How to Do It?

Minimally invasive procedures to tighten and lift skin give natural results with minimal risk and recovery time. Monopolar radiofrequency delivers a high-frequency electric current—tissue resistance to electrical current results in volumetric heating to the deep dermis and underlying tissue. The resulting heat leads to immediate collagen contraction and a delayed wound healing response, with new collagen formation up to 4 to 6-month post-treatment. INITIALLY, the FDA approved monopolar radiofrequency (RF) devices to treat periorbital wrinkles. Since then, they have been used to treat laxity of the forehead, cheeks, nasolabial folds, marionette, lines, jawline, and neck. Although the results of RF are not as dramatic as a facelift, over 90% of patients obtain noticeable tightening of the treated areas, and it never looks “pulled.” Another benefit of radiofrequency is reducing fat and tightening the skin by directing energy to target collagen. For example, a patient with flabby upper arms may have more loose skin than fat in this area. In this instance, Prof Moawad might use radiofrequency to tighten the skin first and then remove excess fat. However, if he determines that there is fat mainly in an area, he will remove the fat first and then tighten the skin afterward. “Radiofrequency is a versatile procedure that can be used on any area of the body – from large areas like the abdomen to minimal areas such as the chin – with the same degree of success.

Fractional radiofrequency (FRF) is the newest in the nonabrasive approach. FRF uses an array of microneedles arranged in pairs between which bipolar RF energy is delivered. The fractionally delivered energy creates zones of thermally damaged skin adjacent to unaffected areas. The damaged skin stimulates wound healing and deposits new collagen, elastin, and hyaluronic acid formation. The unaffected areas serve as a reservoir of stem cells that accelerate wound healing.  FRF improves acne scars, large facial pores, and skin quality. FRF devices are safe, tolerable, and effective modalities for wrinkles and facial laxity reduction. I may use a topical anesthetic cream before the treatment to minimize pain. Fractional radiofrequency is combined with PRP with significant amounts of growth factor and heal promoting factors to fasten healing. Recently, Nanofat has been combined with fractional radiofrequency to enhance skin quality and stimulate hair follicles. Fractional radiofrequency gives a wake-up call to your skin to remove injured collagen and elastic fibers, encouraging your fibroblast to synthesize new collagen and stimulate hair follicles to stem cells.

Skin rejuvenation laser peel involves the removal of the outer layer of damaged skin. Many ablative skin resurfacing techniques are available at MSI, broadly grouped as mechanical, chemical, and laser abrasion. All ablative techniques result in upper to the mid-dermal wound. Dermabrasion relies on mechanical 'cold steel' injury, acid peels result in a 'caustic' injury, and lasers result in a thermal injury. All ablative resurfacing treatments work the same way. First, the outer layers of damaged skin are stripped away. Then, as new cells form during the healing process, a smoother, tighter, younger-looking skin surface appears. Superficial or medium resurfacing is limited to the epidermis and papillary dermis. For deeper resurfacing, I can also remove the upper levels of the reticular dermis. Unlike chemical peels and dermabrasion, laser skin resurfacing (LSR) with the CO2 laser generates heat, which results in immediate tightening because of the shrinkage of collagen, which forcefully shortens the collagen fibers by 30%. This translates clinically into the smoothing out of superficial irregularities, including wrinkles, acne scars, nevi, epidermal growths, and even tumors, and a tightening effect that improves the skin's overall appearance. The laser stimulates the growth of healthy new collagen and elastic fibers in the skin continuously for six months after resurfacing. Therefore, any wrinkles or scars will continue to improve for up to one year. Nonablative or minimal ablative fractional CO2 holds great promise in both treatments of skin textural abnormalities (acne scarring, wrinkles, and skin mottling associated with photoaging) and pigmentary variation (melasma, hyperpigmented scars, lentigines, and dyschromia

Acne inversa or hidradenitis suppurativa (HS) is a disease that usually begins as pimple-like bumps on the skin. The pimple-like bumps tend to develop in places where everyday pimples do not appear. HS is most common on the underarms and groin. Getting treatment for HS is important. Early diagnosis and treatment can prevent HS from worsening. If HS worsens, the pimple-like bumps can grow deep into the skin and become painful. They can rupture, leaking bloodstained pus onto clothing. This fluid often has a foul odor. As the deep bumps heal, scars can form. Some people develop tunnel-like tracts under their skin. As the skin continues to improve and scar, the scars thicken. When thick scars form in the underarm, moving the arm can be difficult. Thick scars in the groin area can make walking difficult. Because HS can look a lot like acne, folliculitis, or boils, it is best to see a dermatologist for a diagnosis.

A dermatologic surgeon usually does plantar warts removal. Plantar warts are small growths that usually appear on your feet' heels or other weight-bearing areas. This pressure may also cause plantar warts to grow inward beneath a hard, thick layer of skin (callus). Plantar warts are caused by HPV. The virus enters your body through tiny cuts, breaks, or other weak spots on the bottom of your feet. Dermatologists have many treatments for warts. The procedure used depends on the patient's age and health. I prefer to cut the callus by scalpel. Then I use a curette to remove the viral material. Then I use a vascular laser to burn or cauterize tiny blood vessels that feed the virus. Then it cauterizes the base using an ablative laser or chemical TCA. A topical antibiotic is applied, and a special dressing is applied. The patient can walk without any pain immediately

There has been a 70% increase in minimally invasive cosmetic procedures and a 50% increase in dermabrasions over the past decade. Dermabrasion has many applications as a skin resurfacing technique and is used to treat fine perioral rhytids and many scars, including acne scars. It is done under local anesthesia with the option of sedation. The area to be dermabraded is marked. The appropriate diamond fraise tip is chosen, the skin is held taut, and the dermabrader is moved across the surface with constant, gentle pressure. A back-and-forth motion is used for the diamond fraise tip. The borders of the treated area are feathered to prevent any noticeable transitions. The depth of skin that is dermabraded is one of the most critical factors that will determine the outcome. Punctate bleeding is visualized when entering the papillary dermis. The papillary reticular junction is the ideal endpoint of Dermabrasion and is identified by increased, confluent bleeding. Immediately following the procedure, saline-soaked gauze moistened with dilute epinephrine may be temporarily placed on the open wounds to achieve hemostasis. A moist environment is necessary to promote wound healing. Dermabrasion is a useful skin-resurfacing tool; when performed correctly, it can achieve dramatic results and can be more effective than chemical peels or lasers, with a low risk of complications in patients with darker complexions

Hair loss treatment is mistakenly thought to be a strictly male disease, women make up a significant percentage of American hair loss sufferers. Hair loss in women can be devastating for self-image and emotional well-being. Unfortunately, society has forced women to suffer in silence. It is considered far more acceptable for men to undergo the same hair loss process. Unfortunately, the medical community pays little attention to the issue of women's hair loss. Since hair loss doesn't appear to be life-threatening, physicians often overlook women's complaints about hair loss and essentially tell their patients that" it's no big deal" and that "you'll just have to live with it." Of course, these physicians don't realize that the psychological damage caused by hair loss and feeling unattractive can be just as devastating as any severe disease. It can take an emotional toll that directly affects physical health. The most recent available hair preservation and restoration treatment is the newly introduced combination of mesotherapy, infrared technology, and oxygen therapy only at the MSI hair care unit. A tiny amount of active ingredients of minoxidil, and finasteride together with all vitamins and trace elements are injected via computerized mesogun into the mesoderm of bald areas. It gives excellent results in both Androgenic and pseudo androgenic alopecia.

Upper eyelid lift surgery or blepharoplasty is required when the eyelids require recontouring. Specifically, blepharoplasty is most useful when excess skin needs to be removed, the orbicularis oculi muscle is hypertrophic or requires tightening, or orbital fat should be removed or redistributed. Upper eyelid lift surgery typically involves an incision made in the natural crease above the eye. Your cosmetic surgeon will remove a precise amount of excess skin and fat and adjust the surrounding muscles to make the desired improvements.

Lower eyelid lift surgery or blepharoplasty involves several surgical approaches. Cosmetic surgeons can use various surgical techniques to improve the lower eyelids; incisions are located on the outer edge of the lower eyelid, just beneath the eyelashes, or inside the eyelid. Your cosmetic surgeon will explain the approach they determine is best for you. Your cosmetic surgeon will remove or reposition fat through the incisions to create a smooth, natural contour beneath the eyelid. Depending on the case, I may remove excess, sagging skin or tighten the lower eyelid muscle to supply the most natural, effective results. Lower eyelid transconjunctival blepharoplasty is readily carried out using the CO2 laser or standard incisional devices (radiofrequency)

Light skin treatment or photo-rejuvenation encompasses many procedures using light or laser-based technology to reverse the effects of photoaging. Photo-rejuvenation refers to the controlled use of thermal energy to enhance skin rejuvenation without disturbing the overlying epidermis and with minimal to no downtime. Currently employed non-ablative modalities include primarily intense pulsed light (IPL), visible wavelengths including 585nm pulsed dye laser (PDL), and 532 nm green light (KTP laser). Different infrared wavelengths with water as the target are used for remodeling dermal collagen. The primary mechanism of action is thermal injury, either by heating the dermis to stimulate fibroblast proliferation or by heating blood vessels for photocoagulation. The newest way to deliver these wavelengths is by fractionating the dose. The non-thermal mechanism, which represents a fundamental change in thinking, is the theory of photo-modulation. This novel approach to photoaging uses non-thermal light treatments to regulate the activity of cells and not invoke thermal wound healing mechanisms. The two types of photo-rejuvenation available are the Intense-Pulsed Light (IPL) and the Light-Emitting Diode (LED) treatments. It's essential to understand the difference between these technologies to get the results you hope to do. Your best bet for minor skin problems is to schedule an LED (often called a Non-IPL) treatment, and for more severe conditions, you'll book to IPL.

No needles mesotherapy or electroporation device seeks to do the same as injection mesotherapy such as skin rejuvenation, whitening, acne, hair re-growth, localized fat reduction, and cellulite treatment. It uses a pulsed low-frequency current, whose intensity is adjusted by the operator. It delivers a particular waveform that ionizes the molecules in the active ingredients used in the treatment and creates tiny channels in the skin for the elements to travel down. Ingredients in water-soluble molecules permeate the skin's natural lipid barrier and then cascade through the tissue beneath via minute channels to penetrate the surface up to 9 -10cms and introduce 90% of the active ingredients being administered. This pain-free option is said to offer a practical mesotherapy alternative for needle-phobic.

Buttocks high definition (HD) liposuction is a demanded procedure in Egypt. The buttock area has received much media attention in recent years, which has produced increased patient demand for buttock reshaping. Four different anatomic variables:1. The underlying bony framework, 2. Gluteus maximus muscle,3. Subcutaneous fat topography, and 4. Skin influences the overall shape of the buttocks. The subcutaneous fat has the most significant impact in establishing the overall shape of the buttocks. Liposuction, the number one cosmetic surgery performed globally, is a procedure removing unwanted lumps, bulges, and areas of resistant fat deposits from specific areas of the body. Buttocks Liposuction is performed using a hand-held instrument (cannula) attached to a vacuüm-like machine or a syringe. By pushing and pulling the cannula, fat cells are broken up and then sucked out with a vacuüm which is called traditional Buttocks Liposuction. Today, I can use several liposuction techniques to improve the ease of the procedure and enhance the outcome. Based on the experience of Prof Moawad for the last 20 years, he prefers the tumescent technique assisted with a suction cannula for considerable buttocks reduction. If precise contouring is the goal, he prefers syringe liposculpture. Syringe liposuction is a must when fat transfer is needed. Thorough anatomic analysis, surgical technique, and constant communication with patients to determine their aesthetic preferences are encouraged.

Thigh-high definition (HD) liposuction is indicated for patients present for thigh contouring to take care of obesity, fat collection, skin laxity, or both. The ideal patient for liposuction is the one who has localized areas of fat in the thigh but is otherwise fit and does not have skin laxity. Patients may also present with deformities after a prior attempt at thigh lift or thigh liposuction elsewhere will benefit from thigh fat injection. Lower extremity liposuction treats lymphedema that does not entirely resolve with nonsurgical measures. There is a risk of contour deformity and skin laxity. Liposuction in the knee and thigh, therefore, must be conservative. Based on the experience of Prof Moawad for the last 20 years, he prefers syringe liposculpture for small thighs and the external ultrasound power-assisted liposuction for large ones.

ack HD liposuction applies to individuals with localized fat in the upper and lower back. Both men and women present with fullness in the back which primarily comprises subcutaneous fat. Women are more typically present for upper back contouring as lipodystrophy leads to issues with fullness around the bra line and dissatisfaction with the appearance of clothing fitted in the torso. Women and men present with lipodystrophy in the waist and hip/flank region, often part of a circumferential process. The back typically houses fibrous fat and relatively thick skin, which contracts well after Liposuction, particularly Our technique with ultrasound-power-assisted Liposuction. Liposuction of the back often nicely complements abdominoplasty in men and women to give a more global improvement in the torso with improvement in the waistline. Liposuction of the back can decrease fullness in the upper back by reducing subcutaneous fat and can result in skin retraction, particularly with power-assisted ultrasound liposuction (U-PA) or HD liposuction. Liposuction of the upper back is an excellent complement to the arm, and breast lifts, while Liposuction of the lower back will complement the abdomen, buttocks, and thigh lifts. Liposuction of the upper and lower back secondarily unmasks and enhances the buttock region. The sacrum often has a fatty deposit that responds well to Liposuction and helps contour the buttock. Liposuction of the back is not a procedure often applied to massive weight loss patients who have achieved a body mass index of less than 30. Their issue is more skin redundancy and lax tissue than subcutaneous fat. After 15 minutes of massage with external ultrasound, the power of Vibro-assisted Liposuction (PAL) or HD liposuction is used to enhance back contouring.

Arm HD liposuction is appropriate for younger patients with fatty collections and good skin quality. Women request this procedure more than men. Skin is relatively thin in the arm, so skin retraction is less likely in the standard patient than abdomen or back. Skin laxity is possible after liposuction, and if this is anticipated, it is best to discuss the potential need for second-stage skin removal. Arm HD Liposuction treatment is often weighed against arm lift with the possibility of a visible scar. While liposuction reduces bulk and improves the contour of the arm, it cannot adequately treat skin redundancy. Liposuction in the arm is challenging, finding the balance between removing subcutaneous fat to uncover a more muscular physique without removing so much that there is resulting skin redundancy. Today, non-invasive options are performed as an adjunct to liposuction to enhance the completeness of fat removal and the evenness of the result and aid in skin tightening and smoothing.

Arm lift surgery or Brachioplasty is rapidly increasing. Tremendous variability in presentation has led to different types of arm recontouring. From suction-assisted lipectomy, for appropriate candidates, to minimal incision Brachioplasty and a more extensive arm lift procedure. The objective is to reproduce a proportional functional proportional and functional arm contour. Patient selection, preoperative assessment, and a clear understanding of the arm’s anatomical features are paramount. Preoperatively designed markings of four significant groups of arm lift-minimal incision, standard, extensive, and chest-arm lift are based on the position and proximal and distal involvement of excess skin and fat and preferred scar position. Selective ancillary procedures, such as breast recontouring and upper body lifts, can be helpful adjuncts to arm lifts. 

Abdomen HD liposuction is indicated when a patient has average weight with firm elastic skin. However, he has pockets of excess fat that are resistant to diet and exercise and disproportionate to the rest of their body. Overweight patients may also have lipodystrophy, but food and exercise, rather than large-volume abdomen liposuction, are the mainstays of treatment for generalized obesity. Some patients must have multiple procedures if they have more fat than I can safely remove in one operation setting. While no method of abdomen liposuction is a substitute for proper nutrition and physical exercise, nor is it an alternative for general weight reduction. Abdomen liposuction is helpful as a secondary procedure after prior abdominoplasty to help further contour the abdomen. Abdomen etching is a form of superficial abdomen liposuction performed to simulate the appearance of muscle definition (high definition Lipo). Today, fat extraction or fat injection is used to improve the outcome. Based on the experience of Prof Moawad for the last 20 years, he prefers the tumescent syringe technique for a small stomach and ultrasound power-assisted cannula for the large abdomen.

Mini-tummy or abdomen lift surgery is an excellent procedure for patients with slight skin excess who want skin tightening. The ideal candidate already has a suprapubic horizontal scar, such as for cesarean section, and is young and fit except for some lower abdominal muscle weakness. Mini-abdominoplasty may be performed as an outpatient. The overall idea is to improve the contour of the abdominal wall by rectus abdominis fascia plication and remove excess skin and fat from the region. Mini-tummy tuck is achieved using a low-lying suprapubic incision that can be hidden under the bikini line. First, liposuction (Ultrasound-power-assisted liposuction) is performed in the epigastric or flank fat collection. After liposuction is complete, an incision is made in the suprapubic marking. Dissection is taken through the subcutaneous fat to the abdominal wall, and then superior dissection elevates the skin flap up to the umbilicus. The lower rectus is plicate with two layers of the suture. The flap is advanced inferiorly, the excess is removed, and the incision is closed by re=approximating Scarpa’s fascia and skin. The downward traction of the flap might pull down the navel a centimeter or two. Drains might be usually used.