Breast implant exchange surgery

It's not uncommon for women who have already had a breast augmentation some years ago to come and consult with us about an implant exchange. Most commonly, this is for reasons of wanting a different size; most often a little bit larger, sometimes a little smaller. People do change their minds about the look they want, compared to their original implant choice, and we understand that.

In situations like these, where the breast is soft (doesn't have capsular contracture) and the pocket where the implant sits is in good shape, we can do what's termed a "simple" implant exchange surgery.

This involves helping the patient select the desired new size and shape, and going to surgery to replace the older implants. There's definitely a skill to selecting the new implant - and we've got a few little tricks for this!

With the resurgence in popularity of silicone gel implants, many women who first had breast implant surgery back in the "saline-only" era often consider switching to silicone gel implants. Here at our Orlando practice, four out of five patients who have experienced both types of breast implants tell me that they far prefer the gel implants. Gel implants also help to reduce wrinkle and ripple problems in the slender patient with saline implants. Using a different implant shape can also be a helpful suggestion. This keeps the implant width proportional to the patient's frame, but allows more (or less) fill up front, where most patients want it.

At surgery, we can typically use the same surgical incision - so there are no new scars. And if the old scar has widened out, we get a chance to revise it during surgery, and hopefully get a nicer looking scar.

Most women are pleasantly surprised: the recovery from a "simple" implant exchange is usually very easy, with little pain, bruising or swelling. Since the pocket for the implant is already present, and only few small adjustments need to be made to the tissue pocket, the recovery is much quicker.

More complex implant exchange surgeries involve the correction of tissue stretch or pocket expansion, or the correction of scar tissue / capsular contracture issues. As the name suggests, these surgeries are much more involved. But that's a topic for another day. Cheers!!

Allergan "LashPerks" - save $20 on Latisse

If you are a fan of Latisse, the eyelash lengthening treatment from Allergan, now you can sign up with the company's LashPerks program, on their website (link) - and get a $20 rebate from Allergan. :)

Offer only for first-time registrants to the program. Expires 5/4/2010.

Spring Specials 2010

Yes...they're here!! Plastic Surgery specials for Spring 2010 (Feb - Apr).

You can find all the details on our website (link)

Included are discounts on breast augmentation, Botox, Juvederm, microdermabrasion and laser hair removal.

Now you can get the best - for a little less! Yay!!

Juvederm XC announced - more comfortable injections

Allergan, Inc. announced today it has received approval from the U.S. Food and Drug Administration (FDA) for JUVÉDERM® XC, which is JUVÉDERM with a little xylocaine added in. Xylocaine, known in the U.S. as lidocaine, is a local anesthestic agent used for numbing the skin, and this should make the injection process significantly more comfortable for our patients.

JUVÉDERM® also received their "one year indication" from the FDA, which means they are now permitted to advertise as having "the first and only hyaluronic acid dermal filler approved by the FDA to last up to one year from initial treatment".

In the clinical study comparing JUVÉDERM XC (with lidocaine) to regular non-lidocaine JUVÉDERM, 93 percent of patients reported less pain when treated with the new formulation of JUVÉDERM, while maintaining a similar safety and effectiveness profile to the non-lidocaine formulation of JUVÉDERM®.

Of course, don't use this product if you have a lidocaine allergy.

Telomeres, aging and immortality.

One recent breakthrough in the understanding of aging, aging-related diseases and cancer has to do with the detailed mechanics of how our human cells divide. It's really a pretty nifty discussion - and I promise not to get too technical. But it has major implications for research and development of new medical therapies, as well as anti-aging implications, so it's worth hearing about.

We remember, from high school biology, that our cells DNA is duplicated as cell division takes place, right? Well, it turns out that there is an important detail missing from that explanation, and that our little human DNA photocopier doesn't make perfect copies.

At the end of a strand of DNA, there is a "cap" called a telomere. Dr. Elizabeth Blackburn, who was later awarded the 2009 Nobel prize in medicine for her work in this area, famously compared telomeres to the little plastic tips on the ends of shoelaces that keep them from fraying. (For those of you in the crowd who like cell biology, a telomere is a long repeating section of DNA, with the base pair pattern TTAAGGG repeating many times.)

As our cells undergo division, our personal little DNA photocopier, called "DNA polymerase", can't properly copy this section properly, and so the newly minted telomere gets progressively shorter with each round of cell division. That's the problem.

This limits cells to a fixed number of divisions, and sets a limit on the cell's lifespan. Except for cancer cells - which have figured out how to beat this problem with a telomere repair enzyme, called telomerase, giving them the potential for an unlimited number of replications, or a sort of immortality.

Studies have found shortened telomeres in many cancers, including pancreatic, bone, prostate, bladder, lung, kidney, and head and neck. Short telomeres have also been linked to an aging effect on the cells ("senescence") and are found in multiple non-cancer disease states, like Alzheimer's dementia, ALS and coronary heart disease.

So, significant research is going into ways to keep telomeres from shortening, or perhaps how to reverse the telomeric shortening process. Not only would this help to fight multiple cancers and Alzheimer's, but there could be significant anti-aging effects as well. Ideally, we could find a way to keep telomeres nice and long in healthy cells, but not in cancerous cells.

In this week's issue of JAMA, researchers looked at the effect of a fish oil, omega-3 fatty acid, and its effect on telomere shortening over a 5 year period. It turns out that omega-3 fatty acid is good for your telomeres. People with the lowest levels of omega-3 fatty acids in their blood stream showed the most aging changes in their telomeres, and vice versa. You might want to consider getting some omega-3 supplements!

A double-blind, randomized trial on whether omega-3 fatty acid actually reduces cellular aging is now planned.

Here in Orlando, UCF has a national reputation in this area: much research is done here on the effect of telomere shortening and neuro-degenerative diseases. Go team!

Was it worth it? - the least satisfactory procedures

According to the readers poll over at RealSelf.com, here is the "rogue's gallery" as of today - the procedures at the bottom of the barrel on the "was it worth it" scale. The 20% satisfaction rating for lipodissolve, for example, means that 80% of people didn't think it was worth the cost.

You can see the full list here (link)

Procedure.........Percentage satisfied.........Average cost

Velashape...............32%............................$2785

Mesotherapy ............32%...........................$2282

Lifestyle lift..............28%..........................$5470

Cellulite treatment......25%..........................$2557

Lipodissolve...............20%..........................$1918

Astute readers of this blog will recognize many of these offenders from previous posts and discussions! Four out of five of these procedures have minimal science or proof of efficacy to back them up.

Interestingly, the Zerona non-invasive fat zapping laser was not on this list. But this device didn't rate well either: Realself voters only gave the Zerona a 20% rating, which ties with Lipodissolve for last place. Ouch!!

Experts say: Large volume buttock injections are dangerous

This press release is from our colleagues over at the PSP (Plastic Surgery Practice) website.
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The Physicians Coalition for Injectable Safety recently launched a campaign aimed at reminding consumers that no pharmaceutical filler or injected device is presently FDA-approved for large volume injection to the buttocks.

The popularity and hype surrounding buttock augmentation and other large-volume body enhancing injections on blog sites like RealSelf.com and outside U.S. borders is an alarming and potentially deadly trend, cautions the Physicians Coalition for Injectable Safety. Permanent fillers such as polymethylmethacrylate (PMMA), silicone, and polyacrylimide used in augmenting buttocks and hips can not only result in disfigurement but have resulted in death and serious injuries both in the U.S. and abroad.

The recent death of a woman in Argentina following buttock augmentation was not a result of plastic surgery," says Brazilian plastic surgeon Joao Carlos Sampaio Goes, MD, PhD, and past president of the International Society for Aesthetic Plastic Surgery. It (was) the result of a dangerous practice with fillers that are not intended to be used in this way." Buttock augmentation is a hot topic in the media and a popular procedure of surgical tourism," often performed in countries where standards are less stringent.

Recent headlines of death in the U.S. include cases in Tampa, Florida where an unlicensed, non--medical provider allegedly injected two women with a homemade combination of industrial silicone oil and saline to augment or enhance the shape of their buttocks, and a woman in the Bronx who died after illegal silicone injections resulted in the substance migrating to (traveling) her lungs, producing respiratory failure."

FDA approves Cytori's PureGraft fat grafting device

This week, the FDA approved the PureGraft device, made by Cytori Therapeutics. This device greatly simplifies the collection, processing and re-injection of fat. It could be a major "game-changer" for both cosmetic and reconstructive plastic surgery.

Until now, one of the major issues with fat grafting has been that it is a slow and tedious procedure with an unpredictable outcome: it's hard to know how much of the transferred fat will actually survive the move to the new location, even with the use of the specialized techniques developed by Dr. Sidney Coleman and others. We liposuction out the fat with specialized instruments, centrifuge it, reload the good quality fat into small syringes, then inject it slowly and carefully, just a little bit at a time, into the desired area. Then we hope and pray that the injected fat will survive in its new location. Sometimes, we watch as it melts away almost totally in several months - and that's so frustrating for both patient and surgeon!

The Cytori device should allow more predictable, less laborious fat fat grafting procedures. The PureGraft device not only purifies the fat, but increases the number of the patient's own stem cells in the material to be re-injected. This "turbo-charging" effect of the stem cells seems to lead to better outcomes, in recent research studies, with a higher rate of fat survival and less fat necrosis.

I'm very excited by this new technology. I think it's the next big thing.

New study: First generation SmartLipo no better than traditional lipo

Here's an eye-opening study published in the recent issue of Lasers in Surgery and Medicine, comparing the efficacy of laser-assisted lipolysis using various fat-busting lasers, including the first generation SmartLipo and CoolLipo machines (10 watts power). The authors are respected laser experts from La Jolla, California.

Liposuction of the arm was performed, using tumescent technique, with one of three fat removal devices, and the results were evaluated at 1 week, 1 month, and 3 months post-operatively.

In the first comparison between SmartLipo and standard non-laser liposuction, no significant improvement of results over tumescent liposculpture alone was noted using the 10 W Smart Lipo laser.

The second study showed no difference using the 10 W SmartLipo device versus the 10 W CoolLipo laser-assisted lipolysis system.

Finally, the multiplex (combination) 1,064/1,320 nm system appeared to show improvement in skin laxity and fat reduction. However, more complications were seen, with intra-operative thermal burns in 2 of 20 patients using the multiplex system.

Comment: Of course, the laser manufacturers now have increased the power of the laser lipo machines. While this may melt fat more effectively, it also increases the potential for thermal injury. We'll have to see whether the newer, more powerful machines can be actually proven to show a significant difference over standard non-laser liposuction in an objective study. It's great to finally see some science looking at this.

I feel bad for the physicians that spent a lot of money on the first generation (10 watt) machines - they got conned by the lure of new "laser" technology and didn't wait for the scientific proof.

Mom was right: shut off that TV!

A new study released Monday in Circulation: Journal of the American Heart Association confirms what Mom always told you - too much TV watching is bad for you.

The study looked at health data among 8,800 men and women over age 25 in the Australian Diabetes, Obesity and Lifestyle Study. Researchers separated the participants into three groups: those who regularly watched less than two hours a day, those who watched two to four hours a day and those who regularly watched more than four hours of television each day.

People with a history of cardiovascular disease were excluded from the study.

People who watched more than four hours a day showed an 80 percent greater risk of death from cardiovascular disease and a 46 percent higher risk of all causes of death, compared with those who watched less than two hours a day. Researchers controlled for smoking, high blood pressure, high cholesterol, an unhealthy diet and leisure-time exercise.

Researchers found a strong connection between TV hours and risk of death from cardiovascular disease; that link was found not just among the overweight and obese but among people who had a healthy weight and exercised.

It's probably pretty similar for playing video games and surfing the web. Being a couch potato is a dangerous occupation!