John Shieh M.D.

Recent comments

• Posted to Velashape make your cellulite worse? on 29 Jun 2009

  Hello, VelaShape should not be making the cellulite worse, although during the treatment series there are some changes going on cause the skin to look different. This would be due to swelling, possible bruising (especially during the early treatments that are causing a lot of new stretching of the connective tissues, etc). It is definitely important to have the treatment performed correctly for the best results. The practitioner should first determine your treatment areas, and they should be divided into areas approx the size of two open hands (two adjacent 8"x8" areas). They should treat the area of 1 "hand" size for about 5-7 minutes, then do the adjacent "hand sized" area for 5-7 minutes. Then they should return to the first "hand" sized area and repeat the process again. Each of these "2-hand sized" areas should be treated for a total of around 25 minutes. The total time is just a critical for a good response. I had one patient come to see us after being treated somewhere else for 25 minutes total for 3 areas. They should have been treating her 3 areas for a total of 75 minutes! Once we did it correctly, she saw immediate improvements over the failed 4 treatments done elsewhere incorrectly. They should be moving the large head slowly at first in a back and forth motion or circular motion. After the area starts to get much hotter, then the movement is much faster to avoid overheating the skin. However, the ideal threshold is when the skin is just getting uncomfortably hot. There are also settings on the device for infrared level, RF electrical level, and suction level. In our office, these settings are adjusted depending upon what the problems are. If it is fat that needs to be reduced, we use minimal infrared (lowest level, 0 or 1), highest level RF(level 3), and low level suction(level 1). If it is cellulite we are after, then we use medium infrared (level 1 or 2), high rf (level 3), and medium suction (level 2 or 3). If it is skin tightening needed, then use higher infrared, medium to high RF, and low level suction. Finally, ask the practitioner when they were trained on the VelaShape, and how much experience they've had with it, and if they've checked on the latest protocol update from the laser company. VelaShape first came out in August 2007, but the protocols were updated in June 2008. Wish you the best, and hope everything turns out great for you. John Shieh, MD

• Posted to Velasmooth Does Not Work on 27 Aug 2008

  Hello, I am so sorry that you have had the negative experience at a franchise center. We've had patients come over from the franchises and found that the treatment was performed very differently and longer with us. I have expressed these concerns directly to the laser company (Syneron) a few months ago, and they sent out a bulletin on July 28, 2008, to all users to download the new revised protocols. This should help, but individual businesses have to take the responsibility to take these steps to improving their patient care. The problem that I've found is that some of these franchises were not even doing the proper original protocol in the first place. Now with the new updates, they are even further behind. If you let me know what area you live in, I will look into the local practices that are adopting the new protocols, have good experience with it, and verify it with their local laser rep. I actually have more aggressive protocols for VelaShape that I have been sharing at recent cosmetic conferences (next one in Chicago on Sept 20) and hope that these tips will assist those practices in obtaining better outcomes. Again, if you can find a practice where there is actually a medical director that is involved with the practice, and that you can meet with directly for consultation, you will improve your potential for the best results. The physician should feel directly responsible for you obtaining real results. I know that I am, and do interim evaluation after 3-4 treatments to make sure that the results are progressing as they should. Take care, John Shieh, MD

• Posted to Should I get Velashape? on 2 Jul 2008

  If you are seeking a non-invasive approach to reduce cellulite and fat, the VelaShape may be your best option. It is the first FDA approved medical device for cellulite and for circumferential reduction. It accomplished these approvals when other devices failed to receive them. When performed correctly, the VelaShape does accomplish noticeable results in 4 to 5 treatments. Of course, patients that are very obese or have BMIs over 30 may not be the best candidates and therefore will need more than the basic 4 - 5 treatments. The saddlebags, buttocks and thighs are difficult areas to reduce with just diet and exercise. The VelaShape is your best non-invasive option that accomplishes cellulite reduction, fat reduction, and skin tightening. The other options would be: lipo-dissolve - slightly invasive due to the multiple injections. Good for gradual fat reduction, but poor for cellulite. Does not tighten skin. laser-assisted lipolysis - mildly invasive, but good for sculpting and tightens skin. Will still need VelaShape for cellulite reduction though. liposuction - invasive, good for gross reduction in fat, will not help cellulite and could look worse. Sometimes use lipo-dissolve and VelaShape after liposuction to help even out irregularities. VelaShape has definitely become very popular, but with that popularity there are many new spas popping up with variable experience and skill. If you decide to have VelaShape, just make sure you are comfortable with the practice and confident that they are experienced and knowledgable about the treatment.

• Posted to Velasmooth Does Not Work on 2 Jul 2008

  Again, it is so unfortunate that there are practices that may be offering poor treatments and poor business practices. It is not the machine or the laser company's fault that people are having poor results. Hoping for a class action lawsuit would be futile, but a direct complaint to the manufacturer (Syneron) about the practice that is doing poor treatments could be effective, along with asking the practice to make things right for you. Just this past week we have had at least 5 people that came to us after having some bad experiences with the VelaShape at some "(franchise) laser centers" as mentioned above. After determining the areas that were treated, and how long was spent on those areas, we realized that they were only treating the areas for half the necessary time. Also, technique is important to attain the proper clinical endpoints. When these previously unsatisfied clients had their first treatment with us, they immediately commented that the treatment was very different, that the treatment was twice as long as at the other practice's, and that they could feel the immediate changes. We offered them "a la carte" treatments, and they have all continued to proceed with more treatments with positive improvements. So to answer "lah in Miami", I would definitely ask them what type of guarantee they can offer. These practices should stand behind any of the treatments they offer. Ask them for references if possible (patient privacy may prevent them from giving out names, but they could ask their other clients to share experiences with you). The treatment covering abdomen, buttocks, and posterior thighs on a 5'7", 130 lb person in our practice would be about $2400-2800 for 5 treatments, and each of those treatments would take between 1 hr 40 min to 2 hrs to perform. And we do guarantee results. It does take good understanding of the treatment and good technique along with this much time to accomplish consistent excellent results. Everyone should be weary of signing contracts with high-pressure-sales-spas that get you pre-approved with Care Credit, entice you into a "special deal that just happens to be ending today", then when you decide not to go through with the treatments, they charge you a huge "admin fee". Please, everyone, do your due diligence, call and visit a few practices before signing up, make sure they are knowledgeable and stand behind their work, and are looking out for the client's best interest. Find out how long they have been performing the treatments, and if they are seeing results in their clients. Find out if they have had advanced training with the device, or if they are just starting out with the basic protocols. There are many experienced practices that give great results consistently, and the changes include not just cellulite and fat shrinking, but also real skin contraction/tightening and shrinking of stretchmarks. These are changes that are not available with an endermologie or at-home device.

• Posted to Vela Suck on 13 Jun 2008

  The VelaShape treatments take approximately 25 min for an area the size of an 8.5" x 11" piece of paper. The original question posted was dated June 30, 2007. This most likely would be with the VelaSmooth device. The VelaShape wasn't FDA approved until about August 2007, and actual release of the VelaShape to most providers didn't occur until Sept-Oct 2007. If it was the old VelaSmooth treatment it would actually take about 30% longer than a VelaShape treatment, and it would require around 10 treatments. The VelaShape treatment now take around 4 or 5 treatments. For more information about the differences between VelaSmooth and VelaShape, see my answer to the question about VelaSmooth vs VelaShape differences. If the operator of the VelaSmooth or VelaShape takes too little time, doesn't focus on the treatment, or uses incorrect settings, then you will get poor results (hence the 9 reports of bad results on this site). In studies where the providers know what they are doing, the success and satisfaction rate should be 90-99%. (these people need to join this site to share their positive experiences) So for the original question, 19 minutes is too short for the old VelaSmooth treatment. Even with the VelaShape, it should have been a minimum of about 20-25 min for 1 area. Perhaps the sensitivity of the client to the treatment caused them to cut the treatment short? Thanks John Shieh, MD