29 August 2016 Inside Cosmetic Surgery Today on WebTalkRadio.net
Interview with Dr Barry Lycka & Dr Eugene Nowak
Dr Barry Lycka Cosmetic Dermatologist from Edmonton, Alberta is talking today with
Dr Eugene Nowak board certified Dermatologist from Chula Vista & San Diego, California.
This is your number one internet radio show on cosmetic surgery, in the world! We get over 8000 downloads per week,
because this show is designed for those who want the newest and best information about cosmetic surgery, and of
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possible. If you have any topics you would like us to feature, please email Dr Lycka on [email protected].
Today Dr Lycka is talking with popular repeat guest, Dr Eugene Nowak, from his practice in Chula Vista, California. Dr
Nowak is talking with us about the latest technology and techniques in cosmetic surgery at the moment.
Welcome, Dr Nowak!
Let’s start with Coolsculpting. It has been around for a number of years, after it was realized we could actually
‘freeze’ fat and it would go away. It is very effective for removing small areas of fat.
Yes – Dr Nowak has noticed that is has really ‘exploded’ over the last 6 months. And as things move so fast it is really
amazing that thesedays we have tools & techniques that previously we could only dream about. People do not want
surgery or downtime but want to see a difference in the amount of fat they have. Coolsculpting absolutely delivers on
that. There is no downtime, no recovery time. But what is new is the CoolMini applicator. So when people want to get
rid of their ‘submental’ (under chin / jawline) fat, this applicator sculpts that area just amazingly. This is the double
chin / turkey neck area. Dr Nowak has treated patients with this that previously would have only had surgery as an
option, but now he can do a non-surgical treatment and get them a great result.
These new applicators are very useful – Dr Lycka likes the CoolMini a lot.
And what about the new Advantage applicator – what is that all about?
Well the Advantage applicator shortens the treatment times, and it allows doctors to interchange between the
different configurations ‘on the fly’ instead of having to change the whole applicator. Treatment time has always been
the ‘bear’ with this, it could take longer than an hour with Coolsculpting to get results and the procedure had to be
repeated to get the required results. However, with these smaller areas we get the heat evacuated faster to get better
results in a shorter time.
Yes, the treatment has definitely been ‘optimized’ to get that sweet spot between time and results. The Advantage
uses a slightly different shaped applicator so it gets to temperature quickly and you see the results quicker. Dr Nowak
is also using the Z-Wave machine for Coolsculpting patients, on their body areas. That is a sound wave, radio wave
treatment which when combined with the Coolsculpting when those fat cells are hard and crystallized, it also breaks
them up and he sees results even quicker, and better.
Please tell us more about the Z-Wave machine, as most of our listeners will not have heard about it, Eugene.
The Z-Wave is called a radio sound wave, and it is pneumatic. As soon as the treated area is cool and the fat cells are
crystallized, then we do a kind of massage with the sound wave machine. You can think of it the same as how a kidney
stone is broken up with sound waves, but here we are using them to break up the fat cells. It has been shown to create
a 38% reduction in the number of fat cells in the treated area and those results are seen quicker than with just
Coolsculpting. Dr Lycka & Dr Nowak have talked about combining treatments before, and this is a great example where
several small treatments are combined and usually they give the results of a much greater single treatment but without
the downtime. It is very important for the listeners to know about the benefits of combinations when it comes to
treatments. They are worth thinking about. If the doctor doesn’t offer combinations, then you should think about it.
Inside Cosmetic Surgery Today interview Dr Barry Lycka and Dr Eugene Nowak, 29aug16
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Absolutely because going to a doctor’s office which provides multiple technologies and multiple treatments, and the
knowledge of how to combine them to get the best results, is really what it comes down to. So for example Dr Nowak
offers the Coolsculpting with the Z-Wave machine and then afterwards there will be options to use lasers to improve
the skin, and micro-pens to work on the stretch marks. Absolutely combining things gives better and more longer
lasting results for patients.
Ok let’s go onto a whole different topic please? Dr Lycka really loves the lasers made by Fotona. They are really good
lasers, hard-working workhorses of the office, that work well and require little maintenance. They are from Slovenia.
Please tell us about your laser, the Fotona 4D and the NightLase procedure. This is really exciting!
Dr Nowak decided after research to bring the Fotona 4D into his practice. He went up to an office in San Francisco to
see their results, and decided it was the right machine for his practice. One of the reasons he brought it onboard was
the ability to do this NightLase procedure. It works for snoring, and with a 3 treatment protocol, he is getting up to
80% improvement. In their studies it was 20 to 80% improvement, and Dr Nowak gets wives coming back to the office
saying that their husbands’ snoring is 80% better after this treatment. And there is no downtime and no recovery time.
It’s a non-ablative treatment where the tonsillar area is heated, as is the tissue of the palate and the uvula, and a little
bit on the back of the throat area. In a very short time, the patients are aware that family members and spouses are
very aware of an improvement in their snoring. Treatment is repeated after 15 days, and then the third treatment is
after a month.
And of course, Eugene, our listeners need to be aware that the skin can be tightened on the face as well. As we get
older, the number one thing that happens to us is that our skin gets looser.
The Fotona laser is being used in some centers to tighten the skin without using fillers. Are you doing that currently?
Yes. It was actually as part of the NightLase protocol that they discovered they were able to tighten the skin because
some of those NightLase patients were coming back to say that not only was their snoring better but their cheeks were
getting tighter, and lines and wrinkles were looking better in that area also. So they then created a new protocol, called
the 4D protocol for 4 different depths / levels / layers of laser treatment so that the laser being used for the NightLase
procedure can also treat the inside of the cheeks, and the inside of the lips. Dr Nowak also does a light peel on the
surface of the lip, and then will use the Frac3 mode to do a surface treatment and then do a deep heating treatment
to get some collagen tightening and contraction. Then Dr Nowak will do a customizable peel on the surface of the skin.
So a 2-3 day very light peel, or a 4-day peel or even a 7-day peel. Very customizable depending upon the downtime
and recovery time that someone has and the results they are looking for. Dr Nowak doesn’t promote that it will get the
results without fillers, and thinks that a patient gets a much better result with the fillers. With the Fotona laser and
fillers the results are definitely amazing!
This is not a facelift let’s be clear, but for people who are starting to droop and sag, starting to get those changes that
are characteristic of aging, then this is another combination therapy that will help a lot of people.
Dr Nowak does promote this as a combination therapy but he does have some patients who are not open to using
fillers, and yet he has still seen very nice results with just the Fotona 4D system. It is done as a series of treatments,
and as an indication for every decade of life, we need a treatment. So someone in their 30s needs 2 to 3, someone in
the forties needs 3 to 4, someone in their 50s needs 4-5 treatments. It is also of course based on how well they have
taken care of their skin, and what they are looking to achieve.
Dr Lycka also notes that although results are seen fairly quickly, it is over time that they work even better. We are
somehow changing the skin and the tightening process takes a little longer than originally thought, so combining these
gently and effectively and waiting a little bit, we get pretty good results.
Yes, absolutely the results get better over time! The collagen stimulation needs at least 3 but really up to 6 months.
Everyone is of course different and we know that from when we take a series of sequential photos that in some people
we see the changes quickly and they don’t get as much improvement later on, and in some we don’t see much to begin
with but they get to the end results with a dramatic difference for them.
Now we are going to talk about another ‘hot’ topic that has been all over the news and media, and which seems to
have a niche for some people. It is Kybella.
Inside Cosmetic Surgery Today interview Dr Barry Lycka and Dr Eugene Nowak, 29aug16
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What is Kybella, Eugene?
Well for us it has been the ‘year of the neck’, because not that many months ago, if you came in with a neck concern,
such as a double chin or a turkey neck, then surgery really was the number one option for those problems. We
mentioned that area when we were talking about Coolsculpting, but we also now have Kybella which is an injectable
treatment for the double chin area (submental fat).
It uses deoxycholic acid, which is a natural product which is created in your gall bladder. When you eat a fatty meal,
your gall bladder releases this to help break down the fat that our body takes in. The manufacturer has purified this
product and created the optimum concentration and so with just a little injection in these areas, we can trigger the
process of breakdown in those fat cells, without a lot of downtime and recovery time, and we are getting results for
people that are very close to what we would have achieved with surgery.
Dr Lycka finds that it is a useful agent for some people. He has been doing deoxycholic acid injections since around the
year 2000 – with some good results. The biggest problem is that in some people they get a fair bit of swelling, and
others get a fair bit of discomfort, and in some people they don’t respond for reasons we don’t yet understand. The
gold standard treatment is still submental liposuction, so it is still the best procedure for that area, BUT there are
people who don’t want surgery so this is an option for them.
Yes, the results are close to what can be achieved with surgery, but with submental liposuction Dr Nowak adds in skin
tightening too. However, with Kybella he has managed to control the swelling for patients, and uses ice for anesthesia.
He can do local anesthesia but that adds a little to the risks of swelling. And the amount of the medication that is
injected is also a factor. He doesn’t see the significant swelling that has been reported by others. There is some aching
or soreness to the area, although Dr Nowak has never had anyone say they don’t want to do it. They see the differences
in the photos, and feel the difference in the area and they are excited about having a repeat treatment.
Dr Lycka notes that generally this is not a one-time procedure. It takes a series of treatments.
Yes, it takes a series. The original study was done with anything between 4 – 6 treatments done. So it really depends
upon the patients starting point and what their goal is. And of course, with the Coolsculpting in this area – Dr Nowak
combines these two treatments together. He will use the Mini applicator to sculpt out the jawline. Then in the central
area, he will go back and finish off with Kybella.
Yes, again, this is a point where these treatments are in fact an art, not a science. And a great example once more of
where using combination treatments gives better results than doing either treatment alone. And adding skin tightening
on top of all this which is also very important. Once the submental fat has gone, then the skin needs to be tightened
too especially in people who are a bit older, because without that Dr Lycka finds that there aren’t the dramatic results
that people expect.
Dr Nowak has found that incorporating skin tightening really does take this treatment to the next level. And using
Ulthera can tighten the muscle and give more definition, rather than just tightening the skin alone. And sometimes
we add filler to build up the jaw line to really enhance / complement the result. It absolutely is all about combination
treatments to get the best possible results.
Thank you so much Eugene for spending your time with us today. It is always such a pleasure to find out the ‘cutting
edge’ of cosmetic dermatology.
It’s always great to be on with you Barry – Dr Nowak always loves to share what’s new out there as everything is
changing so quickly! We have to keep current!
Contact details for Dr Eugene Nowak & Dr Barry Lycka:
Dr Eugene Nowak
Telephone: Chula Vista: (619) 420 1840
http://www.drnowak.com/
Inside Cosmetic Surgery Today interview Dr Barry Lycka and Dr Eugene Nowak, 29aug16
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Barry Lycka
Telephone: Edmonton: (780) 665 3546
http://www.barrylyckamd.com
[email protected]
Inside Cosmetic Surgery Today interview Dr Barry Lycka and Dr Eugene Nowak, 29aug16
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