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Dr. Peled Featured in Article About Removing Belly Fat

by Dr Ziv Peled
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on Thursday, 05 April 2018
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Dr. Peled was featured in comments on a new article explaining ways to reduce or eliminate your belly fat.  Please read the full article below or click here for the original.

  • To remove significant amounts of fat, liposuction remains the safest, most effective treatment.
  • Abdominoplasty and panniculectomy are surgical procedure that flatten the stomach by removing excess fat and skin.
  • CoolSculpting, Vanquish and Velashape are good non-surgical options for smaller fat deposits.
  • Laser liposuction and Zerona are controversial as experts remain on the fence about their safety and efficacy.

It may be that you’ve lost a significant amount of weight and you want your smaller clothing and swimwear to fit better. Or perhaps you’re done having children and are ready to reclaim your pre-pregnancy figure.

Whatever the reason, there is a suitable fat reduction treatment to fit your individual needs.

Is Liposuction for You?

Sometimes, no matter how hard you try, localized areas of fat deposits persist, preventing you from achieving more definition or a sleeker body contour.

New York City plastic surgeon Dr. Leonard Grossman notes that “patients who are relatively young, have good skin tone in the abdomen, yet show signs of excess subcutaneous fat make perfect candidates for liposuction.”

In other words, if you’re working out at the gym and eating a healthy diet but still have stubborn pockets of fat, liposuction is right for you. Your skin will also be more likely to tighten up naturally after the procedure if you’re at a healthy weight and have good muscle tone.

Recovery from liposuction is fast and requires very little downtime. Another advantage is that it causes very little scarring, since the incisions are so small. Your surgeon may even hide some of the incisions in less conspicuous places like the navel.

Liposuction Drawbacks

It’s important to consult an experienced plastic surgeon to perform your liposuction. Otherwise, the risk of ending up with less than ideal results (e.g. uneven skin texture) is high.

Liposuction is not a weight loss solution, nor is it a good option for people who want to remove loose, excess skin. It’s also important to remember that weight gain, aging, and pregnancy can impact your results over time.

Liposuction is often used alongside other forms of belly fat removal surgery. For instance, plastic surgeons frequently combine abdominoplasty and liposuction.

When to Choose Abdominoplasty

An abdominoplasty, also known as a tummy tuck, is a procedure designed to remove loose, excess skin and fat from the abdominal area and tighten muscles in the abdominal wall. New York City plastic surgeon Dr. Joshua D. Zuckerman notes that for women who’ve had one or more pregnancies, an abdominoplasty is the perfect option.

A tummy tuck can eliminate fatty tissue, excess skin and stretch marks on the lower abdomen. The major body contouring advantage of this procedure is that it can actually reshape the belly and midsection, helping patients regain their “pre-baby” body.

Additionally, Dr. Zuckerman advises that abdominoplasty is an appropriate corrective option for women who experience ‘diastasis recti’ – an abdominal muscle separation that can occur during pregnancy.

It’s important to note that abdominoplasty is not a suitable option for women who intend to have more children. The muscles that get repaired during a tummy tuck can separate during future pregnancies, so it’s best to wait until your child bearing years are truly over and done.

Abdominoplasty can offer similar benefits to people who have lost a significant amount of weight by removing excess skin and reshaping the belly button.

Specific techniques are employed to target different areas: a full tummy tuck is best suited for the areas above and below the belly button. If you have small amounts of fat and skin below the belly button that need removal, or if you feel your abdomen protrudes a little too much for your liking, a mini tummy tuck may be preferable.

Abdominoplasty Drawbacks

Abdominoplasty is not a weight loss solution. The procedure is best suited to those who have achieved a stable weight, yet maintain a moderate amount of excess skin and subcutaneous fat on the abdominal wall.

While a mini tummy-tuck causes little scarring, a full tummy tuck leaves a longer scar that extends from hip to hip. For this reason, Dr. Zuckerman stresses that it’s critically important to select the right surgeon: those experienced in the procedure will place the incision very low – below the bikini line, ideally.

Another negative is recovery time. You may only feel ready to go back to work and other daily tasks 10-14 days after the procedure. Generally, patients are also required to maintain surgical drains for several days. These drains are then checked and removed by the surgeon during follow-up appointments.

On top of that, patients will be restricted from most physical activity for approximately six weeks to allow the incisions and damaged tissues to heal properly.

Panniculectomy Pros and Cons

A panniculectomy may be right for you if you’ve lost a significant amount of weight, either naturally or following bariatric surgery.

As a result of weight loss, you may have been left with an unsightly flap of excess skin hanging from the abdominal region and draping down over your genitals or thighs. This excess skin is referred to as the “pannus” or “abdominal apron.” Accompanying this uncomfortable protrusion of skin, you may experience frequent irritation and infections (known as intertrigo).

“A panniculectomy is a reconstructive procedure suited for patients who suffer from multiple episodes of fungal infections in their skin as a result of a significant excess of skin folds that are difficult to maintain,” explains San Francisco plastic surgeon Dr. Ziv M. Peled.

“During this operation, an incision similar to an abdominoplasty is made, but the abdominal wall tissues are not elevated to the xiphoid process (bilateral breast bone) to redrape them, and no abdominal wall tightening is performed. This procedure simply involves excision of a ‘pannus’ of fat and skin and direct closure,” he clarifies.

Panniculectomy Drawbacks

Expect a hospital stay from one to three days. Once patients leave the hospital, they may need to contend with surgical drains and return later to have them removed by a physician.

In most cases, patients will be required to wear compression garments and exercise will be off limits for approximately six weeks to allow for adequate healing.

Additional Fat Removal Options

Laser Liposuction

Laser liposuction entails passing a very thin fiber optic cable under the skin, which carries a laser beam that heats tissues to 900 degrees, thereby melting the fat.

With this procedure, however, it’s best to proceed with caution. A study published in The Journal of Clinical and Aesthetic Dermatology suggests that clinicians have been reluctant to accept the treatment as it carries significant risks for adverse reactions.

Plus, there are no proven benefits above and beyond a traditional liposuction procedure, which is considered a very safe and effective option for belly fat removal.

CoolSculpting

One of the most effective nonsurgical options available for belly fat removal is cryolipolysis, the best example of which is CoolSculpting. “During this procedure, a patient simply sits in a room while a machine is applied to the areas of excess fat in an attempt to ‘freeze the fat cells,’ which then die off and are absorbed by the body,” informs Dr. Peled.

The advantage of this procedure is that it entails very little downtime. The disadvantage is that multiple treatment sessions are often required, which can be inconvenient for patients. The results are also more subtle than any of the surgical procedures available for belly fat removal.

Vanquish

Vanquish is a radio frequency device designed to eradicate fat cells without even coming into contact with the body. On average, patients report losing one to two inches from their waist with a fat loss equivalent to two to three pounds.

This nonsurgical fat reduction method is suited to people who have reached a healthy weight but still have stubborn fat deposits that don’t seem to budge – regardless of how much exercise they do or how strictly they stick to their diets. The downside, however, is that the treatment results are only temporary.

Zerona

Zerona uses a cold, low-level laser technology to directly target the cellular contents of fat cells. It claims to liquefy and shrink fat cells while also tightening the skin.

Clinical trials indicate Zerona may reduce waist circumference by an average of 1.8 inches and the upper abdomen by 1.3 inches. However, some researchers who have tested the technology warn that it doesn’t deliver on its promises. They suggest the technology doesn’t have the capacity to reach the fatty layers successfully and produces very little — if any — results.

VelaShape

VelaShape is a nonsurgical treatment that uses radio frequency combined with infrared light energy and mechanical suction massage to melt away the fat. The average reduction of fat in the belly region is half an inch. Velashape can also target other problem areas such as the love handles, thighs and buttocks.

The advantage of the treatment is that relatively no downtime is required. The disadvantage is that the treatment is only temporary and must be repeated every one to two months. The procedure is also best suited to people who are closer to their ideal body weight and are looking to reduce small fat deposits.

 

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Dr. Peled Speaks at Plastic Surgery The Meeting 2016

by Dr Ziv Peled
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on Monday, 03 October 2016
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Masthead AR

Dr. Ziv M. Peled, M.D. was recently a lecturer, injector and surgical trainer at the largest plastic surgery meeting in the world. Plastic Surgery The Meeting 2016, held in Los Angeles, CA in September and sponsored by the American Society of Plastic Surgeons is the premier meeting for plastic surgeons globally. Dr. Peled gave four talks in two sessions over two days on subjects ranging from occipital nerve surgery to coding for headache surgery. The talks were well received and are likely to be repeated in future meetings and to include an expanded curriculum on additional aspects of this exciting treatment option for chronic headaches refractory to conventional therapy.

For more information on how headache surgery can help reduce your "migraine" symptoms, visit www.peledmigrainesurgery.com or call 415-751-0583 to schedule an appointment with Dr. Peled.

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What is the Difference Between Occipital Neuralgia and Cervicogenic Headaches?

by Dr Ziv Peled
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on Friday, 16 September 2016
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I recently read a comment from a patient asking a very interesting question - “What is the difference between occipital neuralgia (ON) and cervicogenic headaches (CH)?”

Unfortunately the answer to this question is not a straightforward one. It has been postulated that pain in the head/neck region can be referred from problems in the bony or soft tissues of the neck, but there is still some controversy as to whether cervicogenic headache constitutes a distinct clinical entity. The upper-most cervical nerves and their branches are the most commonly cited sources of CH with the most common source being the C2/C3 levels. The actual definition of cervicogenic headaches is also not firmly established. One accepted way of defining this disorder is by its clinical characteristics. Specifically, it is a unilateral pain of variable severity that is not stabbing and radiates from posterior to anterior. It doesn’t shift from side to side, is brought on by unusual head position or neck motion and may be associated with shoulder or upper extremity pain on the same side. The biggest issue with this definition is that it overlaps with many of the characteristics of other headache disorders such as tension headaches and migraines without aura. Another way of defining CH is by demonstrating a cervical source of pain and confirming that source with a nerve block.

Diagnostic criteria for CH have been established by the Cervicogenic Headache International Study Group (CHISG) and by the International Headache Society (IHS). The former’s criteria require signs or symptoms brought on by awkward head movements or positioning or by pressure over the occipital nuchal structures and possibly confirmed by anesthetic blockade. The IHS criteria mandate that the pain be referred from an identifiable and plausible source in the head/neck (as demonstrated on imaging such as MRI) or by successful blockade of a nerve or cervical structure. Moreover, the pain must resolve within 90 days of successful treatment of the underlying problem. However, the IHS criteria do not define when, where, and how much pain is caused by CH (i.e. the clinical features).

In contrast, most neurologists would define ON in a very specific way. The classic description is that of paroxysmal pain in the distribution of the occipital nerves, sometimes, but not always accompanied by changes in skin sensation in the back of the scalp. The symptoms of ON are also thought to have a character of burning or hypersensitivity that may be constant on top of the intermittent shooting pains described above. These symptoms should be temporarily relieved by occipital nerve blocks.

So what to do with all of this information? Unfortunately, I find these definitions and descriptions minimally helpful since many of the symptoms of ON and other headache disorders for that matter can overlap with those of CH. For example, many of my patients with ON who have been successfully treated with decompression had exacerbation of their pain with awkward head positions and motions because these positions further compressed and irritated the occipital nerves. There are many patients who have unilateral ON. Therefore is ON a subset of CH? From my reading of the literature, most neurologists would seem to disagree, but I am uncertain as to why. Is CH a distinct clinical disorder? As stated above, there is disagreement as to whether it is versus just a descriptor of where the pain is coming from.

All of which brings me to the take home message. When it comes to any disorder, but especially chronic headaches, the only relevant questions in my humble opinion are: 1) can you figure out what’s causing it and 2) if you can, can you do anything about it? You can call the headache whatever you like - migraines without aura, CH, George - the names are irrelevant. With that in mind, I believe that the literature has shown that accurate diagnosis of ON with nerve blocks or Botox is a good predictor of a good result with surgical decompression. Moreover, surgical decompression has been shown to be very effective and have a very low complication rate with good long term results.

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THE NEW BOTOX

by Dr Ziv Peled
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on Monday, 10 October 2011
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Many people have been asking me about the newest Botulinum Toxin available for cosmetic use. It’s name is Dysport and later I will be posting more information about this exciting new product which we now offer in our office.

Dr. Peled

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THE NEW BOTOX PART II

by Dr Ziv Peled
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As promised, more info on Dysport. Basically, this new product is the identical substance as that found in Botox - Botulinum Toxin type A. It carries pretty much the same indications as Botox does according to the FDA. It is formulated slightly differently which basically accounts for the minimal differences in results with Dysport. So far, much of the published clinical cosmetic experience with Dysport is in the form of a few initial studies. The bottom line from these studies is that results with Dysport are very similar to those with Botox. Dysport has a slightly quicker onset of action, but not significantly so. In equivalent doses, the effects of Dysport lasted a bit longer than those with Botox, but again the results were not significantly different. Finally, there were no significant differences in side effects between the two products. The upside of Dysport is that it is a bit less expensive than Botox at present and with the initial promotion from Ipsen BioPharm (the company that makes Dysport), the prices are even sweeter. The only real downside at present is that there is relatively little experience with Dysport as compared with Botox, so theoretically you are taking a small chance with a newer product, although the risks are minor.

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Excessive sweating can be treateted effectively

by Dr Ziv Peled
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on Monday, 10 October 2011
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Hyperhydrosis or excessive sweating is a problem that can be a real source of frustration and embarrassment. Until now, when the usual deodorant and antipersperants have failed, the only next option was an operation to physically remove the offending sweat glands. Now, however, it has been realized that BOTOX (yes that BOTOX) can be used to treat this problem with great effectiveness. The overwhelming majority of patients treated in this way had a significant decrease in the sweat produced by these glands (usually in the armpit) that lasted over 6 months. Patients can be treated in the office with minimal downtime and the procedure is minimally invasive and uncomfortable. If you would like to learn more about this exciting new treatment, please feel free to call the office.

Ziv M. Peled, MD

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YOU GET WHAT YOU PAY FOR

by Dr Ziv Peled
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on Monday, 10 October 2011
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Plastic Surgery News, a publication of the American Society of Plastic Surgeons, recently published an article describing the unethical practices of well known company called Lifestyle Lift. According to the article, this company was “charged with ‘astroturfing’ - publishing fake, online reviews of its procedure using employees who posed as independent consumers to express their ’satisfaction’ with the company and it’s product.” In fact, Andrew Cuomo, the Attorney General of New York stated on his website (http://www1.plasticsurgery.org/ebusiness4/OnlineCourse/CourseInfo.aspx?Id=12791) “this company’s attempt to generate business by duping consumers was cynical, manipulative and illegal.”

I am posting this blog because I am often asked by my patients seeking facial rejuvenation about the Lifestyle Lift procedure. In plastic surgery, as in life, you get what you pay for. While we are all looking to save money these days, your body and health are the few things which you only get one of and simply searching out the least expensive alternative can often have distastrous consequences. Among board-certified (American Board of Plastic Surgery) plastic surgeons, this company has a dubious reputation as one that refuses to do state exactly which techniques their physicians use to achieve their results, thereby potentially opening themselves to criticism as those of us who publish in scientific, peer-reviewed journals do all the time. Therefore, the company’s methods are suspect from the outset and stories like the one above are not that surprising. Buyer, and patient beware!

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NEW HOPE FOR MIGRAINE SUFFERERS

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on Monday, 10 October 2011
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New Surgical Procedure Holds Promise for Permanent Relief from Migraines

Existing treatments for migraines, such as oral medication or injected drugs, have been shown to temporarily alleviate symptoms in some, but not all, patients. In some instances, these treatments, whether effective or not, have unwanted side effects. But now there is good news for the more than 28 million Americans who suffer from migraines: According to a recent study, an outpatient surgical procedure provided 80% of patients with pain relief at or above 50%, and over 43% with complete and lasting relief from their migraines, altogether.

Over the past few years, several studies have been performed to test a recent theory that migraines are caused by nerve compression: Nerves in the neck, temples or forehead that are pinched as they pass through various anatomic structures or canals. As a result, the severe and recurring pain is similar in origin to carpal tunnel syndrome, a commonly diagnosed condition for which surgical decompression is frequently performed. This surgical method has now been adapted for headaches caused by neuralgia, or trapped nerves.

I am a San Francisco-based, Harvard-trained plastic surgeon with specific training and experience in a variety of different peripheral nerve operations, including successful nerve decompression to treat migraines. I have performed well over 100 different peripheral nerve procedures and feel fortunate to be among the few surgeons in the world with the background and training to perform these delicate operations. Moreover, most procedures can be done as an out-patient. For example, in a patient with the most common site of pain originating in the back of the head/scalp, the procedure involves a small incision on the nape of the neck, just above the hairline. Once the surgical site has healed, typically in a couple of weeks, patients report significantly fewer headaches, lower headache severity, and shorter headache duration in those who still report headaches at all.

For more information about this exciting new treatment, please contact our office at (415) 751-0583 (San Francisco) or (925) 933-5700 (Walnut Creek). I can also be reached by e-mail at This e-mail address is being protected from spambots. You need JavaScript enabled to view it. .

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5-YEAR OUTCOMES OF MIGRAINE SURGERY DEMONSTRATE PERSISTENT RELIEF

by Dr Ziv Peled
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Just this month in Plastic and Reconstructive Surgery (the leading plastic surgery journal in the world), Dr. Guyuron published his five-year results with surgical decompression for migraine surgery. The findings of this study show that relief of headaches persists even five years from the time of surgery. More specifically, at five years post-surgery, the average number of migraines per month were reduced to 4 from 11, average migraine intensity decreased from 8.5 out of 10 to 4.5 out of 10 and the average duration of a migraine if and when it occurred was reduced from 1.4 days to 8 hours. Just as impressive were the findings that 88% of patients still reported a significant decrease in their headaches after five years and that 29 reported elimination of their migraines altogether! These results suggest that surgical decompression can produce a lasting if not permanent degree of relief from the debilitating headaches that affect so many people worldwide. If you suffer from migraines and would like to learn if you are a candidate for decompression surgery, please contact our office at (415) 751-0583 or (925) 933-5700.

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