Category: Doctor-Patient Relationship


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

New Primer for Facing Breast Cancer

Madhulika Sikka’s A Breast Cancer Alphabet 

BreastCancerAlphabetFor years, my mornings have begun listening to National Public Radio’s “Morning Edition” broadcast. Madhulika Sikka, news editor for NPR, is a name I have heard regularly as a producer of newsworthy and provocative stories.  When I heard that she had written a book about her experience with breast cancer, my curiosity was aroused to put humanity to her faceless radio presence. I was very pleased by what I found.

Her new book, “A Breast Cancer Alphabet,” is part memoir of her personal encounter with breast cancer, part social commentary about the “Cancer-Land Culture,” and part intuitive self-help advise for any woman facing dark days.

Memoir

Madhulika describes how each detail of the day she received her cancer diagnosis was stamped on her brain. Sikka was at the White House for an interview with President Obama on the day she was waiting for the fateful call from her doctor.   She talks about the impersonality of having her breasts suddenly become objects of inspection by technicians, residents and doctors.  She calls this both manhandling and “woman-handling” of her private life.  She describes the “I is for Indignities” of mammograms, claustrophobic MRI exams, and special needle localization biopsy where your body has to adapt to the rigid Plexiglas box machine while positioned on your stomach.  

She describes her mastectomy and chemotherapy and how her new diagnosis affected her marriage and her relationships with her children. She describes how losing a breast and losing her hair gave her a different relationship to her body. The rapid change was assault.

“The thing about breast cancer is, it does things to your looks, and not necessarily good things. So, whatever category you fall into–plain or primpedyou find yourself thinking: Why am I so worried about looks right now?”

She recognized that if she needed to look better in order to feel better, “almost like applying a shield.”

Social Commentary

“Cancer-land” was the name she gave to the all-encompassing world of oncology, a land you can never leave once you enter. She was critical of the social pressure to use warrior images of the patient’s treatment endeavor. She disliked the gauzy breast cancer world of pink ribbons and sexy, glamorous warriors fighting back.

“But I am not a woman warrior. I am just a woman, a woman who has been diagnosed with a horrible disease; a woman who has gone through brutal surgery; a woman who has had her body poisoned to “kill” the disease. Can I just be a woman who is going through that? Can I not be a woman warrior? Please?”

Self Help Advice

A Breast Cancer Alphabet is readable, thoughtful and genuine. Her “R is for Reconstruction” chapter  encourages you to think of your reconstructive  plastic surgeon as your very own Michelangelo, who sees each woman’s breast rebuilding as an original artistic creation.Her “T is for Therapy” chapter encourages a variety of ways to heal from the Cancer-Land experience. 

“Therapy is all about healing, and the beauty of healing is that it can apply to your body, your soul, your mind, and your surroundings.

Her writing is beautiful and her word choice speaks to deep reflection on the subject of facing loss in life. Her book is about breast cancer, but is really a healthy reminder of how to respond to many types of dark days, whether they be the result of cancer or not.  

Announcements, Book Review, Breast health, Doctor-Patient Relationship

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

Want To Be a Better Version of You?

Accept the Challenge in 2014 

Walk ParkWonder diets and quick weight loss plans get a lot of attention with the start of each New Year. I suggest skipping extreme solutions. Dropping 20 lb. and gaining it right back is not success. The real path to your best health, vitality and weight control requires commitment to a lifestyle that is practical. Here are a few practical suggestions for sustainable health and fitness improvements:

  1. Diet without counting calories. It is too much trouble to weigh and measure every bite of food you put in your mouth. Use portion control and avoid calorie dense foods.
  2. Hit your goal 80% of the time. If you are a perfectionist you will be disabled by your disappointment. Perfect is definitely not practical. So allow yourself some margin.
  3. Keep a journal so you are accountable and honest with yourself.
  4. Drink 11-12 glasses of water a day to combat hunger and fill your stomach.
  5. Keep moving!! You have to move to lose weight and exercise is a good to fight anxiety and depression. 
  6. Weigh weekly to avoid weight drift.
  7. Your weekly exercise routine should include 30 minutes of cardio a least 3 times and resistance training 2-3 times. Find exercise you like doing. Make your exercise social. Exercise with a friend to accomplish two important functions at once.

A sound body requires a sound mind. Learning methods for managing stress and building resilience are important for the sustainability of your challenge. Most women are so accustomed to being caretakers, they neglect their own needs, both physical and psychological. Make time for your mental and physical well being.   

Announcements, Anti-aging, Body Contouring, Doctor-Patient Relationship, Exercise, Nutrition, Personal Fitness, Weight loss

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

Plastic Surgery after Bariatric Surgery Shown to Improve Long Term Weight Control

Weight lossBeing massively overweight is associated with poor body image, low self-esteem and reduced health related quality of life. In the United States, over 100,000 bariatric surgeries are performed annually to address these health concerns. Gastric bypass, the most frequently performed weight loss procedure, allows rapid weight loss in the first 18 months. However, half of these people gradually regain 10-15 % of the lost weight over the next 10 years. Those regained pounds undo some of the improvements the bariatric surgery brought. A new study reported out of Geneva Switzerland shows that those who have body contouring plastic surgery for the excess skin after massive weight loss are more successful at keeping the weight off for the long haul.

A group of patients who had undergone gastric bypass surgery between the years of 1999 and 2007 were compared for their ability to keep the weight off. Average weight loss was an impressive 99 lb. With a follow up of seven years, the 102 people who had not chosen to have plastic surgery to get rid of the deflated skin had regained an average of 50 lb. However the 98 people who chose body contouring plastic surgery to complete the process after their bariatric surgery only regained an average of 13 lb. over the seven year period.

The authors conclude that bariatric plastic surgery is crucial for successful treatment of morbid obesity. The plastic surgery improves psychosocial functioning and strengthens long term weight loss maintenance.

www.PRSJournal.com, October 2013

Anti-aging, Body Contouring, Doctor-Patient Relationship, Mommy Makeover, Nutrition, Personal Fitness, Uncategorized, Weight loss

BRA DAY USA

Jewel-Kilcher---Performing-in-Lancaster--09National Breast Reconstruction Awareness Day

October is Breast Cancer Awareness Month, a  campaign to  educate women  about this all too common disease. Though the disease is common, the treatment can vary widely  and decisions for therapy need to be individualized. For the second year in a row, the American Society of Plastic Surgeons has sponsored Breast Reconstruction Awareness Day, or BRA DAY as part of the October campaign.  

This year’s spoke’s person for BRA Day is singer/songwriter Jewel, who has composed a song The song is entitle “Flower” and can be downloaded on I Tunes to benefit breast reconstruction patients.

Here are a few facts about public awareness of breast reconstructive options:

  1. Only 19% of women understand that the timing of their treatment for breast cancer and the timing of their decision to undergo reconstruction greatly impacts their options and results.
  2. Only 23% of women know that there are a range of options available for breast reconstruction.
  3. Only 22% are familiar with the quality of outcomes that are possible.
  4. 89% of women express the desire to know more about results of breast reconstruction prior to undergoing treatment for breast cancer.

The American Society of Plastic Surgeons urges women to make sure a plastic surgeon is part of their treatment team as they select options for treatment.  Here are a few online resources for breast reconstruction information.

American Society of Plastic Surgery

plasticsurgery.org/choices

BRAdayUSA.org

American Cancer Society

 

Breast health, Doctor-Patient Relationship, Mommy Makeover, Tubular Breasts

“COVERAGE IS HERE”

Washington-Health-Plan-FinderThere is a lot of change occurring in healthcare currently. One of the best changes is that health insurance will be available to many who were previously ineligible. “Coverage is here” is Washington state’s slogan to educate the public about the new state health benefit exchange. The federal Affordable Care Act has a mandate to increase the number of people covered by health insurance. Enrollment is beginning now for plans that go into effect January 1, 2014. There are 46 health insurance plans participating in the new system. Here are some common questions about the new health benefit exchange:

  1. Who is eligible for these plans?
    Individuals, families and small businesses can purchase insurance through these new plans.
  2. How much will it cost? 
    The cost will vary by how much coverage you choose and whether or not you are eligible for any fee reductions, based on your income.
  3. Will I be able to see my own doctor on the new plan?
    Each insurance plan will have its own panel of doctors.  You may be able to find the plan that your doctor works on before you purchase.
  4. If I have insurance through my employer will I have to go through the state healthcare exchange?
    Most individuals will be able to stay on their company’s plan.

 For more information go to www.wahealthplanfinder.org.

Announcements, Breast health, Doctor-Patient Relationship, Personal Fitness

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