Today, the FDA announced the approval of the “MemoryShape” breast implant, made by Mentor. This is the teardrop-shaped implant, filled with the latest generation of form-stable silicone gel. It’s certainly a home-run for breast reconstruction patients, and may be useful for some breast augmentation patients as well. Mentor now joins Allergan and Sientra with implants of this type.
Other HA fillers, when they are placed too close to the surface of the skin, can have an issue called the “Tyndall effect” – which basically looks like a blue-grey colored bleb caused by the superficial placement of the filler. This doesn’t happen with Belotero. So it’s really quite useful in areas where the skin is thin, like near the eyes. Belotero, however, does not come with added lidocaine, which may be a disadvantage for some patients, making the injections a little less comfortable.
The manufacturer, Merz Pharmaceuticals, claims that Belotero lasts longer than the other fillers, up to 12 months, rather than the usual 6 to 8 month duration for Juvederm. I haven’t seen a head-to-head comparison study yet, so will have to wait and see on that claim.
Allure Magazine’s senior editor, Ms. Joan Kron, recently published an article called the “11 most overrated cosmetic surgery procedures”(link), and I thought this was well worth commenting on. Ms. Kron has received several awards from our plastic surgery societies for journalistic excellence in covering our field – so her articles are always worth a read!
1. Vampire Facelift – There’s no good science to support this treatment as being beneficial. I don’t perform it, even though Ms. Kardashian and others celebs like it. (link)
2. Laser Liposuction – There’s no study showing it’s actually better, results-wise, than regular liposuction. But the trademarked name sure sounds cool, doesn’t it? It’s certainly not minimally-invasive, as often advertised. While some surgeons are enthusiastic about it – typically those who have bought the machine and have to make the payments on it – others say it causes more scar tissue, and makes further liposuction more difficult. I’m in this second group – so I use Power Assisted Liposuction, which has a proven track record.
Recently, Cynosure, the manufacturer of SmartLipo is promoting a modified version of SmartLipo for use in the face called the “lazerlift”. Don’t do it! There’s a whole blog post coming on this bad idea!
3. Stem Cell Facelift – The New York Times just did an article on this (link). Most doctors that offer a so-called stem cell facelift are really just doing standard-issue fat transfer to the face. Since 1% of the fat contains stem cells, they use the “stem-cell” buzz word. Very misleading.
4. Sculptra and Artefill for the lips – These products are designed for the cheeks and other areas where they can be placed deep in the tissues. In the lip, they will cause lumps for sure. And did I mention that these are permanent lumps?
5. Silicone Cheek Implants – Pretty much made obsolete by our injectable products and fat grafting techniques.
6. Ulthera – Very subtle ( i.e. hard to see) results, painful to have done. Current treatment protocol is “under revision” by the company.
7. Fat Injections To The Breasts – Here’s one topic where I disagree with Ms. Kron. I think that this really is a useful technique, for both augmentation and reconstructive purposes. It’s certainly more expensive and more time consuming than a breast implant, and gives a different, more natural looking result than an implant.
8. Brachioplasty – The issue here is the scar, that typically goes from armpit to elbow. This can be a great procedure for massive weight loss patients, especially with our posterior scar technique. It’s not good, however, for someone who just needs a little improvement of a basically normal arm silhouette.
9. Buttock Augmentation with Implants – These are really only used if the patient is not a candidate for fat transfer to the buttock, also called the Brazilian Butt Lift.
10. Zerona Lipo Laser – Essentially this is like shining a few laser pointers on your skin and expecting there to be fat loss. I am still surprised that this gadget got FDA approval.
11. Foot Lifts – My scrub tech, Lindy, says “no go on toe lipo”. Or cosmetic foot surgery. I agree!
Yes, it’s that time of year: time for the biggest gathering of aesthetic plastic surgeons from around the world, the annual American Society for Aesthetic Plastic Surgery meeting. This time, it’s back in New York City, at the Convention Center, starting in about 3 weeks.
I’ll be there, listening to the latest on technical improvements and new equipment, participating in several committees and a couple of panels. This year, for the first time, I am heavily involved in a teaching course which I’m pretty excited about. It’s called “What Patients Really Want”, and it is all about how to improve the overall patient experience as they go from consult to surgery to post-operative care. I’ll be joined by ASAPS past-president Dr. Monte Eaves, Realself.com CEO Tom Seery, and Marie Olesen, plastic surgery consultant par excellence and founder of Real Patient Ratings. It has the potential to be really good!
As usual, I’ll be reporting from the meeting, and will blog about what works, what new & cool developments I see, as well as the flops, failures, the hype and the spin. Stay tuned…
Here’s a cool “infographic” from ASAPS about cosmetic surgery trends for men.
In our practice, the most popular cosmetic surgical procedures are liposuction for the “muffin top” and abdomen, and blepharoplasty, particularly for the upper eyelid.
If you study a youthful-looking face and compare it to its older counterpart, one of the things you’ll notice is that the younger face has fullness in the cheeks, and the older face doesn’t. The older face often loses volume – in the temples, in the cheeks, in the lips. And until recently, plastic surgeons have struggled to reverse these changes. While we were good at tightening up cheeks and necks with facelifts, replacing lost volume in the face was a different matter entirely
After a number of years of work, I’m pleased to say, the techniques of fat grafting to the face have advanced to the point where many of these problems can be significantly improved in a much more reliable way. The concept, like many great ideas, is simple: harvest a little bit of fat from an area of the body where it is unwanted, purify it, and inject it, a droplet or two at a time, precisely where it is needed. It’s almost like miniature liposuction in reverse. You can almost think of it a sculptural process.
I’ve been working with fat grafting over the years too – and in the early days, there were frustrating technical problems with the harvest and re-injection portions of the procedures. These have been largely solved with the inroduction of more refined instrumentation. Our understanding of how and where to put the fat has also improved.
Now, we’re starting to combine fat grafting with facelifting. This is a winning combination, as each procedure does different things to restore the look of youth, and they both work together well. The facelift repositions and tightens the tissues of the cheeks, jawline and neck. The fat grafting fills in the hollows and plumps up the curves where needed, allowing contouring we never could achieve before, particularly in the midface.
And the recovery from facial fat grafting by itself is much easier than a full facelift. If you would like to learn more about facial fat grafting, please come and see me for a complementary consultation.
IN THE UPCOMING ISSUE OF PLASTIC AND RECONSTRUCTIVE SURGERY, DR. ROGER KHOURI AND ASSOCIATES GIVE US AN UPDATE ON THEIR EXPERIENCE WITH FAT TRANSFER TO THE BREAST FOR THE PURPOSES OF BREAST AUGMENTATION. THE BOTTOM LINE: AS LONG AS YOU USE THE BRAVA SYSTEM FOR SEVERAL WEEKS BEFOREHAND, FAT TRANSFER WORKS PRETTY WELL.
IN THE STUDY, 81 PATIENTS USED THE BRAVA FOR 4 WEEKS BEFORE SURGERY, THEN HAD THEIR OWN FAT TRANSFERRED WITH LIPOSUCTION HARVESTING TO THE BREAST. THEY THEN WORE THE BRAVA POST-OP FOR AT LEAST A WEEK. AN AVERAGE OF 277 ML PER BREAST WAS USED – WHICH, COMPARED TO TYPICAL BREAST IMPLANTS, IS A PRETTY CONSERVATIVE VOLUME. THE PATIENTS WERE FOLLOWED FOR AN AVERAGE OF 3.7 YEARS POSTOPERATIVELY.
BASED ON MRI DATA, THEY FOUND ABOUT 82% GRAFT SURVIVAL, WHICH WAS MUCH BETTER THAN EARLIER STUDIES IN WHICH THE BRAVA SYSTEM WAS NOT USED, WHERE THE AVERAGE FAT GRAFT SURVIVAL WAS 55%. ALSO, THE BETTER THE PRE-EXPANSION WAS WITH BRAVA PRIOR TO SURGERY, THE BETTER THE RESULTS. THERE WERE NO SUSPICIOUS BREAST MASSES OR NODULES DURING THE FOLLOW-UP PERIOD.
THESE RESULTS ARE PRETTY MUCH THE SAME AS WHAT DRS. KHOURI AND DELVECCHIO PRESENTED AT LAST YEAR’S BREAST SURGERY CONFERENCE IN BOSTON. BUT NOW THE DATA HAS GONE THROUGH THE FORMAL PEER REVIEW PROCESS.
I’M A FAN OF THIS TECHNIQUE. AS A PLASTIC SURGEON, IT’S EXCITING TO BUILD SOMETHING OUT OF NOTHING – OR IN THIS CASE, BUILD A BREAST OUT OF OTHERWISE UNWANTED FAT. PLUS, THE PATIENT GETS THE BENEFIT OF THE CONTOURING FROM THE LIPOSUCTION AT THE FAT DONOR SITE. WE’RE STILL WORKING ON METHODS TO STREAMLINE AND STANDARDIZE THE OPERATION, BUT IT DOES WORK. WEARING THE BRAVA REALLY DOES HELP THE FAT TO SURVIVE, AND OUR EARLY EXPERIENCE WITH THIS METHOD HAS BEEN VERY PROMISING.
BUT WEARING THE BRAVA SYSTEM ISN’T EASY OR COMFORTABLE – IT CERTAINLY DOES REQUIRE A SOLID COMMITMENT FROM THE PATIENT, TO WEAR IT 10 HOURS A DAY, EVERY DAY FOR THE REQUIRED TIME – SO IT’S NOT FOR EVERYBODY. THE SURGERY IS MORE EXPENSIVE THAN AN IMPLANT SURGERY. ALSO, IF YOU WANT MORE THAN A CUP SIZE INCREASE, OR THE HIGH-PROFILE IMPLANT LOOK, IMPLANTS ARE CURRENTLY STILL THE BETTER CHOICE. WITH FAT GRAFTING, HOWEVER, THERE’S NO WORRIES ABOUT IMPLANT DEFLATION OR CAPSULAR CONTRACTURES – AND THAT CAN BE PRETTY APPEALING FOR THE RIGHT PATIENT.
Dr. Elizabeth Hall-Findlay, the talented plastic surgeon from Canada and author of a textbook on surgery of the breast, did her own experiment on this problem. She tried virtually every sensible method during breast lift surgery to try to solve the mystery of how to get persistent upper pole fullness without an implant. She presented her results at a recent plastic surgery conference. She found that, although the results looked promising initially, by 6-12 months after surgery, the shape of the breast returned to what it was pre-operatively, and that the fullness was lost. Nothing really worked; all of the methods she tried failed to give lasting upper pole fullness.
This month, in PRS, comes a new study reviewing 82 major previous publications in breast lift surgery. Careful photometric analysis was done of the techniques. Once again, it’s a disappoinitment. With the possible exception of fat-grafting to the breast, the author found that upper pole fullness “was not increased by any of the mastopexy / reduction techniques, or by the use of fascial sutures or autoaugmentation techniques”.
In other words, all the methods touted for upper pole fullness failed to work. So put internal lifting sutures, auto-augmentation, and the “internal bra” on the scrap-heap of discredited methods.
What does this mean for patients? Simple: if you want the “implant look”, you have to have an implant. Fat grafting might be an option, too – but we’re still waiting for the studies on that one.
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, as we usually do here at PSB: the Plastic Surgery Blog. New stuff coming soon!