Tag Archives: PLASTIC SURGERY

Don’t Google it

A few months ago the Flemish Government hired a firm to dissuade the public from going to google to look for their symptoms and signs. Invariably the results are ridiculous at best and only lead to confusion and unnecessary fear.

Here is a link to the Washington Post article that discussed this situation and google,

http://www.washingtonpost.com/news/to-your-health/wp/2014/11/11/can-this-ad-campaign-get-people-in-belgium-to-stop-googling-their-symptoms/

A few years ago I wrote about getting medical information from google and sources of medical information that are trustworthy. Here is a link to that blog.

https://www.tavmd.com/2013/05/17/plastic-surgery-information/

Especially after cosmetic surgery, there are many normal aspects of healing that may appear strange or alarming not only to patients but even to most other physicians! Remember that cosmetic plastic surgery is a highly specialised field of surgery and even most general surgeons have never seen many of the procedures plastic surgeons perform.

If you have symptoms after cosmetic plastic surgery your best bet is to call the plastic surgeon’s office and discuss your concerns. A minute on the phone can save you hours and days of anguish when you speak to Dr. Google.

Buttocks plastic surgery update

Buttocks plastic surgery update

 

buttock shapes

I recently saw a classification for buttock shapes. It turns out there are pear, apple, mandarin and tomato buttock shapes.  Funny but no one told me that during my training. It also appears that the citrus fruit among these, mandarin, is the shape most aspire to: two round balls for buttocks. Buttocks plastic surgery keeps on evolving and its time for a buttocks plastic surgery update!

From a cosmetic plastic surgeon’s perspective, there are three types of buttocks plastic surgery that can be performed: patients want their buttocks larger, smaller or just lifted.

A.

Making buttocks bigger

The options for making buttocks larger are:

1. Silicone implants

In this outpatient cosmetic procedure, a 2-3 inch incision is made between the buttock cheeks and a solid silicone implant is placed under the buttock (gluteus) muscles.

  • Silicone implants used are different from ones used in breast augmentation and are firmer to touch
  • Implant have to be placed higher in buttocks, as you cannot sit on implants for fear of rupture; we all sit on the bone under our buttocks
  • Healing takes about 10 days and full recovery 1-2 months

2. Fat injections – Brazilian buttock lift

  •  Even though the Brazilian buttock lift has “lift” in its name, it’s a plastic surgery procedure that both enlarges and lifts buttocks
  • Liposuction of abdomen and hips is performed, and harvested fat is injected into buttocks
  • I typically inject about 800 cc into each buttock at one surgery for maximum effect
  • This is an outpatient cosmetic surgery requiring 3-4 days for recovery and 1 month for full healing
  • About 30% of  fat injections will naturally disappear, but some will remain permanently; everyone is different

B.

Making the buttocks smaller

There is really only one cosmetic procedure to make buttocks smaller, and that is liposuction. In this procedure, three to four small incisions are made around either cheek and fat is removed, leaving behind a smaller buttock. The cosmetic danger is in removing too much fat and turning a plump cheek into a flat and droopy one—not a good idea.

C.

Lifting the buttocks

There are two options for this cosmetic procedure, buttock lift surgery and, again, Brazilian buttock lift.

Buttock lift surgery

In this surgery, a scar is placed in a crease under the cheeks and the skin is turned in to give a modest lift.

The problem is that the plastic surgeon is trying to push and hold your skin and fat tissues in a high position against gravity’s force; given the weight of skin and fat, gravity wins. The scars are not great from this surgery, and I try hard not to perform it!

Brazilian buttock lift 
As above, fat injection will not only make a buttock larger but will also lift it, in the same way an empty bag is “lifted“ when full. With liposuction I can actually change the shape of the buttocks to to make them larger and lifted or smaller and lifted!

The concept to keep in mind with all these surgeries is that by changing the shape of the skin and fat around an area I can change the apparent shape of the area itself!

The update

I first wrote this blog in 2010. $ years later not much has changed other than…

I now perform a lot more Brazilian buttock lifts than before; it is a routine procedure now.

I do very few silicone implants these days

I have not done a simple lift with cutting of the skin in 4 years! – It is just not a good surgery.

We still do not know how come much fat cells survive in some areas and not in others as well!

Latest Cosmetic surgery techniques 2014

The American Society of Aesthetic Plastic surgery meeting 2014

latest techniques

I was recently at the annual meeting of the American society for aesthetic plastic surgery (ASAPS) in San Francisco to see the latest cosmetic surgery techniques 2014.

There are about 6500 Board certified plastic surgeons in the US. Of those, only about 2000 are members of the American society for aesthetic surgery (ASAPS). This select group of plastic surgeons are those whose practice is primarily devoted to aesthetic plastic surgery- cosmetic surgery. Plastic surgeons from all over the world go to the meeting to learn the latest techniques in cosmetic surgery.

Fat injections to the face

The concept of fat injections, and by definition almost, stem cells, continues to be widely popular.

Plastic surgeons are increasingly injecting fat into the face for facial rejuvenation during a face lift. The fat seems to stay in the face for some patients and not for others. Cause unknown.

Fat injections into breasts

fat injections into the breast continues to be problematic. A recent study shows that fat injection by itself does not cause breast cancer. But… if you have a breast cancer, the fat injection will make the migration of  the cells faster and increase the chance of metastatic cancer- not good. Specially when 1 out of 9 women in the US is going to get cancer, getting metastatic cancer is a death sentence.

Fat injections into joints

The most exciting reports for fat/stem cell injections come from studies where fat is being injected into knee joints that have suffered injury. The torn cartilage actually seems to heal itself. Studies are being done now to reproduce the early study which cam from Pakistan…

Deep Vein Thrombosis

Deep vein thrombosis or DVT is a cause of pulmonary emboli which is the number one cause of death in cosmetic plastic surgery patients. Several protocols have been identified for dealing with patients at high risk for DVT. These are patients with previous history of DVT, women who are smokers, and women on birth control. Sitting in a particular position for a long time will also increase the risk.

Putting patients on blood thinners before the surgery was widely advocated as the thing to do. It now turns out the the risk of bleeding during the surgery outweighs the risk of actually getting a PE.

Bacteria around breast implants

Bacteria have long been thought of as being contributors to capsular contracture- a condition which occurs for unknown reasons around some breast implants. The bio-film, a film of bacteria that covers the implants was thought to be the main contributor to this “chronic infection”. Now it may be that the bio-film does nothing or may actually protect against the contracture! Essentially, no one knows.

Take home message

I have rarely come back from a medical conference more confused that when I went there. It seems that the science of cosmetic surgery is in a period of flux. What we thought was true, isn’t, and  what was not true is not true or is true.

What was it that former defense secretary Rumsfeld said recently,

“Reports that say there’s — that something hasn’t happened are always interesting to me, because as we know, there are known knowns; there are things that we know that we know. We also know there are known unknowns; that is to say we know there are some things we do not know. But there are also unknown unknowns, the ones we don’t know we don’t know.”

 

 

Google Glass for plastic surgery

Google Glass the future in surgery

Last week I was at the American society for aesthetic surgery (ASAPS) meeting in San Francisco. The Keynote speaker was the man in charge of Google glass marketing, Ed Sanders, and he proved to be an interesting choice for elucidating the medicine of the future.

Google Glass is essentially an computer hooked up to a pair of glasses. The commands for different actions are given by voice, The glasses have a small screen on the upper right hand side which function as the screen and a camera is also included in the front. You can thus take photos with the glass and store or delete them by voice, surf the web and perform most of the functions that you would do with a normal computer.

Google glass

Google glass for plastic surgery

The applications of google glass to surgery and to cosmetic plastic surgery in particular are particularly exciting.  Mr. Sanders first gave the example of how he uses google glass in his daily life ( he has access to the glasses which currently sell for $6999 on E bay). He told of how his wife watches a game of soccer that their child is playing with the glasses, and relays that info in realtime to her husband who is often traveling. This does not require the cumbersome hand held devices which arguably can do the same ting now. In fact, Mr. Sanders could be watching the game while having a business meeting!

For the cosmetic plastic surgeon, the application of google glass in the operating room is most interesting. In plastic surgery, the surgeon is often the only one who can actually see what is going on  in the operating room. Be it a breast augmentation, face lift surgery or a tummy tuck, the assistants in the operating room usually see nothing and hence cannot be as responsive to the plastic surgeon’s need as in other more “open” surgeries.

The very same small incisions that cosmetic surgery patients want slows the surgery. With Google glass, the surgeon can be relaying the information of what he sees and what he is doing to the whole of the operating team. Paraphrasing the words of Mr. Sanders, Goggle glass gives others your point of view- it gives others your perception. Now we can all see the world through other peoples’ eyes.

Fat injections for breast enlargement

Fat Injections to Breasts

 

I have previously written about fat injections for breast enlargement but new information keeps on coming up and cosmetic plastic surgery patients continue to show interest in this plastic surgery procedure. here are photos from an article in the Aesthetic Surgery Journal of March 2014 by Drs. Spear and

 

Breast augmentation with fat injections  Breast augmentation with fat injections

Breast Enlargement with implants

The traditional methods of breast enlargement by either placement of saline or silicone breast implants under the chest muscles have been performed by board certified plastic surgeons since the late 1960 s.  Breast augmentation surgery has withstood the test of time. The surgery will produce consistent results and has a 98% satisfaction rate amongst patients.

Multiple variations of breast sizes and shapes are possible now that moderate profile implants, moderate -plus sized implants, and high profile implants are available from multiple breast implant manufacturers. These implants satisfy the needs of patients who typically are looking for at least a 2 cup size increase in their breasts.

Breast implants are foreign objects for the body and will form capsules of scar tissue around them which can become problematic at time. The implants can also break or rupture and in general need upkeep.

100% of patients will get a substantial improvement in breast size that is long lasting. Breast surgery with implants takes one hour.

Breast Enlargement wit Fat injections

In order not to have the problems that implants can sometimes cause, fat injection to the breasts has been advanced as an alternative surgery by some plastic surgeons.

Fat is removed by liposuction from one area of the body and injected into the breasts to enlarge them. Breasts are made up of a combination of breast glandular tissues and fat. Breast enlargement with fat injections adds to the fatty tissue already there.

Advantages of breast augmentation with fat injections

  1. Natural tissue and feel of breasts

Disadvantages of breast augmentation with fat injections

  1. Un-predictable loss of  breast volume- some of the fat always dies after a fat transfer. How much will die is unpredictable despite multiple techniques for handling and injection of the fat. Typically the latest study shows that only 30% – 40% of the fat injected remains within 6 months.
  2. Risk of development of breast cancer – The fat that is injected will have stem cells which when in the vicinity of breast tissue could cause breast cancer. This has been shown to occur in animal models. Even the latest plastic surgery article about breast enlargement with fat injections mentions that patients should be counselled about the risk of developing breast cancer!
  3. Small volume of breast enlargement possible.  In general breast augmentation achieved with fat injections only gives one cup enlargement of the breast. Typically about 250 cc fat is injected.  Within a few months after surgery only 30- 40 % of the fat remained. How much of that actually stays long term is unknown.
  4. Longer operative time. Typically surgery took 3 hours for fat injections.
  5. 10% of patients have substantial improvement in breast size, and 50% have a moderate improvement in breast size.

So,

Breast enlargement with fat gives minimal improvement in breast size ,has un-predictable results, of unknown duration, requiring three times longer surgery, and increases the risk of breast cancer.

No thanks- I’ll stick to implants for now.

 

 

 

Tummy tuck scars

Abdominoplasty tummy tuck scars in wrong location

Often a picture is worth a thousand words.

Look here;

High abdominoplasty scar

 

This young patient came to see me after having had an abdominoplasty – tummy tuck surgery by another plastic surgeon. It’s not the first time I see this type of scar after a tummy tuck on a patient. Unfortunately it is far too common and worst of all, in many situations little can be done to fix it by any cosmetic plastic surgeon. The scar is just too high and the plastic surgery patient cannot cover it up even with larger style of panties.

 

Abdominoplasty scar too high

 

 

Reasons why tummy tuck scars are too high

  1. Easier surgery for surgeon

The sad fact is that some board certified plastic surgeons are lazy and do not wish to have any headaches with their surgical procedures even at the cost of a shoddy surgical result.

Placement of the tummy tuck scar high on the abdomen means that the surgeon has

  • less work to do,
  • the work he does perform is easier,
  • the risk of any wound opening or scar disruption is less
  • the patient will have less pain as there is less tension in the abdomen.

It also means that the patient will have

  • a lesser result
  • an unsightly scar forever.

       2.  Easier for the plastic surgery patient

The high scar means there is less tension on the wound and  also a better blood supply. Unfortunately trying to get away with an easy surgery, less pain, and less risk, though something we all want, is not going to give you the result you want. In fact it will give you a result you will hate and regret. Not what we want plastic surgery to do for you!

Many plastic surgery patients who have been to doctors in other countries to have surgery will return with these types of tummy tuck scars. I cannot blame them. They have a medical tourist who is going to be around for a short period of time and who wants a quick fix.  The plastic surgeon will not be there to give post-operative care and does not want any headaches- so, a high scar solves his problem. By the time the plastic surgery patient realizes where the scar is and that it cannot be hidden by normal panties, it is too late and the patient has long left the country.

In summary, for the best surgical results after a tummy tuck the scar should be as low as possible just above the pubic area. Though this may mean that scars may have some small disruption in the early post operative period, they can always be fixed later. The high abdominal scar can rarely be fixed if ever.