Several years ago, interventional radiologist Ziv Haskal, M.D., observed that cosmetic procedures such as injections of botulinum toxin (Botox), dermal fillers and treatment for hyperhidrosis (excess sweating) were being performed “by every specialty of medicine on the planet.”
Along with obstetricians, ophthalmologists, vascular surgeons and internists who offered such treatments, “there was a diagnostic radiologist who had a longstanding cosmetic clinic in midtown Manhattan,” said Dr. Haskal, a professor of radiology at the University of Maryland Medical Center, Baltimore and editor-in-chief of the Journal of Interventional Radiology.
Given that such cosmetic procedures involve many of the tools and procedures interventional radiologists already know well, Dr. Haskal began looking for a way to spark further interest in cosmetic procedures within the interventional radiology (IR) specialty.
“We were already doing procedures such as injecting medications, treatments for pain and nerve blocks,” Dr. Haskal said. “These skills make us as capable—if not more capable—than other specialties that aren’t necessarily wielding needles as part of their daily practice.”
In 2007, Dr. Haskal, the meeting chair of the Society of Interventional Radiology (SIR), organized an all-day symposium to explore what he coined “Cosmetic IR.” He was stunned when more than 600 interventional radiologists showed up. Since then, workshops and sessions on cosmetic IR have become a staple of the SIR annual meeting.
At this year’s SIR meeting, the session “Laser Liposuction in Interventional Radiology,” presented by Abbas Chamsuddin, M.D., drew considerable media attention for its findings suggesting that minimally invasive lasers melt fat more effectively than a “tummy tuck.”
Dr. Chamsuddin, an interventional radiologist at the Center for Laser and Interventional Surgery in Atlanta, and colleagues presented results of a study examining skin tightening in about 2,200 patients who underwent laser liposuction on various parts of the body (75 percent of the patients were women). He has been practicing laser liposuction since it was approved by the U.S. Food and Drug Administration (FDA) in 2008.
According to Dr. Chamsuddin, many people are afraid to try liposuction because they fear it will cause skin to sag after the fat is removed. In his research, Dr. Chamsuddin found that laser lipolysis enables the removal of more fat than standard liposuction. When used in combination with standard liposuction, the fat-melting action of laser lipolysis has the added benefit of producing new collagen. Additionally, the laser causes the collagen to contract, which tightens the skin.
“Combining traditional liposuction with laser lipolysis has now been shown to produce well-sculpted bodies with tight skin,” Dr. Chamsuddin said. “We are able to give people benefits such as a tighter abdomen without the need for surgery.”
Dr. Chamsuddin said that his interest in laser liposuction—and more broadly, cosmetic radiology—was spawned by the development and approval of fiber optic endovenous laser technology for the treatment of varicose veins back in 2001.
Once he decided to pursue laser liposuction, he went through a training period that involved performing 25 different liposuction cases in five different areas of the body under the guidance of physicians who regularly performed the procedure. “I learned the basic techniques of liposuction and purchased my first generator,” he said. “My experience with fiber optic laser helped me feel comfortable doing laser liposuction.”
The fact that many interventional radiologists like Dr. Chamsuddin have offered vein interventions as part of their practice may have sparked these practices into providing other cosmetic interventions, said Dr. Haskal, who added that “it’s a very tiny step to move into these cosmetic interventions for many of the patients you’ve already seen for varicose vein interventions.”
That’s exactly how Dr. Chamsuddin’s practice evolved. Many of his patients were originally treated for conditions like varicose veins or fibroids and began asking him about cosmetic procedures. He estimates that about 50 percent of his practice now involves cosmetic IR. Nevertheless, “I still have my workstation so that every morning at 7 a.m. I’m sitting down and reading studies,” Dr. Chamsuddin said.
While there are relatively few interventional radiologists who have freestanding practices devoted solely to cosmetic IR, “it certainly plays an adjunct or additional role in many practices,” Dr. Haskal said.
“I view this as a natural extension of an outpatient practice, particularly a vein practice,” Dr. Haskal said. “Cosmetic IR fits well into the broad and heterogeneous landscape of interventional radiology. That’s the beauty of interventional radiology—it can house patient care all the way from birth to an advanced age, and everything in between.”
Dr. Chamsuddin expects the trend towards cosmetic radiology to mushroom, particularly as radiologists continue to feel the reimbursement squeeze. Unlike many interventional procedures, Dr. Chamsuddin acknowledges that he expects to be fully reimbursed for laser liposuction since it’s not covered by insurance and the patient is responsible for payment.
“I know at the end of the procedure I’m going to have a satisfied patient and I know I’m going to be paid right away,” he said. “It provides satisfaction in two ways—my patients are happy and I’m able to support my staff and practice.”
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