Jeffrey P. Olson, MD

Thanks lori1987.

You do have beautiful eyes!

I would say the volume deficit here simply seems more pronounced as we are drawn to noting this prominent feature for you. The crease thankfully does not cross mid pupil so it would qualify as a Grade II deformity (mild-moderate). 

An injector skilled in this area is key but it is fairly well tolerated despite a potentially anxiety- provoking location. I use topical anesthetic and ice in part to minimize risk of bruising which is higher in this area.

It is also prudent I believe to consider two stages, being conservative in treatment to see how the area responds as far as swelling and volume correction. But this should be discussed with your provider. 

Juvederm Vollure may be a good choice as it can last up to 18 months.

Hello and thanks for your question. 

Firstly, I’m sorry this wasn’t elucidated further in your history and consultation. Rest assured, I would say the risk of keloid formation is minimal. 

Now, we have to distinguish between keloids and the unique risk with any filler but especially biostimulators like Sculptra - nodules and/ or granulomas. Nodules can form due to an accumulation or bunching of product. Often small and can be felt, are palpable, but usually not visible to others. I would not treat those and would counsel that they are collagen, the desired result. Granulomas are often a delayed response and are an exaggerated autoimmune response. Still rare but might require surgical excision. 

Similarly, keloids which you are prone to are an exaggerated response in scarification. Since the stimulus, a needle poke is much less, I would not expect this to happen, but keloids may occur even after ear piercing. The needle gauge to pierce is much larger than that for Sculptra injection. 20 compared to usual 25. 

So, this is similar to getting blood draws and I would expect little chance of keloid formation.  

I am unaware of any specific risk in the setting of Crohn’s disease.

Hope this comforts you.

Dr. Jeffrey P. Olson

Vanquish is extremely well tolerated and effective. 

Patients often take a nap while undergoing a treatment.

Although unclear of incidence- estimate 10% in my patients- panniculitis - or uneven fat dissolution that may result in nodules of fatty tissue that one may feel but are usually not be visible. They may be slightly painful requiring some OTC pain meds or in the extreme case delaying a treatment a few days. Overall, they tend to resolve or drastically decrease in size within 1-2 months. 

Z wave or Cellutone in conjunction may also decrease the chance of this most notable side effect.

Dr. Jeff

Thank you and this is the quintessential question as new therapies arrive in the marketplace. Which is better? I would say truly, it is based on your need upon examination and assessment and desires or goals.

The science supports a greater a depth of fat reduction looking at cross-sectioned tissue with Vanquish by perhaps 2 times as compared to Coolsculpting. It is also the only one I believe to have had a small study of long term (4 year) maintenance- of 75% of initial fat reduction results. This is because the remaining fat cells can increase in size with behavioral and diet fluctuation. After all, we CAN eat our way out of even a “stomach stapling” invasive procedure and regain the weight.

Vanquish can also treat bodies with BMI > 30 or bodybuilders with 4-6% body fat. Larger folks will see a greater percent reduction and more noticeable effect.  

Coolsculpting requires pinchable fat to enter the suction device but may be better when geared toward sculpting areas that are grossly disproportionate-such as love handles or a distinct concentrated areas of fat that can draw attention.

For an overall reduction and slimmer silhouette, Vanquish may be superior time and $- wise as 4 areas for a full abdomen or 4 hrs of treatment will be covered in 1 45 min. Vanquish session.

Best,

Dr. Jeff 

I would agree that I would not risk injury to friable mucosal tissue with radio frequency energy/heat. Coolsculpting would be the alternative for noninvasive treatment of adipose but would take some skill to place appropriately to achieve an even, aesthetic result.  

Ideally, Coolsculpting (or Vanquish) after reversal of the colostomy if that’s an option knowing that scar tissue can absorb more heat and the energy may have to be adjusted to pain tolerance.