August 31st, 2010
Botox may be used to minimize post-operative pain for breast reconstruction patients, according to plastic surgeon Allen Gabriel M.D., who presented about the topic at the recent International Society of Aesthetic Plastic Surgery Congress.
The doctor conducted a 30-patient clinical trial for this off-label application, demonstrating that botulinum toxin type A can address post-operative pain.
Breast reconstruction often involves the positioning of a temporary expander implant between layers of the chest muscle, which is then filled with water to create a pocket where a permanent implant will reside. Pain can result from muscle contractions and spasms in response to the tissue expansion.
Dr. Gabriel, along with his collaborator Dr. G. Patrick Maxwell, theorized that Botox injections could offer relief by temporarily paralyzing the muscle so that fewer spasms occur, thereby reducing pain and discomfort.
They designed a clinical trial with 30 breast cancer patients, who all planned a mastectomy and subsequent silicone implant breast reconstruction. They were divided into 2 groups: one received Botox injections in the chest muscle and the other received injections of saline solution as a placebo.
After reconstructive surgery, the women who received the Botox injections were reportedly more comfortable than those who received placebo. The doctors measured patient responses 3 times during and after the procedure, noting that during days 7 to 45 of the recovery period, those that received Botox injections used significantly fewer doses of narcotics and muscle relaxants.
More information on Medscape
Tags: Breast Reconstruction, silicone breast implants
August 30th, 2010
A team of 6 doctors and 14 fellows at the Jewish Hospital Hand Care Center completed a double hand transplant last Wednesday, replacing the hands of a patient who had suffered severe burns and loss of hand function.
According to courier-journal.com, the lead hand surgeon says he hopes the patient can recover 80 to 90 percent of his hand function and “reasonably good grip strength.”
During the 17-hour operation, a non-participating physician in the OR sent out periodic Twitter updates on the progress of the transplant, which you can see at twitter.com/jewishhospital. Interesting Tweets like the following were posted:
“Tendon suturing nearing completion. Nerve repair to follow. This includes suturing nerves of each finger from donor to recipient.”
“Surgeons are working on connecting nerves in the right hand from the donor to the recipient.”
“Skin graft on right hand finished and hand is completely closed. Starting cleansing and bandaging.”
The surgery was “complex” but successful. The doctors said Twitter updates would have continued even if they had encountered complications during surgery.
Tags: reconstructive surgeon
August 30th, 2010
A new free article on the website of Plastic and Reconstructive Surgery is about a study of the nutritional status of
post-bariatric patients — specifically, persons who have undergone bariatric surgery (gastric bypass or lap band) and subsequently seek body-contouring procedures from a plastic surgeon.
As the bariatric surgery patient rapidly loses body weight, he or she may become prone to nutrient deficiencies. In this study of 98 gastric bypass patients and 2 lap band patients, nearly 18 percent of the subjects showed protein intake levels that were lower than the recommended intake. Additionally, 39.7 percent showed low iron intake and 11 percent had low intake of vitamin b12.
Why is Protein Important for the Post-Bariatric Patient?
Protein intake is important for general health reasons as well as surgical reasons. Protein aids the healing process during recovery from body contouring and its deficiency has been linked to problems such as “decreased wound tensile strength and increased rates of skin and fascial wound breakdown.”
The authors found certain predictors of low protein intake in their subjects. Those with increasing age and those who underwent a greater change in BMI after bariatric surgery were more likely to have a low daily protein intake. Because food intolerance is relatively common in post-bariatric patients, a higher daily protein allowance may be recommended, the authors suggest.
Read more
Nutritional Assessment of Bariatric Surgery, Patients Presenting for Plastic Surgery: A Prospective Analysis Naghshineh, Nima; O’Brien Coon, Devin; McTigue, Kathleen; Courcoulas, Anita P.; Fernstrom, Madelyn; Rubin, J. Peter. Plastic & Reconstructive Surgery. 126(2):602-610, August 2010.
Tags: bariatric surgery, Body Lift, post weight loss surgery
August 12th, 2010
Global plastic surgery statistics recently released by the International Society of Aesthetic Plastic Surgery suggest that last year, U.S. plastic surgeons performed more surgical and non-surgical cosmetic procedures than plastic surgeons in any other country.
In 2009, plastic surgeons in the U.S., Brazil and China performed more than 1 million procedures each, with U.S. plastic surgeons topping the charts at more than 3 million total surgical and non-surgical procedures performed.
Several hundred thousand procedures were also performed by plastic surgeons in India, Japan, South Korea and Mexico, however they made up a much smaller percentage of the total plastic surgery procedures performed worldwide in 2009.
Body contouring plastic surgery, including liposuction, breast augmentation, breast reduction and tummy tuck procedures were among the most popular surgical procedures last year in both the U.S. and the entire world. Facial plastic surgery procedures, such as nose surgery and eyelid surgery, were also frequently performed by plastic surgeons internationally.
Only three cosmetic procedures addressed by ISAPS statistics in the surgical and non-surgical categories were performed in excess of 1 million times in 2009. In the surgical category, these procedures included:
In the non-surgical category, these procedures included:
- Wrinkle-relaxing injectables (e.g. Botox and Dysport)
- Hyaluronic acid fillers (e.g. Restylane and Juvederm)
- Laser hair removal
Non-surgical procedures were so popular in the U.S. last year that unlike plastic surgeons in most other countries, U.S. plastic surgeons actually performed more non-surgical procedures than surgical procedures in 2009. Other popular non-surgical procedures that were frequently performed by plastic surgeons last year included laser skin resurfacing, including Fraxel Laser treatment, as well as sclerotherapy and laser vein treatment.
Although ISAPS statistics suggest that plastic surgeons most frequently perform non-surgical injectable and laser treatments, their primary areas of expertise are generally breast surgery, body contouring, facial plastic surgery and revision surgery. Houston plastic surgeon Dr. Bob Basu is a breast reconstruction and body sculpting expert.
Tags: statistics
August 6th, 2010
A new injectable wrinkle relaxer called Xeomin was recently FDA-approved and is expected to arrive at doctors’ offices across the U.S. by late September 2010.
What is Xeomin?
Developed by German pharmaceutical company Merz, Xeomin is a new formulation of the botulinum type A neurotoxin that has been used to treat neuromuscular conditions, as well as forehead wrinkles and frown lines, for years.
Currently, Xeomin is FDA-approved only for therapeutic use in treating neuromuscular conditions, such as cervical dystonia and blepharospasm, whereas Botox and Dysport are approved for both therapeutic and cosmetic indications. However, now that Xeomin is FDA-approved, it may be used for any medical purpose, including off-label cosmetic treatment.
Used in Europe since 2008, Xeomin works by temporarily paralyzing muscles that cause facial expressions and neuromuscular conditions, thereby reducing dynamic wrinkles, or expression lines, and calming tense or spastic muscles.
Botox cost unlikely to drop
If the April 2009 launch of Botox’s first-ever competitor Dysport serves as any indication, it is likely that the per-unit price for Xeomin injections will be similar to prices for Botox.
Many physicians and consumers had hoped that once Botox was forced to compete against other wrinkle-relaxing injectables that it would drive prices down, however this has yet to occur, a reality that Xeomin’s launch probably will not change.
Xeomin vs. Botox vs. Dysport
When compared to Botox and Dysport, Xeomin’s botulinum type A formulation may have the advantage when it comes to treating neuromuscular conditions. Xeomin is free of complexing proteins, so the higher doses necessary for therapeutic treatment can be given without resulting in antibody formation.
Xeomin’s advantage will probably not extend to cosmetic uses, as the doses needed for cosmetic injection are so small antibody formation isn’t really a risk that needs to be avoided.
In fact, some believe that Xeomin’s tendency to migrate or spread beyond the injection site might make Botox and Dysport better choices for cosmetic wrinkle treatment, as neurotoxin migration can result in unwanted muscle relaxation, which causes side effects like droopy eyelids or a crooked smile.
For the time being, it is best not to put much stock in speculation regarding the merits and shortcomings of Xeomin until the product can be further studied following its U.S. launch. Only science can prove Xeomin’s worth in cosmetic medicine.
Tags: botox, dysport, xeomin
July 31st, 2010
Two cautionary tales illustrating the dangers of seeking discount cosmetic surgery and injectable treatments have recently surfaced in the media, reminding consumers that when prices seem too good to be true, they probably are.
Plastic surgery performed by non-plastic surgeons
The first story, featured by CBS Atlanta, described the near-fatal experience of Kenyatta Brown, an Atlanta-area mother of four who nearly bled to death after seeking breast augmentation with an eye doctor practicing plastic surgery outside his specialty of ophthalmology.
Breast augmentation surgery is relatively routine for board-certified plastic surgeons who perform thousands of these procedures each year, but for a physician who has not completed a plastic surgery residency and has little experience performing plastic surgery, breast augmentation is risky and may produce disastrous results.
It is important to note that medical authorities, such as state licensing boards, do not monitor or restrict specialty practice, so any licensed physician is legally allowed to practice plastic surgery or any other medical specialty regardless of his or her training or experience level.
Unlicensed cosmetic medicine practitioners
In an even more troubling and more recent incident reported by the Orange County Register, 22-year-old Mayra Contreras died after receiving silicone butt injections administered by two sisters running an unlicensed cosmetic medicine clinic out of their San Fernando Valley home.
Since Contreras’s untimely death, the women allegedly responsible have fled to Mexico in an effort to escape arrest.
Contreras didn’t realize she was taking her life in her hands by allowing non-medical personnel to inject her body using silicone, a substance that is already widely known for producing granulomas and other complications, even when administered by a doctor or other qualified medical professional.
Each of these unfortunate cases underscores the fact that medical aesthetics is truly a “buyer beware” industry. Unscrupulous and unqualified practitioners offer deep discounts to lure potential victims with low prices in an effort to cash in on this lucrative industry where upfront payment is the norm.
Before you consider cosmetic treatment prices
To avoid putting your health and aesthetic outcome at risk, research your doctor’s credentials and training, view his or her before and after photos of similar patient cases and get feedback from other patients before undergoing any cosmetic procedure. Make price the last consideration in choosing a doctor to perform your cosmetic enhancement.
Be sure to seek a board certified Houston plastic surgeon with experience performing breast augmentation, injectable fillers or any other procedure you desire to achieve your cosmetic goals.
Tags: Breast Augmentation, injectable fillers, silicone injections
July 30th, 2010
An article just posted online ahead of print in Plastic and Reconstructive Surgery includes survey data about career satisfaction among ASPS plastic surgeons.
The survey was mailed to 708 plastic surgeons who are members of the ASPS, half of them male and the other half female. Doctors were asked question about career satisfaction such as:
- Was a career in plastic surgery the right choice?
- Would you choose this career again if you had to do it over again?
The results are very positive – it appears that plastic surgery is a very satisfying career in the United States. 93 percent of respondents said it was the right career choice and 78 percent said they would make the choice again if they had to. Only a small percentage said they regretted the choice to become a plastic surgeon.
This information should be considered valuable for both doctors and patients as previous studies found a link between high quality care and the doctor’s satisfaction in his or her job. Such statistics on plastic surgeons may provide a picture of the general health of this profession in America and how it might affect the care you receive.
The most interesting outcomes of the survey were 1) the data regarding differences in satisfaction between surgeons who are “intellectually isolated” and those who are actively involved with their colleagues, and 2) the difference in satisfaction between surgeons who are focused primarily on reconstructive surgery and those who “balanced” their focus between reconstructive and cosmetic operations.
The study is published online ahead of print and you can access it through the journal’s website.
Source Cited
Satisfaction with Career Choice among U.S. Plastic Surgeons: Results from a National Survey. Streu, Rachel; Hawley, Sarah; Gay, Ashley; Salem, Barbara; Abrahamse, Paul; Alderman, Amy K . Plastic & Reconstructive Surgery.
Tags: plastic surgeon career satisfaction, survey of plastic surgeons
July 22nd, 2010
A new device by Cytroi Therapeutics called the Celution System recently received the CE mark of approval in Europe. The Celution System represents a breakthrough in stem cell-enriched fat grafting and promises to expand the uses of autologous fat grafting to effective breast reconstruction for partial mastectomy patients.
In addition to its application for fat graft preparation in breast reconstruction, the Celution System can also be used for fat graft preparation in wound healing and cosmetic fat grafting procedures including Brazilian Butt Lift and fat injection for wrinkle treatment and facial volume restoration.
European Celution System trials
The findings of Celution’s European trials indicated six months after breast reconstruction with stem cell-enriched fat grafting, the satisfaction rate among 51 patients was 73 percent, while physicians’ satisfaction with the same patients’ results was 84 percent.
One year after stem cell-enriched fat grafting for breast reconstruction, the satisfaction rate of the first 30 trial patients was 70 percent, while physician satisfaction of the same patients’ results was 90 percent.
There is still significant research to be done on the viability of stem cell-enriched fat grafting for breast reconstruction, however these initial results look promising.
Improvements in fat graft preparation
The Celution System is also designed to be used in tandem with the PureGraft System, another Cytori device. The PureGraft System is an FDA-approved, membrane-based tissue filtration device that allows autologous fat grafts to be prepared more quickly and in greater quantities.
Compared to other fat graft preparation devices, the PureGraft System works faster, taking only 15 minutes to purify a fat graft ranging from 50 to 250 mL by removing excess and unwanted fluid, lipid, blood cells and debris in a controlled manner, which in turn improves the efficiency of the Celution System
The future of stem cell-enriched fat grafting
Although the Celution System has been approved for distribution and use in Europe, the technology will need to be further tested before it is available in the U.S. Some surgeons are already experimenting with fat grafting as a means of breast augmentation and breast reconstruction, however this is still highly experimental, and the aesthetic outcomes are far from perfected.
When performed in any cosmetic capacity, the success of fat grafting is highly dependent on the technique and skill of your doctor, so be sure to seek an experienced Houston plastic surgeon for fat injections.
Tags: fat grafting, stem cells
June 29th, 2010
After an inquiry by the French Society of Plastic, Reconstructive and Aesthetic Plastic Surgeons revealed safety issues with Poly Implant Prostheses (PIP) breast implants, the British Association of Aesthetic Plastic Surgeons issued a guidance warning the estimated 50,000 British women who have the implants to check for ruptures within the next six months.
PIP breast implants were found to lack an essential protective barrier, causing them to rupture more easily than most breast implants, and were filled with unapproved silicone gel that had not undergone safety tests.
When ruptures or leaks are found in breast implants, a breast augmentation revision may be recommended to replace breast implants; however, it may not always be necessary.
Some women choose not to have revision surgery if their ruptured implants do not cause problems with breast appearance or health, while others choose to have breast explant surgery, or breast implant removal, but do not have their ruptured implants replaced. When breast implants are removed and a breast augmentation revision is not performed, a breast lift may be performed to remove skin stretched by the breast implants. A breast lift with implants is also an option depending on how much ptosis, or sagging, a patient has experienced since the initial breast augmentation surgery.
Unlike the PIP breast implants under recall in Europe, silicone breast implants used for breast augmentation surgery in the U.S. are filled with safe, FDA-approved silicone gel, but they may rupture due to age, implant malfunction or trauma. Ruptures are easy to detect in saline breast implants, as the implants deflate and noticeably lose volume, while an MRI is necessary in order to detect a rupture in silicone breast implants.
If you discover your breast implants have ruptured, it is important to remain calm, as there is no immediate health risk. Consult a highly experienced, board-certified plastic surgeon who can show you before and after photos of patients who have undergone breast revision surgery and help you decide whether breast augmentation revision or implant removal, with or without a breast lift, is right for you.
Tags: revision surgery, silicone breast implants
June 14th, 2010
Maybe you’ve heard about the “next-generation” highly cohesive silicone gel implants or even learned about the technology behind
them. If you haven’t, you may want to read up on the Natrelle 410 or the Mentor CPG 300 series breast implants.
A recent study published in Aesthetic Surgery Journal (“A comparison of outcomes involving highly cohesive, form-stable breast implants from two manufacturers in patients undergoing primary breast augmentation”) compares the outcomes of each breast implant and studies the potential processes that may improve breast augmentation with the new prosthetics.
The authors evaluated data such as:
- Breast characteristics
- Patient’s quality of life
- Patient and surgeon satisfaction with outcome
- Adverse events
After breast augmentation with highly cohesive silicone gel implants, doctors followed up on patients 16 to 77 months later. “The outcome data indicate that these devices produce natural-appearing breasts with extremely low aggregate reoperation rate (4.2%), writes study author Mark Jewell M.D. Between the two breast implant manufacturers, the study showed measurable differences in the incidence of visible implant rippling. Read the abstract to learn more.
Tags: silicone breast implants
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