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.

As its popularity grows, women are becoming more proactive about educating themselves about their decision. One of the most significant concerns is about sensitivity to the nipple post operatively. Women want to know the statistics, not just “opinions” not backed up by any evidence. They want to make fully informed decisions.

An excellent study on this subject was published in the October 2011 issue of Plastic and Reconstructive Surgery. A plastic surgeon from Rome collaborating with a British colleague published data on 1222 patients (that is 2444 breasts!) examining nerve function after breast enlargement surgery. They reported the following:

1. Half of all patients experienced a TEMPORARY change in sensitivity that goes away by itself in 6-8 weeks. 
2. At six months, 94.8% of women had normal sensation, unchanged from before surgery.
3. Large breast implants did not increase the incidence of sensory change.
4. Patient age did not factor into sensory change.
5. Placing the implant above or below the pectoral muscle did not make a difference in sensation.
6. A decrease in feeling was present in 2.7% of women post op. Discomfort was noted for 3.5%.
7. The only risk factor identified for altering nerve sensation was use of the periareolar incision.

In fact the periareolar  incision resulted in more than double the number of women with altered sensation.  Fortunately this sensory change affected only a small number of women. If a scar around the areola is what you prefer, it is good to know the facts up front.

In the information age, doctor patient relationships have changed a lot. People are hungry for health information. iphones have dozens of apps related to healthcare and fitness. Most people consult the internet to explore a health concern many times before they consult their doctor. Most will self diagnose or make medical choices based on their reading and then select a doctor that conforms to that choice. The doctor’s opinion becomes optional in the search for autonomy in making critical decisions.

There is good and bad in that method, yin and yang. People are becoming more informed about the important decisions in their life and becoming proactive about their health. But often it is difficult to put all this information to good use. Healthcare webpages, advocacy sites, and chat rooms all provide both incorrect and correct information. It is hard for the reader to distinguish evidence-based advice from marketing hype. It is difficult to navigate between the extreme and the reasonable. It is harder still to figure out how that information applies to you, and what makes your circumstances unique. 

That is where the doctor comes into the shared decision making process. Having used the internet to check the lay of the land, it is important for you to seek the guidance that only medical training and experience can provide. Ask your doctor how this information you have gathered can be put into perspective in your circumstances. Important decisions are best made in a partnered fashion. Come to the table informed, but keep an open mind about how to apply the information.

Diagrams of MR imaging findings in implant rupture. At left, intracapsular rupture where silicone is contained by the surrounding fibrous scar tissue (black arrows). The collaped outer shell (curved arrow) and often fluid droplets are seen within the gel. At righ, an extracapsular rupture, where silicone gel extends beyond the fibrous scar or capsule.

Silicone breast implants are one of the most extensively researched medical devices in the US. They have a high safety profile and are being used increasingly with good product performance. Breast implant shell failure is one of the concerns many women express when investigating choice of implant type. If the shell of a saline implant develops a break the fluid spills out and deflation occurs within days. If a silicone implant experiences a break in the shell, it generally requires an imaging study to confirm.

The implants currently marketed in the United States are referred to as “Fourth Generation Responsive Gel.” These implants have a silicone center that is thicker than earlier implants. Because of the viscosity, if there is a break in the envelope, shell failure, the gel tends to stick to itself, rather than oozing out of the sac like syrup.

Detecting a leak involves some form of an imaging study. Mammograms give a certain amount of information about the status of an implant, but are not sensitive enough to pick up every rupture. A negative study can give false reassurance that the implant is intact.

An MRI, magnetic resonance imaging, is considered the Gold Standard. The FDA has recommended a post operative MRI at year three and every two years thereafter. There is no scientific evidence that backs the timing of this recommendation, and most plastic surgeons believe the recommendation is overly cautious. Both the cost and the inconvenience of MRI exams are barriers to women using this for follow up. Additionally, MRI exams can over read, meaning give the appearance of a rupture where none exists. This can lead to unnecessary surgery.

Technology advances in some areas with mind boggling speed. Medical imaging is a field of rapid technological expansion. As predicted, there is an emerging technology that is not yet market ready that promises to vastly improve post operative imaging of silicone implants.

High resolution ultrasound is being studied for its ability to give accurate information about the shell of silicone breast implants. Preliminary research is published in the Aesthetic Surgery Journal, February 2012, p.157. The authors report that as they refine this ultrasound technique, it may provide relative affordability, accessibility, and availability. It’s good news for the future of monitoring the shells of silicone breast implants.

Our team of three doctors, two nurses, and a dentist were able to visit five remote villages in the mountains of central Honduras. We treated 919 people in the medical clinic, treating infections, skin diseases and screening for major health problems. 239 people had eye exams and were fitted for glasses. 531 patients received deworming medication, as the Honduran water supply is heavily contaminated and  Hondurans carry three types of intestinal parasites that cause malnutrition. 140 people had rotten teeth removed. The population knows little of oral hygiene and the children chew on sugar cane like a pacifier. Their teeth are full of cavities early on.

Our team had wonderful support from local Hondurans. Programs are being instituted to improve education about basic health and sanitation. A cardiac surgery team comes annually to provide the only open heart surgery in the entire country. The cleft lip and palate surgical team provides high quality on going care  of Honduran children with this birth defect. I will be joining that team in April of 2012.

To see more photos of my journey please visit my Facebook page 

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.

The American Board of Plastic Surgery continues to be the organization that sets high standards for the type of training, and the demonstration of competence for Plastic Surgeons. Board Certification in Dermatology or Otolaryngology is not plastic surgery. Those calling themselves plastic surgeons are “alternate” practitioners of the art. 

The New York Times January 31, 2012 Health Section described how non-specialists have expanded into the field of cosmetic surgery.  Visit Non-Specialists Expand Into Lucrative Cosmetic Surgery Procedures – NYTimes.com for their discussion.

If you want to know if your doctor is certified by the American Board of Plastic Surgery, you can visit www.certificationmatters.org.

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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How Much Younger Does a Face Lift Make You Look?

1. Where is the breast located on the chest wall?  The base of the breast (breast disc or footprint) should meet the chest wall in a way that is the foundation for the overlying three dimensional structure of the breast. This footprint is constant throughout life. An abnormal location of the footprint or an irregular chest wall can interfere with the aesthetics of the breast. Is your breast fold too high or too low?  Is your spine straight?  Does one side of the chest project more than the other?  Are your ribs crooked? 
2. What is the shape or “conus” of the breast? Breast shape varies widely among women and quite a bit over a given woman’s lifetime. In adolescence the breast is cone shaped. Over time there should be a progressive transition with a greater portion of its volume resting in the lower outer quadrant. The nipple should be at the area of maximum breast projection, roughly at the apex of the cone shape. 
3. What is the quality and quantity of the breast skin? Too much skin leads to a drop in the breast position on the chest wall. The skin provides the major support for the breast gland. If elasticity is poor, the skin envelope cannot contain the gland in a suitable shape.
4. Is the areola size a good match for the volume of the breast? Is the nipple position correctly located on the projecting portion of the breast and in the middle or slightly lateral to the middle of the breast?
5. Do the two breasts look alike? Most women’s breasts are more like sisters than identical twins, but symmetry is one feature of the hoped for end result.
6. Is the volume appropriate for the rest of the body’s proportions? You should express your size concerns to your surgeon and have a careful discussion about any possible downsides to your choice. 

Tubular Breasts

The term “TUBULAR” refers to SHAPE for a tubular breast. It is used to describe a breast shape that is long and narrow, rather than being broad at the base with a gradual decrease in width up to the top, like a cone or pyramid. Women that have tubular breasts often have a very high fold at the base of their breast, and they have puffiness in the nipple-areolar region where the breast seems to bunch out of the top. A mild tubular breast shape is quite common. Extreme tubular breast deformity can be very troubling  to have, and women often want the shape improved.

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The Impact Honduras project has targeted twenty-four communities located in remote areas of the mountains of central Honduras. The goal is promote sustainable change among the poor by providing basic healthcare, with extended healthcare services for special needs children and pregnant women. The program designates community health care providers, assists in water purification, health education workshops, trains midwives and promotes leadership development. 

Our team consists of 15 people, two pediatricians, one surgeon (me), two nurses, an optometrist, four translators and pharmacy specialists and team leaders. Each day we will be visiting one of these targeted communities to screen for health problems among the children, educate about health issues, and provide basic care to all that request it. Children with severe problems are referred elsewhere for more complex treatments. The Friends of Barnabas also provide cardiac surgery to children with congenital heart conditions and plastic surgery for children with cleft lip and palate.

The Friend’s of Barnabas Foundation’s mission is to improve the lives of the Honduran poor by providing high quality sustainable medical care and enabling communities to become self sufficient through health related training and education.

You can learn more about Impact Honduras or make a donation by visiting the website www.fobf.org.

I will be documenting my trip with my daughter Sarah, my Spanish translator, on my Facebook page in January 2012.