Is ThermiVa Vaginal Rejuvenation Treatment Painful | Orlando Med SpaThermiVa RF system is a unique procedure based on radio frequency energy to tighten loose vaginal muscles and labial tissue. For women who want to improve their sexual aesthetics without involving cosmetic surgery may consider ThermiVa as a safe, comfortable and effective treatment option.

Some women will naturally be concerned about whether ThermiVa vaginal rejuvenation procedure is painful. The treatment provider will discuss this aspect in detail during the initial consultation. Board certified plastic surgeon Dr. Thomas Fiala provides ThermiVa treatment to patients in Orlando, Altamonte Springs, FL, and surrounding locations.


Safe and Painless RF System

Traditional RF systems were known to cause considerable amount of discomfort during the procedure. These systems were designed to blast RF heat and then use cooling techniques to reduce the pain. These ‘blast and cool’ devices were unable to deliver sustained, controlled, gentle heat to the targeted tissue. ThermiVa vaginal aesthetics procedure has changed all that.

ThermiVa applies heat a consistent temperature ranging between 40 and 45 degrees Celsius. The delivery is comfortable and sustainable because of the “Temperature Controlled” system. Advanced software and technology used in ThermiVa enables slow heating of the tissue to the desired temperatures, and then maintain the temperatures to achieve tissue contraction in a gentle, painless manner.

Detailed clinical studies to determine the safety and comfort levels of ThermiVa procedure have been completed with clearly established results. No burns or blisters or other adverse events have occurred since 2009 with ThermiVa. Burns and blisters typically occur above 55 degrees Celsius temperatures, a limit which is never reached by ThermiVa.

ThermiVa system is not only more comfortable than a plastic surgery procedure, but it also scores over advanced laser systems that may be used to shrink the labia majora. Ablative lasers will require local anesthesia and involve significant downtime, while ThermiVa does not require any specific recovery time. Dr. Fiala receives patients from Orlando, Altamonte Springs, FL, and nearby areas for ThermiVa vaginal rejuvenation.


Anesthesia and Downtime

While laser and other systems will usually require local anesthetic for treatment of the labia major and the vaginal opening, ThermiVa RF system does not require any type of anesthesia. ThermiVa treatment may feel similar to a warm stone massage, and give any stinging or prickly sensations during the procedure.

Another good thing is that ThermiVa entails zero downtime. The patient can immediately resume her normal activities. She will have no restrictions on sexual activity, going to the gym or performing any physical exercises. No abnormal discharge will occur after the treatment.


No Risk of Complications

ThermiVa does not have any risk of side effects or complications that are normally associated with a surgical procedure. Therefore, it has emerged as a treatment of choice for many women. Busy mothers and working women, in particular, prefer ThermiVa because they do not want to go through a procedure that would involve a prolonged downtime and discomfort.

A lot will also depend on the skill and experience of the treatment provider how they perform the procedure and whether they follow all the safety protocols that are related to any RF based aesthetic treatment.

For more information of the treatments and procedures offered at this Plastic Surgery Center & Orlando Medical Spa by Dr. Thomas Fiala please contact us at (407) 339-3222 or visit ; ;

Laser Vein Treatment for Varicose Veins

Laser Treatments | Sclerotherapy | Varicose Veins | Orlando FLLaser technology has revolutionized the medical aesthetics field by making a wide range of surgeries less invasive, more efficient and more precise. Varicose vein treatment may be performed through traditional methods such as injectable sclerotherapy, invasive surgery, or through advanced laser therapy. A state of the art cosmetic surgery or med spa facility providing vein treatments will usually include laser therapies.

A highly focused laser beam is passed through the diseased varicose and spider veins. The heat energy generated through laser in a concentrated area causes the vein to form scar tissue, which closes the targeted vein. As the closed vein loses its blood supply source, it gradually collapses and dies. Board certified plastic surgeon, Dr. Thomas Fiala, is a leading providing of laser vein treatment for patients in Orlando, Altamonte Springs, FL, and surrounding communities.

Superficial Laser Treatment

If the patient suffers from tiny varicose veins and spider veins, usually in the facial area, the surgeon may recommend a superficial laser vein treatment. This simple treatment will be performed on the outside of the skin to remove spider veins and improve skin aesthetics. More than one laser treatment session may be required for this procedure.

In some cases, prior to carrying out the simple laser vein treatment, the cosmetic surgery and laser vein expert may first treat the larger feeder vein that may be causing poor blood circulation in the tiny veins. This will be done through endovenous laser surgery, sclerotherapy, RF treatment, or other procedures.

Endovenous Laser Therapy

Endovenous laser therapy is a moderately invasive procedure aimed at removing larger varicose veins in the legs. The procedure involves the passage of a laser fiber through as thin tube or catheter into the vein. The laser expert monitors the vein on an ultrasound screen during this process. Endovenous laser therapy is less painful as compared to stripping and vein ligation, and involves shorter recovery.

In most cases the plastic surgeon or the laser vein expert will perform this procedure with the patient under local anesthesia or mild sedation. Dr. Thomas Fiala is an eminent plastic surgeon receiving patients from Orlando, Altamonte Springs, FL, and surrounding locations for laser vein treatments.

Recovery Process

Following the superficial laser therapy for spider veins, no specific downtime is involved. The patient will be able to resume the normal daily routine immediately in most cases. Even with endovenous laser therapy, the recovery process is significantly easier as compared to traditional surgery.

In about two days following the endovenous procedure, the patient should be able to return to work or resume regular activities. Walking can be started almost immediately after the treatment. The laser expert will provide compression stockings, which may have to be worn for a few weeks to provide added support and promote healing.


In the last 20 years, simple laser treatment for spider veins has evolved as one of the safer and more effective treatment options. In case of endovenous laser therapy, the success rate is as high as 94 out of 100.

In other words, the desired results for certain varicose veins may not be achieved with endovenous laser treatment in about six out of 100 cases. In such cases, the surgeon may apply traditional surgery, sclerotherapy, or other invasive solutions to treat the targeted varicose veins.

For more information of the treatments and procedures offered at this Plastic Surgery Center & Orlando Medical Spa by Dr. Thomas Fiala please contact us at (407) 339-3222 or visit ; ;

shutterstock_154101329Laser has emerged as one of the most powerful non-surgical techniques to reduce skin anomalies and restore enhanced aesthetics and attractive appearance of the skin. The treatments that employ laser technique can provide similar benefits as traditional cosmetic surgery, and usually deliver more precise and targeted outcomes.

Dr. Thomas Fiala is a leading, board certified plastic surgeon providing state of the art laser skin treatments and other procedures. Patients in Orlando, Altamonte Springs, FL, and nearby locations have an opportunity to receive some of the latest and innovative laser skin treatments from Dr. Fiala.

How does Laser Treatment Work?

A laser essentially represents a single wavelength source of intense and consistent light that can be transferred into the affected area of the skin to address a particular skin condition. The laser energy reaches the deeper skin tissue without the need for any surgical cuts or incisions, and produces the desired skin aesthetics from inside out.

Therefore, the outcomes can be more natural looking and sustainable. In comparison to cosmetic surgery procedures, the results can be more precise, and the damage to surrounding healthy tissue may be minimal. Dr. Fiala is an eminent plastic surgeon providing laser skin treatments to patients in Orlando, Altamonte Springs, FL, and other areas.

Skin Conditions Treated with Laser

Laser treatments can be designed to produce effective results in the following common skin conditions:

  • Birthmarks
  • Sun damage
  • Acne scars
  • Wrinkles
  • Fine lines
  • Skin texture irregularities
  • Eczema
  • Rosacea
  • Pigmented Lesions
  • Scars
  • Skin Redness
  • Treat damaged blood vessels
  • Skin Laxity
  • Cellulite
  • Spider Veins

Laser Skin Resurfacing, Skin Tightening, and Fractional Laser Skin Resurfacing are three of the most important anti-aging aesthetic skin procedures that involve customized laser therapy.

Latest Laser Technologies

Fiala Aesthetics Medical Spa employs some of the most advanced and proven laser technologies for skin treatment, which include the following:

  • Cutera XEO platform with Nd:YAG 1064 laser and IPL Laser Genesis
  • Titan Skin Tightening with infrared energy
  • Fractional CO2 laser for resurfacing

Results with Laser

Results with laser treatments are very significant in most cases, but the degree of improvement may vary according to the patient’s unique skin condition and the technology employed. Wrinkles and lines, for instance, can be reduced substantially with CO2 laser skin resurfacing.

On the other hand, if the patient needs only subtle changes, Laser Genesis treatment may be used. This is a much less invasive procedure and involves almost no downtime. Appropriate laser technique and degree of treatment can be determined to match with the patient’s specific condition and their unique aesthetic needs.


Laser treatments for skin enhancement have been in use for several years as a part of various medical and aesthetic procedures. It is important to ensure that the laser skin solution is provided only by a qualified facility that is fully equipped and trained in every aspect of laser therapy.

Most aesthetic procedures with laser have a low risk profile, but individual results may vary according to the patient’s condition, laser provider’s expertise, and the technology used.

For more information of the treatments and procedures offered at this Plastic Surgery Center & Orlando Medical Spa byDr. Thomas Fiala please contact us at (407) 339-3222 or visit ; ;

Here’s an interesting idea:  what happens if you laser an incision right at the time of wound closure?  Does it help?  According to a tiny pilot study published in Archives of Dermatology last month, it might help the scar end up looking better.

Ten dermatology patients, who were having some skin lesions excised from their face or arms, were put into this study, where one-half of the wound was treated with a fractional CO2 laser at the time of suture repair.  The incisions were then graded at about 2-3 months post-op by having other dermatologists review the photos.  In this study, 9 out of 10 times, the laser treated side looked better to the patients and to the physicians.  One photo, which was not overwhelming to me personally, showed a slight improvement on the laser side.

So, what do we make of this study?

1)  It’s interesting, but needs to be repeated in a larger version with more patients.
2)  The  scars need to be followed for longer than 2-3 months, in order to make a judgement about things.  It may be, for example, that the laser treatment only delays the final appearance of the scar, which could show up later.
3)  Most of these incisions were on the face, where laser resurfacing treatment is better tolerated than any other area of the body.
4)  There was no division of patient results according to skin type – and we know that darker skin types have more side effects from laser resurfacing.  Is this a treatment that only works for Caucasians?

Conclusion:  Too early to say whether we’ll end up adopting this concept.  More work needs to be done first.

Here’s a cool product I checked out in Boston: 3-D imaging for patients, without an expensive, dedicated multi-camera system.

Swiss software company Crisalix has been working on this for several years, and now they are at the stage where they are offering a commercial product, designed to help patients thinking about breast augmentation surgery. Simply upload 3 standard digital photos, 1 taken face on, and two taken from the lateral (side) position to their secure & protected server, add in some measurements, place some digital markers on selected topographical landmarks, and five minutes later – they send you a 3-D reconstruction image.

Then, using their morphing software, they can show you how the image would change with an implant placed there, and even demonstrate how it might look in a swimsuit or in a shirt! They have all the dimensions for commonly used saline and silicone implants, and can show what a subglandular, dual-plane, or submuscular implant might look like. I checked this out in Boston, and the images look pretty good – close to what I would expect in a clinical situation.

They charge $50 for this service – so it’s a fair question if patients would be willing to pay extra for this, or not. (Let me know what you think, people!)

Imaging companies like Canfield Imaging and Axis Three have also had 3D imaging systems like this – but they were expensive, costing in the range of $20,000 – $40,000. The dedicated cameras were moderately large, and required a room dedicated to the equipment. This new software from Crisalix doesn’t have these drawbacks. However, it doesn’t work on ptotic (droopy) or large (D+) breasts as yet – these will apparently be addressed in a future software upgrade. It also may not be quite as good as the Canfield system for patients with a lot of chest wall (ribcage) deformities.

We’ll be trying out the new Crisalix software. If you are interested in having a 3D image of your breast and torso made, let us know during your breast augmentation consultation.

Palomar has received FDA clearance for their latest product, a hand-held, battery-powered laser. It’s called the “PaloVia”, and is the first unit cleared by the FDA for home use.

The PaloVia uses a fractional method, in which only small “polka-dots” of skin are treated, and is non-ablative – meaning there won’t be any raw, oozing areas after the treatment. It uses an established wavelength for treatment, 1410nm.

The company recommends daily treatment to the crow’s feet area for one month, and then maintenance treatments twice weekly thereafter.

In their preliminary study, 92% of patients saw an improvement of one step on the Fitzpatrick wrinkle scale (FWS). The FWS is a nine point scale, so one step, while measureable, is a pretty mild change.

Palomar has been pretty secretive about the other parameters of the laser. Obviously, the power of this laser is much, much less than an office-based machine, so the depth of penetration of the laser beam will be less, tissue heating will be less, and so the total effect will be much less. It might be enough to treat the thin skin around the eyes, but probably not enough to treat other facial areas, where the skin is thicker. It will probably be a good addition to retin-A based skin care and Botox, but time will tell.

Nevertheless, the whole concept of “at-home” lasers is newsworthy. Palomar is marketing these through QVC, so you probably start seeing these on television soon.

When plastic surgeons move tissue from one area of the body to another using the “free flap” technique, the crucial stage is the hook-up of tiny arteries and veins, so that the moved tissue can receive blood and oxygen in its new location. Since the 1960’s, this has been done with micro-sutures, sewing the vessels together with the aid of an operating microscope. It’s quite difficult, and the success of the surgery really depends on the skill of the surgeon, using sutures smaller than a human hair.

In this month’s issue of Plastic and Reconstructive Surgery, a new report from France discusses laser welding of these tiny vessels. Once the tiny arteries and veins are lined up, a small low-power diode laser has been used successfully to join the vessels together, like a high-tech pipe fitter welding two pipes together.

In the French study, 27 patients had reconstructive microsurgery using the laser diode welding technique on 58 vessels, ranging between 0.8 to 1.8 millimeters in diameter. Patency of the laser-welded vessels was excellent, at 96.6%. And the new technique was quicker, reducing overall surgery time and “ischemic” time – the critical time between the separation and the reconnection of the blood vessels to the moved tissue.

Impression: This looks like it could be a winner for microsurgery. The next step will be some direct comparison studies between laser, traditional suture techniques and the mechanical vessel coupler device. In addition, the use of the low-power laser could potentially be adopted for use in laparoscopic surgery, for biliary or urinary tract surgery. Time will tell.

When patients come in with stretch marks, we’ve traditionally had little to offer them. Retin-A cream helps somewhat. IPL and vascular lasers can be used if the stretch marks are red or purple in color. But that was about it, unless the stretch marks were on the lower portion of the abdomen – and the patient wanted a tummy tuck, which would surgically remove the entire zone of stretch-mark laden skin.

Well, guess what. Just this month, Palomar Medical Technologies announced that their Lux1540 laser handpiece has received clearance by the FDA for the treatment of stretch marks. As you might expect, the company, their accountants and their stockholders are all very excited about this, as now they can market this laser to the millions of women worldwide who have unwanted stretch marks.

As we’ve discussed before, FDA approval for devices doesn’t necessarily imply that the gadget is effective – just that it is reasonably safe. So does this laser really do what it claims?

The Lux 1540 isn’t that new – it’s a fractional, non-ablative “erbium-glass” laser that’s been previously used for skin resurfacing and the treatment of scars. What’s new here is the official indication for use in stretch mark therapy. According to the data submitted to the FDA, clinical studies with the Lux1540 achieved an average improvement of between 51% and 75% in the appearance of stretch marks, over a three month time period. Of course, that’s corporate-sponsored research. I haven’t seen any peer-reviewed, independent studies as yet.

So, the stretch marks got better with the treatment, but did not vanish. Nevertheless, this could represent an improvement over the previous non-surgical therapies we’ve had for striae….we’ll have to see how it pans out in independent trials.

Bottom line: cautiously optimistic.


We are now starting to see ads in Orlando for a new fat-melting treatment, a laser beam that melts fat after shining the beam on the the skin. Known as the “lipo-laser”, or more properly, the Zerona, the manufacturer claims that its use can result in the loss of inches of fat – without surgery, injections or other invasive procedures.

The laser used in this machine, is a 635 nm wavelength diode – the very same laser that is commonly used in many hand-held battery-powered laser pointers. According to the manufacturer’s website, the laser power is listed variably in different parts of the webpage, between 7.5 milliwatts and 14 milliwatts, which again is only slightly more than the typical 5 milliwatt laser pointer. (By way of comparison, most lasers used for ablative skin resurfacing treatments are in the neighborhood of 30 watts or more, or four-thousand times more powerful.) Thus, this new machine falls into the category of “low-level laser therapy”.

The FDA has approved this device – in the same category as an infra-red heating lamp – according to the FDA’s own 510(k) document posted on the laser manufacturer’s website. N.B: it’s not currently approved as a fat melter.

Neira and associates have been enthusiastically promoting the use of low level lasers to help with liposuction for several years. They claim that use of this type of laser leads to a deflation effect on the individual fat cells, resulting in the contouring effect.

This claim is certainly controversial. A study published in the Plastic and Reconstructive Surgery Journal, performed by the well-respected Plastic Surgery & laser group of Brown, Rohrich, Kenkel, Young and associates at UTSW, carefully duplicated the Neira protocol for laser fat treatment. However, they found no appreciable difference with this laser treatment, comparing the fat before and after treatment under a scanning electron microscope. Zip. Zilch. Nada. There was no effect whatsoever on the fat in the treated area, and certainly no evidence of any fat-cell deflation.

I have no personal experience with the new Zerona machine, and while I would love to have a non-invasive method to treat fat, the physics of the device make it hard to believe that the beam could possibly penetrate through the skin down to the underlying fat with enough energy to do anything.

I’ll need to see better evidence from independent researchers before I can accept and recommend this treatment. To me, it seems like waving a laser pointer over the skin, and somehow expecting the fat to magically disappear. Caveat emptor.

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