For the past few years, like most plastic surgeons, I have been using Botox ( Botulinism Toxin) to treat the small furrows that occur between the eyebrows above the nose (glabella), the crows feet on the side of the eyes, and the horizontal lines of the forehead. The toxin, commonly referred to as the most potent toxin in the world, is the same that can cause serious conditions in people exposed to the bacteria that causes Botulinism. In fact, as noted today in the WASHINGTON POST, the toxin had been extensively studied by The US ,Soviet, and Iraqi scientists in an attempt to use it as a chemical weapon. It is lethal, but weaponising it proved too difficult. In its use as a plastic surgical aid, it is used in minuscule amounts to block the connections between nerves and muscles, effectively rendering the muscle inactive. The results have been excellent! The tiny shots are administered through small needles and when patients come a little earlier than their appointment, a little numbing cream makes the experience painless! I know because I get the shots myself. The material starts to work in about 7-10 days even though many patients report earlier effects. In my experience this is due to the swelling produced by the injection and not the pharmacological effects of the medicine.
The effects last about 3-4 months and, in some, even up to 6 months. One gets used to the new wrinkle free face so quickly that when the effects do begin to wear off you notice it quickly- "Where did those lines come from?" I've asked myself. Botox has been in use for over 30 years in medicine and has only recently found its cosmetic applications. It has been used, and continues to be used, to treat facial tics and twitches stemming from neurological problems for all these years.
So what about "Dysport"? The "new" Botox. Dysport which was approved recently for use as a neuromuscular blocker is......Botulinism Toxin. Same thing as Botox, but produced by a different company. The Dilution is a bit different in that a greater quantity needs to be injected to achieve the same result as with Botox,and it may have a speedier onset of effect, less pain on injection, and more chance of giving you a headache, but for practical purposes there are no differences despite what the marvels of advertising may have you believe. I'm offering it now to my patients just so that one company, Allergan, the maker of Botox, does not continue to have the monopoly of the market.
So the title should really be Botox = Dysport!
About Dr. Tavallali
- Dr. Tavallali
- Annandale, Virginia, United States
- Dr. Tavallali is one of the area's most experienced surgeons specializing in cosmetic plastic surgery. He completed his undergraduate work at Georgetown University, after which he obtained a Masters Degree in Physiology and Biophysics before entering the Medical School. He graduated with Honors from Georgetown University School of Medicine and trained as a General Surgeon at Lenox Hill Hospital in New York City. He completed his Plastic and Reconstructive Surgery at Baylor College of Medicine at the Texas Medical Center in Houston. You can visit Dr. Tavallali's website, by going to www.Tavmd.com.
Monday, January 25, 2010
Wednesday, June 10, 2009
Liposuction; ultrasound, laser, power assisted, nuclear?
Liposuction: power-assisted, ultrasound, laser, and nuclear?
Like any technology or new surgical technique, liposuction has undergone multiple refinements and improvements in technique over the years.
Since its entry into the mainstream of plastic surgical usage in the late 1980s, the biggest and most beneficial change occurred with the advent of the tumescent technique in the early 1990s. Prior to that, during my early training, patients for liposuction were admitted to the hospital the night before surgery. They had already been to the blood bank a few times in the months leading to the surgery to donate their blood, which was to be re-infused during the procedure- such was the amount of blood loss that occurred with the surgery!
The cannulae (tubes) used to remove the fat were as large as one’s thumb, and perhaps the strangest of all, an intravenous drip of 5% Alcohol was given to the patient during the surgery to decrease the risk of fat emboli which was real and far too frequent. Drugged and drunk is how patients woke up!
Tumescent liposuction
The “tumescent” technique revolutionizes liposuction. A mixture of saline, epinephrine (adrenaline to constrict the blood vessels) and xylocaine (a local anesthetic), was injected under the skin and into the fat immediately before the liposuction was to begin. The epinephrine stopped the bleeding; the fat that was removed was a pure golden yellow. The xylocaine numbed the area during and after the procedure, allowing less use of anesthesia and a faster recovery for the patient. The procedure was thus transformed into an out-patient procedure, with little risk of blood loss and soon became one of the most commonly performed plastic surgical procedures. At the same time, the cannulae became smaller in size thus decreasing the risk of fat emboli and damage to other structures. Tumescent liposuction is used in all cases of liposuction today, irrespective of the manner in which the fat is removed.
Ultrasound liposuction
In the mid 1990s, ultrasound energy became the “new” method for performing liposuction. Plastic surgeons flocked to ultrasound liposuction courses to receive a certificate and blessing for its use. The idea of the ultrasonic liposuction was to melt the fat under the skin before removing it by a normal cannula. The advantages touted were, less bruising and greater skin tightening. The problems started to show up soon thereafter; burns to the skin from the ultrasound wand being inadvertently pushed into it; seroma (fluid buildup under the skin) after the procedure; delayed healing; larger scars, more operating time and greater expense. Whereas all were using ultrasonic liposuction in all cases, many of my colleagues and I, now use it more judiciously. The results are identical to tumescent liposuction with standard cannulae in terms of bruising. There may be more skin tightening- but I am really not that sure. The risks and complications are real enough that I only use it in cases of secondary liposuction and in specific areas such as the male chest and back, where tissues are tougher and the melting of the fat makes the procedure easier on my arm. After all, during the average liposuction, the surgeon’s arm moves back and forth 4000 times! Ofcourse newer machines based on this technology are always being produced. Currently the ”Vaser” machine is toast of the town, but I am still to be convinced of its benefit to my patients given its increased cost (about $300 more per surgery).
Power-assisted Liposuction
With the downsides to the ultrasound liposuction becoming more apparent new avenues were investigated. The principle used in a jack- hammer was applied to the liposuction cannula to assist in the removal of fat. The Power assisted liposuction is attached to an oscillating machine that drives the cannula back and forth at a steady rate. This allows the cannula to penetrate the fat more easily and thus requires less force from the surgeon, while removing a greater amount of fat faster. There is no burn to the underlying skin or structures, or damage to the skin if the tip of the cannula hits it. There is a certain vibration in the larger cannula handle that some surgeons find annoying, but it does not bother me.
Laser liposuction
The latest technology to be applied to liposuction is the use of lasers. The idea of “laser liposuction” is to again melt the fat under the skin before removing it. Again the touted advantages are less bruising, less pain, and more skin tightening. Excellent goals- unfortunately the devices on the market today are designed for removal of fat in very small areas such as under the neck or from the arms in thinner women. They are not designed for the majority of liposuctions which include removal of larger amounts of fat from larger areas such as the abdomen and the thighs. currently these are marketed as slim lipo, smart lipo, and other dis-ingeniuos names. None of the so called advantages have so far been proven scientifically or un-scientifically!
So….Which is better?
I have learnt over the years is that in terms of result, I find no difference in the techniques that are available. One may produce more skin shrinkage, less bruising, or less pain than the other, but I am convinced that the variation is probably more to do with the patient’s own skin elasticity and attributes than the technology being used.
I have learnt that there are differences between the techniques in the level of fatigue that they produce for the surgeon. Traditional liposuction requires force to push the cannula in and out of the fat- a brutal looking procedure that has had many aghast watching YouTube. The ultrasound and laser techniques are much slower by comparison, with the cannulae being moved slowly under the skin, and then having the fat removed by the traditional cannula which now is easy to manipulate as there is only liquefied fat. The power- assisted machine likewise makes the surgeon’s experience less of a sweat producing chore.
I have learnt that the companies that produce medical technologies or drugs, are not always truthful about their products, and make claims that are unsubstantiated. Like all companies involved in selling something, their profit is often the prime motivating force. An ultrasound machine costs $30,000-$50,000; a laser liposuction machine between 100,000- 250,000! I often wonder if a surgeon’s judgment is affected by the incentive to recoup that financial outlay for such expensive medical equipment.
In late 2008 a study was performed showing the difference between the above three current three technologies of liposuction. No differences in results were noted. Power assisted liposuction was however the technique that had the least amount of damage to the skin and its structures- and by extension the safest. I’ll keep using it until the “nuclear liposuction” comes along; we’ll see if that is any better.
Like any technology or new surgical technique, liposuction has undergone multiple refinements and improvements in technique over the years.
Since its entry into the mainstream of plastic surgical usage in the late 1980s, the biggest and most beneficial change occurred with the advent of the tumescent technique in the early 1990s. Prior to that, during my early training, patients for liposuction were admitted to the hospital the night before surgery. They had already been to the blood bank a few times in the months leading to the surgery to donate their blood, which was to be re-infused during the procedure- such was the amount of blood loss that occurred with the surgery!
The cannulae (tubes) used to remove the fat were as large as one’s thumb, and perhaps the strangest of all, an intravenous drip of 5% Alcohol was given to the patient during the surgery to decrease the risk of fat emboli which was real and far too frequent. Drugged and drunk is how patients woke up!
Tumescent liposuction
The “tumescent” technique revolutionizes liposuction. A mixture of saline, epinephrine (adrenaline to constrict the blood vessels) and xylocaine (a local anesthetic), was injected under the skin and into the fat immediately before the liposuction was to begin. The epinephrine stopped the bleeding; the fat that was removed was a pure golden yellow. The xylocaine numbed the area during and after the procedure, allowing less use of anesthesia and a faster recovery for the patient. The procedure was thus transformed into an out-patient procedure, with little risk of blood loss and soon became one of the most commonly performed plastic surgical procedures. At the same time, the cannulae became smaller in size thus decreasing the risk of fat emboli and damage to other structures. Tumescent liposuction is used in all cases of liposuction today, irrespective of the manner in which the fat is removed.
Ultrasound liposuction
In the mid 1990s, ultrasound energy became the “new” method for performing liposuction. Plastic surgeons flocked to ultrasound liposuction courses to receive a certificate and blessing for its use. The idea of the ultrasonic liposuction was to melt the fat under the skin before removing it by a normal cannula. The advantages touted were, less bruising and greater skin tightening. The problems started to show up soon thereafter; burns to the skin from the ultrasound wand being inadvertently pushed into it; seroma (fluid buildup under the skin) after the procedure; delayed healing; larger scars, more operating time and greater expense. Whereas all were using ultrasonic liposuction in all cases, many of my colleagues and I, now use it more judiciously. The results are identical to tumescent liposuction with standard cannulae in terms of bruising. There may be more skin tightening- but I am really not that sure. The risks and complications are real enough that I only use it in cases of secondary liposuction and in specific areas such as the male chest and back, where tissues are tougher and the melting of the fat makes the procedure easier on my arm. After all, during the average liposuction, the surgeon’s arm moves back and forth 4000 times! Ofcourse newer machines based on this technology are always being produced. Currently the ”Vaser” machine is toast of the town, but I am still to be convinced of its benefit to my patients given its increased cost (about $300 more per surgery).
Power-assisted Liposuction
With the downsides to the ultrasound liposuction becoming more apparent new avenues were investigated. The principle used in a jack- hammer was applied to the liposuction cannula to assist in the removal of fat. The Power assisted liposuction is attached to an oscillating machine that drives the cannula back and forth at a steady rate. This allows the cannula to penetrate the fat more easily and thus requires less force from the surgeon, while removing a greater amount of fat faster. There is no burn to the underlying skin or structures, or damage to the skin if the tip of the cannula hits it. There is a certain vibration in the larger cannula handle that some surgeons find annoying, but it does not bother me.
Laser liposuction
The latest technology to be applied to liposuction is the use of lasers. The idea of “laser liposuction” is to again melt the fat under the skin before removing it. Again the touted advantages are less bruising, less pain, and more skin tightening. Excellent goals- unfortunately the devices on the market today are designed for removal of fat in very small areas such as under the neck or from the arms in thinner women. They are not designed for the majority of liposuctions which include removal of larger amounts of fat from larger areas such as the abdomen and the thighs. currently these are marketed as slim lipo, smart lipo, and other dis-ingeniuos names. None of the so called advantages have so far been proven scientifically or un-scientifically!
So….Which is better?
I have learnt over the years is that in terms of result, I find no difference in the techniques that are available. One may produce more skin shrinkage, less bruising, or less pain than the other, but I am convinced that the variation is probably more to do with the patient’s own skin elasticity and attributes than the technology being used.
I have learnt that there are differences between the techniques in the level of fatigue that they produce for the surgeon. Traditional liposuction requires force to push the cannula in and out of the fat- a brutal looking procedure that has had many aghast watching YouTube. The ultrasound and laser techniques are much slower by comparison, with the cannulae being moved slowly under the skin, and then having the fat removed by the traditional cannula which now is easy to manipulate as there is only liquefied fat. The power- assisted machine likewise makes the surgeon’s experience less of a sweat producing chore.
I have learnt that the companies that produce medical technologies or drugs, are not always truthful about their products, and make claims that are unsubstantiated. Like all companies involved in selling something, their profit is often the prime motivating force. An ultrasound machine costs $30,000-$50,000; a laser liposuction machine between 100,000- 250,000! I often wonder if a surgeon’s judgment is affected by the incentive to recoup that financial outlay for such expensive medical equipment.
In late 2008 a study was performed showing the difference between the above three current three technologies of liposuction. No differences in results were noted. Power assisted liposuction was however the technique that had the least amount of damage to the skin and its structures- and by extension the safest. I’ll keep using it until the “nuclear liposuction” comes along; we’ll see if that is any better.
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Monday, November 10, 2008
Beauty and Plastic surgery
Almost on a daily basis I ask myself the relationship between beauty and what I, as a plastic surgeon performing cosmetic operations, do. I ask myself did I achieve a beautiful result; did I make the patient look “younger”, “more rested”, more beautiful? The more years I am in practice, the more I understand this relationship between our perceptions of beauty and what I do surgically or by other interventions to enhance that idea.
The surprising conclusion I have reached is summed up in one word; Normal.
The best results that I can possibly achieve are where the patient looks normal! That is to say that my patient has no physical characteristics that stand out to such an extent that allow you, the observer, to identify, classify or remark on. In essence, and contrary to commonly held modern beliefs about our uniqueness and individuality, when it comes to our looks we all just want to be normal; with unimpeachable physical characteristics.
As humans we have a tendency to identify each other by physical characteristics. The most obvious and nefarious has been skin color along with its well known historical and social sequelae. But even after color we keep on separating and identifying each other by the size and shape of our nose, breasts, body, ears, hair, eyes, and so on. How many times has someone tried to identify another as “ the normal height and weight white girl with normal breasts and normal eyes, ears and nose, and with no scars.” A much more common identifier is” the short, fat, black man with big breasts and a hooked nose with floppy ears, droopy eyelids, and a scar on his face”. (Guess what? Almost all these characteristics can be improved by plastic surgery! )
In a reverse anthropomorphism, we identify other humans by the physical characteristics that set them apart from the rest of the herd. “Ugliness” can hence be defined as physical characteristics and deformities that fall outside of the perceived social norm for that group, in that particular time period, and by which an individual can be identified as being other. But does the inverse definition apply to our concept of beauty?
That is physical characteristics that are at the middle of the norm of the group for a particular period? Surely we do not mean that the most “plain Jane” is the most beautiful? The girl or boy that we cannot describe in any way? Well, try it- think of a beautiful woman of our times; try to describe her. It is difficult. Yet we all have a very similar concept of what makes a human “beautiful”, hard wired into our brains, even if we cannot put it into words. That concept may change somewhat over time with new fashions and styles, but the basis is the same across races and history. Physical beauty ends up meaning that we find a certain harmony in the characteristics we are looking at, be they a whole body, a face, a hand, or even a nose.
The Golden mean or ratio ( 1:1.618) is a mathematical ratio found throughout nature that relates differing parts of natural objects to one another. This is one ratio that we find beautiful; this is one of those harmonies we seek. For example the length of the eyelid (1) to the length of the mouth (1.618) is though by most to be beautiful. Likewise, the width of the front incisor tooth (1.618) to the tooth directly next to it(1). The list goes on ad infinitum.
Apart from these “hard wired” perceptions of beauty, there are other “ hard wired” criteria by which we also judge each other’s appearance.
For example, we are pre-programmed to look for and notice objects that are dark and round. They attract our attention much more than, say, a dark line. This ability rests on a species recognition trait that allows us to recognize each other as being from a similar life form as opposed to a lizard. Our pupils, out nipples, belly buttons, are all round and dark for that reason. In fact, during the 18th century both men and women of means and fashion used this innate ability of our brains to attract attention to themselves by the use of applied beauty marks, mimicking skin moles.
The quality of the skin is also one such criterion. Even if one’s bone structure and relations of nose to mouth are not in the golden mean proportion, should we have a clear complexion with smooth skin, we are thought of as being more attractive. The answer to this is that we are programmed to beware of outward (skin and body) signs of disease in those around us. It’s a warning mechanism with its basis as the suitability of the individual as a sexual partner. For example, if your neighbor has pimples and pustules, skin discoloration, unevenness of the texture, or peeling skin, you are apt to keep your distance and avoid contact lest you catch their illness. God forbid that they have wrinkles, moles, or other growths on the skin that are giveaways for being older (and less attractive for procreation)- Just close your eyes and imagine a witch. Do you see her warty growths on her nose and chin?
The converse, clear skin that is smooth and free of blemishes, alludes to a healthy young person who is sexually more attractive.
A multi-billion dollar cosmetic industry exists worldwide to counter our innate ability to discern. Cosmetic surgery is also part of this collusion against our primitive instincts of judging each other by our physical characteristics. It makes the playing field more even and allows our intellect the opportunity to shine through our body coverings. Plastic surgery procedures allow the unsightly conversation pieces that our bodies may provide, to be transformed and disappear. It’s that change that we see in ourselves when looking in a mirror, and that others see when looking at us, that changes attitudes from within and from the outside.
Beauty is truly in the eye of the beholder, but it seems we are all looking through the same lens at different periods of history. Also, we all know that the eye can be tricked by the sleight of hand (with a scalpel).
The surprising conclusion I have reached is summed up in one word; Normal.
The best results that I can possibly achieve are where the patient looks normal! That is to say that my patient has no physical characteristics that stand out to such an extent that allow you, the observer, to identify, classify or remark on. In essence, and contrary to commonly held modern beliefs about our uniqueness and individuality, when it comes to our looks we all just want to be normal; with unimpeachable physical characteristics.
As humans we have a tendency to identify each other by physical characteristics. The most obvious and nefarious has been skin color along with its well known historical and social sequelae. But even after color we keep on separating and identifying each other by the size and shape of our nose, breasts, body, ears, hair, eyes, and so on. How many times has someone tried to identify another as “ the normal height and weight white girl with normal breasts and normal eyes, ears and nose, and with no scars.” A much more common identifier is” the short, fat, black man with big breasts and a hooked nose with floppy ears, droopy eyelids, and a scar on his face”. (Guess what? Almost all these characteristics can be improved by plastic surgery! )
In a reverse anthropomorphism, we identify other humans by the physical characteristics that set them apart from the rest of the herd. “Ugliness” can hence be defined as physical characteristics and deformities that fall outside of the perceived social norm for that group, in that particular time period, and by which an individual can be identified as being other. But does the inverse definition apply to our concept of beauty?
That is physical characteristics that are at the middle of the norm of the group for a particular period? Surely we do not mean that the most “plain Jane” is the most beautiful? The girl or boy that we cannot describe in any way? Well, try it- think of a beautiful woman of our times; try to describe her. It is difficult. Yet we all have a very similar concept of what makes a human “beautiful”, hard wired into our brains, even if we cannot put it into words. That concept may change somewhat over time with new fashions and styles, but the basis is the same across races and history. Physical beauty ends up meaning that we find a certain harmony in the characteristics we are looking at, be they a whole body, a face, a hand, or even a nose.
The Golden mean or ratio ( 1:1.618) is a mathematical ratio found throughout nature that relates differing parts of natural objects to one another. This is one ratio that we find beautiful; this is one of those harmonies we seek. For example the length of the eyelid (1) to the length of the mouth (1.618) is though by most to be beautiful. Likewise, the width of the front incisor tooth (1.618) to the tooth directly next to it(1). The list goes on ad infinitum.
Apart from these “hard wired” perceptions of beauty, there are other “ hard wired” criteria by which we also judge each other’s appearance.
For example, we are pre-programmed to look for and notice objects that are dark and round. They attract our attention much more than, say, a dark line. This ability rests on a species recognition trait that allows us to recognize each other as being from a similar life form as opposed to a lizard. Our pupils, out nipples, belly buttons, are all round and dark for that reason. In fact, during the 18th century both men and women of means and fashion used this innate ability of our brains to attract attention to themselves by the use of applied beauty marks, mimicking skin moles.
The quality of the skin is also one such criterion. Even if one’s bone structure and relations of nose to mouth are not in the golden mean proportion, should we have a clear complexion with smooth skin, we are thought of as being more attractive. The answer to this is that we are programmed to beware of outward (skin and body) signs of disease in those around us. It’s a warning mechanism with its basis as the suitability of the individual as a sexual partner. For example, if your neighbor has pimples and pustules, skin discoloration, unevenness of the texture, or peeling skin, you are apt to keep your distance and avoid contact lest you catch their illness. God forbid that they have wrinkles, moles, or other growths on the skin that are giveaways for being older (and less attractive for procreation)- Just close your eyes and imagine a witch. Do you see her warty growths on her nose and chin?
The converse, clear skin that is smooth and free of blemishes, alludes to a healthy young person who is sexually more attractive.
A multi-billion dollar cosmetic industry exists worldwide to counter our innate ability to discern. Cosmetic surgery is also part of this collusion against our primitive instincts of judging each other by our physical characteristics. It makes the playing field more even and allows our intellect the opportunity to shine through our body coverings. Plastic surgery procedures allow the unsightly conversation pieces that our bodies may provide, to be transformed and disappear. It’s that change that we see in ourselves when looking in a mirror, and that others see when looking at us, that changes attitudes from within and from the outside.
Beauty is truly in the eye of the beholder, but it seems we are all looking through the same lens at different periods of history. Also, we all know that the eye can be tricked by the sleight of hand (with a scalpel).
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Wednesday, April 9, 2008
Which Skin Filler should I use?
I get asked this question daily. There appears to be a great deal of confusion regarding the role of facial fillers and even the difference between a facial filler and Botox; and it is not difficult to understand why when there are so many different products being touted as the cure all for facial lines /wrinkles.
I hope this explanation helps to clear up the confusion so we can decide which of the alternatives is best for you.
First, we must distinguish between wrinkles / lines that are caused by active muscle action and others that are due to passive muscle action. An active muscle is one that you can contract and which then causes a wrinkle. Good examples are the muscles around your eyes, between your eyebrows and in your forehead. You can move these muscles and they cause wrinkles to appear. Botox is the primary way to improve these lines. It stops the muscle action and prevents the wrinkle from forming for about 4 months. The treatment then has to be repeated. So, if you can move it, you need Botox to stop it.!
The wrinkles that exist on the skin surface, and which you can not cause by using your facial muscles, are caused by the passive muscles, and your skin quality. Examples of these are the lines between the nose and the corners of the mouth (The Nasolabial lines), the lines between the corners of the mouth and the sides of the chin (The Marionette lines), and the lines under the eyelids (the dark circles under the eyes). You can not move these lines. They are just there. These are the lines that need facial fillers.
There are today three main types of facial line fillers.
"Juvederm".
This is a hyaluronic acid (one of the components of our own skin) and looks like jelly. The older form of this product was the better known "Restalyn", whose manufacturer did and continues to do, a tremendous publicity campaign. Juvederm is injected without the need for anesthesia under the lines. It lasts about 9 months. There may be a little irritation, swelling, or bruising, but most patients come in, get the injection and go back to their activities. Juvederm is the least expensive of the fillers I use.
"Radiesse" .
This material is similar to Juvederm in that it is also made of Hyaluronic acid, but it also has little crystals of Hydroxy apetite, a crystal that is found in our bones. The addition of the crystals means that the material will stay in the skin longer before it is reabsorbed. Usually for 1-2 years. I like to give a local anesthetic to my patients when injecting this material because it stings a little bit as it is injected. It needs to be massaged 5 times a day, for 5 minutes, for 5 days in order to mold it better into the areas required. There seems to be a little more bruising in my hands than with other materials, but still patients return to their business after an hour or so after the injection. The cost is intermediate.
"Artefill".
The newest of the material is Artefill. This is a different type of material than the above because it is touted as a permanent filler. As of this date studies corroborate that it remains at 5 years after injection, but the studies are continuing to see if it really is permanent. The material is made of microscopic balls of a plastic type of material, methyl methacrylate, that are in a collagen carrier. The material gets injected, the collagen gets absorbed by the body after a couple of months, and the body forms scar tissue around the little plastic balls. The scar tissue supposedly then stays for a long time. There is no downtime with these injection; like the one above. It is the most expensive of the materials.
"Sculptra".
I am including this material only for completeness since it is not a facial LINE filler, but rather, a facial VOLUME filler. It is best suited for people who have thin faces and wish to have a fuller face. The injection is done with local anesthesia and there is more bruising and swelling than with the other materials above. Initial swelling disappears after a few days and then the body starts to fill in the skin and thicken it to give the desired outcome.
In conclusion, there are a number of safe and effective skin and dermal fillers available.
Patients must weigh the cost/benefit of each product for themselves. Essentially the longer the material lasts the more it costs! The result is the same. Perhaps the biggest difficulty I have encountered is to make my patients understand that sometimes one single injection is not sufficient to get the result they want. If the lines are deep, they may need more material to fill in the crevice of the facial line. Similarly with Botox, if the muscles are very strong, the patient may need more units of Botox to achieve the same level of muscle paralysis. Be sure to discuss all these options with me when you come for your consultation.
I hope this explanation helps to clear up the confusion so we can decide which of the alternatives is best for you.
First, we must distinguish between wrinkles / lines that are caused by active muscle action and others that are due to passive muscle action. An active muscle is one that you can contract and which then causes a wrinkle. Good examples are the muscles around your eyes, between your eyebrows and in your forehead. You can move these muscles and they cause wrinkles to appear. Botox is the primary way to improve these lines. It stops the muscle action and prevents the wrinkle from forming for about 4 months. The treatment then has to be repeated. So, if you can move it, you need Botox to stop it.!
The wrinkles that exist on the skin surface, and which you can not cause by using your facial muscles, are caused by the passive muscles, and your skin quality. Examples of these are the lines between the nose and the corners of the mouth (The Nasolabial lines), the lines between the corners of the mouth and the sides of the chin (The Marionette lines), and the lines under the eyelids (the dark circles under the eyes). You can not move these lines. They are just there. These are the lines that need facial fillers.
There are today three main types of facial line fillers.
"Juvederm".
This is a hyaluronic acid (one of the components of our own skin) and looks like jelly. The older form of this product was the better known "Restalyn", whose manufacturer did and continues to do, a tremendous publicity campaign. Juvederm is injected without the need for anesthesia under the lines. It lasts about 9 months. There may be a little irritation, swelling, or bruising, but most patients come in, get the injection and go back to their activities. Juvederm is the least expensive of the fillers I use.
"Radiesse" .
This material is similar to Juvederm in that it is also made of Hyaluronic acid, but it also has little crystals of Hydroxy apetite, a crystal that is found in our bones. The addition of the crystals means that the material will stay in the skin longer before it is reabsorbed. Usually for 1-2 years. I like to give a local anesthetic to my patients when injecting this material because it stings a little bit as it is injected. It needs to be massaged 5 times a day, for 5 minutes, for 5 days in order to mold it better into the areas required. There seems to be a little more bruising in my hands than with other materials, but still patients return to their business after an hour or so after the injection. The cost is intermediate.
"Artefill".
The newest of the material is Artefill. This is a different type of material than the above because it is touted as a permanent filler. As of this date studies corroborate that it remains at 5 years after injection, but the studies are continuing to see if it really is permanent. The material is made of microscopic balls of a plastic type of material, methyl methacrylate, that are in a collagen carrier. The material gets injected, the collagen gets absorbed by the body after a couple of months, and the body forms scar tissue around the little plastic balls. The scar tissue supposedly then stays for a long time. There is no downtime with these injection; like the one above. It is the most expensive of the materials.
"Sculptra".
I am including this material only for completeness since it is not a facial LINE filler, but rather, a facial VOLUME filler. It is best suited for people who have thin faces and wish to have a fuller face. The injection is done with local anesthesia and there is more bruising and swelling than with the other materials above. Initial swelling disappears after a few days and then the body starts to fill in the skin and thicken it to give the desired outcome.
In conclusion, there are a number of safe and effective skin and dermal fillers available.
Patients must weigh the cost/benefit of each product for themselves. Essentially the longer the material lasts the more it costs! The result is the same. Perhaps the biggest difficulty I have encountered is to make my patients understand that sometimes one single injection is not sufficient to get the result they want. If the lines are deep, they may need more material to fill in the crevice of the facial line. Similarly with Botox, if the muscles are very strong, the patient may need more units of Botox to achieve the same level of muscle paralysis. Be sure to discuss all these options with me when you come for your consultation.
Wednesday, January 9, 2008
Improving your shape
ADDING MUSCLE TO YOUR WORKOUT
The American College of Sports Medicine and the American Heart Association have updated their exercise recommendations. Brisk walks are no longer enough.
The recommendation is for adults ages 18 to 65 to participate in moderate-intensity aerobic activity at least 30 minutes 5 days a week. Short spurts of activity, including housecleaning, taking out the trash or walking in the office do not count.
We all now know that exercise helps to reduce the risk of heart disease, stroke, type 2 diabetes, osteoporosis, and some types of cancers.
The new recommendations encourage adults to do eight to 12 repetitions of eight to 10 different exercises on the major muscle groups. These include the chest, back, shoulders, upper legs, lower legs and arms. The muscle training exercises should be done on two non-consecutive days during the week.
Insight: Aerobic exercise is important, but not enough to maintain a healthy body. Add muscle training to your workout two times a week.
Adapted from "New guidelines urge: Put some muscle into your workout." USAToday.com, Aug. 2007. Accessed September 24, 2007 from http://www.usatoday.com/news/health/2007-08-01-exercise-guidelines_n.htm
SETTING SMALL GOALS TO REACH GOOD HEALTH
There are many changes that we know we should make to improve our diets and increase exercise. But, the question remains, how do we get there? Experts agree that setting small goals to reach good health is the key to lifelong change. Making a few small changes can have a big impact on your health.
Ask yourself these questions to get started:
Is your health at risk? Do you have an elevated BMI? Has your doctor encouraged you to lose weight?
Are you ready, willing, and able to make change?
What are you ready, willing and able to change?
For each of your new goals, think about these next four questions
1. How long will you try to reach this goal?
2. Is it easy to do in your regular daily life?
3. Is it limited in scope?
4. How often will you do this?
The key to setting goals is to make them SMART goals- Specific, Measurable, Attainable, Realistic, and Timely.
Examples of goals:
Eating: For the next week, I will consume one piece of fruit per day.
Eating: For the next week, I will limit my consumption of fast food to one time per week.
Physical Activity: In the next four weeks, I will take a 15 minute walk three times a week.
Did you succeed?
What is your next step? Do you plan to continue with the same goal, or do you intend to increase it?
Insight: Start small. Make SMART goals.
Adapted from "Weight loss matters- small steps for your health" American Diabetes Association. July 2007. Accessed September 24, 2007 from http://www.diabetes.org/weightloss-and-exercise/weightloss-small-steps.jsp
WAIST SIZE AND HEART DISEASE RISK
Researchers are finding that waist size may be a better way of telling if you are at risk of heart disease than stepping on a scale. Even if people are not overweight, those with a larger waistline are more likely to show signs of heart disease than those with smaller waists.
A team at the University of Texas Southwestern Medical Center in Dallas studied participants with a mean age of 45 and found a direct relationship between waist size and early indications of heart disease.
After taking into account heart disease risk factors, the researchers found that weight alone did not predict a person’s chances of having early artery clogging. However, waist size did.
Insight: According to the research, waist size increases risk of heart disease. Increase activity and consume a healthy diet to decrease waist size and risk.
Adapted from "Tape measure, not scale , key to known heart risk" CNN.com Accessed September 24, 2007 from http://www.cnn.com/2007/HEALTH/conditions/08/13/heart.potbellies.reut/index.html
SURVEY HIGHLIGHTS AMERICANS’ PERCEPTION OF THEIR HEALTH
The 2007 IFIC Foundation’s Food and Health Survey: Consumer Attitudes toward Food, Nutrition & Health found that Americans’ perception of their health improved over the year before. This year’s results found that 39 percent feel their health is "excellent" or "very good" compared to 33 percent from the 2006 survey.
The survey found that Americans continue to focus on making changes to improve their diet. More than half of those surveyed said they are trying to lose weight through diet and increased physical activity. However, nine out of 10 Americans do not know how many calories they should consume.
Other findings included:
Diet and Physical Activity: Eighty four percent surveyed reported to be physically active at least one time per week. This is an increase from the year before.
Breakfast: The first meal of the day was found to be the most important. However, only half reported eating breakfast everyday.
Fats: There was an increase this year in consumers’ concern over the type and amount of fat in the diet. Those surveyed reported trying to consume less trans fat ( 78 percent in 2007 vs. 54 percent in 2006).
Carbohydrates: Seventy percent of those surveyed reported trying to consume more carbohydrates with fiber and whole grains.
Caffeine: Forty- eight percent of those surveyed reported trying to limit their caffeine consumption.
Insight: This survey shows that more Americans are trying to make healthy choices to reduce weight and decrease risk of chronic disease.
Adapted from "Calories Count, but….Consumers Don’t Seem to Know How: Food and Health Survey Highlights Six "Diet Disconnects"." International Food Information Council. October 2007. Accessed October 8, 2007 from http://ific.org/foodinsight/2007/mj/fandhsurveyfi307.cfm
HOW TO CHANGE UNDESIRABLE EATING HABITS
It is easier to changes when we focus on one area at a time. Small changes over time will help improve health and lead to long term success. Here are a few:
1. Undesirable eating habit: Snacking throughout the day
Snacking throughout the day may lead to overeating. Having a planned healthy snack once or twice a day is fine. To improve energy and decrease hunger, add two snacks a day of 100 to 300 calories each. This can be a great time to add healthy foods like low fat yogurt, fruit, vegetables or whole grain crackers and low fat cheese.
2. Undesirable eating habit: Eating too quickly
Eating too quickly can lead to stomach troubles and doesn’t allow your brain time to catch up to the stomach. Your brain needs 20 minutes to receive the signals you’re your brain that you are full. Try to slow down. Avoid finger foods. Eat while sitting down and avoid eating in front of the television. Pause often, and take the time to drink fluids during meals.
3. Undesirable eating habit: Eating because of your emotions
Try to think about why you are eating before you do. Many people eat because they are happy or sad, feeling stressed or bored. Try something else to change your mood. Go for a walk or call a friend.
4. Undesirable eating habit: Careful all week, but overeat on the weekends
It is easy to reverse all the good choices that were made during the week with overeating on the weekends. Because most of the socializing and eating out happens on the weekends, make sure to have a strategy. Have a snack before going to parties. Avoid the bread basket at the restaurant. Continue to have one or two snacks between meals to keep energy up and decrease hunger.
Insight: It is important to be aware of why we are eating and to have a strategy to get through the tough times.
Adapted from "How to break bad eating habits." CNN.com. October 2007. Accessed October 9, 2007 from http://www.cnn.com/2007/LIVING/personal/10/04/rs.bad.eating.habits/index.html
Information provided by Novartis corporation. Please contact Dr. Tavallali with any questions you may have.
The American College of Sports Medicine and the American Heart Association have updated their exercise recommendations. Brisk walks are no longer enough.
The recommendation is for adults ages 18 to 65 to participate in moderate-intensity aerobic activity at least 30 minutes 5 days a week. Short spurts of activity, including housecleaning, taking out the trash or walking in the office do not count.
We all now know that exercise helps to reduce the risk of heart disease, stroke, type 2 diabetes, osteoporosis, and some types of cancers.
The new recommendations encourage adults to do eight to 12 repetitions of eight to 10 different exercises on the major muscle groups. These include the chest, back, shoulders, upper legs, lower legs and arms. The muscle training exercises should be done on two non-consecutive days during the week.
Insight: Aerobic exercise is important, but not enough to maintain a healthy body. Add muscle training to your workout two times a week.
Adapted from "New guidelines urge: Put some muscle into your workout." USAToday.com, Aug. 2007. Accessed September 24, 2007 from http://www.usatoday.com/news/health/2007-08-01-exercise-guidelines_n.htm
SETTING SMALL GOALS TO REACH GOOD HEALTH
There are many changes that we know we should make to improve our diets and increase exercise. But, the question remains, how do we get there? Experts agree that setting small goals to reach good health is the key to lifelong change. Making a few small changes can have a big impact on your health.
Ask yourself these questions to get started:
Is your health at risk? Do you have an elevated BMI? Has your doctor encouraged you to lose weight?
Are you ready, willing, and able to make change?
What are you ready, willing and able to change?
For each of your new goals, think about these next four questions
1. How long will you try to reach this goal?
2. Is it easy to do in your regular daily life?
3. Is it limited in scope?
4. How often will you do this?
The key to setting goals is to make them SMART goals- Specific, Measurable, Attainable, Realistic, and Timely.
Examples of goals:
Eating: For the next week, I will consume one piece of fruit per day.
Eating: For the next week, I will limit my consumption of fast food to one time per week.
Physical Activity: In the next four weeks, I will take a 15 minute walk three times a week.
Did you succeed?
What is your next step? Do you plan to continue with the same goal, or do you intend to increase it?
Insight: Start small. Make SMART goals.
Adapted from "Weight loss matters- small steps for your health" American Diabetes Association. July 2007. Accessed September 24, 2007 from http://www.diabetes.org/weightloss-and-exercise/weightloss-small-steps.jsp
WAIST SIZE AND HEART DISEASE RISK
Researchers are finding that waist size may be a better way of telling if you are at risk of heart disease than stepping on a scale. Even if people are not overweight, those with a larger waistline are more likely to show signs of heart disease than those with smaller waists.
A team at the University of Texas Southwestern Medical Center in Dallas studied participants with a mean age of 45 and found a direct relationship between waist size and early indications of heart disease.
After taking into account heart disease risk factors, the researchers found that weight alone did not predict a person’s chances of having early artery clogging. However, waist size did.
Insight: According to the research, waist size increases risk of heart disease. Increase activity and consume a healthy diet to decrease waist size and risk.
Adapted from "Tape measure, not scale , key to known heart risk" CNN.com Accessed September 24, 2007 from http://www.cnn.com/2007/HEALTH/conditions/08/13/heart.potbellies.reut/index.html
SURVEY HIGHLIGHTS AMERICANS’ PERCEPTION OF THEIR HEALTH
The 2007 IFIC Foundation’s Food and Health Survey: Consumer Attitudes toward Food, Nutrition & Health found that Americans’ perception of their health improved over the year before. This year’s results found that 39 percent feel their health is "excellent" or "very good" compared to 33 percent from the 2006 survey.
The survey found that Americans continue to focus on making changes to improve their diet. More than half of those surveyed said they are trying to lose weight through diet and increased physical activity. However, nine out of 10 Americans do not know how many calories they should consume.
Other findings included:
Diet and Physical Activity: Eighty four percent surveyed reported to be physically active at least one time per week. This is an increase from the year before.
Breakfast: The first meal of the day was found to be the most important. However, only half reported eating breakfast everyday.
Fats: There was an increase this year in consumers’ concern over the type and amount of fat in the diet. Those surveyed reported trying to consume less trans fat ( 78 percent in 2007 vs. 54 percent in 2006).
Carbohydrates: Seventy percent of those surveyed reported trying to consume more carbohydrates with fiber and whole grains.
Caffeine: Forty- eight percent of those surveyed reported trying to limit their caffeine consumption.
Insight: This survey shows that more Americans are trying to make healthy choices to reduce weight and decrease risk of chronic disease.
Adapted from "Calories Count, but….Consumers Don’t Seem to Know How: Food and Health Survey Highlights Six "Diet Disconnects"." International Food Information Council. October 2007. Accessed October 8, 2007 from http://ific.org/foodinsight/2007/mj/fandhsurveyfi307.cfm
HOW TO CHANGE UNDESIRABLE EATING HABITS
It is easier to changes when we focus on one area at a time. Small changes over time will help improve health and lead to long term success. Here are a few:
1. Undesirable eating habit: Snacking throughout the day
Snacking throughout the day may lead to overeating. Having a planned healthy snack once or twice a day is fine. To improve energy and decrease hunger, add two snacks a day of 100 to 300 calories each. This can be a great time to add healthy foods like low fat yogurt, fruit, vegetables or whole grain crackers and low fat cheese.
2. Undesirable eating habit: Eating too quickly
Eating too quickly can lead to stomach troubles and doesn’t allow your brain time to catch up to the stomach. Your brain needs 20 minutes to receive the signals you’re your brain that you are full. Try to slow down. Avoid finger foods. Eat while sitting down and avoid eating in front of the television. Pause often, and take the time to drink fluids during meals.
3. Undesirable eating habit: Eating because of your emotions
Try to think about why you are eating before you do. Many people eat because they are happy or sad, feeling stressed or bored. Try something else to change your mood. Go for a walk or call a friend.
4. Undesirable eating habit: Careful all week, but overeat on the weekends
It is easy to reverse all the good choices that were made during the week with overeating on the weekends. Because most of the socializing and eating out happens on the weekends, make sure to have a strategy. Have a snack before going to parties. Avoid the bread basket at the restaurant. Continue to have one or two snacks between meals to keep energy up and decrease hunger.
Insight: It is important to be aware of why we are eating and to have a strategy to get through the tough times.
Adapted from "How to break bad eating habits." CNN.com. October 2007. Accessed October 9, 2007 from http://www.cnn.com/2007/LIVING/personal/10/04/rs.bad.eating.habits/index.html
Information provided by Novartis corporation. Please contact Dr. Tavallali with any questions you may have.
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Saturday, November 10, 2007
Lessons we should learn from the case of Dr. Jan Adams and Mrs.West.
The unfortunate case of Mrs. West's death following breast reduction and abdominoplasty by Dr. Jan Adams, in California has generated many questions and intense scrutiny in the Press and from Patients. As in many of these unfortunate types of cases, there are many lessons to be learnt and currently the Press is ignoring the truly important aspects that need to be discussed.
Let me make a disclaimer. I know Dr. Adams personally, as we were co-residents in General Surgery during five years of training at Lenox Hill Hospital in New York City. I have seen Dr. Adams operate and take care of his patients first hand- most plastic surgeons cannot make this claim with respect to their colleagues. Dr. Adams is a great surgeon- he is intelligent, educated, articulate, and exceptionally well trained as a plastic surgeon at some of the premier institutions in this country, and is technically gifted. (Many surgeons are fumblers-believe it or not!)
From what I can gather, Mrs. West was an equally intelligent, well informed middle aged women with minor medical conditions which many patients have and which would not exclude anyone from undergoing cosmetic surgery.
Complications can occur in any surgical procedure and though death is extremely rare, it is obviously what all patients and surgeons at least think about, however fleetingly, as a possibility at some point during the consultation, surgery set up period, during the surgery or in the post-operative period. It is the "unspeakable but not the mentionable" risk that exists with any surgical procedure. What the cause of Mrs. West's demise was, will hopefully be made clear after tests are done. One thing that is already clear to any surgeon is that Dr. Adams did not kill Mrs. West, as has been insinuated in the Press and TV.
The fact that Dr. Adams is not a board certified plastic surgeon does not have any relation to the case. He was trained as a plastic surgeon and has been practicing as one for over 15 years. MANY THOUSANDS OF PLASTIC SURGEONS ARE NOT BOARD CERTIFIED - BUT THEY ARE PLASTIC SURGEONS. There are numerous reasons why a plastic surgeon may not become board certified and almost all are due to politics within the Plastic surgery community, or personal reasons on the part of the surgeon. To think that a candidate for board certification in plastic surgery, after going through some of the most rigorous training offered in medicine and surgery, after having taken literally thousands of exams, and risen above his or her competitors during high school, college, medical school and residency training, should somehow not be performing plastic surgery is nonsense.
The real issue that we should be focusing on and for which a national discussion is long overdue is the fact that the majority of cosmetic surgery procedures in this country are performed by doctors who are not trained plastic surgeons, and in many cases, not even surgeons. There are about 450,000 doctors in this country and 60,000 doctors who perform cosmetic surgery- yet there are only 6000 plastic surgeons- and of those, only about 3000 are members of the American Society for Aesthetic Plastic Surgery- plastic surgeons who perform cosmetic surgery primarily.
The vast number of cosmetic surgeries are being performed by doctors who are untrained in plastic surgery. They may be board certified, but are board certified in disciplines other than plastic surgery. Plastic surgeons typically have trained for 6-8 years after medical school. They are dermatologists ( with a one month training as a junior resident on a surgical team as part of their 3 years of dermatology training), gynecologists / obstetricians (whose area of expertise is obviously limited to certain anatomical areas during their 4-5 years of training), general surgeons (who do not take the extra 2-3 years of training needed to become a plastic surgeon after a 5 year general surgery training), Ear nose throat (ENT) surgeons - 4 years training-who call themselves facial plastic surgeons yet somehow manage to include the whole body in the ear/nose/throat area!), and even doctors such as anesthesiologists and internists, who have barely ever held a scalpel, and now days even dentists are doing facelifts!
Why does this happen?... and this is the shocker - because they can! Any physician receives from their state a license to practice Medicine and Surgery. The License is not restrictive in any sense within the boundries of Medicine and Surgery. Any doctor can do anything! Theoretically nothing prevents me from performing brain surgery on a patient- even though I am not a trained brain surgeon- all I need is a patient who will let me operate on them - and imagine that I tell them that "I am board certified" (as I am in Plastic surgery but not Neurosurgery). They would think that the state or federal government has qualified me to perform the brain surgery I am proposing! and how wrong they would be.
So why do so many doctors perform plastic and cosmetic surgery without being trained to do them? Because they figure that the risks of plastic surgery and cosmetic procedures are low enough that they can risk a complication for the economic gains they get; and should they get a complication, nothing in the law says they could not do that procedure!
Are the doctors doing cosmetic surgery cheaper than the plastic surgeons? No! In some cases they even charge more for the same procedure than a qualified surgeon- it’s pure ignorance on the part of the public- and license laws that are arcane.
The threat to public safety is not from plastic surgeons that have been trained and are not board certified in Plastic surgery: the threat is from doctors who are not trained in plastic surgery and "board certified" in other disciplines.
Let me make a disclaimer. I know Dr. Adams personally, as we were co-residents in General Surgery during five years of training at Lenox Hill Hospital in New York City. I have seen Dr. Adams operate and take care of his patients first hand- most plastic surgeons cannot make this claim with respect to their colleagues. Dr. Adams is a great surgeon- he is intelligent, educated, articulate, and exceptionally well trained as a plastic surgeon at some of the premier institutions in this country, and is technically gifted. (Many surgeons are fumblers-believe it or not!)
From what I can gather, Mrs. West was an equally intelligent, well informed middle aged women with minor medical conditions which many patients have and which would not exclude anyone from undergoing cosmetic surgery.
Complications can occur in any surgical procedure and though death is extremely rare, it is obviously what all patients and surgeons at least think about, however fleetingly, as a possibility at some point during the consultation, surgery set up period, during the surgery or in the post-operative period. It is the "unspeakable but not the mentionable" risk that exists with any surgical procedure. What the cause of Mrs. West's demise was, will hopefully be made clear after tests are done. One thing that is already clear to any surgeon is that Dr. Adams did not kill Mrs. West, as has been insinuated in the Press and TV.
The fact that Dr. Adams is not a board certified plastic surgeon does not have any relation to the case. He was trained as a plastic surgeon and has been practicing as one for over 15 years. MANY THOUSANDS OF PLASTIC SURGEONS ARE NOT BOARD CERTIFIED - BUT THEY ARE PLASTIC SURGEONS. There are numerous reasons why a plastic surgeon may not become board certified and almost all are due to politics within the Plastic surgery community, or personal reasons on the part of the surgeon. To think that a candidate for board certification in plastic surgery, after going through some of the most rigorous training offered in medicine and surgery, after having taken literally thousands of exams, and risen above his or her competitors during high school, college, medical school and residency training, should somehow not be performing plastic surgery is nonsense.
The real issue that we should be focusing on and for which a national discussion is long overdue is the fact that the majority of cosmetic surgery procedures in this country are performed by doctors who are not trained plastic surgeons, and in many cases, not even surgeons. There are about 450,000 doctors in this country and 60,000 doctors who perform cosmetic surgery- yet there are only 6000 plastic surgeons- and of those, only about 3000 are members of the American Society for Aesthetic Plastic Surgery- plastic surgeons who perform cosmetic surgery primarily.
The vast number of cosmetic surgeries are being performed by doctors who are untrained in plastic surgery. They may be board certified, but are board certified in disciplines other than plastic surgery. Plastic surgeons typically have trained for 6-8 years after medical school. They are dermatologists ( with a one month training as a junior resident on a surgical team as part of their 3 years of dermatology training), gynecologists / obstetricians (whose area of expertise is obviously limited to certain anatomical areas during their 4-5 years of training), general surgeons (who do not take the extra 2-3 years of training needed to become a plastic surgeon after a 5 year general surgery training), Ear nose throat (ENT) surgeons - 4 years training-who call themselves facial plastic surgeons yet somehow manage to include the whole body in the ear/nose/throat area!), and even doctors such as anesthesiologists and internists, who have barely ever held a scalpel, and now days even dentists are doing facelifts!
Why does this happen?... and this is the shocker - because they can! Any physician receives from their state a license to practice Medicine and Surgery. The License is not restrictive in any sense within the boundries of Medicine and Surgery. Any doctor can do anything! Theoretically nothing prevents me from performing brain surgery on a patient- even though I am not a trained brain surgeon- all I need is a patient who will let me operate on them - and imagine that I tell them that "I am board certified" (as I am in Plastic surgery but not Neurosurgery). They would think that the state or federal government has qualified me to perform the brain surgery I am proposing! and how wrong they would be.
So why do so many doctors perform plastic and cosmetic surgery without being trained to do them? Because they figure that the risks of plastic surgery and cosmetic procedures are low enough that they can risk a complication for the economic gains they get; and should they get a complication, nothing in the law says they could not do that procedure!
Are the doctors doing cosmetic surgery cheaper than the plastic surgeons? No! In some cases they even charge more for the same procedure than a qualified surgeon- it’s pure ignorance on the part of the public- and license laws that are arcane.
The threat to public safety is not from plastic surgeons that have been trained and are not board certified in Plastic surgery: the threat is from doctors who are not trained in plastic surgery and "board certified" in other disciplines.
Tuesday, October 30, 2007
The Latest trend in Breast Augmentation
This week I attended the annual meeting of the American Society of Plastic Surgeons, the national organization to which all board certified and eligible Plastic surgeons can belong,in Baltimore, Maryland.
This conference and others like it which I attend regularly, provides not only an opportunity to discuss with colleagues their techniques for surgery, the chance to see the latest tools and gadgets for plastic surgery, but also an educational opportunity to learn new techniques that are being proposed.
Last year saw the FDA approval of silicone breast implants and their re-introduction into the US market after 15 years of restricted use. Currently only 16-18 % of breast implants in the US are being performed with silicone implants. The majority of patients and surgeons still prefer the saline implants. Last week a new technique for breast augmentation using the patient’s own fat was proposed as being an alternative for some patients.
Fat has always been thought of as the ideal breast augmentation material since the breast itself is mainly made of fat in any case. With a breast enlargement with fat, there would be no foreign implants or the risks associated with such. However, Plastic surgeons have been taught for decades that fat injection into the breasts is not a choice in breast augmentation as the fat would lead to micro-calcifications over time that could be confused with the type of calcifications seen with breast cancer. This was then thought to lead to many women having unnecessary breast biopsies and having to deal with the ordeal of a possible breast cancer.
Now it seems, that the techniques for identification of calcifications on mammograms have improved that there seems to be no confusion between a benign fatty calcification and the type caused by cancer. Fat injection into the breast is now being studied as an alternative to breast augmentation with implants.
From my experience with fat injections into the face and buttocks I already know that when injected, some fat will die and be re-absorbed into the body. The skill of the surgeon, technique used, amount of fat used and its preparation are all factors that affect the survival of the fat grafts. However it is safe to assume that some fat will remain and that the breast enlargement will be permanent to some degree. I would suspect that initially this is would be a good method for patients who would otherwise be candidates for smaller implants. Of course, patients need to have sufficient amounts of fat to be liposuctioned before any can be injected and should realize that multiple (2-3) procedures may be necessary. Patients who are considering this technique can contact me for more information.
This conference and others like it which I attend regularly, provides not only an opportunity to discuss with colleagues their techniques for surgery, the chance to see the latest tools and gadgets for plastic surgery, but also an educational opportunity to learn new techniques that are being proposed.
Last year saw the FDA approval of silicone breast implants and their re-introduction into the US market after 15 years of restricted use. Currently only 16-18 % of breast implants in the US are being performed with silicone implants. The majority of patients and surgeons still prefer the saline implants. Last week a new technique for breast augmentation using the patient’s own fat was proposed as being an alternative for some patients.
Fat has always been thought of as the ideal breast augmentation material since the breast itself is mainly made of fat in any case. With a breast enlargement with fat, there would be no foreign implants or the risks associated with such. However, Plastic surgeons have been taught for decades that fat injection into the breasts is not a choice in breast augmentation as the fat would lead to micro-calcifications over time that could be confused with the type of calcifications seen with breast cancer. This was then thought to lead to many women having unnecessary breast biopsies and having to deal with the ordeal of a possible breast cancer.
Now it seems, that the techniques for identification of calcifications on mammograms have improved that there seems to be no confusion between a benign fatty calcification and the type caused by cancer. Fat injection into the breast is now being studied as an alternative to breast augmentation with implants.
From my experience with fat injections into the face and buttocks I already know that when injected, some fat will die and be re-absorbed into the body. The skill of the surgeon, technique used, amount of fat used and its preparation are all factors that affect the survival of the fat grafts. However it is safe to assume that some fat will remain and that the breast enlargement will be permanent to some degree. I would suspect that initially this is would be a good method for patients who would otherwise be candidates for smaller implants. Of course, patients need to have sufficient amounts of fat to be liposuctioned before any can be injected and should realize that multiple (2-3) procedures may be necessary. Patients who are considering this technique can contact me for more information.
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