Robotic hair transplantation – NEWS

RIVA Clinic is offering a new method of hair transplantation. The F.U.E. system (follicular unit extraction) is an extremely quick method for the extraction and implantation of individual hair follicles (1–3 micrografts) with the help of a robotic machine. This new system is unique, and little known in the Czech Republic. Its patent originates in the USA, while the robotic instrument was developed by the French company Medicamat. This method has many advantages over the traditional “strip” technique of hair transplantation, one of the most fundamental of which is the fact that it uses no scalpel, and therefore leaves no scar and has a lower risk of infection. The operation itself takes around half as long as a traditional transplant, and is more comfortable and convenient for the patient in many regards.

Who is this technique suitable for?

The best results are achieved on men by hair transplants in the receding hair area, while women’s hair can be thickened, particularly on the top of the head. This method can also be used on eyebrow loss injuries and to correct small alopetic patches (areas on the hairy part of the head where hair is missing) resulting from injury or other causes.

What should you know?

Each client is individually assessed by a trained specialist in automated hair transplantation at a personal consultation session, and is provided with detailed information on the extent and approximate length of the proposed operation. A laboratory blood test is required before the operation, consisting of a complete blood count, basic coagulation parameters and a biochemical test. Any further tests required will be determined by the consulting doctor, who will also decide if drugs diluting the blood will need to be discontinued.

How does the operation itself take place?

The operation is performed in an operating theatre. First a strip of hair on the back of the head around 4 x 15 cm in size, depending on the density of the client’s hair, is shaved with an electric shaver. Follicular units are then extracted in sterile conditions under local anaesthetic by a plastic surgeon using a robot. A special attachment makes it possible to core hair in the skin by rotation and draw it into the instrument under pressure. The grafts are the same size and do not contain more than the essential amount of skin and hypodermis, which enables the application of greater numbers of follicular units to a particular area and reduces the risk of damage to the hair seedlings in comparison with the traditional method. Collection of follicular units is followed by local anaesthetic to the site of implantation where the follicular units are applied one at a time.

How long does the operation take?

The length of the operation varies from person to person, and depends of the number of hair seedlings to be transplanted. The transplantation of around 400 follicular units takes around two hours.

Post-operational care

The whole head need not be bandaged, as there is little bleeding from either the collection or implantation points. Generally available analgesics suffice to alleviate patient pain, and in many cases no analgesic is required. The transplant area may be showered the day after the operation. The collection point heals within a week. Everyday life may be recommenced after around a week, though the patient is recommended to avoid greater exertion for at least 14 days.

Robotic hair transplantation – news

Who is this technique suitable for?

What should you know?

How does the operation itself take place?

How long does the operation take?

The length of the operation varies from person to person, and depends of the number of hair seedlings to be transplanted. The transplantation of around 400 follicular units takes around two hours.

Post-operational care

As. MUDr. Sabina Švestková Ph.D.

Education

Faculty of Medicine, UJEP in Brno

Experience

1986 – 1989: Dermatovenerology Clinic, University Hospital Pekařská, Brno

1989 – today: attendant physician, Dermatovenerology Clinic, University Hospital Brno

1996 – today: private practice in aesthetic and corrective dermatology

2000 – today: assistant professor at the Faculty of Medicine, Masaryk University in Brno

2009 – today: chief physician at the Dermatovenerology Clinic, University Hospital Brno

Traineeships Abroad

1991: St. Thomas Hospital, London, Great Britain

1999: flebology training, Bordeaux, France

2005: training in wound healing and its disturbance, Ulm, Germany

2005: training in wound healing and wound treatment, Stuttgart, Germany

2008: training in wound care and compression therapy, Lisbon, Portugal

Organisations Membership

Czech Medical Society (ČLS) JEP

Czech Dermatovenerology Society ČLS JEP

Czech Flebology Society ČLS JEP

Society for Lasers in Medicine ČLS JEP

Central European Vascular Forum

Czech Academy of Dermatovenerology

European Academy of Dermatovenerology

Qualification

1989: Medical Licensing Examination in Dermatovenerology

1993: basics in university pedagogy, Faculty of Philosophy, Masaryk University in Brno

1994: non-invasive examination methods in angiology

1997: problems of dermatological angiology

1999: compressive and pharmacological treatment of CVI

2001: Medical Lecturer Licence

2009: Ph.D. in Dermatovenerology

MUDr. Zdeněk Brodecký

After graduating from the Faculty of General Medicine of J.E. Purkyně University in Brno( 6/1980), Dr. Brodecký began to work in the field of anaesthesiology and resuscitation in the Hospital in Jihlava. Between 1981 and 1989, he gained experience in the in-patient resuscitation department of the hospital in Třinec, where he was later employed as head doctor of the Emergency Ambulance Service. Following a stay in the Faculty Hospital at St. Anna in Brno, he accepted a position as head doctor at the emergency department in the Prague Emergency Care Hospital “Na Malvazinkách”.He simultaneously worked as a doctor for the medical emergency service in Prague (helicopter). Between 1992 and 1997 he was employed at the Clinic of Anaesthesiology and Resuscitation in the Faculty Hospital at Royal Vinohrady in Prague 10. Than he worked in private Plastic Surgery clinics in Prague. He has been employed as an anaesthesiologist specialist since 1997 till 2006. Since 2006 he worked only as an private anaesthesiologist for more Plastic Surgery clinics. Just now for RIVA –clinic in Brno, for MedicomVIP clinic in Prag.

Completed certificates, granted licences

Certificate in anaesthesiology and resuscitation, level I, 1984
Certificate in anaesthesiology and resuscitation, level II, 1989
Certificate for private practice issued by the Chamber of Medicine, Czech Rep., 1992
Certificate for private praktice issued by the Chamber of Medicine, Austria,Wien,2007
Certificate for private praktice issued by the Chamber of Medicine, Norway,Oslo,2007

Membership in professional societies

J.E. Purkyně Czech Medical Society
Anaesthesiology, resuscitation and Intensive Medicine Society (ARIM)
Society for Treatment of Pain
Czech Chamber of Medicine,
Austria-Wien Chamber of Medicíně, Norwegian Chamber of Medicine.

Courses, study stays

Course in emergency medical assistance for head doctors, Ústí nad Labem, 1986
Training position in paediatric anaesthesiology, Prague-Motol, 1988
General anaesthesia – professional stay at the District Institute of National Health of the Faculty Hospital in Brno, 1988
Course in clinical pharmacology, Prague, 1991
Current aspects of the field of anaesthesiology and resuscitation, Prague, 1991
Stay at the aeronautical emergency medical service in FRG, Eutin, Germany,1991
Stay at the Universitätsklinikum Carl Gustav Carus, Dresden, Germany,1995
Course in treatment of chronic pain, Prague, 1996
Study stay in Cincinnati, Ohio, USA, 1996

Anaesthesia

An examination of the overall state of health and evaluation of the degree of risk in relation to the planned surgery are necessary to ensure the safe progress of the operation and the post-operation period. After discussing the patient’s information pre-operational preparation form (PDF) the doctor proposes the type of anesthesia that will be most suitable and least unpleasant for the patient. There are different types of anesthesia for preventing pain other than total anesthesia. Emphasis is placed on an individual approach. We want our patients to be well informed of all the possibilities and types of anesthesia available information for patients. Following the discussion of the information, the patient is requested to provide his/her consent
form for preoperative assessment (PDF).

Pre-operational preparation form (PDF)

Information for patients

Form for preoperative assessment (PDF).

Travelling from the Main Train Station

When you arrive at the Main Train Station, go to the subway and then to the tram no. 1 to Bystrc and get off on the stop called Výstaviště – vstup G2 (Trade Fairs Brno – G2 Entrance). The building of the Clinic is a big orange house about 100 m away from the stop (in the direction of the tram) opposite to the Trade Fairs Brno grounds (G2 entrance).

You can take a TAXI (about 22 Kč/km = about 1 €/km).

Travelling from the Central Bus Station

Go from the Zvonařka bus station to the Main Train Station (Hlavní nádraží) junction (about 300 m by foot or by tram no. 9 or no. 12). Then take tram no. 1 to Bystrc and get off on the stop called Výstaviště – vstup G2 (Trade Fairs Brno – G2 Entrance). The building of the Clinic is a big orange house about 100 m away from the stop (in the direction of the tram) opposite to the Trade Fairs Brno grounds (G2 entrance).

You can take a TAXI (about 22 Kč/km = about 1 €/km).

Travelling from Bratislava

Take the D2 highway from Bratislava, go straight past shopping park and then change to D1 highway. Take exit 194 to Brno centre. Go through the Heršpická Street (no. 52) to the crossway with the Poříčí Street and turn left to the Poříčí Street (no. 42). Continue to Voroněž hotel and then turn right and go to the main entrance of the Trade Fairs Brno. When you get there, go under the viaduct and turn left to Hlinky Street. Go straight about 700 m and you will find the Clinic on the right side of the street.
Highway exit 190, go through the tunnel and then take the second turn to the right and keep going to the city centre.

Travelling from Vienna

You can get to the Clinic by modern equipped buses of “Student Agency” company www.studentagency.cz.

By car (130 km) – highway exit 190, go through the tunnel and then take the second turn to the right and keep going to the city centre.

Travelling from Prague

You can get to the Clinic by modern equipped buses of “Student Agency” company www.studentagency.cz.

By car (200 km) – highway exit 190, go through the tunnel and then take the second turn to the right and keep going to the city centre.

MUDr. Petr Pachman

Specialist for Injections

Education

1999 – 2005: Faculty of Medicine, Masaryk University in Brno

Experience

2005 – 2007: General Surgery Clinic, University Hospital Brno
2007 – 2008: Medical Advisor for clinical trials
2007 – 2009: MYCLINIC Prague – specialist for injections
2008 – today: Centre for Burn Injuries and Reconstruction Surgery, University Hospital Brno

Traineeships Abroad

2007: Traineeship at the Elzen Injectables Kliniek, Naarden, Netherlands

Qualification

2006: ECFMG Certification (United States Medical Licensing Examination)
2008: Botox certification
2008: Juvéderm certification
2008: Surgiderm certification
2008: Restylane training
2008: Macrolane training, Paris, France
2008: training in Renophase chemical peeling
2008: training in NeoStrata chemical peeling, Princeton, USA
2009: Esthélis and Fortélis training

Prof. MUDr. Pavel Brychta, CSc.

Education

1976 – 1982: Faculty of Medicine, UJEP in Brno

Experience

1982 – 1984: internal medicine resident, Plastic Surgery Clinic, Brno, Berkova 34
1985 – 1986: internal medicine resident, Institute of Traumatology (IOT), Brno, Ponávka 6
1987 – 1989: attendant physician, Department of Burn Injuries, IOT, Brno, Ponávka 6
1990 – 1993: chief physician assistant, Centre for Burn Injuries and Reconstruction Surgery, University Hospital Brno
1993 – 2000: chief physician, Centre for Burn Injuries and Reconstruction Surgery, University Hospital Brno
2001 – today: chief physician, Centre for Burn Injuries and Reconstruction Surgery
1997 – 2002: chief physician, Centre for Laser and Aesthetics Surgery
2002 – today: chief physician of Private Clinic Riva, s.r.o.

Traineeships Abroad

Professional traineeships abroad: USA, Great Britain, Germany, and Netherlands.

Organisations Membership

Domestic Organisations:

Czech General Surgery Society
Czech Plastic Surgery Society
Czech Burn Injuries Treatment Society – vice chairman
Society for Lasers in Medicine
Laser Aesthetic Surgery Section – chairman since 1998

International Organisations:

International Society for Burn Injuries (ISBI) – national representative of the Czech Republic
World Association for Disaster and Emergency Medicine (WADEM)
European Burn Association (EBA) – national representative of the Czech Republic
Member of Executive Committee of the EBA since 1999
European Society for Laser Aesthetic Surgery (ESLAS)
Member of Skin Substitutes of the EBA since 1999
Skin Council EATB (European Association of Tissue Banks) – chairman

Qualification:

1986: Medical Licensing Examination of level 1 in Surgery
1991: Medical Licensing Examination in Plastic Surgery
1987: CSc. in Surgery, Faculty of Medicine, Masaryk University in Brno
1997: Associate Professor of Surgery at Faculty of Medicine, Masaryk University in Brno

Publications

Monographs:

Brychta, P., Stanek, J.: Laserová estetická chirurgie, Galén 2000
Co-author of: Klinise Aspekte der Applikation kultivierter epidermaler Transplantate in der Verbrennungsmedizin – Brychta, P. Adler, J. Řihová, H. In: Wundheilung und Wundauflagen Sedlarik, K. M., Lippert, H. Wissenschaftliche Verlagsgesellschaft, Stuttgart 1996
Cultured Epidermal Allografts strongly Stimulate Reepithelialisation in Deep Dermal Burns, Brychta, P., Adler, J., Rihová, H. Suchánek, I. Kaloudová, Y., Koupil, J.: Cultured human keratinocytes and tissue-engineered skin substitutes – state of the art, Horch, R. E., Achauer, Munster, Georg Thieme Verlag, 2001
Co-author of: Ševčík P., Brychta P., Franců M.: Tonutí a poškození fyzikálními vlivy Ševčík P., Černý V., Vítovec J. a kolektiv: Intenzivní medicína, Galén 2000

Botulinum toxin

Wrinkles are connected with ageing. Aesthetic medicine uses all possible resources to remove them or at least improving the clients overall look.

There are two types of wrinkles. Static wrinkles have their base in diffusive degenerative changes in skin due to ageing. Dynamic active wrinkles have their base in structural changes in localized areas of skin and form due to repeated activity of mimic muscles. We can compare this with a leather handbag that develops cracks in high usage areas; our skin will also show the effects of time. Younger skin has enough elasticity to return to its original state after muscles relax. Later, when skin loses its elasticity, dynamic wrinkles, which were once only temporary, become more evident. These wrinkles occur in mimic active areas: lateral commissars of the eyelids, zone between eyebrow, forehead and nose-lip transition (nose labial ripple).

Botox is the commercial name for the agent Botulotoxin A, which is produced by a species of bacteria. This bacterium alters the transfer of nerve impulses from nerve fibers, blocking the function of the muscle. Botulotoxin A is a poison, but in cosmetic treatment it is used in such small doses that its toxic effects are controlled. Treated muscle will regenerate after a few months. The procedure is easy and painless. Patients feel only small needle pricks and sometimes a minor burning sensation. After the application, it is necessary to stay in an upright position for one hour and actively use the muscle where Botox was applied. Through this movement, Botox bonds to the muscle and enhances the final effect. Results can be seen after 24 to 76 hours, with full the effect achieved in 4 weeks.

Muscle regeneration begins immediately and according to individual differences, will be complete in 3-6 months. After that, normal muscle activity is restored and dynamic wrinkles form again. Repeated injections of Botox are necessary to maintain the desired effect.

Face-lift

Face-lift surgery is a procedure with a long tradition around the world. This technique creates a younger, more vital appearance of the face and neck by removing excess skin, then tightening the remaining skin and smoothing the wrinkles.

This surgery can be combined with laser resurfacing, which contributes to the tightening of the skin and also removes small wrinkles and undesirable pigmentation. Some patients wish to have eyelid surgery after they have recovered from the face lift procedure.

During the consultation, the surgeon will assess the age and general health of the patient, their skin elasticity and the extent of the correction desired. The psychological aspect of this surgery is also a factor – the surgeon needs to know the client’s expectations.

The surgery is performed under general anesthetic; rarely is a local anesthetic or sedation/analgesia (intravenous administration of analgesics and sedatives) used. The patient’s hair is washed (but not cut) and the operation area is sterilized. The surgeon makes an incision which starts at the temple (hidden in the hair line) and continues down following the curve of the ear, then around the earlobe and up behind the ear before curving gently back into the hair at the beginning of the occipital area. Using these incisions on both sides of the face, the skin of the face and neck, together with the deep tissues, is lifted from the base and remodeled and tightened. This smoothes wrinkles on the face and neck. A deep face lift, where an even deeper layer of tissue is lifted, can be performed for longer lasting effects. This layer, called SMAS, consists of fascia and facial muscles and its remodeling is very important for successful results and for the longevity of the procedure.

Bandages are removed 4 to 5 days after the surgery and are no longer needed. Clients may then wash their hair. In the next 10 to 14 days all the stitches are removed. The healing process is highly individual. Swelling around the face and neck may occur and sometimes tiny, subcutaneous hematomas form. Slight pain in the operated area can be handled by common analgesics. Results of the surgery are visible in 2 to 3 weeks.

Gluteal Implants

Some people are not satisfied with the shape, size or outline of their buttock. Gluteoplasty is a surgery developed to refill and reshape this area. Gluteoplasty is not a very common surgery at this time; it makes up only 0.52% of all aesthetic surgeries worldwide.

This procedure can be carried out by either an intramuscular insertion of a gluteal implant or the Dermotuberal Anchorage technique. In addition, we use a permanent filling material (Bio-Alcamide) to achieve optimal results. These techniques have been available at Private Clinic Riva since 2003.

Our highly trained surgeons and a combination of all three methods guarantee very satisfying results for most patients. Gluteoplasty is a part of the Body Contouring programme at Private Clinic Riva.

Injection Lipolysis

Dr. Rittes, a dermatologist from South America, came up with the idea of removing fat with Lipolysis injections. She developed this technique which injects the substance phosphatidylcholone (a natural substance found in soya beans) directly into fat deposits anywhere on the body. Phosphatidylcholone enhances the metabolism of fats. This method was then improved by Austrian Dr. Hasengschwadtner, who has performed it over a thousand times.

Injection Lipolysis is not a miraculous weight reduction method. It is designed to help patients remove fat deposits that are resistant to dieting and physical exercise. This method will change body outlines.

Unlike Liposuction, which is the surgical method used to remove larger amounts of fat, this procedure is performed without anesthesia and does not require a hospital stay. Clients may go to work immediately after the procedure and do not need to wear any support garments, as is the case with Liposuction.It is only recommended not to eat certain types of food.

The substance is injected directly into fatty tissue using a thin needle. After the procedure, the area will turn red, swell and itch. This may last a few days. Two to four treatments in a six to eight week time period are optimal. More than 80% of patients were satisfied already after two or three procedures. Their fat deposits were markedly reduced and the effect is long lasting.

Treatable areas are:

Double chin
Cheeks
Thighs, inner and outer
Buttock
Arms
Lower and upper tummy
Fatty pads of on the shoulders, hands, joints, or back
Cellulite

The number of procedures required varies from person to person and on the area being treated. Men react differently than women because of the structural difference in their fibrous connective tissues and their fat cells are deposited in a different way.

Injection Filling – Hyaluronic Acid and the Others

Hyaluronic Acid

Hyaluronic acid is a natural compound in our skin and skin of all mammals. In the extracellular space of the skin tissue this substance binds huge amount of water and therefore:
Maintains the distance between the cells in connective tissue and enables their cell division,
Enables the transport of nutrients, metabolism in the skin cells, and
Binds free radicals and suppresses the influence of the damaging agents at the skin tissue.

The amount of the hyaluronic acid decreases during the ageing process and so the skin looses the ability to sustain enough moisture. The skin thus looses its smoothness, tightness and the wrinkles appear.

What to expect of the procedure?

In the areas with greatest strain the wrinkles appear and deepen in the course of time.
The physician applies the hyaluronic acid with a thin needle directly under the wrinkle, so the defect is filled in the subcutaneous region and the wrinkle is reduced or even eliminated.
Treatment of emerging, shallow wrinkles slows down the process of wrinkle formation and delays other, more invasive methods of skin rejuvenation.

What is face outline sculpting?

The amount of subcutaneous fat may be decreased during the ageing process. The aesthetically most problematic is this loss in the cheeks and under the eyes. To fill the space under the skin the hyaluronic acid is applied broadly deep into the subcutaneous area.
Many clients wish to give their lips a plumper contour and this effect can be also achieved immediately by application of the hyaluronic acid.

How does the hyaluronic acid work?

In aesthetic medicine the hyaluronic acid is used in a form of a gel in the one shot injections. The products vary in size of the particles in gel and manufacturing technology. For correction of the deep wrinkles and defects, the products with larger particles are used and vice versa. Effects of the hyaluronic acid application:

It increases the ability of the skin to bind water, and enhances strength and elasticity of the skin,
It enables new collagen and elastic fibres formation, and
The treated parts of the skin are soft, pliable and have natural appearance.

Side Effects and Complications

The place of the puncture may become sensitive immediately after the hyaluronic acid application, it may be also reddish, swelled or bruised a little. These reactions are most apparent during the procedure and within several hours after it. Mild symptoms can last for a few days and then they spontaneously disappear.

Discolouration or redness of the treated skin is caused by applying of the substance not deep enough, too big amount of filling substance, especially in the regions with thin subcutaneous layer, or by many other factors like the condition and structure of the skin and the client’s diseases. They also resolve spontaneously after some time.

Very rare side effect is an inflammatory reaction towards the material and formation of a so-called granuloma, which is a ball-like collection of fibrous tissue in the vicinity of the foreign material. It may emerge several months after the procedure. It is cured by intravenous administration of corticoids or surgical removal. This complication is presently very scarce, because of today’s new, improved and safe products.

How to prepare for the procedure?

If you have often a cold sore, the similar formation may appear at the place of the puncture. If you take some drugs, small bruises and swelling may appear at the place of the puncture. Your physician will advise you and inform you how to prevent these complications. You do not need to make any other arrangements or preparations.

How precisely is the treatment performed?

The procedure lasts approximately 10 to 40 minutes depending on the extent of the treated area. The way of preventing the pain depends on the treated locality, it may be an anaesthetic cream so-called EMLA spread on the treated area for about 30 to 40 minutes, the anaesthetic substance administrated intravenously (then the procedure can be performed immediately), or in case that the filling substance contains already an anaesthetic, no additional pain suppressing is needed. It varies patient to patient and everything is adjusted to make the client fully satisfied. The procedure itself is absolutely painless and to make it even more tolerable we will cool the treated area. The substance is applied by many punctures into precisely chosen spots. The technique and the precise accomplishment are the key factors ensuring the perfect results.

What to do after the procedure?

The treated area should not be exposed to strong warmth (solarium, sauna) or cold, and direct sunlight; also increased physical activity should be avoided, until the redness and swelling disappear.

You should not touch the treated area for 6 hours. Then you may wash it with water and gentle soap.
Make-up may be put on after 6 hours at earliest.

The results of the treatment can be assessed practically immediately considering the necessary short convalescence.

It is good to see the physician again after 3 weeks, when the material is stabilised in the tissue and the final results are visible. The physician will assess them with the help of the before- and after-treatment photos and possibly he or she will plan the next strategy.

The duration of the effect differs according to the location of the material, individual disposition, activity in the treated area, and sufficient amount of applied material. Since the material undergoes the so-called isovolumic degradation (a volume is sustained for a long time and there is more and more water molecules bound to the more and more exposed molecules of degraded hyaluronic acid) the effect is long lasting with slightly faster loss of the volume at the end of the period of efficacy. Often the smoothing effect lasts even much more longer, because of natural remodelling of the skin tissue leading to smoothing the wrinkle naturally.

Injection filling techniques are now replacing or supplementing other aesthetic surgery procedures. Considering their efficacy they are becoming more and more popular and frequent. All this together with using the excellent materials and the procedure being performed by top physicians ensure that the whole procedure will fulfil the client’s desires.

Injection Implants – Bio-Alcamide

Bio-Alcamide is currently the best and most stable inert polymer used in aesthetic medicine. Once inside the body, it becomes encapsulated. Therefore it may be removed, even after many years, through a tiny incision. There are several different volume packages on the market for different parts of the body. Newest is the 5 ml body package, which is used to fill larger defects such as Poland syndrome, pectus excavatum, scarring after larger surgeries, or sculpting of the buttock, calves, arms, forearms, a man’s chest, etc.

Injection Filling – Scar and Tattoo Correction

Every skin injury leaves a scar after healing. The appearance of the scar depends on the type of injury and its extent, the patient’s healing ability and general health condition. Scars differ in colour and height – hypertrophic or hypotrophic. Keloid scars form in individuals with an inherited or acquired predisposition, or after strong exogenous intervention into the skin. Their occurrence is related to age, gender, and localization of the injury. Patients can be traumatized by the appearance of the scar or experience movement restriction. The surgeon needs to consider these factors when planning the operation to avoid other complications. Through consultation, the surgeon and patient will decide which method fits their needs. Options are:

Scar excision and suture
Scar excision and closing the defect with movement
Dermabrasion
Laser dermabrasion
Corticoid administering

Dermabrasion is used for acne scars on the face and for posttraumatic or surgery scars. This method smoothes scars elevated above the surrounding skin using a high speed milling machine. Both dermabrasion and excision can be performed under local or general anesthetic depending on the size and location of the scar.

Hyper pigmentation may be a problem after surgery, especially after sunbathing. We recommend the use of a sunscreen with high UVA/UVB protection for 6 months after the surgery.

Hypertrophic and keloidal scars are aesthetically not pleasing. Sometimes they are accompanied by pain and itching. There is no universal method assuring perfect treatment results. The healing process depends on biochemical, genetic, metabolic and immunological factors which are also influenced by the origin of a scar. Considering the complexity of the problem, it is absolutely necessary that the patient and surgeon work together to choose the best treatment method.

Nose Surgery – Rhinoplasty

The nose is a dominant feature of the face and its shape is either congenital or acquired. First references to nose surgery are several thousand years old. Gradual improvements in operating techniques illustrate the complexity of this procedure and the surgeon’s interest in creating a “perfect” nose shape.

Each Rhinoplasty is individual. During the consultation with the surgeon, you will discuss your problems, motivations and expectations. The surgeon needs to find out if the reason behind the surgery is aesthetic, functional or psychological. The ideal age for this procedure is from age 16 to18 years up to age 30.

Nose surgeries can be divided into two groups. Soft nose Rhinoplasty is the correction of the nose tip without intervention into the bone structure. Hard nose Rhinoplasty surgery also involves the nose bones. Sometimes it is necessary to adjust the shape of the nose with a bone graft.

Minor surgeries are performed under a local anesthetic. Major surgeries are either combined with sedation/analgesia or performed under a general anesthetic, which is better for the patient. At the completion of the procedure, a nasal tamponade is inserted and a splint is applied to help the nose maintain its new shape. During this time the patient is only able to breathe through the mouth. The tamponade is removed on the third day after surgery and the patient must then clean the nostrils several times a day with wet swabs.

Hospital stay is required the first two days after surgery. Swelling and oedemas around both eyes fade in 10 to 14 days. The splint can be removed two weeks after the procedure. We recommend that patients avoid strenuous activity for 2 to 3 months. Nose tissues need up to one year to stabilize and are susceptible to damage. Final results depend on the patients own diligence and willingness to follow the surgeons advise.

Face Augmentations

Aesthetic criteria for the face demand symmetry and well connected outlines. The chin outline is very important to attain a balanced, aesthetic look.

Chin augmentation (Genioplasty) is performed using chin implants.

Hair Transplant Surgery

A technique developed for dealing with hair loss, especially in men, is hair transplant surgery using mini and micro grafts. This procedure thickens the existing hair in several stages, thus restoring hair growth. The surgeon uses hair grafts from the scruff of the neck. Mini grafts consist of 3 to 8 hair follicles and micro grafts consist of 1 to 2 hair follicles. These grafts are put into prepared sites. They have to be placed at a certain distance; therefore a second session is recommended. Only some of these planted hairs will continue to grow. Most of them will fall out, but new hairs will grow from the follicle. This process lasts several months.

The operation is performed under local anesthetic or general anesthetic if the patient wishes. It is a long procedure lasting up to several hours. Approximately 80% of the implanted grafts will grow successfully. The head is bandaged for 2 to 5 days. The treated area will most likely swell, but this resides in a few days. A short hospital stay is required and the convalescence period is short. The hair can be washed with shampoo after 7 days and cut 14 days after the procedure.

Prominent Ears Surgery (Otoplasty)

The goal of otoplasty is to reshape and reposition the ears to give them a more normal and symmetric appearance. Three objective and one subjective criterion are used to assess the ears and decide whether they are symmetrical or not.

The objective factors are size, shape and especially angle, at which the prominent auricle stands out. The normal size of an ear is roughly one third of the head’s size. The shape should be regularly developed in all parts of the auricle, the relief should be distinct and it should not be deformed. If the angle, at which the auricle stands out, is too big, it may be the source of teasing from the others and prominent ears may be a frustrating problem not only in childhood, but also later in life. The evidence that it is a really serious problem is also the fact, that until 10 years of age the otoplasty is a procedure fully covered by health insurance. Once older than 10 years, the otoplasty is considered aesthetic surgery and therefore the health insurance does not cover it anymore.

The objective factors are size, shape and especially angle at which the prominent auricle stands out. The normal size of an ear is roughly one third of the head’s size. The shape should be regular in all parts of the auricle; the relief should be distinct not deformed. If the angle at which the auricle stands out is too large, it may be the source of teasing. Prominent ears can be a frustrating problem not only in childhood, but also in later life. The seriousness of this problem is recognized by the fact that up to age 10, otoplasty surgery is fully covered by health insurance. At a later age, this procedure is considered aesthetic surgery and is no longer covered by health insurance.

Consultation and a detailed examination precede every ear surgery. The surgeon will assess the shape of the auricle, quality of the skin and cartilage (especially its elasticity) and discuss the angle. Then the surgeon will then plan the operation.

During the surgery cartilage is remodeled and the excess skin behind the auricle is removed. The size of the auricle can also be corrected if necessary. Most surgeries are performed under local anesthetic and do not require a hospital stay. Operation techniques will depend on the extent of the correction and elasticity of the cartilage. The incisions are generally placed behind the ear. At the end of the procedure, the wound is closed with absorbable sutures, which do not require removal. The patient’s head is wrapped in an elastic bandage immediately following the surgery which holds the ears in position with gentle pressure.

After a few days, the initial bandage is replaced by a lighter head dressing similar to a headband. All bandages can be removed in 10 to 14 days. We recommend that the patient wear an elastic headband for some time, especially at night, and depending on the operation, also during the day

Patients usually tolerate the procedure well and are satisfied with the results. Complications are rare and not serious. There can be some bleeding. The need for surgical revision is very rare.

Venter Pendulus – Tummy Tuck (Abdominoplasty)

Abdominoplasty is requested most often by women who, after repeated pregnancies or great weight loss cannot regain a flat, firm tummy. The skin has lost its elasticity and the ability to return to its original shape and size.

This procedure requires at least a one night stay in the hospital. It is performed under general anesthetic. A long incision is made in the lower abdomen, so the scar can be hidden by underwear. Excess skin is removed and the wound is closed in several layers.

In some cases Abdominoplasty is combined with Liposuction, a technique where excess fat is suctioned from the body, if the fat cannot be removed surgically. After Liposuction, patients wear a special compression belt or underwear that assists healing.

Eyelid Surgery (Upper and Lower Eyelid)

Upper and lower eyelid surgery (blepharoplasty) is one of the most frequently performed procedures in aesthetic surgery. The motive for this surgery is usually to correct sagging eyelid skin and wrinkles around the eyes. Women undergo this procedure more often than men. The procedure does not require a hospital stay and is performed under local anesthetic. The excess skin is excised along with the fatty bags – prolepses – which are around the eyes and cause deformation of the eyelid.

Cool dressings are applied to the eyelids after the surgery. Stitches are removed in 4 to 6 days. Swelling and bruising may last 2 to 3 weeks and then it gradually fades. We recommend wearing sunglasses to protect the sensitive treated eyelids from strong light or sunlight and to avoid vigorous activity for two weeks.

Breast Augmentation

Mammaplasty or breast enlargement is a solution for a woman who feels, for personal reasons, that her breasts are too small. It can also be used to restore loss of breast volume after pregnancy. In the case of excess skin, it might be better to consider remodeling of the breast before augmentation.

We use French made silicone implants (Sebbin) or implants with a textured surface filled with gel (Polytech, Silimed). Silicone implants have been used for many years. They have no negative side effects and do not promote any disease. However it is a foreign material and so we cannot exclude the possibility that the implant may be rejected by the body.

The surgery is performed under a general anesthetic and requires a 2 to 3 day hospital stay. The size of the implant, their position and conducting of the incision will be determined after a detailed consultation with the surgeon.

The incision (about 5 cm long) can be placed in the armpit (this is the most common location), under the breast, or in the areola. The implants are placed under the mammary glands or under the pectoral muscle – this will ensure a natural look.

Convalescence time is long and gradual. The implants must be held in place by a supporting bra and breast belt immediately after the surgery to avoid unwanted movement of the implant. The size of the implant is according to the wishes of the patient; most common volume is about 250 ml.

Possible complications include hematoma, infection or implant exertion. These complications can be reduced by maximum precaution and cooperation between the patient and the surgeon.

This procedure is very popular with both young and middle aged women. Results are usually very satisfying.

Botulinum toxin

The development of wrinkles is a part of the aging process. Aesthetic medicine uses every possible means to eliminate wrinkles or at least reduce their impact.

Is it really a poison?

Botulinum toxin is a poisonous substance produced by the bacteria Clostridium botulinum. It is commonly known as “sausage poison” because this bacterium often caused food poisoning – botulism – in improperly handled or prepared meat products, (often canned sausages) in times when food conservation was not well developed.

Botulinum toxin’s positive effects on the neuromuscular system have long been used to treat various diseases and it is now used in aesthetic medicine.

How does the Botulinum toxin work?

Muscles move only after receiving signals from nerves. In the nerve terminal, there is a substance called acetylcholine, which after its release, affects the muscle and induces its contraction. The Botulinum toxin blocks the release of this substance and therefore disrupts the functional connection between nerve and muscle. The muscle is unable to contract. The Botilinum toxin is used to cure various neurological defects such as muscular over activity leading to paroxysmal spasms of the extremities or unnatural movements of facial muscles.

In aesthetic medicine, the Botulinum toxin is used to reduce wrinkles and to treat excessive sweating. The dosage used for these procedures is approximately 3 times lower than those used in neurology.

Mimic wrinkles

When a mimic muscle contracts, it becomes shorter and the skin above it folds. If the skin is elastic enough, it will return to its original shape when the muscle relaxes. As we age, our skin loses its elasticity and does not return to precisely the same shape. Thus dynamic wrinkles, which once were only temporary, become more distinguishable. These wrinkles form in regions with high mimic activity; external eye corners, the area between the eyebrows and forehead, and the nasolabial fold

What happens during the procedure?

The treatment is simple and virtually painless. Botulinum toxin is injected with a very fine needle into the mimic muscles. The client feels small needle pricks and sometimes a burning sensation. After the application, it is necessary to actively use the muscle where Botilinum toxin was applied for two hours and stay in an upright position for four hours. Movement helps Botulinum toxin bonds to the muscle and enhances the final effect.

What results can you expect from this procedure?

Injecting the Botulinum toxin into facial subcutaneous muscles will reduce their activity and smooth or reduce wrinkles which are related to mimic muscle activity. Results can be seen in two to ten days, and last usually three to four months. This effect however, is only temporary. The extent and duration of the results are closely related to the dosage. After a second procedure, results can last up to nine months.

The elimination or reduction of wrinkles results from the cooperation between muscle relaxation which lessens the depth of the wrinkle during muscle contraction, reduction of muscle tone, and the natural regeneration of the skin which fills the wrinkles. It is possible to combine the Botulinum toxin procedure with other plastic surgeries or with laser rejuvenation of the skin.

How to prepare for the procedure?

Your physician will inform you about prescription drugs or health conditions which may influence the efficiency of the Botulinum toxin. We recommend that you avoid exercise, strenuous physical activity or using a sauna/solarium on the day of the procedure. You may apply make up to the treated area six hours after the procedure and have professional cosmetic treatments after 72 hours.

Excessive Sweating – Hyperhidrosis

Malfunction of the sweat gland and increased perspiration is called Hyperhidrosis. Generalized Hyperhidrosis is usually a sign of some system disease, such as Endocrine Glands Disorder. Localized or focal Hyperhidrosis can also be caused by some diseases. Therefore it is essential to perform a through medical examination to rule out the possibility of a more serious cause to the sweating.

Where does Hyperhidrosis appear?

Hyperhidrosis usually appears in the most active regions of perspiration; palms, feet, armpits and groin area. It may also occur on the forehead or in hair.

How is the treatment performed?

The physician identifies the area of the skin with increased sweat gland activity. An anaesthetic cream is applied to the area to prevent pain during the procedure. The Botulinum toxin is injected into the skin with a thin needle. The treatment lasts about 20 minutes

What are the results of the procedure?

Botulinum toxin injections prevent excessive stimulation of sweat glands. The reduction of perspiration differs however from patient to patient. Results are seen four to five days after the treatment and last usually seven to twelve months.

How to prepare for the procedure?

We recommend that you avoid exercise, strenuous physical activity or using a sauna/solarium the day of the procedure. Also avoid using the treated area six hours after the procedure. Hair removal in the armpit is possible after three days.

The Botulinum toxin injections are very efficient, simple and safe. These treatments have increased in popularity and now replace many other more expensive Hyperhidrosis therapies.

Chemical Peel

Chemical peel is a procedure which uses a chemical solution to remove damaged outer layers of skin. After the skin is renewed, the new components of cutaneous tissues are formed: collagen and elastic fibres and new epithelial cells. This new skin is smoother, clearer and healthier.

Three Basic Types of Peels:

The depth of the peel is determined by the desired effect: it may be surface, middle or deep. A deeper peel will bring more noticeable the results, but this will also require longer healing time.

2 to 3 weeks before the treatment, you will begin an at home preparation of the skin. This increases the intensity of the peel and helps to achieve optimal results. Your physician will then apply a higher concentration of the solution. There are usually 3 or 4 sessions in the space of 2 to 3 weeks. The treated area will be red after the procedure and after a few days some skin will peel off. The skin must be protected from sunlight and a sun screen with high protection factor should be used during the whole peel period.

Fruit acids are used for chemical peelings, e.g. glycolic acid. Private Clinic Riva uses Neostrata products. Brand new in this field is also a product called BIOMEDIC. This peel contains lipohydroxy acids made by the La Roche-Posay company, which is very gentle to the skin.

Chemical peels can be used to minimize changes to the skin connected with ageing (small wrinkles, loss of elasticity, pigmentation). It may also be used to treat acne as it decreases sebum production and adjusts the keratinisation disorder around the opening of the sebaceous glands.

How to prepare for the procedure?

Your physician will recommend the best peel suited for your skin type to achieve the desired results. You will also be informed of the risks involved with this procedure. To prepare the treatment area, you will need to apply a special cream with a concentration of 8 to 10% of the strength that will be used for the clinical peel and protect this skin with a high protection factor sun screen. This preparation enables regular removal of the skin surface and promotes faster healing. It will also decrease the risk of infection and the emergence of uneven changes in skin pigmentation. The cream is applied once a day in the evening on clean skin for the first 7 to 14 days. When well tolerated, it is then applied twice a day, morning and evening, for the next 2 weeks. Patients usually feel a gentle tingling or stinging sensation for several minutes after the application. If this feeling does not fade after a few minutes, reduce the cream application to once every 2 days until the skin gets used to the effects of fruit acids.

What to avoid before the peel?

Stop using isotretinoin (Roaccutane) at least 6 months before the peel. The week before the procedure you should avoid creams and solutions that contain vitamin A and benzoyl peroxide, do not color or perm your hair or have a cosmetic facemask, and avoid waxing/epilation. Please do not use make-up and do not shave the treatment area on the day of the procedure.

What happens during the procedure?

The treated area is cleaned and degreased. An acid solution is applied with a fine brush, allowed to work 2 to 7 minutes, and then removed with a special neutralizing solution. Patients feel a gentle tingling, stinging sensation during the procedure. Cool dressings are applied afterwards to calm the skin and minimize any unpleasant feelings.

Skin Care after the Peel

Wash the treated skin with clean, boiled water, and then pat dry with a towel. Apply a nourishing cream (recommended by your physician) to the skin 2 to 3 times a day during the first week. If scabbing occurs, do not remove or touch. Avoid sunbathing as long as the skin is peeling. Then use a sun screen with the protection factor of 30 or more. New skin is prone to injury, so it is better to reduce sunbathing to a minimum.

Possible Side Effects and Complications

Flare (Erythema) – usually disappears after recovery. May last for a few weeks with some skin types.

Emergance of scabs.

Infection – peels may evoke the cold sore virus in infected individuals.

Hypersensitive reaction towards the chemicals used.

Enhanced sensitivity to sunlight.

Results:

The new skin is smoother and tighter; small wrinkles are reducedhe
Pigmentation spots are removed and the skin has a unified colour
Dilated pores are closed and the skin is less greasy

Laser Epilation

Excessive Hair Growth

The idea of beauty changes over time and people follow contemporary fashion trends. Today excessive hair growth is undesirable, especially for women. More than 90% of our clients requesting excessive hair removal are women from various countries and cultural backgrounds. They want to remove hair on the face – usually on the upper lip and chin, and on the body – on the calves, in the bikini area and the armpit. Men usually request hair removal on the back and shoulders.

What is the cause of the excessive hair growth?

In most cases, excessive hair growth is hereditary. People with darker skin, e.g. coming from Mediterranean regions, have more conspicuous hair and that is natural. However some diseases, taking specific drugs or transsexualism may produce excessive hair growth. A disorder of the endocrine gland may be discovered. Therefore, it is necessary to be examined by your physician before you decide to undergo laser epilation.

How does the laser treatment work?

The laser beam is absorbed by skin pigment called melanin, which is found in hair root cells. Light energy is transformed into heat energy which burns the hair root. This removes the hair permanently.

Every hair on the body has an active growth phase, then a quiescent phase, after which the hair falls out. The hair root then remains inactive for some time before the new growth phase begins again. In this phase, all the cells are very active and contain a large amount of melanin. To affect the maximum amount of hairs in the growth phase, it is necessary to repeat the treatment in regular intervals.

How many times do we have to repeat the treatment?

The growth phase has different lengths depending on the part of the body. We have to determine the date of the next session carefully to be able to hit the most hairs in their growth phase. Usually 3 sessions are needed to treat a particular body section. More sessions will be needed in parts of the body where hair growth is regulated by hormones (i.e. upper lip, chin). Your physician will inform you.

Laser beams best affect dense and dark hairs on individuals with pale skin. Brown and blond hairs need more sessions. Laser epilation results on red and grey hairs are very poor.

Is the procedure painful?

The laser beam travels through a glass plate through which cold water runs, before it touches the skin. This cools and calms the skin. During the procedure clients may feel a slight tingling or stinging sensation at the treated area. This is highly individual. At the sensitive parts of the body, i.e. armpits or neck, we may apply an anesthetic cream

How to prepare for the procedure?

Do not remove hairs by plucking (wax, tweezers or epilator). You have to shave the hairs one day before the treatment. The procedure cannot be performed on tanned skin (sun or solarium). You will have to wait until the color fades.

Protect the treated skin from sunlight for at least one month after the procedure. We recommend using a sun screen with high sun protection factor (30 or more) while the skin is still sensitive. During the summer months, we advise to use a sunscreen during the time between the procedures to prevent the emerging of pigment spots.

Side Effects and Complications

The epilation will be effective and without great risk if you follow our post operative advice. There may be temporary depigmentation with darker skin types and there is the possibility of mild burns with reddish skin and small blisters, but these complications are very rare.

Photorejuvenation

Photo Rejuvenation is a term encompassing various techniques with the same purpose – to rejuvenate and improve skin quality. The basic principle is to disrupt collagen fibres in the skin with heat. This starts a process of healing. Substances promoting regeneration are released from the skin cells. This in turn stimulates cells producing collagen fibres. Through this process the skin is tightened and its elasticity is improved. Further benefits of photo rejuvenation are: better skin surface quality, pigment spots disappear, small veins dilate, small scars are filled, and wrinkles caused by damaging sun rays are smoothed.

There are two basic photo rejuvenation techniques:

1. Ablative Resurfacing (regenerating the skin surface)

For this technique we use one of the following Ablative Lasers: CO2 Laser, Erbium Laser, and the new MiXto Fraction Laser. The laser rays vaporize the skin. The treated area will be reddish, slightly weepy, and require special care. During the recovery period, you will need to keep the treated skin cool with sterilized water and apply a cream on a regular basis. The skin will be completely healed in 7 to 14 days. The results are amazing – your skin will appear 5 to 10 years younger! This procedure is also recommended for the treatment of acne or pox scars and to smooth rough skin surface and deep wrinkles, especially those around the eyes and upper lip.

The recently developed MiXto Fraction CO2 Laser exposes only a limited area of skin to laser radiation. Noticeable rejuvenation can be achieved without damaging the skin. Recovery time is therefore very short – usually only one week.

2. Nonablative Photo Rejuvenation (Undersurface Remodeling of Collegen Fibres)

This technique gently warms the cutis with small doses of light energy. This stimulates the fibroblasts, cells that produce collagen fibres, and new production of collagen starts. This smoothes small wrinkles and tightens the skin. Part of the light energy is also absorbed by tiny dilated veins on the face, causing them to close. In a few weeks these veins will disappear altogether. Although this is not a typical pigment spot treatment, the skin appearance may be improved in this regard. There are three light sources which may be used: Intense Pulsed Light (IPL), Pulsed Dye Laser (VBeam) or Diode Laser (1450nm).

Nonablative Photo Rejuvenation is a similar but less intense method to improve skin appearance than the Ablative Resurfacing technique. This method improves the skin surface – dilated small veins and pigment spots disappear. Wrinkle reduction is minimal (15 to 30%) with best results achieved around the eyes.

Skin rejuvenation is fast, painless and requires no restriction of daily activities. The risk of side effects is minor if you follow all recommended skin care procedures. Rejuvenation is a very gentle method and can be combined with other procedures including: chemical peels, other laser procedures, application of the Botulinum toxin, skin implants and surgeries.

Injection Filling – Hyaluronic Acid and the Others

(Restylane, Juvéderm, Esthélis, Fortélis, Radiesse)

Hyaluronic Acid

Hyaluronic acid is a natural compound in our skin and the skin of all mammals. In the extracellular space of the skin, this substance binds large amounts of water. This maintains the distance between the cells in the connective tissue and enables cell division. It also enables the transport of nutrients, boosts the metabolism of the skin cells and binds free radicals and suppresses the influence of damaging agents in the skin tissue.

The amount of hyaluronic acid decreases as we age, so skin loses the ability to maintain enough moisture. Its smooth, tight appearance fades and wrinkles appear.

What to expect of the procedure

The physician injects hyaluronic acid with a thin needle directly under the wrinkle. The defect is filled in the subcutaneous region, reducing or even eliminating the wrinkle. Treatment of emerging, shallow wrinkles slows the processes of wrinkle formation and delays other more invasive methods of skin rejuvenation

What is face outline sculpting?

The amount of subcutaneous fat may decrease as we age. This loss is the most aesthetically problematic in the checks and under the eyes. To fill this space, hyaluronic acid is injected deep into the subcutaneous area. Many clients wish to give their lips a fuller contour and this can also be achieved immediately through hyaluronic acid applications.

How does hyaluronic acid work?

In aesthetic medicine, hyaluronic acid is used in gel form in single shot injections. The product varies in the size of gel particles and manufacturing technology. For example, a gel with larger particles is used for the correction of deep wrinkles and defects. Hyaluronic acid applications increase the skins ability to bind water and enhance strength and elasticity of the skin, which enables new collagen and elastic fibres to form. Treated skin remains soft and pliable and has a natural appearance.

Possible Side Effects or Complications

The injection site may be sensitive immediately after the application. Redness, swelling or bruising can occur, but these reactions fade after a few hours. Mild symptoms may last a few days.

Discoloration or redness of the treated area could also be a result of hyaluronic acid not being applied deep enough or too much gel being injected into an area, especially regions with thin subcutaneous layers. This resolves itself after some time. The physician must also take into consideration the condition and structure of the client’s skin and overall health.

A very rare side effect is an inflammatory reaction to the material and formation of a granuloma, which is a ball-like collection of fibrous tissue in the vicinity of the gel. It may form several months after the procedure. This can be reversed by intravenous administration of corticoids or surgically removed. New and safer products have practically eliminated this complication.

How to prepare for the procedure?

If you are prone to cold sores, a similar formation may appear at the injection site. Also some medications will cause bruising and swelling in the treated area. Your physician will discuss this with you at your consultation to help avoid these complications. No other preparations on your part are necessary.

How is the procedure performed?

The procedure lasts approximately 10 to 40 minutes according to the size of the treated area. The gel is applied by injections into precisely chosen spots. Your physician’s skill in placement of the gel is the key factor to ensuring perfect results. There are a few options to reduce the discomfort felt during the process. An anesthetic cream, EMLA, can be spread on the treated area 30 to 40 minutes before the procedure or an anesthetic substance may be administered intravenously which allows the procedure to be performed immediately. In some cases, the gel contains an anesthetic, so no additional pain suppression is needed. The treated area will also be cooled. These options are tailored to each individual patient to ensure full satisfaction.

What to do after the procedure?

Avoid excessive heat or cold (no solarium or sauna) and direct sunlight. Increased physical activity should be avoided until the redness and swelling have disappeared. Do not touch the treated area for 6 hours, after which you may wash it with water and gentle soap. Make-up may also be applied at this time.

Results can be assessed practically immediately. We recommend you see your physician again after 3 weeks when the gel has stabilized in the tissue and the final results are achieved. With the comparison of the before and after treatment photos, you can plan the next strategy if desired.

The duration of the results differs according to the treatment location, the amount of gel applied, movement in the treated area and individual disposition. Since the material undergoes an isovolumic degradation (a volume is sustained for a long time and there are more water molecules bound to the more exposed molecules of degraded hyaluronic acid) the effect is long lasting with a slightly faster loss of volume at the end of the period of efficacy. Often the smoothing effect lasts even longer because of a natural remodeling of the skin tissue which leads to naturally fewer wrinkles.

Injection filling techniques are now replacing or supplementing other aesthetic surgery procedures. Considering their efficiency, they are being performed more frequently and are becoming increasingly popular. Our excellent materials and highly qualified physicians ensure that you will be completely satisfied with your results!

Scars

Every intervention into the tissue integrity including skin integrity leaves a scar after healing. Unfortunately no defect can be removed from the skin without leaving the scar and wounds heal with a scar too.

Scar treatment requires right judgement of the dermatologist when choosing the appropriate method or combination of methods. Therefore the scar treatment is very difficult and depends on many factors.

What is the effect of the procedure?

No medications and no treatment even the most advanced can remove the scar absolutely; we only try to improve its condition. Hypotrophic scars as a result of acne show 50 % improvement.

The latest method is repeated treatment with the fraction CO2 laser.

When should we start with the scar treatment?

Scar treatment is recommended to start when the scar is forming. In the case of red hypertrophic scars emerging after surgeries the best is to start 2 to 3 weeks after stitches are removed.

How should we look after the scars?

Scar tissue differs very clearly from neighbouring skin tissue. It is annoying aesthetically for the patients and it also requires special care. It is very important to protect scars from sunlight by sunbathing creams with high sun protection factor.

Acne Treatment

Through the treatment of acne scars with lasers, physicians and scientists have discovered that the number of new inflammatory manifestations associated with acne decrease 7 to 10 days after the treatment.

How does the laser affect acne?

Laser beams have long been used to treat various skin disorders. In relation to acne treatment, research has revealed that the laser beams influence on dilated blood vessels has an anti-inflammatory effect on certain types of acne. In Propionibacterium acne, which is a bacterium multiplying in dilated sebaceous glands that causes inflammation that manifest itself as a red pimple, positive results can be achieved. The treatment is effective because this bacterium produces a substance which is activated by light. This substance then destroys the bacterium. The results are visible from the first month of the therapy and are three times faster than the local or general antibiotics. Effects last usually 3 months.

Is the procedure painful?

Very low doses of light energy are applied in short intervals. This dilates the small blood vessels and eliminates bacteria in sebaceous glands. The gentle treatment does not harm the skin, is painless, and had no side effects. Patients may feel slight stinging during the procedure, but most patients do not need pain medication.

Possile side effects and complications

Gentle flaring may last 1 to 2 days. Individuals who are susceptible to bruising may have isolated tiny bruises which will disappear in 7 to 10 days.

How to prepare for the procedure

This treatment does not require any special preparation or changes to your daily routine. Some medicines should be avoided, but your physician will discuss this with you. Drinking alcohol is not advised 3 to 4 days before the session.

After the laser therapy you must avoid sunbathing and protect your skin from sunlight by using a high protection factor sunscreen.

A new approach in acne therapy is the use of Fraction CO2 Lasers. Fast and immediate improvement of the general skin condition can be achieved with this treatment.

Viral Warts Treatment

Viral warts are caused by a virus multiplying in the skin cells. This virus is cultivated in warm and wet surroundings such as public swimming pools or saunas. The disease is contagious and can be spread to other parts of the body or transferred to other family members.

What do enlarged warts look like?

In the center of the wart are dark dots. These dots are dilated blood vessels which nourish the wart. It protrudes above the surrounding skin and may be painful.

Local Treatment of Viral Warts

Acid solutions are commonly used; mostly they contain salicylic or lactic acid and are applied directly on the wart. Acids soften the indurated skin where the virus reproduces. Thorough removal of dead tissue by the use of a pumice stone or scissors is very important and best done by a physician once a week.
Cyostatics or immune modulators can also be used for local treatment of warts. They effect the virus directly and prevent its reproduction in the cells.

Laser Treatment of Viral Warts

Laser treatments of viral warts most often use two types of machines: CO2 or Dye Lasers. CO2 Lasers have been used the past 10 years. They vaporize the infected skin which usually causes a burn that has to be treated with a cream. It heals with a faint scar.

Dye Lasers are the latest invention in wart treatment. They have about a 95% efficacy rating. Dye Lasers emit light, which is then absorbed by small blood vessels that nourish the hyperkeratotic wart papules. When these blood vessels are destroyed, the wart also disappears. Scaring is rare because the surface of the skin remains intact. It is important to remove the calls tissue above the wart with a pumice stone. Multiply sessions are needed to ensure 100% removal.

Mesotherapy

Dehydrated skin ages prematurely and this problem is difficult to correct, especially on the neck and the back of the hands. Hydrating creams affect only the upper layers of the skin and are unable to reach the lower layers. Mesotherapy is a method of applying various effective substances by injection into the middle layer of skin of mesodermal origin.

The application of solutions based on hyaluronic acid enables deep hydration. This acid is a natural component of human skin and its main function is to bind water. It also activates the production of collagen fibres which in turn enhances skin elasticity. The result is hydrated, rejuvenated and tightened skin.

NEW in the field of injection applications is HYDROBALANCE concept with the product Restylane Vital Light. Its unique injector enables precise measurment of the dosage and makes regular distribution of the substance, even over a larger surface, possible. Optimal results require 2 to 3 sessions over a period of 2 to 4 weeks. We also apply other compounds based on Hyaluronic acid such as Surgilift and Mesolis.

Hydrated skin is the key factor to beauty enhancement and your overall contentment!

Port-wine Stains

Port-wine stains or naevus flammeus were a serious aesthetic problem before lasers were used to treat this vascular disorder. The stains basically consist of many tiny interconnected veins and therefore can be treated the same way as facial spider veins.

Which laser is used?

The state of the art machine is pulsed dye laser. We use this type of laser manufactured by an American company Candela (VBeam). This laser enables the physician to choose a treatment suitable for each patient.

When should we start with the treatment?

The port-wine stains often darken and become protuberant over time and therefore the sooner you begin treatment, the better. This may start already in infancy. More sessions are necessary to remove stains in older patients.

Laser treatment does not require any hospital stay. We treat children aged 2 years and older. This procedure can be performed under general anesthetic for our younger patients and parents may be present throughout; they may sit next to the child’s bed or hold them on their lap. Immediately after the procedure, the treated area changes color, but it is still visible. Absorption takes place in the following weeks when treated vascular lesions are eliminated by the immune system.

How many sessions are needed?

The number of sessions depends on the extent of the condition. Darker stains require more sessions. In most cases 5 sessions are needed for the optimal results. Noticeable improvements can be seen after 2 to 3 sessions.

What is the efficacy of the procedure?

Most stains are about 75 % lighter; some even 95 % after the procedure.

Side Effects and Complications

The risks or side effects will be the same as in the facial spider veins treatment if the same laser is used.

Varicose and Spider Veins on Legs

Spider veins on legs are a very common problem for women, especially after giving birth. Venous wall weakness is hereditary. Spider veins will emerge over time regardless of the colour of your skin or your weight and there is little that you can do to prevent them.

What are the treatment possibilities?

The size of the vein is the major factor that your physician will take into consideration when deciding of the method of treatment.

Sclerotisation Method

In the treatment of tiny spider veins the best results are achieved by the Sclerotisation Method. A substance is injected into the veins which induces a mild damage to the inner venous wall. That is enough for the venous wall to glue together. A slight inflammation arises around the vein but is then absorbed back into the surrounding skin tissue.

A blood clot forms in the vein immediately after the intravenous application. This will not be visible, but can be felt as a tiny induration. The treated area may be sensitive or a little red but this will subside after two weeks. Indurations will also disappear. The treatment is simple, painless and does not require any restrictions in the patient’s daily life. It is possible to treat a number of spider veins on both legs in one session. The length of the treatment depends upon the condition of the patients legs.

You will need to wear elastic compression stockings, which will be prescribed by your physician 2 to 4 weeks after the treatment.

Laser Treatment

The smallest red coloured veins may be treated by the vascular laser Candela V Beam. This laser is also used to treat facial spider veins and port-wine stains. Repeated sessions are usually necessary to achieve optimal results.

Surgery

Vein surgery, either classic or laser, is performed in the case of large varicose veins

How effective are leg spider vein treatments?

These treatments are very effective. Most of the spider veins will disappear after the procedure. Unfortunately new spider veins may develop at any time, especially in individuals with hereditary background.

How to prepare for the procedure?

These procedures do not require any special preparations

What to do after the procedure?

We recommend that you walk for at least 2 to 3 hours after the procedure and then every day at least one hour. You will need to wear compression stockings for 2 to 3 weeks.

Possible Side Effects or Complications

Complications are rare. In some cases however, patients have experienced the one of the following complications:

Pigmentation change – a transient brown colouring of the skin that will disappear.

Incomplete removal of spider veins – if a vein i only partially treated, a second session will be needed.

Skin ulcer – an unusual complication caused by wrong application of the sclerotising substance outside the vein.

Spider vein treatment is usually a simple procedure which does not require a hospital stay. It has a very high success rate. We will gladly answer any further questions you may have.

Facial Spider Veins

Tiny red veins on the face may be an aesthetic problem, especially for young people. Although it is said that their formation is related to excessive alcohol use, this is not always true. The appearance of dilated veins is usually hereditary, but they may also occur in smokers, women who take hormonal contraceptives and as a consequence of over exposure to the sun.

Can facial red veins be treated?

Regardless of the cause of their occurrence, dilated facial veins can be treated with lasers. Treatments using older types of lasers were painful and caused visible burn injuries on the skin which could not be covered with make-up. It was a slow process and had very limited results.

Today’s techniques and equipment enables a quick and painless procedure with high results.

How does the vascular laser work?

Lasers produce a yellow light of a certain wavelength, which is absorbed by red hemoglobin pigment in red blood cells. This absorbed light energy is transformed into heat energy and causes the vein to seal up. The damaged vein is gradually absorbed, then disappears and never forms again. The benefit of this procedure is that the surrounding skin remains intact. Laser treatments however, do not prevent the formation of new spider veins, especially in smokers.

How many sessions are needed?

Minor disorders may be treated in one session. Patients with more prominent veins will need to 2 to 3 treatments to achieve the desired results.

What to expect after the procedure?

After the treatment flares may appear, lasting a few days. If a higher power laser beam is used, small bruised may emerge which will disappear within a week. Some patients may feel mild stinging that can last 2 to 5 days. In rare cases small pustules may emerge, but they disappear spontaneously. Veins will continually fade over a period of 6 to 8 weeks after the procedure.

Is the procedure painful?

During the procedure the patient may feel a slight stinging sensation. Pain is controlled with a cooling spray which is produced by the laser machine together with the light beam.

How to prepare for the procedure?

You should refrain from drinking alcohol and not take anticoagulants one week before the treatment.

Your skin should not be tanned and you must avoid sunbathing/tanning of the treated area 6 months after the procedure.

After the procedure, the treated area must be protected with a high sun protection factor sun screen every day. For complete protection. sun screen needs to be applied 1 hour before you go out into sunlight.

Possible Side Effects and Complications

Thanks to dynamic skin cooling, thermal skin injury is mild. Side effects are rare but may include:

Pigmentation: brown spots may appear after the treatment if the skin is not protected from sunlight.

Scars: these are very rare, but may emerge especially on the neck.

Infection: happens infrequently.

Reappearing of the spider veins: this happens most often in women who are taking hormonal contraceptives and in smokers. In patients with the hereditary form of the disorder, laser treatments cannot prevent the appearance of new spider veins.

Medical Cosmetics

Medical Cosmetics NeoStrata

NeoStrata® products are highly effective medical cosmetics whose main ingredient is fruit acid. Regular, long term application will give you healthy, clear and tight skin. Skin quality is improved and small wrinkles and lines are reduced.

These cosmetic products are not scented, do not contain dyes, and undergo rigorous dermatological testing. NeoStrata products are not tested on animals.

You may order these products by phone: 543 211 818

Laser Resurfacing

Laser beam effects also long-lasting stimulation of collagen creation, which gives the skin young look. The advantage of the fraction laser is treatment of only certain areas of skin, when part of skin stays untreated. The healing process is faster and you can sooner return to normal activities.

Laser treatment that removes:

dark spots
pigmentions problems
reduces pore sie
wrinkles
acne scars
and lifts skin during one session

The laser treatment patients prefer:

short procedure time
no collaterall effect
faster ealing time
remarkable result

Deep Laser Peel

This is a technique for the global removal of the thin outer layer of skin. Laser peeling can help remove the signs of aging and initiating the regeneration process. It treats greasy skin susceptible to acne and smoothes the structure of the skin. It is a unique method that reaches into the deeper layers of the skin in a precisely determined depth to markedly influence the remodeling of ligamentous fibers in the skin.

Laser Resurfacing – Wrinkle Elimination

Facial wrinkle elimination and laser resurfacing of the whole face are often combined with a face-lift. The combination of these procedures are suitable, especially in the areas where a face-loft alone fails, We recommend laser surgery for those wrinkles which are static and gravitational, i.e. those in nasolabial folds, at the root of the nose, around the mouth and eyes.

We use two types of lasers – Carbon Dioxide (CO2) and Erbium. The cause of wrinkle formation is the gradual loss and degeneration of collagen fibers. Laser resurfacing enables the remodeling of collagen. Collagen fibers shrink during the procedure (1/3 shorter) and the outer layer of skin is smoothened.

The use of the CO2 laser will achieve long-term aesthetic effects. Areas treated by this method need 2 to 3 months to heal; and that is too long. Another drawback is that the skin is reddish throughout the healing phase. This type of laser vaporizes the outer layer of tissue; the cells are destroyed and are replaced by new ones with better quality. We can determine the depth in which the laser beam works by computer.

With the Erbium laser, healing time is markedly shorter; about one half of the time needed with the CO2 laser. This type of laser is used especially for younger people (in their 30’s) where the ability of collagen remodeling is greater. Aesthetic results are short-term, but the procedure can be repeated. Superficial small wrinkles are eliminated by this method. In the case of deep wrinkles, we achieve noticeable improvements, although we cannot remove them completely.

Laser treatment can be performed on a particular part of the face or on the entire face at once. This method is called full-face resurfacing. It is suitable for middle age or older patients and allows the greatest aesthetic effect. For a face with excess skin, lowered tissue tension, or excess tissue, we recommend a surgical face-lift combined with laser resurfacing that can eliminate especially radial wrinkles around the eyes and upper lip. These wrinkles cannot be removed surgically.

The procedure is performed under local anesthetic (either injection or cream, e.g. EMLA) combined with sedation/analgesia, or it can be performed under a general anesthetic, especially in full face treatment. This extensive procedure may last up to 2 hours. Cooling dressings are applied to the face afterwards to reduce swelling.

The patient is released from the hospital usually one day after the procedure. In the following days the face is covered by dry crusts, which will peel in 14 days. Slight redness of the treated skin will disappear during the next 3 to 6 months. The sunbathing is forbidden for 1 year to avoid emerging of unwanted pigmentations. It is good to apply smoothing creams all the time.

Laser full-face resurfacing can be combined with endoscopic brow-lift, eyelid surgery or surgical face-lift.

Warts and Pigmented Naevi Removal

Great pigmented naevi or warts may appear on the face or other parts of the body. Reasons for their removal are highly individual.

We recommend that the patient visits a dermatologist before the procedure. Pigmented naeves must be examined thoroughly before surgery and the whole procedure should be supplemented with a histological examination of the excised tissue.

Removing pigmented naevi or warts brings satisfaction to the patient and improves his or her quality of life.

Warts and benign pigmented naevi from 5 to 8 mm in diameter can be treated by laser surgery. They are removed by a CO2 or Erbium Laser. The laser affects the tissue by transferring light energy into heat energy which damages the surface layer of skin in the treated area. The cells are damaged and vaporized, being replaced by new and better quality cells. With modern laser machines, the depth of the beam can be controlled by a computer. The procedure is performed under local anesthetic.

Larger pigmented naevi and warts (more than 1 cm in diameter) are removed by surgical excision. The incision is placed into physiological lines or natural wrinkles to make the scar less noticeable.

The wound heals in 7 to 14 days, sometimes longer, according to the extent and depth of the lesion. After the surgery, the treated area is covered by an antibiotic ointment, i.e. Framykoin. While healing, the area may be slightly reddish and may itch, but this will gradually decrease with time. We recommend that our patients apply a cream and massage it gently. Sunbathing is prohibited up to 1 year after the treatment. Properly removed warts or pigmented naevi heal without any aesthetic consequences. Sometimes a slight disorder of pigmentation or gentle itching may remain. In the case of a questionable histological find, regular check-ups are recommended. We never treat malignant pigmented tumors or suspect tumors with laser surgery.

After the surgery the same recommendations apply: grease the wound thoroughly and do not sunbathe.

Spider Veins Removal on the Face and Body

Spider veins are small clusters of red veins that appear on the cheeks, around the nose or on the chin. Although they are medically insignificant, they can be aesthetically unpleasing. The high quality vascular laser used at our clinic enables the gentle removal of even the tiniest veins. This method can also be used on smaller varicose veins on the legs. Vascular laser treatment can be combined with other classic methods of vein removal, i.e. sclerotisation, electrocoagulation or varicose vein surgery.

Candela VBeam Laser

The laser beam selectively binds red hemoglobin pigment and decomposes it. Treated vascular lesions are absorbed by the action of the immune system, depending on the age of the individual and the extent of the treatment.

Laser treatment usually does not require any hospital stay. We treat children aged 2 years and older. This procedure can be performed under general anesthetic for our younger patients and parents may be present throughout; they may sit next to the child’s bed or hold them on their lap. Immediately after the procedure, the treated area changes color, but it is still visible. Absorption takes place in the following weeks when treated vascular lesions are eliminated by the immune system.

We recommend covering the treated area with some healing ointment (e.g. Calcium panthotenicum) the first few days after the procedure. When sunbathing, a cream with high sun protection factor (50) should be used. Furthermore you should restrict physical activities and avoid hot baths.

A consultation with the physician is necessary before the procedure.

This treatment cannot be performed when the patient has tanned skin, is pregnant, or if the patient has decompensated diabetes, cancer or other serious conditions.

Viral Warts Removal and Molluscum Contagiosum Removal by Laser

Viral warts may appear on the skin after visiting a sauna, swimming pool or similar facility. The virus may enter the body through tiny wounds in the skin if precautions are not followed; e.g. wearing plastic footwear / using foot disinfectant. The disease is contagious; it can spread to other parts of the body or can be transferred to other family members if not cured. We recommend that everyone who has viral warts see a dermatologist, who can make a diagnosis and start a therapy. In the case of viral warts or Molluscum contagisum, laser treatment removes the lesion totally without leaving a scar.

The laser beam selectively binds red hemoglobin pigment and decomposes it. Damaged blood vessels are attacked by the immune system and are absorbed. The cure is based on sealing the blood vessels that nourish the wart. Once this happens, the wart will atrophy.

This procedure cannot be performed when the patient has tanned skin, is pregnant, or in patients with decompensated diabetes, cancer, or other serious conditions.

Port-wine Stains (Naevus Flammeus) Removal

Haemangioma and Angioma Removal

Parents of children and adult patients who suffer from different types of port-wine stains and haemangioma often describe the distress they experience trying to treat these skin disorders. After long hours spent in waiting rooms at various dermatologists, they finally realize that the only treatment is laser therapy. Unlike the older argon lasers, state of the art laser technology allows the energy of the laser beam to be focused so accurately that it will disrupt blood vessels, but not the surface skin. Tiny spider veins will disappear without a trace and the stains gradually fade. Patients see results after the first session. The combination of our experienced team and the high quality vascular laser makes complete remove of these skin disorders possible.

Candela VBeam Laser

A consultation with the physician is necessary before the procedure.

This treatment cannot be performed when the patient has tanned skin, is pregnant, or if the patient has decompensated diabetes, cancer or other serious conditions.

Radio Frequency Therapy

New – a machine for the aesthetic treatment of wrinkles and loose skin using radio frequency technology.

How does the machine work?

High megahertz electric and magnetic waves penetrate through the epidermis and reach the cutis which contains high amounts of collagen. The pervading waves cause water molecules to vibrate making heat, which influences the collagen fibres and cause them to shrink. New collagen fibres are produced creating a tighter skin. Most commonly treated areas are: imperfections on the face including loose chin and neck, and tightening the skin on arms, belly and buttocks.

What happens during the procedure?

The treatment lasts about 10 to 15 minutes and is absolutely painless. You may feel a slight tingling sensation. The head of the machine is placed on the treated area. Through this contact, the radio frequency energy is transmitted into the skin.

What to do after the procedure?

No special precautions are necessary other than keeping the skin properly hydrated. You may go home immediately after the treatment and do whatever you want. A small percentage of patients experience reddening in the treated area, but this will disappear in a few hours.

How often should you repeat this procedure?

The optimal schedule is 8 to 10 sessions, with one week in between each treatment. No special preparations are needed and the procedure can be performed any time of the year. The complete therapy can be repeated 1 to 2 times a year.

Information

As with any other surgery, you will need to undergo preoperative evaluation before your plastic surgery procedure.

You will receive all the information about preoperative evaluation at the initial consultation. Your general practitioner may carry out the tests, but the results should be no more than 14 days old before your scheduled surgery date. It is possible to have this evaluation done at the Riva Clinic.

What happens during the operation?

Every surgical procedure has its risks. Aesthetic surgery is no different.
Possible complications may include bleeding, infection, healing problems, or deformation of the treated area (e.g. abdomen or breasts). In order to achieve optimal results, each patient will be instructed about their postoperative regime before they are released. The length of hospital stay depends on the procedure performed, but on the average it is about 1 to 2 days. After surgeries like abdominoplasty, breast augmentation or liposuction, the patient may feel discomfort. It is necessary to wear special compression underwear for some time after these kinds of surgeries. For plastic surgery, cooler weather is better. It is recommended that these procedures be performed in spring, autumn or winter, but this is only a recommendation.

Prof. MUDr. Brychta’s Opinion on This Subject:

“On the other hand we have to consider that plastic and aesthetic surgery is most popular in southern regions (Brazil, California, Florida, Mexico, Caribbean, etc.). In these lands even the coldest season is warmer than summers in the Czech Republic. Therefore, the decrease in demand for plastic surgery during the summer in Europe may not be related to the fact that plastic surgery is not recommended in the summer months.”

Your Final Decision

The most crucial factor for successful aesthetic results is the choice of surgeon. You need to feel that you are in good hands! The right combination of education, experience and training all play a part in assuring superior results.

Consultation

At the consultation you will meet your surgeon and thoroughly discuss your needs. You will learn about all the available procedures with the benefits and drawbacks involved. There is no surgery without risk. Your surgeon will discuss possible complications, acquaint you with the course of the operation, length of stay at the clinic if necessary, and subsequent convalescence period.

Choosing a Physician

The aim of plastic aesthetic surgery is to beautify the body. The most crucial element is choosing your surgeon. It is important to make a well informed choice to ensure the best results.