Catherine Vanderloos, MD

First of all, congratulations on the weight loss.  It is a battle.  I tell my patients that we girls have three times of our lives with weight-puberty, pregnancy, and menopause.  Get that weight down before menopause, it is even harder that the other two times.  You cannot spot reduce with exercise, that is what the SculpSure was designed to do. There are four heads to the machine, each has a "rectangular" fitting that is attached with a strap.  This allows applications where you need the most help-horizontal, vertical, two here, three or four there.  Every patient has a different shape, so consultation is very important.  I fit the rectangle around your scar and the sites that you need. I chose SculpSure for my office and myself because it is very specific to fat cells only (laser setting

for wavelength for only fat itself so avoids nerves and blood vessels
within the tissues as well as fascia and muscle below and skin above) -heating
the fat cell walls only causing them to breakdown and your body removes
the fat through the lymph gland system.  It will take at least 6 weeks to
see the full effect. You will see changes before then but patience is
important.  I recommend at least 2 treatments for the full 43% decrease
each 6 weeks apart.  I found on myself, that even more change continued on
after the 12 weeks. There is absolutely no down time-we encourage exercise and
hydration and massaging the area daily to increase the rate that the fat is absorbed. 
The procedure it self is a cycling of 50 seconds of heat and a cooling 10
seconds over 25 minutes.  The sensation of the heating time is
different for everyone, but the 10 second cool break makes all the difference,
so that people read or look at their phone.  If someone is especially
anxious, my office also offers Nitronox, similar to what dental offices
offer.  Most people do not need it.  The SculpSure effect also
"feathers" the surrounding areas into the heated area, so there is a
smooth transition.  Good luck.  If you are in our area, please come for a consultation.  Dr. V

These are unrelated topics, votiva is definitely an option for you. We offer great support to our PCOS patients for the various issues associated with PCOS, medical management with weight loss suggestions,  as well as aesthetic care including hydrafacials and hair removal and SculpSure for those hard to resolve fat sites.  Bladder leakage is a problem for so many patients of all ages.  We offer: 1.  INTONE physical therapy program that allows you to do your therapy in your home with office support and is great for overall pelvic floor strengthening - it does require the patient to do work at the house. 2. VOTIVA performed in the office  for 25 to 45 minutes depending on your bladder symptoms and there is no "homework".  It is a radiofrequency therapy performed with a wand placed into the vagina and encourages collagen formation for improved support.  How many treatments involve is very individual.  I have had good results with 1-4.  3. MONA LISA TOUCH is also available in our office.  It is a laser therapy to overcome dryness and pain from lowering estrogen levels associated with menopause, but bladder symptoms improve with this therapy as well.  4.  If you are menopausal, vaginal medical therapy to over come the dryness and pain without any procedures is available.  We have something for everyone.  Our motto "No pads, no pills and no surgery."

Your calculated BMI (body mass index based on your height and weight) is 24.1.  That is a very healthy number (overweight is 25 and above)-congratulations- and  a great candidate for  SculpSure which is done in my office.  Your age is not an issue.  I chose SculpSure for my office and myself because it is very specific to fat cells only (laser setting for wavelength for only fat itself so avoids nerves and blood vessels within the tissues as well as fascia and muscle below and skin above) -heating the fat cell walls only causing them to breakdown and your body removes the fat through the lymph gland system.  It will take at least 6 weeks to see the full effect. You will see changes before then but patience is important.  I recommend at least 2 treatments for the full 43% decrease each 6 weeks apart.  I found on myself, that even more change continued on after the 12 weeks. There is absolutely no down time-we encourage exercise and hydration and massaging the area daily to increase the rate that the fat is absorbed.  The procedure it self is a cycling of 50 seconds of heat and a cooling 10 seconds over 25 minutes.  The sensation of the heating time is different for everyone, but the 10 second cool break makes all the difference, so that people read or look at their phone.  If someone is especially anxious, my office also offers Nitronox, similar to what dental offices offer.  Most people do not need it.  The SculpSure effect also "feathers" the surrounding areas into the heated area, so there is a smooth transition.  Good luck.  Dr. V

Unfortunately, the answer is no.  They are resistant to even paying for any estrogen or estrogen-like therapy.  Recently there is discussion of the medications possibly being covered in Part D but it may take a long time for any further action.  Osphena which is a pill that is very effective for vaginal dryness can be covered as self pay even when you are on Medicare.  The company has a mail-order system that works very well.  I suggest you bring this up with your provider to see if you are a candidate.  Samples and a form regarding the information are available from the company,  Duchessnay.  Good luck.

There is discomfort, especially at first, as the machine warms up and you are adjusting to knowing that the cooling time is coming.  When the pain not being tolerated, there is a cooling button and you get a much longer moment of cooling sensation and the machine will automatically decreased to the next lower setting.  Almost always as the treatment progresses the settings can be increased and are tolerated.  Being on your period may also have been an issue in your case, as many women who are stilling having regular periods will feel menstrual cramping at the time of treatment.  I suggest that you take some tylenol (not advil) before your next treatment.  You will still have good effect from the session even at a lower setting.  The afterward discomfort can be improved with massage to the areas.  Good luck.

I work with the patients on a low carbohydrate-ketogenic diet and often use Contrave pills to block food craving (this is a combination of wellbutrin-antidepressant that blocks smoking and food craving- and naltrexone-blocks drug abuse and food craving). It takes time, but I have patients that have lost #60 pounds in one year.  Depending on your insurance, it may pay.  SculpSure can be used to reduce areas that have not resolved with weight loss and exercise.  My patients use the Sculpsure as a carrot or reward for losing weight.  SculpSure does not replace lifestyle changes.

The discomfort immediately after should be about the same,if not less.  Do you have issues with yeast infections or diabetes? I have learned to treat with diflucan before and after and this can head off pain that is outside the immediate recovery.  Another site that can give pain is just at the opening, called the vestibule, and treating with a compounded cream of testosterone and lidocaine can be helpful until the symptoms resolve, and then I laser right over the top of the area.  You would need to be evaluated to see if this is a cause.

Pelleve is for all skin colors and skin types.  We use Pelleve for skin tightening but combine it with a Hydrafacial before (this allows even more hydration to the skin for more pelleve effect) and I think the combination would be very helpful for you.   The combination is also wonderful to do before pictures or parties.

The SculpSure cycles for 40 secs of heating and 10 second of cooling.  Sometimes, the patient will need a little break and when we hit the cool button for that it is for 20 seconds.  Turning the heat amount can vary between patients, but as long as it is getting hot it is working-you may see more benefit at the higher temperatures.  The cooling cycles really makes the difference in tolerance and the temp can often be turned up without the patient noticing a difference.  We are using Pelleve radio frequency for three cycles between the two treatments of SculpSure for skin tightening.

I have had great results with Mona Lisa Touch and lichen sclerosis-even improving cases that were very resistant even to clobetosol (which has been my mainstay therapy for a long time).  There is discussion of it curing but I think that data is still incoming-I sure hope it will be true in the end, but no data yet.  Lichen sclerosis is an autoimmune process (your body fighting with your own tissues) and should be considered life-long, even if it is not giving trouble at the time.  There is a 5-fold increased risk of skin cancer (not related to hpv) associated with lichensclerosis-they just travel together, not one leads to the other; so maintenance treatment and observation for any ckin changes of the vulva is very important.