Well it's finally here. The first of many online newsletters I plan to write to keep my patients and friends informed on trends and new innovations in the complex world of Plastic Surgery. I hope you like it and I hope that you will email me your comments, questions and feedback. More importantly, I want you to tell me what topics you'd like to hear about in the near future. If you're interested in a specific topic, most likely many others are as well. So keep in contact, as I look forward to hearing from you

Best wishes,

Warren Lent, MD

I have just returned from an amazing experience in Uganda, where I had the privilege of participating in a medical mission that treated nearly 3,000 patients. The people we treated came from near and far, some traveling for days over hundreds of miles, just for the rare opportunity to get some medical care. The team, sponsored by Operation Heal Africa, was made up of seventeen Americans, and many Ugandan physicians, nurses and volunteers, who strove to provide a broad cross-section of medical care including general medicine, pediatrics, eye care, gynecology and surgical services. The most important volunteer on our team, in my humble unbiased opinion, was my daughter who plans to pursue a career in medicine. We mostly treated the common problems seen everywhere, but also had the opportunity to treat illnesses rarely found in the U.S. such as Malaria and Tuberculosis. Several members of our team saw problems most American physicians have never seen such as tertiary Syphilis and Elephantiasis. Of course there were the expected cultural idiosyncrasies to overcome. The equatorial heat and humidity were oppressive. The constant hanging smoke from burnt garbage made one long for the comparatively crystal clean air of smoggy Los Angeles. What a world for a Beverly Hills, Plastic Surgeon to find himself in!

The mission took place in Bombo, a small town located about an hours drive from Kampala, Uganda's teaming capital city. Like most of the populated areas in Uganda, Bombo is basically an oversized village, situated along the country's main road. Its people, who are predominantly Muslim, survive by subsistence living in an agrarian economy. Survival seemed to be measured in days rather than years, despite a country that appeared to be rich in natural resources. In spite of Uganda's natural wealth, most basic necessities have become precious commodities, with proper medical care being the scarcest of all.

Uganda's medical care is administered through a national healthcare system that is minimally supplemented by private care. Considering the current debate raging in our own country over whether to institute a national (aka socialized) health care system, I felt the acute timelines of having a front row seat to witness the extreme adversity caused by the bureaucracy and financial strains such a system creates. Bureaucratic indifference and inflexibility turned out to be our biggest obstacle to operating on any of the 3,000 people who needed it. My role as a Plastic and Reconstructive surgeon was to treat soft tissue tumors, burn victims, chronic open wounds, hernias, congenital deformities and extreme scars such as Keloids. Unfortunately, I spent far too much time trying to overcome the bureaucratic nightmare of securing reasonable operating facilities. Several days were spent operating in a makeshift operating room set up in a one room, free-standing concrete structure. Our resources were little more than injectable anesthesia and the natural light that intermittently streamed in through the windows. Water was brought in buckets filled from an old-fashioned outdoor hand pump.

What was most disturbing about Uganda's health care system was the shear lack of basic equipment and supplies. The local hospital, a mere quarter of a mile from our temporary clinic, lacked such basics as an EKG machine. What little equipment they did have was technologically outdated by over 60 years. The ultimate irony was having the doctors and nurses from that hospital come to us for their own long deferred care.

I had the special privilege of experiencing some of Uganda's unique natural wonders. I trekked thru the dense, overgrown jungle of the Bwindi Impenetrable Forest, lead by machete wielding, rifle toting guides to come just a few feet away from families of the rare Mountain Gorillas. Photographing a 500-pound, dominant Silverback gorilla or getting a rare portrait of a mother with twin infants was the experience of a lifetime. I also had the opportunity to see the rare tree-climbing lions of Ishasha.

I have much to tell you about my time in this strange and unusual country. In part-2, I plan to tell you the stories of some of the patients I treated and some of the people I had the opportunity to meet. Come follow along with me on this adventure in my next newsletter.

"Help me doctor! I keep hearing about all these new and improved liposuction techniques. What does it all mean, and which ones really work?" As a Los Angeles plastic surgeon, I regularly hear these questions from people interested in plastic surgery. All the claims and counter claims make it very difficult for people to understand the truth. It is important to provide clarity on each of these Beverly Hills liposuction techniques and technologies.

Liposuction, also known as Suction Assisted Lipectomy (SAL), is the term used to describe the basic surgical procedure of removing fat cells from the space under the skin. It is done with a hollow metal tube, called a cannula, which is attached to a suction machine.

The Dry Technique is the original method of conducting liposuction. A small incision is made into the skin and the hollow tube is inserted into the area where excess fat will be removed. No other fluid or medicine is placed into the area and this technique is associated with a higher degree of blood loss, which leads to more swelling, bruising and overall risk. In general, except in rare special circumstances, this type of liposuction is no longer performed.

Tumescent Liposuction, is the most preferred technique today. TheBeverly Hills, plastic surgeon first places a large volume of saline, usually mixed with a pain killer (Lidocain, which is sometimes inaccurately referred to by the public as Novocain) and a medication that decreases bleeding (dilute Epinephrine) to the area where the procedure is being performed. Several advantages to this technique include diminished postoperative pain, decreased bleeding and bruising and a better aesthetic result. It is believed that the improved cosmetic results are due to the firmness created by the added fluid, which allows the surgeon to actually sculpt the area to the desired shape. This method is still considered the gold standard for liposuction

Ultrasound-Assisted Liposuction (UAL) is liposuction that adds an ultrasound wave-producing device into the fat. The theory is that the sound waves will dislodge fat cells from their attachment to thicker collagen fibers. This technique may be useful in areas of the body where there are many of these thick fibers, such as the upper abdomen, back and where scar tissue exists. The downside of UAL is that the device has been known to cause skin burns, leave increased wavy irregularities of the skin and may be associated with additional blood loss.

Power-Assisted Liposuction is when a small motor is attached to the cannula to move it in and out. The major advantage to this technique is to the surgeon, who experiences less fatigue, and not to the patient. This technique offers no improvement to the final results.

Laser-Assisted Liposuction adds laser technology to the standard liposuction procedure. It is a two-step method, where, first a thin glass fiber is inserted into the area and the fat is melted in small volumes by the laser energy. The second step requires a standard form of liposuction to remove the liquefied fat and any additional fat cells. This technique is still relatively new, and it is unclear whether the laser truly adds any benefit to the final results. Thus far, reputable studies have shown no major clinical benefit.

External Devices such as external ultrasound and skin vacuum rollers or cellulite massage devices have not been shown to have any benefit in eliminating fat from under the skin. Despite various claims to the contrary, they are not alternatives to liposuction.

Injection techniques such as Mesotherapy, injection lipolysis or Lipodissolve claim to be non-surgical alternatives to liposuction. These techniques involve the injection of fat-dissolving chemicals that are supposed to dissolve fat cells. This technique has many unknowns and the results are uncertain, difficult to control and unpredictable. Allergic reaction, skin ulcers, scarring and infections have been known to occur.

The Future holds many possibilities for advances in Beverly Hills liposuction techniques. The Power Water-Assisted liposuction and improved laser technology may offer viable future improvements in the current methodology for SAL. Only with critical scientific analysis will we know if they offer true clinical advantages.

For questions regarding liposuction, plastic surgery or skin care, contact Dr. Warren Lent, MD, FACS, at 310.652.6500, via email at drlent@mybestplasticsurgeon.com or visit www.mybestplasticsurgeon.com.

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