THE VERSATILITY OF BREAST IMPLANTS

(CNN) -- She arrived on a suspicious flight. Her story didn't sound right. And then there was the blood ... under her breasts. An airport security check in Spain led to an operating table for a passenger -- where, authorities said, they found she had tucked packs of cocaine in her breast implants. The Panamanian citizen landed at Barcelona's Prat airport on a so-called "hot flight," one that came from a destination known for drug trafficking -- in this case Bogota, Colombia. Ninety percent of cocaine trafficked into the United States, for example, comes from Colombia, according to the U.S. Drug Enforcement Administration.
The passenger came under the scrutiny of security agents, who weren't satisfied with the vague answers she kept giving about why she was in town, Spain's interior ministry said. Her behavior aroused the suspicion of officers that she might be carrying drugs either in her luggage or on her. When a female officer patted down the woman, she found bloodied bandage material under the passenger's breasts. The gauze, the officer found, was covering incisions. And the breasts were hiding "a white foreign material."  Fresh breast implants, the suspect mustered an explanation. Must not have healed up right. The story didn't convince police, who hauled her off to a hospital. "There, a medical team extracted a bag-shaped prosthesis from each breast containing a white pasty substance," the ministry said. Cocaine. Nearly 1.4 kilograms (3 lbs) of it.
Pure cocaine goes for about $35,000 a pound, according to the DEA. The expensive implants landed her in jail.

HOUSE RESOLUTION 826 BY JOHN FLEMING

"We are in our fifth straight year of trillion dollar annual deficits, and the president believes that – despite the Constitution – the power of deciding how much more debt the government can accumulate belongs to him instead of Congress. The president is asking for a blank check, and he wants Congress to abdicate power to him so he can raise the debt ceiling as he pleases. H.Res. 826 affirms the value of our three-part government, and the checks and balances that keep the pendulum from sticking in the liberal position. Giving the president the ability to raise the debt ceiling– without congressional authority– would be giving him power far beyond anything the Constitution intended. H. Res. 826 must be passed to remind the president that Congress will not surrender its power."  Introduced by John Fleming, M.D., U.S. Congressman

In addition, Congress needs to get its act together forcing the government to live within its means and abide by a balanced budget, just as we have to do in our personal and business activities.

CHECK CREDENTIALS BEFORE HAVING PROCEDURES

Early last year, Irma Carabajal LeCroy was a successful Dallas real estate broker who owned two homes, a luxury car, an SUV and a small office building. Today, she is out of work, uses a walker and wheelchair to get around and says she has nothing left to her name.And it's because of what she thought was a minor cosmetic surgery procedure.LeCroy is one of a growing number of women who have had liposuction, sometimes combined with fat-transfer surgery, in doctors' offices or med spas — salon-like medical facilities that have doctors on the premises and offer skin care treatments, such as Botox injections, facials and laser resurfacing. Some patients have found themselves disfigured or disabled. Others have died. Critics say the victims may not know that the rules that govern hospitals do not necessarily apply to the medical offices or spas popping up across the country. That's where a new breed of cosmetic surgeon now practices, often down the hall from where they do routine physicals, perform gynecological exams or pull wisdom teeth, according to state regulators, lawyers and plastic surgeons. USA TODAY reported last year that only half of states require licensing or accreditation of medical offices where surgery is performed. But even when there are office-based surgery rules or laws in place, they often aren't enough, critics say. For example, most accreditation or licensing rules cover surgeries only if the patient is fully anesthetized. Some rules apply only if private insurance or Medicare is billed, which typically isn't the case in cosmetic procedures.

There are now about 4,500 med spas in the United States, up from about 800 five years ago, says Allan Share, executive director of the International Medical Spa Association. The growth of med spas has states scrambling to figure out how much legal oversight is needed. The Federation of State Medical Boards recently hosted a workshop for medical board attorneys that covered the regulatory oversight of med spas and office-based cosmetic surgery. State medical boards and the laws regulating the practice of medicine were "created 100 years ago when cosmetic procedures or surgeries weren't anything that anyone had contemplated," says Mari Robinson, executive director of the Texas Medical Board. "It was about treating illness and disease — not this idea of people personally pursuing medical procedures solely based on improving their appearance." In September, Maryland's health department shut down the Monarch Medspa in Timonium after three women contracted Group A Streptococcus infections during liposuction and one died. The department cited "deviations from standard infection control practices." The Group A Streptococci bacteria, which can cause strep throat, are often found in the throat and on the skin and are spread through direct contact with mucus from infected people or contaminated surfaces, according to the health department. Most of these infections are relatively mild, such as with strep throat, but they can cause serious and even life-threatening complications. Joshua Sharfstein, Maryland's secretary of Health and a pediatrician, sent a letter to three committee chairmen in the Maryland legislature last month asking them to tighten laws governing outpatient surgery. The existing law doesn't apply to outpatient surgery centers unless insurance companies are involved, according to a department press release. Health insurance typically covers only medically necessary or reconstructive plastic surgery after cancer. He also asked that the state Board of Physicians database include information on whether doctors perform cosmetic surgery and whether their facility is accredited. "We asked ourselves if more needs to be done to protect consumers from unsafe cosmetic surgery," says Sharfstein. "There are some protections that exist for bigger surgical centers, but gaps in regulation might put consumers at risk" because smaller operations, including med spas, can take advantage of loopholes. In Texas, doctors with office-based surgery centers or med spas that aren't accredited by one of three outside entities or licensed as ambulatory surgery centers, can register them for any level of anesthesia used that is above local anesthesia. It wasn't the anesthesia that harmed LeCroy, however. It was the surgery itself, according to a lawsuit filed on her behalf against internal medicine doctor Hector Molina and the company that sold him the liposuction machine. The suit charges that Sound Surgical Technologies should have known of the risks of a non-surgeon who was not adequately trained in liposuction using the machine. In its response to the suit, Sound Surgical denied the allegations and says it was not to blame for any of LeCroy's injuries. In a statement provided to USA TODAY, the company said LeCroy's attorneys aren't suggesting the liposuction machine was defective, so it "is confident that it will be dismissed from this lawsuit either before or during trial." LeCroy's attorney, Jim Mitchell, says it wasn't that the machine was defective, it was that "Dr. Molina simply didn't know how to use the system."
When they prohibited Molina from performing cosmetic surgery in April, a Texas Medical Board disciplinary panel found his "entire knowledge" of the procedure he performed on LeCroy (who it did not name) "consisted of reading a book provided by the manufacturer of the liposuction equipment, completing an online program over two weeks, passing an online exam and completing one procedure under the direct supervision of another surgeon." LeCroy was left permanently disabled by Molina due to problems including massive infection and the nerve and muscle condition known as "compartment syndrome," which causes body tissue to die, according to her lawsuit and an expert witness report by Miami plastic surgeon Alberto Gallerani. Molina denied the allegations in an answer to the lawsuit, and his lawyer declined to comment.
After LeCroy's more-than-nine-hour liposuction and fat-transfer surgery, Molina and a doctor assisting him abandoned her in his office "without any medical supervision or monitoring," according to Gallerani's report. Her friend, Marilyn Walker, found her "short of breath, unable to stand" and in severe pain in her legs and feet, the report said. She was rushed to the emergency room and transferred to a trauma center. So much fat was injected into the muscles in her buttocks, it caused the compartment syndrome, which Molina failed to diagnose, according to Gallerani's report. LeCroy needed 27 more surgeries to treat the compartment syndrome and related complications, according to Gallerani's statement. She spent a month and a half in the hospital. LeCroy, 49, now has a home health aide coming to her house three times a week. The money she earned selling real estate, which she did starting at age 25, went to pay medical bills, because complications from cosmetic surgery aren't covered by insurance. She says she is unable to walk without a walker and needs a wheelchair for long distances. "I have nothing," says LeCroy. "I'm down to $698 a month in disability benefits." Harlan Pollock, a Dallas plastic surgeon and past president of the American Association for Accreditation of Ambulatory Surgery Facilities, says Texas' law doesn't go far enough to protect patients. When offices register with the state of Texas, certain requirements kick in for the safe administration of anesthesia, according to Texas Medical Board spokeswoman Leigh Hopper. These include the presence of a doctor and another person certified in treating cardiac arrest and a "crash cart" containing life-saving equipment. But Pollock says these requirements apply only to anesthesia and have little to do with the safety of the surgery itself. Accreditation, on the other hand, would require sterile procedures, physical requirements for the operating room, safety equipment and thorough record-keeping procedures, Pollock says. Sterile procedures are key for infection control, which was what Maryland officials found lacking at Monarch Medspa, medical experts say. This kind of "an out," in Pollock's words, means "The public has no real assurance that the facility is an adequate facility, and that is disturbing and a real concern," he says. On Nov. 30, the Texas Medical Board barred Molina from ever performing surgery or dispensing controlled substances, a category that includes some pain medications, such as those with codeine. But Texas has done little to crack down on the offices and med spas where doctors like Molina practice cosmetic surgery, say plaintiff attorneys and plastic surgeons. Hopper emphasizes that Texas' medical board "rigorously screens" doctors who apply for medical licenses. And once they have these licenses, doctors are required to meet what's known as the generally accepted standard of care no matter what area they practice in, she says. Still, if Texas' state Legislature wanted to address office-based surgery, Robinson says, the board would "be happy" to implement any new rules. LeCroy isn't the only Texas patient to suffer after cosmetic surgery in a doctor's office or med spa. The Texas Medical Board also found OB/GYN Barbara Marino didn't meet the "standard of care," have emergency procedures in place or maintain a sterile operative facility during liposuction on patients at Medspa 21 in Houston. One died two days after his liposuction, and an autopsy report said the cause of death was "acute toxicity" from the combined effects of four medications, including a patch for the pain medication Fentanyl, according to the medical board's records. Another patient had excessive levels of pain medicine, the board said. Late last month, Marino was ordered to observe at least 30 hours of cosmetic surgery by a board-certified plastic surgeon and document other procedures for treating at-risk patients and dealing with emergencies. She did not espond to calls seeking comment. In November 2011, Laura Bennack, an emergency room doctor who owns Radiance MedSpa in San Antonio, had her practice put under the supervision of another physician by the Texas Medical Board. It had investigated the treatment of 10 cosmetic surgery patients and found she didn't meet what it considers the appropriate "standard of care" or keep adequate surgery records. According to the board's disciplinary order, Bennack performs tummy tucks, liposuction and breast augmentation while patients are awake. The board said in an order in February 2010 that Bennack acknowledged her medical recordkeeping was "sparse at best." Bennack did not respond to calls seeking comment. Med spas typically offer only procedures without anesthesia or under local anesthesia, which isn't regulated in Texas or many other states. "There is absolutely no regulation of med spas," Pollock says. "That's something that to me is very frightening." Some doctors, including Marino and Molina, register their facilities for higher levels of anesthesia. Several states require accreditation for offices intending to use deep sedation or general anesthesia, since it is the type used for the most serious procedures, says Tampa anesthesiologist Hector Vila. But doctors can get around the law by registering for a lower level of anesthesia or using large volumes of local anesthesia, says Vila. Vila says existing laws need to be more strictly enforced to ensure people don't continue to skirt them. Performing surprise inspections and more frequent inspections could be one way to accomplish this, he says.   In Florida, the state changed its law early this year to authorize the state to inspect any facility, including med spas, that remove more than 1,000 cc's of fat during liposuction. That would cover all but the most minor procedures, says Democratic state Sen. Eleanor Sobel, who introduced the bill. Previously, the inspection authority existed only for facilities that accepted Medicare or other insurance. The law was passed after two women died of an overdose of lidocaine, a local anesthetic similar to novocaine, after liposuction. In California, under a law passed in January, California's medical board keeps a list of accredited outpatient surgery settings. The board approved four accreditation agencies that inspect and accredit outpatient surgery settings, including medical offices and spas. These agencies can reject, revoke, or otherwise restrict a facility's accreditation. If that happens, the medical board is notified and alerts the public on its website. In New York, any office-based surgery facility that removes more than 500 cc's of fat during liposuction or uses anything more than minimal sedation must be accredited. Still, even though New York has some of the most stringent regulation of office-based surgery, any licensed physician can perform cosmetic surgery under a local anesthetic in an unaccredited facility, says Manhattan plastic surgeon Adam Schaffner. "My hope is that they will require that physicians who perform such procedures perform them in accredited facilities (and) that they have hospital privileges for any procedure they perform outside the hospital," says Schaffner. The issue of med-spa regulation is "absolutely rising to a national level ... everyone is really looking at it right now," says Robinson.

HAIR LOSS - GENETICS AND ENVIRONMENTAL FACTORS

Arlington Heights, Ill. - The risk of hair loss in women is affected by genetics, but also by a wide range of health and lifestyle factors-notably factors related to high stress levels, reports a study in the December issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).
"Increased stress, smoking, having more children and having a history of hypertension and cancer were all associated with increased hair thinning," writes ASPS Member Surgeon Dr. Bahman Guyuron and colleagues of Case Western Reserve University School of Medicine, Cleveland. They believe that modifying these factors might help reduce risk in women concerned about hair loss.
Stress and Other Factors Affect Hair Loss-Not Just Testosterone
The researchers studied risk factors for hair thinning in a series of 98 identical female twins, average age 54 years. Studying identical twins-who share 100 percent of genes-provided an opportunity to separate out the genetic and social/environmental factors associated with any disease or condition.
The twins posed for standard photographs, which the researchers used to measure hair loss or thinning at specific locations: the front, sides and top of the head. Testosterone levels were measured, reflecting hormonal causes of hair loss.
The women also completed detailed questionnaires assessing a wide range of possible environmental, lifestyle and health-related factors-from diet and marital history to common diseases. Differences in these factors could help to explain differences in hair loss risk between genetically identical twins.
As expected, higher testosterone levels were associated with increased hair loss, particularly at the sides and top of the head. This was consistent with the hormonal causes of female pattern hair loss.
But the study also identified a wide range of environmental risk factors for hair loss. Although associations differed by site, women reporting higher levels of stress had more hair loss and thinning. Life situations related to higher stress-including being separated or divorced, multiple marriages and more children-were also linked to hair loss.
Other risk factors potentially related to high stress levels included higher income. Prolonged sleep was another risk factor, possibly related to depression/anxiety as well as stress.
Modifying Risk Factors May Help Prevent Hair Loss
Several medical risk factors for hair loss were identified as well, including cancer, high blood pressure and diabetes. Smoking, not exercising, and not using sun protection also increased risk. Women with higher caffeine intake were actually at lower risk of alopecia, possibly because caffeine counters the hormonal effects leading to hair loss.
Although typically regarded as a male problem, hair loss can also occur in women, in whom it causes even greater psychological distress. Hormonal and genetic factors contribute to female alopecia, but do not fully explain the risk. Studying twins allowed the researchers to evaluate other, nongenetically determined risk factors for female alopecia.
The study confirms the impact of hormonal causes for female hair loss, while also highlighting the contribution of various health and lifestyle-related risk factors-many of them related to high stress levels. The good news is that at least some of the identified risk factors are potentially modifiable. Dr Guyuron and coauthors conclude, "Many of the environmental factors discussed in this study such as smoking, sun exposure and excessive stress can be targeted by both patients and physicians as potential ways to augment hair loss prevention strategies."

"A PAIN IN THE BUTT"

With all the plastic surgery nightmare stories circulating around the web, you'd think the dangers would be self-evident by now, and people would be cautious as to who is performing their surgery.But the recent arrest of an Ontario woman reveals that many people are still risking their lives by submitting to surgical procedures at the hands of unqualified practitioners.The Toronto Sun reports that police charged Marilyn Ely Reid with criminal negligence causing bodily harm last week after a 28-year-old woman suffered debilitating side effects from a series of Reid-administered butt injections last August.Police say the woman felt ill with a high fever immediately afterward, and three days later she'd deteriorated to the point where she required hospitalization.ER. "She was treated for several days with antibiotics but the woman's condition continued to deteriorate and she received surgery," Toronto Police Det. Louise Farrugia tells reporters, adding that the surgery was necessary to remove the substance from her rear. Although the woman is expected to make improvement over time, Farrugia says that she can "barely walk," is still hooked up to IV and has trouble sitting down.Reid -- who shilled her injectable wares on the website pmmainjection.com -- advertised "lip, muscle and buttock injections" and would meet her clients at their private homes or hotel rooms.As the National Post notes, PMMA stands for polymethyl methacrylate, and it's an expensive thermoplastic once commonly used as bone cement in cosmetic surgery procedures. By the 90s, PMMA got mixed with bovine collagen to create a long-term injectable that helped kick off the Botox craze.
The problem, as Julie Khanna of The Institute of Cosmetic & Laser Surgery tells the Post, is that the product was easy for unlicensed people to get their hands on. "People are downplaying these injectables — 'Oh yeah, your hairdresser can do it for you, anyone can do it for you.' And that's pretty scary to me," she says.

JEWEL'S BENEFIT CONCERT FOR "BRA DAY" USA

NOBEL LAUREATE, JOSEPH MURRAY, DIES AT 93

Nobel laureate and renowned plastic surgeon Joseph Murray, MD, passed away Monday, Nov. 26, at Brigham and Women's Hospital, Boston, after suffering a stroke at his home on Thanksgiving Day. He was 93.Dr. Murray is credited for performing the world's first organ transplant in December 1954. The recipient was 23-year-old Richard Herrick, who received a functional kidney from his twin brother, Ronald. Since that time, more than 600,000 people have received life-saving organ transplants as a result of Dr. Murray's groundbreaking work, for which he awarded the Nobel Prize in Medicine in 1990."Kidney transplants seem so routine now," Dr. Murray told The New York Times after he won the Nobel. "But the first one was like Lindbergh's flight across the ocean.""He brought comfort to thousands of patients and families with his compassion and the exquisite care he provided," wrote Betsy Nabel, MD, president of Brigham and Women's Hospital, in an e-mail sent to the hospital community upon hearing of Dr. Murray's passing. "He selflessly sought to share his knowledge with his colleagues and to teach and mentor younger physicians." Dr. Nabel was among those who honored Dr. Murray as a Special Guest during a Veterans Day celebration at the hospital on Nov. 12.A 1943 graduate of Harvard Medical School in Boston, Dr. Murray was commissioned by the U.S. Army Medical Corps in 1944 and served at Valley Forge General Hospital in Phoenixville, Pa., treating wounded soldiers - many badly burned - returning from the battlefields of World War II.One of his first and most memorable patients was a pilot named Charles Woods who survived extensive burns to his face and hands. The skin grafts required to treat his injuries provided Dr. Murray a fascinating view into the budding study of immunology and rejection of transplanted tissue. After his military discharge in 1947, Dr. Murray completed his surgical residency at Boston's Peter Bent Brigham Hospital (where he would retire from in 1986 as chief of plastic surgery) and then moved to New York for plastic surgery training.
"I consider myself a plastic reconstructive surgeon," Dr. Murray told PSN in 2006. "Transplantation was merely a side issue and it really is a form of reconstruction. I never considered it competitive. They're both the same - taking care of patients." Dr. Murray's interest in reconstructive surgery was sparked primarily as a means of treating children with deformities, but he also enjoyed doing purely cosmetic surgery.
Dr. Murray's surgical DNA could also be traced to the first partial face transplant, which was performed in 2005 on Isabelle Dinoire in Amiens, France. "The surgeon who did that face transplant (Jean-Michel "Max" Dubernard, MD) was one of my former research Fellows," Dr. Murray told PSN. "They've done a great job on a partial facial transplant. It's been a great success." Advances in hand and limb transplantation were also gratifying for the ASPS Life Member."The whole field of transplantation continues to expand far beyond the simple replacement of skin or kidney," Dr. Murray told PSN. "It's been a glorious experience to be a part of."

During his remarkable career, however, Dr. Murray also focused on developing treatments for congenital facial deformities in children, and he served as chair of the American Board of Plastic Surgery and president of the American Association of Plastic Surgeons. He was also a professor of surgery at Harvard.

Perhaps more than anything, Dr. Murray simply enjoyed caring for people.

"Each person is intrinsically valuable. Whether you're repairing a small blemish of the cheek or a major facial reconstruction, for the patient, it's 100 percent," Dr. Murray said. "You're putting them back into the mainstream - improving the quality of their life.

"Life goes on, and it's a very rich life, but it's all one theme: taking care of patients," he said.

"Enjoy everything about living," he added. "Even how a spider spins its web."

"DESIGNER VAGINA"

Women seeking information about genital cosmetic plastic surgery are ill served by Web sites purporting to provide expert advice and guidance about such procedures, a new study finds.Researchers at the UCL Elizabeth Garrett Anderson Institute of Women’s Health, University College Hospital in London, England wanted to assess the quality of information available online to women considering surgical alteration of their genitals – a practice that, for the record, the American College of Obstetricians and Gynecologists advises against. To that end, they Googled the term “designer vagina,” which they report is commonly used to describe procedures aimed at improving the appearance of women’s genital areas.The team of researchers reviewed the first five U.S. and the first five British Web sites that search yielded, analyzing content according to 16 criteria they developed, including accuracy, the kinds of procedures offered, and representations of success rates and potential risks of those surgeries.What they found was a mishmash of confusing information, the study said. Common procedures – 72 of them -- were identified by a baffling number of terms, from "labioplasty" and "liposculpting" to "hoodectomy" and "hymenoplasty." Though all 10 sites mentioned risks related to surgery, only six spelled out what those risks were. Hardly any mentioned that women’s vulvas naturally differ from one another in size and appearance and that a broad variety of appearances are normal. Worst of all, according to the authors, none of the sites mentioned an age below which such surgery is inappropriate. According to the study, women typically seek genital cosmetic surgery because they’re not happy with the way they look in that area or because they think surgery might help them or their partners achieve greater sexual satisfaction. It’s unclear how many such surgeries are performed in the U.S.; the American Society of Plastic Surgeons doesn’t keep track because the numbers are so small, according to that organization’s media relations office. But the new study suggests these procedures are increasingly popular. “The quality and quantity of clinical information in [female genital cosmetic surgery (FGCS)] provider sites is poor, with erroneous information in some instances,” the study concludes. “Impeccable professionalism and ethical integrity is crucial for this controversial practice. Clear and detailed guidelines on how to raise the standard of information to women on all aspects of FGCS are urgently needed.



Their work appears in the "Obstetrics & Gynaecology" edition of the on-line journal BMJ Open.

BOTOX POKER FACE

Card players who don’t want to give themselves away and tip their hand can turn to a Manhattan doctor who says bet on him — and “Pokertox.”Dr. Jack Berdy, an East Side doctor of aesthetic medicine, just launched the idea of using Botox to “allow people to gain a poker face’’ in a service he calls Pokertox.
“Very few people can maintain a real poker face,’’ said Berdy. “They have some ‘tells,’ some expression that gives away that they have a good hand or a bad hand’’ to an opponent.
He said he and his patients would go over those ‘‘tells’’ and the expressions that would give away a hand.
Some players look at their cards and ‘‘might raise their eyebrows or raise one eyebrow’’ if they do or don’t like what they see.“Some squint, or furrow their brows,’’ Berdy said.“We can inject Botox appropriately’’ so the other player doesn’t get the message that they’re angry, disappointed or happy.“What someone sees across the table is no movement,’’ he said.Pokertox costs an average $600 to $800 and lasts three to four months, he says.The idea came to Berdy because he used to be a gambler and his specialty is Botox — “and they go together.’’

"CAT MAN"

No one could like cats as much as Denis Avner, who was known as "Cat Man" for the rather obvious reason that he had numerous plastic surgeries to make himself look, well, like a cat. Specifically, a tiger. In fact, his tattoos, piercings, and cosmetic surgeries were so plentiful that he earned a world record for body modifications. But if reports are true, no amount of changing his exterior could save his interior -- he reportedly may have committed suicide. Avner also went by his Native American name, "Stalking Cat." If you look at pictures of him, you will be truly startled. In his face is little left of a human being as we recognize it. His eyes are slanted like a cat's and he wears colored contacts. His cheeks bulge out. His teeth are sawed and carved to feline perfection. He had piercings put in for whiskers. He's tattooed with the stripes of a tiger. I can only imagine that wherever he went, he was greeted with stares, gasps, and finger pointing. Which must be what he wanted, considering his physical appearance took a lot of effort.According to Wikipedia, Avner's "totem" was a tiger and he began his face modifications in an effort to "follow the ways of the tiger." He also reportedly dedicated himself to "exploring the species line as much as possible," said a friend. And apparently in Native American tradition, it's not that unusual to try to look like your spiritual inspiration. But I'd guess that even Native Americans would say that Avner went pretty damn far in his spiritual quest. In fact, if becoming one with your totem is any guarantee of emotional fulfillment, then Avner should have been the happiest man on the planet -- clearly not the case if he took his own life. There may be a story here that I'm not aware of. Perhaps Avner was sick. Perhaps taking his life was just another way of showing devotion to his "cat ways." (Don't they have nine lives?) I don't know. But I tend to believe that anyone who alters their outside to a huge extent is really trying to alter their inside -- and it doesn't work. It must be a sad shock for people who get a physical "ideal" in their minds and work very hard to achieve it -- only to find that they still feel like the same person. Rest in peace, Cat Man.

What do you think of this man's surgeries? Here he talks about them in this video.

"MOMMY MAKEOVER"

If going through child birth wasn't enough, for many women, the big challenge starts after the baby arrives. We're talking about getting your body back to its original shape. Now, some moms are choosing to go under the knife to get that pre-baby body back. The gym has become a second home for 28-year-old Shellie Schoellkoph."I jumped into diet and exercise and lost 75 pounds," she said. Schoellkoph weighed 262 pounds at her peak. Now she's 187 pounds and still wanting to lose more. But she has plateaued, her strict diet and exercise wasn't working like it once was. "I was seeing a lot of changes just in my silhouette and change in my shape in general. But I wasn't seeing the smooth lines, no matter what I did in the gym and how hard I exercised," Schoellkoph said. Houston plastic surgeon Dr. Franklin Rose says he sees it all the time. "They are very common, not just in my practice but in most plastic surgeons practices. There are so-called mommy makeover, which is really it might encompass 40, 50 percent of the patients we do," Dr. Rose said. A typical "mommy makeover" usually focuses on three main procedures.
First, there's the breast lift or implants. "First, the breast will enlarge, shrink, enlarge, shrink through the process which is called postpartum involution and patients end up with no filler or many cases with quite a bit of decent," Dr. Rose said. Second, liposuction. "It's not talked about enough in liposuction is the reduction in body mass index, her fat content," Dr. Rose said.And finally, a tummy tuck to get rid of that unwanted skin. Schoellkoph will have all three. "This absolutely metamorphosis the patient," Dr Rose said. "The improvement in body image that we are able to provide gives them long-lasting boost in self-esteem for many years to come." That improvement in body image and self esteem won't come over night.
Four hours of surgery is followed by several weeks of recovery, something Schoellkoph weighed heavily before making her decision."I wanted to know that he could match the image that I had in my head of my pre-baby body. And he seems confident that he can," Schoellkoph said. Clinical psychologist Nanine Ewing says that every woman is different and getting that your figure back might not happen, even with plastic surgery.  "When that's the case and it's really that impeding of one's life, I think it's a natural progression, it's a natural thing if you can afford it. But the expectations need to be realistic," Ewing said.Schoellkoph now is 15 pounds liter and 2 sizes smaller. "I think they were right on par with what I was expecting," she said. "I was able to put on a bikini the last week or two of the summer so that was nice and I have been really, really pleased with it." And all that extra skin is gone. "There is scaring along the hip. It's a little longer than I expected, but I would trade the scar for the before any day," Schoellkoph said. Now she has the best of both worlds: a healthy boy and her pre-baby body back. The mommy makeover isn't cheap. Dr. Rose days it can set you back between $15,000-$20,000.

MISS AMERICA CONTESTANT, 24, TO UNDERGO PREVENTIVE DOUBLE MASTECTDOMY

Allyn Rose is more than just another pretty face. The Miss America contestant, who will represent Washington, D.C., in the Jan. 12 pageant live on ABC, lost her mom to breast cancer at age 16. Now, at only 24 years old, Rose has decided she will undergo a double mastectomy as a preventative measure after learning she is a carrier of the same rare chromosomal disease that her mother had.
"The idea that I could wake up one day and not have the same body that I did the day before is very scary," Rose, a self-proclaimed former tomboy, tells PEOPLE. "But I also realize my mom was diagnosed at 27. That's three years away from me. I'm not going to let my fear of losing this part of my femininity stop me from living." Of the disease, Rose explains, "It manifests in male children, but there have been studies that women who are the carriers of it have almost a 75 percent likely chance of contracting breast cancer. It's a very strange change in our genetic code. Almost all of the women in my family have passed away from it."

Thinking back to completing teenage milestones that she couldn't share with her mom, Rose wants to take all the necessary precautions to ensure that these experiences are ones her own children will be able to share with her."My mom had her right breast removed at 27, but at 47 or 48, it came back in her left breast," she says. "It was already stage three. She could have had that other breast removed, but I'm sure there was a part of her that thought she didn't want to give up this other part of herself."
She adds, "My dad said he begged her for years and years to get it removed, but she said no. It's ultimately the thing that killed her. I had to become my own mentor. I had to go pick out my prom dress by myself. I had to go to my high school graduation without my mom. She didn't see me go off to college or go on my first date or drive a car for the first time." But after the "very difficult" experience of losing someone she calls "incredible," Rose will make a huge sacrifice to ensure her own life will last."It's a very scary proposition," the model, who also works as a paralegal, says of undergoing the surgery. "But my father and I have met with a surgeon and countless doctors. Some of them are wary because I don't have breast cancer and I am so young, but others have said it's a very smart move, especially for someone who is genetically predisposed."
Choosing Life over Beauty
Rose describes the breast reconstructive plan as "very risky" and "not exactly seamless," but one that is worth it."Your skin may be damaged in a way that you will lose your nipple, or sometimes women lose all of their breast tissue," she says, [but], "Breasts don't define your life. I'm choosing life over beauty. I'm choosing to remove something that's so iconic to my womanhood." Rose – who looks up to Robin Roberts and Giuliana Rancic, who both have battled breast cancer – is using her pageant opportunity as a platform to teach people how to be proactive in their healthcare. "Title holders across the country get an opportunity to speak to their generation and have something they can advocate," she says. "Being in the industry and competing in the most iconic swimsuit competition in the world, I thought to myself, 'If I were to win and have this surgery a year from now, would I be a different Miss America because I lost my breast?' No."
Should she win the competition, Rose plans to undergo surgery after her duties are complete in January 2014. If she does not win, she will have the procedure done after her local duties are complete next June.
"To win the pageant would truly have my mother's dreams for me come to fruition," says Rose, who will show off her unique roller skating talents during the competition. "Never once in my life did I doubt my mom's love for me or that she wouldn't do anything to have me succeed in life. Some people will never experience that kind of relationship with a parent."

TISSUE EXPANSION HELPS A YOUNG GIRL

A nevus is a birthmark, a mole. The treatment for a mole is relatively straightforward: Just do a simple procedure to cut it out and close it up,” said Dr. Albert Oh, director of fellowship for craniofacial and pediatric plastic surgery at Children’s National Medical Center. “But in this patient's case, because it involved a good one-third to half of her face, you couldn’t just cut it out. It was too big.” Agusta was born with a dinner-plate-size mole that swept across her scalp and the right side of her face. Others stippled her body. Besides being unsightly, these large moles have an elevated risk of turning into melanoma. They also can enter the brain and spine, causing seizures. Doctors in Iceland knew it would take a series of operations to remove the facial birthmark. They told Agusta’s parents the last procedure would be when she was 15. Meanwhile, her parents had gotten in touch with Dr. Oh, who at the time was at Hasbro Children’s Hospital in Providence, R.I. He said he could finish by the time Agusta started school at age 6. “When I had to choose between the age of 15 and the age of 6, I would always choose the age of 6,” said Agusta’s mom, Sigrún Thorsteinsdóttir. The first few operations were done in Rhode Island, the final ones at Children’s Hospital, to which Dr. Oh moved in 2009. He used a technique called tissue expansion to enable Agusta to grow herself extra, blemish-free skin.

A sterile plastic balloon was inserted under Agusta’s normal skin. Every week over the course of a month or two, saltwater was injected into the balloon, swelling it. Over time, a hillock of pristine skin — from the size of a lemon to the size of a banana — grew over the balloon.Once enough new skin had grown, Dr. Oh cut into the birthmark right down to the fat layer, removing it and covering it up with the graft. In all, Agusta had eight surgeries: four to insert tissue expanders, four to remove parts of the nevus. Agusta’s family lives in Gardabaer, near Reykjavik. Agusta is now 6, the middle of three children, with an older brother and a younger sister. Sigrún is a flight attendant with Icelandair and so is very familiar with Washington. Agusta is now, too. Last time they were here, mother and daughter stayed in Columbia Heights. “It was such a good time, though it was always a hard time,” Sigrún said. “She always looked forward to going here. She thought it a little like a vacation, though she knew she was going for an operation. She has never complained when she comes here.”Agusta had her last procedure in October 2011. Then she started school. “I was so scared,” said Sigrún. But it went well. Other students asked about Agusta’s scars. “She just tells everyone, ‘I’m born like this,’ and it’s over and they don’t ask anymore,” Sigrún said. “Hopefully it will stay like that. She’s very strong. She’s very joyful. She’s always smiling.”

ANOTHER BAD IDEA FROM THE OBAMA ADMINISTRATION

Every day, America’s medical technology community gets up and goes to work, focused on improving the lives of patients throughout the world. Whether manufacturing pacemakers, CT scanners or catheters, our passion for innovation and ingenuity is why this proud American industry continues to lead the world in these challenging times.Unfortunately, in fewer than 60 days, a new medical device tax will hit this innovative industry, and it threatens patient care and U.S. jobs. This onerous policy — which is expected to cost more than $30 billion — is already having a real-world, everyday impact on our health care system and our economy. Even though it doesn’t take effect until Jan. 1, medical technology companies are already announcing job cuts and canceling plans to build plants to pay for the tax. Others are trimming budgets in important areas like research and development. Put simply, this is a tax on innovation, and it is going to hurt American workers and patients most. Congress can and should repeal it immediately. Medical innovation is key to providing cutting-edge, lifesaving technologies to patients. Between 1980 and 2000, new diagnostic and treatment tools helped increase life expectancy by more than three years. But the new tax will take money from our research and development pipelines, reducing our ability to discover and develop lifesaving medical devices such as heart valves, molecular diagnostic tests and MRI machines. The effect this will have on patients is real. Today, a patient can walk into an emergency room with chest pain, receive a noninvasive CT angiography that discovers heart blockage and receive a stent in two hours. Compared with yesteryear’s technology, this example of an advanced diagnostic and treatment protocol demonstrates profound clinical- and cost-effectiveness, saving lives and doing so more quickly and efficiently. If the device tax goes into effect, the march of medical innovation will be inhibited and patient access to the next generation of medical technology won’t be realized. Many of the novel, cutting-edge medical technology innovations come from small companies with very few employees. Unfortunately, the medical device tax will hit these small companies and startups hardest, because it will be applied on sales, regardless of whether a company is making any profit. Small businesses often suffer losses in the early years of operation when they are investing in research and development on new products. Paying a sizable new tax while incurring traditional startup-driven losses will be more than many small businesses can bear.

MEDICAL TOURISM

Arlington Heights, Ill. - The busiest travel season of the year is approaching, with many people headed to tropical locales, but plastic surgery patients need to know who is performing their surgery before traveling abroad. The American Society of Plastic Surgeons (ASPS) cautions that while inexpensive vacation packages that include cosmetic surgery may sound appealing, it may be difficult to assess the training and credentials of surgeons outside the United States.

"It is a significant patient safety concern when consumers are having major surgical procedures performed by unqualified practitioners," said Dr. Gregory Evans, president of the American Society of Plastic Surgeons. "There are no U.S. laws that protect patients or mandate the training and qualifications of physicians who perform plastic surgery outside of the U.S. There may be no legal recourse if surgical negligence by the physician or institution occurs."

This warning comes on the heels of a new survey from global market research company Ipsos on behalf of Reuters News. The survey shows one in five people "definitely would consider traveling to another country to receive medical or dental care if the cost were significantly lower than in their country."
"All too often we see patients who think they will enjoy a vacation following plastic surgery abroad only to end up paying dearly for the surgeon's lack of training and expertise," Evans said. "These patients end up paying more in revision surgeries and time off work than if they had paid a bit more to see someone who was qualified to perform the procedure. The ASPS Find-a-Surgeon tool is an invaluable resource to patient's looking to have plastic surgery."
The ASPS Find-a-Surgeon tool allows consumers to search for qualified plastic surgeons in the U.S. and around the world. All plastic surgeons in the Find-a-Surgeon database have completed extensive surgical training, including plastic surgery, and adhere to a strict code of ethics, among other requirements.
Consider the following when evaluating whether medical tourism is for you:
• Vacation-related activities may compromise patients' health. Although enticing, vacation activities should be avoided after surgery. Rest is required to properly heal and to reduce the possibility of complications.
• Cosmetic surgery is real surgery. At the highest level of care, every surgery, including cosmetic surgery, has some risks. Infections are the most common complication seen in patients that go abroad for cosmetic surgery.
• Travel combined with surgery significantly increases risk of complications. Individually, long flights or surgery can increase the potential risk of developing pulmonary embolism and blood clots. Traveling combined with surgery further increase the risk of developing these potentially fatal complications, in addition to, swelling and infection.
• Quality critical care facilities are not always available. In the event that an unanticipated complication should occur, a critical care facility equivalent to U.S. standards should be accessible. Such facilities are costly to operate and are frequently unavailable in locations that offer heavily discounted plastic surgery.
• Follow-up care and monitoring may be limited. Follow-up care and monitoring is an important part of any surgery. Cosmetic surgery vacation packages provide limited follow-up care, if any, once the patient returns to the United States. Patients who travel outside the U.S. for cosmetic surgery and experience a complication may find it hard to locate a qualified plastic surgeon to treat the problem or to provide revision surgeries. Local doctors may not know what surgical techniques the physician used in the initial operation, making treatment difficult or nearly impossible. Revision surgeries can be more complicated than the initial operation and patients rarely get the desired results.
• Bargain surgery can be costly. Patients can incur additional costs for revision surgeries and complications that may total more than the cost of the initial operation if originally performed in the U.S.
• Surgeon and facility qualifications may not be verifiable. In order for cosmetic surgery to be performed safely, it requires the proper administration of anesthesia, sterile technique, modern instrumentation and equipment, as well as properly trained surgeons. Vacation destinations may not have formal medical accreditation boards to certify physicians or medical facilities. Many facilities are privately owned and operated, making it difficult to check the credentials of surgeons, anesthesiologists and other medical personnel.
• Devices and products used may not meet U.S. standards. Cosmetic surgery products or devices used in other countries may not have been tested, proven safe and effective, or been approved by the U.S. Food and Drug Administration (FDA). For example, an implant used in the United States must meet standards of safety and effectiveness, a process regulated by the FDA. Other countries may not have similar regulations.

HISTORICAL EVENTS IN SURGERY

1846:  Anesthesia first used in patient care

1918:  Surgical Leadership and innovation advances in the care of wounded warriors
           during WW1. Dr Franklin Martin, the Mayo brothers, George Crile and
           William Halsted were instrumental in organizing field hospitals for the American
           Expeditionary Force.  Plaster casts were used to treat fractures.  Advances in
           the treatment of open chest wounds and empyema.

1924: Doctors Cole and Graham devise new method (X-rays combined with contrast media)
          to detect gall bladder disease.

1935: "Whipple Procedure" introduced by Allen O. Whipple, M.D. of Columbia University
          was used to treat pancreatic cancer.

1937: "Blood Bank" opens at Cook County Hospital in Chicago under the direction of
          Bernard Fantus, M.D.

1938:  First Congenital Heart Defect (ligation of a patent Ductus Arteriosus) corrected in a 7 year old girl in
           Boston by Robert E. Gross, M.D.

1939: Study published by Alton Oshsner, M.D. and Michael DeBakey linking tobacco use to Lung Cancer.

1939: Segmental lung resection by Edward D. Churchill, M.D. of Massachusetts General Hospital
          to treat tuberculosis.

1940:  Michael DeBakey invents roller pump for a direct donor-to-patient transfusion.

1942: Albumin is used to save burn victims in Pearl Harbor attack.

1942-1945:  Many advances in military medicine: early debridement of contaminated wounds; delayed
                    closure of wounds; improved air evacuation process for treating wounded soldiers.

1945:  "Blue Babies" successfully treated by Alfred Blalock, M.D., Vivien T. Thomas (surgical
            assistant) and Helen Taussig, M.D. (pediatric cardiologist).

1945:  First Surgical Procedure to correct coarctation of the aorta performed by Robert E. Gross, M.D..

1952:  First Open Heart Operation performed by John Lewis at the University of Minnesota.

1953: "Heart-Lung Machine" used to perform open heart surgery

1954: First successful Human Organ Transplant (Kidney) perfomed by Joseph E. Murray, M.D. at
          Boston's Peter Bent Brigham Hospital.  In 1990, Dr. Murray received the Nobel Prize for Medicine.

1954:  First Carotid Artery Surgery successfully performed

1954:  First Cross-Circulation Procedure successfully performed in which a patient's father was used as a
           living oxygenator during a procedure on a 13 month old boy.

1959:  Endoscopsy vastly improved through application of Hopkins rod-lens system.

1961:  Successful repair of a brain aneurysms reported by Canadian Neurosurgeon Charles Drake, M.D.

1962:  Hip replacement becomes established procedure with Sir John Charnley, M.D. leading the charge.

1964: First Coronary Artery Bypass graft procedure performed by H. Edward Garrett, M.D. and
          colleagues.

1966: First Gastric By-pass procedure for weight reduction performed by University of Iowa Surgeon,
          Edward E. Mason, M.D.

1966: Prostate cancer treatment discovery captures Nobel Prize in Physiology and Medicine by Canadian
         Charles Huggins, M.D., professor of Urology at the University of Chicago.

1967: First Liver Transplant performed by Thomas E. Starzl, M.D. at the University of Colorado.

1967: First Human Heart Transplanted by Christiaan Barnard, M.D. in South Africa.

1968:  Infant kept alive through intravenous feeding: Stanley J. Dudrick, M.D. published a benchmark report
           in the J.A.M.A. on the use of intravenous feeding which proved that an infant could receive all
           nutrients by vein and still grow and develop.

1969: Artificial Heart successfully implanted by Denton Cooley, M.D. at Baylor College of Medicine.

1972:  First toe-to-thumb transplant by plastic surgeon Harry J. Buncke, M.D.

1972:  First Cochlear Device implanted by William House, M.D.

1972-1974: U.S. implements Emergency Medical Service System (EMS)

1973: Greenfield Filter introduced by Lazar J. Greenfield, M.D. which allowed trapping of clots
          to prevent pulmonary embolus.

1975: Radical Mastectomy no Longer a Standard Treatment for Breast Cancer

1981:  Burn Patient saved by artificial skin ("Integra")

1985: Robot-assisted surgery debuts to biopsy a brain lesion

1986:  Double Lungs successfully transplanted

1989:  General Surgery Revolutionized by the introduction of Laproscopic Techniques

1991:  Endovascular Technique introduced to repair aortic aneurysms.

1994:  First Face Replant Peformed by plastic surgeon  Abraham G. Thomas, M.D.
           when a 9 year old boy's face and scalp were pulled when caught in a thresher.

2011: Landstuhl Regional Medical Center's Trauma Center in Landstuhl Germany, an overseas military
          hospital treating American civilians and military in Europe achieved a Level I trauma status, the only
          medical center outside the U.S.A. to achieve this status.

2011:  Face Transplant performed in Boston during a 20 hour operation with a 30 member surgical team
           transplanting a new face to Charla Nash who loss her face in a vicious attack by a friend's pet
          chimpanzee.

2012:  Nerve Transfer surgery gives quadriplegic patient partial use of his hand, performed by plastic  
           surgeon Susan McKinnon, M.D. at Barnes-Jewish Hospital in St. Louis.    

RADIATION THERAPY AND BREAST RECONSTRUCTION

Houston, Texas: From the Department of Plastic and Reconstructive Surgery, University of Texas M. D. Anderson Cancer Center.  Steven J. Kronowitz, M.D.; Department of Plastic Surgery, University of Texas M. D. Anderson Cancer Center, Unit 1488, P. O. Box 301402, Houston, Texas 77230-1402, skronowi@mdanderson.org

Background: Increasing numbers of patients with breast cancer are being treated with postmastectomy radiation therapy. The author reviewed the literature to determine the clinical impact of this increasing use of postmastectomy radiation therapy in patients with breast cancer who desire implant-based breast reconstruction.

The author searched the MEDLINE database for articles on breast reconstruction and radiation therapy published between January of 2008 and June of 2011 and reviewed the abstracts of those articles to identify articles with information about the impact of irradiation on implant-based breast reconstruction. This subgroup of articles was reviewed in detail.

Results: Two hundred eighty-five articles were identified. Nineteen articles were reviewed in detail. Eight articles provided level III evidence; one provided level I or II evidence from high-quality multicenter or single-center randomized controlled trials or prospective cohort studies. Two articles provided level IV evidence from case series and were included in the review because they offered a novel approach or perspective. The most recent studies find a significant need for unplanned or major corrective surgery in irradiated breasts reconstructed with implants. Although breast implant reconstruction in irradiated breasts is associated with high rates of complications, only a minority of patients require conversion to an autologous tissue flap.

Conclusion: Although the majority of patients who undergo implant-based reconstruction and irradiation ultimately keep the implant reconstruction, patient surveys show that irradiation has a significantly negative effect on patient satisfaction.

GENTIAL SURGERY - HAVE WE GONE TOTALLY OBSESSIVE??

In the quest for perfection and amid a growing obsession with body image, it seems women now have a new part of the anatomy to worry about - their vaginas. Genital plastic surgery is one of the fastest-growing areas in cosmetic surgery, and one of the most popular procedures being requested - mostly by young women - is a labiaplasty. A labiaplasty - or labial rejuvenation - is a procedure whereby the inner labia, or labia minora, get trimmed back so they look more "tucked in". The surgery is generally done under a local anaesthetic, so the patient is awake while it is being performed. The process takes around 90 minutes and you can walk out of the surgery, returning to normal activities within a few days - except for sex, which you should hold off having for four to six weeks. The reason for the rise: "There has been a huge surge in the past five years of people looking to get genital surgery, and the vast majority of these are getting a labiaplasty, vaginoplasty (vaginal tightening) or liposuction in the pelvic area or labia," says Dr Laith Barnouti, a leading Sydney plastic surgeon. Barnouti says that currently around 20 per cent of his clients are coming in for genital surgery. The youngest to date was 14, the oldest in her mid-60s. A 2010 report also found that the number of clinically necessary procedures - that is, not solely for cosmetic reasons - performed by private practitioners nearly doubled in recent years.

So why are women requesting this procedure? There are a few reasons, says Barnouti, including feeling "socially embarrassed… people can’t wear certain types of bathers, people feel embarrassed in intimate situations". But the reasons go beyond the aesthetic, he claims.

"Labiaplasty and vaginoplasty are often performed due to a medical condition - people actually have it for a functional reason," Barnouti says. "Labial hypertrophy - enlargement or sagging of the labia - can be unhealthy and unhygienic."

Vaginoplasty, which is usually performed on women who have a weakened perineum after giving birth, is a "restorative, reconstructive procedure", says Barnouti. "This is something completely different from, say, liposuction, which is a purely cosmetic procedure."

What is normal? But are women having genital surgery for other reasons - to please a boyfriend perhaps, or because they feel their vagina is not normal? Do women actually hate the appearance of their vulvas so much that they will have parts of them surgically removed? The 2008 UK documentary The Perfect Vagina explored the reasons why women opt for this type of surgery, and found that many do it because they’ve been teased by someone close to them about the way their genitals look, or have just decided their vagina looks abnormal. In the documentary, Professor Linda Cordoza, a leading UK gynaecologist, says while women are much more aware of what’s available in terms of plastic surgery procedures, it doesn’t necessarily mean they know what’s normal.

"There’s been a huge trend towards bikini waxing, doing things with your pubic hair as well as the hair on your head. So [women think] if you can have cosmetic surgery done to your face, you can also have cosmetic surgery done on your genitals," Cordoza says.

"I sometimes get two or three generations of women in the same family coming in saying they want their labia trimmed."

The role of pornography:
Our perception of what is normal is most definitely clouded by the proliferation of pornographic images featuring women with smaller, tucked in - and often heavily airbrushed - private parts.As women, we don’t often see vaginas other than our own, so if the only images we see are of highly airbrushed genitals, naturally many of us are going to assume that what we have is "different" or "abnormal".

Melinda Tankard Reist is a media commentator and author of Big Porn Inc and Getting Real - Challenging the Sexualisation of Girls (Spinifex Press). She believes pornography is a big driver in the rise in cosmetic surgery."Girls are made to feel inadequate and think that there’s something wrong with their perfectly natural, healthy bodies. And boys are expecting girls to provide the porn star experience," Reist says.
Reist adds that it’s important women pass on positive body image messages to their daughters, and that cosmetic surgeons should play their part by refusing to operate on very young women, rather than "capitalising on the body angst of girls".

Barnouti says women contemplating any type of cosmetic surgery should be doing it for themselves, not anyone else. "What we do here is for the patient, not their partner," Barnouti says. "If you’re going to have a procedure, have it for yourself. Just because someone makes a negative comment doesn’t mean you should change your whole body."

"I had this surgery and love the results": Lisa Smith, 23, recently had genital surgery at the Ashley Centre in Melbourne. "Labiaplasty is something I’ve wanted to do for years. I have never had a problem with how I look, nor have I received any negative comments from partners. For me it was about feeling discomfort and swelling in that area, particularly after sex. The procedure wasn’t uncomfortable and I was surprised by how minimal the pain was, especially considering how sensitive that area is. I am a dancer and I’ve talked to a lot of friends about it and many say they have also had it done. It’s just not something people are talking about very openly yet."

Did you know? This type of surgery gets 74,000 global monthly internet searches on Google.

CREDENTIALS ARE IMPORTANT

A Florida woman's quest for more youthful skin turned deadly this past July when her face became dangerously swollen after she received vitamin injections at a day spa.

Isabel Gonzalez paid nearly $900 for "facial rejuvenation" injections at Viviana's Body Secrets Spa in Doral, Fla. After receiving the treatments, her face started to swell and became infected, and she soon landed in the hospital, where she spent more than two months. Doctors fear her face may be permanently deformed.
The spa owner, Viviana Ayala, was arrested this week on charges that included aggravated battery and practicing medicine without a license, according to a report from the Doral Police Department. Ayala wasn't trained or certified to deliver facial injections. She wasn't even a licensed massage therapist as she advertised on her website. Ayala, according to the Miami Herald and other news sources, has denied all charges against her. Neither Ayala nor her lawyer, Milena Abreu, could be reached for comment.

Experts are alarmed at the increasing number of people seeking such cosmetic procedures. According to the organization Cosmetic Plastic Surgery Research, more than 8 million people underwent cosmetic treatments to freshen up their appearance last year. Treatments included Botox, chemical peels and laser skin resurfacing, and consumers migtht not be aware of the risks. Isabel Gonzalez remains in the hospital after  after receiving facial rejuvenation treatments from an unlicensed spa owner.

"Cosmetic procedures are now so mainstream there's a misperception that it's like getting your hair done," said Dr. Leo R. McCafferty, a board certified plastic surgeon who is president of the American Society for Aesthetic Plastic Surgery. "They are inherently safe, but this is predicated on [their] being delivered by properly trained professionals in a properly equipped facility."

ASAPS recommends that cosmetic procedures be performed only by board certified plastic surgeons or dermatologists in an accredited facility, although some states al/so allow registered nurses and physician's assistants to deliver therapies under doctors' supervision. Members of the ASAPS, and similar professional organizations, are required to operate only in certified centers or hospitals.

Some spas meet these criteria, but even if a facility brands itself a "medispa," that's no guarantee of proper oversight. A clinic may claim it's affiliated with a board certified plastic surgeon, but a surgeon might only show up to check charts once a month. Or a spa may try to pass off a practitioner who has no medical training as a cosmetic surgeon. Although this is illegal in some states, McCafferty said, no one's really checking.

Dr. Nima Patel, a plastic surgeon at Maimonides Medical Center in Brooklyn, N.Y., said spas can mislead consumers in other ways, too.
"Most people know they probably shouldn't get an injection from the same person who gives them a massage but don't think twice about letting a dentist or a physician who doesn't have intensive training in a cosmetic specialty give them an injection," she said. "In some spa settings, this is who is delivering the services."
Patel also emphasized the importance of making sure the attending professional maintains privileges at a nearby hospital and remains on the premises when cosmetic procedures are done. If there are side effects or complications, a patient can be transferred to the emergency room.

Dr. Felmont Eaves, a Charlotte, N.C., board certified plastic surgeon in private practice, advised any consumer considering any type of cosmetic touch-up to do their homework. "Check out the credentials of anyone performing or overseeing your treatment and know the risks of the product you are considering," Eaves said. As for bargain hunting, Eaves warned against it.

BREAST RECONSTRUCTION OPTIONS

During October, pink ribbons seem almost as ubiquitous as jack-o'-lanterns. If that's any indication of breast cancer awareness, knowledge of the disease must be at an all-time high. However, one aspect of recovering from breast cancer remains obscured by lack of information and a degree of stigma: breast reconstruction. A 2008 study revealed seven out of 10 breast cancer patients are not told their options for post-mastectomy reconstruction.

  "We don't do an adequate job informing patients about what's going on," says Dr. Scott Sullivan, a general and plastic surgeon and co-founder of the Center for Restorative Breast Surgery. "The general surgeons are the gatekeepers (for reconstructive surgery), and they may not know the options or may choose not to discuss it. A community hospital may not have a plastic surgeon around, and even in some big cities, the quality of the surgery is not what it should be."
  Two-time breast cancer survivor Kim Sport knew about her reconstruction options because she was an active volunteer in the cancer community. It wasn't until after her mastectomy and reconstruction that she learned this made her a bit of an anomaly.
  "I didn't know that doctors weren't telling their own patients they didn't have to live with disfigurement after a mastectomy," says Sport, who created Breastoration, an organization that sheds light on breast reconstruction. "I was so outraged by it. I can't imagine looking down and dealing with disfigurement as a daily, constant reminder that at two times, I had a life-threatening disease."
  Sport and Dr. Malcolm Roth, president of the American Society of Plastic Surgeons (ASPS) and chief of the division of plastic surgery at Albany Medical Center, say that some surgeons may intentionally or unintentionally lead women to believe that breast reconstruction is an unnecessary or narcissistic cosmetic procedure.
  "The fact that we have mandated insurance coverage takes (reconstruction) out of the realm of cosmetic surgery and makes it medically necessary procedure for a woman's physical and emotional well-being following her mastectomy," Sport says.
  Roth says not only does reconstruction pose no risk to survival in suitable patients, it also aids recovery.
  "Women who have immediate reconstruction are more likely to return to work and social situations faster, have less chance of depression, and the quality of life gets back to normalcy much faster," Roth says. "So it may actually be better to do it immediately, though in some cases it is better to wait. A board-certified plastic surgeon is knowledgeable about that and collaborates with the oncologist, the breast surgeon, about what the best road for her may be."
  There are a number of sophisticated techniques for breast reconstruction, with implants being the most common, according to Dr. Frank DellaCroce, co-director of the Center for Restorative Breast Surgery. Cohesive silicone gel or saline implants and supportive collagen are placed immediately following the mastectomy. Often, the skin and nipple can be spared, though sensation and functionality are lost. Fat transplant procedures involve transferring fat from the stomach or hips to create a natural feeling breast from living tissue that responds to weight gain or loss. The operation and recovery are longer than with implants — five or six hours in surgery compared to one or two, and a hospital stay that's two days longer — but fat transplants never wear out or need to be replaced.
  "Plastic surgeons are at the ready with super-sophisticated technology that women need to know about," DellaCroce says. "And they need to know about them before they need them, ideally."

AGING BREASTS

Twin Study Sheds Light on How Breasts Age


Want to know how to keep breasts looking young? A new study of twins provides revealing information for patients on which factors help breasts maintain their youthful qualities as well as those that seem to diminish them.
Breastfeeding, daily moisturizing, and hormone replacement therapy may help breasts stay younger-looking. By contrast, smoking, drinking alcohol, multiple pregnancies, higher body mass index, and larger bra and cup sizes contribute to accelerated breast aging, according to a new study in the September issue of the Aesthetic Surgery Journal.
“Identical twin studies like this one are very valuable because they allow us to control for genetic influences,” says lead researcher Hooman T. Soltanian, MD, of University Hospitals Case Medical Center and Case Western Reserve University School of Medicine in Cleveland, in a new release. “This allows us to more accurately assess the impact of external factors on breast aesthetics, such as environmental and lifestyle factors.”For the study, researchers recruited 161 pairs of identical female twins with a mean age of 47.6 years in 2009 and 2010. Aesthetic breast features were rated by plastic surgery residents using standard medical photographs. The ratings were analyzed against data on participants’ medical and personal histories to determine the significance of different external factors on breast appearance. Twins who moisturized their breasts daily had significantly fewer wrinkles in that area, and those who received hormone replacement therapy after menopause had a more attractive breast shape, size, projection, areolar shape, and areolar size. Women who breastfed had less attractive areolar size and shape, but better skin quality.

“This study is significant because it clearly shows women what they can do right now to help slow the aging process and keep their breasts looking attractive, even without surgical intervention,” says Foad Nahai, MD, the editor-in-chief of Aesthetic Surgery Journal, in a news release.

PLASTIC SURGERY UPDATE - VIDEO

ROSACEA

Does Bacteria Cause Rosacea? New Study Suggests it "Mite"


Bacteria that reside within tiny mites may cause rosacea, a new review study suggests.
Researchers out of the National University of Ireland report that rosacea may be triggered by bacteria that live within tiny Demodex folliculorum mites which make their home in our skin. Their findings appear in the Journal of Medical Microbiology. Previous research has shown that the numbers of Demodex mites living in the skin of rosacea patients is higher than in normal individuals. More recently, the bacterium Bacillus oleronius was isolated from inside a Demodex mite and was found to produce molecules provoking an immune reaction in rosacea patients. Other studies have shown patients with varying types of rosacea react to the molecules produced by this bacterium. In addition, this bacterium is sensitive to the antibiotics used to treat rosacea.
The new findings may give rise to more effective treatments for rosacea, conclude study authors who were led by Kevin Kavanagh, PhD. “Targeting these bacteria may be a useful way of treating and preventing this condition,” he says in a press release. “Alternatively, we could look at controlling the population of Demodex mites in the face. Some pharmaceutical companies are already developing therapies to do this, which represents a novel way of preventing and reversing rosacea, which can be painful and embarrassing for many people.
Michele Green, MD, a dermatologist at Lenox Hill Hospital in New York City, says that the new findings make sense. “I am not surprised, considering how often Rosacea improves or resolves with oral and or topical antibiotic therapy. Rosacea like traditional acne may indeed have the same cause and, hence, the same treatment.“

AUTOGENOUS TISSUE THE BEST IN NASAL SURGERY

Nose implants may increase infection risk, a new study suggests.

Researchers analyzed infection rate seen following 662 rhinoplasty procedures performed by three surgeons from 1999 to 2008. Medpor or Gore-Tex implants were used in 151 cases. Nineteen patients developed an infection, and all of the infections occurred in patients who had implants. In all but one of these cases, the implant began protruding through the skin.

UPDATE ON CHIMPANZEE ATTACH

Charla Nash, the victim of a horrific attack by a 200-pound chimpanzee, appeared Friday at a Connecticut legal hearing, where officials are deciding whether she can sue the state for $150 million.

The attack occured when Nash had gone to visit her friend, Sandra Herold, back in 2009. She had just gotten out of her car when Herold’s chimp spotted her, went berserk and attacked. A terrified Herold dialed 911 and Charla was rushed to the hospital where doctors managed to save her life, but not her face or her hands.
Speaking clearly and looking remarkably recovered from the disfiguring attack and her 2011 face transplant, Nash spoke exclusively to NBC News about her recovery and her hopes for the future.
"I need to keep building up my stamina," Nash said. "Hopefully by Christmas I could get hands."
Back in May 2011 doctors gave Charla her new face, from an anonymous donor, in a grueling 20-hour surgery. The 30-member surgical team, under the leadership of Dr. Bohdan Pomahac at Brigham and Women’s Hospital in Boston, performed a groundbreaking full face and double hand transplant. She later lost the hands due to complications, but her new face thrived.
Charla Nash was severely disabled after she was attacked by a friend's chimp. As time went on and the swelling went down, Charla's new face began to mold to her underlying bone structure, giving her an appearance reminiscent of the way she looked before the horrifying attack in 2009. Looking at Nash on Friday, it was hard to imagine that just three years ago she had no nose, lips, or ears. Though the right side of her mouth droops a bit because of nerve damage, Nash’s face looks otherwise quite normal.
“Overall, it’s really superb – a remarkable result,” said Dr. Eduardo Rodriguez, a professor of surgery at the University of Maryland School of Medicine and Chief of Plastic Surgery at the R Adams Cowley Shock Trauma Center. Rodriguez, who led the team that transplanted a face in March of this year, suspects that Nash will continue to improve with time as nerves continue to rewire and the facial muscles get more use. Nash told NBC that she's been exercising to build up her muscles, and demonstrated with pride how she can now close her lips fully.Experts say it takes months for the nerves emanating from transplanted faces to connect with a patient’s brain.
In Nash’s case, “she is more than a year past her surgery and the nerves have started to grow back so she can make facial expressions and do the kinds of things a normal face does,” said Dr. Daniel Alam, section head of facial plastic and reconstructive surgery at the Cleveland Clinic. Alam was Nash’s initial reconstructive surgeon and took part in her transplant surgery.
“The holy grail for us is to learn to make the nerves work better,” Alam said. “Right now, we can make them work and recover function, but there tends to be some asymmetry, with the nerves on one side working better than the other.” The magical part, Alam said, is not that the transplant survives and molds to the patient’s face, but that it actually hooks up with the region of the brain that tells it how and when to move.
“Inside your brain there’s a part near the ear, called the facial motor, that tells the face what it needs to do,” Alam explained. “Its branches tell the eyes when to close, the mouth when to smile. Each tiny movement of the face is like a note in a piece of music. If you think of the face as an instrument, the brain is sending all the notes to that instrument and making it play.”The process doesn’t end when doctors put in their last stitch, though. After surgeons connect up what they can, the brain does its own bit of rewiring.
“It’s fascinating,” Alam said. “Six months to a year after the transplant, the recipient’s nerves grow into the face. So you get a hybrid. You’ve got the donor face, but your own nerves grow into the muscles and tell them what to do.”Nash said she was tired after the hearing because she's not used to such lengthy public outings, but overall said, "I'm doing OK."
Nash, who has amassed millions of dollars in medical and other bills, said she's holding out hope she will be granted permission to sue the state's Department of Energy and Environmental Protection, which she holds responsible for not seizing the animal despite a state biologist's warning it was dangerous, according to the Associated Press.
Assistant Attorney General Maite Barainca told Claims Commissioner J. Paul Vance Jr. that Nash deserves sympathy for her plight and admiration for the courage she has shown in dealing with her situation, but argued that the state should not be held liable for actions of the privately owned animal, the AP reported.
A decision on the state's motion to dimiss is expected to be issued within 30 days. If the commissioner rules against Nash, she can ask state legislators to overrule the decision. If the state's motion to dismiss is denied, a trial-like hearing will be held. Then the commissioner would then have to decide whether to allow Nash to sue the DEEP in superior court, according to the Associated Press.

Charla Nash's family has established a fund for her care at nashtrust.com.

DOG BITE INJURIES

Alarming rise in the number of children needing hospital treatment for dog attacks•Three-quarters of children admitted had to undergo surgery

Hospital admissions for injuries caused by dogs rose by 5.2 per cent in England last year, with young children suffering the most wounds.
New figures revealed that 6,450 people were admitted in the 12 months to April 2012, up from 6,130 the year before. Children aged under 10 were the worst-affected group, accounting for one in six of admissions. Three-quarters of them needed surgery, according to the data from the Health and Social Care Information Centre.

TRENDS IN MALE PLASTIC SURGERY

Nearly 9% of the patients seeking cosmetic surgery in 2011 were men, according to the American Society for Aesthetic Plastic Surgery, and plastic surgeons say the number of male patients is growing. Men often seek gynecomastia treatment, liposuction, blepharoplasty and dermal fillers, according to plastic surgeons Richard Zeff and Charles Gaudet and data from the American Society of Plastic Surgeons. Gaudet said men "know the procedures are available and they are taking advantage of the confidence it gives them." SeacoastOnline (Portsmouth, N.H.)

AUGUST VIDEO UPDATE

SCOPE OF PRACTICE

Utah plastic surgeons remind patients to check out doctors


The Utah Plastic Surgery Society is running billboards reminding patients to ensure their doctor is board-certified in plastic surgery before getting cosmetic or reconstructive procedures. Increasingly, doctors who are board-certified in other specialties, such as dentistry or OB-GYN, are offering cosmetic and reconstructive surgeries. "A lot of these doctors will go to a cosmetic boot camp, learn the procedures, come back on Monday morning, and they're doing them," plastic surgeon Grant Fairbanks said. KTVX-TV (Salt Lake City) (8/14)

DON'T LIKE YOUR PROFILE?

Chin implants have become more popular than ever. Studies show they're up 71% from last year, making chin implants or chin augmentation the fastest-growing trend in plastic surgery. ThePlasticSurgeryChannel.com (8/17)

RESEARCH AND DEVELOPEMENT

Scientists print ears, grow muscle at regenerative institute

Researchers at the Wake Forest Institute for Regenerative Medicine have used cells taken from patients and grown in the lab to engineer body parts. They have used 3D printing to make ears, have grown urethras for children who suffered pelvic injuries and are engineering muscle to repair injuries

TANNING AND MELANOMA

Study: 1 in 20 Cases of Melanoma Linked to Indoor Tanning


Fully one in 20 cases of melanoma is related to use of indoor tanning beds, new research suggests. According to the study, indoor tanners have a 20% increased risk of skin cancer, and this jumps to 87% if they start using tanning beds before they turn 35.
“Sunbed use is associated with a significant increase in risk of melanoma [and] the cancerous damage associated with snubbed use is substantial and could be avoided by strict regulations,” report researchers led by Philippe Augier, director of the International Prevention Research Institute in Lyon, France. The findings appear online in the BMJ.
Researchers analyzed 27 studies published between 1981 and 2012. In all, they identified more than 11,000 cases of skin cancer. They stated that more than 3,400 of the almost 64,000 new cases of melanoma in Western Europe each year are directly attributable to tanning bed use. Tanning bed use is also estimated to cause 800 deaths from melanoma each year. Put another way: each trip to the tanning salon increases melanoma risk by about 1.8%.
The ban the tan movement continues to take flight across the globe. The number of countries with nationwide indoor tanning legislation restricting use by young people 18 years or younger increased from two countries (France and Brazil) in 2003 to 11 countries in 2011, according to a recent study in the Archives of Dermatology. The 11 countries were France, Spain, Portugal, Germany, Austria, Belgium, England, Wales, Northern Ireland, Scotland and Brazil.
In the US, New York state, California, Vermont, and Rhode Island have banned most indoor tanning by minors. Ban the tan legislation is pending in many states. The Affordable Care Act include includes a 10% tax on indoor tanning.

MID EAST COSMETIC SURGERY

Demand for cosmetic surgery in Dubai increases by 100%


New figures released by the Dubai Health Authority have revealed a huge spike in the number of people having cosmetic surgery procedures in Dubai.

According to the organisation, 68,000 men and women underwent surgical and non-surgical treatments at the country's clinics last year – double 2010's total.

Some of the most popular treatments include skin peels and laser rejuvenation treatments, which are designed to leave skin looking more healthy and youthful, as well as nose reshaping operations known as rhinoplasty.

The figures revealed that the most popular non-surgical treatment in 2011 however was laser hair removal.

Top surgeons in Dubai have claimed that an increasing number of professionals in the country are choosing to undergo cosmetic procedures in order to boost their career prospects, with workers in their 40s and 50s keen to be on a par physically with younger employees.

The fact that many procedures can now be carried out with minimal downtime, or even none at all, has helped to boost the popularity of non-surgical treatments.

FEDERAL MANDATES ARE "KILLING US"

Obamacare: Its Latest Assault on Religious Freedom

With every passing day, Obamacare becomes more entrenched as the law of the land. The latest reality is a Health and Human Services (HHS) mandate that requires health plans to provide contraception, sterilization, and abortion-inducing drugs. Even an employer or organization with religious objections can be forced by the government to provide coverage for medications and procedures against which they have deeply-held convictions. This is an intentional act of discrimination against people's religious beliefs and a violation of the First Amendment of the U.S. Constitution.

The Obamacare HHS mandate is being challenged in court. One of those challenges is from a family-owned company that simply wants the right to administer its health plan in a way that is consistent with the owner's beliefs.

It's also worth noting that forcing insurance companies to provide contraception, sterilization, and abortion-inducing drugs "free of charge" means the cost is likely to be passed along to that insurer's customers, even those who morally oppose contraceptives and/or abortifacients.

Federal mandates should never infringe on personal liberties!