these types of procedures, you’ll regret it in a few years.”

Laser lipolysis is a hot topic in the U.K., according to Mr. Juma. “Patients might consider the Smartlipo MPX over traditional liposuction because of the smaller incisions, smaller scars, less bruising and shorter recovery time.” “The future of the Smartlipo MPX in my practice is small area lipolysis,” Dr. Millard said. “And it’s also a wonderful tool for touch-ups.

I’m getting patients I wouldn’t get if I only offered them traditional liposuction.” Dr. DiBernardo advises his colleagues entering the market to search for a laser device with a track record of reproducible results. “You want to see impressive before and after photographs from a device that brings unique advantages as a tool and as an enhancement to standard liposuction,” he said. “Make sure the manufacturer is an established player in the market, that their devices don’t require a lot of service and results can be obtained in a single treatment.”

“With the introduction of new, safer systems offering potentially better outcomes and fewer side effects, such as   Smartlipo MPX, I am looking forward to a continually expanding market,” Mr. Juma concluded.

You can knock years off yourself – without that Botox freeze-dried effect. They key is having the right surgeon

I’ve said it before, and I’ll say it again: I don’t like Botox. It’s not an ideological objection; I just don’t find frozen foreheads attractive. An entirely wrinkle-free face is unnatural, not to say spooky: people are not supposed to look like shop mannequins.

There is, however, one injectable treatment that does seem to work: Sculptra. The name would suit a James Bond villain and so, in some respects, would the product. It is crystallised poly-L-lactic acid which, after reconstitution with salt water, is injected deep into the tissue of the face. It works by stimulating the production of new collagen – which in turn plumps up the face and, yes, smooths out wrinkles. The results last anything up to three years.

Lactic acid is something the body produces naturally. In children and young people, it is plentiful; as we grow older we produce less of the stuff, which in turn contributes to a deterioration in muscle and skin tone.

What happens when you have Sculptra is this: the skin of the face is cleaned, and a local skin anaesthetic applied. The needle is then plunged quickly in and out of the face, at various key points. It doesn’t hurt (says my close and reliable friend), but it is quite unpleasant. As she said through watery eyes, it’s one of those things that you get halfway through and think: what on earth am I doing to myself?

It is vitally important to use a well-qualified surgeon, since the facial nerve fans out across the cheeks and if you hit that, you’re in serious trouble. The whole process takes probably no more than 15 minutes, but by the end you’ve had quite enough. Afterwards, the face is vigorously massaged to aid absorption of the solution and then, as the brochures say, you are free to go.

What of the results? Impressive, that’s what. The beauty of Sculptra is that it’s very gradual. At first, the face just looks slightly plumper and a bit swollen. This persists for roughly 24 hours. Then, slowly but gradually – rather like the ageing process itself, in fact, but in reverse – you begin to notice a change. It’s subtle, really subtle. The full effect takes a few months to emerge, at the end of which my friend uncannily resembled herself from ten years ago – like Dorian Gray, but in a good way. The slight droop at the jaw had gone; the bags under the eyes had evaporated; her skin tone was more even and her pores less visible. Now she looks as though she’s had a long, relaxing holiday. She does not look like she’s had “work”. And she certainly doesn’t look like a shop dummy.

For more information, contact the London Medical & Aesthetic Clinic (020-8342 1100; www.lmaclinic.com)

When you're looking to make cosmetic changes, it is advisable to do it with the right doctor and at the right place; with someone who you feel comfortable with and somewhere you have researched thoroughly. Here are two professionals that I recommend, and whom you can trust to give you the best advice.

Dr Ayoubi should be your first port of call for Smart Lipo. He was the first surgeon to bring the Cynosure SmartLipo MPX technique to the UK - see www. cynosureuk.com. He gives you a full consultation before undertaking the procedure and stresses that so-called 'lunchtime' treatments need to be taken as seriously as any other surgical procedure. His consultations are at the LMAC clinic -1 Harley Street, W 1 (www.Lmaclinic.com) as well as at the Hurlingham Clinic and Spa - 67 Studdridge Street, London SW6 3TD, where the SmartLipo procedure is then carried out. To book an appointment call 020 8342 1100.

You have to be brave to try lipo, but is it worth the trouble?

The Hurlingham Clinic in Putney is a discreet affair, a converted church that now worships an entirely different deity: the body beautiful. I am here to witness Smartlipo, the very latest in fat-busting technology. Owing to extreme cowardice, however, it is not I who will be having my excess fat lasered; it is my friend Bella: the bravest, most reckless person I know.

Bella’s surgeon is Mr Ayham Ayoubi, an exuberant gentleman with a reassuring bedside manner. He is a pioneer of Smartlipo in Britain, and has evolved his own technique: a combination of laser and suction, followed by a treatment called Velashape to help eliminate fluids and improve skin texture.

The treatment starts with a couple of Valium (for Bella, not me), after which Mr A marks her up with a felt-tip pen. She is having her tummy and upper arms done. Mr A explains the science: unlike traditional liposuction, which attacks solid fat, Smartlipo zaps the fat cells first, emulsifying them. This makes it easier for the surgeon to remove the blubber, and enables the body to metabolise the remaining fat cells as waste. Bella will see an immediate change, but the final result will take a few months.

Next, Mr A slides a very big needle underneath the skin, releasing anaesthetic through a series of tiny holes. Then the laser goes in. There is occasional pain where the laser meets the end of the anaesthetic, but overall it is more uncomfortable than sore.

There is some suggestion that patients might read during the procedure, but as Bella pointed out, it would have to be the most engrossing book in the world. Instead, she and Mr A keep up a constant banter. When it’s time to do her arms, he manoeuvres her into a series of awkward positions to get the correct shape – and an errant globule of fat shoots out and hits him on the shoulder. Ever professional, Mr A smiles and carries on.

All in all, Bella was on the operating table for three hours: “A very long time to be brave,” as she put it. As I escorted her to the car she was sore and slightly hysterical, but otherwise fine. Mr A gave her a course of prophylactic antibiotics, strict dietary advice and support bandages. He had removed almost two litres of fat.

I have to be honest: it was pretty hairy. No matter how skilled the surgeon (and Mr A was extremely impressive), this is not something you should undertake lightly. However, Bella has no scarring (the small puncture wounds healed almost immediately) and she has had no complications. What she does have is thin arms, a flat belly – and the holy grail of the fortysomething female: a waist. I cannot lie; I am green with envy.

Smartlipo with Mr Ayoubi starts at £1,800. 020-7348 6380; www.hurlinghamclinic.com

Want to change your shape in just 6 weeks but think it’s impossible? We have eight sure fire ways to get you a beach body in time for holiday season. Whether you need to change your eating habits, get fit or detox we show you how to get results – fast…

Smart Lipo, by Dr Ayoubi, 020 8342 1100

Smart Lipo is a less evasive form of liposuction surgery, which removes fat by laser technology. The idea is that the lasers breakdown the cell wall liquidising the fat which is then broken down in the body through the liver. Due to the fat being flushed out through the body it’s not safe to have large areas of fat removed but if, like most people, you have stubborn fat pockets that won’t budge no matter what then it is perfect for targeting these specific areas. As the fat isn’t removed at the clinic you won’t notice the results straight away – expect to wait around 4 weeks to see the effects and around 3 months for the fat to disappear completely. But be warned this is not a lunchtime quick-fix, expect to go through the same procedures as you would for a serious operation. You need to take a day or afternoon off work as the pain killing drugs combined with the procedure itself will leave you feeling wobbly and you should expect the area to feel sore for a few days after. At the clinic you are talked through every step of the process, the surgeon discusses and marks out the areas you want zapped beforehand and you are then dressed in a gown to wait for the drugs to take effect. A liquid anaesthetic is injected under the top layer of skin, the laser is then sent in and poked around under the skin which our tester found uncomfortable but not painful. The needle is small there are no stitches after and there are no scars which means you can happily show off your newly  slimmed self in no time. You can have the smartlipo just about anywhere – the chin, tummy, arms and thighs are popular choices ( our tester had inner thighs with great results). The process costs around £2000, so if  you are expecting extreme or instant results you might be disappointed, however for subtle and steady improvements and a relatively easy process it is definitely worth every penny and our tester said she would absolutely do it again.

Best for: slim people with stubborn fat pockets.

THE second sign of ageing is loss of fullness in the face which happens after the age of 35 to 40. This can now be treated with volumising fillers which are injected deep into the skin, often above the top of the cheek under the orbital bone which surrounds the eyes as well as underneath the cheek, around the jaw and near the mouth like Carol.

The other option is fine fillers designed to smooth out lines and wrinkles on the surface of the skin.

TRY THESE

•RESTYLANE and Laresse for lines: deep fillers Restyiane Sub and volumiser Sculptra. Choose a clinic that is registered with the w ww.x y aue.vvm

•FOR Sculptra, contact Dr Ayham Ayoubi, London Medical & Aesthetic Clinic, 1 Harley Street. Tel: 020 8342 1100

London Medical & Aesthetic Clinic proves how Sculptra is bridging the gap between invasive surgery and non-surgical facial countering.

One of the things that most compels people to visit a cosmetic aesthetic practitioner is concern about facial ageing. Over time, skin loses its full, _rm, youthful appearance — a natural result of the ageing process. Skin starts to become loose and begins to wrinkle and the fat tissue that helps to _ll out the face is lost. The reduction in skin volume may make facial features begin to look thin and narrow, sometimes giving the impression the face is older than it actually is.

While dermal fillers, such as Restylane and Perlane, o_er an e_ective non-surgical option for clients, until recently the only way to noticeably improve the shape of the face was through invasive surgical procedures like face lifts and fat grafting.

Sculptra is designed to go one step further and close the gap between surgical and non-surgical cosmetic procedures. As it _lls and lifts sagging skin by restoring volume, it is the answer for men and women seeking an alternative to more invasive treatments such as plastic surgery.

It is designed for facial sculpting and, in particular, to increase de_nition in the cheek bones and to restore facial volume where the cheeks have become hollow as a result of ageing or loss of fatty tissue. Sculptra can be used as a stand-alone treatment or alongside dermal fillers.

Where should Sculptra be used?

• Deep folds between the nose and mouth (nasolabial folds)

• Folds around the corners of the mouth (marionette lines)

• Wrinkling in cheeks or chin

• Sunken cheeks

• Deep scars

Sculptra has long-lasting results which can be seen for up to three years.

Mode of action

Sculptra is available in powder form and has to be reconstituted with sterile water 72 hours before injection. When injected into the skin, it immediately _lls the contour defect and restores volume.

Within two to three days, it is absorbed by the body and wrinkle depth increases slightly. However, over the following weeks, a second phase occurs consisting of a build-up of soft tissue, smoothing out the wrinkles and contour defects.

Four to six weeks after treatment, patients are re-evaluated to determine if additional correction is needed. On average, after a six-week period, a clear e_ect can be seen from treatment. The total number of treatment sessions needed may vary. The most common side e_ects include tenderness, redness and slight bruising, which lasts, on average, two to four days.

Dr Ayham Ayoubi is an ENT, Facial Plastic and Laser Surgeon; an expert on non-surgical cosmetic treatments and a pioneer in Sculptra treatment in the UK. His fundamental philosophy in facial plastic surgery and cosmetic treatments is to enhance natural facial beauty without changing or losing natural facial features and expressions.

Spring is just around the corne, so let the London Medical and Aesthetic Clinic freshen your looks - it specialises in cosmetic treatments, facial rejuvenation and skin care treatment. Safe, non-surgical cosmetic treatment alternatives to cosmetic surgery include:

Sculptra: non-surgical facelifts

Botox®: a cosmetic to smooth lines and wrinkles such as frown lines, crow’s feet and nasal srunches

Dermal Fillers (Restylane, Perlane ans Softline): _lling (nasolabial folds) and lip augmentation

Restylane for lips: for sensuous lips and a more de_ned lip border.

Smartlipo: Revolutionay laser treatment for fat reduction under local anasthetic, introduced into the UK by Dr A Ayoubi.

London Medical and Aesthetic Clinic is located at:

1 Harley Street London W1G 9QD

For more information or to book a consultation with Dr Ayoubi MD MS MEAFPS DLORCS (London), visit:

www.lmaclinic.com or call our cosmetic advisor on 020 8342 1100.