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.

A survey sent to 600 liposuction patients looked at their long term satisfaction, asking a long list of questions, such as:

• How would you rate your appearance after liposuction?  87.3% rated “good or better.”
• Are you more productive in your work?  Better productivity reported in 27%, no change in 71%.
• Would you have the procedure again? 79% said yes.
• Would you recommend the procedure to family and friends?  86% said yes.

The vast majority reported favorably to each of these questions. However, it was found that those who ate a healthy diet, exercised regularly, and maintained a stable body weight were 2x more likely to have increased productivity, 15x more likely to have dropped in clothing size, 2.5x more likely to have a high self appearance score, and 3x more likely to have improved health. Those who took active control of their health were far happier.  

The authors concluded that there are four elements to having a good long term result from your liposuction procedure.  The first is having a good surgeon performing a well executed procedure, but the other three are controlled by you, the patient. Healthy eating habits, regular exercise, and commitment to a positive lifestyle are huge determinants of satisfaction with the choice. So, real satisfaction involves team work with your doctor. The authors developed a map of how to tell what factors affected your happiness with the choice.

PRS Vol.114, No.7, p.1945 

www.PRSJournal.com The_Key_to_Long_Term_Success_in_Liposuction__A.40

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!

Studies have shown that beauty is hard to define, but there is a universal consensus on what constitutes the beautiful face. Balance, or facial harmony, is seen as beautiful when the face is divides into roughly equal thirds of the brow, mid face, and jaw line. A poorly defined neck or jaw line is considered less attractive than one that is well defined and represents a proportional third of the face.

So chin and neck aesthetics are important. Statistics from the American Society of Plastic Surgeons showed that in 2011 there was a big increase in the number of people that chose to have chin augmentation. No one knows for sure what prompted this increase, but it does reflect an awareness of how the lower face is a huge contributer to attractiveness. 

A small chin or a “weak” chin is seen in our society as indecisive, less confident. Poor definition of the jaw line accompanies sagging  of skin from aging. The neck can reveal things that the face is trained to hide.

A chin augmentation (enlargement) is a great way to enhance facial harmony and balance. It is a procedure that is often combinrd with a facelift or a rhinoplasty to improve the overall results.  

Chin and jaw line contouring can be accomplished by a variety of techniques. The jaw bone can be made larger by repositioning of your own bone, placement of a scaffolding that will allow your bone to grow into (cancellous bone chips), biocompatible implants, or fat grafting of your own tissues. The best choice should be individualized with you and your plastic surgeon.  

A beautiful neck may require removal of excess fat, repositioning of musles,or tightening of stretced out skin. There are anumber of ways to accomplish this improvement and each person should have a very individualized plan that considers the interplay of the variables.  

If your neck and chin seem to be a detracting factor  for  you, a considered consultation can help you develop a plan personalized to yourown needs. Dr. Peters can help you think through the possibilities.

Also, for additional information read more at Hive Health Media.

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.

Madonna brings up the rear of the baby boomer generation.

Here are a few “Baby Boomer” facts:

• Those born between 1946 and 1964 constitute 28% of the US population.
• 76 million Boomers will hit 65 over the next two decades, at a rate of 10,000 a day.
• Boomers account for half of all consumer spending.
• The typical Boomer feels 9 years younger than their chronological age, according to Pew Research Council data.
• Elective cosmetic surgery is up 65% in this age group since 2005.
• Non-invasive plastic surgery procedures are up 87% in the same time period.

So what is contributing to the upsurge in plastic surgery in this demographic? Boomers have chosen to redefine what it means to age. They are re-inventing themselves. Sixty is their new forty. They pay more attention to health, diet, exercise and general sense of well being. They are not afraid to spend money on improving quality of life. They expect the quality of the last third of their life to be high.

 Americans are living longer.  For women, life expectancy has lengthened 34 years over the last fifty years. But the focus for Boomers is not so much on life span as it is getting to the end of their health span in better shape. They are working longer than anticipated. Older workers want to look better to fit in with younger co-workers. Boomers want to stay active, relevant, and engaged with society in important ways. Their outlook on life is to do what they can to enjoy the years they have left.

Pablo Picasso once said, “It takes a long time to become young.” Boomers are taking their time and savoring it.