According to the American Society of Plastic Surgery there were 286,000 breast augmentations in the United States last year, an increase of over 200% since 1997. In my last blog, I reported on evidence that shows a high degree of satisfaction with the choice to have breast implants. We know that breast implants do not last a lifetime, but women want the satisfaction with their procedure to last a very long time. The US implant manufacturers advise that implants will need to be removed or replaced eventually. So what are some of the reasons for revising breast surgery?

A study (published last month in Aesthetic Surgery Journal) looked at 110 consecutive women that underwent revision of their breast implants between the years 2004 and 2009. The reoperation rate in this study was 16.3% with an average time from first surgery to revision of 8.9 years.

Here are the reasons for re-operation in this surgeon’s practice:

1. 42%developed sagging (ptosis) of their breast, a natural progression of biological change.

2. 29% had capsular contracture (scar tissue around the implant resulting in firmness).

3. 19% were re-operated for a high riding implant.

4. 14% indicated implant position was not where it belonged (malposition).

5. 7% had infection.

6. 5% developed breast cancer.

7. 4% objected to rippling of implant.

8. 4% had synmastia (implant pocket lifting up over the sternum).

9. 3% had a “double-bubble” where implant and breast did not merge in a smooth transition.

10. 2% deflation.

As humans age their skin thins, loosing elasticity. As breast volume fluctuates with weight changes and pregnancy, there is a natural sagging of the breast. Implant placement can accelerate these natural changes. This report shows that the majority of revisionary breast implant surgery is to improve appearance and reverse changes of aging, rather than for medical necessity. That is a good thing if you are the patient, because you can choose the time when it matters to you. www.aestheticsurgeryjournal.com

The purpose of aesthetic plastic surgery is to improve quality of life by enhancing one’s body confidence and comfort. A recent study published in the Aesthetic Surgery Journal looks at the satisfaction and well-being of a group of 155 women that had breast augmentation in 2008 and 2009. The data confirms that women report a significant improvement in their satisfaction with breast appearance, psychosocial well-being, and sense of sexual well-being after surgery. The anonymous survey was administered before and six weeks after their breast implant procedure. The scores were tabulated on a 1-100 point basis.

Here are some of the outcomes reported:

1. Satisfaction with breast appearance improved from a score of 26 to 82.
2. 79% were satisfied with the size of their breasts post operatively.
3. Sense of wellbeing increased from a score of 52 to 85. 
4. 97% reported they felt attractive, up from 51%.
5. 96% felt more self-assured, up from 51%.
6. 94% reported that they felt confident most or all the time, improved from 53% prior to surgery.
7. 91% answered that they felt confident sexually after their augmentation, up from 46% preoperatively.

The research did not examine those women that did not report improved quality of life after the procedure. This group was small but it would be valuable to gain insight on why they did not achieve the same satisfaction. 

The questionnaire that was used is called the BREAST –Q. It was developed to meet national and international standards of outcomes assessment for evidence based medicine. For a closer look check out the Aesthetic Surgery Journal 33(2)245-251, 2013.

My office received a phone call last week asking if we offered either stem cell facelifts or vampire facelifts?? We were happy to say no…not that we do not like being early adopters of new technology, but because these two procedures have marketing claims that are far ahead of any science. In other words…HYPE.

So what might advertisers mean by stem cell facelift? Fat is one of the body’s tissues that carry adult stem cells. When a facelift is performed, fat can be added to bring fullness to sites of volume loss. In fat transfer to the face, a small number of stem cells may be moved at the same time. We do not know how many (if any!) are being transferred, and we do not know if they will become activated in their new home, to provide the hoped for repair and youthful, healthy look. The procedure for fat grafting is a good one, but calling it a “stem cell” facelift is hyperbole (HYPE!!).

The “vampire” facelift is also not ready for prime time. The procedure involves drawing a tube of your blood, spinning it down to isolate the portion that contains the most white cells, known as the buffy coat. The theory is that this fraction contains more growth factors and possibly stem cells. To date this is all unproven. Surgeons that use this as a selling point for their services  are trying to win confidence by suggesting that they are employing a “cutting edge” technology, but these claims are unfounded.

The American Society of Plastic Surgery and the American Society of Aesthetic Plastic Surgeons published a joint position paper in 2011 on stem cells and fat grafting. In this paper they state:

“Extreme caution should be exercised when a physician is promising results from any treatment that sounds too good to be true. Stem cells in aesthetic surgery are promising, but marketing claims are far ahead of the science.”

I am a closet fan of the “What Not to Wear” show…not that I want anyone to know that I watch a reality TV show….but I love the concept that everyone should be comfortable with their own body and that external changes can make a world of difference for one’s psyche. Stacy London, co-host of TLC’s What Not to Wear, has just come out with a new book, The Truth About Style (Viking Press, 2012) in which she describes her philosophy of style. Her Zen-like mantra is “take what life has given you, accept it wholly, and then build on it.”  With that as a baseline style can be healing.

Style, according to London’s philosophy, requires an unbiased acceptance of self, where your body is and what your life circumstances are. Style starts with your brain before it gets to your body.

Stacy discusses how to dress well, why to dress well and why we often do not. She helps us get into the mindset that leads to a happier and healthier sense of self. She talks about the kinds of psychological obstacles we place in our own path that keeps us from owning our personal style. Style, unlike fashion, is personal. It’s about the individual. 

Style is about enhancing who you are and not attempting to look like someone else. 

“By changing your style, you are forced to change the way you perceive yourself. And if you can see yourself differently, you can start to feel differently.” Eventually we believe because we can see.  

In her book Stacy tells stories of ten women that she helped to see themselves differently. Each is a metamorphosis from cocoon to butterfly.  Her tales provide a “kick in the step, a swing in the hips, and a twinkle in the eye.” Try her short enjoyable read and see how comfortable you are in your own skin!

Seattle had a beautiful summer this year that stretched out through most of September. It was easy to stay inspired for outdoor sports. As the leaves are turning and daylight is shorter don’t let weather hold you back from training. Here are a few suggestions:

1. Train with friends. Having a buddy helps to keep you accountable. It is too easy to let yourself off the hook when you are tired, and besides you can accomplish your social goals at the same time as your fitness goals. Consider it multi-tasking.
2. Work on your core. The stronger your trunk muscles are, the better your balance and stability.  It enhances any other sporting activity. Yoga and Pilates classes are popular ways to strengthen your abdomen and back.
3. Increase aerobic endurance. Thirty minutes three times a week is an important baseline for aerobic fitness. Make that 30 minutes increasingly difficult to improve stamina after your routine becomes habit.
4. Return to the gym. Spinning classes, swimming pools and treadmills are easier to use when there are others around. The energy from other people is contagious. Sports equipment at home is a great idea, but it seems to collect dust before it ends up in garage sales.

What ever you do, be adventurous, creative and open-minded. Staying fit is good for your mood, good for your brain, good for generating energy, and good for your health. Don’t let it lapse when it is unseasonable!

Aging is the Most Common Cause

Your eyes are believed to be a window to the soul. They convey a full range of expression and make a difference in how you are perceived in terms of health and beauty. Dark circles beneath the eyes are detractors. They suggest fatigue or sadness or being past your prime. The physical characteristic can suggest troubles even when your emotions do not match. What causes dark circles and what can be done about them? 

Some people have dark eyelid skin that they inherited from their parents. “Hyper pigmentation” is benign, but just as it is impossible to erase a leopard’s spots, it is difficult to change the natural color of your skin if that is your genetic type. 

Illnesses can cause changes in the tissues around the eyes. Lack of sleep, smoking, and excessive alcohol intake are lifestyle choices that negatively impact the appearance of your eyes. Thyroid, kidney and liver disorders can contribute to dark under-eye circles. Allergies, asthma, and circulatory diseases cause swelling that may lead to eyelid changes. 

For those of us in good general health who were not born with dark lower eyelid skin, the most common cause of circles under the eye is simply aging. Eyelid skin is thin and cheek skin is thick. The zone where thin meets thick is called the “lid-cheek junction.” This line begins to drop as we age. The zone between eyelid and cheek becomes more pronounced and the surface irregularity casts a shadow that creates the dark circle. The lower eyelid shape changes and looks like an upside down triangle with its peak pointing away from the middle of the eye. The line from the inner corner of your eye to the peak of the triangle is referred to by plastic surgeons as the “tear trough deformity.”

The problem can be a combination of dark skin pigment, loose skin, fine wrinkling, excess fat, or loss of fat, gravitational forces and irregular contour.

So what choices are there for dark lower eyelids? Treatment begins with identifying the cause.

1. Hyper pigmentation is caused by excess brown pigment (melanin) in the skin. This may be responsive to fade creams, such as hydroquinone, chemical peels, and sun screens. Other skin care products such as Retin A can be useful. 

2. If the cause of the shadow beneath the eye is a contour abnormality, then injectable fillers such as Restylane and Juvederm can be placed in the tear trough deformity for an improvement that lasts 6-9 months.

3. A blepharoplasty is eyelid surgery that gives long lasting improvement for the eyelid changes of aging. It tightens eyelid skin, repositions fat in the orbit, and smoothes the transition from lower lid to cheek. For more on this topic check out Services>Surgical Facial and visit my Facial Procedures gallery.

“Research finds that cosmetic surgery patients do not differ from nonpatients in body satisfaction, except that they are more likely to express dissatisfaction with the specific body region targeted for surgery.”

MSNBC conducted an online study of 50,000 volunteers to research how satisfaction with body image correlated with interest in plastic surgery. A 27 point questionnaire posed questions like:

*How comfortable are you in a bathing suit?

*Do you like your face?

*How many times a day do you check yourself in the mirror?

*Are you self conscious about your weight?

The respondents were heterosexual men and women between 18-65 years of age There were equally divided between men and women. The large sample size allowed for statistical significance. 71% of women and 40% of men expressed interest in cosmetic surgery. Here are some of the interesting findings of this large scale survey.

1. Body image satisfaction was gauged by self rated attractiveness and comfort in a swimsuit.  There was no difference between those women interested in plastic surgery and those not interested. 
2. Men interested in plastic surgery were not any different in body image satisfaction than those with no interest. 
3. Appearance investment was gauged by self reported mirror checking. Both men and women that monitored their appearance in the mirror frequently showed more interest in plastic surgery.
4. Relationship status did not correlate to interest in plastic surgery. Those who were married, co-habitating, or dating seriously were no more interested in cosmetic surgery than singles.
5. The study subjects were divided into five age groups. The percentage of men and women interested in plastic surgery was relatively constant across the entire spectrum.

The study suggests that plastic surgery has become a widely accepted form of enhancing physical attractiveness, and that those interested in this type of body change have much in common with those with no interest.

The VI Peel

For many of us it is hard enough to achieve a work life family balance, much less take time for personal needs. We might enjoy the benefits of plastic surgery but have trouble finding downtime for it. As fewer people have taken time for aesthetic surgery during the recession, there has been a rise in popularity of non invasive cosmetic procedures. Minimally invasive techniques have become a maintenance routine for aging faces.

For those interested in improving skin quality, there is a new product that I like, the VI Peel. I tried it on myself a couple of months ago. This medical grade peel is a light peel that requires minimal downtime and creates little interference with your daily obligations. 

The Vitality Institute Skin Care System has produced the VI Peel to decrease fine lines, fade age spots or sun damage and improve acne scarring. The peel also promotes collagen and elastin growth. This results in better skin clarity and texture and younger looking skin. The procedure takes a few minutes in our office. Your skin turns red like mild sunburn and peels within three to seven days. It can be used on all skin types including Afro Americans and Asian skin. The peel removes the damaged upper layers of skin and repairs from new cells below. 

The peel has a combination of peeling agents that enhance one another. TRICHLOROACETIC Acid (TCA) penetrates the skin. RETIN a causes a rapid turnover of skin cells to reduce wrinkles. SALICYLIC ACID is an exfoliant. PHENOL is antiseptic and helps numb the skin. VITAMIN C is an antioxidant and an exfoliant. 

The peel does not replace a facelift if that is what you need, but it can make a great difference in your skin quality without missing a day of work!

Medical therapy for aging skin can reverse some of the cellular damage that has occurred and create a healthier, younger looking skin.

How Long Will My Facelift Last?

Colleen is 48 years old, in the prime of her career, and particular about her appearance. Her face has changed as she has aged. The lines and sags create a tired appearance when she actually feels energized. Botox and chemical peels have erased a few wrinkles, but she has been wondering whether this might be time for a face lift to keep ahead of the curve. Should she do it now before her changes become extreme or wait until she can really tell more of a difference. If she waits until she is older will the result last longer?

A recent study published in Plastic and Reconstructive Surgery (Vol 129.no1.p263) looked at the age a patient chose to have a facelift and compared it with their long term satisfaction and results. The results were surprising. Younger patients had longer lasting effects from their surgery and were more satisfied. Independent surgeon rating of the results also favored the younger patient.

The women in the study were grouped by age, under 50, 50-60, and over 60. The over 60 group consistently rated their early and long term satisfaction as lower than those in the two younger groups. The surgeons examined before and after photographs of these women to see if the facelift provided long lasting consistent change in five areas.

1. The junction between eyelid skin and cheek skin
2. The fold from nose to corner of the mouth, nasolabial fold
3. The fold from corner of lip to jaw line, “marionette” line
4. The jowls, excess skin that hides the jaw line
5. Neck muscle bands and extra fat

A minimum of ten years of follow up was required to be part of the study. Women who had undergone facelift before the age of 50 had maintenance of their youthful appearance for many more years than those in the two older categories. The surgeon’s observation of the 5 anatomical areas was consistent with the patient satisfaction survey.

So Colleen might well choose to have the facelift she is considering for her early signs of aging so that she will have many years ahead to enjoy its benefits. The “maintenance” facelift while tissues are healthier has been shown to be more long lasting and more consistently satisfying both at year one and year ten.

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