Celebrity Plastic Surgery, News, Gossip

By Dr John Saia MD

Times are tough and money is tight. Budgets for cosmetic surgery and even reconstructive plastic surgery are down. Women are actually choosing not to have reconstruction after breast cancer surgery. People were trying things out for themselves before the economy tanked. They just seem to be pushing it a bit harder these days. Is DIY plastic surgery really dangerous?

Well it can be. I have posted at my Cosmetic Surgery Truth blog about such stories. The most recent was a silicone injection nightmare. Liquid silicone is not even used by licensed plastic surgeons, but DIY types think of it as a permanent filler. When injected into the face it tends to become infected and “scars in” like hardening plaster. It cannot be removed with a needle but usually requires surgery to cut it out. Stay away from liquid silicone injections.

I review cases of proposed negligence for the California Medical Board and have seen fake Botulinum toxin injections that were of animal grade product. On the internet you can see cases in new stories of people in salons injecting all kinds of things into people.  When you go to a qualified plastic surgeon you pay for professional grade advice and quality medical care. You can go elsewhere but you are accepting risk in doing so.

What can you do by yourself? I would recommend only over the counter strength facial peels. No injections. No surgery. A few years ago, I saw a woman who had obtained a doctor’s office strength facial peel and applied it herself. She came into the office a week later crying “help” with a face that looked like it had been hit with sandpaper. I had her sign an agreement that I was not responsible for her results and could not promise her anything. She turned out OK considering, but many others will not.

When you choose to self-inject Botox or a filler like Restylane, you first have to know what you have materials wise. Many people don’t know the difference between safe and unsafe products (like liquid silicone) and get themselves into trouble. Then you have to know how to do it. Doctors and nurses are probably better equipped to do this and some do self-treat themselves. For others you are accepting more risk and I can’t recommend that.

John Di Saia MD is a board certified Plastic and Reconstructive Surgeon. He has been board certified by both the American Board of Surgery and the American Board of Plastic Surgery. He reviews cases for the California Medical Board in their expert reviewer program and contributes to a number of medical journals and internet forums. His practice is founded on the concept of a Higher Level of Care.

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By Peyman Solieman, MD & Jason Litner, MD

By all accounts, cosmetic plastic surgery is on the rise in America for ethnic patients. In fact, in 2007, ethnic minorities accounted for 22 percent of the nearly 11.7 million surgical and nonsurgical cosmetic procedures performed in the United States, an increase of 105 percent from 2000. More specifically, in 2007, Hispanics underwent 1,011,071 procedures (up 153% from 2000) while African-American cosmetic surgeries increased 170%.

Yet, we see a number of ethnic patients every month who tell us they’ve had a hard time finding a surgeon who seems to make a practice of doing “ethnic plastic surgery”. Why?

Well, in our opinions, there are a few reasons for this:

The aesthetic is different. We now know that there is tremendous variation in anatomy among and between ethnicities and an equally wide variation in the desired aesthetic.

When it comes to rhinoplasty, which is by far the most popular facial surgical procedure among ethnic minorities, the nuances of ethnic differences in facial structure and aesthetics require a different type of surgeon: one who moves beyond the “one size fits all“ model to tailor results.

If a surgeon is not experienced with the nuance of ethnic rhinoplasty, this can be hard to accomplish in a natural-looking way. Which brings us to the final point…

The procedures are different. For a typical rhinoplasty in patients of European ancestry, the focus is usually on making the nose smaller, reducing a bump, etc. and so we trained to remove some tissue in order to accomplish this. Ethnic noses can tend towards thicker skin, softer tip cartilage, weaker septal cartilage, excessive nostril flare, and sometimes lower nasal bridges. For these patients, the emphasis is typically on narrowing and adding to the bridge, refining and supporting the tip, and on specialized procedures such as alar base reduction (nostril narrowing).

Achieving these goals relies heavily on more advanced grafting techniques in order to have thicker skin drape favorably and show the desired degree of refinement. It is critical to build up tip structure in order to provide not only adequate support but also lasting tip shape and definition. At the same time, most of our patients are seeking refinement in the way of a thinner tip that is not over-built and rock hard. So, there is a balance that needs to be struck and a fairly unforgiving line that needs to be walked. Luckily, with the increase in interest from ethnic patients, we are sure to see more and more surgeons interested in achieving fantastic results for them.

Please let us know if you have any more detailed questions related to Ethnic facial surgery. You can ask both the doctors questions directly just by clicking the link:

Ask Peyman Solieman, MD and Jason Litner, MD a Question

About Peyman Solieman, MD & Jason Litner, MD

At their practice named PROFILES (www.beverlyhillsprofiles.com), both Drs. Solieman and Litner meet and consult with you from your initial consultation through to your surgery and at every visit thereafter. We’re the only center that does that, and our great results and satisfied patients are the reasons why.

Ask Peyman Solieman, MD and Jason Litner, MD a Question

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By: Make Me Heal Staff

Just in time for the holidays and for consumers looking to keep looking their best at an economy budget, Makemeheal.com has just launched  Classifieds, which aspires to become the Craiglist and coupon site for plastic surgery, dermatology, and beauty treatment deals, promotions, and sales.  Now, plastic surgeons, dermatologists, spas, skin care companies, and beauty professionals of all kinds can advertise their deals and promotions in one place and consumers looking to save money can find them in one spot.

On Makemeheal.com’s Classifieds you can now find Botox, Breast Augmentation, Liposuction, and spa treatment deals in your local city.

“Makemeheal.com’s Classifieds app offers a strong and proven way for advertisers to connect with millions of consumers seeking deals on beauty treatments and products.  With the recession and unemployment levels being where they are today, people cannot afford the treatments and surgeries they used to at the prices of yesterday, so doctors and beauty professionals are stepping up and giving better deals than before.  Makemeheal.com is here to facilitate the awareness of these deals to consumers. The consumer and professional both win,” says Ariel Perets, President of Makemeheal.com.

Classifieds enables you to search for deals by city and state.

Check out Classifieds at: www.makemeheal.com/classifieds

Learn more about the benefits of advertising on Makemeheal.com’s Classifieds.

ABOUT MAKE ME HEAL

Makemeheal.com is the world’s largest website for all things plastic surgery, beauty enhancement, and anti-aging.  With 1.5 million members and over 900,000 unique visitors per month, Make Me Heal is a one-stop portal for all the products, services, and information resources needed by the consumer.  Serving all major countries in the world, Make Me Heal’s shopping division is comprised of over 100,000 products, including the leading brands of recovery and preparation products for every type of plastic surgery and non-surgical cosmetic procedure. Beyond plastic surgery products and services, we offer one of the largest selections of beauty and science-based antiaging skin care.  Make Me Heal also has specialized boutiques in other areas including bras, shapewear, and lingerie, anti-aging nutrition and supplements, breast cancer products, weight loss, maternity, wigs, and numerous other departments. With over 1 million members and as the largest social networking hub for plastic surgery, Make Me Heal hosts over 100 message boards, tens of thousands of personal blogs, and numerous video and text chat rooms.  Make Me Heal has the web’s largest library of before and after plastic surgery photos and videos.  Also, Make Me Heal has the web’s largest and only patient-reviewed directory of leading plastic surgeons, dermatologists, and beauty professionals.  Further, Make Me Heal’s News Division is a leading information source for all things plastic surgery, anti-aging, celebrity plastic surgery gossip, and beauty-related entertainment news.

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By, David Shafer, MD

Liposuction is a general term used to describe removal of fat using a suction machine. Tumescent liposuction is the most popular method. In this technique, tumescent solution is injected into the area of fat to be removed. The tumescent solution typically contains lidocaine (to reduce pain) and epinephrine (to minimize bruising). After the solution is injected, liposuction is performed using cannulas (long, thin tubes) to suck out the fat. Fat can be removed from almost anywhere on the body. The most popular areas are the abdomen, waist, back, bra rolls, thighs, buttocks, and chest. Liposuction is usually performed under anesthesia to help minimize any discomfort and to monitor your body during the procedure. Awake liposuction is also possible, but it takes a motivated patient and surgeon since the tumescent solutions must be injected very slowly and the suction performed very meticulously. The volume removed during awake liposuction is also much less than can be removed under general anesthesia in a hospital or surgical center. All types of liposuction are based on variants of the tumescent technique. Liposuction is only for healthy patients.

Recently, laser liposuction (particularly Smartlipo) has received considerable attention and popularity. Smartlipo involves an extra step after the injection of tumescent fluid and before sucking out the fat. During the Smartlipo procedure, a small fiberoptic cable is inserted under the skin and uses a laser to destroy or melt the fat cells. The laser can be set to different modes with different wavelengths to focus more on destroying fat and/or heating up the skin. It is thought that heating the skin leads collagen production and a slight tightening of the skin. After the laser treatment with Smartlipo, the surgeon then performs traditional liposuction with smaller cannulas to remove the melted fat. In most cases, Smartlipo can be performed while you are awake. The advantages are potentially a quicker recovery, slightly smaller incisions, focused treatment and potential for slight skin tightening. Disadvantages, however, are less aggressive treatment since you are awake and can feel the movement of the cannula, smaller volumes of fat removed, inadequate skin tightening and potential for skin burns if you are being treated by an inexperienced surgeon. Also, you should keep in mind that the Smartlipo machine is also sold to doctors who are not plastic surgeons and they perform the procedure with little or no training in liposuction.

In my Manhattan plastic surgery practice, I use both Smartlipo MPX and Power-Assisted Liposuction. I use the Smartlipo MPX, a dual-wavelength laser lipolysis machine, for patients who have small or focused areas requiring liposuction such as love handles, abdomen, arms and neck. I perform these procedures in an accredited, office-based operating room while my patients are awake. In most cases, we perform the procedure on a Friday and patients are ready to go back to work on Monday. For patients requiring larger volume liposuction on multiple areas of their body, I perform Power-Assisted Liposuction in a hospital or surgical center while the patient is under general anesthesia. The Power-Assisted Liposuction (PAL) machine uses a vibrating cannula to quickly breakup the fat and easily such it out. This is a great device for larger volumes of fat to be removed. This can still be performed as an outpatient procedure. However, in the hospital setting, the patient has specialized monitoring. Our priority is patient safety and every precaution is taken to ensure that the procedure is safe and effective.

Whether Traditional or Smartlipo is best for you should be determined in consultation with your plastic surgeon. In either case, liposuction should not be viewed as a weight-loss procedure. Rather, it should be considered a body contouring procedure. Liposuction is not going to prevent you from gaining weight. It will, however, remove fat from specific areas and make drastic changes to your body shape. I like to tell patients that liposuction is a “second chance” to have a nice body. For one reason or another, you let your body get out of control and need fat removed. After liposuction, the patient needs to maintain a healthy lifestyle, eat a balanced diet, and exercise regularly to maintain the results.

Dr. David Shafer completed his plastic surgery residency at the world famous Mayo Clinic. He was then selected to continue his education at the prestigious Manhattan Eye, Ear & Throat Hospital. While most plastic surgeons go directly into practice after residency, Dr. Shafer had the honor to operate with many of the world’s most distinguished plastic surgeons. This unique experience allowed Dr. Shafer to advance his skills to a level that most surgeons take a lifetime to develop. Dr. Shafer continues to operate at MEETH and now teaches the next generation of plastic surgeons from NYU, Columbia and Cornell.

Ask Dr. David Shafer A Question on Makemeheal.com

Visit us at www.ShaferPlasticSurgery.com.

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By John Di Saia, MD

When a reality show contestant ruptured her breast implants after jumping 20 feet off a rope swing, I felt compelled to address the concern that some breast augmentation patients have about this problem.

Bursting a breast implant is not usually so dramatic as what the reality show girl experienced.  Then again, it is uncommon for a patient to know when the break occurred. Breast implant rupture is usually a low key event. Maybe in this case the lady did do some soft tissue damage as well as the break seems to have occurred with a fall from some height. It is conceivable to cause a muscle tear although I have only seen small ones. Torn muscle can hurt.

Usually the implant ruptures quietly and slowly over a few days the breast gets smaller (with a saline implant). If the implant is a silicone gel type, the rupture may not be noticed for quite a while. This is one of the reasons the new FDA recommendations are for breast MRIs periodically after silicone gel breast implant surgery.

The “fix” involves removal of the broken implant and frequently the capsule of scar tissue around it. Silicone gel implants generally have a larger amount of this scar reaction and in removing this scar the healthy tissue available to cover the implants gets thinner. This can be a problem if done repeatedly or if the reaction is long standing or extensive as the breast can be left looking more foreign. The newer generation silicone gel implants will hopefully have less of this reaction than their predecessors, but the truth is we don’t have enough information yet to really say that. The answer to how surgeons minimize this potential problem is a matter of opinion.

John Di Saia MD (www.ocbody.com) is a board certified Plastic and Reconstructive Surgeon. He has been board certified by both the American Board of Surgery and the American Board of Plastic Surgery. He reviews cases for the California Medical Board in their expert reviewer program and contributes to a number of medical journals and internet forums. His practice is founded on the concept of a Higher Level of Care.

Ask John Di Saia a question on Makemeheal.com

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By Dr. David Shafer

Dysport is often called the “New Botox.” However, Dypsort has actually been available in Europe for therapeutic indications since 1991 and for cosmetic applications since 2001. In April 2009, Dysport (officially known as BoNT-A/D) was approved in the United States for the “temporary improvement in the appearance of moderate to severe glabellar lines.” These are the lines between your eyebrows. However, just like Botox Cosmetic, Dysport can be used “off-lable” for treatment of crow’s feet (squinting lines around your eyes), forehead wrinkles, chemical brow lifts, platysmal bands (neck bands) and sweaty palms and armpits.

The molecule in Dysport is exactly like Botox Cosmetic but is covered by a different coating, which dissociates (dissolves) at a different rate. That is why the onset of action of Dysport is thought to be faster than Botox Cosmetic since the coating comes off faster. In Botox Cosmetic Treatment the usual onset of action is 3 to 7 days where the Dysport onset of action seems to be a few days faster. The dosing is different with Dysport, so there may be some confusion when translating Botox “units” with Dysport “units.” This is why you need to see an injector who has experience specifically in Dysport injections. Also, there is a learning curve with Dysport injections, so you may not initially achieve the same results as you are used to receiving with Botox Cosmetic.

There is also some confusion about the pricing of Dysport with many reports on the Internet and advertising claiming that it is cheaper than Botox Cosmetic. There is a discrepancy in the potency of units. A “unit” of Botox is not equivalent to a “unit” of Dysport, so unit pricing is not comparable. There is a slight savings with Dysport, but it is about 5% - nothing substantial. So, do not expect to go to your plastic surgeon to achieve the same results as Botox Cosmetic for half the price. However, with competition, hopefully prices will come down. Allergan (Botox Cosmetic) is currently offering a $50 mail-in rebate for Botox Cosmetic customers and Medicis Aesthetics (Dysport) is offering a $75 mail-in rebate. With these rebates and introductory pricing, you may be able to get a better deal than your last injection.

In the end, it is great to have another minimally invasive product approved on the market which can give consistent and noticeable results with virtually no downtime and minimal risks.

Dr. David Shafer completed his plastic surgery residency at the world famous Mayo Clinic. He was then selected to continue his education at the prestigious Manhattan Eye, Ear & Throat Hospital. While most plastic surgeons go directly into practice after residency, Dr. Shafer had the honor to operate with many of the world’s most distinguished plastic surgeons. This unique experience allowed Dr. Shafer to advance his skills to a level that most surgeons take a lifetime to develop. Dr. Shafer continues to operate at MEETH and now teaches the next generation of plastic surgeons from NYU, Columbia and Cornell.

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By Lois W. Stern, Editor-at-Large, Makemeheal.com

Two simple words hold the keys to understanding the concept of skin renewal: wound and heal. The skill of the practitioner – be s/he dermatologist, esthetician or plastic surgeon – makes all the difference in whether that wound ultimately stimulates the production of healthier, younger looking skin, has little impact or, worst scenario, scars the patient.

That youthful glow you see in a child’s face is the result of constant skin renewal, the shedding of old skin cells continually being replenished with new cells. A baby’s skin is in a constant state of renewal, shedding old cells while growing new ones. Alas, as we enter our teen years and beyond, skin renewal already begins to slow.

Research has shown that by the time we reach our forties and fifties, skin sheds approximately once every fifty-three days. As old, unshed cells build up on the skin’s surface, they become dual culprits to our skin’s dull, aging appearance. This is where the skill and experience of a knowledgeable practitioner who understands both theory and technique behind the wound-heal concept can come to the rescue, helping us kick the skin out of its old habits and coaxing it along into some new ones. Today one popular method for accomplishing this goal is found in a variety of laser treatments. A second, lesser known method for achieving similar goals is through dermal roller treatments.

Let’s begin with a basic understanding or the anatomy of our skin.

Stratum Corneum (the outermost surface of the Epidermis)

The outer layer of our skin is called the epidermis, with the stratum corneum its outermost surface. Beneath the epidermis lies the dermis. When we talk about resurfacing the skin, we are targeting treatment within the epidermis. When we speak of remodeling for wrinkle treatments, we are targeting treatment within the mid-dermis.

The basic concept behind both laser and dermal roller technologies is the same: wound and heal. One must wound the skin to remove old surface tissue, which in turn stimulates the growth of new collagen.

Let’s first take a look at the newer breed of lasers, known as nonablative fractional lasers, claiming to produce the results of older ablative “field” lasers, but with minimal downtime. Fraxel is one fine example of these newer lasers.

To best understand how fractional lasers work, you need to think of your skin as a digital photograph in need of restoration or touch up. Just as you can alter a photographic image pixel by pixel, fractional lasers treat your skin with thousands of tiny microscopic laser spots. During treatment, these thousands of columns penetrate deeply into the dermis. What distinguishes fractional lasers is their ability to leave untouched specific skin areas while treating others. By creating microscopic treatment zones, the laser affects only a fraction of your skin at a time.

During treatment, the fractional laser penetrates the non-living protective barrier of the skin, the stratum corneum, as if it were a window, leaving it completely intact. It then creates microscopic “wounds” within the targeted areas well beneath the outermost epidermal layer of skin. Both epidermal and dermal tissue are removed. In so doing, it triggers the body’s natural healing process to accelerate the production of collagen and new, healthier skin cells.

Below you can see some befre/after photos of one patient treated with a Fraxel laser.

Now let’s take a look at the dermal roller technology, of which the Microneedle Roller is one fine example

The Microneedle Roller uses its 200 extremely fine needles to penetrate the skin. During treatment the Roller leaves the epidermal barrier fully intact, while creating micro-channel wounds with its 200 fine needles. An effective optional compliment to this treatment is the simultaneously infusion of therapeutic serums, which penetrate more deeply while the skin is in its wounded state. These channel wounds fully close within just a few hours after initial application, providing enough time for new collagen structures to form within the skin’s lower layers, but short enough recovery time to ensure the patient nearly immediate resumption of normal schedules.

Photos First Printed in Chapter 3 of Tick Tock, Stop the Clock

During treatment

Immediately following treatment and saline rinse

Clinically-conducted studies in South Korea, Europe, and U.S. have shown that the Roller can increase serum absorption by as much as 1,000 percent. Moreover, the Microneedle Roller is “skin friendly,” in that it leaves the epidermal barrier fully intact, and the micro-channels created by the 200 fine needles fully close within just a few hours after initial application. This provides just enough time for new collagen structures to form within the skin’s lower layers, while ensuring the patient of rapid recovery with the ability to almost immediately resume one’s normal schedule.

For every microscopic zone the Fractional laser or Roller targets and treats intensively, it leaves the surrounding tissue unaffected and intact, allowing the skin to heal much faster than if the entire area were treated at once. Both treatments wound the skin and then use the body’s natural healing process to create new, healthier, tighter tissue to replace the imperfections of the older skin.

Both the Microneedle Skin Roller and the non-ablative Fraxel laser are two viable non-surgical treatments for stimulating elastin and collagen production, thereby thickening the skin, smoothing away fine lines and wrinkles and ridding the skin of hyperpigmentations. Because these treatments spare healthy tissue, they are effective even on delicate skin areas such as the neck, chest and hands. But for more dramatic results, with the downside of more visible wounds and longer downtime, the ablative laser might be a better option for you.

Lois W. Stern, Editor-At-Large at Makemeheal.com, is the published author of two books: Sex, Lies and Cosmetic Surgery www.sexliesandcosmeticsurgery.com and Tick Tock, Stop the Clock www.ticktockstoptheclock.com/ as well as a number of magazine articles. Her Professional Edition DVD is a popular aid to office staff while interacting with their patients. She and Patty Kovacs are the co-founders of http://coast2coastbeauty.com/CURRENT_NEWS.html. Check it out!

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By Lois W. Stern, Editor-at-Large, Makemeheal.com

A little over a year ago I wrote an article about the tragic death of Donda West, mother of the celebrity rapper, Kanye West, following plastic surgery. In the aftermath of Kanye’s rude mishap with Taylor Swift at the VMA Awards , I thought I would revisit his mom’s tragic story.

Why tragic? After doing some research on her case, I concluded that a significant factor in her death was due to poor medical judgment. Well, here we go again, some more bad news following plastic surgery. But this time, due diligence may avert the supreme tragedy of another life lost.

While investigating the Donda West tragedy, I had called both the ABPS (American Board of Plastic Surgery) and the ABMS (American Board of Medical Specialties) to inquire about the board certification of Donda West’s surgeon, Dr. Jan Adams. I learned two alarming facts. Dr. Jan Adams was not listed as a board certified plastic surgeon. Furthermore the only physician on record with the ABMS bearing the name Dr. Jan Thatcher Adams was board certified in Family Medicine – not plastic surgery.

I concluded that if Donda West had only made those phone calls prior to selecting her surgeon, she might have selected differently. She might even be with us today.

Donda’s autopsy results yielded no physical findings (such as a heart attack or blood clot) to explain why she went into cardiac arrest. According to Barry L. Friedberg M.D., a board certified, globally recognized leader in the field of office-based anesthesia, it was unlikely that either the length or extent of West’s surgeries caused her death. “More likely, it was the manner in which the surgery was performed; i.e. under general anesthesia which does not reliably produce pre-emptive analgesia and, therefore, often necessitates postop narcotics to manage pain. If West had sleep apnea as a pre-existing condition, even average doses of narcotics could easily prove fatal,” claims Dr. Barry Friedberg.

We will never know for sure what killed Donda West. But we do know that sound medical judgment comes only with quality training followed by lots of experience putting that training to practice.

On June 13^th, 2009, the Hartford Courant ran a story about Dr. Efraim Gomez-Zapata, a name currently in the news for allegedly practicing plastic surgery without proper credentials. (According to the Hartford Courant, Dr. Efraim Gomez-Zapata is credentialed as a family practice physician, but because his name is not listed with the Connecticut State Medical Board, I was unable to verify this information.). His medical license has been suspended by this same board based on charges that he violated medical standards by performing plastic surgery without appropriate qualifications or standards to protect patient safety. The allegations of the Connecticut Department of Public Health against Dr. Efraim Gomez-Zapata include administering anesthesia and performing plastic surgery on patients without the proper license or qualifications and failing to keep proper records or have the appropriate staff, equipment, office setup and hospital privileges required in case of complications. In two patient cases cited where complications did occur, one woman had a seizure after Gomez-Zapata administered a combination of painkillers, anti-anxiety medication and a local anesthesia; while a second went into respiratory arrest after Gomez-Zapata gave her a spinal anesthesia.

What simple steps can the rest of us take to avoid fates similar to those of Donda West or the unfortunate patients treated by Dr. Gomez-Zapata? I like to think of the word TEE (short for Training, Experience and Expertise) as a handy acronym to help me remember how to investigate the credentials of any prospective surgeon.

TRAINING: Know that ANY board certified physician in any field of medicine can legally perform plastic surgery and call himself a cosmetic surgeon.
DO YOUR HOMEWORK. Be sure you have selected a surgeon board certified in the area that relates to your surgical needs or desires.

EXPERIENCE: You can check out the history of any prospective surgeon by calling the medical records department of the state where he practices. Visit http://www.floridamalpractice.com/linksotherstatebds.htm for the telephone number of the medical records department of the state where your surgery will take place.

I do not know how many cosmetic surgeries either Dr. Jan Adams or Dr. Efraim Gomez-Zapata has performed. But I do know that their surgical histories send up some immediate red flags. According to medical records from the state of California, in 2001 two malpractice lawsuits were filed against Adams, ending in payouts of close to half a million dollars. Prior to the Donda West tragedy, three new, unsettled medical malpractice lawsuits were pending against this same doctor. As for Dr. Gomez-Zapata’s record, we do know that one of his patients experienced seizures during surgery and a second went into respiratory arrest. These are enough red flags to alert us to quickly do an about face and walk away from either of these offices.

Another way to assess the adequacy of a surgeon’s experience is to inquire about the number of procedures of a particular type he performs each year and how long he has been performing them. Ask to speak with some of his patients and try to meet with them in person to assess the surgeon’s work.

EXPERTISE: Ask your surgeon where he has hospital privileges and place a phone call to that hospital to inquire if he has privileges to perform the exact procedures you are considering. This step is essential, even if your surgery is to take place in an outside surgical facility. Why? The chief of plastic surgery assesses the experience and skill of the surgeon before granting him privileges for any surgical procedure. Surgeons are often granted privileges for some procedures while having privileges for others withheld, based on their experience and expertise. If a surgeon skirts this issue or tells you it isn’t necessary for him to have hospital privileges since surgery will take place in an outside facility, turn around and walk!

It is important to learn how to separate the sound from the noise. Donda West’s surgeon, Dr. Jan Adams had appeared on numerous national TV shows, including Oprah, CNN, Entertainment Tonight, and Discovery Health, to name a few, as a plastic surgery ‘expert’. I congratulate his PR agent for doing a phenomenal job. But great hype does not a great surgeon make. Surgical expertise does not come from making TV appearances.

Statistically, cosmetic surgery procedures have a strong safety record, but you need to heed some cautions. In a study evaluating the safety of accredited office based surgical facilities, only 1 death occurred in 58,810 surgical procedures, but there is one important caveat to that study that should not be overlooked: All of these procedures were performed in office surgery facilities accredited by the AAAASF.

While in the process of writing my first book, I had the privilege of interviewing Dr. Keyes, the lead surgeon of the above study. He explained that each surgical facility accredited by the AAAASF mandates that a) the doctor be board certified in the medical specialty recommended for that procedure and b) that the doctor has been granted privileges to perform those same procedures in the hospitals with which he is affiliated. Again, remember to do your homework.

Here are just a few of the life saving questions you should ask before engaging a surgeon

Do you have hospital privileges to perform the procedures I am considering? If so, where?

What you should do next: Call the hospital(s) to inquire.

What is your board certification?

What you should do next: Contact the American Board of Medical Specialties (Internet: www.abms.org/ Phone:1-847-9091) Consider surgeons with board certification in: plastic surgery, ophthalmology, otolaryngology, dermatology. Here is where Experience and Expertise come into play.

Is the facility where your surgery will take place an accredited facility?

What you should do next: Ask by whom? You are in good hands if accredited by the AAAASF or AAAHC for ambulatory facilities or the JCAHO for hospital facilities.

Who will administer my anesthesia?

What you should do next: Find out if this person is a board certified anesthesiologist? Understand that the training of a board certified anesthesiologist is far more comprehensive than that of a nurse anesthetist. In determining the extent of your anesthesia needs, consider the extent of your surgery, your physical condition and age.

You need to consider the risks and rewards to your surgery. Here are some additional questions to ask your surgeon:

What are the risks to my surgical procedures?

Do you consider me a good candidate for the surgeries I am requesting?

Do I have any medical condition, health habits, etc. that we need to consider?

I am ever mindful of the words of Dr. Rohrich, former president of the ASAPS and a member of their Innovative Procedures Committee: Most women spend more time selecting a pair of shoes than selecting a plastic surgeon. You can take back your shoes, but you can’t take your face or your life back.

Lois is the author of Sex, Lies and Cosmetic Surgery and Tick Tock, Stop the Clock. She also has developed a special Support Tool DVD for Professional office use – a practical communication tool to help surgeons personalize their services while communicating with their patients. Check out Lois’s website at: www.sexliesandcosmeticsurgery.com.

Lois and Patty Kovacs are the co-founders of Coast2Coast - Eye on Beauty Newsletter.

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By Shervin Naderi, MD

Although Collagen based fillers such as Zyplast and Cosmoderm had initially dominated the market, they fell out of favor due to their short lasting results and the potential for allergic reactions.

Over the last five to ten years, we have seen the Hyaluronic Acid dermal fillers become the predominant work horse for most Plastic Surgeons and Dermatologists. These are used for reduction of nasolabial folds (smile lines), Marionette lines as well as other wrinkles on the face. They are used for cheek enhancement as well as lip plumbing. Tear troughs under the eyes can often be reduced using these fillers. As with any filler, a properly trained and licensed injector with good judgment and technique is the key in success and avoiding complications.

Restylane gained FDA approval first in the United States followed by Juvederm. These two Hyaluronic Acid (HA) fillers have been the most versatile synthetic dermal fillers in the United States. Other HA fillers such as Hylaform, Captique and Prevelle never became as popular. Allergan plans on introducing a Juvederm with Lidocaine (numbing medicine) pre-mixed, in the near future.

However Hydrelle by Coapt is already here! This is an FDA approved HA filler with a higher concentration of HA molecule and Lidocaine added. The higher concentration of HA molecules mean that 1cc of Hydrelle will give you more HA and volume and wrinkle correction than 1cc of Restylane or Juvederm. The added numbing medicine means that patients who require several shots in the same area for fine contouring will have less pain and more comfort during the procedure.

There is no one great filler. Each patient needs a unique assessment and approach. For those who are happy with Restylane or Juvederm then I would recommend sticking to what you like and what works best for you. But for those who want to try something new, then Hydrelle may be worth a shot!

You can find out more here:

http://www.hydrelle.us/patients/patients_landing.html

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A Q & A with Jason N. Pozner, M.D., F.A.C.S.

What are the main reasons patients seek revision breast augmentation procedures?

Previously, capsular contracture, implant rupture, and size were the reasons most women sought revision breast augmentation. However, today many patients tend to complain about shape and skin texture abnormalities following subglandular saline augmentation.

What are the primary benefits of submuscular conversion?

Conversion to submuscular implant placement provides four main benefits:

A well vascularized cover

Separation from the breast parenchyma

“Padding” that prevents implant palpability

Framework that prevents excessive inferior descent of the implant

More specifically, what type of patients typically seek submuscular revision augmentation?

Patient seeking reaugmentation following subglandular augmentation falls into four broad categories that have considerable overlap.

Caegory 1- Size Change

Patient with adequate tissue coverage seeking size change often request submuscular conversion. Although there are no studies to verify it, in my experience there is considerable evidence that submuscular placement decreases capsule rate and implant palpability.

Category 2- Palpability and Ripping

Palpability and rippling are usually due to inadequate tissue coverage and can be compounded by type of implant used (i.e., textured saline). Submuscular conversion will improve upper pole and medical rippling but will not usually correct lateral rippling. Submuscular conversion with smooth silicone implants may be needed if lateral rippling is extreme.

Fig 1 Preoperative Preoperative Postoperative

Subglandular saline implant with superior After conversion with mentor

Pole and lateral rippling smooth silicone 800 cc high

Profile implants

Category 3- Ptosis, Shape, and Position Changes (Fig 2)

Breast Malposition-patient with subglandular implants, especially after multiple pregnancies, often present with grade three pstosis and the “rock in sock” phenomena. Submuscular conversion with mastopexy offers some advantage for long-term support.

Implant Malposition- patients may have misplaced subglandular implants. During consultation a “tilt test” is performed by having patients sit in a power chair. The chair is then lowered to assess the degree of lateral implant movement. Submuscular conversion in itself will improve superiorly and medially displaced implants, but capsulorrhaphy is needed in addition for lateral or inferiorly displaced implants.

Fig 2 Preoperative Postoperative

Subglandular 275 cc with dropped left and failed previous repair. Exchanged with conversion for 400cc smooth moderate profile silicone with capsule repair.

Category 4-Cacpsular Contracture (Fig 3)

In my experience, submuscular conversion with capsulectomy appears to improve recurrent contracture. It is important to consider nipple areolar viability in extremely thin-skinned women in which Capslectomy and mastopexy is performed simultaneously.

Fig 3 Preoperative Postoperative

Subglandular saline with Baker 3 contracture. Exchanged the conversion or 425 cc smooth saline with Benelli.

What’s involved in your patient evaluation process?

During patient evaluation, a determination is made regarding the breast pocket dimensions and position, implant size, skin dimensions and nipple position. Both the patient’s and surgeon’s input is important to determine the best surgical plan. For example, a patient with capsular contracture may need a larger implant or mastopexy with a smaller implant after capsulectomy.

What surgical technique do you prefer?

Ideally, an aereolar approach is used, although an existing inframammary incision may be used if mastopexy or full caspsulectomy is not needed. If capsular contracture is present, full capsulectomy is performed. With no siginifigant capsular contracture, the subglandular pocket is opened and the implant is removed. If the fold is to be lowered or remain constant, the capsule is removed from the pectoralis major muscle. The anterior capsule is scored and brushed with a electrocautery device. Partial capsulectomy (at least) is always performed to allow the tissue to heal without serroma or excessive scarring (Fig 4). The pectoralis major muscle is elevated and divided. The muscle is then plicated to the anterior tissues, usually at the level of the superior areola with several 2-0 Vicryl sutures. Sizers are placed to determine size and pocket shape. Drains are placed in all Submuscular conversions. After the implants are placed, the patient is brought to a seated position and symmetry is assessed and corrected. If no mastopexy is indicated, the wounds are closed.

Are the special considerations that must be considered during surgery?

Implant Descent

If the inframammary fold needs to be elevated, a capsule flap is elevated from the pectoralis major muscle prior to elevation. The inferior capsule is excised and the tissues closed. The capsule flap is then sutured to the anterior tissues to reinforce the inferior tissue placation.

Symmastia

Overdissection of the medical pocket may create symmastia or excessive cleavage. IN such cases, medial capsulectomy with closure of the overdissected pocket and creation of a submuscular pocket is performed. Postoperative taping and support are essential.

Lateralized Implants

For lateralized subglandular implants, the lateral pectoral attachments are preserved if possible, and the overdissected tissue is corrected with partial capsulectomy and suture of the cut capsule ends.

Ptosis

After submuscular conversion is complete, the skin is tailor tacked with silk sutures to gauge areolar position and the degree and/or necessity of skin excision. Saline implant fill tubes are then removed at the end of the mastopexy.

What breast implant do you prefer for this procedure?

I prefer smooth round implants. A revision augmentation qualifies the patient for silicone gel implants; however, saline implants can be used if the patient prefers. Postoperatively adjustable implants are useful when there is significant asymmetry or insufficient skin.

Fig 4

Previous conversion with failure to remove subglandular capsule. Note the muscle below and the thickened capsule above.

About Jason Pozner, MD

Jason Pozner, M.D., F.A.C.S., can truly claim aesthetic surgery and skin care as his life’s work. The son of a successful health spa and diet center physician in New York, Dr. Pozner is certified by both the American Board of Plastic Surgery and American Board of Surgery, and is a member of the American Society of Plastic Surgeons, the largest and most prestigious organization of board-certified plastic surgeons in the world.

Learn more about Jason Pozner, MD

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