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Cellulite Removal

July 20th, 2017

So what is Cellulite? Cellulite is the herniation of subcutaneous fat within fibrous connective tissue that manifests topographically as skin dimpling and modularity, typically affecting the buttocks and the thighs.   Approximately 85 to 98% of women have cellulite which indicates that it is physiologic rather than a pathologic condition in women.

Causes of Cellulite

1)Hormonal - the hormone estrogen maybe the culprit for the development of cellulite in women.  Although there’s no clinical evidence that estrogen may cause cellulite.

2)Genetics – There’s a genetic predisposition of cellulite.  Some women have more cellulite than others.  Scientists were able to trace the genetic component of cellulite in angiotensin converting enzyme (ACE) and hypoxia-inducible factor 1A (HIF1a) genes.

3)Lifestyle - A high-stress lifestyle will cause an increase in the level of catecholamines, which have also been associated with the development of cellulite.  Thus, reducing stress, such as during exercise, may improve cellulite.

Treatment of Cellulite

1)Cellulaze – it’s the first FDA-approved treatment of cellulite.  Although it may improve the appearance of cellulite, it’s not a guarantee to completely remove it.



Prevention and Treatment of Double-Bubble Deformity with Dual Plane Technique for Breast Augmentation

May 24th, 2017

The double-bubble deformity is a widely recognized complication of breast augmentation.

Prevention of Double-Bubble Deformity
• This deformity can be avoided with selection of a subglandular or dual plane (type II or III) placement, a sufficient implant volume or projection and anatomic prosthesis
There are several techniques one can employ to treat and correct the double-bubble deformity. These techniques include:
• Use of a dual-plane pocket
• Form-stable shaped implants
• Capsulorrhaphy
• Pocket plane conversion
• Use of acellular dermal matrices


Handel N. The double-bubble deformity: cause, prevention, and treatment. Plast Reconstr Surg. 2013 Dec;132(6):1434-43. doi: 10.1097/01.prs.0000434405.91316.96.

Emmanuel De La Cruz MD, PLLC
Plastic & Reconstructive Surgeon
Houston, Texas

Reduction of Seroma in Abdominoplasty

May 22nd, 2017

Seroma is the most common complication of abdominoplasty (tummy tuck.)  There are certain modifications to abdominoplasty that may reduce the risk of seroma.

A recent meta-analysis involving 1824 patients revealed the following:

  • Abdominoplasty with preservation of Scarpa’s fascia reduced incidence of seroma compared with that of standard abdominoplasty (P < 0.0001)
  • Abdominoplasty with placement of progressive tension sutures was associated with a significantly reduced incidence of seroma compared with that of standard abdominoplasty (P < 0.0002,).
  • Application of fibrin glue has no impact on seroma formation.  It does not reduce seroma formation in abdominoplasty.


Ardehali, et al.  A Meta-Analysis of the Effects of Abdominoplasty Modifications on the Incidence of Postoperative Seroma. Aesthet Surg J. 2017 May 6. doi: 10.1093/asj/sjx051.

Emmanuel De La Cruz MD, PLLC
Plastic & Reconstructive Surgeon
Houston, Texas


Brazilian Butt Lift Fat Transfer vs Gluteal Implant Buttock Augmentation

May 22nd, 2017

Buttock augmentation has been performed more frequently in the past decade.  There’s approximately over 21,000 procedures performed in the past year alone. The most popular methods for buttock augmentation involve silicone implants and autologous fat grafting.

So which Buttock Augmentation Procedure is safer and have lesser risks and complications?

The most commonly reported complications in 2375 patients receiving silicone implants has an overall complication rate of 21.6 percent (n = 512).
• Wound dehiscence (9.6 percent)
• Seroma (4.6 percent)
• Infection (1.9 percent)
• Transient sciatic paresthesias (1.0 percent

The most commonly reported complications in 3567 patients receiving autologous fat injection has an overall complication rate of 9.9 percent (n = 353).
• Seroma (3.5 percent)
• Undercorrection (2.2 percent)
• Infection (2.0 percent)
• Pain or sciatalgia (1.7 percent)

Sinno, et al. Determining the Safety and Efficacy of Gluteal Augmentation: A Systematic Review of Outcomes and Complications. Plast Reconstr Surg. 2016 Apr;137(4):1151-6

Emmanuel De La Cruz MD, PLLC
Plastic & Reconstructive Surgeon
Houston, Texas

Preventing Fat Embolism in Brazilian Butt Lift

May 19th, 2017

Brazilian Butt Lift involving fat transfer to the buttocks had been recently become very popular. As in any surgery, there are risks and complications, especially when combined with fat injection. There had been numerous case reports of fat embolism that have been documented. The possible explanation for these cases may be attributed to the puncture and tear of gluteal vessels during the procedure, especially when a deep injection is planned.

Figure 1: 4D VASER Hi-Definition Liposuction with Fat Transfer to the Buttock (Before & After Procedure: 6 weeks after surgery) performed by Dr. Emmanuel De La Cruz

What are the risks of Fat Embolism during Brazilian Butt Lift?

  • Fat embolism with Brazilian Butt Lift is more common in South America (Columbia and Brazil- ~7%) than it is here in the US.
  • Twenty-five fatalities were confirmed in the United States over the last 5 years through of autopsy reports and interviews with surgeons and medical examiners. Four deaths were reported from 2014 to 2015 from pulmonary fat emboli in AAAASF facilities.

How to Prevent Fat Embolism in Brazilian Butt Lift

1)Knowing the Anatomy of the Perforators of Gluteus muscle is Key to Avoid iatrogenic injury the vessels
Cadaveric studies have shown that the area under the gluteus muscle where the superior gluteal vessels traverse the muscle was located 6.4 ± 1.54 cm from the intergluteal crease and 5.8 ± 1.13 cm from the superior border of the gluteus muscle. The inferior gluteal vessels were located 8.3 ± 1.39 cm from the intergluteal crease and 10 ± 2.24 cm from the superior border of the muscle.
Cadaveric studies have shown that the angle of fat injection is important in avoiding injury to the gluteal perforators.
A 30° angle allows for an injection into the muscle without passing into deeper structures, unlike a 45° injection angle.

2)The fat is injected ONLY when the cannula is being withdrawn. This minimizes the risk of vessel puncture.
3)Use of blunt cannula during fat injection. The blunt cannula is used to decrease the likelihood of penetrating a blood vessel.

4)Avoid downward slope injection of fat into the buttock since the likelihood of iatrogenic penetration of the gluteal perforators is higher.

5)Avoid injection of fat into the gluteus muscle.  Intramuscular gluteal lipoinjection was found to be associated with mortality caused by gluteal blood vessel damage allowing macroscopic and microscopic fat embolism


Preventing Fat Embolism Syndrome

1)The use of methylprednisolone as a “membrane stabilizer” would reduce the incidence of Fat Embolism Syndrome. Pooled analysis of 389 patients found that corticosteroids reduced the risk of FES by 78%.


Emmanuel De La Cruz MD, PLLC

Plastic & Reconstructive Surgeon  Houston, Texas

Bederman, et al. Do corticosteroids reduce the risk of fat embolism syndrome in patients with long bone fractures? A MetaAnalysis. Can J Surg 2009. Oct 52(5)386-93

Cardenas, et al. Deaths Cause by Gluteal Lipoinjection:  What are We Doing Wrong? Plast Reconstr Surg. 2015 Jul;136(1):58-66. doi: 10.1097

Mofid et al.  Report on Mortality from Gluteal Fat Grafting:  Recommendations from the ASERF Task Force. Aesthet Surg J. 2017 Mar 21. doi: 10.1093/asj/sjx004. [Epub ahead of print]

Ramos-Gallardo, et al. Prevention of Fat Embolism in Fat Injection for Gluteal Augmentation, Anatomic Study in Fresh Cadavers. J Invest Surg. 2017 May 9:1-6. doi: 10.1080/08941939.2017.1321703. [Epub ahead of print]

Schonfeld SA, Ploysongsang Y, DiLisio R, Crissman JD, Miller E, Hammerschmidt DE, et al. Fat embolism prophylaxis with corticosteroid: A prospective study in high-risk patients. Ann Int Med. 1983;99:438–43.

Sculptra Injection in The Woodlands, Texas

May 19th, 2017

Sculptra is a synthetic material containing poly-L-lactic acid.  This is an FDA-approved injectible that has been in use since 1999.  It’s a biocompatible and biodegradable product that is naturally absorbed by the body.  It’s a material that is frequently used in absorbable sutures.

What are the benefits of Sculptra?


  • It can last up to two years.
  • It can thicken your dermis up to 10-12 mm with progressive treatments.
  • It stimulates collagen growth which helps restore facial volume and the look of fullness to wrinkles and folds over time.

How many treatments does one typically would need?

  • Per session, one would need approximately 2 vials of Sculptra to treat the whole face.
  • One may require at least 2 to 3 treatments in 4 to 6 week intervals

How does Sculptra work?

Emmanuel De La Cruz MD, PLLC
Houston Plastic Surgeon


Preventing Complications after Breast Augmentation

May 17th, 2017

Currently, there are no high-level evidences about the best technique or the best implant to use for obtaining the best outcomes in aesthetic breast augmentation.

So what are the potential complications after Breast Augmentation?

  • Capsular contracture - Capsular contracture rates (Baker scale grades III and IV) at 10-year follow-up were 9.2% for breast augmentation and 14.5% for breast reconstruction.
  • Breast implant rupture – Breast implant rupture rate was 9.4% without any report of extracapsular silicone gel migration.  MRI screenings are recommended 3 years after initial implant surgery and then every two years after to detect silent rupture.
  • Anaplastic Large Cell Lymphoma
  • Seroma - The seroma rate was 1.6% for augmentation subjects, 0.6% occurring more than 1 year after implantation (late seroma).
  • Infection
  • Breast asymmetry
  • Breast Malposition
  • Implant rippling or wrinkling - The 10-year data also show a very low rate of implant rippling or wrinkling (0.9% for augmentation, 6.2% for reconstruction).


How to Prevent Complications after Breast Augmentation?

  • Implant pocket irrigation with antibiotic solutions
  • Minimize handling of the breast implants such as the usage of the Keller Funnel
  • Avoid the usage of drainage
  • No touch technique breast augmentation
  • References:

    Nava, et al. How to prevent complications in breast augmentation. Gland Surg. 2017 Apr; 6(2): 210–217.

    Emmanuel De La Cruz MD, PLLC

    Plastic & Reconstructive Surgeon  Houston, Texas


    Which Cosmetic Procedure is Safe during Pregnancy and Lactation?

    May 17th, 2017

    There are many concerns among pregnant women and those who recently had given birth with regards to the safety of cosmetic surgery. The safety of cosmetic procedures in patients who are pregnant and/or lactating is a complex clinical question surrounded by uncertainty.

    So which procedures are considered safe during pregnancy and during lactation?

    • Minor procedures such as shave, punch, snipping, and electrocautery are considered safe.
    • With respect to chemical peels, glycolic and lactic acid peels are deemed safe; however, trichloracetic and salicylic acid peels should be avoided or used with caution.
    BOTOX or Dysport injections may be safe because systemic absorption and placental transfer are negligible.
    • Sclerotherapy can be safe during pregnancy. However, this should be avoided during the first trimester and after week 36 of the pregnancy.
    • Laser and light therapies have been considered generally safe for patients with granulomatous conditions and condylomata.
    • Epilation should be limited to waxing, shaving, and topical treatments instead of permanent procedures.

    Are there any procedures not safe during lactation after giving birth?

    • In patients who are lactating, most surgeries, chemical peels, botox injections and LASER therapies
    • Fat transfer, sclerotherapy, and tumescent liposuction are not recommended during lactation

    Trivedi, et al. A review of the safety of cosmetic procedures during pregnancy and lactation. Int J Womens Dermatol. 2017 Feb 27;3(1):6-10. doi: 10.1016/j.ijwd.2017.01.005. eCollection 2017 Mar.

    Emmanuel De La Cruz MD, PLLC
    Plastic & Reconstructive Surgeon
    Houston, Texas

    Clinic Locations:

    2219 Sawdust Road Unit 1203
    The Woodlands, Texas 77380

    1700 Post Oak Blvd (2 BLVD Place) Unit 600
    Houston, Texas 77056

    Fraxel LASER Therapy in The Woodlands and Spring

    May 16th, 2017

    The most effective non-surgical solution available, the minimally-invasive Fraxel Dual is Dr. De La Cruz’s pick for laser skin resurfacing and pigment correction. This non-surgical procedure is intended to smooth the surface of the skin. It also corrects the variations in skin tone, skin texture, skin pore size, acne scarring, sun-damage, pigmentation and melasma, all with minimal downtime.

    A Fraxel Laser treatment will improve the look of:

    • Wrinkles and fine lines on your face
    • Areas of uneven pigmentation (such as sun spots) in the face
    • Melasma (the ‘Mask of Pregnancy’) of the face
    • Acne and surgical scars on the face
    • Tighten large skin pores

    Benefits of Fraxel LASER Treatment
    • Improvement of Skin Texture and Skin Tone
    • Improvement of Brown Spots
    • Less wrinkles and fine lines

    Results of Fraxel LASER Treatment
    • May see the results in less than a month
    • Most people will need more than one session of Fraxel LASER treatment

    Post-Procedure Care after Fraxel LASER therapy
    • Avoid direct sun exposure
    • Use a sunscreen with SPF 30 or higher
    • Recommend the use of Biocream by Neocutis twice per day

    Ultherapy in The Woodlands|Spring|Houston

    May 16th, 2017

    Ultherapy is the so-called non-invasive facelift. It’s the only non-invasive procedure that is FDA-cleared to lift skin on the neck, under the chin and on the eyebrow. It’s also FDA-cleared to improve the appearance of lines and wrinkles on the décolletage.

    So what is Ultherapy?

    Ultherapy harnesses the power of ultrasound to transform the brow, chin, neck and chest. Ultrasound, of course, has been used safely throughout the medical field for more than 50 years—and Ultherapy has been established as safe and effective in clinical studies and in over half a million treatments worldwide.
    Ultherapy relies on ultrasound therapy which delivers its collagen-boosting treatment. It also incorporates traditional ultrasound imaging, which allows practitioners to see the layers of tissue they are treating, ensuring the treatment energy is delivered to where it will be most beneficial.

    Ultherapy on the TODAY Show from Ultherapy on Vimeo.

    Benefits of Ultherapy
    • It is Non-invasive with no incision and no bleeding
    • Performed in the Office
    • No General Anesthesia
    • The procedure takes between 30 and 60 minutes
    • No downtime

    Call NOW to book your Procedure at 832-776-1134