Interventional radiologists are uniquely poised to incorporate cosmetic procedures into their toolkits, according to speakers in the “Cosmetics in interventional radiology” session, held during SIR 2022.
The session introduced attendees to the basics of cosmetics, from sclerotherapy to liposuction. “For a lot of you, spider veins are the gateway drug,” said co-coordinator and speaker Raj Pyne, MD, FSIR. “It’s where you get into doing cosmetic IR.”
Dr. Pyne presented his techniques for sclerotherapy for spider veins, which he says many patients value and will routinely ask for. However, though it may be the entry to cosmetic IR, Dr. Pyne stressed that the procedure must be done effectively to provide lasting improvement. The key to this is injecting the reticular vein as well as the more visible spider veins.
“It’s the double-destroy theory,” he said. “What you see on the skin is the tip of the iceberg. You have to treat the reticular veins feeding them, or else the spider veins will recur. Some patients think it’s normal to have to go back for treatment over and over. It isn’t.”
Dr. Pyne showed videos of several cases, including both successes and failures, giving tips on what may lead to recurrence. “It’s crucial to set expectations up front,” he said. “Some patients may need up to five treatments. If you don’t set expectations up front, patients wont trust you.”
Taking before and after photos, showing patients videos and avoiding difficult areas like the ankles when starting out are the keys to patient satisfaction, he said.
“Once you get going, it’s very addicting,” he said. “And patients really appreciate the procedure.”
Once IRs have gone through the cosmetic gateway, so to speak, they can learn multiple other cosmetic procedures, according to Neda Vanden Bosch, MD. “IR is well suited to expand into the emerging field of cosmetics,” she said. “IRs have the finest skill set in medicine when it comes to performing minimally invasive procedures.”
According to Dr. Vanden Bosch, IRs are uniquely positioned because of their comfort with procedures, their anatomical dexterity, procedural dexterity, imaging expertise, established outpatient settings and equipment. There are two settings in which IRs can pursue cosmetics—a rapidly expanding U.S. market: in outpatient IR, where patients undergo treatments such as liposuction, cellulite treatments, deep resurfacing lasers and ultrasound guided injections, or in the med spa setting, which provides procedures such as injectables, micro needling, skin tightening, hair restoration, IV therapies and fractional lasers.
Before starting anything, however, Dr. Vanden Bosch says its important to understand the multiple reasons why humans age, and how the process presents in skin loosening, skeletal reabsorption and mandible shifts. This knowledge is crucial before beginning treatments such as Botox injections, so as to avoid injecting too much or too little in the wrong places and creating a non-natural look.
Dr. Vanden Bosch walked through the common areas for Botox treatments and gave tips on injection points, dosage and depth. She also detailed “homerun” procedures that are easy to do and make patients happy, such as injections for master muscle hypertrophy, which can cause bruxism, jaw grinding, TMJ issues and poor sleep quality.
When she notices this, Dr. Vanden Bosch brings it up to patients and will discuss treatment—which can also result in a slimming effect to the face. “This treatment creates lifelong patients. They’re happier, they sleep better, and they’re thankful forever.”
She also noted that Botox has more than just cosmetic applications—IRs should consider offering Botox injections for migraine relief.
Dr. Vanden Bosh also introduced how to use dermal fillers and collagen stimulators, which she believes are the future of cosmetic medicine. While more advanced than Botox, she assured the audience that these skills can be easily learned, especially for those who have a strong knowledge of arterial anatomy and will understand tissue connections and reactions.
These treatments are commonly used to lift and define areas of the face such as the jawline, tear trough hollows and lips.
“Patient selection is key,” she said, especially when doing any kind of laser treatment, where knowledge of the Fitzpatrick scale is crucial.
Cosmetic lasers, according to Dr. Vanden Bosch, are an obvious choice for IRs to pursue, as they serve as adjunct to many existing IR services, such as the treatment of venous insufficiency and associated skin changes. These treatments can be advanced into many applications for cosmetic treatments of the face and body with lasers.
These lasers are useful for concerns like noncannulizable spider veins, venous matting, facial veins or pigment concerns. Different types of lasers can also be used for hair removal, scar rejuvenation and superficial pigmentation.
They can also be used for hyperthermic treatment of fatty tissue, according to co-coordinator and speaker Abbas Chamsuddin, MD, FSIR, a cosmetic radiologist who specializes in laser liposuction and fat transfer.
“It’s a brand-new topic, but there’s nothing to it,” Dr. Chamsuddin said, echoing that IRs, with their knowledge of anatomy and complications, will have an easy learning experience. “I think you will find it a lot more accessible to learn than other physicians would.”
Dr. Chamsuddin presented his technique for laser-assisted liposuction, which eliminates fat and tightens skin through laser energy delivered both above and below the skin and tissues.
“You essentially melt the fat, suck it out, then use that same energy to cause skin tightening,” he said.
He detailed his techniques for sedation, treatment and sequence, then showed videos of the procedure, emphasizing the need to continually move your hand during treatment to avoid burning skin. He also showed multiple before and after photos to showcase the impact of the procedure, especially on areas such as the under arm. He called one patient, who had both fat aspiration and lipolysis, a miracle. “I don’t think you can achieve this through exercise and diet.”
This treatment can be particularly effective for patients with male gynecomastia, in some cases of lymphedema, or patients who have had breast cancer and now have fat hypertrophy.
In addition to liposuction, Dr. Chamsuddin does fat transfer, also known as fat grafting, fat injections, lipofilling or a fat transplant. The procedure takes a patient’s own fat tissue and places it in other areas to create a more even tone. It’s commonly used for patients with sunken cheeks, or for buttock and breast enhancements.
Dr. Chamsuddin shared tips for fat harvesting—that it should be done at the time of liposuction in other areas and should not be laser treated—and warned that you cannot just harvest fat and leave the site alone. Some kind of sculpting will be required.
Though it’s an accessible procedure, IRs cannot just jump into liposuction, he warned. “Learn your essentials, and your first few liposuction procedures should be supervised,” he said, adding that his first 20 procedures were supervised. He shared resources and links for mini fellowship and training courses for those who are interested in learning.
Dr. Chamsuddin also gave a brief description of Platelets Rich Plasma (PRP) and its use in hair loss therapy and facial rejuvenation.
These didactic sessions were followed by a 2-hour workshop with hands-on and access to cosmetic lasers, laser lipolysis, laser liposuction equipment and a sclerotherapy hand on station. Participants were able to gain knowledge of the equipment and got introduced to the different techniques used in cosmetic procedures.
“IRs have the knowledge and experience and a desire to learn,” he said. “Adding these novel procedures to your practice can really expand your patient population.”
Missed this session? You can watch at any time via SIR Now.
