Is your Botox really a Bargain?

Botox it seems is everywhere. Plastic surgeons and dermatologists have been very good at developing treatments and medication applications which have pushed Botox and now others like it, such as Dysport, into the top spot for most requested nonsurgical cosmetic procedures. With the success of botulinum toxin for dynamic wrinkles, there has been a trickle of treatments leaving the hands of plastic surgeons and dermatologists to ‘Botox parties’ and now a flood of treatments marketed in hair and nail salons and day spas all across the country. And not to be outdone by the hair salon next door, it is likely that your dental hygienist will offer Botox after your next cleaning.

If you somehow just can’t find Botox at a corner near you, try to Google ‘Botox Specials’ and work your way through the 10,000 plus listings for an offer near you. We dare you to give your e-mail, as the Botox specials and coupons will begin to arrive like owl letters for Harry Potter. Groupon? There is deal every day. Who will ‘do’ your Botox? It can be hard to say, though the weekend courses to teach ‘injectionists’ abound, some of which are sponsored by the manufacturers themselves. Some individuals we see race from special to special trying to get the best deal and lowest cost for the product without the concern for what the treatment will actually be. More time (and loyalty) might be spent selecting a hair colorist, because Botox is just Botox, right?

The word on the street is that not all Botox is equal. The medication is dose dependent, and the effectiveness depends on proper storage, and proper dilution. As the number of specials increase and the prices fall, corners can be cut just with dilution alone like a bartender watering a drink. Botox storage is also critical, as once mixed the medication will lose its effectiveness in a short period of time. When it comes to Botox, freshness is everything. Use it or lose it, and a salon just might not be willing to let it go.



So who will ‘do’ your Botox? We hope it will be us, your trusted plastic surgeon. Remember, the specialized service, knowledge of anatomy, facial aesthetics, proper application, and development of treatment plans has made Botox what it is today. Maintaining a record of where, how much, how often, will keep you looking consistently great time after time. The next deal of the day might not provide that. You probably spend a fortune at your special hair colorist, and give a nice tip to boot because they got you in. Why should you rush off with a coupon for your Botox application and see what you get. Otherwise Botox is just Botox, and it’s no bargain.

Considering Large Breast Implants? When can “Big” be “Too Big”?

The stock market has often been compared to hemlines. When skirt hemlines are rising so is the market, and as hem lines fall goes the Dow Jones market index. With the recovery and rise of the stock market since 2008, we have seen hemlines in skirts and shorts as high as they can go. Confidence is on the rise, but not just in hemlines. It seems that the size of breast implants might also be tied to our emergence from the Great Recession.

If we look at our trendsetting West Coast, the high profile breast implant has taken center stage, with common implant volumes of 500cc and more. Mentor has even released a new breast implant, the Ultra High Profile which can put the most volume on the smallest of chests. In the late 90’s, it seemed that a 270cc to 360cc, round, smooth, lower to moderate profile implant, would give wonderful results for almost anyone. With the prosperity of that time came implant inflation with Bay Watch and Pamela Anderson. The following decade resulted in the implant decline of 2000’s with the silicone gel implant moratorium. As the size of implants and interest in them fell back, by 2008 the market came to rest at a new low as well. Now with an increasing interest in higher profile breast implants, we are again at an implant ‘high’ and the worry is that implants and indeed the current markets have gotten a bit ahead of themselves.

High profile breast implants do have an important role in breast augmentation, though there are arguments against them. There are thoughts that they may have a higher risk of complications such as bottoming out, thinning and stretching of the breast, and showing through the breast tissue. Difficulty arises too when considering breast shape and symmetry. In our suburban Chicago practice, we focus on a ‘natural look’, though in some areas this goal may refer to an implant look, or a very full look, a ’higher’ breast look, or even a fake look. There is nothing wrong with a high profile implant if the choice is carefully made, but be careful what you ask for if you are only following the trend. When markets are high, hems are very short, and implants are large, euphoria can be replaced with regret. Caution is key.

Remember that as you consider breast size, think of your investment in good looks over years. Be as big as you want to be, but only as big as you are meant to be. The fit and proportion should last a lifetime. Stay true to yourself, and remember that other peoples choices are just that and trends don’t need to be followed. Implant sizes and dimensions require skill and judgment that we feel only a surgeon should make. What implant you will need for breast augmentation is determined by a careful assessment of your particular breast and chest size, shape, and breast tissue. Even the breast skin envelope and position of the nipple and breast fold will influence your augmentation. Photos of what you like and what you wish for are an excellent tool to help us get your augmentation just right. A picture is worth a thousand words, and far better ones than “natural”.

The stock market is now at a four year high, and implants are bigger than ever. Many large breast implants came out with the last big market correction, and we just might be headed for another fiscal cliff. This is a great time for those considering breast augmentation to choose a safe “buy and hold” approach. Find a look you can enjoy for a lifetime, ups and downs and you will have made a very good investment in yourself, even when the next bubble bursts.

Breast Augmentation: The Shape of Things to Come

Though it seemed that the evolution of the silicone gel breast implant stopped with the silicone implant moratorium in 1992, our office among others, continued clinical trials of implants we hoped will improve the outcome of breast reconstruction. Implants at the time of the moratorium came in a limited variety, round low to moderate profile implants, which do extremely well for augmentation of the breast. Augmentation is in essence enhancement of the natural breast size. Reconstruction of the breast where the breast shape and characteristics have been lost is a different matter. Our work has evolved in studies with the Allergan 153 implant, the Mentor Lumera, and now the Allergan 410, all of which are shaped implants which better mirror the natural breast shape and form. The shaped implants, also called teardrop have a tapered upper edge which can prevent a rounded look and mimic the natural breast profile. Instead of working with the implant diameter and projection alone, the shaped implants allow us to vary the height, width, and the projection independently.

As the new shaped form stable implants from Sientra have reached the market, and both Mentor and Allergan are in the process of FDA approval for their versions, we are likely to hear much more about them and how they will benefit breast augmentation. In our practice, we prefer an implant that is soft and fits and flows within the breast, moving and shifting in shape as the breast naturally moves. The best implant is one that does its job enhancing the breast in a way that cannot be seen or felt, out of mind. Smooth, round, moderate profile implants, either saline or gel will provide the need for most, and it is unlikely that stiffer shaped implants will have a broad appeal. Just our guess, however shaped implants will give us better control when we need it most. The very tight AA breast just might take on a better silhouette when compared to a round implant, and with breast asymmetry we might be able to keep the projection and dimension where we need it. Thin breast tissue and ripples? Again, the shaped implant may be a solution as it will show through less and ripple less than either saline or gel.

Though shaped breast implants will not take the place of current implants in breast augmentation, for those with special challenges, shaped implants will indeed be the shape of things to come.

The Ultimate in Breast Lift

Breast lift is an increasingly attractive option for rejuvenating and restoring a youthful and perky shape lost over pregnancy, or perhaps weight gain and loss. Traditionally, breast lift has been about firming the breast tissue, and lifting the nipple up and onto the front of the breast. At best, a great lift is a ‘no bra needed’ look. The trending or the “ultimate” in breast lift is a combination of lift, and augmentation for the upper fill and roundness we just cannot seem to get through a lift alone.

With volume loss in the breast, and relative skin excess, the nipple can appear low, or for that matter the whole breast can appear to sag lower on the chest. With good support and an upper push, things are not so bad. But sooner or later you must get out of the bra and into a bathing suit. Then again there is the dreaded pencil test. Not the one about cleavage, but the one about the breast that hangs over when you place the pencil in the breast fold underneath. Only a nipple that sits an inch above the fold gets a passing grade.

A good breast lift will move the nipple up to where it belongs, with or without a bra, through an around the nipple approach, or a vertical lift, if the upward move must be greater. Still, the breast may show an upper scoop or a lack of projection above the nipple and the ultimate in breast lift can be had by the addition of an implant, even a small one to fill out the remainder of the breast and firm and round out the breast shape. The majority of those we see who ask about breast lift, favor the look of the lift and implant combined. Even a little fill will do if a fuller cup size isn’t the goal, and the ultimate in breast lift is worth looking into.

Proud member of the ‘Sun Scare’ Industry

While catching up on the pulse of the nation, I just happened to notice that we have been rebranded as part of the ‘Sun Scare’ Industry. Yes, we have been guilty of giving out “misinformation” about the harms and risks of ultraviolet radiation and been active participants in recommending sun blocks and sunscreens to hapless millions at a cost (and our personal benefit?) of billions of dollars. I have also sadly come to learn too that plastic surgeons and other well meaning physicians within this industry are vastly outnumbered, as there are more sun tanning salons in the U.S. than McDonald’s. The tanning industry is no lightweight, and polls have indicated that 90% of those who work within its ranks believe that sunbed exposure causes no health risk! This is something you have to see for yourself, and we suggest www.SunlightScam.com so you too can appreciate where the argument is going.

The tanning industry has rounded up notable endorsements, even from a few physicians who feel that the skin cancer link to sun exposure is a weak one, but they don’t stop there. The key to their defense of the sun is vitamin D. Vitamin D, of course, is an essential vitamin and the lack of it even has its own disease, rickets. Proper bone formation and bone strength relies on vitamin D, even for adults. Our skin becomes a vitamin D factory when exposed to sunlight. And, for all of you lactose intolerant out there, other than your skin, dairy products are the only place you can get it: not meat, vegetables, fruit, or breads. The salon staffs are no longer the agent of photo aging, wrinkles, and skin cancer, but Vitamin D Angels, spreading a warm happy glow and good health. Could it be as well that tanning beds and the vitamin D produced also prevents cancer? You got this right. Some have proposed that vitamin D also prevents cancer of the colon and breast, and the tanning salon is really about cancer prevention. I have to admit I really did not see this one coming.

Unfortunately, the link to cancer prevention and vitamin D is a very weak one. However, the link of sun and ultraviolet exposure is a very strong one. Skin cancer rates are up by 50% according to the National Cancer Institute, especially in young women -- perhaps many of those young women, 28 million visits to tanning salons each year and growing, are in that number. It is a fact that skin cancer kills young women, something the Australian’s have come to know all too well. They believe strongly as a nation the link and risk of sun exposure and ultraviolet exposure. Did you happen to notice the beach volley ball in the recent Olympics? The American team was wearing, well, not too much and was great for ratings; however the Australian team had ‘full cover’ of arms and legs. I may be proud to be American, though I am also proud to be a member of the Sun Scare Industry. Go Australia, you are right on this one.

Mesotherapy at the Day Spa

We received a call today in the office from an individual who was at a spa in downtown Chicago, and underwent a mesotherapy treatment by a “therapist” and she was very alarmed by the severe facial swelling and pain, and a misunderstanding of what she had gotten into. She had called the spa and they could give no advice as the therapist was not available.

First and foremost, mesotherapy is a medical procedure according to the state medical board. The main purpose is to reduce fat and improve cellulite. The process is one of injection of medications and vitamins, sometimes amino acids into the skin to rejuvenate the tissue, and cause lypolysis or the death of fat cells. The concept was popularized in Europe where it is more wildly practiced, and the key agent is phosphatidylcholine, a detergent which causes swelling and inflammation and local fat cell death. It is combined with many agents as I have mentioned into a ‘cocktail’ (they do indeed call it that) which is quite variable from practice to practice, and there are very few studies which confirm the safely or effectiveness. Even the most common ingredient sold under the name lipostabil is not FDA approved and falls within an ‘off label’ use or gray area in medicine. Though the procedure is touted as noninvasive, it is an injection of drugs never the less.

Is mesotherapy safe to reduce fat and cellulite? There simply is not consistent data or a consistent method of treatment, and the American Society of Plastic Surgery does not endorse the treatment and has issued a warning. The fact that an individual in our city was able to receive facial injections in a spa without medical guidance and supervision is alarming. The internet is full of mesotherapy sites, even selling home kits on-line. We wish to reinforce the fact that injection of drugs into the skin is not ‘non-invasive’ and comes with considerable risk Before anyone injects you with anything at the spa, ask to see the doctor for a full explanation of the procedure, the purpose, and the risk so you can make the best decision as to whether mesotherapy is right for you. Be careful out there.

The Medi Spa Crisis; is there is Doctor in the House?

It seems that medispas are everywhere today with hair salons and health clubs offering treatments such as facials, lasers, microdermabrasion and even injections, such as Botox and facial fillers. Of course ‘medi’ suggests medical, and injections certainly fall under services that require skilled, licensed medical care. There is no gray area here. When someone is injecting a medication or medical filler into your face with needles, medical practice is the only way to define it. So, is the medical office where you receive Botox or Juvederm injections the same ‘medical’ office where you exercise or color your hair? According to government regulations it is one and the same. And if the hair salon or health club is where your medical care is provided, is there even a doctor in the house?

Recently in a California hair salon, Posh Hair and Skin Studio, offering Botox and fillers government inspectors arrived to find a nurse practicing without any supervision. She was arrested and is out on bail for medical practice without a license. The doctor with whom she was working was a gynecologist/hair salon operator seeing patients in another location. Yes, he was indeed a co-owner in the hair salon and argued that his nurse had standing orders to administer Botox to his patients. The doctor is unlikely to get off easy on this one, as the government views the hair salon part of his medical corporation and medical offices. How one manages infection control, medical waste, and patient confidentiality at the hair salon is anyone’s guess.

Nurses can be well trained and can become experienced at administering Botox, and even facial fillers. The laws as things stand require that a physician be present and determine by an exam that the treatment as prescribed is right for you. The physician must be available for questions and mishaps, and be responsible to you if problems occur.

A bad hair color or cut is disappointing; however a bad injection can be quite worse. Next time you consider Botox or filler at a day spa or health club, ask yourself, is the environment clean and secure? Is the medication secured and stored according to guidelines? Is there a record of what was done and instructions available to you? Is the person treating you properly licensed? And finally, is there a doctor in the house?

Botox and Juvederm, what is the difference?

With the extreme popularity of both products in our office, Botox and Juvederm, we continually have to sort out confusion between the two, and what each can accomplish. Just today on the Twitter stream the issue was raised. Do you need one, or the other, or will you need both?

In order to set the record straight let’s go back to the basics. Starting with Botox, the medication is a neurotoxin, which sounds a bit scary, though this is indeed how it works. There are now three formulations out there; Botox, Dysport, and now a new one from Merz called Xeomin. They are all formulations of botulinum toxin type A, and studies to date show a very similar result and duration for all three with skilled application. The toxin binds to the end of the motor nerves and stops the connection so the muscle cannot react. Over time, the nerve ends replenish themselves and the muscles again respond to commands to flex and frown. The key here is ‘flex and frown’. Botox, and the like, treat dynamic lines and folds from facial over expression. Wear your worries on your forehead, or smile and squint expressively from the corner of your eyes, Botox is your cure.

Juvederm is quite a different matter, and is one of a group of “fillers” based on hyluronic acid gel. The gel is a chemical which is a normal component of cell membranes, part of the regular stuff in the body and is importantly not a protein. The fact that it is not, prevents any reaction or inflammation which was a dread from collagen injection of days gone by. The hyluronic acid gel is a great plumper because it is hydrophilic, which means it attracts and holds water, and is slowly absorbed and recycled by the surrounding cells. A filler does just that, it plumps and softens lines and folds that are always there or have crept in during the aging process. Smile lines and folds are the first to come to mind.

So, Botox or Juvederm, what is the difference? Wrinkles at rest, Juvederm to fill and contour. Dynamic line or wrinkles with motion, Botox is the cure. Will you need both? Maybe.

Breast Augmentation Revision: Can you Avoid It?

Breast augmentation has been a procedure with very high satisfaction and very low instances of a complication. Still, as we talk to colleagues at meetings and review the published experience, the revision rate after breast augmentation is often alarmingly high. As I look at issues raised on RealSelf.com, which is an open forum of questions and answers about cosmetic surgery, the #1 question that appears is; “What size should I be after breast augmentation?” Indeed, too big or too small is the key motive for many asking about revision after implants.

Clearly everyone will have an opinion as to what breast size is best for you, your friends, spouse or significant other, perhaps even your mother will give you advice on this one. And yes, your surgeon might have just the idea for you and how he might present you on his website as a knockout result. A particular surgeon’s goal might be following a current trend, such as very round and full high profile, and may tell you such things as ‘I always use a gel implant’. But whose choice is it really? The revision after breast augmentation seems to come down to size. The ‘look’ of your breast augmentation might be best left to you. This takes a self exploration as to what look is the real ‘you’ and sticking with your instincts.

Size is not the most important matter in breast augmentation. We feel the most important issue is the look. You will need to explore photos and websites for examples of what you like, and also what you don’t. You may wish to purchase the dream bra you want to wear, pad and fill it out and give it a trial run. When you know the look you need to complete the picture, take all this information with you to a surgeon who will focus his skill toward your goals and not his. Sharing your ideas with others can be like sharing baby names, so unless you trust the source it is best to trust your instincts.

So, can you avoid revision after breast augmentation? If you take the time and do your homework, too big or too small can become just right. And that is the kind of ending both patient and surgeon want each and every time.

The Neck is the Key to a Great Facelift

These are dramatic times for the baby-boomer and their quest for graceful aging. As a group, we have become quite accustomed to looking good and stealing the limelight while we still can. Whether we are on film, aging rockers, or in charge at the office, as a group we just refuse to give up and insist on being as timeless as the music and culture we created.

With sluggish jowls, and loss of the cheek volume, a ‘soft lift’ is great in our late forties and early fifties, to refresh and smooth. The ‘soft lift’ keeps vitality and youth in the cheeks and chin. In our later fifties, bigger problems can emerge, and for some the focus is no longer up front and center. Though we still might call it a facelift, the neck is likely to cause the most distress. Turtlenecks and scarves are not the answer.

It seems that the key to a great facelift is actually in the neck, as the visual focus shifts to the chin and below. Certainly by age sixty, the neck is ‘the’ issue for perhaps half of all looking into a facelift procedure. We could of course call it a neck lift, but a smooth transition into the cheek and upper face is also a must, if we are to get from good to great. But if the neck is right, the rest will follow. We get there with a combination of techniques, reduction and contouring of the fat within the neck and chin, tightening the bands within the neck from below, and lifting the neck upward supported by its own special muscle below, the platysma, or SMAS as it is often called. The healing can be a bit longer, but the efforts are well rewarded.

So for you baby boomers out there, go ahead and stick your necks out, and as Bob Dylan said, may you be ‘forever young’.

UK Cosmetic Surgeons Support Psychological Screening before Cosmetic Surgery

According to new findings, which will be presented this July by the Center of Appearance Research located in Bristol, little is known about the psychological impact of aesthetic surgery, and ability of patients to cope and function long term. Here in the U.S., we might call this ‘long term’ satisfaction with cosmetic surgical procedures. Based on our practice experience, and the hundreds of studies which have considered safety and satisfaction of cosmetic surgery, evidence has clearly demonstrated its success and benefits. We don’t know how the Center of Appearance could have missed all the current published data as it is fairly easy to find. Some individuals have cosmetic surgery for the wrong reasons, and we too have written about this recently, and the careful practice will try to stay ‘patient’ focused and select only those who goals are reachable and meaningful.

In the UK over the last decade, cosmetic surgery has tripled and become a multi billion dollar industry, all of which is in the private sector outside of the national health program, or to quote the sentiment of the article the “unregulated private sector”. Is it really true that UK cosmetic surgeons believe psychological testing vital before cosmetic surgery? We will have to wait and see how the study is received after the July presentation, which might suggest that a well crafted screening process offer a “quick and efficient” guide to alternative care for those who do not measure up. It seems their government is leaning in this direction as the National Confidential Enquiry into Patient Outcome and Death Report was quoted as including “psychological assessment is an important part of any patient’s aesthetic surgery episode and should be routine”.

In the U.S., we may also have to consider what we must share in order to show why we feel that a breast augmentation will enhance our lives, or perhaps that a facelift won’t really land us a better job but really could make us feel better. As a U.S. Cosmetic Surgeon, we hope not. There is something about our independence and free will to settle our own lives that makes us distinctly American. The Edwardian sense of order and protocol may not have left the UK which clearly has been surprised by the tremendous growth in the self improvement cosmetic surgery has to offer. I predict that they will hear back from their subjects what our favorite nanny, Mary Poppins, told her employer George Banks when asked to explain herself about how she was caring for the Bank’s children; “Frankly I never explain myself to anyone”.

Sizing Up Breast Augmentation Revision

Considering the need to revise any cosmetic surgical procedure, we tend to think about complications -- a poor scar, bleeding, perhaps an infection which may have occurred after a procedure, all of which are the ‘real’ risks of a surgical procedure. However, when it comes to breast augmentation it seems that breast size is ‘the’ issue and according to what we read, drives most of the revisions after breast augmentation. Some studies claim that the need for revision after breast augmentation can be as high as 20%, or one out of five. In our own practice, we have been able to get this number down to 1% (we can’t be perfect) and I hope to give you some simple steps how get best out of your breast size.

First and foremost, follow your own instincts. Everyone will have an opinion as to the best breast size for you. Even as you look over pictures of others who have had a breast augmentation, keep in mind that you are looking at other’s choices, and you too should have the say on what is right for you. If ‘everyone’ you see has very full or large breast implants, it doesn’t mean that you too must have them and have that ‘look’, unless of course that is what your goal is. Be true to yourself.

It is the look, and not cup size which will ultimately translate into a great result. When planning augmentation focus on the look that is right for you, how you live, and how you feel inside. Pictures and trial bras are a great way to communicate your ideas. Cup size is relative to the chest size, and will vary by different bra manufacturers. If you fit a full C-cup after augmentation, yet wanted a small D should you be disappointed? If your C-cup is soft and the ‘look’ is you, no one will see you as a particular cup size and you shouldn’t either.

Frequently we hear of patients who are asked to try on breast implants, and are asked then to choose the size they want, say the 320cc or the 360cc. Or, some will tell that their friend has the 420cc implant and they want to have the same one. Breast augmentation by the numbers is a gamble. Unfortunately, you just can’t try on an implant, read the number off the back, and know how it will look and feel after augmentation. If it could only be that easy. And, it should be no surprise that if you use the same implant on two different people, you will get two different results. If we ask patients years later what size implant they are wearing very few will remember, however they will be reminded of how they look every day. It is best to forget about numbers when it comes to breast augmentation.

So if it isn’t about the amount of fill or volume of the implant in the bra, just what do we look for with the trial bra? Again, it is back to basics, the volume as it appears, the upper fill, the cleavage and spacing, projection, how clothing drapes and feels. Next, is a review of photos of the ideal you. You might even be able to find someone just like you before, and close to your goal after if you research well. And don’t forget about photos of what you don’t like. A great surgeon will commit all to memory, and use skill and experience to get you there. The number? I forget them too as we have so many implant choices in size and style. But if the end result or ‘look’ is the ‘you’ that you had dreamt about after breast augmentation, revision becomes our least worry.

Liposuction rebound. Does the fat come back after liposuction?

One of the most frequent questions we are asked about liposuction is whether or not the fat will come back after, or is the procedure permanent. First, and foremost, we know that liposuction is very poor at controlling weight. After all, we are what we eat. But a recent study cited by U.S. News & World Report raised the question as to “where the fat might go, if it indeed comes back after liposuction”?

The source of the recent web stir came from a study just this July published by researchers at the University of Sao Paulo in the Journal of Clinical Endocrinology and Metabolism. They looked at 36 eager volunteers who were heavy though not obese (BMI less than 30) and performed liposuction of two to three pounds of fat. Here is the twist. The individuals were then divided into two groups, one participated in a program of exercise, and the other maintained a more sedentary life. Remarkably for both, the ‘cosmetics’ were good, though we all know that liposuction does indeed ‘work’, and at four months weight was stable and comparable.

So where is the problem? Think of the fat distribution as the ‘whack-a-mole contest’ of body contouring; reduce the fat bump in one place, up pops the fat in another. We have two fat spaces, the fat under the skin, and visceral fat around internal organs. The visceral fat is linked to poor health and an inactive lifestyle, and as you now might have guessed, the Brazilian study showed that after liposuction the couch potato group had an increase in visceral fat where the active group did not. Could you be less healthy after liposuction? The answer is perhaps. We have known for a very long time that visceral fat is more ‘active’ than fat under the skin, and that exercise works to reduce it. The conclusion we draw from the study is that you could be less healthy after liposuction as the fat goes through its whack-a-mole rebalancing act, but exercise after surgery works! No need to starve the moles out of existence, but regular exercise after liposuction will help you not only look the best, but keep you in the best of health. Didn’t we know that all along?

Recent Polls show Breast Implants will improve your Sex Life

As a regular contributor to RealSelf.com, we noted the results of their recent poll concerning breast implants and sexual satisfaction. As expected, women who have completed breast augmentation report a better sex life. What was not so expected was the extent of the gain in sexual awareness and satisfaction. Given the huge number of breast augmentation procedures, over one million in the last three years, fewer people are getting enough rest these days.

The RealSelf.com poll discovered that 70% of women found their sex life improved after breast augmentation. Yes, a whopping seven out of ten found that a fuller breast worth it regarding intimacy and sexual satisfaction. In the poll, 61% reported an increase in the frequency of sex. Is more really better you might ask? Well, 34% reported sex as better after breast augmentation. If you are still not convinced, the intensity and enjoyment of the sex was rated on a scale from one to ten, and 28% of those who responded to the survey reported that sexual pleasure went up 4 points or more on the ten point scale.

Of course, breast implants are not the only means to bedroom bliss, but if you were ever wondering what life might be like after a breast augmentation, the number are really quite revealing. Look for the survey on the RealSelf.com website, where you can find us as well. Ready for any question you might have about cosmetic surgery.

Vampire Fillers are Invading Cosmetic Medicine

Clinical research in plastic surgery has been on the lookout for advancements in facial fillers to add to our compliment in facial rejuvenation. Platelet rich plasma, or PRP, is one such filler which is made from a sample of the patient’s own blood. Early in its investigation, it has become dubbed the ‘vampire filler’. PRP is actually a product developed for orthopedics and approved by the FDA as an injection to promote healing. Use as a facial filler is ‘off-label’, meaning it is not accepted yet as safe and effective as a filler, but can be used in a well informed patient, if a physician’s professional judgment supports the intended use. It appears since Ann Rice reintroduced America to vampires of a romantic sort, and the teen age group followed with the hugely popular Twilight series, it has been love at first bite. Marketing genius combined with branding and trademarks have turned the ‘vampire filler’ into the “vampire face lift”, a name patented in 2010 pushing the interest in PRP fillers to the top of Google searches. Many practices now can offer the Vampire FaceLift just by watching an online tutorial, and paying a monthly licensing fee to use the name. The Vampire FaceLift was demystified to us by a recent report of the story in Plastic Surgery News, our ASPS trade magazine. The procedure is in essence not really a facelift after all, but a combination of an HA filler such as Juvederm, filling around it with a PRP product such as Selphyl to add significant volume to the face. As with fillers we currently use today, volume can provide a short term fix and many patients stay with it until they are ready for facelift surgery to set things straight longer term. As plastic surgeons, we take pride in thorough training, and treatments based on the best medical evidence. We doubt we will ever see the complete end of vampires, though with knowledge and an understanding of just what the vampires are up to, perhaps we can put on a little garlic and protect ourselves from misinformation or a love affair gone wrong.

Maintaining, not regaining: The new paradigm in Facelift

Looking over our patient experience the past several years, the concept of the aging curve has firmly taken hold. Facial aging is a continuum with a gentle upward slope and efforts these days have focused on leveling the aging curve. The traditional facelift candidate used to be an individual with clearly visible signs of aging. Typically, we see laxity in the cheek and jowl, marked by redundant skin and loss of the contour in the neck. Clearly, theses are the hallmarks of facial aging in need of repair. Well before such signs firmly set in, we can see a loss of fullness and volume around the mouth and lip, a flattened cheek, a soft jowl and facial folds. The new paradigm shift in facelift has been maintaining, not regaining, and slowing the upward trend in visible signs of facial aging with earlier intervention. The early maintenance approach is definitely not your mother’s facelift of years ago. Early intervention most often includes individuals in their late forties to early fifties, though for some it makes sense to begin even in the early forties. And maintenance can include fillers and fat replacement, or skin care with peels; however the key is preserving the support in the cheek and jowl. The lift needed to maintain a youthful neck and cheek will address the SMAS, the deeper muscle layer, and in every sense is a real facelift with meaningful and sustained support. Recovery, however, is typically very quick, perhaps a week, and then back to work and social schedules. Maintaining has become the name of the game, and forever young its theme. Holding on to what you have without letting go is an attractive alternative to repair and make over. And an early facelift just may be the way to cheat graceful aging. A woman of an uncertain age or a woman of a certain age, the choice is yours.

The Extraordinary Rise of the Mommy Makeover

It seems that just a year or two ago we spoke often about breast augmentation after pregnancy and for some tummy tuck to contour and tone the abdomen. Yet now there has been an evolution in how we approach the end of childbearing. For the lucky few, such as Brittany Spears, pregnancy and childbirth is a moment off stage and a rise again like a phoenix as if it never happened. (And whoops, she even did it again) But, what about JLo, or Mariah Carey? Did they really have it, the mommy makeover? Like an explosion, the mommy makeover has become a new social trend in restoring and reversing the natural changes which can happen after pregnancy. Media, and the internet, have responded with thousands of references on Google and on Bing. The photo listing on Bing alone will prove to all that we in the U.S. are no longer fearful of baring it all and flaunting our successes, too. Just what exactly a mommy makeover is has no strict definition. The procedures most often combined in restoration of body form after pregnancy are: tummy tuck, breast augmentation with or without a lift, and liposuction. None of these procedures are new, however, what is improving are the techniques that make the combination of procedures safe and the recovery reasonable even for a busy mother. At the core, or heart of the mommy makeover, is where the babies come from, the abdomen, and with the efficiency and increased safety of tummy tuck, the addition of breast rejuvenation, and even some liposuction, are now within reach. After motherhood, women can again have it all in one neat package. Hence, the development of the renewed you, the mommy makeover. We have refined tummy tuck in our practice to suit your office experience with recovery at home. The hospital is the place for labor and delivery, though not for the mommy makeover. Our anesthesia techniques have been lightened, and combined with new local acting anesthetics or blocks to eliminate discomfort. Tummy tuck times have been shortened and the inconvenience of drains has been eliminated, and a rapid return to activity and daily living all have improved the tummy tuck experience, and made possible the addition of breast augmentation or lift, or other procedures to complete the mommy makeover. What is in your mommy makeover, will depend on your specific needs, but the potential of rejuvenation after childbearing has caught hold. With the savings of combined procedures, perhaps a new wardrobe will be a part of your mommy makeover, too.

Breast Augmentation Revision: Can you Avoid It?

Breast augmentation has been a procedure with very high satisfaction and very low instances of a complication. Still, as we talk to colleagues at meetings and review the published experience, the revision rate after breast augmentation is often alarmingly high. As I look at issues raised on RealSelf.com, which is an open forum of questions and answers about cosmetic surgery, the #1 question that appears is; “What size should I be after breast augmentation?” Indeed, too big or too small is the key motive for many asking about revision after implants. Clearly everyone will have an opinion as to what breast size is best for you, your friends, spouse or significant other, perhaps even your mother will give you advice on this one. And yes, your surgeon might have just the idea for you and how he might present you on his website as a knockout result. A particular surgeon’s goal might be following a current trend, such as very round and full high profile, and may tell you such things as ‘I always use a gel implant’. But whose choice is it really? The revision after breast augmentation seems to come down to size. The ‘look’ of your breast augmentation might be best left to you. This takes a self exploration as to what look is the real ‘you’ and sticking with your instincts. Size is not the most important matter in breast augmentation. We feel the most important issue is the look. You will need to explore photos and websites for examples of what you like, and also what you don’t. You may wish to purchase the dream bra you want to wear, pad and fill it out and give it a trial run. When you know the look you need to complete the picture, take all this information with you to a surgeon who will focus his skill toward your goals and not his. Sharing your ideas with others can be like sharing baby names, so unless you trust the source it is best to trust your instincts. So, can you avoid revision after breast augmentation? If you take the time and do your homework, too big or too small can become just right. And that is the kind of ending both patient and surgeon want each and every time.

Plastic Surgery Update: Stretch Mark Removal for Men, Procedures for Bri...

Who Should You have Cosmetic Surgery for?

As my homepage came up on the computer today I noted an article on Slate.com concerning a college student who was worried about her summer at home because her mother has been nagging her to look better and pushing her to have cosmetic surgery to improve her life. Surely, this is the stuff of daytime television. The scenario was that of a “Dear Abby” sort of thing, with the young woman seeking advice about how to keep her summer at home pleasant and resist her mother’s need to “improve” her. Some how we see such posts and figure that this can’t be real, yet as a plastic surgeon I can assure you this is the world we live in today. When we see individuals in the consultation room to discuss a concern as to how cosmetic surgery will improve one’s life, it can be helpful to understand just whose life is in need of improvement.


Pressure to look good, or the need to defy aging, can be intertwined into our family relationships, those with a spouse, or even with those who we interact with at work, in very complicated ways. It can make perfect sense for a mother to want the best for her daughter and use persuasion to encourage her to fix a nose which is less than beautiful. Or perhaps, she might bring her daughter in to consider a breast reduction because she knows how difficult her daughter will find the unwanted looks she may get from others, or the clothing issues she will face in a fashionable workplace. The arguments can make perfect sense, a mother wants the very best for her daughter, knows what is right for her, and her daughter must consider what her mother is doing for her and the family, not to be ungrateful. The drama can be considerable in the consultation room, and as one familiar with drama, romance and life’s complexities, I recall the torment of Anne Elliot in Jane Austen’s novel Persuasion as she struggles to fit in with her blended family and turns away her first love, Frederick Wentworth.


Anne could tell us that the decisions are not so easy when so many others are involved. Just who should you have cosmetic surgery for? Should a young woman have her nose fixed to fit into the family photos? How about a woman I had seen, with her husband looking into breast implants to enlarge her breast as he considers what size she should be? That can be a scary one. Though the rhinoplasty might be the ‘right’ thing to do, or even the breast implants for that matter, I have come to the conclusion that cosmetic surgery is something we should do for ourselves. Like so many decisions in life, others you trust, or those who care, may have an opinion; yet cosmetic surgery is for you and about you alone. Seems rather selfish, though we live best following our own insights as to how we should look and feel.


The breast implants by the way, they decided on a D cup (unknowing to him it was her idea all along), and did, as far as we know today, live happily ever after. The young woman we knew did not have the rhinoplasty (as her mother did at her age) and did not look like the family in the group photo. She became engaged to a young man after graduation, just the way she was and the way she felt and looked her ‘best’, for better or worse, as all marriages are. As I always have known, Jane Austen had it right. And Anne, too, finally, after much persuasion did what was right for her and her alone. She and Frederic lived happily ever after. Thank you, Jane.

New Alternatives are Emerging for Breast Reconstruction

Currently about 250,000 women will face breast cancer each year. As our screening and detection have improved, our patients have become younger and fortunately, the breast cancers have become smaller. The early diagnosis with smaller cancers, many of which are noninvasive, has pushed the interest in reconstruction. The American Society of Plastic Surgeons (ASPS) data has shown that 96,000 seek breast reconstruction annually. Still, many who face the challenges of breast cancer diagnosis and treatment are not fully aware of all their options. Some states have even moved to ensuring women have the option to consult with a plastic surgeon before mastectomy.
In our own practice, we find patients are very active in pushing the discussion and taking an active role in understanding what their breast cancer journey will be like. Consider with early diagnosis at age forty, women have to look ahead to forty years of life without a breast, and today’s generation tells us they want to participate and make treatment decisions. They expect to have a full life and look as good as possible, and some wish to look even better than they did before mastectomy.
New alternatives our practice is investigating involve cohesive gel, or form stable implants which come in numerous shapes and sizes to match the natural breast shape. We began with the Allergan 153 implant trial which was a first evolution of a shaped implant. We found that mastectomy removed some the personality of the breast which was not as easily restored with current round breast implants, and the shaped implants gave us some very good results. This progressed into the current Allergan 410 or ‘gummy bear’ implant study which is still ongoing.
Tissue expanders may also take a new turn. A tissue expander is often needed to hold the space, and later expand the breast skin in preparation for an implant. The expander is filled over several office visits which can be time consuming for those eager to get back into a regular schedule. A newer expander being developed can be filled by the patient according to their own schedule and comfort level, and just might improve the whole process.
Finally, nipple reconstruction has always been the finishing touch to the perfect reconstruction, and something so simple can be a powerful and life changing event as the new breast comes to life. The nipple is so important to the essence of the normal breast that newer mastectomy techniques may be able to preserve the nipple for a fortunate group of patients. Sparing the nipple can allow an immediate implant placement and a one step process to restore a normal breast form and appearance.
Just as our ability to diagnose and cure breast cancer has greatly improved, so has our appreciation and ability to reconstruct the breast. Younger patients continue to push us beyond the pink ribbon as they demand the very best path to a full, active and beautiful life.

Springtime Renewal for your Skin

Spring is as important time to gear up for coming sun season. Most of us are in a habit to use UV protection, and when combined with antioxidants we get the best defense for our skin. But what about the damage that is already done? Accumulated UV exposure results in uneven skin tones and blemishes, and at worse skin cancers. The spring season can also be a time to introduce a renovation and repair for your skin. You don’t have to live with your past sunburns and problematic skin. It may be time to introduce your skin to retinol. Retinols are vitamin A derivatives which are clinically proven to nourish the skin and produce increased cell turnover, increased collagen production, and over time will reduce the UV damage of summers past. With regular use, retinols are one of the most powerful tools available to truly repair and correct blotchiness, age spots, fine lines, and wrinkles from both photo-aging and intrinsic aging of the skin. Few products can claim to turn back the clock on environmental skin aging. In addition to sun protection this spring, we hope to see you to discuss the addition of a Retinol to you skin care plan. We have found the SkinCeuticals Retinol 0.5 ideal for daily nighttime use. And for those who are preparing for a peel or laser procedure, the SkinCeuticals Retinol 1.0 is a great way to get you skin ready for a maximal result from your procedure. With continued regular use, retinols can help you to a lifetime of healthy young looking skin.

The U.S. is not the most “Nip and Tucked” Nation after all!

We often get a bad reputation for being a culture obsessed with youth and beauty, driven to stay competitive while at work and out and about. The U.S. is certainly the largest market for both surgical and non surgical cosmetic procedures. However, according to a recent survey by the International Society of Aesthetic Plastic Surgeons (ISAPS), the United States comes in a distant sixth in our quest to look the very best. An unscientific survey was circulated to ISAPS members, about 20,000 in all, and 698 responses were returned. The winner is: South Korea! Yes, the U.S. has been thoroughly out done by South Korea, where it is estimated that one out of every five women has had cosmetic surgery. The most popular procedures listed were liposuction, nasal reshaping, and double eyelid surgery to reduce and Asian influence and produce a more western lid shape. The second place finish goes to: Greece! Despite all the economic turmoil and austerity measures, Greece has drawn a line on looking good at all cost and it seems that breast augmentation has captured the hearts and minds of the Greek women who refuse to sacrifice cosmetic surgery as the economy struggles for a rebound. The third place country, Italy, is also a bit of a surprise, but the interest here appeared to be Botox treatments for a more subtle and conservative approach to cosmetic enhancements. Brazil is a country known for the importance of good looks, and there was a bit of contention as to why Brazil did not come in higher on the survey list. Remember, the poll was not scientific. Brazil takes its cosmetic surgery so seriously that the government allows tax deductions for those who invest in their looks. Beauty is a benefit to Brazilian culture and society, and their overall economy as well. And speaking of the economy of cosmetic surgery, Columbia, number five, has become a magnet for ‘medical tourism’, within reach of many seeking cosmetic procedures at an affordable cost, and a pleasant locale to recover. Is the U.S.A. really number six on the list of nations in the pursuit of beauty? We are, after all, the largest market and probably outspend the top five combined, but we are not as unique in our culture and interests as we might think. And just consider China, an emerging economy that did not even appear in the recent survey. Well, they just may be next poised to take number one spot away from everyone else.

Facts Grow about Fat Grafting and Lipo-Transfer

True, fat grafting into the breast is controversial. However, as we have gained experience, we find that some of the early concerns of calcifications and cysts can be minimized and the result from grafting or lipotransfer can be durable. The most important application at the present is filling contour deformities and improving the result of breast reconstruction. By layering in fat grafts, the breast can be filled and shaped with softer and more natural results. As yet, there is not a clear consensus on the best technique, the exact role of stem cells, or the correct amount to transfer at any one session. We find that layering the fat in smaller volumes is giving good results and is an idea gaining the most traction in the community. There is of course, the added benefit of body contouring elsewhere to obtain the fat needed. Breast enhancement with fat grafting still under investigation may benefit only those who wish a very modest increase in the breast size, or help those who have a modest breast asymmetry and wish to avoid a breast implant. We are not yet ready to consider fat grafting as a replacement for breast augmentation as our patients will often ask for an increase of one to two cup sizes, but liposuction candidates can put the fat to good use to provide fill in the upper breast or to improve a breast deflated after weight loss. Many studies will follow, however lipotransfer of fat grafting with care can be a durable and versatile tool for breast contouring and shaping. The bad fat can be turned into good fat in the right location!

The New “Gummy Bear” Breast Implants

The new line of breast implants which has come available will include a very cohesive gel implant, which maintains a stable shape, nicknamed the “gummy bear” breast implant. We have been interested in the “gummy bear” and have studied the Allergan 410 “gummy bear” for breast reconstruction for several years now, in anticipation of market approval. The form stable implant has been very important in reconstruction because the implant shape will put back some the personality of the breast that might have been lost after breast cancer removal. So just what is a “gummy bear”? We get images of the little, colored bear candy; soft, yet keeping bear shape after a good squeeze. Unlike a silicone gel implant that is more ‘runny’, the “gummy bear” will return to the breast shape after a good squeeze or hug. Because of this unique gel that sticks tightly to itself, the implant will also keep its shape even after a rupture and keep the gel in place with fewer leaks. With the new implants from Sientra, the “gummy bear” will become more widely available, and perhaps, Allergan, will too get market approval. This is a great relief for those who need a stable implant for breast reconstruction and may not qualify for the current studies. Also, some might consider the “gummy bear” for breast augmentation if the breast is denser, or perhaps for capsules that have caused implants to feel round and firm. Choice is always a win and we are glad the FDA has given us a go on the “gummy bears”.

The Dramatic Increase in Chin Implant Surgeries

By now, you have probably seen the “quoted” dramatic rise in the popularity of chin augmentation which has blanketed the internet -- noted everywhere from Fox News to WebMD. Although chin augmentation procedures have seen a 70% increase, the actual number of chin implants performed is roughly about 20,000. Compared to breast augmentation where 300,000 are performed annually, chin augmentation is still very selective. So why the interest in chin implants? Some have blamed the internet and social media for producing trends and exchanges of ideas at lightening speed. As true with fashion, cosmetic surgery can “go viral” as well. Chin implant surgery, also called genioplasty, has always been a means to balance facial features and profile. We like chin implants in individuals where excessive facial convexity is an issue because of a weak or receding chin. Chin augmentation, coupled with nasal refinement or rhinoplasty, can have a profound affect on your facial form and can create a ‘new you’. Recent articles show genioplasty as a means to stay in the game at work; strong chins look confident, and are popular with baby boomers. This procedure does make powerful improvements and is a strong statement about who you are. As we age, strong changes in facial form can also be harder to work into your ‘Facebook’ page without significant edits. Computer imaging should be a must to ‘try out’ the new look and avoid mistakes or regrets. We don’t know exactly how it happens, but yes, chin implants are on the rise, and to those who jump in on the trend . . . “see the new you on Facebook.”

Fifty Years with Silicone Gel Breast Implants. What’s on the Horizon in 2016? [Part 5 of 5]

As I began this series, we have come to a new chapter in the use of the silicone gel breast implant. The chapter actually began in 2006 when the FDA released silicone gel back into the U.S. market for breast augmentation. The silicone “crisis” never reached other countries in the world, only the U.S. with its very unique legal system. When implants were released, there were new product warnings, labeling, follow-up recommendations, age restrictions, and the requirement for an additional 10 years of post market studies to add to the already burgeoning implant research data. But what did we truly learn from the past experience? Breast augmentation remains a very popular procedure with very high satisfaction rates. Those who choose breast augmentation will most likely wear implants their entire life. Satisfaction is so high that most would prefer never to even think about their breast implants, and even forget to mention them when they have a mammogram. Herein lays the problem; all breast implants will wear out and need replacement. We repeat the need for implant maintenance, the value of MRI tests, importance of the ‘ten year’ check, though is everybody listening? Everyone wearing a silicone gel implant should keep the implant identification card, keep in touch with a surgeon for check ups, and know all good things come to an end, and for most, new implants and a new beginning. Implants will have a significant, though low leak rate at ten years of perhaps 8%, so I have marked my calendar for 2016; just ten years after silicone gel implants came back and hit the ground running. This could be critical year, if we have not learned from the past one. Remember, your breast implants will not make you sick, and do not cause cancer, and will not explode in your chest, but they will eventually leak, each and every one of them. When the news comes on in 2016 and newscasters break the story, remember you heard it here first. Let’s not panic, no shock and dismay, just out with the old ones and in with the new. Ten good years is, well, ten very good years. By then, the silicone gel implant will turn 54, and no doubt will still be the most studied medical device in the world.

The Silicone Gel Breast Implant, the Most Studied Device in the World [Part 4 of 5]

During the silicone breast implant moratorium, juries continued to grant large awards based on “junk science” and an unproven link to autoimmune illness, and the plaintiff’s bar and “experts” continued to reap huge fees for their efforts. Even before the historic bankruptcy of Dow Corning, the medical community responded with study after study failing to show any link to silicone implants and autoimmune or connective tissue disease. The Mayo Clinic published their findings in 1994, Harvard in 1995, the compiled work by the American College of Rheumatology in 1995, all finding no increased risk to women with silicone gel breast implants. Despite the data, over 400,000 women had filed for settlements. With continued U.S. and international studies, the turning point was reached in late 1996 when the federal court in Oregon ruled that plaintiff’s lawyers could no longer present evidence that was scientifically invalid. The National Cancer Institute later published their results refuting any link between breast implants and breast cancer. And in 1999, the National Academy of Sciences under the Institute of Medicine released its report refuting the claim that silicone breast implants are responsible for any major disease. As the decade of the 1990’s ended, the toll on American women was horrific with scares of cancer and illness, and the toll on the American worker and investor, with thousands of lost jobs, devastating. The “hoax” cost Dow Corning over 3 billion dollars, and destroyed many other companies altogether.

The Silicone Gel Implant Moratorium [Part 3 of 5]

In the spring of 1992, thirty years after the development of the silicone gel breast implant, Dr. David Kessler the head of the FDA placed a moratorium on the use of the silicone gel implant. This decision occurred despite the fact that FDA expert panels were unable to find any casual link to illness. Despite the ruling, silicone implants were released and allowed only for those women needing reconstruction after breast cancer. For all but two manufacturers, the decisions came too late. The firestorm of litigation and increasing awards based on vague “silicone induced” autoimmune disorders had caught hold. A jury in Texas where the silicone gel breast implant was born awarded over $55 million in damages in one single verdict. Just one year after the moratorium on the silicone gel breast implant was imposed; there were over 12,000 lawsuits against Dow Corning alone. By the spring of 1994, a group of companies tried to form a fund or global settlement to cover the multitude of suits regarding questions about the silicone gel breast implant in order to provide a settlement for individuals without question of any illness or cause. Despite all, the firestorm raged and by spring of 1995 Dow Corning filed for bankruptcy, with over 20,000 pending lawsuits. The human side to this tragedy is that many women believed that they had become ill from silicone gel implants. Vague flu like symptoms, aches, malaise, and fear complicated many women’s lives. There was no science which supported the relationship, but to very many the symptoms became real, and with the assistance of internists, rheumatologists, and others, plastic surgeons were left to guide and support their patients. Countless hours were spent discussing what was truly known, and many more removing implants for better or worse. The bonfire of litigation spread to the giant Dow Chemical, the parent company of Dow Corning, but as the legal battle raged, the medical community turned the silicone gel breast implant into the most studied medical device that the world has known.

Silicone Breast Implants on Trial and the Advent of ‘Junk Science’ [Part 2 of 5]

As we continue to look back at the amazing history of the silicone gel breast implant, it seemed that by the 1980’s we had the ideal solution at hand for augmentation and reconstruction of the breast. Though implant rupture might require a second surgery for removal, and implant hardening was a problem for some, there were few safely concerns. As the implants had now been on the market for nearly thirty years, it seemed an unnecessary effort to collect the scientific data that the FDA asked for in 1988. By 1990, there were several manufacturers with a wide choice of implant sizes and styles. However, companies and surgeons began to collect and submit the data and studies to the FDA by the hundreds. Over the past decades, the number of silent implant leaks and ruptures were growing and everything changed for plastic surgeons in December of 1990. Many of us have recollections of where we were the night when ‘Face to Face’ with Connie Chung aired, raising the fears about the dangers of silicone gel breast implants, exposing her own unhappy experience and those of others. The level of national awareness went to an all time high with images of leaking ‘goo’ in the media and rising health concerns. Still despite the data collected, we could find no health problems or cancer links to the silicone gel implants, though questions arose -- could the implants be proven to be safe? By the next year, the FDA assembled a panel of experts from all areas of medicine and material experts, including toxicology, immunology and oncology as well as plastic surgeons, to review all the data available. That same year what the FDA panel was not able to find, a link between silicone gel implants and any human illness, trial lawyers in Alabama did. According to plaintiffs’ experts, an individual with breast implants had developed an autoimmune condition caused by the implants. Actually this was the second such case where “experts” introduced a theory that silicone gel somehow affected the immune system causing illness. Thus “junk science” the ability to introduce scientific theory as fact in order to receive financial compensation was established in U.S. courtrooms. In short order, hundreds of lawsuits were filed against both surgeons and implant manufacturers, and by 1992 silicone gel breast implants were voluntarily withdrawn for use. Left with only saline breast implants, we held our breath and waited. And just when things looked very dark indeed, they became darker. More to come.

Silicone Gel Breast Implants Turn 50 [Part 1 of 5]

The most studied, and yes, the most litigated device in medical history, is set to turn fifty years of age with the coming of spring 2012. Despite the tempestuous course, breast augmentation and the rise of the silicone gel breast implant has been an exciting story and remains the second most popular cosmetic surgical procedure in the US, and the number one procedure in Europe, with well over two million women wearing breast implants world wide.

The silicone gel breast implant was first conceived by two surgeons in Houston Texas, Thomas Cronin and Frank Gerow. They confronted a demand for a safe means to enlarge and enhance the breast, a challenge with a very long history. We may think that the current youth-oriented society and the fashion industry are responsible for the demand, but the quest for a full and attractive breast is documented in late 1800’s with advertisements for breast creams and suction devices to enhance breast size. Surgical breast augmentation was tried in the 1920’s with glass beads, paraffin, fat grafts (yes, we are back at it), and later a sponge material which was used up until the 1950’s. The hardships from these attempts were well known to Dr.’s Cronin and Gerow, as well as knowledge of the introduction of silicones in the 1940’s during the war. Reports were circulated of a home remedy used by Japanese prostitutes of paraffin and industrial silicone injections to enlarge the breast. Though very many resulted in infection and terrible cysts, some were soft enough to warrant the concept of containing the silicone in a balloon or pillow and thus the idea of the silicone gel implant was born.

It was the spring of 1962 and the first silicone gel implant breast augmentation was performed on Timmie Jean Lindsey in Houston Texas, and later presented at the International Society of Plastic Surgeons in Washington DC in 1963. Mrs. Lindsey is alive today and has been noted to have enjoyed her procedure for decades. The success, fame and fortune of Dr.’s Cronin and Gerow are almost of legend, and were chronicled in a semibiographical film ‘Breast Men’ in 1997 directed by Lawrence O’Neil. Though the movie is not completely factual, it offers a rather comical look into the meteoric success of cosmetic breast enhancement. At last, plastic surgeons had the “prefect” solution to augmentation of the breast in a safe and affordable way.

The rest has been history, though what a history it has been. Dow Corning manufactured and distributed the widely popular silicone gel breast implant enjoyed by many. And though reports of silicone bleed and implant rupture surfaced, the implants had a very good run for the next 20 years.

When I began to enter plastic surgery in 1979 the FDA had just begun collecting “safety and efficacy” data, and as surgeons we knew about eventual leaks and capsular contracture, but patients expected implants to last a lifetime. We had set ourselves on a collision course of public misunderstanding and this is where the story about the silicone gel breast implant really takes off. More in my next blog.

Are Seniors at Risk during Cosmetic Surgery?

There has been a continued trend for facelift, or nip and tucks, at a younger age. The idea is one of maintenance, rather than repair for signs of aging. After all, many of us would prefer not to age at all. But for those of us who might have delayed facelift or rejuvenation, is it ever too late, or perhaps are the risks just too high? Certainly all cosmetic surgery contains some risk, though for most the risks can be managed. Facelift can be an option at any age, though it should begin with a careful plan.

For seniors who have some health issues, and almost all will, your primary care physician will be your advocate to get you into the best of shape and provide a ‘medical clearance’ for cosmetic surgery. High blood pressure, even diabetes which is well controlled, may not hold you back as your physician and our office can partner as a team to see the ‘best’ you become the ‘new’ you. We have been able to take steps which shorten the facelift and neck lift procedure, and find that as we age we require less sedation for comfort and care. An overnight friend can be comfort for some, though there is little to do except rest and relax.

As they say, you may never be too old to look your best and facelift or eyelid rejuvenation can still be a safe option. It can start with a simple dream of getting rid of your loose neck skin. Just know you can follow through with a plan for a safe and comfortable procedure.

The Results are now in -- the 5 Top Cosmetic Surgery Procedures for 2011!

And the envelope please . . . the results from the American Society for Aesthetic Plastic Surgery were just released and despite the economy, cosmetic surgery continued to hold its own, and has even grown by 1%. The bottom line is that over 9 million cosmetic procedures were performed in the U.S. last year. Some of the most impressive growth has come from nonsurgical rejuvenation, which made up 82% of the total.

And, the top five cosmetic surgical procedures are: liposuction (325,332 procedures), breast augmentation (316,848 procedures), tummy tuck (149,410 procedures), eyelid surgery (147,540 procedures), and breast lift 127,054 (procedures). Women are still 90% of the total, though there was a small, though significant, increase in men seeking cosmetic procedures. Although breast augmentation and liposuction have been competing neck to neck the past several years, liposuction has again pulled ahead for 2011.

The really big numbers have been in the nonsurgical procedures that we, plastic surgeons, offer. The top five for 2011 are: botulinum, such as, Botox (4,030,318), hyaluronic injectable fillers, such as, Juvederm (1,662,480), laser hair removal (1,452,880), microdermabrasion (794,357), and IPL treatments (726,125).
Perhaps this is your spring to tune up your looks, whether you are ready for nonsurgical skin care, or would like to plunge into liposuction or the breast augmentation you have been waiting for. The aesthetic spa rooms and our private surgical facility are ready and waiting for you!

Breast Augmentation Revision: Is there a second chance for a better Breast Augmentation result?

Of course, the best revision of breast augmentation is none at all, and communication is the key to the dream result, matching the expectation to what you see after your augmentation procedure. Where we see the most trouble is with breast augmentation by the numbers. Many practices will ask those seeking breast implants to try an implant on in a bra, and then read the number of the size they like best. The argument goes that you chose the number, and if too big or too small after augmentation, it was after all your decision. Troubles also come from implants that are just too large for the available skin envelope and breast diameter. Other problems are seen with implants pockets which are not centered in the breast with an implant too high or too low, breast asymmetry, or breast droop or ptosis. Finally, the biggest nemesis of all is capsular contracture with a firm and rounded breast.

Breast augmentation revision can’t solve every problem, though if you have a result that falls way short of the real ‘you’ implant exchange for size can be very satisfying. There are also a variety of techniques to improve the breast implant pocket and implant position to get a better marriage between the implant and natural breast tissue. Breast lift can raise the nipple and keep it up front and center on the breast for the best aesthetic result. And capsular contracture, a difficult and recurring problem might respond to newer techniques with an allograft, a new implant pocket, or even a highly textured and form stable implant, such as the gummy bear.

Remember, communication is the most important step before breast augmentation. In order to get the result you expect, be certain that we know what is expected. The implant size is only a number, one which is easily forgotten, the right look will give you confidence and a look worth remembering.

What a Breast Reduction Can Mean for You.

It seems unfortunate that insurance companies and health plans have a continuing trend of denial of coverage for breast reduction surgery. Our experience over the past 20 years has demonstrated, time and again, the incredible benefit to life and health from a breast reduction. Breast reduction surgery has remained as one of the pleasing procedures for patients, with the highest satisfaction rates of all cosmetic surgical procedures. According to ASPS statistics, there were over 80,000 breast reduction procedures in 2009 despite poor support by the insurance industry.

A recent study and review of all the available data on breast reduction was compiled and published by the plastic surgeons at Emory University in the Journal of Plastic Surgery in 2011. Their work compiled data from breast reduction patients from 1977 to 2010. As we all expected there were significant improvements in musculoskeletal pain, headache, improved sleep patterns, less fatigue, and improved breathing. This alone should impress the insurance industry. The bigger news, however, is that breast reduction also had an impact on improved self esteem, improved sexual function, improved quality of life, decreased anxiety and depression, improved exercise, and a reduction in eating disorders! We, too, had noticed that breast reduction patients tend to lose on average 15 pounds after their reduction. This news just couldn’t be any better!

We do enjoy good support for breast reduction from primary care physicians in our community who recognize the benefit to their patients as well. Even if your insurance plan has turned you down and the benefits seem too good to pass you by, our office can help find a way to make reduction a reality for you.

Number of Patients Seeking a Breast Lift sees a Dramatic Rise.

According to the statistics of the American Society of Plastic Surgery, over the past ten years there has been an increase in the number of breast lift procedures by a whopping 600%. Liposuction which remains the most popular cosmetic procedure has seen the demand fall slightly during this same period. We hope that this is a sign that we are finally addressing weight issues, exercising more, and focusing on body shaping, both in and out of clothing. Certainly body shapers, such as Spanx, have seen explosive sales increases. Plastic surgeons, too, have seen the same effort from patients, hoping to get the best look from the skin they are in as well.

What makes breast lift such an attractive procedure is the flexibility in clothing, such as bathing suits and even camisole tops, which might have been unthinkable without a lift. The freedom from dependence on a bra to hold the breast and nipple up on the chest and relief from the dreaded ‘National Geographic’ look can give an incredible boost to the quality of life. Breast lift can correct a breast which has become thin and flat from weight loss, aging, or pregnancy. Would you dare go braless on a hot summer day? The huge increase in breast lift tells us many might not have before, though after a breast lift there is a whole new world of possibilities.

A New Line of Breast Implants will soon be available from Sientra®.

Every time we have a new breast implant enter the market in the U.S. the news is fairly big for plastic surgeons. We have had two very good choices for most seeking breast augmentation, the Allergan Natrelle®, and the Mentor Memory Gel® implant lines. Worldwide the selection has been all the greater, though now the FDA has released approval for the Silimed® silicone line of breast implants from Sientra®.

We have not seen all the details on the implant series, as the news was just passed on from the American Society of Plastic Surgeons (ASPS). And, we have yet to compare the new implant warranty with the excellent ones from Mentor and Allergan. However, when patient individual needs are concerned, choice is good and the new implants will get our closer “look over” to see where they fit some special needs, such as the Allergan Gummy Bear 410 in our practice. We have had good experiences with the Allergan 410 in selected patients, and we hope too they will become more broadly available and out of the current study restrictions next year.

Yes, Dr. Johnson and the Center for Aesthetic Surgery are on Facebook!

Just when we thought there wasn’t the time for one more thing during the day, we discovered that over 42% of you out there use social media and Facebook for research and exploration into issues concerning cosmetic surgery. So we have made the leap, turned off the television, switched off the radio, and fired up the i-pad. We have created links for Facebook to take you to our website and blog and hopefully to some of the timeliest information in cosmetic surgery today.

Like the rest of you out there, we are caught in the web with links from the American Society of Plastic Surgeons, the American College of Surgeons, Looking Your Best, Realself.com, and many more. We’ll see you on Facebook, and hope we can friend you, and hope you will ‘like’ us!

Time to Shed your Winter Skin: the Season for Microdermabrasion and Facial Peels has Begun.

Over winter with lack of sun and moisture, our skin goes into hibernation, and the outer dry layer begins to build. The winter dryness can lead to the development of fine lines, loss of supple skin tone, and the dry buildup can cause the appearance of age spots and telltale signs of environmental damage.

Spring cleanup is an essential part of maintaining healthy skin, and there is no better way than a program to exfoliate the winter skin as we prepare for warmer weather. Microdermabrasion is an excellent way to combat dryness, and reduce fine lines. Your skin will become more receptive to moisturizers and make-up will flow and blend better. For those with more buildup and blotches, facial peels such as Lactic, Glycolic or TCA will improve skin color and lessen age spots. Beside the blotches, they may also improve under eye circles.

Preparation is the key and we have a program to get you off to good start. Before treatments, you should start with a micro- exfoliating cleanser, and perhaps pigmentation control, followed by a vitamin enrichment of the skin with retinol, Retin-A, to wake up the winter skin.

After your skin is clean and clear, don’t forget the importance of protection. Sun blocks can provide color and physical defense, and sunscreens will allow you fun in the sun while protecting your good looks for years to come. Give us a call for your spring cleaning!

Cosmetic Surgery Horror Stories are on the Rise.

With the changes imposed by the national healthcare transition, it seems that more physicians are making a transition into cosmetic surgery, often with very little training. Under current practice inIllinois, any physician in the state may call themselves a cosmetic surgeon, or open offices featuring cosmetic medicine. We are entering the wild west of cosmetic surgery, where your obstetrician may wish to perform your tummy tuck, or even your dentist may ask if will have Botox with your cleaning. Your last treatment may have been featured on the ‘daily deal’, or perhaps you had a facial filler at a hair salon or house party.
Patients don’t often consider that cosmetic surgery is ‘real’ surgery and can have a false sense of security. In Illinois, we seem to have been spared the worst so far, though the national press has been filling with stories of the ‘uni-boob’ after breast augmentation, death by liposuction, breast implants from hell, and unapproved ‘fillers’ with disastrous results. And nationwide it seems revisionary surgery is on the rise. We, too, have seen an increase in the ‘redo’ consultations or second opinions at our office.

We predict that the trend will continue to grow, and it is time to emphasize that cosmetic surgery is a serious surgery and should be performed safely by a well-qualified, experienced surgeon. The best surgeon for you, whether it is Botox and fillers, or breast enhancement and facelift, is one, board certified by the American Board of Plastic Surgery, and practicing in an accredited office facility. Good standing in the local medical community is also a must, and don’t forget to ask your surgeon if he or she has privileges to perform the same procedures in the local hospital.

So remember, it’s a wild world out there and you will have to do your homework to play it safe. Or, you could just give us a call. I’ve done the hard part for you.

Hope for Capular Contracture after Breast Implants.

Every breast implant used in breast enhancement, augmentation, correction of breast asymmetry, and breast reconstruction will form a natural capsule, a kind of scar over the surface of the implant. For a very few individuals, the capsule will become tight and firm in perhaps two out of a hundred, and the implant will become round, losing its natural softness. The cause is poorly understood, and for most, the contracture happens on just one side. Despite every effort to place the implants cleanly and free of any contaminates, capsules will occur.

Once a capsular contracture has begun, our options have been medical approaches using vitamin E, Singulair™, and implant massage. The success has been poor for most. The surgical options are opening the capsule or removing it altogether, or placing the implant in a new pocket in front of or behind the old one. Surgery is successful about half of the time. Yes, the capsule will eventually return and firm up for half of breast implant wearers. Of course, the implants can be removed, but patients are so pleased with their implants that most will live with the capsule, rather than live without breast implants.

A new idea has emerged with our experience in breast reconstruction. We have trended to more breast preservation and immediate breast reconstruction after mastectomy. Patients with breast reconstruction seem to have the highest rates of a capsule or firm breast implant. However, when we place the implant immediately, and support it with an allograft, the capsular contracture rate has been less than expected. An allograft is a sheet of collagen prepared from a donor that covers and supports the implant and it may prevent the capsule from tightening. Many surgeons are now using allografts ‘off label’ with success to solve problems with capsular contracture giving new hope to those with a firm breast implant. As full studies have not been completed, the proof is yet to come. In time, the allograft may be the tool we have been looking for to solve a very difficult breast implant problem.

Develop a Lifetime of Healthy Skin with Us.

As children, our skin needs very little care -- just cleaning, moisture and, of course, sun protection. But as we age, beginning in our thirties, our skin begins to behave differently. Moisture content starts to diminish, and collagen production begins to slow down. Also, the elastic fibers in the skin begin to give way and are replaced at a slower rate, creating the visible signs of aging.

The concepts of prevention and maintenance must be started at the earliest time possible, to wake the skin and stimulate cellular function and collagen production. In our office, with the help of products from SkinCeuticals, we can start a program of cleaning, toning and moisturizing, and offer sun and environmental protection. As the skin slows its natural cycle of repair, we can also restore those vitamins which can active and restore cell function.

Some of my favorites are: Hydrating B5 Gel to enrich the skin, and vitamin C and E Ferulic to take advantage of the healing effects of vitamin E, and the exfoliating properties of vitamin C. Finally, vitamin A over the long term is the most effective of all to wake up the skin and stimulate cellular function. Retinol from SkinCeuticals is very effective and well tolerated for daily care. And for those who need greater help and have controlled dryness, prescription strength vitamin A preparations such as tretinoin (Retin-A) creams and gels are a proven step.

We know that the majority purchase their skin care products from retail stores, and this is why we have put in place a simple and effective program with SkinCeuticals to see you through your thirties and beyond. Prevention with cleansing and sun protection, and maintenance with hydration, exfoliation and the right concentrations of vitamins, especially vitamin A, can give you a lifetime of skin health.

Breast Reduction Evolves as an Office Based Cosmetic Procedure

On a regular basis our practice sees individuals who have a very large and heavy breasts who are unable to find bras or clothing that will fit both their upper and lower body. Bathing suits are out of the question, back strain is a daily problem, and exercise a challenge. In the past, we had the support of insurance coverage for the physical comfort provided by breast reduction surgery, not to mention the improvement in appearance and self esteem. Yet, we now experience insurance coverage for breast reduction trending lower, with frequent insurance denials, despite appeals. Some insurance plans will not consider breast reduction for any reason, as they pull back under the changes of the new health care plan passed by the government.

Fortunately, the evolution in breast reduction began before the insurance companies stopped including coverage. Over the past eight years, we have adjusted our reduction to involve a smaller scar, eliminated the need for drains, and shortened the recovery time needed. Hospital stays after breast reduction has been eliminated. Breast reduction is now a shorter, safer, outpatient plastic surgical procedure.

Many who are looking forward to breast reduction, and are turned away by insurance have an option to go it alone. Office based surgery is safe and affordable, and with the evolution in reduction techniques, breast reduction is available as an office based procedure. We like office based surgery as the cost is so much lower than hospital settings; safety is assured by our commitment to high standards and accreditation. Of course, this doesn’t include the comfort and patient experience that a private center can provide.

So don’t despair if your insurance has turned you away from a procedure that can have such an impact on the quality of your life. Be free of pain and back strain, wear the clothing you like, and have a look you deserve at our Center for Aesthetic Surgery.

Cosmetic Surgery is Trending to a Younger Age Group: Welcome Generation X.

Review of plastic surgery procedures by the American Society of Aesthetic Plastic Surgeons has revealed a new trend in the demand for cosmetic procedures. According to their 2010 statistics there had been a shift from the Boomers, to Generation X, as the drivers and consumers of cosmetic surgery procedures. The 30 to 45-year-old group, or Generation X, accounted for 43% of all procedures, while the 50 to 65 year olds only 28%!

With shows such as Nip and Tuck, and the ever-present emphasis on beauty as seen in our national magazines and other media, cosmetic surgery is no longer something to be considered in the ‘later’ stage of life, but as a process of continued enhancements to defy the aging curve and maintain youthfulness over time. This major shift has pushed us from restoration of beauty, to one of prevention and maintenance of a youthful and vital look.

Though we will never give up on our Boomers who need our care and attention, numbers indicate that prevention is here to stay. To compare, consider a full SMAS facelift or deep peels at age 60, clearly ‘rejuvenation’, to that of a soft lift or minimal-incision facelift at age 45, for maintenance and prevention.

Preparing for the shift to the nip and tuck generation, we have developed a minimal facelift with a short scar, with a short recovery to match. Eyelid procedures have also been tailored to more subtle changes of aging. Lighter peels and lasers refresh and rejuvenate the skin. And, of course, body contouring has shifted to a mommy makeover to address the wear and tear of pregnancy that our gen-Xers are facing.

The desire to stay young has taken on a whole new strategy, with “preserve and maintain” being the new norm of the next generation. Combined with skin care and other anti-aging programs, plastic surgery is in the mainstream for Generation X.

Number of Plastic Surgeries Rise Again for the Second Straight Year despite Difficult Times

Interest in plastic surgery has remained strong, both in our practice and nationally, as recently reported by the American Society of Plastic Surgeons, of which we are proud members. We are fortunate that 2011 was a pretty good year because individuals, out and about in the workplace and job market, understood the importance of looking good to stay in the game.

Plastic surgery procedures, such as breast augmentation and tummy tuck, have always and continue to enjoy a strong demand. Facelift has jumped ahead, possibly because of the pressure on those 50 somethings to prepare for the ever increasing retirement age. Among men, we have seen significant interest in lid rejuvenation, as no one wants to look tired at the office and on the go.

The biggest surprise has been in the surge in nonsurgical treatments. Overall, a big winner has been Botox Cosmetic. Facial fillers, too, – Juvederm being one of our favorites – have also increased in popularity. Injectable fillers remove frown and laugh lines, and are used also for lip enhancement. We aren’t referring to the Hollywood look, just enough fill to smooth out facial lines and plump lips enough to give back a fullness of health and youth.

As spring season approaches, we are ready to shed the winter skin, and peels, photo facial laser, and microdermabrasion are very effective on the dry non-tanned skin of the winter season. And don’t forget about laser hair removal! We hope 2012 is even better for all, and we look forward to helping get you ready for it.

Botox versus Dysport, New Results are in Comparing which Works Best.

Botox has been a standard in our practice for the control of frown lines or ‘eleven’s’, softening crow’s feet by the corner of the eye, lip lines, and let’s not forget forehead lines that build up over time. We have had excellent results by mapping each treatment and have our followers in a consistent program with consistent results, now for at least ten years or more, for some of our patients. Our total experience goes back even further to the mid 1980’s before Botox Cosmetic came along, when we were first pioneering new ideas with the standard Botox preparations in order to control frown lines better than with a brow lift alone.

Now a new form of injectable botulinum toxin to control frown lines is available called Dysport and we frequently get calls as to which is better. Dysport is certainly newer on the scene, but is newer better? And how does it compare?

A January article in the Aesthetic Surgery Journal by Dr. Michaels at the University of Massachusetts has compared Botox and Dysport to answer these questions. In a very well designed study, patients were treated with Botox on one side of the face, and Dysport on the other in standard patterns. The dosage was adjusted as one unit of Botox is equivalent to 2.5 units of Dysport. The results have shown both are able to get measurable improvements, and both last the same length of time. In short, when used in the dosage and patterns described, the results were identical!

So there your have it, new, but not improved. And Botox has been a godsend to so many in our office who will just not kick the Botox habit. Even a special event such as a Wedding, can require Botox in the underarm to keep you cool and dry. We welcome Dysport, though Botox is here to stay!

Confusion about Liposuction is on the Rise.

The competitive world of medical technology is always trying to build the better tool for liposuction. We have reached a point in the medical arms race where there is confusion as to the ‘best’ way to perform liposuction or body shaping. Monthly, the list of various techniques seems to lengthen: traditional, tumescent, ultrasound, water, tickle, laser, vaser, smart, external ultrasound, radio-frequency. And, let’s not forget ‘non-surgical’ liposuction, like mesotherapy, and cool liposculpture. The list keeps growing. As they say, there must be fifty ways to lose your blubber. The claims of one system’s benefit over another’s are clouded in marketing hype and promotions. It seems that one system will drift off as interest wanes, only to be replaced by the “new and improved” next generation.

So what really is the best way to complete liposuction? Our practice focus is, and always will be, on the result. The procedure is matched to the individual’s needs with an emphasis on a safe and pleasant experience. It is not the tool, or the liposuction system, that gives dramatic body contouring and previously “unseen” superior results, as ads may claim. It is the skill and artistic ability of the surgeon that will give you an excellent result. Some systems may be easier in one instance or another, but skill and judgment trumps all of them. Michelangelo might have changed chisels over time, but we bet that the results have been the same no matter what he used.

With your liposuction, set your focus on the best result as we do, and worry less about the best tools to get you there.

Can your Breast Implants save your life?

After breast augmentation, there is a worry that breast implants might limit a very robust and physical life because of a concern that breast implants can rupture. Mammograms, perhaps, cause the first worry, followed by strenuous active adventures, such as scuba diving, and rock climbing. Even kick boxing will come up as a risk to breast implants. The facts are that implants are quite durable, and with all sports and activities, anything goes. Sport related injuries are bound to happen before your implants will develop problems.

Can you believe that your breast implants could save your life? We have heard stories of women who have believed that their breast implants have cushioned the blow in an auto accident and saved them from death and injury. We have recently heard in a report by a Florida television station that a woman was attacked by an assailant wielding a knife and was stabbed in the left chest. Her saline breast implant prevented the knife from piercing her chest, saving her life!

Let’s hope for all we drive safely, and stay out of harms way. After implants, you can count on a full and active life. Though maybe, just maybe, your breast implants might save the day for you as well.

Is Stem Cell Breast Reconstruction a Reality Today?

There is a virtual news storm on television and over the internet concerning stem cell reconstruction of the breast since an announcement by Suzanne Somers, a noted television personality, that she had chosen stem cell reconstruction of her breast after lumpectomy and radiation. The story has been covered by popular programs such as Dr. Oz, and CBS news which carried a story about the new way stem cells re-grow the breast. The internet now is blanketed with stories about stem cell breast reconstructions, and clinics have begun to advertise the merits of the technique.

We have known that fat grafting is gaining ground for facial rejuvenation, breast enhancement, and correcting dents and defects. We know also that abdominal fat does indeed carry stem cells, which are the ‘originators’ of all tissues. Teams of researchers have been investigating methods to separate and enhance the stem cells with growth factors to improve the results of grafting. Many of the publications have come from a team in Japan under Dr. Yoshimura who actually came to the U.S. to participate in Ms. Somers’ reconstruction, and there is ongoing work in the U.S., the U.K. and Australia to confirm and advance our medical knowledge.

Stem cell is the buzz phrase of today, and is extensively promoted in surgery and even in skin creams. So is stem cell enhanced breast reconstruction a reality today? Unfortunately, there is much hard work to be done before an FDA approved regimen is in clinical practice. We just don’t know enough about the process, the effect of growth factors, and risks. The FDA has a careful role to make certain that patients are not deceived, or at worst harmed. The American Society of Plastic Surgeons anticipated the explosive claims and promotion of stem cell therapy with a position statement which can be found on their website, which reinforces the fact that good science will lead to good medicine. In the meantime, structural fat grafting and replacement in the breast is now a taking shape and is supported by medical studies, and may be the basis of Ms. Somers’ fortunate result after all.

New Study Shows You Do Look Younger after Facelift!

We have always relied on face and neck lift as a foundation for facial rejuvenation. Facelift has been a very popular procedure in our practice for those who simply wish to look their best. How much improvement do patients enjoy from facelift procedures? A recent study quoted by the American Society of Plastic Surgeons has evaluated individuals, between the ages of 45 to 70, both before and after facelift. The panel was asked to judge the ages of the patients based on the photos from before their surgery, and candidates were estimated to be a year younger than they actually were. Generally speaking, people who want to look good, do look better than average. However, after face and neck lift, the panel estimated the patients’ ages to be 7 to 8 years younger than they actually were!

The study did uncover another interesting fact. When facelift is combined with eyelid rejuvenation the impression on the panelists was even greater. Multiple procedures lead to happiness and better results according to the study. None of the patients had included any skin care, or facial fat transfers, as is our standard of care, so who knows just how good the results might have been.

So the results are in; facial rejuvenation will not only make you look fresher, you can look younger by 7 years. Now that is something a cosmetic surgeon can be proud of. Not the fountain of youth, but a fountain of youthful looks and living a life worth having.