Plastic Surgery Innovations: An Interview with Dr. Theodore Diktaban
Dr. Theodore Diktaban credits his tenth-grade biology teacher at Westbury High School with inspiring him to go into medicine, but it was actually his own health issue that helped him choose his specialty. “He was one of the most influential teachers I ever had and biology really captured my interest.” After getting his undergraduate degree from Colgate University, Diktaban went on to New York Medical College. It was there, when he needed surgery to fix a deviated septum, that his future as a surgeon decided. Although the plan was to have the deviated septum fixed, the surgeon asked Diktaban if he wanted him to “fix the outside of his nose as well.” Diktaban agreed.
A highly specialized plastic surgeon, researcher and pioneer of minimally-invasive surgical techniques with nearly 30 years of experience, Diktaban has the distinction of being one of only 180 surgeons in the U.S. certified by both the American Board of Plastic Surgery and the American Board of Otolaryngology. For eight consecutive years, he has been listed in the prestigious Castle Connolly “New York’s Top Doctors” Directory as one of the “Best Plastic Surgeons in New York.”
Education Update (EU): What are the most common procedures you perform?
Dr. Diktaban (Dr. D): “Lasers, fillers, Botox are all very popular,” the doctor says. “When people age now, there are so many choices.” Breast augmentation, liposuction (traditional and Smartlipo), Cellulaze and rhinoplasty.
EU: What has been the most challenging surgery you’ve performed?
Dr. D: Microsurgeries are the most challenging that I’ve experienced.
EU: What exactly is Cellulite?
Dr. D: Connective tissue bands beneath the skin, called fibrous septae, are arranged in a crisscross manner in normal skin. When they are oriented in a parallel manner from birth, they allow the fat to bulge up against the skin’s thinner surface, creating a rippling, lumpy look. Some septae also harden and contract as women age, which causes more bulging and dimpling by pulling the skin surface inward.
EU: What causes cellulite and is it preventable?
Dr. D: We’re not sure of the exact causes, but they’re believed to be genetic and hormonal. Cellulite can’t be prevented, but staying thin makes it look less pronounced. The fat cells get larger or increase in number with grossly overweight people, which cause them to push up against the thin skin. The skin cannot contain their force. When you lose weight, they shrink, but don’t disappear.
EU: Where is cellulite most likely to appear?
Dr. D: The lower buttocks and back of the thighs are definitely the most common areas. The abdomen, inner thighs, front of the thighs, and even the upper, outer arm can be affected.
EU: How does Cellulaze work?
Dr. D: The FDA approved the treatment about five months ago. It’s a minimally invasive, one-time procedure that uses smart lipo laser technology. It works with a 1440 mm wavelength that has the greatest affinity for fat and water. Besides its ability to be fired straight ahead, the laser can be aimed off to the side and directed right down at the fat, up against the skin, as well as sideways at the fibrous septae. This multidirectional laser treatment allows us to finally be able to correct the anatomy that causes cellulite.
We work with a plastic grid with 12 squares, each measuring 2 by 2 inches, and we completely mark out the area affected by cellulite.
We give patients a couple of valiums and painkillers to get them nice and relaxed and then inject a thin layer of liposuction liquid under the skin. Following that, we make a small pinpoint puncture to let the angel hair size laser enter. Each of the squares will receive a calculated amount of energy to the bulging fat, contracted septae and the thin skin. After the calculations, it’s time to go to work. We aim the red laser sideways to cut the septae; straight down to melt the fat, and then up against the undersurface of the skin to directly tighten and thicken it. Once all of the laser energy is delivered to the squares, the melted fat and liquid is gently rolled out. The patient is placed in an elastic garment and then sent home shortly after.
EU: How has cellulite been treated in the past?
Dr. D: All treatments up until now have been non-invasive. There were lotions and potions but they didn’t work. Heating and vacuuming or suction massage caused temporary improvement at best. The reason these external treatments cannot work is because we can’t heat the skin enough to be really effective and the suction isn’t powerful enough to disrupt the fat or divide the fibrous sepate bands. Cellulaze is a one-time treatment in contrast to the external devices that require 8 to 12 treatments over a number of weeks, which cause a little bit of swelling, but then they go back to looking the way they were.
Patients should take two days off to relax and let the oozing subside. The patients can take a shower the day after their treatment and then put the elastic garment back on.
Bruising and swelling have been mild. Some patients are taking one painkiller a day to ease the discomfort. Initially, we were concerned about using the laser close to the skin, but numbness has been minimal.
Patients can exercise after a couple of weeks, but other than that, they can return to normal activity after a few days rest. It takes about six months to see the full effects of the Cellulaze treatment. The skin also needs to be massaged while it’s contracting. #
Theodore Diktaban, M.D., F.A.C.S. can be reached at 635 Madison Avenue, 4th Floor, New York, NY 10022. (212) 988-5656 | www.drdiktaban.com