MRSA CHALLENGES PHYSICIANS, ENDANGERS COMMUNITIES

USA Today (12/17, Eisler) reports in a nearly 2,700-word article on the dangers of MRSA bacteria and their ability to resist antibiotics, reporting that “MRSA infections, particularly outside of health care facilities, are much more common than government statistics suggest,” affecting hundreds of thousands of Americans annually with minor skin boils, deadly pneumonia, and other symptoms, and causing over 20,000 fatalities. Public health officials remain unable to detect or track cases, with Center for Disease Dynamics, Economics & Policy head Ramanan Laxminarayan stating, “It’s not about winning or losing the battle (against MRSA), it’s that the battle is shifting. You’re seeing people who are young and healthy getting this (in the community), and it’s very serious.”

        Another USA Today (12/17, Fecto, Eisler) article reports that MRSA can be particularly dangerous where individuals remain close together or have frequent skin-to-skin contact, such as in schools, athletic facilities and prisons. The paper mentions open skin, such as scrapes, as avenues for the disease to enter the body, and the Center for Disease Control and Prevention encourages educating athletic coaches and players about prudent hygiene and laundry practices as well as antibacterial soap and improved laundry methods in prisons.

        A USA Today (12/17) video depicts individual Eric Allen’s experience with the disease, noting that he was hospitalized for 45 total days.

        On the front of its Personal Journal section, the Wall Street Journal (12/16, D1, Wang, Subscription Publication) reports an over 1,100-word article that new strategies to combat antibiotic-resistant bacteria include combining substances like silver with antibiotics, genetically sequencing bacteria to develop drugs more quickly, or simply rendering bacteria incapable of infecting humans. Some pharmaceutical companies are experimenting with additives to short-circuit bacteria’s defenses.

GENE THERAPY AND "KILLER T CELLS"

Researchers reprogram T cells to fight leukemia.

In a 1,000-word article, the AP (12/8, Marchione) reported, “In one of the biggest advances against leukemia and other blood cancers in many years, doctors are reporting unprecedented success by using gene therapy to transform patients’ blood cells into soldiers that seek and destroy cancer.”

        In an 1,100-word article on its website, CNN (12/8, Cohen) reported that first, a patient’s T cells are removed. Physicians “then reprogram the cells by transferring in new genes.” After they are “infused back into the body, each modified cell multiplies to 10,000 cells. These “hunter” cells then track down and kill the cancer in a patient’s body.”

        In an 1,100-word article, Bloomberg News (12/8, Lopatto) reported, that in one study, presented at the American Society of Hematology meeting, researchers found “that 15 of 32 patients with chronic lymphocytic leukemia experienced a reduction of their cancers and 7 achieved remission.” Meanwhile, researchers found that among those “with acute lymphoblastic leukemia, 19 of 22 children experienced complete remission, as did all five adults tested.”

        The Philadelphia Inquirer (12/8, McCullough) pointed out, however, that as is the case “with conventional chemotherapy and radiation, remissions achieved with the T cells are not necessarily cures.” The data indicated that “five pediatric patients whose cancer seemed to be eradicated – sensitive technology could not detect a single malignant cell – relapsed after months of robust health.”

BREAST CANCER AND CHOLESTEROL

Byproduct of cholesterol may fuel tumors in some common forms of breast cancer.

McClatchy (11/30, Price) reported that previous research has “shown a link between obesity and breast cancer, and now scientists at Duke Cancer Institute may have found one important explanation: a byproduct of cholesterol that fuels tumors in some of the most common forms of the disease.” The findings are published in Science. The research, partially funded by the National Institutes of Health, may lead to “simple methods to reduce breast cancer risk, including using cholesterol-lowering drugs such as statins and eating a healthier diet.”

        The Cleveland Plain Dealer (12/1, Townsend) reported that the researchers “found that a byproduct of cholesterol – a molecule called 27-hydroxycholesterol, or 27HC – functions like estrogen, fueling the growth and spread of breast cancer.” Although “the findings are drawn from studies in mice and tumor cells, the” scientists “say they are significant enough to set the stage for what the researchers call ‘near-term’ clinical trials in humans that can begin exploring how statins and other anti-cholesterol drugs might be used to help lower, or even prevent, a woman’s chances of developing breast cancer.”

        BBC News (11/29, Gallagher) pointed out, however, that “cancer charities cautioned that it was too soon to advise women to take statins.”

"NIP TUCK" COACH

 Michele is a "coach" that helps patients get through the sometimes confusing large volume of information on cosmetic surgery issues. She does background work for patients to help them make wise decisions.  It is important that patients do their own research, but in some cases, patients may need assistance.  Web Sites like the one by the American Society of Plastic Surgeons offer detailed information about dozens of surgeries and procedures.  Researching the doctors being considered is another important aspect of preparing for cosmetic surgery. "What are the qualifications of the physician they're going to see, how many types of procedures have they performed, of course board certification, and also talk to previous patients of that practice," recommends board certified plastic surgeon, James Newman, M.D., FACS. Some patients turn to Michele to do much of that background work for them.  There is a fee for her service. Michele Garber has written an e-book called "Safety First: 10 Golden Rules for Safe Cosmetic Surgery."

TREATMENT OF HYPERTROPHIC SCARS WITH LASERS

Current laser therapy approaches are effective for treating excessive scars resulting from abnormal wound healing, concludes a special topic paper in the December issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).
The review by Dr. Qingfeng Li and colleagues of Shanghai Ninth People's Hospital in Shanghai, China, provides strong support for laser treatment of hypertrophic scars-but less so for another type of abnormal scars called keloids. The authors highlight the need for further research in this and other key areas, including the benefits of different types of lasers and the results of laser treatment for scarring in patients with darker skin.
Seventy Percent Success Rates with Laser Treatment for Excessive Scars...
Dr. Li and coauthors identified and analyzed previous studies of laser treatment for abnormal scarring. They found 28 well-designed clinical trials using various medical lasers for two types of excessive scarring: hypertrophic scarring and keloids. Both are abnormal tissue responses that lead to raised and thickened areas of scarring, resulting in cosmetic and sometimes functional problems.
Hypertrophic scars are limited to the initially injured area. Keloids-which are more common in dark-skinned individuals-can spread beyond the area of the initial wound. Most of the studies evaluated the effects of laser therapy for hypertrophic scarring; just three reports focused exclusively on keloids.
Data from more than 900 patients showed high success rates with laser treatment: about 70 percent for both hypertrophic scarring and keloids. Based on studies targeting scars that were less than one month old, laser therapy had a similar success rate in prevention of excessive scarring.
The responses appeared best with two specific lasers: the 585/595 nm pulsed-dye laser (PDL) and the 532 nm laser. (The figures in nanometers [nm] indicate the wavelength of the laser light used.) About two-thirds of the studies reviewed examined the 585/595 nm PDL; just three studies evaluated the 532 nm laser.

Some studies provided data on objective responses to laser treatment, reporting improvements on standard rating scales and measures of scar height and redness. Data from the PDL studies suggested that the best interval for repeated laser treatments was five to six weeks; PDL treatment appeared most effective in patients with fairer skin types.
More Research Needed on Darker Skin, Different Laser Types

INFECTIONS AFTER COSMETIC SURGERY

Boston health officials are investigating several reports of severe infections in patients who traveled to the Dominican Republic for cosmetic surgery.

At least two patients in Boston, and another in Worcester, are believed to have been infected with Mycobacterium abscessus, bacteria that are not easily battled with antibiotics and can take months of treatment to vanquish.

The patients were part of a group that went to the Dominican Republic during the summer for surgeries and started having health problems earlier this fall, including abscesses and drainage from their surgery sites, said Dr. Anita Barry, director of the infectious disease bureau at the Boston Public Health Commission.

HOLD ON - IT WILL BE A "WILD RIDE"

Insurance sold on marketplaces may limit access to doctors, hospitals.

In a front-page story titled “Insurers Restricting Choice Of Doctors And Hospitals To Keep Costs Down,” the Washington Post (11/21, A1, Somashekhar, Cha, 4.28M) reports that “Americans...are discovering that insurers” selling plans on the Affordable Care Act’s marketplaces, “are restricting their choice of doctors and hospitals in order to keep costs low, and that many of the plans exclude top-rated hospitals.” According to the Post, there is now “a two-tier system” as “many of the people who buy health plans on the exchanges have fewer hospitals and doctors to choose from than those with coverage through their employers.” The Post says this situation has been exacerbated by some “providers” that “have balked at being in exchange networks because they are unhappy with the reimbursement rates or are concerned that the exchanges could be dominated by sick people who won’t be able to pay their portion of the bills.”

        As the AP (11/21, Alonso-Zaldivar, Ramer) notes, President Obama “promised people could keep their doctors,” which could make this “the next health overhaul issue.” American Medical Association president Dr. Ardis Dee Hoven is quoted as saying, “Although it may be too early to reach any definitive conclusions, we are monitoring the adequacy of the exchange networks and will be analyzing the impact of these restrictive strategies on patient access to care.”

        Moreover, the Washington Examiner (11/21, Pollock, 319K) reports that consumers visiting healthcare.gov are not able “to learn whether their doctors participate in an Obamacare-approved health care plan because the website doesn’t include such information.” Jessica Waltman, senior vice president of government affairs for the National Association of Health Underwriters, explained to the Examiner: “Under the exchanges, the government did not require health plans to submit detailed network information. That’s why the networks aren’t listed on healthcare.gov. When you go to look in at the plan choices, you can’t see the provider networks.”

ANOTHER INVESTIGATIONAL DRUG THAT MAY BE BENEFICIAL - THE BODY'S IMMUNE SYSTEM IS THE KEY

Merck says cancer drug boosts survival of advanced melanoma patients.

The Wall Street Journal (11/18, Subscription Publication, 5.91M) reports Merck & Co. provided an update Monday to its early-stage study of a melanoma treatment, showing that it has an 81 percent survival rate at the one-year mark. The pharmaceutical giant provided data on its investigational MK-3475 against advanced melanoma at the International Congress of the Society for Melanoma Research, reports the Journal.

        Bloomberg News (11/19, Cortez, 1.91M) provides more details, noting the drug being “evaluated in nine different malignancies kept more than four of five melanoma patients alive for a year in a study,” including patients who had “exhausted all other treatment options.” The study found 41 percent “responded to treatment and 9 percent showed evidence of the tumor disappearing.” The drug belongs to a new group of medicines called PD-1 inhibitors “that harness the body’s immune system to attack cancer.” Merck is evaluating the drug in more than 3,000 patients suffering from cancers such as lung, bladder, breast and colorectal tumors, the article notes.

ANOTHER SURGICAL PROCEDURE THAT IS USUALLY NOT NECESSARY

Sharp rise in number of women getting genital plastic surgery: researchers 

Experts blame porn for confusing teen girls and women about what a vagina is supposed to look like. In Britain, there’s been a fivefold increase in the number of female cosmetic genital surgeries, which aren’t medically necessary and could cause health problems.

 

 

There’s been a scary rise in the number of women and teen girls getting unnecessary labiaplasties, researchers said.

 

A shocking number of teen girls and women are undergoing plastic surgery on their vaginas to replicate what they see in pornography, British researchers said.
The Royal College of Obstetricians and Gynecologists reported a fivefold increase in labiaplasties, which are considered cosmetic surgeries, over ten years.Experts attribute the sharp uptick, in part, to porn. “The misapprehension arises from the prominence of just one type of ‘neat’ genital appearance, the type to be found prominently depicted in pornography,” Thomas Baldwin of RCOG’s ethics committee, told Agence France-Presse.

The paper examines the dangers associated with these surgeries, which aren’t medically necessary.
“The younger a girl begins her labiaplasty trajectory, the higher the number of operations over her lifetime and the greater the risk of scarring and sensitivity loss,” researchers wrote.

The operations aren’t recommended for women under age 18, whose vaginas aren’t fully developed.
In Britain, 2,000 of these operations were performed in 2010, according to the report. But experts say the true number is much higher, as that figure doesn’t take into account surgeries done in the private sector. The trend is also growing in the United States, despite a 2007 warning to physicians from the American College of Obstetricians and Gynecologists, to consider the “medical validity and safety” of female genital cosmetic surgery, Reuters reported.

GOOD NEWS AND BAD NEWS

CDC: Teen smoking down but use of cigars, e-cigarettes up.

The Wall Street Journal (11/14, Esterl, Subscription Publication, 5.91M) is part of the group of US national media outlets reporting on new findings from the US Centers for Disease Control and Prevention that were published yesterday. Though the CDC revealed that cigarette use among minors in the US is dropping over last year, the use of alternative tobacco products, such as miniature cigars, electronic cigarettes, and hookah, has risen. The Wall Street Journal focuses on the first of that group, cigarillos and little cigars, as being the second most used tobacco product among teenagers.

WE STAND ON THE SHOULDERS OF GREAT MEN - DR. TOM REES WAS AN INSPIRATION

November 15, 2013

Plastic surgery mourns loss of one of its giants: Thomas Rees, MD, passes at 86

Plastic surgery pioneer and ASPS Life Member Thomas Rees, MD, Santa Fe, N.M., passed away Nov. 14. Dr. Rees was world-renowned for facial aesthetics, particularly rhinoplasty. He was also a prolific author who literally wrote the book – actually, six textbooks - on cosmetic plastic surgery and other procedures.

Along with his mentor Sir Archibald McIndoe, MD, and fellow plastic surgeon Sir Michael Wood, MD, Dr. Rees in 1957 co-founded the African Medical and Research Foundation, more commonly known as the Flying Doctors Service of Africa. The organization was dedicated to providing those living in the most remote areas of Eastern Africa with access to hospital care via air transport.

“During my years of active practice in New York City for 40-45 years, I was spending every winter in East Africa,” Dr. Rees told PSN in 2006. "I had this side avocation going on.”

“Dr. Rees’s contributions to aesthetic techniques – both in the United States and throughout the international aesthetic community of plastic surgeons – are extraordinary,” says ASPS President Robert X. Murphy Jr., MD. “His dedication to sharing his knowledge with residents and other plastic surgeons is overshadowed only by his tremendous humanitarian work with the Flying Doctors of Africa. He was truly a giant in our specialty and beyond.”

Dr. Rees stopped practicing plastic surgery in 1994, and penned a memoir chronicling his experiences in Africa titled Daktari: A Surgeon’s Adventures with the Flying Doctors of East Africa. He also continued to make annual trips to Africa with his wife of 63 years, Nan, who passed away in May 2012.

“Dr. Rees is a shining example of plastic surgery at its best,” says Kevin Chung, MD, president of The PSF. “His significant contributions extended well beyond the clinic, and he left a blueprint for international service that is inspiring and enduring.”

Dr. Rees, who came from a family of physicians, says he developed an interest in plastic surgery during a rotation in the specialty as part of his general surgery training.

“I liked it very much because it left a lot of room for innovation,” he said. “If you’ve done 50 gallbladders, you’ve done them all, [but] plastic surgery was different. It appealed to my artistic sensibilities. I liked the idea that you were constructing things instead of destroying things.”

As a dedicated teacher and humanitarian, Dr. Rees leaves a rich legacy that impacted generations of plastic surgeons and thousands of patients’ lives a world away.

INFORMATION PLASTIC SURGEONS WON'T TELL YOU: NUMBER 10

10. “Those who need surgery the most will benefit from it the least.”

Most people turn to plastic surgery when they feel age has finally caught up with them and nothing else will rid them of that troublesome bulge or crease. But the dirty little secret of plastic surgery is that with many procedures, the more you need it, the less of an impact you can expect.

Those who have damaged skin, more common as we age, can expect some serious complications. Skin stretched by weight gain, for example, loses its elasticity; following liposuction, skin may not snap back into place but instead will hang like an apron over the area that was suctioned. Because smokers have poor circulation to the epidermis, their skin can die after surgery, meaning months of unsightly scars and possible additional surgery. And procedures such as a face-lift done on sun-damaged skin won’t last as long and may result in more-prominent scarring. Likewise, those hoping for dramatic weight loss from liposuction are looking in the wrong place; surgeons say it’s meant only to shape a certain part of the body in conjunction with diet and exercise.

Ironically, those who need cosmetic treatments the least — generally, those who are younger (say, in their late 30s or 40s) and opt for a little tweaking here and there — are going to fare the best. What’s more, while plastic surgeons sometimes downplay the role that lifestyle can play in one’s looks, a growing body of evidence suggests that overall health and appearance are indeed related, Sarwer said.

INFORMATION PLASTIC SURGEONS WON'T TELL YOU: NUMBER 9

9. “Of course I’m board certified, for what it’s worth.”

A board-certified plastic surgeon should be the best, right? Not always. Because any medical doctor can legally perform any cosmetic procedure, without obtaining any specific certification, and because certification boards are self-regulating, many certifications aren’t so telling. The American Board of Laser Surgery, for example, certifies nurses, veterinarians and oral surgeons in laser surgery — through a take-home written exam and video Web conference. “This being the U.S. and the land of entrepreneurship, just saying you’re board certified is not enough,” says Nahai. “Ask them which board.”

There are some certifications that matter. The American Board of Plastic Surgery’s is one of the most rigorous for this specialty and the only certification for whole-body plastic surgery recognized by the American Board of Medical Specialties that provides training and assessment for entire body cosmetic, plastic surgery, and reconstructive treatments. The American Board of Medical Specialties is a nonprofit organization that’s widely recognized as a leader in physician certification. Members of the ABPS have completed residences in both general surgery and plastic surgery and are trained to do all procedures from liposuction to nose jobs. Other ABMS Member Boards may have some specific plastic surgery procedures for which their certified physicians are also qualified (for example, physician members of the American Board of Otolaryngology may be very well qualified to perform nose jobs). The American Board of Medical Specialties runs a website, CertificationMatters.org, where patients can see if their doctor is certified by a rigorous board.

INFORMATION PLASTIC SURGEONS WON'T TELL YOU: NUMBER 8

8. “You’d be better off spending money on a good therapist.”

Cosmetic surgery doesn’t make you crazy, but research suggests those who have had it, both men and women, are more likely to suffer from psychological problems. Several studies in the 2000s found that women who chose to get breast implants were two to three times more likely to commit suicide than demographically similar women without cosmetic implants. And 20% of patients seeking cosmetic treatments were on some kind of psychiatric medication (versus roughly 9% of the overall population, according to the Centers for Disease Control and Prevention), including drugs to treat depression or a low-grade mood disorder, according to a 2004 study by researchers at the Center for Human Appearance at the University of Pennsylvania’s Perelman School of Medicine.

In addition, up to 15% of cosmetic plastic surgery patients suffer from “body dysmorphic disorder,” versus an estimated 1% to 2% of the of the overall population, according to UPenn’s Sarwer; the disorder is marked by obsessive and exaggerated concern over aspects of one’s appearance. It may sound like a convenient diagnosis for our beauty-obsessed culture, but it is a very real, very dangerous condition. “At the extreme, people will not leave their home, they’re so preoccupied with how they look,” Sarwer says. BDD suffers often seek plastic surgery thinking it will magically transform their lives, and when it doesn’t, they may harm themselves — or sue the surgeon, Sarwer says. Every plastic surgeon worth his or her salt asks questions to gauge patients’ motives, and concerned doctors should refer patients to a mental health professional. But to date there’s no standardized screening tool for BDD.

INFORMATION PLASTIC SURGEONS WON'T TELL YOU: NUMBER 7

7. “Sure, I can turn back the clock, but it just starts again.”

Just because you shelled out $10,000 for a face-lift doesn’t mean you’re set for life. Even the most skillful work will need some attention a decade or so down the line. Some jobs may require supplemental fillers (compounds that are injected under wrinkle lines into the skin) or minor surgery to tighten up a few sags, while others could call for a repeat of the same procedure. A face-lift can be expected to last about eight to 10 years, says Nahai, the Atlanta surgeon and editor. Exact results will depend on the condition of the patient’s skin; how well the patient cares for the skin, such as by keeping out of the sun and maintaining a stable, healthy weight; and the surgeon’s skill. Any work done on the lower face will age more quickly than on the upper face since the lower is fleshier and has less bone for sagging skin to hang onto: “The jowls are the first to come back,” Nahai says.

INFORMATION PLASTIC SURGEONS WON'T TELL YOU: NUMBER 6

6. “You look great; your husband needs some work.”

Swanson says men usually come to him for a face-lift around age 65, whereas women come in a good 10 years earlier, at age 55. “There’s a difference in tolerance for wrinkles in our society,” Swanson says. Men are told that they look distinguished with crow’s feet, while women hear that they look just plain old. The tipping point for men, Swanson says, is their desire to get rid of the “turkey wattle.”

                                         

Boomer men take the Botox plunge

However stealthily, men are having a little work done in increasing numbers these days. Elizabeth O'Brien and dermatologist Dr. David McDaniel explain on Lunch Break. Photo: Shutterstock.

While men represent just 9% of cosmetic procedure patients, they’re increasingly getting a little work done these days, according to the American Society of Plastic Surgeons. Total cosmetic procedures for men rose 22% from 2000 through 2012, according to the society. Minimally invasive procedures in particular have soared, with botulinum toxin treatments up 314% during that time. Some men are getting injections to look younger on the job, while others are getting treatments to keep up with their younger girlfriends, plastic surgeons and dermatologist report.

INFORMATION PLASTIC SURGEONS WON'T TELL YOU: NUMBER 5

5. “I make a mint off other surgeons’ mistakes.”

Dr. Sam Rizk, a plastic surgeon in New York City, says 1 out of 3 of his rhinoplasty patients have had previous nose jobs. Among the most common problems he sees are “scooped bridges,” over-restricted nostrils, and pinched tips. The number of botched nose jobs he has repaired has soared over the past three to five years as more surgeons are performing the surgery who aren’t well trained or experienced, he says. Industry wide statistics bear out his experience: Revision surgery is up 35% from 2008 to 2012, according to the American Academy of Facial Plastic and Reconstructive Surgery.

What’s more, “revision rhinoplasty” is a more complex procedure that can take twice or three times as long as the original surgery — and can cost 50% to 100% more, depending on what’s needed. Dr. David McDaniel, a dermatologist in Virginia Beach, Va., says he spends much more time these days correcting others’ mistakes with lasers and injectables than he did even a few years ago.

INFORMATION PLASTIC SURGEONS WON'T TELL YOU: NUMBER 4

4. “Long-term effects? Beats me.”

More than other specialists, plastic surgeons are under pressure to compete with one another, and an easy way to get the upper hand is to offer all the latest technology. Doctors are sometimes happy to try new techniques before the long-term effects are clear. While still a small part of the overall market, cosmetic vaginal “rejuvenation” surgery is popular in certain circles despite concern by the American College of Obstetricians and Gynecologists and others about the long-term safety and questionable ethics of the procedure.

Even when a procedure isn’t new or controversial, there’s hardly a wealth of information on long-term results. While a prospective patient has only to do an online search of a procedure to come up with half-naked pictures and commentary from patients who have had it done at websites such as RealSelf.com, an online community, most of the talk surrounds the procedure and its immediate results. Fewer patients weigh in decades after the fact. And in their “after” shots, surgeons don’t often include photos of a procedure years later.

“They’ll all say their techniques will give you the longest result,” says Nicole Fallen, 38, a mother of three (including twins carried to term) from the San Francisco Bay Area. She says she interviewed at least seven surgeons before choosing one — based in part on his communication skills — to perform a tummy tuck and breast lift that also corrected her pregnancy-related diastasis recti (a separation of the abdominal muscles).

INFORMATION PLASTIC SURGEONS WON'T TELL YOU: NUMBER 3

3. “Bargains can come back to bite you.”

With social media sites handing out cosmetic-treatment discounts like candy, it’s easy to get caught up in bargain-hunting for Botox. But cosmetic procedures — from facial fillers to face-lifts — are not commodities that are equivalent regardless of the practitioner, some doctors caution. “No two surgeons have the same pair of hands, experience and knowledge,” says Dr. Foad Nahai, editor-in-chief of the Aesthetic Surgery Journal, a publication of the American Society for Aesthetic Plastic Surgery, and a plastic surgeon in Atlanta. Complications from botched procedures can range from the cosmetic (think: frozen facial muscles) to the fatal, as in cases where patients have died from infections and other post-surgery complications.

                                      

Plastic surgery perfected with 3-D?

3-D technology is helping plastic surgeons make more-precise cuts and easing patients’ anxiety by giving them an advance look at their future faces. The WSJ’s Kurt Achin reports from Seoul, South Korea.

Patients should also be cautious about going abroad for treatments, some experts say. While a tummy tuck in a developing country might set you back $3,000, half of what it costs here, that savings can be easily swallowed up if complications occur. Dr. Eric Swanson, a plastic surgeon in Kansas City, Kan., says he treats patients who’ve had less-than-optimal surgeries abroad. In the case of a tummy tuck, he may have to fix the belly button scar or even redo the entire surgery. There are plenty of skilled surgeons abroad, says Swanson, who spent part of his training in Mexico City, but in some places doctors’ skill levels vary more than here, and regulations can also be more lax. “It’s not like taking a cheap cruise, where you’re not taking a chance with your life,” Swanson says.

INFORMATION PLASTIC SURGEONS WON'T TELL YOU: NUMBER 2

2. “Discomfort? More like extreme pain and oozing.”

Before Kim Gregson, 49, had her tummy tuck and liposuction operation several years ago, her doctor told her she’d experience some “discomfort” after the surgery. The reality was some of the most intense pain she’d ever experienced, says Gregson, a human resources professional in Madison, Wis. While she couldn’t be happier with her results three years later, she still shudders at the memory of the recovery: Despite regular doses of two prescription painkillers and ibuprofen, “I was miserable,” she says. Blood oozed from the two temporary drainage pipes that hung from her hipbone-to-hipbone incision. After the worst of the pain subsided, the swelling began. Her doctor’s office said it would be “mild.” Instead, she had massive swelling that lasted for seven months. Forget about skinny jeans — she didn’t fit into her regular, pre-surgery pants for more than two months after surgery. Gregson had requested two weeks off work but ended up taking three and a half, returning swollen and sore nonetheless.

                                       

Weight-loss surgery that isn’t just about vanity

More patients are opting for tummy tucks or other "body contouring" procedures after serious weight loss or bariatric surgery that aren’t just about vanity: they lessen the risk of infection and improve healing after surgery. Laura Landro reports. Photo: Miami Plastic Surgery.

There’s a general perception in society that cosmetic surgery is somehow less physically taxing than regular surgery, since it’s elective and aesthetic in nature, says Dr. Robert X. Murphy Jr., president of the American Society of Plastic Surgeons and a practicing plastic surgeon at the Lehigh Valley Health Network in Bethlehem, Pa. Surgeons should stress during the pre-operative discussions that “this is a real operation, not something whimsical,” he says. He uses diagrams to reinforce that message, showing how much of the body is affected by different procedures. (Some patients might be surprised that work during a tummy tuck extends from the rib cage all the way down to the pubic bone, for example.)

Dr. Jack Fisher, president of the American Society for Aesthetic Plastic Surgery and a practicing plastic surgeon in Nashville, says there’s a “continuum of recovery” with plastic surgery procedures, and some patients fall on one end or the other. Tummy tucks cause some of the worst discomfort of any procedure, he says, since they tend to involve a long incision and extensive muscle repair and tightening; what’s more, of all tummy tucks, those done after extreme weight loss on excess skin (as opposed to on postpartum pooches) tend to be the most intensive, Fisher says. Gregson had her surgery to trim excess skin after losing 60 pounds on her own beforehand.

INFORMATION PLASTIC SURGEONS WON'T TELL YOU: NUMBER 1

1. “I trained a whole weekend to learn this procedure.”

Dentists, gynecologists, barely trained spa technicians — it seems like everyone’s offering anti-aging treatments these days. And no wonder: Cosmetic treatments are a lucrative business, with $11 billion spent (on 14.6 million procedures) in the U.S. in 2012, up 5.5% from 2011, according to the American Society of Plastic Surgeons. That’s appealing not only to physicians hoping to offset the costs of higher malpractice premiums and lower reimbursements from insurance carriers but also to so-called medical spas that don’t even have a doctor on site when certain treatments are administered.

Traditionally, doctors from just four medical specialties — plastic surgery, dermatology, otolaryngology (ear, nose and throat), and ophthalmology — have handled the bulk of cosmetic offerings, including everything from minimally invasive aesthetic treatments like botulinum toxin (sold under the brand name Botox) to more involved procedures like face-lifts. And those specialists spend years honing their chops in residency training programs that teach skills unique to each specialty in addition to basic surgical skills.

                                        

Americans spend billions on cosmetic plastic surgery every year but MarketWatch's Thomas Bemis says there are things you may want to know before you and your wallet go under the knife. (Photo: Getty Images)

By contrast, those hoping to offer a little Botox in between filling cavities or giving Pap smears tend to opt for quicker training in cosmetic procedures, including weekend workshops offered by the International Society of Cosmetogynecology, an organization that promotes plastic surgery as an extension of gynecology, two specialties that are linked mainly by their female patient base. (Dr. Marco A. Pelosi III, a cosmetic gynecologist and founder of the association, says that the relevant skills and knowledge necessary to grasp and master the majority of common aesthetic contouring is easily understood and quickly learned, as the requisite skills are common to all surgery.)

Indeed, less formal training doesn’t necessarily correlate to reduced proficiency. Experts urge consumers to look for physicians with extensive experience, which could potentially compensate for shorter training. Still, some experts worry that it’s difficult for consumers to distinguish between hype and quality: “Unfortunately, this is an industry where the most creative, assertive, sexiest marketing often drives the business, but it may not be someone with the best experience,” said David B. Sarwer, a professor of psychology at the Perelman School of Medicine at the University of Pennsylvania.

SMOKING AND FACIAL AGING

Arlington Heights, Ill. (October 29, 2013) - Twins who smoke show more premature facial aging, compared to their non-smoking identical twins, reports a study in the November issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).
The study finds significant differences in facial aging between twins with as little as five years' difference in smoking history, says a new report by ASPS Member Surgeon Dr. Bahman Guyuron, Professor and Chairman, Department of Plastic Surgery, University Hospital Case Medical and Case School of Medicine, Cleveland. The results also suggest that the effects of smoking on facial aging are most apparent in the lower two-thirds of the face.

COMPLICATIONS HIGHER IN GERIATRIC BLACKS AND HISPANICS

Researchers say pre-existing medical conditions make a difference.

WEDNESDAY, Oct. 2 (HealthDay News) -- Older black and Hispanic patients are more likely than white seniors to have complications after surgery, and pre-existing medical conditions are a major reason for that difference, a large new study suggests.
Researchers examined the rates of 13 common types of complications among more than 587,000 white, black and Hispanic patients aged 65 and older who had general, orthopedic or vascular surgery in 600 hospitals in the United States.
The investigators found that black patients were nearly three times more likely than white patients to develop 12 of the 13 complications. Hispanic patients were twice as likely as white patients to develop nine of the 13 complications but less likely to develop two of the complications.
However, the number of complications among black and Hispanic patients dropped significantly when the researchers accounted for hospital and patient characteristics, according to the study published in the September issue of the Journal of the American Geriatrics Society.
"The risk of developing a postoperative complication may be attributed to a number of factors. Most pronounced, however, was the effect of pre-existing medical conditions," study lead author Dr. J. Margo Brooks Carthon, at the University of Pennsylvania School of Nursing, said in a journal news release.

COMPLICATIONS INCREASE WITH HIGH BLOOD SUGARS

Arlington Heights, Ill. - A new study released today shows that among patients undergoing surgery for chronic wounds related to diabetes, the risk of wound-related complications is affected by how well the patient's blood sugar levels are controlled before surgery. These findings appear in the October issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).
The risk of serious wound complications is more than three times higher for patients who have high blood glucose before and after surgery, and in those with poor long-term diabetes control, according to the study by ASPS Member Surgeons, Drs. Mathew Endara and Christopher Attinger of the Center for Wound Healing at Georgetown University, Washington, DC. The researchers emphasize the need for "tight control" of glucose levels before surgery for diabetic patients at high risk of wound complications.

Board Certified - Make Sure the Board is Recognized by the ABMS

2013 Legislative Session Delivers a Victory for "Name Your Board" Legislation in Nevada

Posted June 17, 2013 -- As session wrapped up, Nevada joined the growing list of states that limit physician advertising of board certification.   On June 1, Gov. Brian Sandoval signed Assembly Bill 456 into law.  The bill requires physicians who advertise as "board certified" to disclose the full name of the medical specialty board from which they receive their certificate. The legislation also implements criteria that medical specialty boards must meet in order for physicians to be permitted to advertise as "certified." ASPS worked with stakeholder physician groups and Nevada ASPS member Michael Edwards, MD to champion the proposal as it moved through the legislature.  Dr. Edwards worked tirelessly the past two legislative sessions to seek passage of this important measure and was a key player in this victory.  The law becomes effective Jan. 1, 2014. 

Board certification is an important part of a doctor's credentials. The American Board of Medical Specialties (ABMS) is the only recognized organization in designating which boards are legitimate and meet rigorous criteria for their members.  Any doctor can advertise as being "board certified" - without being recognized by a legitimate board designated by The American Board of Medical Specialties. A doctor can take a course or undergo abbreviated training and be issued a piece of paper stating they are "board certified"- this means absolutely nothing and is misleading to the public.  More states should enact legislation to protect patients from misleading advertising of credentials. Unfortunately, the attorneys and lobbyists many times prevent good legislation.

The American Board of Plastic Surgery is the only board recognized by the ABMS in certifying Plastic Surgeons.

SUDDEN CARDIAC ARREST (SCA)

The recent death of James Gandolfini, who played mafia boss Tony Soprano in the hit TV series The Sopranos, and recent malpractice cases are reminders that healthcare providers need to be on alert for the risk factors of sudden cardiac arrest (SCA).

SCA is the unexpected loss of heart function, breathing, and consciousness. In SCA, the electrical system of the heart fails and, at times, a heart attack may occur concurrently.

About half of people who suffer SCA had no previous symptoms, such as fatigue, dizziness, and racing heart rate. Approximately 325,000 people in the U.S. die from SCA annually. People who smoke or have coronary artery disease, have had a previous heart attack, have high cholesterol, and/or have a family history of heart disease have a higher risk.

 

These tips can help providers avoid misdiagnosis of SCA:

• Consider the possibility of advanced cardiac risk in patients who:

–• Are overweight and unable to control their weight with diet and exercise.

–• Have high blood pressure not responsive to medication.

–• Have evidence of erectile dysfunction.

–• Are glucose intolerant.

–• Have consistently high cholesterol levels.

–• Have a history of alcoholism.

• Take into account other factors associated with SCA, including:

–• Incidence increases with age—men after age 45 and women after age 55.

–• Men are two to three times more likely to have SCA than women.

–• Personal or family history of heart rhythm disorders, congenital heart defects, heart failure, or cardiomyopathy.

–• Use of illegal drugs (amphetamines or cocaine).

–• Nutritional imbalances (low potassium or magnesium levels).

 

BREAST REDUCTION AND ATHLETIC PERFORMANCE

There's a surprising surgery trend many young athletes are undergoing to improve their performance on the field. Experts say breast reduction surgery is becoming a popular way for girls to get a competitive edge.International tennis player Simona Halep, 21, made headlines after disclosing she had a breast reduction three years ago, in part to help improve her game.
Now it's not just professional athletes going under the knife. Carly Mortensen, 19, had the surgery to improve her softball game.
"It just felt uncomfortable for me because I had to wear two sports bras every time," she said. "It was emotionally pretty tough." "We are tending to a lot more young patients who realize there's a surgery out there that can help them, help them feel better and to help them become more athletic," plastic surgeon Dr. Michelle Spring said. According to Cosmetic Surgery National Data Bank statistics, more than 100,000 women had similar surgeries last year.

SURVEY ON PROPHYLACTIC MASTECTOMIES

If you’ve been diagnosed with breast cancer, the last thing you want is for it to come back. That sentiment goes a long way toward explaining why as many as 25% of women with breast cancer --  especially young women -- have been opting to have healthy breasts removed.

In an effort to dig deeper into patients’ decision-making process, researchers from Memorial Sloan-Kettering Cancer Center in New York and various schools and hospitals affiliated with Harvard developed a lengthy survey. They sent it to breast cancer survivors who were already part of on ongoing study tracking younger women who have been diagnosed with the disease. Responses from 123 women were included in the study, which was published in Tuesday’s edition of Annals of Internal Medicine.
The women who took the survey were between the ages of 26 and 40 when they got their diagnosis. All of them had breast cancer in just one breast -- most of the tumors were Stage 1 or Stage 2 – and all of them opted to have their healthy breast removed (a procedure known as a contralateral prophylactic mastectomy). When the women took the survey, they were an average of 2.1 years past their surgeries.
At first glance, their responses seem to tell a good-news story: 97% of them said they knew the risks and benefits of all of their options, 96% had a strong sense of which factors were most important to them, and 93% said they were sure that removing their healthy breast was the right decision for them.
Why did they take such drastic action? The desire to essentially eliminate any risk of cancer developing in the other breast was cited an “extremely important” or “very important” reason by 98% of the women. In addition, 95% said removing both breasts would give them peace of mind, and 94% believed that it would increase their odds of beating breast cancer and contribute to a longer life.
That doesn’t mean everything went completely smoothly -- 33% said they wound up needing more surgeries than they had expected, nearly the same proportion felt more self-conscious about their appearance than they'd thought they would, and 42% said their “sense of sexuality” was worse than they had anticipated. Still, 90% of the women said that if they could do it all again, they would still get the surgery.
So what’s the problem? The researchers suspect that at least some of these women decided to remove their healthy breasts under false pretenses. For instance, women who didn’t have any mutations in the BRCA1 or BRCA2 genes that would put them at higher risk of developing breast cancer estimated that they had a 10% chance of finding a new tumor in their healthy breast over the next five years; the actual risk is only 2% to 4%, according to the study.
Similarly, the women did not seem to fully grasp that they could keep their healthy breast and have the same long-term odds of surviving breast cancer. An editorial that accompanied the study noted that over a 20-year period, no more than 1% of those who decide to keep their healthy breast later die because their breast cancer has spread there.
The survey found that 87% of the women recalled being “extremely concerned” or “very concerned” about the prospect of cancer showing up in their healthy breast at the time they made their decision. This anxiety may have colored their decision-making process, the researchers wrote. It probably didn’t help that only 51% said their doctors talked with them about reasons not to have the surgery.
“Anxiety and fear of recurrence probably influence women during the decision-making process,” the researchers concluded. Doctors may not be telling these women that their risk of developing cancer in a healthy breast is “relatively low.” Even if they are told, they may be “unable to comprehend their low risk.”
The editorial, written by two doctors from the University of Minnesota, put things more bluntly: The high levels of “patient satisfaction” in the survey could be due to women’s “erroneous estimations” of their future breast cancer risk.
“With improved patient education, perhaps the CPM [contralateral prophylactic mastectomy] trends in the United States will plateau or be reversed,” they concluded.

PENIS SURGERY ON THE RISE

Italian men want bigger penises according to a top plastic surgeon.
They might be known as Italian stallions, but new data on cosmetic surgery suggests men in Italy are less confident than we imagined, with the number of surgical procedures to boost men's manhood surging by as much as 25% every year.
A more superficial society is causing a surge in the number of men opting to undergo radical enlargement surgery, Dr Alessandro Littara, director of the Centre for Sexual Medicine in Milan, has claimed.

A top Italian plastic surgeon has claimed demands for penis enlargement surgery have surged

Despite the operation - formally known as penoplasty - costing between £2,500 and £6,000, men are queuing up for the procedure, the surgeon told Adnkronos news agency.
“The demand for these operations is growing constantly,” he said, revealing he has completed more than 300 operations this year alone.
The operation is usually to make penis thicker, he said, but there are "quite a few who want it longer and sometimes both,” he added.
According to Dr Littara, most men don't even need the surgery – or want the operation to satisfy their partners – instead, he claims, society's obsession with looks is increasing insecurities.
“With everyone seeing images of the body the whole time these days, men are more aware and worried about their bodies – all the parts are important, and the genitals are no exception.”
“We’re living in the age of images, with sexual ones very often on the front page,” he told the news agency. “So sex gets more attention and people feel the need to be competitive.”
Dr Littara said Italian men weren’t the only ones worried about what is going on below their belt line.
“It’s an international problem,” he said – a claim backed up by the international survey of penis size published last year by an Ulster University academic.

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RISK FACTORS FOR PLASTIC SURGERY

For patients undergoing plastic and reconstructive surgery procedures, obesity, anemia and postoperative complications—especially surgical and wound complications—are independent risk factors for hospital readmission, reports a study in the September issue of Plastic and Reconstructive Surgery^®, the official medical journal of the American Society of Plastic Surgeons (ASPS).

BODY ART AS AN ALTERNATIVE TO BREAST RECONSTRUCTION

More women are choosing not to reconstruct after a mastectomy and tattoo over the scar tissue instead. Photograph: Guardian

Undergoing a mastectomy is a harrowing experience. Although a mastectomy is an undoubtedly life saving necessity, there is something primitive and brutal about the removal of a breast. Many women report feeling less feminine after the operation, or say that their sexuality is compromised. Mastectomy scars are rarely neat and can be perceived as disfiguring.
Reconstructive surgery is difficult, expensive and not always successful. A full reconstruction can take several surgeries to complete, and it is highly likely that the reconstructed breast will bear little resemblance to the original or its twin.
As a result, more women are actively choosing not to reconstruct. There is a small but growing trend in the US (slowly filtering though to the UK) to refuse reconstruction and tattoo over the scar tissue instead. For many women, the battle with breast cancer is the most intense fight of their lives and they are seeking a way to acknowledge this, rather than disguise it.
Pam Huntley from Fort Bragg in California says: "Getting my tattoo was the culmination of a three year dance with breast cancer. The tattoo changed my mastectomy scar into a shield." For many, the choice to tattoo is a liberating alternative to plastic surgery or hiding the loss of a breast.
There are a number of celebrated female tattooists specialising in mastectomy tattoos. Madam Chinchilla, based in California and author of Stewed, Screwed and Tattooed, talks about how mastectomy tattoos differ from other types of tattooing. "These tattoos represent vanity and survival simultaneously", she says. "We are creating a space where beauty can arise from sheer pain and terror".
Roni Falgout from Seattle is also fast becoming a famous name in the mastectomy tattoo business. She says, "Most women seeking this are feeling less like a woman, and either ashamed of the way they look, or just plain sick of people feeling sorry for them.
One client explained it best. She swam a lot at the public pool and when in the changing room she felt the eyes of pity on her. She hated it and wanted to shout, 'this is a victory, not a defeat. I'm alive. I won'. So she asked for the image of a phoenix to cover the scars, which is appropriate if you know the mythology. Now, when she goes to the pool, instead of the pity she sees and hears: "Wow! How beautiful!".
Women who have chosen tattoos over reconstruction cite the reclaiming of their bodies as the main reason for the choice. Some women refuse reconstruction because they feel it is a denial of the impact of cancer, both positive and negative, and that a tattoo (often very carefully designed to express the personal nature of the cancer journey) is the exact opposite.
Denise Levine was diagnosed with breast cancer in 2009 and was clear from the outset that a reconstruction wasn't for her. "I wanted to return to my old self as quickly as possible" she says, "I didn't see how that could happen if I let a plastic surgeon rearrange my muscles and tissue."
It was a year later (the minimum recommended time to let the scar fully heal) that she decided to visit a tattoo parlour for the first time. Although she was worried about it being the right decision, she made the right choice. "It is hard for me to describe how much I love my tattoo and how happy I am with it… I admire the beauty of the bird and the balance it has brought back to my appearance," Levine says.
Earlier this year an image of Inga Duncan Thornell's mastectomy tattoo was posted on Facebook. It quickly went viral, but was removed shortly afterwards under Facebook's obscenity policy. But it was the removal, rather than the original posting, that caused the most controversy. Facebook has now officially changed its guidelines on showing images of mastectomies and mastectomy tattoos, taking another long awaited step toward public acceptance.
Although Curly Moore, resident tattooist at the Tattoo Club of Great Britain and one of the UK's most respected tattoo artists, hasn't yet been asked to design for mastectomy. But if previous north American breast cancer trends are anything to go by (pink ribbons and Breast Cancer Awareness Month, for example), the UK will soon catch up. The mastectomy tattoo will become just another option for post cancer patients and a truly personal way of regaining control over post cancer bodies and proving once and for all that breast cancer is not just a pink ribbon.

MORE DOCTORS NOT TREATING MEDICARE PATIENTS

Posted August 13, 2013 -- A story by the Wall Street Journal reports numbers released by the Centers for Medicare & Medicaid (CMS) indicate that fewer physicians are treating patients enrolled in Medicare, largely due to issues related to payment rates and the increase of burdensome rules.
9,539 physicians who had previously accepted Medicare opted out in 2012 according to data released by CMS. While only a small percentage of the 685,000 physicians that do accept Medicare patients, the number of doctors leaving the program has tripled from 2009 when only 3,700 physicians opted out of the program. Many of those physicians that are still taking Medicare patients are reducing the number they treat. This is the first time that CMS has ever released opt out data related to the Medicare program

ACID ATTACKS

Acid attacks like the ones that targeted two British teenagers volunteering in Zanzibar are grimly effective – and difficult to treat, burn experts say.
The key to recovery is quick removal of acid-soaked clothing, immediate rinsing with copious amounts of water and fast treatment by doctors who can address issues like skin grafts, scarring and dealing with searing pain.
“It’s a terrible, terrible injury and it’s terrible to inflict it on someone else,” said Dr. Sidney F. Miller, founder and past director of the Burn Center at The Ohio State University.
Acid is cheap, widely available and invariably devastating when it is intentionally thrown with the goal of maiming, disfiguring or blinding the victims, according to the Acid Survivors Trust International, a nonprofit group that tracks acid attacks and works to help victims.
Teenagers Kirstie Trup and Katie Gee were due to arrive back in London Friday for treatment of burns suffered Wednesday, when two men riding a motorcycle poured acid on them. The 18-year-olds were in Zanzibar to volunteer as teachers on the majority Muslim island.
The young women reportedly suffered “horrendous” burns to their faces, hands, legs, backs and necks, Gee’s father, Jeremy, told the Telegraph newspaper.
But they are only the latest victims of acid violence, which occurs regularly in several countries, including India, Bangladesh, Colombia, Nepal, Cambodia and Afghanistan, the Acid Survivors group reports on its website.
About 1,500 cases are recorded every year, although that number is likely to be massively underreported, experts say. Between 75 percent to 80 percent of cases involve women, and about 30 percent of the women are younger than 18.
There aren’t many intentional cases of acid attacks in the U.S., said Dr. Tom Tallman, an emergency physician at the Cleveland Clinic. But the key here – or in other countries is to address the injury as quickly as possible.
Depending on its strength, acid can burn through the full thickness of the skin in seconds, even eating into tissue and muscle below. As the skin heals, it develops scar tissue, which creates much of the disfigurement often associated with acid burn victims.
Skin grafts and plastic surgery are often required, he added.
For the British girls, who have access to Western medical care, plastic surgery techniques can include both surgical and non-surgical options, said Dr. Howard Liu, director of cosmetic dermatology at Cedars-Sinai Medical Group in Los Angeles.
Fat grafts, bio-compatible dressings that encourage new skin growth and other innovative treatments could help them heal, even from the whole-body and splatter injuries that typically occur with acid burns, he said.
"For these two young ladies, hopefully they will get the resources they need to recover," Liu said.
But that’s not often the case for typical acid attack victims, said Miller, who is also associated with the American Burn Association. They are forced to contend with medical systems equipped only to provide basic wound care -- at best.
The burn association reaches out to doctors and hospitals in low-income countries to help train medical teams to respond quickly and effectively to the heinous intentional injuries.
“There are a lot of ways to hurt people,” Miller said. But this is one of the worst, he added.

THE HIDDEN DANGERS OF PLASTIC SURGERY

It is a frightening trend, and a fact that more plastic surgery procedures are being performed by doctors that may not be qualified.

 

I could even perform brain surgery in my office if a patient was foolish enough to agree to it, but I would not do so because I'm not properly trained to do it." Said Dr. Braun H. Graham of Sarasota Plastic Surgery Center in Sarasota.

 

"As long as you're a doctor you can perform any procedure that you want to do in the confines of your office." Said Dr. Scott J. Engel, also of Sarasota Plastic Surgery Center. Dr. Graham Added, "It's legal in the State of Florida to perform surgery in your office if the patient is willing to submit themselves to the procedure."
This information came too late for Julie Rubenzer, who died in 2003 following a breast augmentation performed in Sarasota
"The problem we have here in town is we have untrained people in the operating room helping the doctor" Said Dr. James W. Marsh, of James W. Marsh M.D.P.A., Plastic and Reconstructive Surgery, "And, they weren't trained well enough to take care of the problem when the problem came up."
More recently 44 year-old Christine Patterson of Sarasota is charged with practicing medicine without a license, accused of performing a post-operative procedure on a patient after a cosmetic surgery.
So what should you know to protect yourself?
"Make sure that it says the American Board of Plastic Surgery, "Said Dr. Engel, "and that they see that symbol, if that's not on there then they need to question whether or not that person is adequately trained to do these procedures."
Check that your surgeon is affiliated with a hospital. it could make a difference between life and death.
Dr. Engel said, "Hospital have the highest standards of any practice and so they need to make sure that you are qualified to do these procedures" and, Dr. Marsh added, "And they're going to require you to have training to pass boards and to be monitored before you start working in their hospital."
If your procedure is performed at a private center, make sure that its accredited. AHCA is one of the certifications you can look for. But, here's one of the top things you need to know.
"The biggest red flag would probably be saying that they are board certified but not saying what they're board certified in." Said Dr. Engel.
So, when choosing a plastic surgeon do your research and don't be scared to ask questions.

 

 

 

 

BREAST AND ABDOMINAL CONTOURING AFTER PREGNANCY

After the birth of a child, it takes several months for your body to return to its pre-pregnancy form. During pregnancy, the body makes hormones and changes to allow for the birth and growth of the new child. Not only does the abdomen have to stretch to accommodate the growing child, but breasts engorge to help provide milk for the baby. Once these changes are no longer necessary, the skin will contract to varying degrees in an effort to return the body to its pre-pregnancy state.
Following pregnancy, despite regular diet and exercise, some women may find that they have excess skin in the lower abdomen, and others may find that they have breasts that have lost volume and "sag," even after returning to their pre-baby weight. A mommy makeover describes the surgical procedures done to correct these changes and may include an abdominoplasty (also known as a "tummy tuck"), liposuction, and either a breast lift, breast reduction or breast augmentation.
These surgeries are body contouring procedures, not weight loss procedures. To ensure that you have a long-lasting result, you should be at your goal weight for at least six months and have stopped breast-feeding for 6 months. It's important to have stopped breast-feeding because your breasts need to return to their normal size and shape and stop producing milk. Additionally, I advise patients to have completed childbearing before proceeding with a "mommy makeover." You can have a successful pregnancy after a "mommy makeover," but you may require more procedures if you have more children or large weight fluctuations after your initial surgeries.

A GENEROUS GIFT

UM medical school creates plastic surgery professorship with $2.5 million gift

Face transplant doctor to be invested later this year

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July 23, 2013|By Andrea K. Walker

A Swiss businessman has given the The University of Maryland School of Medicine $2.5 million to create a professorship in plastic and reconstructive surgery with the first awarded to the doctor who recently performed a groundbreaking face transplant.
Dr. Eduardo D. Rodriguez will be invested at a ceremony later this year. He led a team last year in a 36-hour face transplant that included replacement of both jaws, teeth, tongue, skin and underlying nerve and muscle tissue from the scalp to the neck.

HERBAL SUPPLEMENTS

FRIDAY, July 26 (HealthDay News) -- About half of patients take herbal and other supplements before undergoing cosmetic facial plastic surgery, according to a new study.
Many of these supplements can put patients at risk during surgery and they should stop taking them at least two weeks before their procedure, Dr. Bahman Guyuron and colleagues at Case Western Reserve University advised.

The investigators examined the medication lists of 200 patients scheduled for cosmetic facial plastic surgery -- such as a facelift or nose job -- and found that 49 percent of the patients were taking at least one type of supplement.
Overall, the patients were taking 53 different types of supplements. The average number of supplements was nearly three per patient, but one patient was taking 28 different supplements, according to the study in the July issue of the journal Plastic and Reconstructive Surgery.
Older patients and women were most likely to be taking supplements, according to a journal news release.
One-quarter of the patients were taking vitamin and mineral supplements only, most commonly multivitamins, vitamin D, calcium and vitamin B. Twenty-two percent were taking animal- and plant-based supplements -- most often fish oil -- in addition to vitamins and minerals. Just 2.5 percent of patients were taking animal- and plant-based supplements only.
Thirty-five patients were taking supplements linked with an increased risk of bleeding, such as bilberry, bromelain, fish oil, flaxseed oil, garlic, methylsulfonylmethane (MSM), selenium and vitamin E.
In addition to the supplements linked to bleeding risk, other popular supplements with potential harmful effects include echinacea, ephedra (ma huang), ginkgo, ginseng, kava, St. John's wort, valerian, feverfew and ginger.
The patients in the study were told to stop taking supplements two to three weeks before surgery.
"These high-risk supplements . . . are quite commonly used and the surgeon must elicit a complete history in order to avoid the known adverse consequences of supplement use on surgical outcome," the researchers wrote.

TOXIC INJECTIONS

HOUSTON (KTRK) -- Three women are facing charges, accused of practicing medicine without a license. Investigators say they were injecting people with toxic chemicals.
Investigators say this isn't the first time that one of the women at a clinic in west Harris County has faced charges. Prosecutors confirm there is a lengthy criminal history involving this particular clinic, and charges pending against it. In this latest allegation, in court documents a patient testified that she was lied to and severely injured. Maria Teran is not a medical doctor, but a patient who saw her at a west Houston office says Teran told her she was one. "She went there thinking Maria Teran is a doctor," said Harris County prosecutor Justin Keiter. "She is anything but." The incident happened at Teran's "Le Femme's Clinic" on June 27, when Harris County prosecutors say Teran, assisted by her two daughters, Victoria and Camille Urgiles, who are also charged with felonies, injected Argiform -- a Russian-made gel filler that is not FDA approved -- into the woman's buttocks and her genital area. The patient was charged $4,000 and said she immediately suffered extreme pain and was seen by another doctor who said the substance was toxic. Keiter said, "She had several problems in her buttocks. She had them inject her there. The results in the pictures speak for themselves." Maria Teran has a long history in Harris County. In 2011, she was charged with delivery of a dangerous substance twice -- once for Botox and a second time, for Amoxicillin, an antibiotic. She was also charged with practicing medicine without a license.In April, she was charged again with practicing medicine without a license. Now she has these two latest charges. She was still out on bond for the previous charges.   Attorney Chip Lewis represents Teran and her daughters, and says the allegations are untrue.  "We have reams and reams of interviews of patients who have said that she made it very clear that she and her daughters, when they administered Botox or the like, were doing so under the direction of a doctor," Lewis said. Because of the previous charges against them, Maria Teran and one of her daughters, Victoria Urgiles, are being held without bond. Their next court appearance will be Thursday. Teran's other daughter Camille Urgiles is out on a $100,000 bond.

PLASTIC SURGERY ADDICTIONS

                               Bad Augmentation and Liposuction

 

                               Implants much too Big and Unnatural

We’ve all seen them, the beautiful celebrities that begin having plastic surgery only to correct the flaws in their minds, leaving them with looks that are distorted and harsh. Media puts additional pressure on women and men as they age, wanting to preserve the look they had years ago. Actresses with lips so plumped they talk with a lisp, faces pulled so tight that the appearance is alien, or cheeks so filled and full that the eyes look bizarre when they smile for the paparazzi. We have come to expect this distorted look in Hollywood, because so many of them have cosmetic surgery, and we no longer question the addictive component of repeated surgeries to correct the flaws left by the first one.

                           (AP)  Wayne Newton looks plain comical now. 

 

                                                                                           
           Donatella Versace looks like she's been molded out of plastic.

 

 

 

(AP) Barry Manilow's face seems a little too feminine.

 

(Getty) Carrot Top has gone beyond the normal means of trying to look young. He's even gotten implants in his chest and arms to make him look buff.

 

(Getty) Courtney Love's face seems to be stretched to within an inch of its life.

 

    Jessica Simpson's lips were enhanced a little too much. Good thing lip injections aren't permanent.

(AP) Kenny Rogers has publicly admitted that he's not thrilled with the results of his plastic surgery.

(AP) Lil' Kim is headed down a path forged by Michael Jackson.

(Handout) Plastic surgery has not been kind to the formerly brooding, handsome face of KISS frontman Paul Stanley.

(Handout) Singer Pete Burns won his medical malpractice lawsuit against the doctor who injected his lips with collagen. But he seems to have done a lot more since.                                                                   

Addictions to distorted body image aren’t only seen in Hollywood. They are seen among our friends and family. Beauty is a huge industry, and women suffer from the loss of perceived beauty as they age. There are limited mentors in magazines or on television who allow themselves to age naturally. This continues the illusion that aging is unacceptable or a problem that needs to be fixed rather than allowing the changes and appreciating beauty at all ages. The problem with having a distorted body image and using cosmetic surgery to repair the perceived flaw is that it will never be enough. When your view is distorted you continue to find other areas of your body that need tweaking, tucking and cut away. A face pulled tight by surgery is not attractive; it’s unnatural and gives a waxy appearance that isn’t human. The objective viewer notices the alien look, but to the person with the tight skin face the focus quickly shifts to other areas that are slack and need tightening. It’s scary when adults have this addiction, but when our teenagers and younger children begin saying they need cosmetic changes to be happy with their looks, it becomes a tragedy.
What causes this addiction to begin with? It’s complicated. People who want to change dissatisfaction with their body or face seek cosmetic surgery, and instead of being satisfied with the new look they begin focusing on their expectations not being met, and this leads them to identifying another imperfection. Once the cycle of addiction begins it is vicious and continues through numerous surgeries, a loss of income, and many times severe depression.
There are many reasons people seek plastic surgery, and identifying your reasons can help you decide if this is something you need for your self-esteem, or if your self-esteem is based more on distorted emotional issues that counseling may be more effective handling.

1. Plastic surgery works well for those with an average to healthy self-esteem, know exactly what they want, and have many other interests in their life besides their looks.
2. If you have a low self-esteem and you think cosmetic surgery will give you more confidence and make you happier and content, this may be a red flag. Happiness is an inside job, and external factors don’t bring happiness. You may feel content after the surgery, but if you believe surgery will change your life and make your dreams come true, you are probably going to be disappointed.
3. The people most likely to become addicted lack self-worth. They feel content immediately after the surgery, but that is followed with emptiness and dissatisfaction. They seek out another surgery as a way to feel better. Those affected by a low self-worth believe that enhancing their body by way of surgery will make them happier with jobs, success, love, sex, and a younger appearance. Denial with the addiction helps to keep this illusion in place. The media furthers the denial by sending messages that beauty and youth are linked to competitiveness, success, love, sex and happiness.

 
People that are addicted, no matter what the addiction, suffer from a constant doubting of themselves. They are constantly in need of being reassured that they are good enough. They don’t have the ability to see their own potential, so they look to others for approval. Society has helped enable the importance of our appearance. You see normal human imperfections powdered, photo-shopped and airbrushed no matter where you look. However, our childhood also influences our addictions. A child who doesn’t grow up feeling that their emotional needs were met suffers low self-esteem. When the inside is broken, no plastic surgeon can make you a new one. Counseling is the only way you can re-parent yourself and build a healthy self-esteem.  Plastic surgery is a wonderful option. However, if you are expecting it to make you happy, heal a broken relationship or give you a renewed self-esteem, think again!!!!Mary Jo Rapini