News and Facts

Fixing prior tummy tucks

When you do a lot of a particular surgery, it's not uncommon to see patients that have had a procedure elsewhere, that come in to see if a previous result can be improved. Recently, I performed two full "re-do" tummy tucks....which is the topic of this blog. While there isn't a formal classification system, I would suggest that patients seeking out a re-do tummy tuck, or "secondary abdominoplasty", fit into one of four main groups. These are: 1. the "under-done" first operation 2. scar-related i...

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Thomas Fiala, MD 3/12/2014 Comments(0)

BOTOX - now approved by the FDA to treat Crows’ Feet

Just this month, the FDA decided to officially grant Allergan another approved indication for the use of Botox: the treatment of Crows’ Feet. The approval was granted after the FDA reviewed data for effectiveness and safety of Botox in the crows’ feet area in a placebo-controlled study of over 800 patients. Of course, physicians have been using Botox for this purpose off-label for years - pretty much ever since Botox was approved for cosmetic use for glabellar wrinkles, back in 2002!...

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Thomas Fiala, MD 9/27/2013 Comments(0)

Drug smuggler puts cocaine in her breast implants...

File this report under "news of the weird"...cocaine smuggled inside a breast implant. A Panamanian citizen travelling from Bogota, Colombia flew to Barcelona. But she wasn't acting right, making security officers there suspicious that she might be carrying drugs either on her person or in her luggage. After all, Colombia is the source for 90% of the cocaine smuggled into the U.S. She also had fresh blood stains under her breasts. When a female officer patted down the woman, she found blood-stai...

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Thomas Fiala, MD 12/18/2012 Comments(0)

A plastic surgery giant, Dr. Joseph Murray, passes away

A moment of silence for the man who won a well-deserved Nobel prize for performing the very first kidney transplant, the renowned plastic surgeon Joseph Murray, MD, who passed away Monday, Nov. 26, after suffering a stroke at his home in Boston on Thanksgiving Day. He was 93. Dr. Murray performed the world's first organ transplant in December 1954. The recipient was 23-year-old Richard Herrick, who received a functional kidney from his twin brother, Ronald. Since that time, more than 600,000 peo...

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Thomas Fiala, MD 11/27/2012 Comments(0)

Is your plastic surgeon one of the eight thousand?

If you talk about plastic surgery for any length of time, you'll probably hear about the importance of board certification. Why is this important? Board certification is the hallmark of a specialist. If you are a physician, and you are NOT board-certified, it means that you are not officially recognized as a specialist in any established field of medicine or surgery. "Board-certified" means that the physician has: 1 successfully completed an approved residency training program in their field, 2 ...

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Thomas Fiala, MD 10/17/2012 Comments(0)

No contaminated steroids here!

Recently, there has been a major problem with a contaminated steroid medication known as methylprednisolone acetate. Apparently, 3 lots of this preservative-free medication, from the New England Compounding Center in Framingham, Massachusetts, were contaminated with a fungus. This has caused a serious problem known as with fungal meningitis in about 100 patients, after spinal injections for back pain. Some people have died, as a result of this illness. Signs and symptoms of fungal meningitis com...

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Thomas Fiala, MD 10/8/2012 Comments(0)

FDA warns L'Oreal about over-the-top ad claims

When I hear television ads for skin care products that promise "younger, firmer skin in just 7 days", I always cringe. It's simply not possible. The only effect that can happen in just 7 days is that your skin is better moisturized. Well, the FDA has noticed this too, and recently warned L'Oreal / Lancome to alter some advertised claims about its anti-aging products, or face a suspension order . The FDA issued a warning to L'Oreal / Lancome, about their claims that their products boosts the acti...

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Thomas Fiala, MD 9/25/2012 Comments(0)

Race for the Cure 2012

Once again, we're delighted to support the Susan G. Komen Foundation's Race for the Cure Event. This year, the event will be held in Orlando at Bright House Stadium on Sunday, October 21, 2012. We'll have our Fiala Aesthetics walking team suited up in our pink & black t-shirts and ready to go - and friends and supporters are welcome to join us & walk the 5K course with us. Denise is serving as our team captain. Please call her for details or to support this worthy cause in the fight agai...

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Thomas Fiala, MD 8/29/2012 Comments(0)

Breast Reconstruction Awareness Day = BRA-day

The American Society of Plastic Surgeons and four-time Grammy nominee singer-songwriter Jewel are teaming up to promote breast reconstruction. Studies show that only a relatively small percentage of breast cancer patients know about their breast reconstruction options. "Each year nearly 150,000 women learn they undergo a mastectomy due to breast cancer," Jewel said. "But seven out of 10 women are never told about their breast reconstruction options. And the numbers are even worse for minorities....

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Thomas Fiala, MD 8/21/2012 Comments(0)

"Best Plastic Surgeon" award from Orlando Magazine

I am delighted to announce that the readers of Orlando Magazine have voted, and that they have selected our practice for the "Best Plastic Surgeon" award, along with two of my colleagues. The results for all the "Best of Orlando" winners were announced in the August issue. Thank you to all that voted for your loyalty and confidence in us. Positive feedback and recognition like this brings a smile to all of our faces here at the office - we're honored to be "The People's Choice" when it comes to ...

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Thomas Fiala, MD 8/1/2012 Comments(1)

Liposuction doesn't cause fat to re-distribute...

Here's an interesting news flash from ASPS, the American Society of Plastic Surgeons, about a new study of liposuction patients: ************** Since it made its debut in North America 30 years ago, liposuction has promised to permanently remove excess fat from stubborn areas, barring extreme weight gain. New research reveals liposuction lives up to its promise. According to a study in the August issue of Plastic and Reconstructive Surgery , fat cells neither return to treated areas nor get redi...

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Thomas Fiala, MD 7/31/2012 Comments(0)

FDA Approves First New Weight-Loss Drug in 13 Years

This week, the FDA approved lorcaserin Belviq for the treatment of obesity— the first new weight-loss drug to be approved in the U.S. in 13 years. Before you get all excited and call us for a prescription, there are some details you need to know. First of all, it won't be rolled out until early 2013. Belviq pronounced Bel-VEEK is only approved for use in: - adults with a BMI of 30 or more, - adults with a BMI of 27 or more who have at least one weight-related "co-morbid condition" type 2 d...

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Thomas Fiala, MD 6/28/2012 Comments(0)

RealSelf CEO Speaks Out on the Importance of Board Certification

Reprinted from Plastic Surgery Practice magazine. I couldn't have said it better myself! ******* By Tom Seery, founder and CEO of RealSelf.com As founder of the cosmetic surgery reviews and community site RealSelf.com, 4 years ago I made a controversial decision to remove 3,000 doctors from our Web site and doctor directory because they were not board-certified in a cosmetic medicine specialty. As a site whose primary purpose is to empower consumers to make informed decisions about cosmetic, ele...

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Thomas Fiala, MD 6/4/2012 Comments(0)

The Miss Plastic Surgery award goes to.....

Guess which country has the most plastic surgery per capita...I'll give you a hint - it's not the United States or even Brazil, that hotbed of South American cosmetic surgery, although in total numbers, the U.S. is #1. I was surprised to learn that, according to research firm Trend Monitor, South Korea has more procedures per capita than anywhere else. Nearly one out of five women there have had "something done" - whether it's a non-invasive procedure or actual surgery. Here's the graph, reprodu...

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Thomas Fiala, MD 4/24/2012 Comments(0)

Headline from ASLMS: cosmetic laser surgery not always best

An article in the Orlando Sentinel covering the recent laser meeting in Orlando American Society for Laser Medicine & Surgery, also known as "ASLMS" came out with this headline. I thought it would be educational to look at the article in more detail, and comment on it. Article: "...of all the procedures, hair removal seemed to deliver best on its promise. The before and after photos presenters showed of vascular lesions - particularly the small broken blood vessels on the side of the nose an...

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Thomas Fiala, MD 4/24/2012 Comments(0)

No more "boob-jab" - Macrolane withdrawn from breast augmentation in UK

For the past 5 years, there was an injectable filler called Macrolane that was being used in the UK for all sorts of body contouring operations - including breast augmentation. As you might imagine, the idea of a "lunchtime" breast augmentation by injection - in 45 minutes without the need for implants - became quite popular in the U.K. However, there were significant problems with breast hardness and lumpiness after the treatment. Rather than behaving like a typical soft tissue filler like we m...

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Thomas Fiala, MD 4/22/2012 Comments(0)

Insider espionage: Allergan wins injunction against Merz

Allergan, the makers of Botox, have announced that they recently won an injunction against Merz Pharmaceuticals and Merz Aesthetics. The injunction prohibits Merz from selling Xeomin, a Botox competitor, in the U.S. for 10 months. U.S. District Judge Andrew J. Guilford wrote in his decision that Merz misappropriated trade secrets belonging to Allergan. He wrote, "there is overwhelming circumstantial and direct evidence" that Merz stole the trade secrets and that "Allergan faces a substantial thr...

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Thomas Fiala, MD 3/15/2012 Comments(0)

Florida Liposuction Safety bill passes!

As part of Florida House Bill 1263, the new liposuction requirements have passed. This means that any physician MD or DO who performs liposuction of more than 1 litre of fat, or any sedation case lasting more than 5 minutes must do so in an accredited surgical facility . Lipo in the back room of a spa, unaccredited medical office, hotel or some other location....is now officially a no-no. This is a legislative victory, as it should improve safety for cosmetic surgery patients in Florida. As we'v...

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Thomas Fiala, MD 3/13/2012 Comments(0)

FDA approves new silicone gel-filled breast implants

Today, the U.S. FDA gave approval to a third breast implant manufacturer - Sientra - to supply silicone gel-filled breast implants for both cosmetic and reconstructive patients in the U.S. Sientra joins Allergan and Mentor as FDA-approved implant manufacturers. As a condition of approval, Sientra is also required to conduct several ollow-up studies that will assess patient outcomes and safety issues. The FDA based the approval on a three year study of 1,788 patients. Complications and outcomes w...

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Thomas Fiala, MD 3/9/2012 Comments(1)

Who gets the most cosmetic surgery training & experience in residency?

Myth #1 : Many people mistakenly believe that plastic surgery residency teaches only reconstructive surgical techniques, and not the cosmetic ones. Myth #2 : Many people think that the more anatomically limited fields of dermatology, ophthalmology, or facial plastic surgery must get more cosmetic surgery experience during residency than the over-worked plastic surgery resident, who has to master techniques covering the entire body, including craniofacial, burns, pediatric plastics and hand surge...

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Thomas Fiala, MD 2/29/2012 Comments(0)

More consolidation in the laser industry

Big laser companies just keep getting bigger.... This week, Cutera , the California based laser company, announced that it had acquired laser competitor Iridex for $5+ million, adding Iridex and Laserscope-branded devices to their stable of lasers. Just a few months ago, Solta Medical , the makers of Thermage radiofrequency units and Fraxel lasers, purchased Liposonix, the new FDA-approved fat melting technology, for $35 million. No wonder those darn lasers are so expensive! photo credit: laserf...

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Thomas Fiala, MD 2/15/2012 Comments(0)

US adult obesity figures released, 1999-2010

The latest numbers in the American obesity epidemic were released in this month's issue of JAMA . Here's the one bit of good news: - American women, overall, aren't getting any bigger than they were during the last study, which looked at the 1999-2008 data, but 35.8% of US women still fit the BMI-derived definitions for obesity. The average age-adjusted BMI was 27.3 The bad news: - More American men are obese than before, with 35.5% nationwide more than one-third being obese. Average age-adjuste...

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Thomas Fiala, MD 2/2/2012 Comments(0)

New meaning to the term "drug bust"

According to the Daily Mail newspaper London , a 33-year-old woman was charged in December with international drug trafficking, after she was found carrying more than five and a half pounds of cocaine - with an estimated value of £250,000 - that had been molded inside some artificial breast and buttocks inserts "falsies" . The woman, a model identified only as MFM, was detained by security personnel at Rome's Fiumicino Airport after a flight from Buenos Aires, Argentina. "She tried to distr...

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Thomas Fiala, MD 1/23/2012 Comments(0)

Timing of surgery doesn't affect complication rates

Did you ever wonder whether a surgery on Monday or Friday was riskier than one during the rest of the week, or whether surgery in July, when there are new interns on the wards in teaching hospitals, was riskier than a surgery in May? Well, a new study has analyzed this...and there's no difference in the rates of post-surgery death. So, while you might not buy a car made on a Monday, it's perfectly fine to have elective surgery then! Here's the rest of the story, from Cosmetic Surgery times.... *...

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Thomas Fiala, MD 1/5/2012 Comments(0)

Tightening up Florida liposuction requirements - it's about time!

According to the Sun-Sentinel, there is a bill working its way through Tallahassee which will make some improvements to safety standards for office-based liposuction. Honestly, it's about time! The bill would require liposuction of more than 1000 cc of fat to be done in surgery suites inspected by the state, and would require doctors to have life-support training. Currently, many low-cost providers perform liposuction in unregulated physician offices, and lack ACLS training. I think this is defi...

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Thomas Fiala, MD 12/28/2011 Comments(0)

Dr Fiala submits article to Aesthetic Surgery Journal

Observant readers will have noticed that I recently took a little break from blogging- and you're right. I've been working on a manuscript for the Aesthetic Surgery Journal, which is one of the most respected journals in our specialty... and I just finished it and submitted it to the journal today. Hopefully, with a little luck, the editors will like my paper, and we'll be seeing it in print in a few months! So now, I can get back to blogging about new and cool developments in plastic surgery, a...

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Thomas Fiala, MD 12/6/2011 Comments(0)

Dr. Fiala's OR aces AAAASF inspection

Having a top-quality office surgery center like we do means that, every third year, there is a detailed and thorough inspection process that must be passed to retain our certification. An independent inspector, typically another plastic surgeon, is assigned to check our facility with a long checklist of safety and quality standards. It's a big deal, and one we take very seriously. We had this inspection yesterday. A great deal of time and effort on our part went into preparing for it...and belie...

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Thomas Fiala, MD 11/6/2011 Comments(0)

Results from "Race for the Cure"

Two weeks ago, the 5k walk/run fundraiser for the Susan G. Komen foundation was held here in Orlando, at the UCF stadium. I thought you'd be interested in the results of this breast cancer fundraiser: Money raised: $303,198.21 Number of Participants: 7,701 Number of Teams: 362 More of the official race photos can be seen here . Great job, everyone! I'd also like to thank our sponsors again who donated to our own office effort. Support these very community-minded merchants when you need their pro...

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Thomas Fiala, MD 10/25/2011 Comments(0)

"Boob tax" increases the price of plastic surgery in the UK

A new tax on cosmetic surgery has been passed in the U.K. Government estimates hope that it will raise up to £500 million a year. The tax, mockingly called the "boob tax", will raised the price of cosmetic surgery by 20%, or about $1500 U.S. for an average breast augmentation. Reconstructive patients will not be charged the tax. Needless to say, British cosmetic surgeons are none too pleased. A spokesperson for the British Association of Aesthetic Plastic Surgeons was unhappy with the lack ...

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Thomas Fiala, MD 10/21/2011 Comments(0)

Fashion tips for curvy girls

Dressing stylishly, when you are extra-curvy up top, can be a challenge. Here are some suggestions from fashion pros that may be helpful, whether you are naturally well- endowed, or recently had an augmentation. Consider trying: - scoop or V-neck designs - wrap dresses - keep detailing on top to a minimum - keep it simple - shirts and jackets should be fitted to show off waistline - solid colors typically work better than patterns - good fit is a must; if necessary, buy a slightly larger size an...

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Thomas Fiala, MD 10/18/2011 Comments(0)

California bans teen tanning

Beginning January 1, 2012, teens under age 18 in California will no longer be permitted to use tanning beds. This makes California the first state to prohibit minors from using commercial indoor tanning devices, regardless of parental consent. The measure was sponsored by the California Society of Dermatology and Dermatological Surgery and the AIM at Melanoma Foundation. A spokesman for the Indoor Tanning Association said the ban will hurt businesses, since 5-10% of ITA members' customers are un...

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Thomas Fiala, MD 10/12/2011 Comments(0)

OT: Breast implant saves Russian woman from stabbing

Pravda , the famous Russian newspaper, reports an offbeat story: a 40-year old Moscow woman was saved from certain death by her breast implants. She had been attacked by her former husband, with a knife, after an argument got heated. He apparently tried to stab her in the heart, but the knife got stuck in the middle of her silicone gel breast implant! Interestingly, she had the "gummy bear" style cohesive gel implant available in Europe, but not here in the USA - and the implant contents did not...

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Thomas Fiala, MD 10/7/2011 Comments(0)

OT: ...and you think you have a headache!

Here's the story of how British plastic surgeons donated their skills and time to successfully separate a pair of conjoined twins that were joined at the head. Well done! ********* Reuters - Surgeons at a British hospital have successfully separated conjoined twin baby girls in a complex and extremely rare operation, the charity that funded the surgery said on Sunday. Sudan-born Rital and Ritag Gaboura are "craniopagus" twins, meaning they were born joined at the head. Conjoined twins are very r...

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Thomas Fiala, MD 9/25/2011 Comments(0)

Congrats, USA Today

Recently, a series of excellent articles on cosmetic surgery has appeared in USA Today . I think they're well worth reading, and would like to be among the first to congratulate reporter Jayne O'Donnell on this series. It really highlights the need for careful research when considering cosmetic surgery. Unfortunately, some of the major problems reported in the articles have happened here in Florida. Once again, caveat emptor ! The titles, with links, are: 9/14/11 Cosmetic surgery gets cheaper, f...

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Thomas Fiala, MD 9/20/2011 Comments(0)

The SCIP project fails to reduce surgical infections

The SCIP project - short for the Surgical Care Improvement Project - was a program that was supposed to reduce the numbers of post-operative surgical infections that happened nationwide in the USA. It all seemed so logical. Hospitals would be rated based on their adherence to rules , such as giving the correct antibiotic within one hour prior to making the surgical incision. These were all the traditional teachings that we learned as interns to reduce infection rates - how could it not help? Not...

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Thomas Fiala, MD 9/20/2011 Comments(1)

Does every single physician deserve.. to be sued? Really?

Ask yourself: should malpractice claims be reserved for those few doctors that are particularly bad, or should every doctor just get "spanked" once in a while, whether they need it or not? According to a new article in the New England Journal of Medicine , virtually all U.S. physicians in all specialties will be sued at least once during their career . In the 5 most claim-prone fields, namely neurosurgery, thoracic cardiovascular surgery, general surgery, orthopaedic surgery, and plastic surgery...

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Thomas Fiala, MD 8/24/2011 Comments(0)

OT: the cure for the common cold & maybe more...

How many times have we heard it: " if we can put a man on the moon, why can't we cure the common cold? " Well, some smart guys from MIT may have figured it out. Meet " DRACO " - short for Double-stranded RNA dsRNA Activated Caspase Oligomerizer. It's an all-purpose anti-viral agent. So far, in tests in mice, DRACO kills cells infected with viruses, but leaves uninfected cells alone and unharmed. Early testing shows the DRACO concept works to cure 15 different viruses, including H1N1 influenza, a...

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Thomas Fiala, MD 8/13/2011 Comments(0)

Bogus surgeon convicted of murder

A Phoenix, Arizona physician who had three patients die during liposuction surgery was found guilty of murder and manslaughter last week in Maricopa County Superior Court. He was not a trained plastic surgeon, nor a surgeon of any kind . Dr. Peter Normann had been an emergency-room physician, certified as an internist, and had never done a residency in plastic surgery. He had undergone six days of training in liposuction and had done some "hands-on training" in liposuction and breast augmentatio...

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Thomas Fiala, MD 7/24/2011 Comments(0)

Three arrested after illegal liposuction in a North Carolina apartment

Here's the story from wbtv.com . Edited for brevity. *********** NORTH MYRTLE BEACH, SC WMBF – After three people were charged with an illegal liposuction procedure in a North Myrtle Beach apartment, the doctor who treated the victim has spoken up to warn others about the threat of uncertified plastic surgeons. Dr. Ralph Cozart said he was the on-call plastic surgeon at Grand Strand Regional Medical Center in Myrtle Beach Friday when he was called in to respond to a 19-year-old woman who c...

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Thomas Fiala, MD 7/14/2011 Comments(0)

Need a trachea? Grow it in the lab!!

Here is the amazing story of how a man with cancer of the trachea and no other remaining treatment options was treated with a tracheal transplant created from "scratch" in the tissue engineering lab, using the patient's own stem cells. Very exciting, cool stuff, reported today in the Wall Street Journal . ************ Cancer Patient Saved With Lab-Grown Windpipe By GAUTAM NAIK, Wall Street Journal Doctors have replaced the cancer-stricken windpipe of a patient with an organ made in a lab, a land...

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Thomas Fiala, MD 7/7/2011 Comments(1)

New Florida narcotic rx laws

In an effort to eliminate the "Pill Mill" situation here in Florida, the State has passed a major new law, which totally reforms how doctors are allowed to prescribe pain medications. As of July 1, 2011, most physicians who are not pain management specialists are no longer authorized to dispense Schedule II or Schedule III controlled substances i.e. pain medications at all, with these few exceptions: - In connection with specified surgical procedures, in certain time frames - In the health care ...

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Thomas Fiala, MD 7/7/2011 Comments(2)

OT: airport scanners in the news

When traveling, I've often wondered why the TSA agents don't wear the little dosimetry badges that all medical and dental personnel who work around X-rays wear on their lapels. It's a standard safety precaution in the industry, another method of ensuring that medical personnel aren't inadvertently getting exposed to too much radiation at work. Well, here's an article from TIME magazine on this very topic. It turns out that a few TSA agents in Boston have developed various cancers, and they're wo...

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Thomas Fiala, MD 6/30/2011 Comments(0)

FDA update on breast implants - 2011

When the FDA re-approved silicone breast implants for general use, back in November of 2006, one of the conditions was that the two major manufacturers and the FDA would co-operate to do some ongoing follow-up studies about implant safety and effectiveness. Now, approximately 5 years later, the FDA has released an update, discussing the first installment of this data. In a nutshell: it confirms what we knew 5 years ago. Implants, when used correctly, are safe devices...but they're not perfect. T...

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Thomas Fiala, MD 6/25/2011 Comments(0)

OT: Would you give a 7 year old this?

More bizarre parenting, this time from the UK. Plastic-surgery obsessed mom gives daughter a voucher for breast augmentation...but she's only SEVEN. Here's the story, from the Daily Mail : ******** She made the headlines last year when she confessed to teaching her then six-year-old daughter Poppy to pole dance. And now Sarah Burge is back in the spotlight again - for all the wrong reasons. The 50-year-old mother - a self-confessed plastic surgery addict known as The Human Barbie - has boasted t...

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Thomas Fiala, MD 6/10/2011 Comments(0)

Bye-bye "Food Pyramid". Hello "MyPlate"!

Say goodbye to the USDA Food Pyramid. The Pyramid, introduced in 1992, has been replaced by a simpler new graphic, the Plate. It's a lot simpler, and easier to understand. There's less emphasis on grains, and more emphasis on fruits and vegetables, which now make up one-half of the plate. It's all part of the USDA's new "Dietary Guidelines 2010" program. Other key messages from the program include: - Balancing Calories ● Enjoy your food, but eat less. ● Avoid oversized portions. - Fo...

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Thomas Fiala, MD 6/2/2011 Comments(0)

Clever public service announcement about the dangers of tanning

"You look great in leather!" I see that leathery sun-damaged skin too often, here in sun-drenched Florida! And it's hard to fix! In all seriousness, though, here are some tips about how to preserve your skin from sun damage and avoid skin cancers , from skincancer.org - Seek the shade, especially between 10 AM and 4 PM. - Do not burn. - Avoid tanning and UV tanning booths. - Cover up with clothing, including a broad-brimmed hat and UV-blocking sunglasses. - Use a broad spectrum UVA/UVB sunscreen...

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Thomas Fiala, MD 6/1/2011 Comments(0)

Transplant surgeon murdered at Florida Hospital

A murder-suicide in a parking garage at Florida Hospital in Orlando left a doctor and the gunman dead today, police said. The doctor was identified as 41-year-old Dmitriy Nikitin, a skilled transplant surgeon. The gunman, allegedly a disgruntled patient, killed himself after shooting the surgeon several times in the chest. Officers closed off the hospital garage after being called about 5:10 p.m. to the facility at 601 E. Rollins. St. Jones said that the shooting happened near the elevators on t...

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Thomas Fiala, MD 5/27/2011 Comments(0)

A genetic "master switch" for obesity?

This breaking news story from the Reuters News Agency ***** Scientists have found that a gene linked to diabetes and cholesterol is a "master switch" that controls other genes found in fat in the body, and say it should help in the search for treatments for obesity-related diseases. In a study published in the journal Nature Genetics , the British researchers said that since fat plays an important role in peoples' susceptibility to metabolic diseases like obesity, heart disease and diabetes, the...

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Thomas Fiala, MD 5/18/2011 Comments(0)

High resolution ultrasound & breast implants

When the FDA approved silicone gel breast implants for general use in breast augmentation a few years ago, one of their recommendations was to have the patients get follow-up MRI's of the breast...."just in case" of an asymptomatic implant leak. While there is not very much good science to support this decision, especially in the first 5-7 years post-op when implant leakage is very rare, you just can't argue effectively with the FDA once they've made up their mind. At the 2011 ASAPS meeting, Dr....

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Thomas Fiala, MD 5/9/2011 Comments(1)

FDA panel says Restylane OK for lips

According to Reuters news service, an FDA advisory panel today recommended that the popular wrinkle-filler Restylane can be officially used to plump up and shape thin lips. The injectable gel has been approved for years- but only for facial wrinkles and laugh lines. It is, as we know, widely used "off-label" to fill out lips and give them more attractive contours. FDA approval would allow the manufacturer Medicis to specifically market and promote the product for that use. The panel was nearly u...

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Thomas Fiala, MD 4/28/2011 Comments(0)

Corporate mergers: J & J buys Synthes

Healthcare giant Johnson & Johnson and orthopedic specialty device maker Synthes have agreed to a merger deal, worth $21.3 billion USD Synthes, Inc., founded in Switzerland, has long been a leader in the fields of orthopedic trauma and craniofacial surgery. They manufacture specialized bone-holding plates, screws and OR equipment, and have always been very active in clinical education efforts. J&J already owns DePuy Orthopedics. I suspect they think that the combination will dominate the...

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Thomas Fiala, MD 4/27/2011 Comments(0)

OT: Russian Cat gets plastic surgery ?!!

Here is another one from the "Believe It or Not" Files, courtesy of the Austriantimes website. Sounds like the Russian cat had a blepharoplasty and canthopexy...or would that be a "cat-o-pexy"? Crazy!! ********** Fury over cat's plastic surgery Animal rights activists have criticised a "cruel" cat owner who put her pedigree puss through plastic surgery so she would win pet shows. Lyuska - a two-year-old British shorthair - has undergone an eye-lift from cosmetic surgeons in Rostov, Russia, to ma...

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Thomas Fiala, MD 4/13/2011 Comments(0)

Americans not ready to use social media to talk to their doc

Here's an interesting article from Health Care IT News.com - which says, when it comes to talking with your doctor about medical issues, most Americans want to do it the traditional way, and not online with social media. What do you think? Comments welcome. *********** Americans may not be embracing social media as a way to communicate with their providers, but they aren't opposed to using the Internet for more administrative functions such as billing, accessing their records and setting appoint...

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Thomas Fiala, MD 4/4/2011 Comments(0)

Valencia College student receives a hand transplant

Linda Lu, a 21-year-old Valencia College student, received the Southeast's first hand transplant March 12th at Emory University, in Atlanta. The operation was detailed in a press conference earlier this week. She lost her left hand at age 1 due to Kawasaki disease, a vascular condition that can restrict blood flow to extremities, resulting in an amputation at her wrist. She wore a hand prosthesis until the third grade, but after that managed with just one hand. Looking at her new hand, Lu said, ...

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Thomas Fiala, MD 3/30/2011 Comments(0)

OT: Pageant-obsessed mom gives 8 year old daughter Botox

Here is a story that is certainly offbeat - a beauty-pageant obsessed mom is injecting her 8 year old daughter with Botox & fillers that she buys online with the hopes of making her a famous star. link According to the story: Kerry, 34, buys botox and fillers online and injects them into her daughter's Britney's forehead, lips and around her eyes, every 3 months. Kerry says these treatments will guarantee Britney becomes famous as a teenager. She says: "What I am doing for Britney now will h...

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Thomas Fiala, MD 3/29/2011 Comments(0)

FDA approves new treatment for metastatic melanoma

On friday, the FDA approved a new drug, called Yervoy , that should help some people with very advanced cases of melanoma. The drug works in an interesting way - by revving up the body's own immune system to fight the melanoma tumors. When melanomas are detected early - as a mole "gone bad" - they can be treated with surgery. But once the cancer has spread metastasized , treatment of metastatic melanoma has been very difficult. According to the American Cancer Society , there were about 8700 dea...

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Thomas Fiala, MD 3/27/2011 Comments(0)

First face transplant in U.S. performed

As reported in detail on CNN.com , the first whole face transplant in the U.S. was successfully performed at Boston's Brigham & Women's Hospital last week. The transplant recipient, a 28 year-old Texan named Dallas Wiens, had suffered devastating full facial burns following a high-voltage electrical accident in 2008. This left him blind and with a badly disfigured face, one without obvious facial features, despite skin grafting. He was a good candidate for the face transfer procedure, even t...

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Thomas Fiala, MD 3/22/2011 Comments(2)

OT: Information on Japanese earthquake & tsunami relief efforts

Our condolences, thoughts and prayers are with those affected by the massive earthquake and resulting tsunami in Japan. The search and rescue phase of this response is still underway with 15 international teams augmenting the Japanese resources. The American College of Surgeons sent out this handy reference page for news updates and aid organizations, which I am reproducing here. Please refer to the following sites for situational updates: ReliefWeb USAID American College of Surgeons Relief Effo...

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Thomas Fiala, MD 3/14/2011 Comments(1)

Reconstructive ear surgery for a 9 year old boy

Here is a nice story about a 9 year old who is having reconstructive plastic surgery to fix a deformed ear that he was born with, due to a condition called Goldenhar syndrome. Now, at age 9, he has undergone the first step of the classic two to three stage surgical reconstruction to transform the nub of the earlobe he was born with, into to something that looks like an ear. In the first stage, a framework made of cartilage is put underneath the skin, in the correct position. The cartilage is typ...

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Thomas Fiala, MD 3/10/2011 Comments(0)

Channel 6 interview on awake breast augmentation

If you were up early this morning, you might have seen yours truly on channel 6, at 6:45. I had been interviewed by WKMG's Jessica Sanchez on Monday. We discussed the controversy regarding "awake breast augmentation" surgery. We've discussed that topic at length here in this blog. Unfortunately, only a very short bit of the TV interview was used. They didn't even mention one of the most important points: that many of the providers who use this technique are not board-certified plastic surgeons, ...

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Thomas Fiala, MD 2/3/2011 Comments(0)

Back-log at the FDA

We all want the FDA to be the watch-dog it is, and only allow safe and effective products and drugs onto the market. I just wish they moved a little faster . For example, here is a partial list of products that are awaiting FDA approval. All of them could be significant improvements over what we have now. And these are just a few examples... Fillers: Belotero by Merz, and Aquamid by Contura Botulinum toxins : PurTox by Mentor Breast implants : "gummy bear" form-stable implants - both Allergan an...

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Thomas Fiala, MD 1/25/2011 Comments(0)

Facial bone structure changes with age

It turns out that it's more than just the skin and facial fat that undergoes changes as our faces ages. There are changes in the actual shape of the underlying facial skeleton, too. The most recent issue of PRS has an article on this topic, in which CT scans of the facial bones in young, middle-aged, and older age groups were compared. The results: there are a number of significant structural changes that occur in all areas of the face as we age. Overall, the facial skeleton loses volume as we a...

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Thomas Fiala, MD 1/9/2011 Comments(1)

Waist lines and New Years Resolutions

Happy New Year, everyone! If you are like me, you've probably made a resolution to try to lose weight and get more fit this year. Good for you! Most of us do this to lose some of the weight we gained over the Thanksgiving to Christmas season of over-eating. But it turns out, a smaller waistline can have significant health benefits, too. Here's the science: there's actually a large body pardon the pun of scientific evidence linking obesity, especially excess fat around the middle, to cardiovascul...

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Thomas Fiala, MD 1/5/2011 Comments(0)

Another step closer to the "bionic man"?

This is like Luke Skywalker's artificial hand...except it's not a Hollywood special effect. There's some pretty cool research coming out of the University of Michigan, which one day, might allow amputees to control prosthetic limbs with their thoughts and own nerve impulses. My friend from residency, Dr. Paul Cederna, is one of the team working on this. His project, called a bio-artificial neuromuscular junction, connects a sophisticated robotic prosthesis directly to the peripheral nerves. The ...

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Thomas Fiala, MD 12/20/2010 Comments(0)

FDA panel recommends Lap-Band for "lighter" patients

Last week, an FDA advisory panel voted in favor of adjusting the rules under which the Lap-Band Adjustable Gastric Banding System, made by Allergan , can be used - potentially allowing more people to qualify for the weight reduction device. Currently, the Lap-Band is an option for patients with severe obesity BMI > 40, or a BMI > 35 with severe comorbid conditions or for those who are at least 100 pounds heavier than their estimated ideal body weight. The panel voted to liberalize the rule...

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Thomas Fiala, MD 12/14/2010 Comments(0)

Personality types and Plastic Surgery

While the vast majority of our patients are lovely, well-adjusted people who I enjoy meeting and helping, Plastic Surgery certainly does attract some of the more unusual personality types... Sometimes, it's actually better for everybody not to operate. When I was researching for this post, I found this wonderful piece by my colleague, Dr. Ramona Bates link to blog . She has graciously allowed me to reproduce it here. ***** Patients I need to watch for when doing aesthetic procedures - Dr. R Bate...

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Thomas Fiala, MD 12/2/2010 Comments(0)

CNN covers breast reconstruction surgery story

CNN has done a nice human interest story on a lady who had bilateral breast reconstruction after mastectomy and radiation therapy using a fairly new microsurgical technique called the S-GAP flap. The link is here . It's good to get the word out about these newer options for breast cancer patients. There are several important "teaching points" about this story: 1 Even today, many breast cancer patients don't realize that breast reconstruction is possible and available to them. A 2009 survey from ...

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Thomas Fiala, MD 11/23/2010 Comments(0)

Darvon & Darvocet to be withdrawn from U.S. market

Source: WebMD The US Food and Drug Administration FDA has asked that propoxyphene, brand names Darvon and Darvocet be removed from the US market. The decision will also affect generic manufacturers and the makers of propoxyphene-containing products. At a press conference last week, Dr Gerald Dal Pan, director of the FDA's Office of Surveillance and Epidemiology, said "For the first time, we now have data showing that the standard therapeutic dose of propoxyphene can be harmful to the heart." Sid...

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Thomas Fiala, MD 11/22/2010 Comments(0)

Better pre-op meds for less post-op pain & nausea

Ask anybody what they worry about when they are thinking of having surgery, and I'm willing to bet that answers like "I'm worried that I'll be in pain or be nauseated" are near the top of the list. What if I told you that, with improved medications prior to surgery, we could make this a lot better than traditional methods? Interested? You betcha! Anesthesiologists and surgeons have been doing a lot of research on this area, to determine the best types of drugs to reduce post-op pain. And the ans...

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Thomas Fiala, MD 11/16/2010 Comments(0)

Collagen fillers discontinued - no more Zyplast & Zyderm

While it seems hard to imagine today, back before the early 1980's, plastic surgeons didn't really have any reliable injectable products to use for wrinkle correction or lip enhancement. When Zyplast and Zyderm arrived in the early 80's, a new generation of of non-surgical corrections via injectable fillers became possible. These bovine-collagen fillers weren't by any means perfect - they required skin testing, had a potential for allergic reactions, and didn't last all that long. Still, they ca...

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Thomas Fiala, MD 11/11/2010 Comments(0)

"Botox Bandit" gets 5 years of jail time

This week in Orange County, California, the "Botox Bandit" was sentenced to five years in prison for committing multiple burglaries, fraud and identity theft against several Orange County businesses. The California woman got her nickname after using fraudulent checks to pay for more than $3,000 worth of Botox treatments, in addition to a string of other crimes. Melissa Chesney, 46, pleaded guilty to 21 felony counts, including nine counts of burglary, five counts of identity theft, four counts o...

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Thomas Fiala, MD 11/1/2010 Comments(0)

Seromas and plastic surgery

It's medical terminology time. Today's word is "seroma". Read this, and impress your friends with your knowledge! A seroma is a fluid collection which may show up after surgery. Different than a hematoma, which is a collection of blood within the tissues a seroma is typically a watery, yellow-colored fluid pocket that has accumulated in one main area beneath the skin. Seroma fluid looks a lot like the fluid you would see inside a large blister. Seromas are considered a minor complication - more ...

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Thomas Fiala, MD 10/15/2010 Comments(0)

Patient shoots Surgeon

CNN and other national news agencies reported that today, an orthopedic surgeon was shot in the abdomen by a patient 's son, while briefing the son about his mother's medical condition. The assault took place at the inpatient building of the prestigious Johns Hopkins Hospital in Baltimore. The surgeon was rushed to surgery, in urgent condition, but is expected to survive. Police were called in to handle the situation. The shooter barricaded himself in the hospital room, distraught about his moth...

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Thomas Fiala, MD 9/16/2010 Comments(0)

OT: People are getting better about hand washing!

According to an article published online in BusinessWeek , the hand washing habit is finally catching on after years of public health promotional activities. As you might expect, women are better about this then men are. Researchers observed 6,028 adults in public restrooms in 4 major cities in August 2010 and found that 85 percent of people washed their hands, compared with just 77 percent in 2007. Among women, 93 percent are hand-washers. Among men, only 77 percent. For best results, the U.S. ...

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Thomas Fiala, MD 9/14/2010 Comments(0)

The FDA's 510(k) approval process: helpful or not?

Last week, in the news, I noticed that the Zerona laser device, which allegedly treats fat by a non-invasive laser process, had received FDA clearance. We've discussed the Zerona before on our blog. I've been quite skeptical of the physics behind this low-power device, and how the laser can possibly get down to the depth of the fat cells, and have an effect there. While the clearance letter is great for the Zerona people, who can now market the device in the U.S., it brings up the whole question...

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Thomas Fiala, MD 9/13/2010 Comments(0)

Cohesive gel implants more prone to rippling?

In a recent study published in the Aesthetic Surgery Journal, Dr. Mark Jewell, a well respected plastic surgeon from Orgeon, reported 6 years worth of data on the use of form-stable "gummy-bear" breast implants. This was part of a clinical trial. Currently, these implants are still awaiting FDA approval, and are not currently available to the public. While overall the patients did well, with outcomes that were generally very good, I was disappointed in the surprisingly high percentage of patient...

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Thomas Fiala, MD 9/8/2010 Comments(0)

NY State has a new breast reconstruction law

New York State has a new law affecting breast reconstruction surgery. link It's now a requirement in that state for the cancer surgeon to discuss options for breast reconstruction surgery with the patient, prior to her mastectomy surgery, even if they have to refer the patient elsewhere for the reconstructive plastic surgery. Recent studies have shown that only 30 percent to 40 percent of the women who had mastectomies received breast reconstruction . Poor, minority women are also less likely to...

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Thomas Fiala, MD 9/8/2010 Comments(0)

Opinion: Are 61% of doctors bad?

According to recent data from the American Medical Association, by age 55, 61% of American doctors have been sued for medical malpractice. That's pretty much like saying that nearly 2 out of 3 doctors are negligent, are performing demonstrably below the "standard of care", and deserve to be punished with a crushing financial blow that could ruin their life and wipe out their savings. In some specialties, the numbers are even higher. For example: in both Obstetrics and Gynecology, and in General ...

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Thomas Fiala, MD 8/26/2010 Comments(1)

New antibiotic-resistant super-bacteria reported: NDM-1

You've heard of MRSA methicillin-resistant staph aureus . Maybe you've heard about VRE vancomycin-resistant enterococcus . Now there's a new class of superbugs out there - and they look particularly nasty. These bad bacteria carry a gene called NDM-1 , which makes them resistant to almost all standard antibiotics , according to a recent report in The Lancet link . The NDM-1 carrying bacteria, first discovered in India and Pakistan, have now been spotted in the United Kingdom, Canada, and the Uni...

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Thomas Fiala, MD 8/11/2010 Comments(0)

Plastic Surgery as an economic indicator?

We're all used to hearing the news about housing starts, retail sales, and employment figures. These are economic indicators - ways to indirectly sort out what's happening with the U.S. economy. Get this: two new studies now suggest that the workload of your friendly neighbourhood plastic surgeon may be another statistically valid way to tell how well the economy is doing. In this month's issues of both ASJ and PRS , are studies from two separate plastic surgery groups examining this very correl...

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Thomas Fiala, MD 7/26/2010 Comments(0)

What is "bottoming out" after breast surgery?

This is a frequently misunderstood concept. Even some plastic surgery websites get it wrong! Traditionally, bottoming-out was the term applied when the lower half of the breast skin stretched and lengthened out after a traditional "inverted-T" style breast reduction surgery. This lower-pole stretch could give a characteristic appearance to the breast, with the following features: 1 the illusion of an overly high placement of the nipple, 2 a vertically oblong-shaped breast, 3 loss of upper pole f...

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Thomas Fiala, MD 7/17/2010 Comments(0)

Best Hospitals Ranking 2010

U.S. News & World Report has released its annual ranking of the nation's hospitals. They have an honor roll of the top 14 hospitals in the nation link , and separate ranked lists for different specialties. I'm proud to see that both University of Michigan Medical Center and Massachusetts General Hospital - both institutions where I did some training - are on the honor roll. Johns Hopkins Hospital came out at #1 this year, as it has for many years. Locally, Orlando Regional ORMC cracked the t...

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Thomas Fiala, MD 7/15/2010 Comments(0)

First full face transplant performed by French surgeons

The following article is an abbreviated version of a news item, originally written by fellow Plastic Surgeon, Dr. Ramona Bates. By the way, if you haven't yet seen Dr. Bates' blog, "Suture for a Living", do check it out link . It's very well written, and shows off both her medical writing and her hobby, making quilts. ****** French surgeon Laurent Lantieri and his team have performed the first successful full-face transplant, which included the eyelids and tear ducts along with the rest of the f...

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Thomas Fiala, MD 7/13/2010 Comments(3)

Website beauties: models or actual patients?

Nearly all cosmetic surgeons now have glitzy, professionally-produced websites. They typically feature images of beautiful women, showing off toned tummies, sleek silhouettes or fabulous faces. It's the sizzle that sells the steak. We have this on our website too...but there's an important difference. All the ladies you see on our website are our actual patients . They've all had cosmetic surgery performed by me. Most websites instead use what's known as "stock photography", where the web design...

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Thomas Fiala, MD 6/9/2010 Comments(0)

Celebrity plastic surgery & gossip

While some of my surgical colleagues love to comment on "who has had this surgery or that procedure" - that's not something I've chosen to do, unless there's some teachable point to the discussion. I prefer to stick to a more educational role, presenting what are hopefully helpful topics, so potential plastic surgery patients can make informed, intelligent decisions about surgery, non-invasive procedures and various products. So, our VIP patients need never worry! That being said, for those of y...

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Thomas Fiala, MD 5/27/2010 Comments(0)

ASAPS 2010: more on biofilms and capsular contracture

As loyal blog readers know, capsular contracture is arguably the most frustrating complication of breast implants, whether they are used for reconstruction or for cosmetic purposes. For years, no one has been particularly sure on why capsules occur, despite all the efforts of the physician and the patient to the contrary. About a year ago, I wrote a blog entry discussing the theory of biofilms as a cause of the contracture. Biofilms, just to review, are what happens when free-floating bacteria s...

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Thomas Fiala, MD 5/2/2010 Comments(0)

French breast implant maker "P.I.P." closes

This report comes courtesy of Yahoo news. Note from Dr. Fiala: We have never used "PIP" brand silicone implants...so our patients don't need to worry about this news item. ******* DRAGUIGNAN, France AFP - A French court Tuesday ordered the closure of a company making breast implants after health authorities ordered a recall of its products for using non-authorised silicone gel. "The company's 100 employees have been made redundant and the plant must close," insolvency administrator Xavier Huerta...

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Thomas Fiala, MD 4/12/2010 Comments(0)

Skincare: the two best products

There's hundreds over beauty creams out there...and most of them are glorified moisturizers, and are a waste of money. Fact is, if you were stranded on a desert island, and for some reason, wanted to have a basic skin care program that was simple and was scientifically proven to work, you would only need 2 items: good sunscreen and retin-A cream. Retin-A really works. And it has been scientifically tested, shown to be safe for long term use, and shown to be effective, which is more than you can ...

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Thomas Fiala, MD 4/12/2010 Comments(1)

Choosing the right breast implant - 2010 edition

This is an update of a classic blog from 2008 - but the information I wrote then is still relevant to selecting the right breast implant size & shape, which is one of the most important factors in getting a nice result, and a happy patient! ***** Breast augmentation is the most popular procedure in our practice ed: still is now in 2010, too! - we help several hundred women with this each year. In order to have a happy patient, one of the most important choices we make together is figuring ou...

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Thomas Fiala, MD 4/8/2010 Comments(0)

Top 10 nutrition strategies for reducing heart disease

Here's a nice summary of sensible dietary recommendations, courtesy of the CBC News website and nutritionist Andrea Holwegner. ********** Nutrition plays a major role in reducing many of the risk factors for heart disease. Making healthy eating choices is not only important to keep your blood cholesterol levels and blood pressure healthy, it greatly influences your ability to manage a healthy weight and protect against diabetes. 1. Boost your intake of omega-3 fats. These fats improve heart heal...

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Thomas Fiala, MD 3/29/2010 Comments(0)

Human interest: the popularity of skin lightening creams in India

Great article from BBC News on a surprising topic - the popularity of over-the-counter skin lightening creams in India. It turns out, that "fair and lovely" is the current fashion there, in addition to being the name of one of the most popular creams! Click here for the link ....

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Thomas Fiala, MD 3/23/2010 Comments(0)

How to prepare for the changes in healthcare

Well, it was a very exciting weekend for political junkies. The president's healthcare plan passed the House, by an oh-so-narrow 217-212 margin. So, the Senate-approved initial bill will become law as soon as the President signs it. What does this mean for you & me? Well, some of the details will depend on what happens with the upcoming reconciliation process. Some tax changes, like the 10% tax on indoor tanning treatments, begin immediately; others don't kick in until 2014. Changes that wou...

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Thomas Fiala, MD 3/22/2010 Comments(0)

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? Wel...

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Thomas Fiala, MD 1/28/2010 Comments(1)

Is it constitutional to have to buy health insurance?

Here's a interesting commentary by Florida Medical Association President, Dr. James Dolan, regarding the constitutionality of the proposed Healthcare reform proposal that requires the mandatory purchase of health insurance. I have quoted the relevant sections, below. **** Interestingly, the one proposal that has united critics on the left and the right is the so-called individual mandate, which requires everyone to carry health insurance. The rationale for this is that adding healthier individua...

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Thomas Fiala, MD 1/8/2010 Comments(0)

MERRY CHRISTMAS - Bo-tax defeated!!

Merry Christmas from us here at "PSB - the Plastic Surgery blog" to you. I hope that 2010 is much better for everyone than 2009! Here's one bit of good news: due to an intense reaction to the highly unpopular "Bo-tax" proposal discussed here , and a whole lot of political lobbying from organized plastic surgery and women's groups, it looks like the cosmetic services tax is going to be removed from the Senate bill. Hurray!! No more Bo-tax!! Thanks to all who pointed out the ridiculous nature of t...

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Thomas Fiala, MD 12/20/2009 Comments(2)

First Orthopedic Surgeon in Space

Robert Satcher Jr, MD, PhD, made history last Tuesday when he lifted off in the space shuttle Atlantis, headed to the International Space Station. Dr. Satcher will be the first orthopaedic surgeon to orbit the earth and is one of only 23 US physicians who have become astronauts. Dr. Satcher is serving as the flight crew medical officer and as a mission specialist on the 11-day assignment. On 2 space walks, he will install an oxygen tank in the space station and perform maintenance work on the st...

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Thomas Fiala, MD 11/25/2009 Comments(1)

Senate Dems propose a 5% cosmetic surgery tax

As part of the 2000 page Senate proposal for health care reform released today, Senate Democrats are proposing a 5% tax on cosmetic surgery. More details can be read in the New York Times report here . The way this proposal is worded, non-surgical cosmetic procedures such as Botox, Restylane and Juvederm, laser treatments and pretty much any cosmetic treatment performed by a licensed professional would be taxed as well. We've talked about cosmetic surgery taxes before, pointing out how...

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Thomas Fiala, MD 11/19/2009 Comments(2)

New simpler rules for cholesterol testing

I had an interesting conversation with a patient this week, who strenuously asserted that the link between cholesterol levels and heart disease remains "unproven". As it happens, this month's issue of the Journal of the American Medical Association JAMA has a major new study reviewing the link between cholesterol, heart disease and stroke, so I was able to show him the data. The study group came up with some new findings, and re-confirmed some older findings: 1. HDL levels high density lipoprote...

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Thomas Fiala, MD 11/18/2009 Comments(1)

New Government Mammography guidelines spark debate

This week, an influential government panel known as the U.S. Preventive Services Task Force USPSTF , whose recommendations influences coverage of screening tests by Medicare and many insurance companies, has come out with new guidelines for mammography, particularly when testing should start, and how often it should be performed. Their article is published in the latest issue of Annals of Internal Medicine link to article . These new USPSTF guidelines are sure to spark a hot debate, as the panel...

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Thomas Fiala, MD 11/17/2009 Comments(0)

"A Spoonful of Sugar..."

Yes, it helps the medicine go down, according to the old song. But it turns out that a little sugar - or more properly dextrose in the intravenous fluid - may help to reduce the chance of perioperative nausea and vomiting in surgery patients, and reduces the need for anti-nausea medications. According to a presentation at the recent American Society of Anesthesiologists 2009 Annual Meeting, in a randomized trial of 56 healthy surgery patients undergoing identical general anesthesia techniques, t...

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Thomas Fiala, MD 10/28/2009 Comments(0)

Donda West Law signed by California Governor

This week, California Governor Arnold Schwarzenegger signed the Donda West Law, which requires anyone undergoing plastic surgery in the state to receive a mandatory physical examination first. The bill was written in response to the death in 2007 of Kanye West's mother, Donda, 58, who died following cosmetic surgery. West underwent several cosmetic procedures without medical clearance, and her coronary disease, diabetes and other postoperative factors are believed to have contributed to her deat...

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Thomas Fiala, MD 10/17/2009 Comments(1)

Looking for breast cancer with MRI's

A patient asked me the other day about whether MRI scans could be used instead of mammograms, as a more high-tech way to screen for breast cancer. By happenstance, there is a major review article on breast cancer imaging and treatment in the latest issue of the Journal of the American College of Surgeons . Here are the consensus recommendations of their blue-ribbon panel of experts: Mammograms, whether standard or digital, are still the recommended method for screening for breast cancer in the g...

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Thomas Fiala, MD 10/12/2009 Comments(0)

Exercise after abdominoplasty

Many patients who have lost significant amounts of weight through either diet, exercise or gastric surgery are very interested to know when they can resume their work-out routines after having a tummy tuck abdominoplasty . They have made exercise an important part of their lifestyle, and miss it during the immediate postoperative time period. While there is no scientific paper on this, and each surgeon's recommendations may be slightly different, we recommend a step-by-step return to activities ...

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Thomas Fiala, MD 9/24/2009 Comments(0)

Breast Augmentation & Surgical Drains

Recently, a patient asked me if I used surgical drains as part of my routine when performing breast augmentation surgery. It's a thoughtful question - as there are a few surgeons locally who do use drains during breast augmentation surgery, removing them at the first or second postoperative visit. Drains, by the way, are small diameter, soft plastic tubes, which are used to remove fluid from a surgical area. They commonly have a bulb-type collection reservoir at one end of the tubing, while the ...

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Thomas Fiala, MD 9/20/2009 Comments(0)

Scars: Part one - Keloids and Hypertrophic scars

Many people have heard the word "keloid", and think it means "any bad looking scar". This is a common misconception. Scars fall into a couple of categories. Since different types of scars and scar problems are treated differently, it's important to diagnose the scar situation accurately. A keloidal scar is a scar that continues to enlarge and spreads beyond the borders of the initial wound . They are more common in African-American patients as well as Hispanics, Philipinos and Orientals, but can...

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Thomas Fiala, MD 8/27/2009 Comments(1)

"Sisters, not identical twins": breast asymmetry

As one of the busiest breast surgery practices in Central Florida, I see many patients who would like a breast augmentation performed. As part of our routine, we carefully examine the patient, and during our examination, it's very common to find several differences or asymmetries between the two sides. Most patients have no idea about these minor asymmetries of the breast until we show them...and then they see them. The reason we do this, of course, is to explain that these asymmetries will stil...

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Thomas Fiala, MD 8/17/2009 Comments(0)

President Obama and the price of surgery

During a recent "townhall" meeting in New Hampshire, President Obama stated, "If a diabetic gets their leg amputated - that's $30,000, $40,000, $50,000 immediately to the surgeon...." link Fact-check: Medicare reimburses a surgeon between $740 and $1140 for a leg amputation surgery. This fee includes the pre-operative evaluation, the surgery, and 90 days of post-operative care. In reality, an amputation is the last thing any surgeon wants to do. But sometimes, there's just no other good option. ...

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Thomas Fiala, MD 8/13/2009 Comments(0)

Career & Lifestyle Satisfaction among Surgeons

I came across an interesting survey in the latest issue of the Journal of the American College of Surgeons . A total of 895 board-certified surgeons were surveyed about their practice, their work hours and the levels of personal satisfaction about their practice, lifestyle and factors that might influence these perceptions. Here are some of the findings: - 80% were men, with an average age of 46. - the average surgeon works 64 hours per week . Most would prefer to work less; about 50 hours per w...

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Thomas Fiala, MD 8/5/2009 Comments(0)

A tax on cosmetic surgery??

Rumors are flying about the possibility of a new 10% tax on cosmetic surgery. Apparently, this is one of the more creative methods that the Senate Finance Committee has proposed, to help pay for the President's new healthcare system. I, for one, certainly hope that this doesn't come to pass. While this tax might look like "easy revenue", it is essentially an unfair tax . Why? - because it unfairly discriminates against women, who are 95% of the consumers of cosmetic surgery. And that's not right...

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Thomas Fiala, MD 7/28/2009 Comments(1)

Say "Yes" to an accredited Operating Room

Recent articles in the Wall Street Journal link have pointed out the need for a more uniform standard in office operating rooms - namely accreditation by one of the three national OR inspection agencies. I couldn't agree more. Improving safety standards for patient care is a good thing. Accreditation of an operating room, whether it's in the hospital or at an office, ensures that the facility meets important standards, like: - appropriate facility design and safety equipment - suitable cleaning ...

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Thomas Fiala, MD 7/22/2009 Comments(0)

U.S. Obesity is getting worse...

According to a recent report, obesity rates in the U.S. have further increased over the last year, with adult obesity rates rising in 23 states. For the fifth year in a row, Mississippi had the highest rate of adult obesity at 32.5%. Three other states - West Virginia, Alabama and Tennessee - also had adult obesity rates in excess of 30%. In just one state - Colorado - was the adult obesity rate below 20%. In 1991, not one state had an adult obesity rate above 20%. Mississippi also had the highe...

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Thomas Fiala, MD 7/2/2009 Comments(0)

Sunscreens: look for UV-A and UV-B protection

With the onset of ridiculously hot weather here in Orlando, it's time to talk about sunscreens. Of all the things you can do to continue having great looking skin over time, using a daily sunscreen is probably the #1 most important thing to do. It turns out that choosing the best sunscreen is a little complicated. While it is common knowledge that it is the ultraviolet portion of sunlight that causes sunburns, skin cancers and sun damage, most people may not realize that their sunscreen might no...

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Thomas Fiala, MD 6/26/2009 Comments(0)

Ripples and breast augmentation

One of the frustrating problems that can sometimes occur after breast implant surgery is known as "rippling" - an irregular wavy look or feel to the breast. This is caused by a combination of factors, related to the physical properties of the implant, the patient's own soft tissue and how it may have changed over time, and the choice of implant pocket design "over vs. under" . Plastic surgeons generally divide these problems into 2 main categories, based on why they've happened. 1. Shell ripplin...

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Thomas Fiala, MD 6/6/2009 Comments(0)

Redheads & Surgery

Back when I was a general surgery resident, one of the sayings passed down from our surgery professors was that "redheads were trouble", because they seemed to bleed a bit more than the average patient during a typical procedure. It was like a surgical superstition, a part of surgical lore that hadn't been proven scientifically, and yet was well known by all wise surgeons. In the last few years, some researchers have started to look at the connection between natural redheads and surgery, and it ...

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Thomas Fiala, MD 5/26/2009 Comments(0)

Australian MD saves boy's life with household drill

Here's a great story of performing under pressure: A doctor in rural Australia used a household drill to bore into a skull of a young boy with a head injury, to drain a potentially-lethal blood clot. The local hospital did not have neurosurgical tools or a neurosurgeon on site, and the young boy was in trouble. According to details on the BBC News website, Dr Rob Carson performed the procedure on Nicholas Rossi, 13, after the boy fell off his bike and hit his head. The boy was initially fine, bu...

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Thomas Fiala, MD 5/21/2009 Comments(0)

Do longer surgeries have a higher complication rate?

A common question around here from patients is whether they can combine surgeries - say, a tummy tuck with liposuction and a mastopexy - as one might be wanting to do in a "mommy makeover". To answer this, we have to look at things from 2 different angles: 1 legal - what do the Florida regulations permit, and 2 medical - what do the studies looking at surgical complications find. First of all, the applicable Florida regulations for office-based surgery state that the "maximum combined duration o...

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Thomas Fiala, MD 4/21/2009 Comments(0)

Saline breast implants: pros and cons

Today's chapter is about saline breast implants. Prior to 2006, saline implants were the most commonly used implant in the U.S. Now, with FDA re-approval of the silicone gel implants, that figure has fallen significantly, down to about 20% in our practice. Here are the more common reasons that my patients give for picking a saline-filled breast implant. 1. Cost . Saline implants aren't as expensive. 2. Adjustability . For women with major breast asymmetry issues, the adjustability of the size of...

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Thomas Fiala, MD 4/14/2009 Comments(1)

Silicone breast implants: pros and cons

A very common question during augmentation consultations is about the various advantages and disadvantages of silicone breast implants and saline breast implants. In this chapter of PSB- the Plastic Surgery Blog , we'll talk about silicone breast implants. The next installment will discuss saline breast implants. Currently, about 80% of our patients select the silicone gel implants. Safety data: The FDA thoroughly looked at the scientific data, prior to allowing silicone breast implants back on ...

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Thomas Fiala, MD 4/13/2009 Comments(1)

Browlift basics

In this era of smoothing forehead wrinkles with Botox and lasers, has the forehead lift, AKA brow lift or upper facelift, been relegated to the dust-bin of surgical history? Hardly! The browlift is still an extremely useful and powerful operation for rejuvenating the forehead, the eye area, and upper face. Why do a browlift? Well, as musicians say, "Let's take it from the top." Very few patients come in thinking about a browlift. Instead, they usually point out the baggy skin around their eyes. ...

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Thomas Fiala, MD 4/10/2009 Comments(1)

DHEA: super supplement or snake oil?

DHEA supplements are widely claimed in the lay press to help with a huge number of diverse conditions: anti-aging, cardiovascular disease, chronic fatigue & fibromyalgia, body building, obesity, osteoporosis, sexual dysfunction, and lupus - just to name a few. Most of this excitement was based on positive results seen in early scientific studies done in mice, and from some anecdotal reports from enthusiastic users...and things took off from there. These days, many people now take the widely ...

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Thomas Fiala, MD 4/3/2009 Comments(0)

The SoCal "Boobie Bandit"

And now, one of those "News of the Weird" stories... Allegedly, a woman in Huntington Beach, CA, recently used a stolen identity to open a line of credit, which was then used to finance a breast implant exchange and liposuction surgery, worth $12,000. The woman lied to her doctor and the staff of the surgery center about her name and personal information, but when she didn't show up for any of the post-operative appointments, the staff became suspicious. The shapely criminal might have gotten aw...

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Thomas Fiala, MD 3/30/2009 Comments(0)

Does Vitamin E help the appearance of scars?

From time to time, people ask me about Vitamin E...and whether rubbing some of it on their incision will make it heal and look better. It's an interesting "urban legend". The belief that Vitamin E helps scars seems pretty widespread. First of all, what is Vitamin E? It's a fat-soluble vitamin that was discovered in 1922. It acts primarily as an antioxidant, helping to protect the membranes of cells from what is known as oxidative stress . It also seems to have anti-inflammatory effects, and adve...

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Thomas Fiala, MD 3/21/2009 Comments(0)

Do the FDA recommendations for MRI's after breast augmentation make sense?

When the FDA re-approved the general use of silicone breast implants in 2006, there were some "strings" attached. One of these was the recommendation for follow-up testing of the breast, using an MRI scan, at years 3, 5, 7 and so on to look for clinically "silent" implant leakage. This was a new recommendation - and a change from the earlier FDA policy of 1992, which had not recommended any screening tests at all for asymptomatic women with silicone implants. So, does this new FDA recommendation...

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Thomas Fiala, MD 3/19/2009 Comments(1)

Silicone breast implants and breast feeding

Breast-feeding is known to be nutritionally superior to commercial infant formulas. Breast milk also has immune-boosting properties, and seems to reduce the chance of the baby developing common childhood conditions, such as eczema, otitis media, and iron-deficiency anemia. In other words, it's good for the baby . Women who are considering breast augmentation with silicone gel implants often ask me whether their breast milk would somehow get "contaminated" from their implants, making the milk pot...

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Thomas Fiala, MD 3/17/2009 Comments(1)

Does breast augmentation affect pectoral muscle strength?

Recently, a number of patients have asked me during their breast augmentation consultations whether the strength of the pectoral muscle is reduced after a sub-pectoral breast augmentation "unders" . I can certainly answer from my patients' experience - very active patients weight lifters, personal trainers, police women, wakeboarders and others have not reported any problems to me whatsoever. The best way to answer the question, however, is to double-check the science. Has pectoral muscle streng...

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Thomas Fiala, MD 3/17/2009 Comments(0)

Over the hill at age 27....?

According to a report on the health page of the BBC news website, new research suggests that mental powers start to dwindle at age 27, after peaking at age 22. Professor Timothy Salthouse of Virginia University tested 2,000 healthy people aged 18-60. Study participants were tested with puzzles, word recall and spotting patterns in letters and symbols. In the majority of tests, top performance was achieved around age 22. In tests of brain speed, reasoning and visual puzzle-solving ability, declin...

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Thomas Fiala, MD 3/16/2009 Comments(0)

Does taking Vitamin E supplements prevent prostate cancer?

In the mid-1990's, two medical studies that were looking at the effects of vitamin and mineral supplements on cancer rates came on a finding, quite by happenstance during the post-study data analysis. It seemed that men who took Vitamin E supplements had a lower rate of prostate cancer. While neither study was particularly designed to investigate prostate cancer issues, the finding generated a great deal of excitment, as prostate cancer is very common in middle-aged and older men. Suddenly, men ...

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Thomas Fiala, MD 1/8/2009 Comments(0)

How to choose a Plastic Surgeon

If you've been doing your research prior to coming in for a consultation, you've probably come across one of those checklists that many of the plastic surgery advice websites seem to have. While I don't mind those lists, there's probably an easier way: choose a member of ASAPS the American Society for Aesthetic Plastic Surgery as a first step. Right away, you've automatically selected a Board-certified Plastic Surgeon with significant experience and interest in cosmetic / aesthetic plastic surge...

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Thomas Fiala, MD 11/30/2008 Comments(0)

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