Dr. DavisCherry Hill, N.J., plastic surgeon Steven L. Davis, MD, says he has and uses all that’s new in fat removal and body sculpting. But there are certain cases — when patients have pesky fat pockets at the bra line, under the chin, around the axilla (that lady lump) or inside the knees — when he might suggest that patients consider something much simpler.
The in-office procedure he markets as FLASH (which stands for Fat Lipo Away Same Hour) uses a small cannula attached to a syringe to permanently remove small fat pockets, without patients having to wait four to six weeks to see results.
The good news for plastic and cosmetic surgeons is that there’s no need to buy expensive equipment, and they can use their skills and experience in liposuction and body sculpting to do it.
Dr. Davis says that for experienced liposuction and body sculpting surgeons, FLASH offers a niche option to patients who might not be ideal candidates for CoolSculpting (Zeltiq) or Kybella (Allergan), but also don’t quite need (or want) laser-, ultrasound- or radiofrequency-assisted liposuction.
“For a patient that comes in and says she really hates the fat that’s on the inside of her knees, you could pull out your big guns and talk about all the [high-tech devices] you have. But, at the end of the day, this lady wants to go to the beach by next week and not have that pocket of fat there. She doesn’t want to take time off from work [to come in for a touchup],” Dr. Davis says.
The solution, according to the plastic surgeon, might be as simple as using a very fine liposuction cannula, making a small incision, using a local anesthetic and suctioning the fat.
“We’re using cannulas that literally have an end to them that will screw onto a Luer lock syringe. It should be a very fine cannula — maybe the size of a coffee stirrer or small straw. At the opposite end of it, it will have multiple openings to help you suck out the fat,” he says.
There are variations to Dr. Davis’s approach. He chooses cannula heads based on the area he’s treating. A pocket with a bulkier amount of fat, would require a more rounded head, for example.
NEXT: Hitting the Bullseye
Hitting the Bullseye
Dr. Davis also does a FLASH technique in which he uses various size cannulas to remove fat according to a bullseye. The most concentrated fat is at the bullseye’s center. He’ll then use a different cannula to remove the fat close to the center and still one more cannula to remove the outer circle of fat, which has the least amount to remove.
The approach, he says, creates a smooth result and prevents divots or caverns.
“We use a dissolvable stitch in the area where we entered with the cannula. Sometimes, you don’t even need a stitch, depending on how thin a cannula you use,” he says. “Now, you’re going to dress it a certain way, you’re going to take care of it a certain way, but that pocket of fat that was the patient’s real concern is no longer there. And that’s where I think the beauty of this is.”
NEXT: FLASHback to Basics
FLASHback to Basics
Plastic surgeons that have been doing liposuction for a long time have their techniques down and know how to do this, according to Dr. Davis.
“It’s just making sure that we’re not forgetting some of the simplistic values that we’ve learned over the years. …you’ll know where best to use the approach. You’ll also know what size pocket will be most likely to work,” he says.
FLASH requires an understanding of superficial liposuction, which was described by Marco Gasparotti http://link.springer.com/article/10.1007%2FBF00450606, as well as deep liposuction.
“…by using very fine cannulas in a very superficial plane, you’re going after the fat that is underneath the dermis. You have to understand how to get into that plane carefully, because once you’re in there, that’s the layer where the skin will learn to shrink and remodel over the anatomic area,” Dr. Davis says. “If you’re only liposuctioning the very deep part of the fat, the very superficial skin layer will be too heavy to readjust over the top of the body part. You want it to look almost like you’re putting a piece of cellophane over something.”
NEXT: A Simple Approach
A Simple Approach
The FLASH approach is all about being able to localize the area with just local anesthesia.
The perfect FLASH patient might have too many small fat pockets to make CoolSculpting affordable or time efficient. The pocket or pockets should be in areas that can tolerate injection of a local anesthetic and can be dressed and compressed during healing.
It’s important that patients are prepared for and can tolerate the procedure under local anesthesia.
“If you start to get the general anesthesia onboard or anything that’s going to be requiring more than just a little local, I think you’re taking away from the beauty of being able to do this simplistically,” Dr. Davis says.
FLASH candidates should be in relatively good shape, with just small pockets of fat that they want removed, for example, the bulge of fat that pops out of evening gowns or bathing suit tops.
Dr. Davis says plastic and cosmetic surgeons can still discuss all the high-tech options for the job with patients, and also add FLASH as a low-tech, quick fix that offers immediate gratification. Patients should know they might have swelling, a wound dressing and compression garment in the treated area for a few days.
Dr. Davis says that he finds that patients like having a low-tech, potentially less expensive option to consider along with the bigger-ticket devices with bells and whistles.
“You start to realize: Why do we have to be techno, when we’re really talking about a pocket of fat that would be easily liposuctioned away?” Dr. Davis says.