This injection is made of deoxycholic acid, which is actually produced by the body naturally. In the body, its purpose is to absorb fat. The synthetic version is injected into the pocket of fat below the chin. So far this is the only location on the body for which Kybella is FDA-approved. Its purpose it to destroy fat cells when properly injected into submental fat. Dr. Brandow says, “Kybella may shrink fat but it is an acid which could burn the skin and cause an abscess or an open wound if placed too close to the skin. Equally important is that it can also destroy the deeper tissues as well, i.e.: platysma fascia and muscle which may destroy the deeper sub-muscular fat pad. This could lead to a dent or deep retraction just under the chin which you sometimes see in a surgery which over resects the deep submental tissues and makes an unnatural look to the neck. Not only is the skin elasticity a problem for older patients, but also is the potential for ‘redistribution of fat’ to other areas of the neck when patients subsequently gain weight, over time. The loss of fat in this focused, submental, Kybella, injected spot will look odd when areas around it are heavier looking. So, what do you do then? How much scarring will there be?”
If you’ve ever considered a breast augmentation, it’s not hard to understand the appeal of “test-driving” a pair of implants for a day. One surgeon offers a method to “try it before you buy it” with a procedure called InstaBreast.
The InstaBreast procedure takes about twenty minutes in office. A saline solution is injected into the breasts until they are enlarged to the desired size. Surgeons who offer the procedure claim that it takes the guesswork out of planning an augmentation by providing patients with 24 hours of experience with larger breasts.
“This is crazy!!” exclaims Dr. Brandow. “How do you anesthetize the breast before you shoot in the saline? Wouldn’t this hurt? Just the thought of it would scare off my patients. Additionally, implants on top of the muscle versus under the muscle look different and the size you use on top looks totally different from the one you would use under the muscle.” Dr. Brandow questions the safety of injecting saline under the muscle in office with a local anesthetic. “I would say it’s a recipe for a punctured lung! Additionally, I would love to know how a surgeon inflates a young, tight skinned, A- cup woman who wants a full C- cup, without causing a lot of pain during that injection.”
A Jab to Dissolve Fat? Mesotherapy and Lipodissolve
Several cosmetic surgeons and dermatologists agree that if there is one procedure to avoid when shopping for a slimmer look, it's one called lipodissolve -- a shot that is purported to dissolve away stubborn fat deposits. This shot is often part of "mesotherapy" -- a shallow injection of a cocktail of substances using a fine needle. "There is really not a single scientific study to show that it definitely works," says Dr. Brandow. Are these chemicals safe when injected into fat? And what happens to this fat? Where does it go? Dr. Brandow feels lipodissolve is an ill advised treatment. “This is a non-FDA approved use of a material called lipostabil, which can dissolve fat and other structures.” He adds, "However, it can cause pain, swelling, hard lumps, ulceration of the skin, and contour irregularities. None of the pharmaceuticals used for injection are FDA approved. There have been no double-blinded studies revealing the mechanism of diffusion of solutions following injection, the precision and control of fat destruction by the chemicals or the long- and short-term effects of the drugs."
The Stem-Cell Face-Lift
They may be the great hope of modern medicine, but stem cells—those blank slates of the body that can turn into nerves, bones, or cartilage—have yet to revolutionize aesthetic surgery. It's been a decade since scientists discovered that fat happens to be loaded with the cells. “Almost immediately, surgeons began to claim—with no proof—that the stem cells in fat improved skin quality and started calling fat injections a stem-cell face-lift,” says Dr. Brandow. But the idea that fat injections could replace a traditional face-lift is "high on marketing and short on science," says Brandow. "Stem cells have great promise, but there is so much conjecture." Currently, there is no FDA-approved device to separate stem cells from fat and no consensus on the number of cells needed for rejuvenation or how many treatments are necessary.
It seems like everything that has the word “laser” in it today is perceived as a state-of-the-art breakthrough, but in this case, using laser to assist in liposuction is not necessarily so. Laser liposuction uses lasers to liquefy the fat before it is removed, making it easier to vacuum out and they may also stimulate the production of collagen and elastin, which results in firmer, tighter, and smoother skin. Lasers may also coagulate small blood vessels in the area, which translates to less bruising. But what’s the downside? Dr. Brandow points out that, “There is greater risk of burning and therefore, pain. Laser liposuction, SmartLipo and similar procedures add both time and money to the typical technique.”
The advantages of buttock augmentation with fat injections over implants have quickly become evident, especially by those patients who have had the misfortune of undergoing the latter only to face the complications later. Buttock implants uses solid silicone implants that are inserted below the muscle in your buttocks. Because this involves a foreign object in your body, there is a chance the implant may be rejected by your body, or else displaced by the movement of your muscles, not to mention the greater risk of infection and the hard, unnatural feel. Patients also face a prolonged healing period (around 4–6 weeks), often accompanied by significant discomfort and pain.
Dr. Brandow is the founder and director of the Brandow Clinic for Cosmetic Surgery. The doors of his Main Line Clinic opened in 1997, in Bala Cynwyd. In 2005, Dr. Brandow opened a second location at The Jersey Shore, in Somers Point. Then, in the summer of 2015, he opened a third location in Center City Philadelphia. These three locations have helped patients from the tri-state area to more easily consult with Dr. Brandow, which gives him the opportunity to see a wide range of issues unique to each one of these geographic locations.
Prior to the 1997 opening, Dr. Brandow was in partnership with Dr. Julius Newman at the Newman Cosmetic Surgery Center in Wynnewood, PA. He was Chief of Cosmetic Surgery at three of Allegany University Hospitals and Director of the Fellowship Training Program in Cosmetic Surgery at Graduate Hospital. Dr. Brandow served as an Associate Editor of the International Journal of Aesthetic and Restorative Surgery as well as a preceptor for many live surgical training conferences where he helped teach other doctors advanced techniques in Cosmetic Surgery.
Previous to becoming board certified in Cosmetic Surgery in 1992, Dr. Brandow started his early general surgical training at the world-renowned institution, Memorial Sloan Kettering Cancer Center, as well as Yale University affiliated, St. Mary’s Hospital. From there, he was selected to enter the internationally acclaimed Plastic and Reconstructive Surgery residency program at The University of Rio de Janeiro, under its world famous chairman, Dr. Ivo Pitanguy. Dr. Brandow spent three years training under Dr. Pitanguy, a globally recognized master in modern Cosmetic Plastic surgery. Dr. Brandow credits his success in cosmetic surgery to his Plastic Surgery experience abroad, which opened his eyes to other philosophies and concepts of beauty. He has developed many innovative, minimally invasive procedures for the face, body and skin. These procedures include The Boomer Lift™, The 48 Hour Facelift™, The Scarless Breast Implant, The Multilayered Micro-Lipo Augmentation, The Tumescent Technique for Liposuction and The CO2 Laser Blepharoplasty.
Dr. Brandow has been named one of Philadelphia’s Plastic Surgery “Top Docs” by Philadelphia Magazine as well as nationally recognized for one of America’s “Best Plastic Surgeons” of this decade. He was also named “Best Plastic Surgeon on the Main Line” by Main Line Life as well as being interviewed in a wide variety of local and national publications regarding Cosmetic Surgery.
In addition, he has been featured on local, national and international television programs including 20/20, CNN’s Headline News, Good Morning America, ABC Action News, TV Globo and Telemundo to provide updates and opinions on the latest trends in cosmetic surgery. Dr. Brandow uses some of his media appearances to speak out on the controversial issues of cosmetic surgery, advising viewers to take a more responsible and more realistic approach to the latest fads and gimmicks in Cosmetic Surgery.