Monday, November 9, 2015

Tummy Tuck - Abdominoplasty Complications


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Healthcare including cosmetic surgery today is increasingly data driven. The computer and internet age has allowed the pooling of information or data from multiple sources. These include insurance billings, hospital admissions, medicare billings, medical specialty society online trackers such as the American Society of Plastic Surgeons TOPS, etc. This data is periodically pooled and analyzed for trends over time, incidence of complications, hospital re-admissions, surgeon report cards, malpractice claims won or lost and so on.

Analysis of claims against insurance that covers for major complications of cosmetic surgery from 2008 to 2013 showed that major complications occurred in 4 percent of tummy tucks, compared with 1.4 percent of other types of cosmetic surgery. The most common major complications that were covered were hematomas (collection of blood outside blood vessels that usually present as tense bulges in the skin and deeper tissues such as a wrestler's cauliflower ear), infections, blood clots and lung-related problems. This type of insurance does not cover minor complications and is separate from health insurance, which typically does not cover complications due to non-covered cosmetic surgery. The risk of major complications was 50 percent higher when patients had other cosmetic procedures at the same time as a tummy tuck.
Male, obese and patients aged 55 or older were also at increased risk. The risk was lower if a tummy tuck was performed in an office-based surgical suite rather than in a hospital or surgical center, although that may be due to sicker less healthy patients being more likely to have this surgery in a hospital setting.

Tummy tuck is the sixth most common cosmetic procedure performed in the United States. More than 117,000 were performed in the US in 2014.



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The Difference Between Abdominoplasty and Panniculectomy
Abdominoplasty Muscle Tightening
 
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Thursday, October 1, 2015

Beauty is in the eye of the beholder - Where You Live


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With modern globalization the most popular films and products are pretty much the same all over the world. Individuals now travel far from home for plastic surgery. That is called medical tourism. At first glance it seems we have reached a global agreement on what beauty consists of. On closer examination we find that is not true.

A survey of 214 Plastic Surgeons from 69 different countries, published in June 2015, revealed that  these surgeons had significantly different preferences for upper breast fullness, areola size in the natural breast, and areola size in the augmented breast based on the country they lived in and their age and independent of their ethnic background. The survey was performed by showing the surgeons computer images that they could make direct adjustments to. Surgeons from India preferred the most full look, while surgeons from France preferred the least upper-breast fullness. Brazilian surgeons preferred the largest areola size, both in natural breasts and in breasts with implants, while German surgeons preferred the smallest areola size. Older surgeons preferred less upper breast fullness and larger areola size.

It turns out it's not just the surgeons. In another study onlinedoctor.superdrug.com commissioned Fractl to investigate perceptions of beauty around the world. Fractl contacted 18 designers (14 women and 4 men) in 18 different countries on 5 different continents and gave them a photo of a woman to Photoshop and retouch to modify haircolor, clothes, shape and form to make her more attractive to citizens of their respective countries.



Saturday, July 4, 2015

Body Dysmorphic Disorder - BDD and Plastic Surgery


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Body dysmorphic disorder (BDD) is a syndrome characterized by a strong preoccupation with an imagined defect in a person’s appearance. In cases where the deficit is not imagined and a slight defect is present, the person’s concern is noticeably excessive. Excessive preoccupation with the imagined or minor flaw involves intrusive thoughts about the body part of concern. In addition to daily intrusive thinking, individuals suffering from BDD engage in a variety of compulsive behaviors aimed at alleviating the anxiety caused by the thoughts. Patients with BDD generally engage in thoughts and behaviors related to their perceived deficit for 1 hour or more per day, and that amount has been reported as high as 3 hours per day among adolescents. Symptoms often start in adolescence or early adulthood brought on by remarks made by peers or family members i.e. early bullying and family attachments are significant factors. The average age of onset is 16 to17 years, although it may occur in older adults overly concerned with their aging appearance. Individuals with BDD frequently check their appearance in mirrors to confirm or attempt to conceal the perceived deformity. They may engage in long rituals of grooming, such as repeatedly combing or cutting their hair to make it just so, applying make-up, or picking at their skin. They typically will spend a great amount of time trying to cover up or camouflage the perceived defect employing elaborate clothing rituals. They will seek excessive reassurance from friends, family members, and/or co-workers to elicit placation that the perceived “defect” does in fact exist, or to assure that the flaw is sufficiently concealed. At the extreme they feel anxious around others, avoid social situations, become housebound, only leaving their homes at night to avoid the scrutiny of others. Some drop out of school, avoid job interviews, or do not work in order to avoid public exposure . Patients with BDD have attempted to engage in self-surgery with knives or razor blades to pick at or remove the blemish or with staples to tighten “loose skin". Clearly they see something that others do not see real, imagined or exaggerated.





Tuesday, May 26, 2015

Plastic Surgery Rehabilitates Criminals


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Between 1953 and the early 1960's Dr. Edward Lewison performed free plastic surgery on inmates of the  Okalla prison in Burnaby, BC Canada. It was renamed Lower Mainland Regional Correctional Centre in 1970. The study involved 450 prisoners and was undertaken with the cooperation of Dr. Guy Richmond, the prison doctor, and Hugh Christie, the warden. Dr. Lewison and a sociologist chose patients on the basis of a  connection between a "bodily defect" and the inmate's behaviour. The idea was that reconstructive surgery that removed deformities would provide such a boost to the prisoners' self-esteem and confidence that they would be motivated to pursue law-abiding lives upon their release from prison. Most of the operations were for congenitally deformed or fractured noses. The rest were for reconstruction of deformed ears, receding chins and removal of facial scars. Almost immediately after surgery, the inmates' behavior improved. "Formerly hostile and incorrigible individuals became polite and gracious in their manner … Among them a keen ambition developed to learn a trade and qualify for transfer to the vocational correctional centre." The studies results were published in the Canadian Medical Association Journal in 1965 citing a 42 per cent recidivism rate for the plastic surgery patients vs. 75 per cent for the general inmate population. Lower Mainland Regional Correctional Centre was closed in 1991. The site is now a park.

Similar studies by different doctors carried out on inmates at Kingston Penitentiary in Kingston, Ont. in the 1960s, in Illinois starting in the 1930s and in Texas in the 1980s had similar results. The theory is still in use today by non-profit organizations in the U.S. which help reformed former gang members to remove facial and body tattoos to help get them out of gangs into jobs. I have been a I volunteer tattoo removal doctor in Los Angeles since the mid-1990s to help get people out of gangs. The patients pay for their treatments by performing volunteer community services and some have gone on to well paying executive or managerial positions. I don't think many people today would support free cosmetic surgery for inmates. In this crazy world some would commit crimes just so they could get the free surgery.
The best way to rehabilitate Two Face back to Harvey Dent would have been Plastic Surgery.

The BBC is currently looking for anyone involved to be in a documentary about the study.


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Saturday, February 7, 2015

Lipedema, Lymphedema and Fat Legs


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The 4 main causes for enlarging leg girth or circumference are lipedema (accumulation of fat in the legs), lymphedema (obstruction of lymph flow in the leg), obesity and impaired venous blood circulation (venous stasis). Lymphedema is observed as swelling that usually involves the feet and shows up as impaired flow on lymphangiograms or lymphoscintigraphy . With time the swelling becomes hard and uncompressible and the skin breaks down and becomes infected. Impaired venous circulation is observed as swelling with brown darkening of the skin color, skin break down and inflammation. The blocked veins are visualized by doppler sonography studies using sound waves transmitted through the skin. This blog will focus on lipedema also known as lipoedema in Europe.

The areas of fat concentration tend to be abdominal in aging men, hips and thighs in aging women and buttocks in certain races as those individuals age. The age at which this occurs varies from person to person. Changes in metabolism and fat deposition can also occur more quickly at puberty, after childbirth, gynecologic surgery, with the onset of thyroid disease or menopause. It is easier to lose fat from areas in which your body tends to not concentrate fat. The fat doesn't go to one place and then another as in first, second etc.. It goes all over but more of it is stored in specific areas and it is mobilized from other areas more easily. In some cases the concentration can be dramatic such as very large buttocks with skinny arms and legs, steatopygia, which is more common in certain African tribes.



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