Category: Beauty


Botox: Might Be Good for Curing the Blues

40s BotoxDepression may be improved with the use of Botox, according to a report in The New York Times, March 23, 2014 edition. Since Botox can prevent frowning and unhappy facial expression, it was theorized that if you can’t frown it may be harder to be depressed. Researchers wanted to study the idea that facial expressions may feed information back to our brains that influence our mood.

74 patients with major depression received injections in the forehead muscles responsible for frowning. The shots were randomized to either Botox or a salt water solution, placebo. Six weeks later 52% of those who received Botox showed improvement in their depression, as compared to only 15% of those with the salt water injections.

Only half of those in the Botox group were correct in guessing that they had received Botox, which is no better than the toss of the coin. Presumably, knowledge of receiving the Botox could not influence emotional response.

Botox for depression is part of a tradition of “Outside In” therapies that aim to improve the psyche by external manipulations. Acupuncture treatment of anxiety, and exercise for the production of endorphins are other examples of successful use of this methodology. Light therapy sends signals to the brain that can effectively counter Seasonal Affective Disorder. We all recognize that when we look better we have a better sense of self esteem. The concept rings true.

It will take more science to show whether Botox is an effective treatment for depression, and which types of depression it works best for. In the meantime, if you are getting Botox to look a little better, pay attention to whether the absence of frowns puts you in a better frame of mind!

Anti-aging, Beauty, Doctor-Patient Relationship, Facelift, Personal Fitness, Skin Care

JUVEDERM VOLUMA XC: The New Injectable for Improving Cheek and Midface Contour

Juvederm VolumaThe 2013 calendar year saw a whopping increase of 18% in the number of people seeking injectable fillers to smooth wrinkles and enhance contours of the face. There were 1.7 million injection sessions of hyaluronic acid, a naturally occurring substance in all human tissues. The filler contains a numbing agent, lidocaine, so the injection is only a minor discomfort.

Voluma is a  new product developed to be thicker than its cousin Juvederm so it lasts longer.  It is intended to fill in the cheekbones and chin when these start to lose fullness. The FDA approved its availability to Plastic Surgeons in the final quarter of last year and it is becoming readily available.

As the face loses volume and skin begins to lose its elasticity, the cheek bone region flattens and folds of skin develop in the lower cheek from nose to mouth. None of us like it. With Juvederm, the injection is placed into the creases to camouflage the skin relaxing as the volume goes away. With Voluma, the injection is placed in the mid cheek, elevating the nasolabial skin folds to their natural position. With the skilled hands of a Board Certified Plastic Surgeon it can give an immediate improvement in fullness.

Voluma has been used extensively in Europe, Latin America, Canada, the Middle East and Asia since its introduction in 2005. It is finally available here in the US.

Voluma can last up to two years, whereas Juvederm has an average duration of six months. Longer lasting—wouldn’t that be nice? For a low maintenance product and no more upkeep than your skin care routine, you can experience improved facial fullness for up to two years!

Anti-aging, Beauty, Doctor-Patient Relationship, Facelift, Fat Transfer / Fat Grafting, Skin Care

THE EVOLUTION OF SILICONE BREAST IMPLANTS

silicone-vs-saline-breast-implantwebThe American Society of Plastic Surgeons released its 2013 statistics in February. Breast augmentation was again the most frequently performed surgery and 72% of augmentations were with silicone implants compared to only 28% saline. The preference for silicone over saline is a reversal of trends from a decade ago. In the early 1990’s the US had a brewing controversy over the reliability of silicone, and the Food and Drug Association responded with a ban on their use except when part of a safety study. The implants remained available and widely used in Europe and South America. The FDA pre-approval study gathered data for fourteen years before returning the silicone implant to the list of approved medical devices. 2006 was the time of their return to the market, but the product had been modified to address the concerns that were raised. They have come a long way from where they started.    

Silicone implants are generally considered superior today because of their natural feel and durability.  The evolution of the modern Silicone Implant can be summarized:

  • First Generation: (1962) the original implant had a thick shell (0.25mm on average) filled with a thick viscous silicone gel. A Dacron patch was on the back. Implants were controversial when they first came out, but they rapidly became popular.
    Mark Twain once said, “A man with a new idea is a crank until the idea succeeds.”
  • Second Generation: (1970’s) About 10 years later the wall thinned out to 0.13mm and thinner gel was used on the inside. This change was undertaken to create a softer feel.
  • Third Generation: (1980s) A thick, silica-reinforced shell was developed for the silicone implant, to improve the strength of the outer envelope. This generation had much thinner gel content, compared to the thickness of syrup. The gel was more likely to travel when the shell was compromised. These are the implants that generated the controversy of twenty years ago.
  • Fourth Generation: (1992) The shell was made stronger and the gel was more cohesive in response to the problems that had been identified. The cohesive gel sticks to itself and is not likely to “ooze” out if the shell has a break down. 
  • Fifth Generation: (2012) The most recent modification to be approved by the FDA is the “gummy bear” or form stable implant. It has a much denser gel inside and is shaped with greater fullness at the bottom and texturing on the surface. This latest adaptation is being incorporated into practice in special circumstances. It allows more choices to personalize implant selection for each patient.

Twenty years ago silicone implants were held in suspicion. Careful clinical trials were undertaken to confirm their safety. Ten years ago, while the controversy was still brewing, most women chose saline implants for their augmentation.  Our thinking has evolved in response to the scientific data as well as patients’ experiences. The community of Plastic Surgeons will continue to evolve its thinking as new science and technology becomes available.

If ten years from now we are thinking the same as today, it is likely we are not thinking at all

Beauty, Body Contouring, Breast Augmentation, Breast health, Breast Implants, Doctor-Patient Relationship, Mommy Makeover

Combining an International “Vacation” with Plastic Surgery: Is Price More Important than Quality?

Womaninhammock“Medical tourism” is a modern reality. It is estimated that there may be as many as 15 million Americans a year receiving some form of care outside of the country. Those that are seeking plastic surgery are lured by combining their desire for cosmetic improvement with their desire for a vacation abroad. The consumer that puts a premium on cost over quality may not be aware of what they are giving up.

Here are some points to consider before booking the trip:

  1. What are the qualifications of the person performing your surgery abroad?  Does the country have any regulation of who is allowed to perform cosmetic surgery?
  2. Will a language barrier make it difficult to communicate with your caregivers, about your medical history, your informed consent, and your after care instructions? Will they know all they need to know about you and will you learn what you need to know from them?
  3. How can you verify the safety and sterility of the operating room where your surgery will take place? The United States has high, likely the strictest standards, for accrediting its medical facilities.
  4. Recovery from surgery is usually a time where rest is needed to heal. Fatigue is likely to interfere with the “vacation” part of the trip.
  5. Who will take care of potential complications? What if you need care beyond the time allotted for the trip?
  6. If the result is unsatisfactory who will revise your surgery? Will you have any follow up?

The American Society for Aesthetic Plastic Surgery has a set of guidelines for those consider international plastic surgery. You can access this checklist here.

Anti-aging, Beauty, Body Contouring, Breast Augmentation, Breast Implants, Discount cosmetic surgery, Doctor-Patient Relationship, Mommy Makeover

South Korea: The World’s Capital for Plastic Surgery

Korean Plastic Surgery FaceI  just returned from a week in Seoul S. Korea, visiting with a manufacturer of US medical devices. This first time visit to Korea was eye opening. My pre-conceived images of Korea, probably formed by watching re-runs of MASH, were of a struggling people recovering from the ravages of Japanese occupation and the Korean Civil War. They have reversed the sufferings of the last century. Seoul is now a sophisticated metropolis, ringing with commerce and populated with meticulously dressed urbanites, rushing from offices, restaurants, karaoke bars, health clubs and university classrooms. South Korea has made an astonishing move from shanty-town poverty into a modern high rise industrialized economy in a span of 50 years. 

Of particular interest to me was the Korean attention to beauty. They dress stylishly, pay careful attention to grooming and consider looks to be an important element to success. This value allows them to be very open to plastic surgery as a means of achieving their ideals.

South Korea has the world’s highest per capita rate of cosmetic plastic surgery, according to the 2009 and 2011 statistics of the International Society of  Aesthetic Plastic Surgeons. 

For Korean college graduates seeking employment, 27.4% get plastic surgery to fare better in the hyper-competitive job market. Every year 74 out of every 10,000 people undergo cosmetic surgery, a rate 1.8 times the United States. One in five women between the ages of 20 and 45 is reported to have cosmetic surgery. 

Korea is followed by Greece, Italy and the United States in the per capita rate of choosing plastic surgery. The people of Brazil and Taiwan also value and utilize plastic surgery with a high degree of frequency.

The Asian specialized procedures that are performed frequently in Korea include the double eyelid surgery to make the eyes appear larger, cheek implants to create an “apple” shape, jaw contouring to decrease the width of the face and rhinoplasty to raise the height of the nose.  Forehead shaping with fat grafts, liposuction and breast implants are also popular. 

For more information consult:

International Society for Aesthetic Plastic Surgeons, www.isaps.org

http://www.huffingtonpost.com/2013/01/31/top-plastic-surgery-countries-world_n_2590757.html

Anti-aging, Beauty, Blepharoplasty, Doctor-Patient Relationship, Fat Transfer / Fat Grafting, Rhinoplasty, Skin Care

After the Weight Loss

scaleOne of the good things about our nation’s obesity epidemic is that there are so many people affected by it learning to reverse the weight gain. I often ask people what made them ready for change.  In my practice about half of the massive weight loss patients I see had bariatric surgery and half used diet and exercise alone. Make no mistake. Both are hard work.

The US population has obesity levels that are sky rocketing compared to our parent’s generation.  Theories abound about the cause of this unprecedented rise, but there is no doubt that it has become a serious public health problem. Health benefits of massive weight loss are large, but people often endure aesthetic and functional impairments that do not go away with weight loss alone.

Studies show that people are pleased with the changes in their appearance after massive weight loss, but their body image satisfaction decreases after 2-3 years.

The change comes from quality of life limitations created by the deflated hanging skin. They experience functional impairments including limited mobility from excess inner thigh skin, postural instability from abdominal skin excess, and increased hygiene demands from areas where the overhanging skin rubs.  16% report sores, rash and skin breakdown. 60% are dissatisfied with the appearance of their thighs.  Many continue to feel uncomfortable about their appearance which can have an impact on sexual and social interactions. The removal of excess skin by body contouring plastic surgery can contribute to better, physical, psychological, and social function. 

Studies have shown that 75-85% of those who have sustained massive weight loss desire body contouring surgery. The desire for plastic surgery after weight loss is twice as frequent in women and inversely related to age.

For more information refer to the December 2012 issue of Annals of Plastic Surgery.

 www.annalsplasticsurgery.com

Beauty, Body Contouring, Breast Augmentation, Breast health, Breast Implants, Breast Reduction, Cellulite, Mommy Makeover, Uncategorized, Weight loss

Asian Eyelid Surgery

AsianWomancropSeattle has a large Asian population of varying ethnicities. I find they express different preferences for beauty in the upper eyelid. Those from Chinese, Japanese or Korean heritage more often favor a narrow crease above the eyelashes. Filipinos, Taiwanese, Malaysians and Indonesians prefer a wider fold. Population genetics show that the narrow or no crease peoples were originally from Northern Mongolia in prehistoric times. The Southern Mongolians evolved different facial features including deep set eyes and a wider crease. Most people want to retain a natural look that is true to their familial background.

The “classic” Asian eye

  1. Slants upward on the outer corner
  2. Has an absent lid crease,
  3. Has a fold of skin that lies over the inner corner, referred to as an epicanthal fold

In reality, the Asian eyelid has a large range of individual variation, including the height of the crease, the width of the eyelid opening, the amount of fat around the lids, and the shape of the eye.

It is possible to vary the blepharoplasty procedure according to each person’s preferences, especially when it comes to the desired fold height. You will want to talk about that when you come in for a consultation. You can make aesthetic changes without  erasing your heritage. A “natural” look is better than a “westernized” look. 

Anti-aging, Beauty, Blepharoplasty, Fat Transfer / Fat Grafting, Skin Care, Uncategorized

Top 5 Cosmetic Procedures for Men

HandsomeManMen in the prime of their life are seeking cosmetic surgery for both personal and professional reasons. In July, the Cosmetic Surgery National Data Bank released its statistics for 2012. It is interesting to see what plastic surgeries men select. Men had nearly 1 million cosmetic procedures in the US, 10% of the total. The winners are listed with the number of reported cases.

  1. Liposuction (41,642)
  2. Rhinoplasty, nose reshaping (29,996)
  3. Blepharoplasty, cosmetic eye lid surgery (23,251)
  4. Gynecomastia, reduction of male breasts (22,736)
  5. Otoplasty, correction of prominent ears (12,053)

The data collection for plastic surgery goes back to 1997. The number of procedures for men has more than doubled since that time. Men are also seeking nonsurgical cosmetic procedures, such as Botox injections in rapidly increasing numbers. There were 808,011 nonsurgical cosmetic procedures reported to have been performed on men in the United States during 2012 according to the American Society for Aesthetic Surgery.

www.surgery.org

Aesthetic Surgery Journal, vol. 33, Supplement 2, July 2013.

Anti-aging, Beauty, Blepharoplasty, Body Contouring, Gynecomastia, Male Breast Enlargement, Male Breast Reduction, Personal Fitness

WHEN DO BREAST IMPLANTS NEED REVISION?

WomanRedheadAccording 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

Anti-aging, Beauty, Body Contouring, Breast Augmentation, Breast Implants, Breast Reduction, Mommy Makeover, Personal Fitness, Uncategorized

Studies Confirm Patient Satisfaction with Choosing Breast Augmentation

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.

Anti-aging, Beauty, Body Contouring, Breast Augmentation, Breast health, Breast Implants, Personal Fitness

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