■Study: Age can be factor in reduction complications
Women age 50 or older have a higher risk of complications following breast reduction surgery, possibly due to age-related changes in hormone levels, according to a Johns Hopkins study. The infection rate for the 50 years and older group was 2.7 times that of the under-40 group, researchers found in a study to be published in the journal Plastic and Reconstructive Surgery. United Press International (11/21
Saturday, December 3, 2011
RESEARCH AND TECHNOLOGY
■Researchers use pig bladder to regenerate human tissue
Researchers at the University of Pittsburgh are testing methods to regrow tissue and muscle from pig bladder cells. The procedure involves implanting an extracellular matrix that includes growth proteins into damaged areas to encourage the body to restore basic muscle tissue, tendons and nerves. "We want to resurrect fetal wound healing," said Stephen Badylak, director of the Center for Pre-Clinical Tissue Engineering at the University of Pittsburgh. Humans Invent (U.K.) (11/24)
■Plastic surgeons, engineers collaborate on nerve growth
A team of plastic surgery researchers at Beth Israel Deaconess Medical Center has worked with engineers from the Massachusetts Institute of Technology to develop techniques to treat damaged nerves using functional electric stimulation while lowering the chances of painful side effects. "This new device works by manipulating the concentration of charged ions surrounding the nerve. This could potentially mean reduced risk to surrounding nerves," said ASDS member and senior study author Dr. Samuel Lin. ScienceDaily (11/21)
Researchers at the University of Pittsburgh are testing methods to regrow tissue and muscle from pig bladder cells. The procedure involves implanting an extracellular matrix that includes growth proteins into damaged areas to encourage the body to restore basic muscle tissue, tendons and nerves. "We want to resurrect fetal wound healing," said Stephen Badylak, director of the Center for Pre-Clinical Tissue Engineering at the University of Pittsburgh. Humans Invent (U.K.) (11/24)
■Plastic surgeons, engineers collaborate on nerve growth
A team of plastic surgery researchers at Beth Israel Deaconess Medical Center has worked with engineers from the Massachusetts Institute of Technology to develop techniques to treat damaged nerves using functional electric stimulation while lowering the chances of painful side effects. "This new device works by manipulating the concentration of charged ions surrounding the nerve. This could potentially mean reduced risk to surrounding nerves," said ASDS member and senior study author Dr. Samuel Lin. ScienceDaily (11/21)
RATING SITES ON THE WEB
■Objective ratings websites are tough to find, study says
More than 80% of rating websites that come up when people search under terms such as "doctor reports" or "hospital ratings" are based on anecdotal reports, according to a study in the American Journal of Medical Quality. Dr. Brian Sick of the University of Minnesota Primary Care Center said highly findable sites, such as RateMDs.com, Vitals.com and Yelp.com, are private and provide information based on patient experience, while sites that have quality information and comparable data are more difficult for consumers to find. American Medical News
More than 80% of rating websites that come up when people search under terms such as "doctor reports" or "hospital ratings" are based on anecdotal reports, according to a study in the American Journal of Medical Quality. Dr. Brian Sick of the University of Minnesota Primary Care Center said highly findable sites, such as RateMDs.com, Vitals.com and Yelp.com, are private and provide information based on patient experience, while sites that have quality information and comparable data are more difficult for consumers to find. American Medical News
Sunday, November 27, 2011
ECONOMY MELT-DOWN
■"Sicker" Americans neglect medical care to save money, report says
More than 40% of people who described themselves as "sicker" had financial problems in getting medical care in the past year, a Commonwealth Fund study shows. They said they were in poor or fair health, underwent surgery or were hospitalized in the past two years, or have chronic conditions. Such patients skipped prescriptions, didn't see doctors and took other steps to save money, the report said. American Medical News (11/21)
More than 40% of people who described themselves as "sicker" had financial problems in getting medical care in the past year, a Commonwealth Fund study shows. They said they were in poor or fair health, underwent surgery or were hospitalized in the past two years, or have chronic conditions. Such patients skipped prescriptions, didn't see doctors and took other steps to save money, the report said. American Medical News (11/21)
Wednesday, November 16, 2011
QUALIFICATIONS IMPORTANT
■Do your homework
It's important for patients to investigate a doctor's qualifications before undergoing any plastic surgery procedures. There is a misconception among consumers that as long as a doctor is certified in a medical field that he or she is qualified to practice plastic surgery. This is absolutely wrong and it is dangerous for patients.
Suspect arrested in cement buttocks lift
Police in Miami arrested a transgender woman accused of posing as a doctor and injecting cement, mineral oil and flat-tire sealant into the buttocks of a woman seeking cheap cosmetic surgery. Police believe other victims exist but are too embarrassed to come forward. USA TODAY (11/22)
■Illegal buttocks lift trend becomes more common
Authorities are seeing an increase in the number of women seeking treatment for complications after illegal silicone buttocks injections. Unlicensed, untrained practitioners have used hardware-grade silicone to enhance the breasts or buttocks of people seeking cheap cosmetic procedures. "Who would imagine someone would let someone else inject them with something from Home Depot? It's insane," said ASPS member Dr. Michele Shermak. Treating those injected with silicone can involve removing surrounding tissue. The Sun (Baltimore) (11/22)
■AMA delegates strengthen patient safety policies
The American Medical Association's House of Delegates endorsed policies to protect patients from invasive procedures performed by non-physicians at spas. Procedures such as injecting dermal fillers or Botox, and procedures involving lasers or intense pulsed light, should be considered medical, the delegates said. The AMA will develop awareness campaigns to alert patients to the dangers of so-called medical spa treatments. American Medical News
■Fill-by-night implant scams bring need for caution
The popularity of buttock-enhancement procedures has been accompanied by a spate of cases where unqualified practitioners have harmed women. Fat fillers are the typical procedure, but some people are turning to silicone that is not medical grade. "So, really, not only is it not good because it's not being done by a certified plastic surgeon, it's because it's being done at all," said ASPS President Dr. Malcolm Roth. ABC News (11/25)
It's important for patients to investigate a doctor's qualifications before undergoing any plastic surgery procedures. There is a misconception among consumers that as long as a doctor is certified in a medical field that he or she is qualified to practice plastic surgery. This is absolutely wrong and it is dangerous for patients.
Suspect arrested in cement buttocks lift
Police in Miami arrested a transgender woman accused of posing as a doctor and injecting cement, mineral oil and flat-tire sealant into the buttocks of a woman seeking cheap cosmetic surgery. Police believe other victims exist but are too embarrassed to come forward. USA TODAY (11/22)
■Illegal buttocks lift trend becomes more common
Authorities are seeing an increase in the number of women seeking treatment for complications after illegal silicone buttocks injections. Unlicensed, untrained practitioners have used hardware-grade silicone to enhance the breasts or buttocks of people seeking cheap cosmetic procedures. "Who would imagine someone would let someone else inject them with something from Home Depot? It's insane," said ASPS member Dr. Michele Shermak. Treating those injected with silicone can involve removing surrounding tissue. The Sun (Baltimore) (11/22)
■AMA delegates strengthen patient safety policies
The American Medical Association's House of Delegates endorsed policies to protect patients from invasive procedures performed by non-physicians at spas. Procedures such as injecting dermal fillers or Botox, and procedures involving lasers or intense pulsed light, should be considered medical, the delegates said. The AMA will develop awareness campaigns to alert patients to the dangers of so-called medical spa treatments. American Medical News
■Fill-by-night implant scams bring need for caution
The popularity of buttock-enhancement procedures has been accompanied by a spate of cases where unqualified practitioners have harmed women. Fat fillers are the typical procedure, but some people are turning to silicone that is not medical grade. "So, really, not only is it not good because it's not being done by a certified plastic surgeon, it's because it's being done at all," said ASPS President Dr. Malcolm Roth. ABC News (11/25)
HEALTH BENEFITS OF LIPOSUCTION
■Liposuction helps improve triglyceride levels, study finds
Patients with high levels of triglycerides experienced a 43% reduction three months after undergoing liposuction, according to a study presented at the annual meeting of the American Society of Plastic Surgeons. White blood cells, which are linked to inflammation and a higher risk of cardiovascular disease, also dropped 11% after the procedure. Los Angeles Times
Patients with high levels of triglycerides experienced a 43% reduction three months after undergoing liposuction, according to a study presented at the annual meeting of the American Society of Plastic Surgeons. White blood cells, which are linked to inflammation and a higher risk of cardiovascular disease, also dropped 11% after the procedure. Los Angeles Times
THE AGING POPULATION
■More seniors seek plastic surgery
More people aged 65 and older are electing to have plastic surgery, due in part to the fact that people are living and working longer, doctors say. As with patients of any age, older patients should consult more than one specialist and discuss their goals as well as risks and their potential for healing, plastic surgeons say. The Wall Street Journal (tiered subscription model) (10/31)
More people aged 65 and older are electing to have plastic surgery, due in part to the fact that people are living and working longer, doctors say. As with patients of any age, older patients should consult more than one specialist and discuss their goals as well as risks and their potential for healing, plastic surgeons say. The Wall Street Journal (tiered subscription model) (10/31)
MINIMALLY INVASIVE SURGERY
■Does minimally invasive mean minimal results?
More people are seeking minimally invasive cosmetic procedures compared with surgical procedures, according to the ASPS. Economics plays a role, but minimally invasive procedures might not pay off in the long run, writes ASPS member Dr. Michael Yaremchuk, chief of craniofacial surgery at Massachusetts General Hospital. The procedures are "too often performed by weekend course trained doctors," putting patients at risk for poor results or permanent damage, Yaremchuk writes. The Huffington Post (11/1)
More people are seeking minimally invasive cosmetic procedures compared with surgical procedures, according to the ASPS. Economics plays a role, but minimally invasive procedures might not pay off in the long run, writes ASPS member Dr. Michael Yaremchuk, chief of craniofacial surgery at Massachusetts General Hospital. The procedures are "too often performed by weekend course trained doctors," putting patients at risk for poor results or permanent damage, Yaremchuk writes. The Huffington Post (11/1)
Sunday, November 6, 2011
LIP REDUCTIONS
■Lip reductions can help with confidence and proper sealing
More patients are seeking lip-reduction surgery, whether from over-augmentation or genetic hypertrophy, writes ASPS member Dr. Robert Tornambe. Abnormally large lips can prevent proper sealing of the upper and lower lips, causing drooling, and can cause speech impediments. Treatment options are limited, Tornambe says, and include steroid injections and surgical reduction, or reduction cheiloplasty. Whether seeking lip reduction or enhancement, patients should be sure to choose a board-certified plastic surgeon to avoid complications and poor outcomes, he writes. The Huffington Post (10/31)
More patients are seeking lip-reduction surgery, whether from over-augmentation or genetic hypertrophy, writes ASPS member Dr. Robert Tornambe. Abnormally large lips can prevent proper sealing of the upper and lower lips, causing drooling, and can cause speech impediments. Treatment options are limited, Tornambe says, and include steroid injections and surgical reduction, or reduction cheiloplasty. Whether seeking lip reduction or enhancement, patients should be sure to choose a board-certified plastic surgeon to avoid complications and poor outcomes, he writes. The Huffington Post (10/31)
CONJOINED TWINS
■Surgeons separate conjoined twins
Surgeons at Stanford University's Lucile Packard Children's Hospital separated 2-year-old twins joined at the chest and abdomen. The doctors evenly divided the girls' shared liver and tissues. Both girls will have abdominal scars from mid-chest to navel, said ASPS member Dr. H. Peter Lorenz, the team's chief plastic surgeon. Doctors expect both to recover well. Reuters (11/1)
Surgeons at Stanford University's Lucile Packard Children's Hospital separated 2-year-old twins joined at the chest and abdomen. The doctors evenly divided the girls' shared liver and tissues. Both girls will have abdominal scars from mid-chest to navel, said ASPS member Dr. H. Peter Lorenz, the team's chief plastic surgeon. Doctors expect both to recover well. Reuters (11/1)
TATTOOS
■Plastic surgeon helps a former skinhead reform
ASPS member Dr. Bruce Shack, chairman of the Department of Plastic Surgery at Vanderbilt University Medical Center, helped a former white supremacist by removing the many tattoos from his face, neck and hands. Dr. Shack "didn't just see the tattoos," said patient Byron Widner. "He saw me as a real human being." The Boston Globe
ASPS member Dr. Bruce Shack, chairman of the Department of Plastic Surgery at Vanderbilt University Medical Center, helped a former white supremacist by removing the many tattoos from his face, neck and hands. Dr. Shack "didn't just see the tattoos," said patient Byron Widner. "He saw me as a real human being." The Boston Globe
Monday, October 31, 2011
SILICONE INJECTIONS - BEWARE!!
■Material used in illegal implants harms the lungs and brain
Hardware store-grade silicone used by unqualified practitioners for buttock and breast implants can dissolve in the body. Despite media reports of deaths and injuries, the incidence of illicit procedures may be rising. "We've been hearing about this," said American Society of Plastic Surgeons President Malcolm Roth. "There are 'pumping parties,' involving high-volume injections to fill up the face, lips, cheekbones, chin or breast. Often it's buttock enhancement and often it's not sterile." The ASPS is reminding patients to check and understand providers' credentials before seeking cosmetic procedures. HealthDay News (10/24)
Hardware store-grade silicone used by unqualified practitioners for buttock and breast implants can dissolve in the body. Despite media reports of deaths and injuries, the incidence of illicit procedures may be rising. "We've been hearing about this," said American Society of Plastic Surgeons President Malcolm Roth. "There are 'pumping parties,' involving high-volume injections to fill up the face, lips, cheekbones, chin or breast. Often it's buttock enhancement and often it's not sterile." The ASPS is reminding patients to check and understand providers' credentials before seeking cosmetic procedures. HealthDay News (10/24)
Monday, October 10, 2011
ANEMIA LEADS TO INCREASED COMPLICATIONS
■Chances of surgical complications rise with anemia in study
A study in The Lancet found that patients with anemia were 35% more likely to experience postoperative complications in the month after surgery and their risk of dying was 42% higher compared with those without anemia. Researchers examined data from more than 227,000 Americans who had surgery and found the increased risk of postoperative complications was 31% for mild anemia and 56% for moderate to severe anemia. HealthDay News (10/6)
A study in The Lancet found that patients with anemia were 35% more likely to experience postoperative complications in the month after surgery and their risk of dying was 42% higher compared with those without anemia. Researchers examined data from more than 227,000 Americans who had surgery and found the increased risk of postoperative complications was 31% for mild anemia and 56% for moderate to severe anemia. HealthDay News (10/6)
Saturday, October 1, 2011
QUALIFICATIONS IMPORTANT
■Plastic surgeons urge patients to do their homework
The American Society of Plastic Surgeons launched a campaign to warn the public of the dangers associated with choosing an unqualified surgeon, including "pumpers," who inject industrial-grade silicone into patients' bodies. Complications range from infection to death. "Our message is very clear and very easy to remember," said ASPS President Malcolm Roth. "Consumers need to investigate their medical provider's background. ... Anyone can wear a white coat and claim to be a plastic surgeon, but not everyone is a plastic surgeon and not everybody is qualified to perform cosmetic procedures." National Public Radio (text and audio) (9/26)
The American Society of Plastic Surgeons launched a campaign to warn the public of the dangers associated with choosing an unqualified surgeon, including "pumpers," who inject industrial-grade silicone into patients' bodies. Complications range from infection to death. "Our message is very clear and very easy to remember," said ASPS President Malcolm Roth. "Consumers need to investigate their medical provider's background. ... Anyone can wear a white coat and claim to be a plastic surgeon, but not everyone is a plastic surgeon and not everybody is qualified to perform cosmetic procedures." National Public Radio (text and audio) (9/26)
SCARS CAN BE UNPREDICTABLE
■When prevention doesn't work, treatment helps patients with scars
In Surgical wounds, traumatic wounds and burns to include chemical peels and laser skin resurfacing, a very important aspect of post-operative care is the prevention of infection. Infection can be caused by bacteria such as Staphylococcus as well as viruses, such as Herpes. If the patient is a carrier of the bacteria or virus, despite good surgical treatment, good post-operative hygeine, and antibiotics/anti-viral medication, infection can occur. It is extremely important that the patient use good hygiene and anti-sepsis in the postoperative healing phases (that means good hand washing, keeping your bathroom and counter-tops cleaned with alcohol, clean bed sheets, avoiding pets, etc.). Many of these infections caused by bacteria and virues can be difficult to treat and can advance despite good treatment. Infection can transform a superficial wound or burn that normally would not scar, into a full thickness injury of the skin that can scar. Sometimes, these scars can be thick and symptomatic (sensitive to touch and itching). These thick scars are classified as "Hypertrophic Scars" or "Keloid Scars". The "Hypertrophic Scar" is a scar that elevates above the surface, whereas a "Keloid Scar" not only elevates above the surface, but spreads out beyond the normal boundry of the initial wound. If the scars occur around structures that are mobile (joints, eyelids, lips), the scars can pull and distort the tissues as they heal.
"Good surgical technique and infection prevention can stop surgical scars, but they often form despite the best methods, says plastic surgeon Kelly Gallego. Surgery, silicone dressings, pressure, corticosteroids, radiation, cryosurgery, lasers, vitamin E and other topical treatments can lessen the appearance of scars and prevent recurrence, he said. The choice of treatment depends on the patient and type of scar. Some patients with hypertrophic or keloid scars may be poor candidates for surgery because the risk of recurrence might be unacceptably high."
In Surgical wounds, traumatic wounds and burns to include chemical peels and laser skin resurfacing, a very important aspect of post-operative care is the prevention of infection. Infection can be caused by bacteria such as Staphylococcus as well as viruses, such as Herpes. If the patient is a carrier of the bacteria or virus, despite good surgical treatment, good post-operative hygeine, and antibiotics/anti-viral medication, infection can occur. It is extremely important that the patient use good hygiene and anti-sepsis in the postoperative healing phases (that means good hand washing, keeping your bathroom and counter-tops cleaned with alcohol, clean bed sheets, avoiding pets, etc.). Many of these infections caused by bacteria and virues can be difficult to treat and can advance despite good treatment. Infection can transform a superficial wound or burn that normally would not scar, into a full thickness injury of the skin that can scar. Sometimes, these scars can be thick and symptomatic (sensitive to touch and itching). These thick scars are classified as "Hypertrophic Scars" or "Keloid Scars". The "Hypertrophic Scar" is a scar that elevates above the surface, whereas a "Keloid Scar" not only elevates above the surface, but spreads out beyond the normal boundry of the initial wound. If the scars occur around structures that are mobile (joints, eyelids, lips), the scars can pull and distort the tissues as they heal.
"Good surgical technique and infection prevention can stop surgical scars, but they often form despite the best methods, says plastic surgeon Kelly Gallego. Surgery, silicone dressings, pressure, corticosteroids, radiation, cryosurgery, lasers, vitamin E and other topical treatments can lessen the appearance of scars and prevent recurrence, he said. The choice of treatment depends on the patient and type of scar. Some patients with hypertrophic or keloid scars may be poor candidates for surgery because the risk of recurrence might be unacceptably high."
Wednesday, September 28, 2011
THE INITIAL PLASTIC SURGERY CONSULTATION
Questions to ask my plastic surgeon
You'll achieve the best results from plastic surgery if you and your surgeon communicate openly and work together to achieve realistic goals. An understanding of your goals, expectations and motivation is essential to a successful partnership between you and your surgeon, helping both of you to determine whether plastic surgery is the right choice for you.
Use this checklist as a guide during your consultation:
•Are you certified by the American Board of Plastic Surgery?
•Are you a member of the American Society of Plastic Surgeons?
•Were you trained specifically in the field of plastic surgery?
•How many years of plastic surgery training have you had?
•Do you have hospital privileges to perform this procedure? If so, at which hospitals?
•Is the office-based surgical facility accredited by a nationally- or state-recognized accrediting agency, or is it state-licensed or Medicare-certified?
•How many procedures of this type have you performed?
•Am I a good candidate for this procedure?
•Where and how will you perform my procedure?
•How long of a recovery period can I expect, and what kind of help will I need during my recovery?
•What are the risks and complications associated with my procedure?
•How are complications handled?
•What are my options if I am dissatisfied with the outcome of my surgery?
•Do you have before-and-after photos I can look at for each procedure and what results are reasonable for me?
You'll achieve the best results from plastic surgery if you and your surgeon communicate openly and work together to achieve realistic goals. An understanding of your goals, expectations and motivation is essential to a successful partnership between you and your surgeon, helping both of you to determine whether plastic surgery is the right choice for you.
Use this checklist as a guide during your consultation:
•Are you certified by the American Board of Plastic Surgery?
•Are you a member of the American Society of Plastic Surgeons?
•Were you trained specifically in the field of plastic surgery?
•How many years of plastic surgery training have you had?
•Do you have hospital privileges to perform this procedure? If so, at which hospitals?
•Is the office-based surgical facility accredited by a nationally- or state-recognized accrediting agency, or is it state-licensed or Medicare-certified?
•How many procedures of this type have you performed?
•Am I a good candidate for this procedure?
•Where and how will you perform my procedure?
•How long of a recovery period can I expect, and what kind of help will I need during my recovery?
•What are the risks and complications associated with my procedure?
•How are complications handled?
•What are my options if I am dissatisfied with the outcome of my surgery?
•Do you have before-and-after photos I can look at for each procedure and what results are reasonable for me?
Tuesday, September 6, 2011
SILICONE IMPLANTS
F.D.A. Affirms Safety of Breast Implants
By GARDINER HARRIS
WASHINGTON — After two days of discussion and testimony about silicone breast implants, a top government health official said he had heard nothing to shake his faith in the safety of the widely used implants. The official, Dr. William Maisel, chief scientist for the Food and Drug Administration’s Center for Devices, said silicone breast implants were safe. “We felt that way before the meeting, and we continue to feel that way after the presentations and discussions over the past two days,” Dr. Maisel said.
There are risks to the implants, however, Dr. Maisel said, including ruptures, a hardening of the area around the implants, the need to remove the implants, scarring, pain, infection and asymmetry. “Women should feel assured that the F.D.A. continues to believe that currently marketed silicone breast implants are safe,” he said. Some patients and women’s groups who testified at the meeting disagreed.
Diana Zuckerman, president of the National Research Center for Women and Families, a research and education group, told an expert panel that the two companies that manufacture silicone breast implants — Johnson & Johnson and Allergan — had done a poor job of studying patients who got the implants, as the F.D.A. required them to do. “And without proper data, we still don’t know how safe or effective they are and whether there are certain patients at risk for extremely negative outcomes,” Ms. Zuckerman said.
Dr. Maisel agreed that the studies conducted by the two companies had failed to follow as many patients as the agency had hoped. One purpose of this week’s meeting was to ask the expert panel what the agency and the two companies should do about that poor follow-up. Some suggested that patients should be paid for participating; others mentioned that doctors should get some money, too. There was some criticism of the 27-page research form that patients who participate in the study are required to complete and whether it could be shortened. Nearly all expressed hope that a registry could be created that would follow all breast implant patients, but such registries are expensive to maintain and complicated to create.
The committee also agreed that patients should no longer be told that they should get a magnetic resonance imaging test three years after getting implants and every two years following. The reason for telling patients to get M.R.I.’s is that silicone breast implants sometimes rupture without women being aware, and an M.R.I. can reveal this unseen problem. But many patients ignore the requirements because M.R.I.’s are expensive and it is not clear what they should do when an unseen rupture is discovered; the risks associated with ruptured implants may not be greater than the risks of the operation needed to take them out.
“F.D.A. continues to believe, as does the panel, that M.R.I. is the gold standard for evaluating breast implants for silent rupture,” Dr. Maisel said. “But there was consensus among the panel that the requirements for ongoing M.R.I.’s should be removed.” Dr. Maisel promised that the F.D.A. would study whether to follow this advice.
By GARDINER HARRIS
WASHINGTON — After two days of discussion and testimony about silicone breast implants, a top government health official said he had heard nothing to shake his faith in the safety of the widely used implants. The official, Dr. William Maisel, chief scientist for the Food and Drug Administration’s Center for Devices, said silicone breast implants were safe. “We felt that way before the meeting, and we continue to feel that way after the presentations and discussions over the past two days,” Dr. Maisel said.
There are risks to the implants, however, Dr. Maisel said, including ruptures, a hardening of the area around the implants, the need to remove the implants, scarring, pain, infection and asymmetry. “Women should feel assured that the F.D.A. continues to believe that currently marketed silicone breast implants are safe,” he said. Some patients and women’s groups who testified at the meeting disagreed.
Diana Zuckerman, president of the National Research Center for Women and Families, a research and education group, told an expert panel that the two companies that manufacture silicone breast implants — Johnson & Johnson and Allergan — had done a poor job of studying patients who got the implants, as the F.D.A. required them to do. “And without proper data, we still don’t know how safe or effective they are and whether there are certain patients at risk for extremely negative outcomes,” Ms. Zuckerman said.
Dr. Maisel agreed that the studies conducted by the two companies had failed to follow as many patients as the agency had hoped. One purpose of this week’s meeting was to ask the expert panel what the agency and the two companies should do about that poor follow-up. Some suggested that patients should be paid for participating; others mentioned that doctors should get some money, too. There was some criticism of the 27-page research form that patients who participate in the study are required to complete and whether it could be shortened. Nearly all expressed hope that a registry could be created that would follow all breast implant patients, but such registries are expensive to maintain and complicated to create.
The committee also agreed that patients should no longer be told that they should get a magnetic resonance imaging test three years after getting implants and every two years following. The reason for telling patients to get M.R.I.’s is that silicone breast implants sometimes rupture without women being aware, and an M.R.I. can reveal this unseen problem. But many patients ignore the requirements because M.R.I.’s are expensive and it is not clear what they should do when an unseen rupture is discovered; the risks associated with ruptured implants may not be greater than the risks of the operation needed to take them out.
“F.D.A. continues to believe, as does the panel, that M.R.I. is the gold standard for evaluating breast implants for silent rupture,” Dr. Maisel said. “But there was consensus among the panel that the requirements for ongoing M.R.I.’s should be removed.” Dr. Maisel promised that the F.D.A. would study whether to follow this advice.
Sunday, August 28, 2011
LOSS OF INSURANCE COVERAGE FOR SOME EMPLOYEES
■Insurance exchanges could chip away at employer-sponsored benefits
About 10% of midsize or large employers expect to stop offering employees health care insurance after 2014, when insurance exchanges are supposed to begin operating, according to a Towers Watson survey of more than 1,200 companies. Another fifth said they are not sure whether they will drop health care benefits or not. The Associated Press (8/24)
About 10% of midsize or large employers expect to stop offering employees health care insurance after 2014, when insurance exchanges are supposed to begin operating, according to a Towers Watson survey of more than 1,200 companies. Another fifth said they are not sure whether they will drop health care benefits or not. The Associated Press (8/24)
Sunday, July 31, 2011
NASAL SURGERY AND B.D.D.
Patients seeking rhinoplasty might have body dysmorphic disorder
About a third of patients seeking rhinoplasty showed possible signs of body dysmorphic disorder, an obsession with perceived defects in their appearance, according to a study in the journal Plastic and Reconstructive Surgery. "Often patients who have this can't stop looking at themselves," said American Society of Plastic Surgeons President Dr. Phillip Haeck. Surgeons should not operate on patients with BDD because the patients will never be happy with the results, Haeck said. The New York Times
About a third of patients seeking rhinoplasty showed possible signs of body dysmorphic disorder, an obsession with perceived defects in their appearance, according to a study in the journal Plastic and Reconstructive Surgery. "Often patients who have this can't stop looking at themselves," said American Society of Plastic Surgeons President Dr. Phillip Haeck. Surgeons should not operate on patients with BDD because the patients will never be happy with the results, Haeck said. The New York Times
Sunday, July 10, 2011
"IMMEDIATE BREAST RECONSTRUCTION"
■Immediate reconstruction doesn't delay diagnosis of recurrence
A study of 170 women with advanced breast cancer who had reconstruction immediately after a mastectomy found that breast cancer recurred in 15 of them, but immediate reconstruction caused no delay in diagnosis. "These findings make a strong argument for immediate reconstruction regardless of cancer stage," the researchers wrote. Dr. Christopher Crisera at the University of California, Los Angeles, Medical Center, led the study, which is published in the journal Plastic and Reconstructive Surgery. HealthDay News (7/1)
A study of 170 women with advanced breast cancer who had reconstruction immediately after a mastectomy found that breast cancer recurred in 15 of them, but immediate reconstruction caused no delay in diagnosis. "These findings make a strong argument for immediate reconstruction regardless of cancer stage," the researchers wrote. Dr. Christopher Crisera at the University of California, Los Angeles, Medical Center, led the study, which is published in the journal Plastic and Reconstructive Surgery. HealthDay News (7/1)
WOUNDED WARRIERS
■Veterans express gratitude for Operation Mend
Dr. Timothy Miller, a veteran and the head of the Division of Plastic and Reconstructive Surgery at the University of California, Los Angeles, leads Operation Mend, which provides free reconstructive surgeries for wounded troops. "I'm at a loss for words," said Marine Staff Sgt. Octavio Sanchez, whose nose, lips and cheeks were reconstructed after being burned by a roadside bomb. "How do you talk about somebody who has done so much for us and has taken his time, and given back to us and given us a little peace of mind," Sanchez said of Miller. KOLD-TV (Tucson, Ariz.) (7/1)
Dr. Timothy Miller, a veteran and the head of the Division of Plastic and Reconstructive Surgery at the University of California, Los Angeles, leads Operation Mend, which provides free reconstructive surgeries for wounded troops. "I'm at a loss for words," said Marine Staff Sgt. Octavio Sanchez, whose nose, lips and cheeks were reconstructed after being burned by a roadside bomb. "How do you talk about somebody who has done so much for us and has taken his time, and given back to us and given us a little peace of mind," Sanchez said of Miller. KOLD-TV (Tucson, Ariz.) (7/1)
Monday, June 27, 2011
NON-INVASIVE FAT REMOVAL
DANA POINT, CALIF. – Practice skepticism when it comes to the efficacy of noninvasive fat removal devices, advised Dr. Matthew A. Avram.
"Fat removal has a long history of 'snake oil' salesmanship," Dr. Avram said at the Summit in Aesthetic Medicine, which was sponsored by Skin Disease Education Foundation (SDEF). "You can count on this to continue, because many of these devices do little, if anything. It is important to critically assess these technologies in this emerging field."
Focused Ultrasound
Dr. Avram, faculty director for procedural dermatology training at Harvard Medical School and director of the dermatology laser and cosmetic center at Massachusetts General Hospital, both in Boston, discussed the evidence surrounding devices for noninvasive fat reduction.
One non–Food and Drug Administration–cleared modality being studied is focused ultrasound, which delivers mechanical, nonthermal energy to the thigh, abdomen, and flanks. A study of 30 patients who were treated once a month for 3 months demonstrated a circumference reduction of 2-4 cm in the treated sites (Lasers Surg. Med. 2007;39:315-23). Liver function tests, a lipid panel, and liver ultrasound showed no adverse systemic effects from the procedure.
However, Dr. Avram noted that the study is limited because there was no untreated control group and that circumference "is an inherently imprecise measure of improvement that can be manipulated." MRI would prove objective improvement, he said, but it was not performed in this trial.
In a subsequent study from Hong Kong, 53 patients underwent treatment once a month for 3 months for body contouring (Lasers Surg. Med. 2009; 41:751-9). No significant changes were observed in circumference and caliper measurements, and patients rated their satisfaction as poor.
High-Intensity Focused Ultrasound
High-intensity focused ultrasound, which is also not FDA cleared, involves the rapid heating of adipocytes that are purported to produce coagulative necrosis and cell death in adipose tissue. A retrospective chart review of the modality that was used in 85 patients who underwent one treatment session showed a mean 4.6 cm decrease in waist circumference after 3 months (Aesth. Plast. Surg. 2010;34:577-82). Adverse events that lasted 4-12 weeks occurred in 12% of subjects and included prolonged tenderness, ecchymosis, nodules, and edema, as well as procedural pain in one patient, which required discontinuation of the procedure.
Dr. Avram called high-intensity focused ultrasound a promising technology, "but it's difficult to assess its efficacy. Further study of this technology is needed."
Monopolar Radiofrequency
Monopolar radiofrequency, conventionally used for tissue tightening of the face, has produced lipoatrophy with aggressive settings as a complication. "Perhaps this can be harnessed to effectively treat fat," he said, noting that clinical studies are currently underway.
Low-Level Light Therapy
Low-level light therapy, an FDA-cleared modality for fat removal, uses a multiple head, low-level diode laser at an energy level of 635 nm, which is "roughly equivalent to a laser pointer," Dr. Avram said. In one randomized trial, 59 patients received three treatments of the technology or sham treatment per week for 2 weeks (Lasers Surg. Med. 2009;41:799-809). At 2 weeks, mean circumference reductions in the treatment group were 0.98 inches at the waist, 1.05 inches at the hip, and 0.85 inches at the right thigh and 0.65 inches at the left thigh. Circumference increased in the 2 weeks following treatment.
Dr. Avram said the study was poorly designed because there was no untreated control group, the duration of treatment was only 2 weeks, and there was no ultrasound or other noninvasive evidence of decreased fat layer. "Treat with extreme skepticism," he advised.
Cryolipolysis
Perhaps the most promising technology is cryolipolysis, he said, which is FDA cleared for noninvasive fat removal. Cryolipolysis involves the noninvasive cooling of fat to selectively cause cell death without damage to surrounding tissue.
The mechanism of action of cryolipolysis is believed to involve selective crystallization of lipids in fat cells at temperatures near freezing. "Apoptotic fat cell death is followed by slow dissolution of the fat cell and a gradual release of lipids," Dr. Avram explained. "The inflammatory process results in fat layer reduction over 2-4 months."
When human studies of the technology were first conducted in 2008, enrollment was restricted to 32 patients whose "love handles" were treated at a cooling intensity factor (CIF) of 33 for 60 minutes, and progressed to higher rates of energy extractions for 45 minutes per application site. One side was treated; the untreated contralateral side served as the control.
Efficacy was evaluated at 4 months post treatment via visual assessment as a primary end point, as well as ultrasound and histology. The ultrasound results demonstrated an average 23% decrease in fat layer thickness.
"In this initial group of 32 love handle patients treated once, discernible changes were seen on the treated side vs. baseline of the treated side, and compared to the untreated contralateral control," Dr. Avram said of the findings presented during a poster session at the 2008 annual meeting of the American Society for Dermatologic Surgery. "This unique study design [using each patient as his or her own control], provided very powerful evidence that this was a true treatment effect rather than a change in the patient's diet or exercise pattern during the 4 months after this single procedure exposure."
Common effects after cryolipolysis include redness, which lasts minutes to a few hours; bruising, which may last for a few weeks; and temporary dulling of sensation in the treated area, which typically resolves in 1-8 weeks. No postprocedural changes in pigmentation or laboratory abnormalities have been observed, he said.
About 1 in 2,000 patients experiences severe pain beginning 3-7 days post treatment, which translates into 26 reported cases out of 60,000 treatments. "We are not sure why these occur, but these cases completely resolve with no sequelae," Dr. Avram said.
He emphasized that cryolipolysis is not a replacement for liposuction. "It is not a weight-loss device," he said. "It's best suited for local fat removal resistant to exercise in relatively fit patients."
Dr. Avram disclosed holding stock options in Zeltiq Aesthetics, which manufactures cryolipolysis equipment.
"Fat removal has a long history of 'snake oil' salesmanship," Dr. Avram said at the Summit in Aesthetic Medicine, which was sponsored by Skin Disease Education Foundation (SDEF). "You can count on this to continue, because many of these devices do little, if anything. It is important to critically assess these technologies in this emerging field."
Focused Ultrasound
Dr. Avram, faculty director for procedural dermatology training at Harvard Medical School and director of the dermatology laser and cosmetic center at Massachusetts General Hospital, both in Boston, discussed the evidence surrounding devices for noninvasive fat reduction.
One non–Food and Drug Administration–cleared modality being studied is focused ultrasound, which delivers mechanical, nonthermal energy to the thigh, abdomen, and flanks. A study of 30 patients who were treated once a month for 3 months demonstrated a circumference reduction of 2-4 cm in the treated sites (Lasers Surg. Med. 2007;39:315-23). Liver function tests, a lipid panel, and liver ultrasound showed no adverse systemic effects from the procedure.
However, Dr. Avram noted that the study is limited because there was no untreated control group and that circumference "is an inherently imprecise measure of improvement that can be manipulated." MRI would prove objective improvement, he said, but it was not performed in this trial.
In a subsequent study from Hong Kong, 53 patients underwent treatment once a month for 3 months for body contouring (Lasers Surg. Med. 2009; 41:751-9). No significant changes were observed in circumference and caliper measurements, and patients rated their satisfaction as poor.
High-Intensity Focused Ultrasound
High-intensity focused ultrasound, which is also not FDA cleared, involves the rapid heating of adipocytes that are purported to produce coagulative necrosis and cell death in adipose tissue. A retrospective chart review of the modality that was used in 85 patients who underwent one treatment session showed a mean 4.6 cm decrease in waist circumference after 3 months (Aesth. Plast. Surg. 2010;34:577-82). Adverse events that lasted 4-12 weeks occurred in 12% of subjects and included prolonged tenderness, ecchymosis, nodules, and edema, as well as procedural pain in one patient, which required discontinuation of the procedure.
Dr. Avram called high-intensity focused ultrasound a promising technology, "but it's difficult to assess its efficacy. Further study of this technology is needed."
Monopolar Radiofrequency
Monopolar radiofrequency, conventionally used for tissue tightening of the face, has produced lipoatrophy with aggressive settings as a complication. "Perhaps this can be harnessed to effectively treat fat," he said, noting that clinical studies are currently underway.
Low-Level Light Therapy
Low-level light therapy, an FDA-cleared modality for fat removal, uses a multiple head, low-level diode laser at an energy level of 635 nm, which is "roughly equivalent to a laser pointer," Dr. Avram said. In one randomized trial, 59 patients received three treatments of the technology or sham treatment per week for 2 weeks (Lasers Surg. Med. 2009;41:799-809). At 2 weeks, mean circumference reductions in the treatment group were 0.98 inches at the waist, 1.05 inches at the hip, and 0.85 inches at the right thigh and 0.65 inches at the left thigh. Circumference increased in the 2 weeks following treatment.
Dr. Avram said the study was poorly designed because there was no untreated control group, the duration of treatment was only 2 weeks, and there was no ultrasound or other noninvasive evidence of decreased fat layer. "Treat with extreme skepticism," he advised.
Cryolipolysis
Perhaps the most promising technology is cryolipolysis, he said, which is FDA cleared for noninvasive fat removal. Cryolipolysis involves the noninvasive cooling of fat to selectively cause cell death without damage to surrounding tissue.
The mechanism of action of cryolipolysis is believed to involve selective crystallization of lipids in fat cells at temperatures near freezing. "Apoptotic fat cell death is followed by slow dissolution of the fat cell and a gradual release of lipids," Dr. Avram explained. "The inflammatory process results in fat layer reduction over 2-4 months."
When human studies of the technology were first conducted in 2008, enrollment was restricted to 32 patients whose "love handles" were treated at a cooling intensity factor (CIF) of 33 for 60 minutes, and progressed to higher rates of energy extractions for 45 minutes per application site. One side was treated; the untreated contralateral side served as the control.
Efficacy was evaluated at 4 months post treatment via visual assessment as a primary end point, as well as ultrasound and histology. The ultrasound results demonstrated an average 23% decrease in fat layer thickness.
"In this initial group of 32 love handle patients treated once, discernible changes were seen on the treated side vs. baseline of the treated side, and compared to the untreated contralateral control," Dr. Avram said of the findings presented during a poster session at the 2008 annual meeting of the American Society for Dermatologic Surgery. "This unique study design [using each patient as his or her own control], provided very powerful evidence that this was a true treatment effect rather than a change in the patient's diet or exercise pattern during the 4 months after this single procedure exposure."
Common effects after cryolipolysis include redness, which lasts minutes to a few hours; bruising, which may last for a few weeks; and temporary dulling of sensation in the treated area, which typically resolves in 1-8 weeks. No postprocedural changes in pigmentation or laboratory abnormalities have been observed, he said.
About 1 in 2,000 patients experiences severe pain beginning 3-7 days post treatment, which translates into 26 reported cases out of 60,000 treatments. "We are not sure why these occur, but these cases completely resolve with no sequelae," Dr. Avram said.
He emphasized that cryolipolysis is not a replacement for liposuction. "It is not a weight-loss device," he said. "It's best suited for local fat removal resistant to exercise in relatively fit patients."
Dr. Avram disclosed holding stock options in Zeltiq Aesthetics, which manufactures cryolipolysis equipment.
SILICONE IMPLANTS
By Christine Mai-Duc, Washington Bureau
June 22, 2011, 11:34 a.m.
WASHINGTON — Five years after allowing silicone breast implants back on the market, the Food and Drug Administration said Wednesday that further studies showed that the decision was sound.
The FDA was criticized by consumer groups in 2006 for approving the implants after a 14-year hiatus because of widespread fear that they caused a wide range of illnesses.
But research by the two manufacturers of the implants, released in a report Wednesday, indicates that they have a "reasonable assurance of safety and effectiveness" when used properly, the FDA said.
"I don't know what the critics will ultimately say," said Dr. Jeffrey Shuren, director of the FDA's Center for Devices and Radiological Health, in an interview, "but what we can say is the current data doesn't indicate that silicone-gel-filled breast implants are linked to breast cancer or connective tissue disease or infertility."
Until 2006, women seeking implants for cosmetic reasons had been limited to the less-popular saline variety, which stayed on the market.
But the report was also quick to warn consumers against the assumption that silicone implants are risk free. Patients should still get MRIs every two years to screen for "silent ruptures" of the silicone implants, which don't deflate when they break, as saline implants do.
The agency also stressed that women should not think of silicone implants as long-term devices. According to the data, as many as 1 in 5 women getting implants for strictly cosmetic reasons had to have them removed within eight to 10 years. For patients undergoing reconstructive surgery — often after mastectomies — as many as 1 in 2 were forced to have them removed within that time frame.
The FDA effectively banned them in 1992, after fears arose of a possible link between the implants and certain autoimmune diseases. Their use was restricted to mastectomy patients participating in clinical trials.
At the time, some in the medical research community criticized the ban, saying the decision was based on public opinion, not science – and that in fact little evidence existed on either side of the debate.
What followed was a rash of lawsuits by women claiming leaked silicon from burst implants had caused ailments including lupus, cancer and arthritis. Dow Corning, the biggest manufacturer of silicone implants at the time, went bankrupt after settling a $4-billion class-action suit brought by women claiming injuries.
Since then, there have been a number of major studies that show no link between the silicone implants and connective tissue disease, reproductive problems or breast cancer.
In January, however, the FDA warned of a possible link between breast implants, both silicone and saline, and a rare form of cancer, anaplastic large cell lymphoma. But the FDA says that the low number of cases identified — just 60 worldwide — means that much more research needs to be done.
The report summarizes initial findings by the devices' manufacturers, Santa Barbara-based Mentor Inc. and Irvine-based Allergan, which were required to conduct post-approval studies on more than 80,000 women over 10 years. Five years in, the evidence doesn't link silicone implants to such diseases.
This is welcome news to the more than 300,000 women who received breast implants last year, more than 60% of whom opted for silicone.
The studies, however, will continue. Mentor and Allergan will be required to continue the research until 2016.
June 22, 2011, 11:34 a.m.
WASHINGTON — Five years after allowing silicone breast implants back on the market, the Food and Drug Administration said Wednesday that further studies showed that the decision was sound.
The FDA was criticized by consumer groups in 2006 for approving the implants after a 14-year hiatus because of widespread fear that they caused a wide range of illnesses.
But research by the two manufacturers of the implants, released in a report Wednesday, indicates that they have a "reasonable assurance of safety and effectiveness" when used properly, the FDA said.
"I don't know what the critics will ultimately say," said Dr. Jeffrey Shuren, director of the FDA's Center for Devices and Radiological Health, in an interview, "but what we can say is the current data doesn't indicate that silicone-gel-filled breast implants are linked to breast cancer or connective tissue disease or infertility."
Until 2006, women seeking implants for cosmetic reasons had been limited to the less-popular saline variety, which stayed on the market.
But the report was also quick to warn consumers against the assumption that silicone implants are risk free. Patients should still get MRIs every two years to screen for "silent ruptures" of the silicone implants, which don't deflate when they break, as saline implants do.
The agency also stressed that women should not think of silicone implants as long-term devices. According to the data, as many as 1 in 5 women getting implants for strictly cosmetic reasons had to have them removed within eight to 10 years. For patients undergoing reconstructive surgery — often after mastectomies — as many as 1 in 2 were forced to have them removed within that time frame.
The FDA effectively banned them in 1992, after fears arose of a possible link between the implants and certain autoimmune diseases. Their use was restricted to mastectomy patients participating in clinical trials.
At the time, some in the medical research community criticized the ban, saying the decision was based on public opinion, not science – and that in fact little evidence existed on either side of the debate.
What followed was a rash of lawsuits by women claiming leaked silicon from burst implants had caused ailments including lupus, cancer and arthritis. Dow Corning, the biggest manufacturer of silicone implants at the time, went bankrupt after settling a $4-billion class-action suit brought by women claiming injuries.
Since then, there have been a number of major studies that show no link between the silicone implants and connective tissue disease, reproductive problems or breast cancer.
In January, however, the FDA warned of a possible link between breast implants, both silicone and saline, and a rare form of cancer, anaplastic large cell lymphoma. But the FDA says that the low number of cases identified — just 60 worldwide — means that much more research needs to be done.
The report summarizes initial findings by the devices' manufacturers, Santa Barbara-based Mentor Inc. and Irvine-based Allergan, which were required to conduct post-approval studies on more than 80,000 women over 10 years. Five years in, the evidence doesn't link silicone implants to such diseases.
This is welcome news to the more than 300,000 women who received breast implants last year, more than 60% of whom opted for silicone.
The studies, however, will continue. Mentor and Allergan will be required to continue the research until 2016.
Sunday, June 26, 2011
UPDATE ON SILICONE BREAST IMPLANTS
FDA issues white paper on silicone breast implant safety
The Food and Drug Administration (FDA) yesterday issued an updated white paper on the safety of silicone gel-filled breast implants. ASPS agrees with the FDA statement that "silicone gel-filled breast implants have a reasonable assurance of safety and effectiveness when used as labeled," and it accepts the Agency's position that women who receive silicone gel-filled breast implants for reconstructive or cosmetic purposes will need to monitor the devices over their lifetime. Both the FDA and ASPS agree that breast implants are not lifetime devices.
ASPS believes that the FDA white paper is informative and will be a fruitful resource for plastic surgeons - as well as for patients considering reconstructive or cosmetic breast augmentation.
ASPS shares the FDA's view in the white paper that more than 90 percent of patients are satisfied with their outcomes from breast implantation and report an improved quality of life.
ASPS has collaborated - and will continue to collaborate - with the FDA to ensure that science forms the basis for all decision-making on breast implants, as well as all other medical devices. The Society supports post-market breast implant surveillance and ongoing data collection related to the safety and efficacy of breast implants. ASPS will continue to reiterate that patient safety is its No. 1 priority.
The FDA has provided the following links to related documents:
FDA - Breast Implants
Update on the Safety of Silicone Gel-Filled Breast Implants (2011) - Executive Summary
The FDA also has made available a Consumer Update that contains current and background information on breast implants, as well as other links to additional documents and FAQs.
ASPS has posted additional resources for members and consumers on its website at plasticsurgery.org.
The Food and Drug Administration (FDA) yesterday issued an updated white paper on the safety of silicone gel-filled breast implants. ASPS agrees with the FDA statement that "silicone gel-filled breast implants have a reasonable assurance of safety and effectiveness when used as labeled," and it accepts the Agency's position that women who receive silicone gel-filled breast implants for reconstructive or cosmetic purposes will need to monitor the devices over their lifetime. Both the FDA and ASPS agree that breast implants are not lifetime devices.
ASPS believes that the FDA white paper is informative and will be a fruitful resource for plastic surgeons - as well as for patients considering reconstructive or cosmetic breast augmentation.
ASPS shares the FDA's view in the white paper that more than 90 percent of patients are satisfied with their outcomes from breast implantation and report an improved quality of life.
ASPS has collaborated - and will continue to collaborate - with the FDA to ensure that science forms the basis for all decision-making on breast implants, as well as all other medical devices. The Society supports post-market breast implant surveillance and ongoing data collection related to the safety and efficacy of breast implants. ASPS will continue to reiterate that patient safety is its No. 1 priority.
The FDA has provided the following links to related documents:
FDA - Breast Implants
Update on the Safety of Silicone Gel-Filled Breast Implants (2011) - Executive Summary
The FDA also has made available a Consumer Update that contains current and background information on breast implants, as well as other links to additional documents and FAQs.
ASPS has posted additional resources for members and consumers on its website at plasticsurgery.org.
Thursday, June 23, 2011
THE PASSING OF A GIANT IN PLASTIC AND RECONSTRUCTIVE SURGERY
Dr. D. Ralph Millard, reconstructive surgeon, UM professor, specializing in cleft lips, dies at 92
While heading the University of Miami’s and Jackson Memorial Hospital’s plastic surgery divisions, he fixed thousands of cleft lips.
BY ELINOR J. BRECHER
ebrecher@MiamiHerald.com
Dr. D. Ralph Millard Jr., the Miami plastic surgeon who developed a method of correcting cleft lips that has saved children all over the world from living with deformed faces, died Sunday at his Sunny Isles Beach home.
Born David Ralph Millard Jr., on June 4, 1919, in St. Louis, he had recently turned 92. Son Bond Millard said his father died of heart failure.
Millard chaired the plastic surgery division at what is now the University of Miami Miller School of Medicine for 28 years, at the same time serving as Jackson Memorial Hospital’s plastic surgery chief.
He was best known for developing “rotation advancement’’ surgery in the ‘50s. The method conserves tissue that doctors had routinely removed when correcting a cleft lip, producing a natural-looking mouth in much less time.
Before he developed it, surgical procedures were performed on patients into their late teens. With his method, most children are operated on by 4 or 5.
Millard also made major advances in corrective rhinoplasty— nose surgery—for people disfigured by accidents, cancer, war wounds, even cocaine abuse.
“His work is considered pure artistry," Dr. Bernard Fogel, dean emeritus of the medical school, told The Miami Herald when Millard retired in 2000, three months before the death of his wife of 45 years, Barbara Smith Millard, orginally from Tulsa, OK. “He’s a giant."
That year, Millard was nominated as one of 10 "Plastic Surgeons of the Millennium" by the members of the American Society of Plastic Surgery. At the time, Plastic Surgery News called him “the most brilliant and creative plastic surgeon we have alive.’’
According to the World Health Organization, cleft lip, with or without cleft palate, is considered a serious birth defect affecting about one in every 600 to 700 newborns, meaning that a child is born with a cleft somewhere in the world every 2 1/2 minutes.
“Eighty to 90 percent of clefts are now done with his method,’’ said Dr. S. Anthony Wolfe, Millard’s longtime medical-practice partner. “He also pioneered [post-mastectomy] breast reconstruction when it was frowned upon, and certain types of facelifts. He operated on ... the wives, daughters and mothers of many prominent plastic surgeons.’’
A prolific author, Millard documented every one of his cases with pictures and notations, son Bond said.
Towering in both physical and professional stature, he was demanding, exacting and “not warm and fuzzy,’’ Bond added. “His students were scared of him.’’
But Millard was quietly generous with needy patients, and spent decades treating Third World children for free.
“He did so much pro bono and never told anyone,’’ Bond said. “He had set up an account for his wealthy patients to put money into for the poor.’’
“He bought cases of baby food for families,’’ Wolfe added. “If he really wanted to get a patient back [for a check-up], he’d buy the family tires.’’
Even those who could afford to pay top dollar didn’t, if Millard felt they needed his help.
Miami attorney Robert Josefsberg went to Millard in 1975 with a devastating wound: a hole in his palate caused by cancer. It affected his speech so dramatically that the sound of his voice became a courtroom distraction.
Millard, who fixed it in a 10-hour operation using a procedure he invented, “saved me and saved my career,’’ Josefsberg said.
When he got the bill, for $500, Josefsberg figured it was a mistake. Millard explained: “ ‘I pay for my fine wines and cruises with fees on elective surgery. When someone absolutely needs me on something that is very difficult, I charge the minimum.’ ’’
Millard, a lawyer’s son who served stateside in the World War II Navy, got interested in clefts as a chief plastic surgeon for the Marine Corps during the Korean War, discharging with the rank of major.
“Driving through little villages, I would see in the shadows of huts children with cleft not wanting to be seen, but to see," Millard told The Herald. He explained that he was “fascinated by the children and shocked by the pain of the parents,’’ and hit on the best way to help them late one night as he stared at the photo of a child with a cleft lip.
He focused on the “cupid’s bow’’ dimple in the top lip, which surgeons routinely excised during corrective surgery. Millard realized he could create a more natural mouth by saving and relocating the tissue.
As a young doctor, he described his new approach at the First Congress of the International Society of Plastic Surgery in Stockholm.
“There was this terrible silence because they saw for the first time how to use the cupid’s bow," Millard told The Herald. Among the few to laud him was Sir Harold D. Gillies, the legendary British surgeon, and a mentor.
“Everyone else,’’ he recalled, “looked like they had taken a cold-water enema."
Dr. Walter Mullin, another of Millard’s private-practice partners, once told The Herald: “Seldom do people truly invent new things in plastic surgery, but he did. In cleft lip, he figured out nothing was missing, it was just out of position."
Millard, an Eagle Scout, graduated from the Asheville School for Boys, Asheville, N.C. He received a B.A. in English in 1941 from Yale University, where he boxed and played varsity football.
His coach: Yale law student Gerald R. Ford, the future U.S. president.
Millard graduated from Harvard Medical School in 1944 and interned in Boston before joining the Navy in 1945. A year later, Lt.jg Millard joined a residency program at Vanderbilt University Hospital in Nashville.
In 1948, he left for England, where he trained under Harold Gillies. They would later co-author the first of his nine books, The Principles and Art of Plastic Surgery. He wrote 149 peer-reviewed journal articles and 53 book chapters.
The principles, both operational and intellectual, include “seek insight into the patient’s true desires,’’ “acknowledge your limitations so as to do no harm,” and “when in doubt, don’t.’’
“His principles have so many applications to any type of surgery,’’ noted Mullin, who practices in Dadeland. “Some of them were applicable to life.’’
Among Millard’s many honors: the American Society of Plastic and Reconstructive Surgeons’ highest award “in recognition of his development of the specialty of plastic surgery and his outstanding scientific contributions to the advancement of its practice,’’ in 1988.
In 1991, the Miami Children’s Hospital International Hall of Fame honored him with a bronze bust.
Dr. Seth Thaller succeeded Millard as the medical school’s plastic surgery chief in 1995.
Because of Millard, UM “was Mount Olympus’’ for the specialty, he said.
“He was a master, an innovator, and what he did laid the groundwork for [procedures] still in effect today,’’ Thaller said. “If not for his legacy, the division wouldn’t be thriving the way it is today.’’
An avid water skier with an affinity for cowboys, Millard would sometimes “show off’’ by roping with a lasso while waterskiing, son Bond said.
“He was very into his [three] children’s sports,’’ said Bond, who played football at Miami Country Day School, then Miami Beach High. His sister, now Meleney Moore, was a state champion in the 330-yard intermediate hurdles.
Millard’s letters to the editor published in The Herald ranged from a defense of UM football Coach Butch Davis in 1995 — “He is a winner, but more important than that, he is a man of principle ... He will eventually have a winning team, but he will not take short cuts to get there’’— to a diatribe against physician advertising in 1996: “It has always been unethical for doctors to advertise, because a reputation is gained by good results, honest and dedicated service to patients, and the respect of referring physicians. … Advertisements can claim merits unearned, skills not present, and results never attained. It can almost make a hero out of a bum.’’
Millard joined the UM medical school faculty in 1956, and was named chief of the Division of Plastic Surgery in 1967, near the start of what Wolfe called Millard’s “most productive period,’’ until the early ‘80s.
“He was very demanding of his trainees,’’ said Wolfe, who was one. “It was a philosophy of life, and most people were very grateful for that kind of attention. He would push everybody to the limit, and then stop.’’
“He used to say that he doesn’t like anything between the hammer and the nail,’’ Mullin added. “If you were good, he would say it, and if you were bad, he would say it.’’
After his wife died, Millard spent three years in Houston with his children before returning to South Florida. He travelled and continued to write into old age.
His autobiography, Saving Faces: A Plastic Surgeon’s Remarkable Story, was published in 2003.
In addition to daughter Meleney and son Bond, Millard is survived by son Duke, and six grandchildren.
A viewing will be held from 6-8 p.m. Friday at Caballero Rivero Woodlawn Funeral Home, 3344 SW Eighth St. A memorial service is scheduled for 1 p.m. Saturday at Miami Shores Presbyterian Church, 9405 Park Dr., Miami Shores.
In lieu of flowers, the family welcomes donations to The Millard Society. Go to www.millardsociety.org.
..
Read more: http://www.miamiherald.com/2011/06/21/v-fullstory/2277873/dr-d-ralph-millard-reconstructive.html#ixzz1Q62uwmmf
While heading the University of Miami’s and Jackson Memorial Hospital’s plastic surgery divisions, he fixed thousands of cleft lips.
BY ELINOR J. BRECHER
ebrecher@MiamiHerald.com
Dr. D. Ralph Millard Jr., the Miami plastic surgeon who developed a method of correcting cleft lips that has saved children all over the world from living with deformed faces, died Sunday at his Sunny Isles Beach home.
Born David Ralph Millard Jr., on June 4, 1919, in St. Louis, he had recently turned 92. Son Bond Millard said his father died of heart failure.
Millard chaired the plastic surgery division at what is now the University of Miami Miller School of Medicine for 28 years, at the same time serving as Jackson Memorial Hospital’s plastic surgery chief.
He was best known for developing “rotation advancement’’ surgery in the ‘50s. The method conserves tissue that doctors had routinely removed when correcting a cleft lip, producing a natural-looking mouth in much less time.
Before he developed it, surgical procedures were performed on patients into their late teens. With his method, most children are operated on by 4 or 5.
Millard also made major advances in corrective rhinoplasty— nose surgery—for people disfigured by accidents, cancer, war wounds, even cocaine abuse.
“His work is considered pure artistry," Dr. Bernard Fogel, dean emeritus of the medical school, told The Miami Herald when Millard retired in 2000, three months before the death of his wife of 45 years, Barbara Smith Millard, orginally from Tulsa, OK. “He’s a giant."
That year, Millard was nominated as one of 10 "Plastic Surgeons of the Millennium" by the members of the American Society of Plastic Surgery. At the time, Plastic Surgery News called him “the most brilliant and creative plastic surgeon we have alive.’’
According to the World Health Organization, cleft lip, with or without cleft palate, is considered a serious birth defect affecting about one in every 600 to 700 newborns, meaning that a child is born with a cleft somewhere in the world every 2 1/2 minutes.
“Eighty to 90 percent of clefts are now done with his method,’’ said Dr. S. Anthony Wolfe, Millard’s longtime medical-practice partner. “He also pioneered [post-mastectomy] breast reconstruction when it was frowned upon, and certain types of facelifts. He operated on ... the wives, daughters and mothers of many prominent plastic surgeons.’’
A prolific author, Millard documented every one of his cases with pictures and notations, son Bond said.
Towering in both physical and professional stature, he was demanding, exacting and “not warm and fuzzy,’’ Bond added. “His students were scared of him.’’
But Millard was quietly generous with needy patients, and spent decades treating Third World children for free.
“He did so much pro bono and never told anyone,’’ Bond said. “He had set up an account for his wealthy patients to put money into for the poor.’’
“He bought cases of baby food for families,’’ Wolfe added. “If he really wanted to get a patient back [for a check-up], he’d buy the family tires.’’
Even those who could afford to pay top dollar didn’t, if Millard felt they needed his help.
Miami attorney Robert Josefsberg went to Millard in 1975 with a devastating wound: a hole in his palate caused by cancer. It affected his speech so dramatically that the sound of his voice became a courtroom distraction.
Millard, who fixed it in a 10-hour operation using a procedure he invented, “saved me and saved my career,’’ Josefsberg said.
When he got the bill, for $500, Josefsberg figured it was a mistake. Millard explained: “ ‘I pay for my fine wines and cruises with fees on elective surgery. When someone absolutely needs me on something that is very difficult, I charge the minimum.’ ’’
Millard, a lawyer’s son who served stateside in the World War II Navy, got interested in clefts as a chief plastic surgeon for the Marine Corps during the Korean War, discharging with the rank of major.
“Driving through little villages, I would see in the shadows of huts children with cleft not wanting to be seen, but to see," Millard told The Herald. He explained that he was “fascinated by the children and shocked by the pain of the parents,’’ and hit on the best way to help them late one night as he stared at the photo of a child with a cleft lip.
He focused on the “cupid’s bow’’ dimple in the top lip, which surgeons routinely excised during corrective surgery. Millard realized he could create a more natural mouth by saving and relocating the tissue.
As a young doctor, he described his new approach at the First Congress of the International Society of Plastic Surgery in Stockholm.
“There was this terrible silence because they saw for the first time how to use the cupid’s bow," Millard told The Herald. Among the few to laud him was Sir Harold D. Gillies, the legendary British surgeon, and a mentor.
“Everyone else,’’ he recalled, “looked like they had taken a cold-water enema."
Dr. Walter Mullin, another of Millard’s private-practice partners, once told The Herald: “Seldom do people truly invent new things in plastic surgery, but he did. In cleft lip, he figured out nothing was missing, it was just out of position."
Millard, an Eagle Scout, graduated from the Asheville School for Boys, Asheville, N.C. He received a B.A. in English in 1941 from Yale University, where he boxed and played varsity football.
His coach: Yale law student Gerald R. Ford, the future U.S. president.
Millard graduated from Harvard Medical School in 1944 and interned in Boston before joining the Navy in 1945. A year later, Lt.jg Millard joined a residency program at Vanderbilt University Hospital in Nashville.
In 1948, he left for England, where he trained under Harold Gillies. They would later co-author the first of his nine books, The Principles and Art of Plastic Surgery. He wrote 149 peer-reviewed journal articles and 53 book chapters.
The principles, both operational and intellectual, include “seek insight into the patient’s true desires,’’ “acknowledge your limitations so as to do no harm,” and “when in doubt, don’t.’’
“His principles have so many applications to any type of surgery,’’ noted Mullin, who practices in Dadeland. “Some of them were applicable to life.’’
Among Millard’s many honors: the American Society of Plastic and Reconstructive Surgeons’ highest award “in recognition of his development of the specialty of plastic surgery and his outstanding scientific contributions to the advancement of its practice,’’ in 1988.
In 1991, the Miami Children’s Hospital International Hall of Fame honored him with a bronze bust.
Dr. Seth Thaller succeeded Millard as the medical school’s plastic surgery chief in 1995.
Because of Millard, UM “was Mount Olympus’’ for the specialty, he said.
“He was a master, an innovator, and what he did laid the groundwork for [procedures] still in effect today,’’ Thaller said. “If not for his legacy, the division wouldn’t be thriving the way it is today.’’
An avid water skier with an affinity for cowboys, Millard would sometimes “show off’’ by roping with a lasso while waterskiing, son Bond said.
“He was very into his [three] children’s sports,’’ said Bond, who played football at Miami Country Day School, then Miami Beach High. His sister, now Meleney Moore, was a state champion in the 330-yard intermediate hurdles.
Millard’s letters to the editor published in The Herald ranged from a defense of UM football Coach Butch Davis in 1995 — “He is a winner, but more important than that, he is a man of principle ... He will eventually have a winning team, but he will not take short cuts to get there’’— to a diatribe against physician advertising in 1996: “It has always been unethical for doctors to advertise, because a reputation is gained by good results, honest and dedicated service to patients, and the respect of referring physicians. … Advertisements can claim merits unearned, skills not present, and results never attained. It can almost make a hero out of a bum.’’
Millard joined the UM medical school faculty in 1956, and was named chief of the Division of Plastic Surgery in 1967, near the start of what Wolfe called Millard’s “most productive period,’’ until the early ‘80s.
“He was very demanding of his trainees,’’ said Wolfe, who was one. “It was a philosophy of life, and most people were very grateful for that kind of attention. He would push everybody to the limit, and then stop.’’
“He used to say that he doesn’t like anything between the hammer and the nail,’’ Mullin added. “If you were good, he would say it, and if you were bad, he would say it.’’
After his wife died, Millard spent three years in Houston with his children before returning to South Florida. He travelled and continued to write into old age.
His autobiography, Saving Faces: A Plastic Surgeon’s Remarkable Story, was published in 2003.
In addition to daughter Meleney and son Bond, Millard is survived by son Duke, and six grandchildren.
A viewing will be held from 6-8 p.m. Friday at Caballero Rivero Woodlawn Funeral Home, 3344 SW Eighth St. A memorial service is scheduled for 1 p.m. Saturday at Miami Shores Presbyterian Church, 9405 Park Dr., Miami Shores.
In lieu of flowers, the family welcomes donations to The Millard Society. Go to www.millardsociety.org.
..
Read more: http://www.miamiherald.com/2011/06/21/v-fullstory/2277873/dr-d-ralph-millard-reconstructive.html#ixzz1Q62uwmmf
Saturday, May 28, 2011
THE UPWARD TREND IN CUP SIZE
■Women seek more significant breast augmentations
The number of women undergoing breast augmentation rose 39% between 2000 and 2010, according to the American Society of Plastic Surgeons, and the trend seems to be toward larger cup size. "The women in my practice used to go a cup size larger. But now about half my patients want to go two cup sizes larger," plastic surgeon and ASPS President Phil Haeck said. Greater social acceptance of cosmetic procedures may be driving the trend, Haeck said. CBS News
The number of women undergoing breast augmentation rose 39% between 2000 and 2010, according to the American Society of Plastic Surgeons, and the trend seems to be toward larger cup size. "The women in my practice used to go a cup size larger. But now about half my patients want to go two cup sizes larger," plastic surgeon and ASPS President Phil Haeck said. Greater social acceptance of cosmetic procedures may be driving the trend, Haeck said. CBS News
Saturday, May 21, 2011
PLASTIC SURGERY IN TEENAGERS
■Teens seek a variety of plastic surgery procedures
Social media and greater social acceptability may be making plastic surgery more popular among teenagers, according to some experts. The number of procedures on teens doubled between 2002 and 2006, and although the total number of procedures on teens dropped in 2010, more types of procedures were performed, according to the American Society of Plastic Surgeons. Rhinoplasty is the most popular procedure, followed by gynecomastia for boys and breast surgery for girls. WLKY-TV (Louisville, Ky.) (5/17)
Social media and greater social acceptability may be making plastic surgery more popular among teenagers, according to some experts. The number of procedures on teens doubled between 2002 and 2006, and although the total number of procedures on teens dropped in 2010, more types of procedures were performed, according to the American Society of Plastic Surgeons. Rhinoplasty is the most popular procedure, followed by gynecomastia for boys and breast surgery for girls. WLKY-TV (Louisville, Ky.) (5/17)
Saturday, May 14, 2011
STEM CELLS FOR FACIAL AND BREAST AUGMENTATION
■ASPS: Use caution with stem cell procedures
Marketing may be ahead of science in stem cell-based breast augmentation and facial enhancement, doctors say. Though lab and clinical studies are encouraging, the science does not yet support some claims being made, University of Pittsburgh plastic surgeon and stem cell expert Dr. J. Peter Rubin said. A joint task force of the American Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery said members should refrain from offering stem cell-based cosmetic procedures until studies prove they are safe and effective. The Orange County Register (Santa Ana, Calif.) (5/9),
Marketing may be ahead of science in stem cell-based breast augmentation and facial enhancement, doctors say. Though lab and clinical studies are encouraging, the science does not yet support some claims being made, University of Pittsburgh plastic surgeon and stem cell expert Dr. J. Peter Rubin said. A joint task force of the American Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery said members should refrain from offering stem cell-based cosmetic procedures until studies prove they are safe and effective. The Orange County Register (Santa Ana, Calif.) (5/9),
MEDICAL TOURISM - A GROWING PROBLEM
■Some patients sacrifice safety for cost savings
An Arizona woman who wanted rhinoplasty and rhytidectomy for her 60th birthday returned from a surgeon in Mexico swollen and bruised due to a damaged salivary gland. Tucson-area plastic surgeon Dr. Gwen Maxwell says medical tourism is a growing problem. "There's a huge economic incentive for people to go and seek care in other countries," she said. But patients often return dissatisfied. "Either the scars aren't placed properly, or they heal badly. There are deformities that can occur in the neck, damage to various nerves," she said. KVOA Communications (Tucson, Ariz.) (5/11)
An Arizona woman who wanted rhinoplasty and rhytidectomy for her 60th birthday returned from a surgeon in Mexico swollen and bruised due to a damaged salivary gland. Tucson-area plastic surgeon Dr. Gwen Maxwell says medical tourism is a growing problem. "There's a huge economic incentive for people to go and seek care in other countries," she said. But patients often return dissatisfied. "Either the scars aren't placed properly, or they heal badly. There are deformities that can occur in the neck, damage to various nerves," she said. KVOA Communications (Tucson, Ariz.) (5/11)
Saturday, May 7, 2011
FLOWERS, CANDY, TUMMY TUCK?
ARLINGTON HEIGHTS, Ill., May 2, 2011 - What would mom get herself for Mother's Day if she had the chance? A new survey shows that it might be a tummy tuck or breast lift.
A survey released today from the American Society of Plastic Surgeons (ASPS) shows that if cost were not an issue, 62 percent of mothers said that they would consider a "mommy makeover" that includes procedures such as a tummy tuck, breast augmentation and/or breast lift.*
According to ASPS statistics, the number of women getting "mommy makeover" procedures is on the rise. Women had nearly 112,000 tummy tucks in 2010, up 85 percent since 2000; 90,000 breast lifts, up 70 percent since 2000; and 296,000 breast augmentations, up 39 percent since 2000.
"In the last decade we've seen women's attitudes about cosmetic surgery change. Today women are not afraid to admit that they love their children, but they wish their bodies looked the way they did before their first pregnancies. And they're not afraid to acknowledge that they may need a little help beyond a healthy diet and exercise," said ASPS President Phillip Haeck, MD.
Another trend that ASPS Member Surgeons are noticing is that the type of patient seeking "mommy makeover" plastic surgery is younger than a decade ago.
"In the past we saw a lot of women in their 50s getting these types of procedures. But today we are seeing young mothers in their 30s coming in for procedures such as tummy tucks and breast lifts. They don't want to wait years to reestablish how they used to look. They want their pre-baby bodies back now," said Dr. Haeck.
The promise of getting her body back is what led 38-year-old Dana Van Gray to undergo surgery for a tummy tuck and breast augmentation just one year after having her last child.
"I didn't like my stomach. I started noticing a muffin top and I thought - why wait? I'm young, I'm healthy and I want to look good now," Van Gray said.
"More and more patients like Dana are coming in today asking for mommy makeovers, because women now openly talk about having these procedures. It's more accepted than it was ten years ago," said Van Gray's plastic surgeon, Allen Rosen, MD, an ASPS Member Surgeon in Montclair, New Jersey.
"The techniques and the technologies are to the point where we can do these procedures in an outpatient setting in a very safe and effective fashion, minimizing the amount of downtime and pain. This appeals to our patients," said Dr. Rosen.
Van Gray says that her new and improved body not only enhanced her looks, but also her attitude.
"I feel good so I can be a better mom to my kids," Van Gray said.
If you are considering a "mommy makeover" the ASPS has these tips:
•Wait at least six months to one year after having your last child to undergo "mommy makeover" procedures
•Be specific about your post-baby body goals so that your surgeon can recommend the most appropriate procedures
•To optimize the final outcome, if you are trying to lose weight, do so before undergoing "mommy makeover" procedures
•Find a surgeon who is board certified in plastic surgery
•Ask to see before and after photos of your plastic surgeon's recent work
A survey released today from the American Society of Plastic Surgeons (ASPS) shows that if cost were not an issue, 62 percent of mothers said that they would consider a "mommy makeover" that includes procedures such as a tummy tuck, breast augmentation and/or breast lift.*
According to ASPS statistics, the number of women getting "mommy makeover" procedures is on the rise. Women had nearly 112,000 tummy tucks in 2010, up 85 percent since 2000; 90,000 breast lifts, up 70 percent since 2000; and 296,000 breast augmentations, up 39 percent since 2000.
"In the last decade we've seen women's attitudes about cosmetic surgery change. Today women are not afraid to admit that they love their children, but they wish their bodies looked the way they did before their first pregnancies. And they're not afraid to acknowledge that they may need a little help beyond a healthy diet and exercise," said ASPS President Phillip Haeck, MD.
Another trend that ASPS Member Surgeons are noticing is that the type of patient seeking "mommy makeover" plastic surgery is younger than a decade ago.
"In the past we saw a lot of women in their 50s getting these types of procedures. But today we are seeing young mothers in their 30s coming in for procedures such as tummy tucks and breast lifts. They don't want to wait years to reestablish how they used to look. They want their pre-baby bodies back now," said Dr. Haeck.
The promise of getting her body back is what led 38-year-old Dana Van Gray to undergo surgery for a tummy tuck and breast augmentation just one year after having her last child.
"I didn't like my stomach. I started noticing a muffin top and I thought - why wait? I'm young, I'm healthy and I want to look good now," Van Gray said.
"More and more patients like Dana are coming in today asking for mommy makeovers, because women now openly talk about having these procedures. It's more accepted than it was ten years ago," said Van Gray's plastic surgeon, Allen Rosen, MD, an ASPS Member Surgeon in Montclair, New Jersey.
"The techniques and the technologies are to the point where we can do these procedures in an outpatient setting in a very safe and effective fashion, minimizing the amount of downtime and pain. This appeals to our patients," said Dr. Rosen.
Van Gray says that her new and improved body not only enhanced her looks, but also her attitude.
"I feel good so I can be a better mom to my kids," Van Gray said.
If you are considering a "mommy makeover" the ASPS has these tips:
•Wait at least six months to one year after having your last child to undergo "mommy makeover" procedures
•Be specific about your post-baby body goals so that your surgeon can recommend the most appropriate procedures
•To optimize the final outcome, if you are trying to lose weight, do so before undergoing "mommy makeover" procedures
•Find a surgeon who is board certified in plastic surgery
•Ask to see before and after photos of your plastic surgeon's recent work
Sunday, April 10, 2011
THE AMAZING PROGRESS IN RECONSTRUCTIVE SURGERY
■Chimp-attack victim gets approval for face and hand transplants
Charla Nash, whose face and hands were destroyed when a friend's pet chimpanzee attacked her, has passed pre-operative evaluations and is eligible for a face and hand transplant at Brigham and Women's Hospital when a suitable donor is found. Doctors at the Cleveland Clinic previously ruled out Nash as a candidate due to the complexity of her injuries. Surgeons led by plastic surgeon Dr. Bohdan Pomahac at Brigham and Women's are considering whether to perform the hand and face transplants simultaneously, which has been done only once before. The Washington Post/The Associated Press (3/31)
Charla Nash, whose face and hands were destroyed when a friend's pet chimpanzee attacked her, has passed pre-operative evaluations and is eligible for a face and hand transplant at Brigham and Women's Hospital when a suitable donor is found. Doctors at the Cleveland Clinic previously ruled out Nash as a candidate due to the complexity of her injuries. Surgeons led by plastic surgeon Dr. Bohdan Pomahac at Brigham and Women's are considering whether to perform the hand and face transplants simultaneously, which has been done only once before. The Washington Post/The Associated Press (3/31)
Sunday, April 3, 2011
FACIAL SOFT TISSUE FILLERS
Collagen Fillers (Cosmoplast; Cymetra; Zyderm; Zyplast): Expected Duration: 3-4 months
Hyaluronic Acid Fillers (Juvederm; Restylane; Perlane; Hylaform): Expected Duration: 6-12 months
Calcium Hydroxylapatite Fillers (Radiesse): Expected Duration: 1 year. Seems to be more effective in correcting nasolabial folds than Hyaluronic Acid Fillers
Poly-L-lactic Acid Fillers (Sculptra): Expected Duration: 2 years; Used to restore volume in HIV patients and used for cosmetic purposes. Should not be used in the perioral or periorbital regions because of nodule formation
Polymethyl Methacrylate Fillers (Artefill): Expected Duration: 5 years
Hyaluronic Acid Fillers (Juvederm; Restylane; Perlane; Hylaform): Expected Duration: 6-12 months
Calcium Hydroxylapatite Fillers (Radiesse): Expected Duration: 1 year. Seems to be more effective in correcting nasolabial folds than Hyaluronic Acid Fillers
Poly-L-lactic Acid Fillers (Sculptra): Expected Duration: 2 years; Used to restore volume in HIV patients and used for cosmetic purposes. Should not be used in the perioral or periorbital regions because of nodule formation
Polymethyl Methacrylate Fillers (Artefill): Expected Duration: 5 years
VAMPIRE FACE LIFT
"Vampire Face-lifts": Smooth at First Bite
By Catherine Saint Louis
In this anti-aging age, perhaps it’s unsurprising that vampires—ancient, but with forever-young skin—are a cultural obsession. Now a cosmetic treatment to fill in wrinkles or to plump up hollow cheeks is being marketed as a “vampire filler” or a “vampire face-lift.”
In fact, it’s not surgery, but an in-office procedure that entails having blood drawn from your arm, then spun in a centrifuge to separate out the platelets. They are then injected into your face, with the hope of stimulating new collagen production. Selphyl, as the system is called, arrived on the booming facial-rejuvenation market in 2009, and is now used by roughly 300 doctors nationwide in the name of beauty, says Sanjay Batra, the chief executive of Aesthetic Factors, which manufactures the Selphyl system.
This year, the “vampire face-lift” has been promoted on The Rachael Ray Show and The Doctors. It’s also gotten airtime on more than a dozen local news programs, some of which presented unproved claims that results will last 2 years.
Andrew Ordon, MD, FACS, one of the hosts of The Doctors and a board-certified plastic surgeon, gushed on air, “Vampires have moved into plastic surgery, too, and I’m one of them.” The patient in his segment had also recently had her own fat injected into her face to plump it, so it wasn’t clear that platelets had anything to do with her fresher appearance. (Not that that stopped audience applause.)
Ghoulish as the procedure sounds, some patients prefer the idea of using their own blood rather than a neurotoxin or synthetic filler to rejuvenate their faces. “We all want to look better,” said Joan Sarlo, 56, who underwent a Selphyl “vamp-lift” performed by Lisa A. Zdinak, MD, a Manhattan-based doctor whose specialty is "ophthalmic plastic surgery." But the “less unnatural the better,” Sarlo says. “What could be better than your own blood?”
By Catherine Saint Louis
In this anti-aging age, perhaps it’s unsurprising that vampires—ancient, but with forever-young skin—are a cultural obsession. Now a cosmetic treatment to fill in wrinkles or to plump up hollow cheeks is being marketed as a “vampire filler” or a “vampire face-lift.”
In fact, it’s not surgery, but an in-office procedure that entails having blood drawn from your arm, then spun in a centrifuge to separate out the platelets. They are then injected into your face, with the hope of stimulating new collagen production. Selphyl, as the system is called, arrived on the booming facial-rejuvenation market in 2009, and is now used by roughly 300 doctors nationwide in the name of beauty, says Sanjay Batra, the chief executive of Aesthetic Factors, which manufactures the Selphyl system.
This year, the “vampire face-lift” has been promoted on The Rachael Ray Show and The Doctors. It’s also gotten airtime on more than a dozen local news programs, some of which presented unproved claims that results will last 2 years.
Andrew Ordon, MD, FACS, one of the hosts of The Doctors and a board-certified plastic surgeon, gushed on air, “Vampires have moved into plastic surgery, too, and I’m one of them.” The patient in his segment had also recently had her own fat injected into her face to plump it, so it wasn’t clear that platelets had anything to do with her fresher appearance. (Not that that stopped audience applause.)
Ghoulish as the procedure sounds, some patients prefer the idea of using their own blood rather than a neurotoxin or synthetic filler to rejuvenate their faces. “We all want to look better,” said Joan Sarlo, 56, who underwent a Selphyl “vamp-lift” performed by Lisa A. Zdinak, MD, a Manhattan-based doctor whose specialty is "ophthalmic plastic surgery." But the “less unnatural the better,” Sarlo says. “What could be better than your own blood?”
HEALTH CARE REFORM LAW ONE YEAR LATER
Today, on the one year anniversary since government-approved health care was signed into law, a look at the implementation of the new health care reform reveals how the legislation has failed to deliver on costs, premiums, spending, and preserving Americans’ existing coverage:
19 — States where parents can no longer buy child-only insurance policies as a result of the law
30 — States suing to block the law from taking effect, or requesting waivers from its requirements
51 — Percentage of American workers who will lose their current health coverage by 2013, according to the Administration’s own estimates
1,270 — New bureaucrats requested by the Internal Revenue Service to implement the law this year
$2,100 — Increase in individual insurance premiums due to Obamacare, according to the Congressional Budget Office
$2,500 — Premium reduction promised by candidate Obama “by the end of my first term as President”
6,578 — Pages of new regulations issued implementing Obamacare through March 14, 2011
800,000 — Reduction in the American labor force due to Obamacare provisions that “will effectively increase marginal tax rates, which will also discourage work,” according to the CBO
2,624,720 — Total individuals in 1,040 plans granted waivers thus far exempting them from the law’s insurance mandates; nearly half of whom participate in union plans
7,400,000 — Reduction in Medicare Advantage enrollment as a result of Obamacare, resulting in a loss of choice for seniors and millions of beneficiaries losing their current health plan
40,000,000 — Firms subject to the health law’s new 1099 reporting requirements, which the National Federation of Independent Business called a “tremendous new paperwork compliance burden”
$118,000,000,000 — New costs imposed on states to implement Obamacare—budgetary costs that will lead to reduced services for other state programs like education or to higher state taxes
$310,800,000,000 — Projected increase in health costs due to Obamacare, according to the independent Medicare actuary, who called its promise of lower costs “false, more so than true”
$552,200,000,000 — Amount of higher taxes Americans will pay if Obamacare remains in place
$1,390,000,000,000 — Federal spending on new entitlements during fiscal years 2012-2021 according to the CBO, a 48 percent increase from an earlier estimate
19 — States where parents can no longer buy child-only insurance policies as a result of the law
30 — States suing to block the law from taking effect, or requesting waivers from its requirements
51 — Percentage of American workers who will lose their current health coverage by 2013, according to the Administration’s own estimates
1,270 — New bureaucrats requested by the Internal Revenue Service to implement the law this year
$2,100 — Increase in individual insurance premiums due to Obamacare, according to the Congressional Budget Office
$2,500 — Premium reduction promised by candidate Obama “by the end of my first term as President”
6,578 — Pages of new regulations issued implementing Obamacare through March 14, 2011
800,000 — Reduction in the American labor force due to Obamacare provisions that “will effectively increase marginal tax rates, which will also discourage work,” according to the CBO
2,624,720 — Total individuals in 1,040 plans granted waivers thus far exempting them from the law’s insurance mandates; nearly half of whom participate in union plans
7,400,000 — Reduction in Medicare Advantage enrollment as a result of Obamacare, resulting in a loss of choice for seniors and millions of beneficiaries losing their current health plan
40,000,000 — Firms subject to the health law’s new 1099 reporting requirements, which the National Federation of Independent Business called a “tremendous new paperwork compliance burden”
$118,000,000,000 — New costs imposed on states to implement Obamacare—budgetary costs that will lead to reduced services for other state programs like education or to higher state taxes
$310,800,000,000 — Projected increase in health costs due to Obamacare, according to the independent Medicare actuary, who called its promise of lower costs “false, more so than true”
$552,200,000,000 — Amount of higher taxes Americans will pay if Obamacare remains in place
$1,390,000,000,000 — Federal spending on new entitlements during fiscal years 2012-2021 according to the CBO, a 48 percent increase from an earlier estimate
Sunday, January 30, 2011
ANAPLASTIC LARGE CELL LYMPHOMA IN THE SETTING OF BREAST IMPLANTS
■FDA issues safety signal on ALCL and breast implants
The FDA on Wednesday warned that women with breast implants might be at a "small increased risk" of an immune system cancer called anaplastic large cell lymphoma after data revealed a total of 60 ALCL cases among those with saline and silicone implants. The FDA is seeking more data on ALCL cases and advises women with implants to consult their doctors if they experience implant-related symptoms, including pain, lumps or swelling.
If you have breast implants, there is no need to change your routine medical care and follow-up. ALCL is very rare; it has occurred in only a very small number of the millions of women who have breast implants.
It is estimated that the incidence of ALCL in patients with breast implants is about 1:500,000, whereas, the risk of a woman developing breast cancer over their life-time is about 1 in 9. To put things in prespective, one is much more likely to be stuck by a lighting bolt or an asteroid than developing ALCL of the breast. The type of ALCL we are talking about is a rare condition that occurs within the capsule (scar tissue) surrounding the implant. It is a T-Cell Lymphoma that is ALK negative. It is different than ALCL that starts elsewhere and spreads to the breast. The ALCL condition that occurs in the capsule around the breast implant seems to be much more indolent than other types of ALCL. It is usually cured by removing the capsule. Whether radiation therapy and chemotherapy are necessary is still uncertain, although some physicians studying this condition feel that radiation and chemotherapy are not needed. It is usually a condition that occurs on just one side. There is no blood test available to diagnose this condition. The most frequent presentation is a late seroma (fluid collecting around the implant) which causes swelling in the breast and pain. A palpable lump may be another presentation. In other words, the patient knows something has changed within the breast so this is not a condition that occurs without symptoms or signs. This condition usually occurs years after having implants - the mean time is about 8-10 years.
Although not specific to ALCL, you should follow standard medical recommendations including:
· Monitoring your breast implants. If you notice any changes, contact me promptly to schedule an appointment. For more information on self breast exams, visit Medline Plus: Breast Self Exam.
· Getting routine mammography screening.
· If you have silicone gel-filled breast implants, getting periodic magnetic resonance imaging (MRI) to detect ruptures as recommended by me. The FDA-approved product labeling for silicone gel-filled breast implants states that the first MRI should occur three years after implant surgery and every two years thereafter.
If you do not currently have breast implants but are considering breast implant surgery, discuss the risks and benefits with me. You may also visit FDA’s Breast Implants website for additional information. The FDA has established a registery (FDA.gov/breast implants) to accumulate more information on this condition, and as more information becomes available, I will share it with you.
The FDA on Wednesday warned that women with breast implants might be at a "small increased risk" of an immune system cancer called anaplastic large cell lymphoma after data revealed a total of 60 ALCL cases among those with saline and silicone implants. The FDA is seeking more data on ALCL cases and advises women with implants to consult their doctors if they experience implant-related symptoms, including pain, lumps or swelling.
If you have breast implants, there is no need to change your routine medical care and follow-up. ALCL is very rare; it has occurred in only a very small number of the millions of women who have breast implants.
It is estimated that the incidence of ALCL in patients with breast implants is about 1:500,000, whereas, the risk of a woman developing breast cancer over their life-time is about 1 in 9. To put things in prespective, one is much more likely to be stuck by a lighting bolt or an asteroid than developing ALCL of the breast. The type of ALCL we are talking about is a rare condition that occurs within the capsule (scar tissue) surrounding the implant. It is a T-Cell Lymphoma that is ALK negative. It is different than ALCL that starts elsewhere and spreads to the breast. The ALCL condition that occurs in the capsule around the breast implant seems to be much more indolent than other types of ALCL. It is usually cured by removing the capsule. Whether radiation therapy and chemotherapy are necessary is still uncertain, although some physicians studying this condition feel that radiation and chemotherapy are not needed. It is usually a condition that occurs on just one side. There is no blood test available to diagnose this condition. The most frequent presentation is a late seroma (fluid collecting around the implant) which causes swelling in the breast and pain. A palpable lump may be another presentation. In other words, the patient knows something has changed within the breast so this is not a condition that occurs without symptoms or signs. This condition usually occurs years after having implants - the mean time is about 8-10 years.
Although not specific to ALCL, you should follow standard medical recommendations including:
· Monitoring your breast implants. If you notice any changes, contact me promptly to schedule an appointment. For more information on self breast exams, visit Medline Plus: Breast Self Exam.
· Getting routine mammography screening.
· If you have silicone gel-filled breast implants, getting periodic magnetic resonance imaging (MRI) to detect ruptures as recommended by me. The FDA-approved product labeling for silicone gel-filled breast implants states that the first MRI should occur three years after implant surgery and every two years thereafter.
If you do not currently have breast implants but are considering breast implant surgery, discuss the risks and benefits with me. You may also visit FDA’s Breast Implants website for additional information. The FDA has established a registery (FDA.gov/breast implants) to accumulate more information on this condition, and as more information becomes available, I will share it with you.
Saturday, January 15, 2011
THE GERMANS ARE ALWAYS ON THE "CUTTING EDGE"
■Drugmaker tests injection to dissolve chin fat
German drugmaker Bayer is starting clinical trials of an injection that dissolves small amounts of fat. The drug, ATX-101, would be given in a series of 40 to 70 mini-injections, with visible results after about 16 weeks, a company spokeswoman said. The Vancouver Sun (British Columbia)/The Daily Telegraph (London) (1/12)
German drugmaker Bayer is starting clinical trials of an injection that dissolves small amounts of fat. The drug, ATX-101, would be given in a series of 40 to 70 mini-injections, with visible results after about 16 weeks, a company spokeswoman said. The Vancouver Sun (British Columbia)/The Daily Telegraph (London) (1/12)
VOLUMETRIC LOSS AFFECTS AGING
■Facial bone mass decreases with age, study finds
Facial bones lose volume and diminish with age, contributing to wrinkles and sagging skin, researchers found. Women can begin losing significant facial bone mass in their 40s, though the process typically does not start in men until they reach their 60s, according to the study published in Plastic and Reconstructive Surgery. "Aging is multi-factorial," said ASPS President Dr. Phillip Haeck. "The things that affect it are genetics [and] external factors such as sun damage and nicotine use. Then there is plain old loss of volume of the soft tissues and bone." MedicineNet.com/HealthDay News
Facial bones lose volume and diminish with age, contributing to wrinkles and sagging skin, researchers found. Women can begin losing significant facial bone mass in their 40s, though the process typically does not start in men until they reach their 60s, according to the study published in Plastic and Reconstructive Surgery. "Aging is multi-factorial," said ASPS President Dr. Phillip Haeck. "The things that affect it are genetics [and] external factors such as sun damage and nicotine use. Then there is plain old loss of volume of the soft tissues and bone." MedicineNet.com/HealthDay News
PLASTIC SURGERY IN TEENAGERS
A board-certified plastic surgeon who specializes in treating adolescents has written a book to help teens and their parents make responsible decisions about plastic surgery. Dr. Frederick Lukash said he refuses to perform procedures on teens who have unrealistic expectations or who do not seem to understand the risks and limitations of surgery. "Plastic surgery is not the panacea for teen angst," Lukash wrote. DNAInfo.com
■Bullying can lead teens to consider plastic surgery
About 90,000 teenagers had cosmetic surgery in 2007, with some doing so to improve their self-esteem or avoid bullying. Teens most commonly seek rhinoplasty, breast reduction or augmentation, Botox injections or ear tucks. Plastic surgeons and psychiatrists worry about the potential trend. Plastic surgeon Dr. Michael Fiorillo said he sees "a fair amount" of these cases but that his "preference is, of course, to work out the issues first, the bullying, the teasing. But there are certain situations where people are mature enough. And surgery is a final resort." ABC News (1/12)
■Bullying can lead teens to consider plastic surgery
About 90,000 teenagers had cosmetic surgery in 2007, with some doing so to improve their self-esteem or avoid bullying. Teens most commonly seek rhinoplasty, breast reduction or augmentation, Botox injections or ear tucks. Plastic surgeons and psychiatrists worry about the potential trend. Plastic surgeon Dr. Michael Fiorillo said he sees "a fair amount" of these cases but that his "preference is, of course, to work out the issues first, the bullying, the teasing. But there are certain situations where people are mature enough. And surgery is a final resort." ABC News (1/12)
Monday, January 10, 2011
OUR NATIONAL DEBT
At the end of 2010, our federal debt totaled over $13.6 trillion. This figure does not include the unfunded debt for Medicare, Social Security, and other federal programs. Some estimate this additional figure to be over $30 Trillion.
PROBLEM WOUNDS TREATED WITH HONEY
The use of honey in wound care dates back to ancient Egypt. How honey works to promote wound healing is still unknown. Honey has been shown to have an anti-bacterial effect. Medical grade honey has become popular in treating a variety of wounds to include burns.
ARE YOU A GOOD CANDIDATE FOR PLASTIC SURGERY?
Plastic surgery has become increasingly popular and accessible in the world today. Still, it’s important that you ask yourself if you’re really a good candidate for cosmetic procedures. A little self-reflection – along with the following criteria – will go a long way when considering plastic surgery.
No. 1: Your Physical Health
There are a number of factors that determine whether or not a patient is a good candidate for plastic surgery. The first consideration is whether or not the patient is healthy enough to undergo the surgery. If you have a shaky medical history, do not respond well to certain types of medication or anesthesia, or have a weak or compromised immune system, plastic surgery might be risky for you. Make sure to discuss your plans for plastic surgery with your primary care physician before proceeding with the surgery. Also, be sure that your plastic surgeon is fully briefed on your medical history before you have your procedure.
No. 2: Being Emotionally Prepared for Plastic Surgery
Being a good candidate for plastic surgery is more complicated that simply being in good physical health. It is important to be emotionally healthy and prepared for the mental effects of the surgery.
Depending on your reasons for undergoing plastic surgery, the procedure and time period afterwards can be an incredibly emotional time. It is important to know that many patients go through a few days of mild depression after plastic surgery. It is also important to be prepared for this and know what to do if the depression does not subside. (If your depression does not subside after three days, contact your physician and plastic surgeon immediately.) Being emotionally prepared for plastic surgery also means being in an emotionally stable place in your life. Sometimes people turn to surgery thinking it will help them through a difficult period in their lives. Getting plastic surgery directly after a traumatic event such as the loss of a loved one or a divorce is often a bad decision.
No. 3 and 4: Being Realistic About Your Goals and Understanding the Risks of Surgery
It is very important that plastic surgery patients to have realistic goals for their bodies. A patient who is 200 pounds overweight will not look like a supermodel the week after bariatric surgery. It can take many years of surgery, physical therapy and proper diet and exercise to completely transform one’s body in such a dramatic way. Furthermore, a complete transformation can require numerous surgeries.
In addition to being realistic about your goals, be sure you understand the risks of your surgery. No matter what kind of surgery you are having, cosmetic or otherwise, there is always risk involved. Be sure to speak frankly with your plastic surgeon about all of the possible outcomes of the surgery, even the negative ones. Being completely informed is the best and healthiest way to enter into this decision.
No. 5: Being Prepared to Follow Your Doctor’s Orders
After plastic surgery, you may be in a very delicate physical state. People who choose to have breast augmentation surgery, for example, must refrain from any rigorous physical activity during their recuperation period. During this period, even light exercise could cause one of the implants to shift or one of the sutures to open. Be sure that you are completely prepared to follow all of your surgeon’s orders during your recuperation period. Be sure that you know how to take care of your body in an ongoing way.
What if I am Not a Good Candidate for Plastic Surgery?
If you are in poor health or, for some reason, your doctor does not feel that you are a good candidate for cosmetic plastic surgery plastic surgery, he or she should tell you so. A doctor who practices with solid medical ethics, and who has your best interests at heart, will not authorize a procedure if it is too risky for you.
No. 1: Your Physical Health
There are a number of factors that determine whether or not a patient is a good candidate for plastic surgery. The first consideration is whether or not the patient is healthy enough to undergo the surgery. If you have a shaky medical history, do not respond well to certain types of medication or anesthesia, or have a weak or compromised immune system, plastic surgery might be risky for you. Make sure to discuss your plans for plastic surgery with your primary care physician before proceeding with the surgery. Also, be sure that your plastic surgeon is fully briefed on your medical history before you have your procedure.
No. 2: Being Emotionally Prepared for Plastic Surgery
Being a good candidate for plastic surgery is more complicated that simply being in good physical health. It is important to be emotionally healthy and prepared for the mental effects of the surgery.
Depending on your reasons for undergoing plastic surgery, the procedure and time period afterwards can be an incredibly emotional time. It is important to know that many patients go through a few days of mild depression after plastic surgery. It is also important to be prepared for this and know what to do if the depression does not subside. (If your depression does not subside after three days, contact your physician and plastic surgeon immediately.) Being emotionally prepared for plastic surgery also means being in an emotionally stable place in your life. Sometimes people turn to surgery thinking it will help them through a difficult period in their lives. Getting plastic surgery directly after a traumatic event such as the loss of a loved one or a divorce is often a bad decision.
No. 3 and 4: Being Realistic About Your Goals and Understanding the Risks of Surgery
It is very important that plastic surgery patients to have realistic goals for their bodies. A patient who is 200 pounds overweight will not look like a supermodel the week after bariatric surgery. It can take many years of surgery, physical therapy and proper diet and exercise to completely transform one’s body in such a dramatic way. Furthermore, a complete transformation can require numerous surgeries.
In addition to being realistic about your goals, be sure you understand the risks of your surgery. No matter what kind of surgery you are having, cosmetic or otherwise, there is always risk involved. Be sure to speak frankly with your plastic surgeon about all of the possible outcomes of the surgery, even the negative ones. Being completely informed is the best and healthiest way to enter into this decision.
No. 5: Being Prepared to Follow Your Doctor’s Orders
After plastic surgery, you may be in a very delicate physical state. People who choose to have breast augmentation surgery, for example, must refrain from any rigorous physical activity during their recuperation period. During this period, even light exercise could cause one of the implants to shift or one of the sutures to open. Be sure that you are completely prepared to follow all of your surgeon’s orders during your recuperation period. Be sure that you know how to take care of your body in an ongoing way.
What if I am Not a Good Candidate for Plastic Surgery?
If you are in poor health or, for some reason, your doctor does not feel that you are a good candidate for cosmetic plastic surgery plastic surgery, he or she should tell you so. A doctor who practices with solid medical ethics, and who has your best interests at heart, will not authorize a procedure if it is too risky for you.
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