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  • Cryolipolysis in Aesthetic Plastic Surgery

    Cryolipolysis in Aesthetic Plastic Surgery

    Cryolipolysis in Aesthetic Plastic Surgery
    Karan Chopra, MD,a,b Kashyap K. Tadisina, BS,c and W. Grant Stevens, MDd
    Keywords: cryolipolysis, body sculpting, nonsurgical fat reduction, noninvasive body contouring,

    DESCRIPTION

    A pleasant 50-year-old woman presented to the plastic surgery clinic with complaints of persistent localized excess fat in her lower abdomen despite improved diet and exercise. Cryolipolysis of her abdomen was performed, and she returned to clinic for her 8-week follow-up.

    DISCUSSION

    Cryolipolysis is the result of continued innovation and development in the area of non-invasive body contouring in aesthetic plastic surgery.1,2 The demand for body contouring procedures is rising because of the advent of bariatric surgery. Body contouring procedures allow surgeons to treat isolated areas of excess fat that lead to asymmetric appearance and adiposity in unwanted locations.2 Currently, liposuction is the most frequently employed and effective technique for body contouring but, due to its invasive nature, comes with inherent risks including bleeding and infection with an associated longer recovery time. Furthermore, one of the most common complications of liposuction is contour irregular-ities. Other noninvasive body contouring methods that have been described with varying degrees of success include: infrared light, lasers, radiofrequency, massage, and even high-frequency ultrasound techniques,3 yet their long-term viability and consistency in results have not been proven. Cryolipolysis is a recent technology used for controlled, natural, and selective fat reduction utilizing localized cooling to extract heat from adipocytes.1 Although there are no established, formal indications of when to use this technology, it is used in a variety of clinical situations, from the patient who desires scarless reduction of adipose tissue to those who are unfit to tolerate the anesthesia required for more invasive forms of liposuction.

    Although the exact mechanism is still being studied, cryolipolysis works at a cellular level by an overarching theme of inflammation followed by phagocytosis and apoptosis. The basic principles of cryobiology date back to the 1960s when research in rapid freezing and concurrent ischemia were being studied.4 Adipose tissue, as compared to other tissues, is more sensitive to cold temperatures.4 Studies performed in porcine and in vitro models, with histological and pathological studies, confirm this cell response. Adipose cells undergo an inflammatory response after exposure to cold temperatures (−1 to −7℃) within the first 72 hours, peaking at 14 days after treatment. Between 14 and 30 days, phagocytosis of adipose cells begins. By 60 to 90 days, the inflammatory process declines and the adipose cell volume decreases with concurrent interlobular septal thickening. This roughly 90-day cycle results in selective subcutaneous fat layer reduction.

    Although one of the greatest advantages to cryolipolysis is its safety in the population, there have been documented unwanted side effects that occur. Symptoms include erythema, edema, decreased sensation, and pain in the treatment area, but none have been reported as permanent.5 Biopsy studies of nerve fibers confirm this short-term decrease in sensation being temporary, with no permanent changes in nerve fibers, and sensation returning in patients by 3 to 4 weeks.6 One area warranting further study is the efficacy of cryolipolysis in patients with cold-induced medical conditions such as cryoglobulinemia, cold urticaria, and paroxysmal cold hemoglobinuria need further testing.1 Isolated case studies report incidences of delayed paradoxical hyperplasia at sites of cryolipolysis as 2 to 3 months,7 with unintended adipose tissue growth stimulation as the hypothesized mechanism. Finally, although found to be effective, cryolipolysis is not a suitable replacement for high-volume liposuction because traditional liposuction can remove more adipose tissue whereas cry-olipolysis is not intended for high volume removal of adipose tissue in a single sitting.

    Cryolipolysis has been found to be effective through porcine model studies as well as numerous recently published clinical studies. Porcine model studies found an 80% reduction in superficial fat layers and 40% total fat layer reduction at 3.5 months posttreatment.  A volumetric quantification study found that per cycle, close to 40 cc of adipose tissue is lost in flank areas 2 months posttreatment.5 Clinical studies have shown cryolipolysis to be efficacious in reducing fat in the lower and upper abdomen, inner and outer thighs, flank area, and back.2 In terms of longevity, case studies report fat reduction sustained for 2 to 5 years posttreatment. Finally, studies show more than 80% satisfaction rate among patients,5 with more than 80% of patients willing to recommend treatment to a friend. Overall, cryolipolysis offers patients a safe, effective, controlled, and noninvasive method to deal with unwanted fat in various parts of the body.

    REFERENCES：

    1. Shek SY, Chan NP, Chan HH. Non-invasive cryolipolysis for body contouring in Chinese—a first commercial experience. Lasers Surg Med. 2012;44(2):125-30.

    2. Stevens WG, Pietrzak LK, Spring MA. Broad overview of a clinical and commercial experience with CoolSculpting. Aesthet Surg J. 2013;33(6):835-46.

    3. Tadisina KK, Patel MN, Chopra K. High-intensity focused ultrasound in aesthetic plastic surgery. Eplasty. 2013;13:ic56.

    4. Sasaki GH, Abelev N, Tevez-Ortiz A. Noninvasive selective cryolipolysis and reperfusion recovery for localized natural fat reduction and contouring. Aesthet Surg J. 2014;34(3):420-31.

    5. Garibyan L, Sipprell WH 3rd, Jalian HR, Sakamoto FH, Avram M, Anderson RR. Three-dimensional volumetric quantification of fat loss following cryolipolysis. Lasers Surg Med. 2014;46(2):75-80.

    6. Coleman SR, Sachdeva K, Egbert BM, Preciado J, Allison J. Clinical efficacy of noninvasive cryolipolysis and its effects on peripheral nerves. Aesthetic Plast Surg. 2009;33(4):482-8.

    7. Jalian HR, Avram MM, Garibyan L, Mihm MC, Anderson RR. Paradoxical adipose hyperplasia after cryolipolysis. JAMA Dermatol. 2014;150(3):317-9.

    8. Manstein D, Laubach H, Waaranabe K, Farinelli W, et al. Selective cryolysis: a novel method of non-invasive fat removal. Lasers Surg Med 2009;40:595-604.

  • Extracorporeal shock-wave therapy effectively reduces calcaneal spur length and spur-related pain in overweight

    Extracorporeal shock-wave therapy effectively reduces calcaneal spur length and spur-related pain in overweight

    Extracorporeal shock-wave therapy effectively reduces calcaneal spur length and spur-related pain in overweight and obese
    patients

    Emrullah Haytaa, Ismail Salkb,CesurGumusb, Mehmet Siddik Tuncaya and Ali Cetinc

    Abstract.

    OBJECTIVE: We aimed to evaluate the effects of extra corporeal shock-wave therapy (ESWT) on the calcaneal spur length and pain severity in overweight and obese patients with symptomatic calcaneal spur.

    METHODS: In eighty patients with symptomatic calcaneal spur, ESWT was administered on days 0 and 7, and visual analog scale (VAS) scores and calcaneal spur lengths (CSLs) before and 3 months later after treatment were recorded. A lateral heel radiograph was used for computer-aided linear measurements of CSL.

    RESULTS: Of 80 patients, 59 (73.7%) were female and 21 were male (26.3%); age was 45.9 ± 8.3 years; BMI was 31.6 ± 4.4 kg/m2; and symptom duration was 2.3 ± 2.4 years. The CSL and VAS score after treatment were significantly lower than those before treatment (CSL before vs. after: 5.7 ± 1.0 vs. 4.4 ± 0.9, p = 0.001; VAS score before vs. after: 8.3 ± 1.4 vs. 4.6 ± 2.2; p = 0.03). The CSLs before and after treatment had a significant strong correlation (r = 0.832, p = 0.001). The VAS scores before and after treatment presented a significant mild correlation (r = 0.242, p = 0.03).

    CONCLUSIONS: In overweight and obese patients with symptomatic calcaneal spur, ESWT reduces the CSL and pain severity during a follow-up of three-month duration.

    Keywords: Calcaneal spur, extracorporeal shock wave therapy, pain X-ray imaging

    1. Introduction
    Plantar heel pain, considerably deteriorating walk-ing and mobility, is related to the calcifications known  as calcaneal spur that is seen in the proximal parts of  plantar fascia in approximately 50% of the patients [1].  Symptoms are generally characterized with burning  and pain that originates from the bottom of the heels and spread to the lower legs. It can be seen in every age, but it is more prevalent in middle-aged women, and male athletes [2]. Symptomatic calcaneal spur is more frequently seen in overweight, elderly, and fe-male patients, and in patients with a previous diagnosis of osteoarthritis or present heel pains [3].

    Calcaneal spur is a self-limiting clinical condition, and majority of the patients are healed by conservative treatments as a first choice [4–6], such as resting, non-steroidal anti-inflammatory drugs (NSAID), orthotics, and local injections of corticosteroids [7]. Physical therapy modalities like iontophoresis, microwaves, and ultrasound applications are widely used therapeutic in-terventions. A;proximately 10% of the patients need further therapeutic interventions [8,9]. Open or endo-scopic surgical techniques are being used for patients  who do not benefit from conservative methods. But,  surgical interventions must be considered carefully  due to the reports about long periods of wound heal-ing, deterioration of foot biomechanics, probabilities of relatively rare complications, and recurrences [10]. All these limitations and complication probabilities in treatment options yielded a research towards a less risky and effective alternative treatment. ESWT has become the recommended modality in recent years  in patients with symptomatic calcaneal spur, espe-cially resistant to conservative treatment [11]. American Food and Drug Association approved the application of ESWT in calcaneal spur after the successful results of Ogden et al. [12] and Buch et al. [13].ESWT utilizes pressure waves of microsecond lengths, which are produced outside and focused to specific parts of body [14]. Unit of the energy produced is millijoule (mJ) and it presents the pressure/time function per unit area. Shock wave energy that concentrated on unit area is described by energy flux density that shows the shock wave stream which is reflected perpendicularly to the source of production, and this term represents the dosage of the shock waves [15]. Pressure waves of ESWT pass through fluids and soft tissues,and expose their effects on areas of impedance changes such as bones and soft-tissue interfaces. These waves have effects at cellular level, as well as their mechanical effects. Most important of these effects is transient damage on neuronal cell membrane or increased permeability. These mechanisms can explain the analgesic effects of ESWT, that is, neovascularization in tissues may facilitate the cellular regeneration. In recent years,ESWT has become to be used successfully in various musculoskeletal diseases 

    The calcaneal spur length (CSL) is measured reli-ably in weight-bearing lateral heel radiographs with the help of computer-aided linear measurement technique [18,19]. According to our knowledge, there was not enough study on the effect of ESWT on the CSL and pain severity measured objectively in overweight and obese patients whose calcaneal spurs measured on lateral foot X-ray. There is a clinical need to know whether there are associations between the decrease in CSL and pain severity in overweight and obese patients. The aims of this study were to evaluate the effects of ESWT on the CSL and pain severity in overweight and obese patients.

    2. Material and methods
    This prospective study included 95 patients who ad-mitted to our outpatient service, and who had mod-erate or severe heel pain due to calcaneal spur di-agnosed with clinical and X-ray examination. The approval of Human Ethics Committee of our uni-versity and informed consent was obtained from all the participants. The exclusion criteria included hav-ing additional pathologies in clinical and radiological data in patient’s charts, relieving of symptoms with conservative therapies, taking medications (NSAIDs, steroids, analgesics) in preceding three months, and unwillingness to receive ESWT. Age, gender, BMI, affected side, and duration of symptoms were noted from each patient. The measurements of pain sever-ity and calcaneal spur lengths were performed before and 3 months later after ESWT. ESWT was applied for 6 minutes on days 0 and 7 as performed with a 25 mm probe, 0.2 mJ/mm2, and with a 15 mm probe, 0.2 mJ/mm2, each treatment consisting of 1200 shocks with a frequency of 120 shocks/min, respectively, in two sessions by the same physician with applications of radial shockwaves. ESWT administration was com-pleted without any event in all the participants. During study period, no orthotics was used by study subjects.

    Pain intensity was measured by using a 10-cm visual analogue scale (VAS) (VAS score expressed in cen-timeters; zero point of the scale = no pain, endpoint = intolerable pain). In the measurements before and after treatment, the VAS scoring was performed by same physician (E.H.)

    2.1. Radiographic measurements

    In a blind manner, the CSLs were measured by senior Radiologists (C.G., I.S.). A weight-bearing lateral heel radiograph was used for computer-aided linear measurements of CSL defined from the tip to the base

    of the spur delineated by a line presenting the calcaneal border, as defined previously [19] (Fig. 1). In brief, two

    lines were drawn on the weight-bearing lateral heel radiograph: an inclined boundary line presenting the calcaneal border and a horizontal lines showing the peak of the spur to the calcaneal border. CSL was described from the edge to base of the spur, as defined by a line boundary line the calcaneal border. Before performing the experimental measurements, interobserver reliability for the Radiologists was determined as Kappa coef ficient of 0.83, and intraobserver reliability was more than that value.

    2.2. Statistical analysis

    Data were presented as mean ± SD. All data were analyzed using IBM SPSS ver. 21 (IBM Co., Armonk, NY, USA). The VAS score and calcaneal spur length before and after ESWT were analyzed with paired test. Pearson’s correlation coefficients were calculated between VAS scores and calcaneal spur lengths before and after ESWT, and between BMI and calcaneal spur length before ESWT. A p value of less than 0.05 was accepted as significant. A post hoc power analysis revealed that the trial had a power of > 0.99 according to the CSL and VAS score as the primary outcomes of this study.

    3.Discussion
    According to findings of this study, ESWT reduced  the CSL and pain severity in overweight and obese patients. Since there is a strong relationship between the CSL values before and after ESWT, our findings supports that ESWT can successfully decreases the CSL in the clinical settings of this study. The VAS scores before and after ESWT appeared as correlated slightly; this was in accordance with the data of literature [20–22]. Moreover, ESWT in the overweight and obese patients with symptomatic calcaneal spur resulted in a decrease in the length of calcaneal spur measured as an objective technique first time in the present study. The CSL may be insignificant for patients with symptomatic calcaneal spur whose spur are on the side with no weight load. However, in many patients with calcaneal spur, there is no direct correlation between  calcaneal spur and pain severity [23].

    ESWT is a good alternative option to surgery and steroid therapy in patients with chronic plantar fasci itis, particularly resistant to conservative methods [24]. Its analgesic effects their biological mechanisms are still controversial [25]. Various studies reported that ESWT causes internal micro-deteriorations in fascia tissues, and accelerates tissue healing and neovascular ization [26–28]. ESWT is a non-invasive method with very low complication rate. Many clinical trials reported successful outcomes of ESWT in plantar fasciitis. Success rates were between 75% and 94% in nonplacebo controlled clinical series. Rompe et al. [29] evaluated the effects of shock wave counts in ESWT on treatment outcomes, and reported a 47% superiority of high impulse rates, when compared with low impulse rates. Krischek [30] and colleagues also reported that low-energy shock waves should be applied with a 3 ×500 impulse rate for an effective treatment.

    Lee et al. [31] applied ESWT to patients with chronic plantar fasciitis and calcaneal spur, but could not achieve any radiological chance after the treatment. However, when the clinical results at 12th months were reviewed, an 82% of improvement was obtained in patient with calcaneal spur, whereas this rate was 79% in patients without calcaneal spurs. çYalcin et al. [32] analyzed radiological and clinical findings of 108 patients with calcaneal spur. They defined their radiological findings as decrease in the angle of spur (17.6%),decrease in dimensions of spur (21.3%), and breakage of spur (0.9%). They did not give details of measurements and assessments of the spur angle and presented their findings as nominal data. They noted that  there was no correlation between radiological and clinical findings. In our study, to determine the association of radiological and clinical findings, calcaneal spur length was determined in an objective way to provide a base for further studies. On the other hand, Cosentino et al. [33] reported that ESWT therapy might improve plantar heel pain symptoms, and caused ultra- sonographic and radiologic structural changes in calcaneal spurs. As presented in that study and found in our study, a correlation may not found between spur size and clinical symptoms. We also presented in this study that ESWT therapy was an effective method on pain relief and radiological improvement in calcaneal spur. According to our results, VAS scores were remained same in 24.4%, and increased only in 6.7% of patients. These stable or increased values of VAS in 31.1% of our patients may be a result of high BMI values. Our results also revealed the fact that efficiency of ESWT therapy in calcaneal spur also related with not only anti-inflammatory and edematous effects, but also with breakage of calcaneal spurs. This effect needs to be confirmed with further studies including control groups. However, according to present results, ESWT therapy has important effects in calcaneal spur. Moreover, there are no reports of serious and irreversible side effects. As many of the clinical trials suggested, ESWT should be considered before surgical options in patients with calcaneal spur that resistant to conservative treatments. There are also many clinical trials, which suggest  that ESWT is inefficient in heel spur. Haake et al. [34] conducted a placebo controlled one year follow-up study, and reported success rates as 81% in ESWT group, and 76% in placebo group. They concluded that  inefficiency of ESWT in calcaneal spur may be related to spontaneous remission of disease in these patients, additional conservative methods, or prolonged placebo effect. Other investigators, such as Buchbinder et al. [35] and Speed et al. [36] also reported in their randomized, double-blind and placebo controlled studies that ESWT had indifferent effects from placebo. In another meta-analysis, six randomized controlled studies that included 897 patients were analyzed, and authors concluded that ESWT has not a statistically significant effect on calcaneal spur [37]. Although many clinical trials reported beneficial effects of ESWT in symptomatic calcaneal spur in recent years, failures in the ESWT in some studies may be re lated with positioning and localization of the patients,,variations in the device selection and the dosages, recruiting patients with symptoms lasting more than 3  weeks and some other factors that could not be determined yet. Limitations of this study was the 3-month duration of the follow-up. Follow-up of longer duration could show the long-term effects of ESWT in patients with symptomatic calcaneal spur. If pain severity was measured with algometry, it may be possible to measure pain severity in a more reliable manner. Further studies evaluating the role of CSL in normal and obese patients selected according to their lifestyle, occupation, side of foot weight load, and footwear type may be beneficial to determine the indications and administration of ESWT in patients with calcaneal spur. As conclusion, ESWT reduces the CSL and pain severity in overweight and obese patients with symptomatic calcaneal spur. ESWT is a good alternative alternative method for the treatment of symptomatic calcaneal spur resistant to conservative treatment in overweight and obese patients.

  • What is IPL Machine and IPL SHR Laser Hair Removal Treatment

    What is IPL Machine and IPL SHR Laser Hair Removal Treatment

    In the season of beauty, hair is the most redundant existence, so many people need to put hair removal on the beautiful schedule, in addition to the previous hair removal cream, there is also a strong pulse light hair removal, strong pulse light hair removal can be permanently removed Hair, eliminating the trouble of repeated hair removal. IPL Hair Removal Treatment with Intense Pulse Light (IPL) ensures a painless, ultrafast and safe treatment. All of our care is designed to meet the busy lifestyle of our customers, minimizing downtime. You can resume all normal activities immediately after your IPL permanent hair removal treatment.

    What is IPL? How does it remove hair?

    The strong pulsed light of IPL hair removal is a color light with a wavelength from 475 to 1200 nm and combines various therapeutic effects. Ipl is an abbreviation of strong pulsed light. Photon hair removal can penetrate the epidermis, is absorbed by the hair follicle in the dermis, generates heat energy, destroys the hair follicle, and removes the photon to obtain permanent hair removal effect. At the same time, it can produce chemical changes in the molecular structure of collagen fibers and elastic fibers in the dermis layer, and promote skin collagen regeneration and rearrangement.

    Treatment Process

    1. Wash the area needing treatment for 3 minutes.
    2. Scrape the hair that needs laser removal.
    3. Daubing the gel to the area where the hair will be scraped off.
    4. Before turning on the device, the operator needs to wear protective glasses, and the patient needs to wear glasses or eye masks.
    5. shooting 2 to 3 spots on the bottom of the ear to test whether it will be allergic. If you have allergies, please stop treatment.
    6. Set the instrument parameters.
    7. After the treatment is completed, you need to apply some skin cream to the treatment area.

    How Many Treatment Do I Need?

    The results are gradual and become more pronounced after each treatment. Most people noticed an improvement after the first treatment, reduced hair and slower regeneration. The number of sessions depends on your particular skin and hair condition and the results you are trying to achieve. Generally, 8 to 12 treatments, 4 to 6 weeks apart (depending on the region) is needed to remove 80% to 90% of the hair.

    The advantages of IPL treatment

    IPL photon hair removal is to restore the original elasticity of the skin, eliminate or reduce wrinkles and reduce pores while photon hair removal. Improves skin texture, skin tone and tightens skin It has the effect of solving mild skin problems such as mild hair keratosis and uneven skin tone. A major advantage of IPL photon hair removal is that the spot size is large, up to 5 square centimeters, so the hair removal speed is very fast. Slight pain.

    Before & After:

    FAQS:

    1. How does IPL hair removal work?
    IPL works by emitting light to the skin. The light is then absorbed by the pigment in the hair and turned into heat. The heat generated then destroys the cells responsible for growing new hair.

    2. What should I do before IPL treatment?
    Avoid sun exposure for a long time before treatment. Avoid spray tanning at least one week prior to treatment. Do not wax at least 2-3 weeks before. Do not pick at least 1-2 weeks before treatment. Please shave in 1-2 days in advance!

    3. Is IPL treatment hurt?
    Depending on the area you are treating, there may be minor injuries. Areas such as the back and legs are almost harmless, while areas such as the pubic area and neck are very sensitive.

    4. I have red /ginger /gray/white hair, will IPL hair remove me?
    White and gray hair is not suitable and the results are not satisfactory. IPL can work on red hair to some extent, depending on how much brown pigmentation is present at the root of the hair. The results will vary. IPL has the best effect on dark hair.

    5. How long does it take me to get results from IPL to remove hair?
    On the day of treatment, your current hair cycle will be killed by the IPL light. You may notice that the beard after the hair looks “tired”. Hair loss takes about 10-18 days. Then, your new hairstyle cycle will start in a week or two, and then repeat the process.

    6. Is IPL safe?
    IPL is widely used and its use is not limited. IPL has been used for many years and is considered a safe and effective way to remove excess hair and various skin regenerations.

  • Penile Low-Intensity Shock Wave Therapy: A Promising Novel Modality for Erectile Dysfunction

    Penile Low-Intensity Shock Wave Therapy: A Promising Novel Modality for Erectile Dysfunction

    Penile extracorporeal low-intensity shock wave therapy (LIST) to the penis has recently emerged as a novel and promising modality in the treatment of erectile dysfunction (ED). LIST has angiogenic properties and stimulates neovascularization. If applied to the corpora cavernosa, LIST can improve penile blood flow and endothelial function. In a series of clinical trials, including randomized double-blind sham-controlled stud-ies, LIST has been shown to have a substantial effect on penile hemodynamics and erec-tile function in patients with vasculogenic ED. LIST is effective in patients who are responsive to phosphodiesterase 5 inhibitors (PDE5i) and can also convert PDE5i non-responders to responders. The response to LIST wanes gradually over time, and after 2 years, about half of the patients maintain their function. Extensive research is needed to understand the effect of LIST on erectile tissue, to modify the treatment protocol to maximize its outcomes, and to identify the patients who will benefit the most from this treatment.

    Keywords: Erectile dysfunction; Penile; Shockwave treatment; Therapy

    INTRODUCTION

    Great advances in the understanding and treatment of erectile dysfunction (ED) have been made in the past two decades. Most patients suffering from ED respond to the available options for treatment, including oral phospho-diesterase type 5 inhibitors (PDE5i) and intracavernosal injections of vasodilating agents. However, these medi-cations are unable to alter the underlying pathophysiology of the erectile mechanism. They are usually taken on de-mand, prior to the sexual act, and do not improve sponta-neous erections [1]. Therefore, a need exists for an effective new treatment concept that would have a durable effect on spontaneous erectile function. Recently, a promising mo-dality was introduced: the application of low-intensity ex-tracorporeal shock wave therapy (LIST) on the penis [2]. Shock waves are acoustic waves that generate a pressure impulse and that carry energy when propagating through a medium. The degree of focus can be modulated non-invasively, resulting in variable concentration of energy at a desired location [3]. When shock waves are applied to an organ, the focused waves interact with the targeted deep tissues and act as transient micromechanical forces that initiate several biological changes [4]. Extracorporeal shock wave therapy has been clinically examined and ap-plied in various medical fields. High-intensity shock wave therapy is used for lithotripsy because of its focused me-chanical destructive nature. Medium-intensity shock waves have been shown to have anti-inflammatory proper-ties and are used for treating a wide range of orthopedic con-ditions, such as nonunion fractures, tendonitis, and bursitis. Low-intensity shock waves probably have angio-genic properties and are used in the management of chronic wounds, peripheral neuropathy, and in cardiac ischemic tissue [1,2,5,6]. 

    When LIST is applied to an organ, the relatively weak yet focused shock waves interact with the targeted deep tis-sues where they cause mechanical stress and micro-trauma, also known as shear stress [3]. This shear force then triggers a chain of events that cause the release of an-giogenic factors inducing neovascularization of the af-fected tissues and enhancing the blood flow. Extrapolation of these findings to ED has led to the assumption that if ap-plied to the corpora cavernosa, LIST could improve penile blood flow and endothelial function by stimulating angio-genesis in the penis [7]. This review summarizes the effect of LIST on erectile tissue as well as the clinical evidence of its effect in patients with vasculogenic ED.

    POTENTIAL MECHANISM OF SHOCK WAVE THERAPY

    Research on the biological changes that result from LIST has mainly been focused on angiogenesis and local neovascularization. More than a decade ago, Wang et al. [8] revealed that LIST stimulates the expression of angio-genesis-related growth factors, such as endothelial nitric oxide synthase (NOS), vascular endothelial growth factor (VEGF), and endothelial cell proliferation factors, e.g., pro-liferating cell nuclear antigen (PCNA). This group also re-ported that LIST induces neovascularization and cell proliferation. This effect is evident 4 weeks after treatment and persists for more than 12 weeks [8]. Moreover, previous studies on transgenic mice revealed an up-regulation of VEGF receptor 2, which is considered a primary mediator of angiogenic signaling. Quantitative immuno-histo-logical studies evaluating ischemic tissue vessel formation showed higher vessel densities in the shock wave-treated groups [6,9-12].

    In recent years, LIST has also been studied in regard to its effect on stem cell recruitment in tissue repair. Stem cells and progenitor cells have the ability to divide and dif-ferentiate into specialized cell types. Their key role in the neovascularization of ischemic tissues was widely studied in recent years [13]. One example is the circulating progeni-tor cells (CPCs). During acute ischemia, the release of che-moattractant factors (i.e., VEGF) acts as a homing factor for CPCs that may contribute to the ongoing endothelial re-pair [14]. Aicher et al. [5] investigated the effect of LIST on the homing of infused human CPCs in rats with chronic hind limb ischemia. In their study, LIST-treated ischemic muscles attracted significantly more labeled CPCs than did the untreated muscles. The treatment significantly in-creased the blood flow in the ischemic muscles. Nishida et al. [6] studied LIST in a porcine model of ischemia-induced myocardial dysfunction and found that LIST significantly up-regulated VEGF expression in ischemic myocardium and improved regional myocardial blood flow and left ven-tricular ejection fraction. Further studies have also demon-strated beneficial effects of LIST on left ventricle remodel-ing in pigs with experimentally induced myocardial in-farction [15] and myocardial ischemia-reperfusion injury [16]. 

    CLINICAL APPLICATIONS OF LIST

    Encouraging results in animal model have set the ground for future studies in humans. Several studies have shown positive effects of LIST in human patients with severe is-chemic heart disease. Kikuchi et al. [17] reported that LIST improved the ejection fraction and stroke volume and sig-nificantly improved chest pain after a 6-minute walk test. Similar results have also been reported by other groups [18-20] in patients with severe coronary artery disease and refractory angina to whom LIST was applied. Following the promising results in patients with ischemic heart dis-ease, other reports on the capability of LIST were published with positive results on a wide range of ischemic wounds and ulcers [21-24].

    LIST FOR ED

    Because one of the underlying functional causes of ED is poor cavernosal arterial blood flow, it has been suggested that induction of neovascularization by LIST could im-prove cavernosal arterial flow, which in turn would im-prove erectile function [13]. The first study of the efficacy of LIST for ED was conducted by Vardi et al. [2] in 2010. In this pilot study, Vardi et al. [2] applied LIST to 20 mid-dle-aged men with mild to moderate vasculogenic ED who responded well to the use of PDE5i. The treatment protocol was based on the described methodology used in patients with cardiovascular disease [17] with modifications ac-cording to anatomical differences. The main challenge pre-sented by the authors was to apply shock waves to the whole area of the corpora cavernosa, including the crus. Another challenge was to adapt the shock wave delivery probe to the anatomy of the penis because the corpora cavernosa lies im-mediately under the penile skin. The protocol consisted of two treatment sessions per week for 3 weeks, a 3-week no-treatment interval, and a second 3-week treatment pe-riod of two treatment sessions per week. Each session com-prised the application of 300 shock waves (energy intensity of 0.09 mJ/mm2) to each of five different sites: three along the penile shaft and two at the crura (Fig. 1). The results showed that 1 month after treatment, erectile function im-proved in 15 men (75%). An increase by more than five points in the International Index of Erectile Function Erectile Function (IIEF-EF) domain score was noted in 14 men and an increase of more than 10 points was noted in 7 men. The average increase in the IIEF-EF domain score was 7.4 points. Furthermore, erectile function and penile blood flow were measured by using nocturnal penile tu-mescence (NPT) and flow-mediated dilation methodology (FMD) of the penis. In the 15 men who responded to LIST, all NPT parameters improved as recorded by significant in-creases in the duration of the erections and penile rigidity. Penile blood flow also improved significantly at the 1-month follow-up examination. At the 6-month follow-up visit, 10 men reported that they still had spontaneous erec-tions and did not require PDE5i support.
    Following these impressive preliminary clinical results, the effect of LIST on erectile function was examined in an animal model. Several groups investigated the effects of LIST on erectile function in diabetes mellitus rats, using the changes in the intracavernosal pressure following elec-trostimulation of the cavernous nerve to assess erectile function. Qiu et al. [25] found that erectile function was sig-nificantly decreased in all diabetic rats, but this effect was less evident in the LIST group. Additionally, histological analysis revealed an abundant amount of nNOS-contain-ing nerves, endothelial and smooth muscle cells, and mes-enchymal stem cells (MSCs) in the LIST group compared with untreated diabetic rats. Such findings support the idea that the underlying mechanism of the therapeutic ac-tion of LIST is the recruitment of MSCs, which was first postulated by Chen et al. [26] almost a decade before. Two more groups have recently examined the effect of ex-tracorporeal shock waves on nerve stimulation-induced erection in rats. Chen and Chang [23] and Liu et al. [24] demonstrated that shock wave energy improved erectile function as well as pathological changes in the erectile tis-sue of diabetic rats. 
    Vardi and colleagues [13] further extended their clinical study in vasculogenic ED patients and examined LIST as a possible treatment for patients with severe ED who re-sponded poorly to PDE5i therapy. The aim of this second study was to investigate the ability of LIST to convert non-responders to PDE5i therapy to PDE5i responders so that they were able to achieve satisfactory erections for vaginal penetration. This study included 29 men who had multiple cardiovascular disease risk factors, cardiovascular dis-ease, and diabetes mellitus and who did not respond to oral PDE5i therapy. The study results showed that 3 months after the completion of the LIST protocol, the IIEF-EF do-main scores improved by at least five points in 76% of men, and the mean IIEF-EF domain score increased by 10 points. Overall, 72% were converted to PDE5i responders. This increase in the IIEF-EF domain scores was also ac-companied by improvements in cavernosal blood flow and penile endothelial function as measured by FMD. One of the key issues addressed in these studies was the partic-ipants’ subjective opinions regarding their sexual function. At screening, all patients were thoroughly interviewed about their medical and sexual history. The total IIEF questionnaire, the Erection Hardness Scale (EHS), the Quality of Erection, the Self-Esteem and Relationship questionnaires, and the Clinical Global Impression of Change rating scale were used to subjectively determine the sexual function of each patient. In these studies, a sig-nificant correlation between the subjective assessment of sexual function by use of validated sexual function ques-tionnaires and the objective results of penile blood flow and endothelial function was found. Most importantly, none of the men in either study reported treatment-associated pain or any adverse events during or after the treatment. 

    A prospective, randomized, double-blind, sham-con-trolled study was designed to confirm these positive outcomes. Sixty ED patients were treated in a similar fash-ion [27]. The probe used for the sham treatment looked identical to the active probe and made the same noise yet did not produce any shock wave energy. The patients in the active treatment group had significantly higher IIEF-EF domain scores as well as improved penile endothelial func-tion compared with the sham-treated men. The overall suc-cess rate of LIST was later analyzed by Gruenwald et al. [28]. In this cohort of 184 patients from various studies, the mean IIEF-EF domain scores increased after LIST by 7 points with the greatest improvement occurring in men with severe ED. Moreover, further analysis revealed that the increases in the IIEF-EF domain scores in the men who were PDE5i nonresponders were higher than in the men who were PDE5i responders (7.52 points vs. 5.7 points). FURTHER CLINICAL STUDIES

    Another study recently introduced by Vardi et al. [29] eval-uated the effect of LIST after 2 years of follow-up and re-ported that the beneficial response that was achieved im-mediately after therapy had not faded in about 50% of the patients. The success rate after 2 years was lower mainly in patients with severe ED and diabetes. The same group also reported their preliminary results regarding a second round of penile LIST. They aimed to discover whether an additional LIST protocol would be therapeutically benefi-cial in patients whose first round of treatment was unsuccessful. Thirty patients were included in this study, 22 of whom (73.3%) had severe ED. Their median baseline IIEF-EF score before treatment was 8 and improved to a median of 10 points after the first treatment protocol. In the “second round” protocol, LIST was effective in approx-imately half the patients, and the median IIEF-EF score increased from 8 to 13.5 points, demonstrating that there are patients who probably need additional exposure to shock wave energy in order to respond [30]. 

    Several other groups have recently studied penile LIST with different shock wave machines. Preliminary results with a machine that produced linear shock waves at 4 ana-tomical areas were presented by Reisman et al. [31]. In this study, 82% out of 57 patients had a successful treatment, with the average IIEF-EF domain score increase of 8 points. Similar results were presented by Lacono [32]. The preliminary results of a third shock wave machine were presented by Lund [33]. In a prospective, randomized, blinded, placebo-controlled study, they demonstrated that LIST significantly improved the EHS in more than 50% of patients, allowing full sexual intercourse without medication. 

    CONCLUSIONS

    LIST is a promising novel therapeutic modality for restor-ing erectile function in men with vasculogenic ED. It is a safe and nonpainful treatment with a long-lasting effect on erectile function. Additional well-designed, randomized, large-scale studies are necessary to confirm these findings and to outline the optimal treatment protocol and the suit-able candidates.

  • What is rf machine and radio frequency body slimming treatment

    What is rf machine and radio frequency body slimming treatment

    Getting more and more popular. With the rapid development of the economy, the standard of living has improved, more and more people care more about their appearance and their health, such as don’t like acne faces, pursue the tightening skin, skin rejuvenation and slimming body. So skin rejuvenation tightening and fat reduction is more than a goal these days, it’s an entire industry. However, the traditional unsafe way can no longer satisfy the current pursuit of health and beauty. Therefore, a scientific and efficient beauty machine slowly appears in the public eye. Radio frequency body slimming could meet everyone’s needs.

    What Is The Radio Frequency Body Slimming Treatment?

    Radio frequency body slimming machine directly acts on the dermis through the epidermis and directly generates heat from the inside of the human body. When the thermal energy of the dermal tissue reaches 40. C–60. At C, collagen fibers produce an immediate contraction that stimulates and secretes more collagen to fill the shrinking and lost collagen voids. As the collagen in the dermis continues to grow and align, the relaxed skin can be treated after treatment. The tight effect of the skin tightens and the soft support of the skin is presented. As collagen becomes more and more dermal layer thickness and density increase fills wrinkles to eliminate scars to restore skin elasticity and luster, sagging skin makes full and firm and elastic.
    Radio frequency is a revolutionary treatment that can tighten the skin and blast fat cells without the need for surgery to achieve weight loss. This treatment is non-invasive and therefore ideal for those who do not want to have surgery or who do not think they are large enough. Amanda Horton and Mel B, which are favored by celebrities, have gained a lot of fans on the radio frequency and will soon become the first choice for body weight loss.

    What Are The Benefits Of Radio Frequency Body Slimming Treatment?

    1. Quicken the blood circulation in the part of skin treated and has the effect of decomposing fat.
    2. Improve absorption of cream, lotion and decrease acne.
    3. Tighten skin and decrease fine wrinkles.
    4. Stimulate collagen cells and increase skin flexibility.
    5. Reshape the outline of the face.

    How Long Does A Radio Frequency Body Slimming Treatment Session Last?

    If you visited a dermatologist, you might go once every 6 months. With your in-home RF machine, it depends on the results you want and the power of the machine. You might do one to three treatments a week, and it may take from one to three months to see results.
    For the body, the course of treatment takes about 25-40 minutes, usually recommended every two to two weeks, and an average of eight times in a body treatment.
    Radio frequency is not only on body slimming, but it also has face rf. For the face, it is recommended to apply a four-time treatment (once every three to four weeks) for firming the face. In our joint treatment training program, patients usually receive six treatments in six weeks and then receive one treatment every four weeks
    After one treatment, you would feel your skin more delicate and tighten. But every patient is different, most people can see the best result after one course of treatment.

    What Contraindications You Should Pay Attention To Doing Radio Frequency Body Slimming Treatment?

    Pregnancy or breastfeeding.
    Heart problem, disease or pacemaker.
    Hypertension.
    Cancer.
    Kidney damage, disease or problem.
    Liver damage, disease or problem.
    Acute inflammatory process.
    Hemorrhagic disease, trauma or bleeding.
    Medical plastic parts or parts with metal inside.
    Immune system abnormality.
    Numbing or insensitive to heat.
    Avoid using during menstruation.

    How Much Does This Radio Frequency Body Slimming Treatment Cost?

    This 30 minutes firming treatment costs about $500 for each session. If you want to see long-lasting and significant results, the recommended number of treatments is about 4 to 6 times.

    FAQs About Radio Frequency Body Slimming Treatment?

    1. How does it feel when using radio frequency treatment?
    Most people find this treatment painless and comfortable. Some people may feel a slight discomfort because certain noises spread in the body, but they do not cause damage and disappear once they are removed. You will also feel warm during the treatment. If the weather is less likely to get warmer, you can ask for an extra ultrasound gel immediately.
    2. Is radio frequency safe? Have any side effects?
    In most cases, radio frequency is a very safe and comfortable feeling by skin sensor and matching system.
    3. Does radio frequency relax the skin?
    No, there is a certain elasticity in the skin of the person, so there will be a tightening effect. In addition, the Italian RF slimming device is the best skin-slimming device in the world. After 1-2 times of radio frequency treatment after liposuction, the skin will be smooth and firm, and the slimming and shaping effect will be more thorough.
    4. After doing radio frequency body slimming treatment, will the weight drop dramatically?
    Excretion does not reduce a lot of weight, because fat is lighter than muscle, reducing the fat of two or three pounds, you can reduce the waist circumference by 5 cm, the improvement of the body curve will be very obvious, but the weight loss is not obvious.