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medical glossary

botulinum toxin
Paralysing agent, produced by the bacterium Clostridium botulinum. This agent can be isolated in the laboratory and applied as a resolutive, rendering it suitable for local injections. Over a period of two weeks, the botulinum toxin is released locally and, depending on the injection site, will weaken or paralyse muscles or immobilise sweat glands. The operating mechanism consists of blocking the signal between the nerve and muscle or sweat gland regulating this. In other branches of medicine, the botulinum toxin is used to treat involuntary muscle contractions or excessive muscle tension (spasticity). As an aesthetic application it is a simple and efficient treatment for some wrinkles, such as forehead wrinkles, glabellar wrinkles, crow’s-feet and neck wrinkles. In addition, it is very effective against sweaty underarms, hands and feet (although the latter two applications require special local injection techniques). The body develops new points of contact between the nerve and muscle or sweat gland, making the effect not permanent. Brand names: Dysport®, Botox®.

Brava®
Brava® is an external tissue expander which enlarges breast volume by gentle suction. The system can be used on its own to generate a slow increase in volume. Pre- and postoperative use of the expander is being used for larger volume fat transfer procedures (lipofilling) resulting in higher rates of fat survival. Before surgery, the system is used to expand the breast matrix, opening up tissue planes thus allowing more space for the transferred fat. After surgery, the system is used as a stent and provides good blood perfusion to the area. For one month before and one month after the procedure, domes with a soft border are applied over the breasts at night and during week-ends. A small pump provides light suction, which makes the breasts gradually expand. To view the system, go to www.mybrava.com. Examples of results are shown at "breast augmentation with Brava® and lipofilling" and at "from capsular contracture to lipofilling, with Brava®". The website of Dr. Khouri, the creator of Brava®, provides more information on this subject.

collagen
Collagen is the fibre structure giving firmness to various tissues such as the cutis and tendons. Injectable collagen to treat wrinkles is derived from cattle. Characteristics typical of the animal species are removed, so that the human body does not consider it a foreign substance. The injected collagen is absorbed by the cutis’ own collagen, but is subsequently also gradually degraded making the effect temporary. Injectable collagen has been used for many years. This is why most experience and results are available on this particular biological wrinkle filler. Some people are allergic to this product; it is therefore to be tested twice on the forearm before being used to fill in wrinkles. Brand names: Koken ®, Zyderm ®, Zyplast ®.

hyaluronic acid
Depending on the production process, this biological product is derived from rooster combs, bacterial cultures or without involvement of any animal material. It is used to fill in wrinkles in more or less the same applications as collagen. The substance is gradually degraded, making the effect temporary. Although a certain amount of irritation cannot be excluded, a real allergic reaction to hyaluronic acid has not been clearly established. This is why, contrary to collagen, no two prior tests are required before use. Brand names: Restylane®, Hylaform®, Juvederm®, and many others. Hyaluronic acid has taken over the leading position in wrinkle filling from collagen.

lipofilling
Fat tissue can be aspirated by careful liposculpture from local deposits (eg. Abdomen, hips or thighs) and reinjected in other areas after purification by filtering or centrifugation. The most important applications are facial volume restoration, correction of local skin retractions (e.g. on the thighs or the buttocks), and breast augmentation. Expansion of the breasts by gentle negative pressure (Brava®) before and after the operation is useful to realise larger volumes.

liposculpture
This is the current term for fat aspiration through incisions only a few millimetres in length. The name change from “liposuction” is a fashion trend. As methods became more sophisticated and offered more prospects, someone came up with this other name. After all, sculpting, shaping, sounds better than aspiration. It is really quite natural that a technique which has been around for decades, has gradually been refined, as happens in all other branches of medicine or other professions. The main evolutionary changes have been the use of thinner aspiration cannulas of 3 to 5 mm instead of 8 to 12 mm and the tumescence. Technical variants are the use of sound waves (ultrasound) or mechanical oscillation (vibro-liposculpture) to facilitate movement of the aspiration cannulas through the tissue.

liposuction
Original term for the aspiration of fat. It has become a fashion trend to call the more refined version of the procedure “liposculpture”.

lymph
Tissue fluid which does not circulate through veins but drains off in the direction of the heart through a fine network of lymph vessels. Pathogens penetrating the body, as well as malignant cells, sometimes travel in this manner. They are fought off in the lymph nodes.

lymph drainage, manual lymph drainage
Specialised, gentle massage, carried out by a physiotherapist, whereby lymph build-up in the tissues and lymph vessels themselves is drained away back into the blood circulation. This technique is important in the treatment of swollen limbs. Aesthetic medicine observes a noticeably faster decrease in swelling after liposuction in combination with this follow-up treatment.

lymph nodes (old name: lymph glands)
Lymph vessels converge into lymph nodes. When dealing with infections or malignant pathogens, defence cells pile up in the lymph nodes to kill off germs or malignant cells. This causes swelling of the gland. Lymph nodes can be found in abundance in the neck, underarms and groin. A gentle to firm, light swelling of one or more glands may be perfectly normal. After all, our body is involved in a constant defensive struggle against the outside world.

lymph vessels
The heart pumps the blood around through the arteries. The arteries branch off into ever smaller venules, then into capilleries. Fluid and nutrients seep through the capillary walls and end up in the tissues. At the other end of the capilleries fluid and waste products are drawn back into circulation and transported back to the heart in ever widening veins. However, not all tissue fluid is reabsorbed into circulation. A part, called lymph, is drained off through a network of very fine vessels without blood cells, the lymph capilleries. This drainage takes place at a much slower pace than circulation. Through collection depots, lymph nodes, the lymph arrives in larger vessels and is eventually returned back in the blood circulation near the heart.

soft liposculpture
Commercial fashion term for soft liposculpture. A properly performed liposculpture on healthy individuals on a not too large part of the body under local anaesthetic, is not very painful or aggressive. Soft liposculpture is therefore standard technique as practised in good plastic surgery.

tumescent liposculpture
Technical term for liposculpture preceded by a specific preparation of the fatty tissue. Substances for a local anaesthetic are added to a saline solution (such as a drip, a "Baxter ®"). At the start of the procedure, the fatty tissue in question is injected with this. In this manner, the procedure can often be carried out under local anaesthetic. The fat cells are weakened, facilitating removal during liposculpture by means of oscillation or aspiration, with less bruising.

vibroliposculpture
Liposculpture using a small engine to carry an oscillating movement to the aspiration instrument. This is a standard technical refinement, a device to perform the procedure with as little force and as evenly as possible.