Teenage Rhinoplasty - Teen Rhinoplasty

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Cosmetic surgery on teens or children is becoming more popular (in 2009 203,000 teens and in 2012 236,000 teens between the ages of 13 and 19 altered their physical appearance) but can be controversial. While adults have appearance altering surgery to stand out or look younger, teens do so to fit in and be more like their average peer.  Not all teens with psychosocial anxiety about a body part have psychological issues, and they should not be dismissed by adults as being too immature to understand their own emotions or automatically be assumed to have primarily psychological problems.

In Australia such surgery is legally restricted. In 2009, breast and nose surgery, liposuction, and Botox on children were banned in Queensland, Australia. Doctors who perform such procedures without medical reason can face up to 2 years in prison. In New South Wales, Australia patients under 18 years of age who are considering cosmetic surgery have undergo a 3-month cooling-off period, followed by consultation with an internist and clinical psychologist before they can have surgery. There are no such regulations in the United States.

Rhinoplasty, nose reshaping surgery, is the most common cosmetic surgery performed on American teens. It is usually performed as same day surgery under general anesthesia. According to the 2010 American Society of Plastic Surgeons report, rhinoplasty made up 45% of all teen plastic surgery procedures. This has been consistent with 44% of teen cosmetic surgeries being rhinoplasty in 2012. Over 30,000 teens a year get nose jobs in the US. The reasons for having the surgery and the specifics of surgery can be much the same as they are for adults:

• Removing a hump on the nose
• Straightening the bridge
• Reshaping the nose's tip
• Increasing or decreasing the size of the nostrils
• Correcting the nose after an injury
• Opening breathing passages
• Making the nose bigger or smaller

But there are additional issues the surgeon has to take into account including:

• is the teenager mature enough and physically old enough to undergo surgery, follow instructions after surgery and wait for complete recovery before judging the result
• are the teenagers motivations for surgery appropriate and are their expectations reasonable
• are the parents supportive and on board

Daily Sunscreen Use Slows The Aging Process

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It has been common knowledge for a number of years that regular sunscreen application prevents skin cancer and the FDA changed the allowed labeling on the counters so they can state this. A study published earlier this month in Annals of Internal Medicine now shows it also slows the aging process.

Researchers at the Queensland Institute of Medical in Australia looked at a group of 900 young and middle-aged, mostly fair skinned men and women under age 55 (to factor out the contribution of genetic aging) that were randomly divided into 2 groups. The first group applied SPF15+ sunscreen to their faces, necks, hands and arms daily. The second group used sunscreen either rarely, or not at all, discretionary sunscreen group. Silicone impressions were taken from the backs of all participants’ hands, at the beginning and then again at the end of the study, 4 1/2 years after it began. Roughly half of the participants worked primarily outdoors, while about four in 10 were regular smokers. The daily sunscreen group showed no detectable increase in skin aging during the course of the study, according to microtopography measures. The visual appearance of aging skin wrinkles from beginning to the end of the study was 24% less in the daily sunscreen group than in the discretionary sunscreen group.

Each group was divided in half again to receive a 30mg beta-carotene supplement or a placebo on a daily basis. The supplement did not affect skin aging in this study. The take home message is that daily sunscreen application can prevent skin cancer, keep you younger looking longer and you are never too young to start applying it. Furthermore, daily sunscreen application does more for you than taking some daily supplements that are believed to be good for your skin.

Suntanning, Tanning, Sunscreens
The Dangers of Sun Exposure
Dr. Aaron Stone - Plastic Surgeon Los Angeles
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Brachioplasty - Upper Arm Lift

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Upper arm fat and skin removal to reduce hanging upper arm skin in obese women was first described in 1930. Cosmetic brachioplasty or upper arm lifts were first described by Argentinian surgeons in 1954 and subsequently became a well established procedure. However, due to the scarring, fluid collections under the skin, nerve damage and wound problems associated with the surgery it was not very popular. According to the American Society of Plastic Surgeons statistics as recently as the year 2000 more than 300 women got upper arm lift procedures in the US. Last year, 2012, the number increased to more than 15,000. 98% of these patients were women, 42% had undergone previous weight loss surgery, 63% were aged 40 to 54 and 33% were over age 55. The total spent on brachioplasties in 2012 was $61 million. What accounts for this 5 fold increase in the number of procedures over 12 years? Some of this is due to the increase in weight loss surgery. Over 200,000 Americans a year undergo some kind of weight-loss surgery, such as gastric bypass.

Malar Bags

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There are 3 separate entities lower eyelid bags, festoons and malar bags.

Lower eyelid bags refers to protruding fat or redundant muscle in the lower eyelid itself above the level of the bone rim under the eye.
Lower Eyelid Bags
Festoons refers to redundant folds of skin with or without muscle in the lower eyelid.

Festoons

Breast Reconstruction with Aeroform Tissue Expander

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It seems like all the latest breast reconstruction techniques like Neopec come from Australia. Now the Australians have come up with a rapid way to expand chest skin after breast cancer mastectomy to allow placement of a breast implant and thereby reconstruct the breast (see my blog Reconstruction After Breast Cancer Surgery). Usually a saline balloon or expander is surgically placed and the surgeon then progressively fills it with salt water that is injected on a weekly basis to stretch the skin. This can take up to 6 months. Now they have devised an expander that contains a cylinder of compressed carbon dioxide gas. The patient controls the release of the gas into the expander with a handheld remote control and slowly expands on a daily basis.

Preliminary data reveal that using the Aeroform Tissue Expander the expansion can be completed in 17 days instead of 6 months. Enrollment in FDA clinical trials have begun in the US and the manufacturer is predicting a 2014 FDA clearance for general use.


Aaron Stone MD - Plastic Surgeon Los Angeles
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Weight Loss After Tummy Tuck - Abdominoplasty

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Obesity is defined as a body mass index (BMI) of 30kg/m2 or greater. By this definition a third of men and a third of women in the US are obese. The prevalence of obesity in this country has doubled since 1980. This is a a major health concern because obestiy increases the risk of many diseases and health conditions, including but not limited to sleep apnea, diabetes mellitus, hypertension, osteoarthritis, dyslipidemia, certain types of cancers, gallbladder disease, stroke, and coronary heart disease. The associated health costs are quite high and have been estimated to be in the range of $75 billion per year. With more severity obesity of body mass indexes of 40kg/m2 or more the condition is considered morbid and weight loss surgery is usually recommended if dieting fails. Weight loss surgery has been proven to reduce the incidence and severity of medical conditions associated with morbid obesity.  The American National Institute of Health guidelines state that bariatric weight loss surgery should be offered to patients with a BMI of 35–40 kg/m² who have obesity related conditions such as diabetes mellitus or obstructive sleep apnea, or in those with a BMI of 40 kg/m² or greater regardless of weight related co-morbidity conditions.


A medical journal article just published revealed on retrospective review that patients maintained weight losses greater than the amount of tissue removed at abdominoplasty/tummy tuck more than a year after the surgery. This amount of maintained weight loss was greater in people who were heavier prior to surgery (24.5kg/m2 or more) and was proportional to the amount of tissue removed at surgery for 4.5 or more pounds of tissue removal. When asked why the weight was lost and the loss maintained these patients responded that they felt full after and between meals so they ate less. In my experience patients lose additional weight because they like and want to maintain their results. That involves lifestyle changes including exercise and eating a healthier diet. Abdominoplasty however should not be performed primarily to lose weight because the complication rates are quite high for patients with BMI over 40kg/m2 and the results are less than optimal with BMI of 35 to 40kg/m2. Nearly every patient I have ever seen who underwent abdominoplasty when morbidly obese (by surgeons other than myself) had complications including disruption of suture lines requiring months to heal. The best results and fewest complications are seen in patients who have stable weights, are not morbidly obese and have good quality skin without stretchmarks.

A Swiss study published in Oct 2012 showed that patients who have abdominoplasty to remove excess skin resulting from weight loss surgery are more likely to keep the weight off after the procedures. These patients regain about a pound a year vs. a 4 pound annual gain for patients who have weight loss surgery without body contouring surgery to remove excess skin. The contouring surgery produces a second wave of elation that helps patients stay on track to lose more weight. The timing is usually 12 to 18 months after the weight loss surgery as the complication rate at that time becomes the same as for those who have never had weight loss surgery.

There is clearly a benefit to abdominoplasty or tummy tuck that goes beyond the initial look achieved by removing excess skin and tightening abdominal muscles. The procedure has a long lasting effect which is different from a facelift whose affect diminishes with time due to the unstoppable aging process.

The obvious weight loss in this patient after abdominoplasty surgery should be maintained.

Abdominoplasty
 Aaron Stone MD - Plastic Surgeon Los Angeles
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Brazilian Butt Lift - Buttock Augmentation Implants and Injections

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Fertility dolls with large hips and buttocks have been found dating back to the pre-dynastic Egyptians of 4000 B.C.

Doll statues and carvings were often placed near a couples bed or on the family altar with suitable offerings that would ask the fertility goddess to work in their favour.

With colonization of Africa in the 1800s women's clothing styles in Europe aimed to accentuate a thin waist with large hips and buttocks. At first this was accomplished by layering clothes on top of each other (petticoats). These could become quite heavy so caged or hooped underskirt frames (crinolines) followed by bustles and then corsets were introduced.

When Looks Can Kill; Toxic Cosmetics to Avoid

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This is a guest post by Valerie Johnston is a health and fitness writer located in East Texas.

Can your makeup kill you? 
At the very least it can make you very sick, according to recent FDA investigations that have discovered toxic levels of mercury and other heavy metals in a number of imported skin creams and makeup products.

The good news is that so far no mercury has been found in American made skin creams; most of the products are those that would only be purchased in some sort of import store or ethnic market. Frustrated with lackluster results from domestic products, consumers often turn to exotic imports hoping to achieve a better outcome.

Creams found to be contaminated are primarily skin bleaching and anti-aging products, including Diana skin lightening formula, Stillman's skin bleach cream and a number of other products labeled in Hindi, Chinese and other foreign languages. If you've been using an imported skin lightening cream, particularly from India, China or Mexico, check the label for mercury, sometimes listed as mercurous chloride, mercuric, mercurio or calomel.

If the product doesn't list ingredients, definitely do not use it! Mercury is highly toxic and even the smallest amounts can cause serious kidney damage among other dangerous effects. Symptoms of mercury poisoning include memory loss, tremors, irritability and hearing or vision problems. Creams containing mercury have turned up in at least seven states and a number of cases of mercury poisoning have been reported.

Facial Feminization Surgery - Forehead and Jaw Contouring Reshaping

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Historically differentiation between male and female skulls was performed by anthropologists and medical examiners by analyzing nose, chin and forehead bone shapes in cadavers. Today it is common knowledge that faces contain secondary sex characteristics that develop during puberty and make male faces easily distinguishable from female faces. The female chin is more rounded or pointed than the square male chin and their less prominent noses have less angular tips . The male forehead has a prominence of bone, a horizontal ridge of bone, running across the forehead just above the eyebrows (bossing), followed by a concave area and then slopes upward and backward. The female forehead lacks bossing and the concave area above it and rises vertically rather than sloping upward and backward.

Additionally as is evident in these photos the angle of the lower jaw in front of and below the ears is more prominent in males

How Long Does A Facelift Last?

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This a question most patients have going into facelift surgery and my usual answer was 5 to 10 years depending on genetics, age at surgery (it lasts longer in younger patients), exposure to extreme climates and active or passive smoking. Now a long study out of the UK shows that more than five years after facelift surgery, three-fourths of patients still look younger than they did before surgery. The researchers looked at photographs of 50 patients who had undergone facelift surgery an average of 5½ years previously. Surgical changes in the lines around the nose and mouth had the greatest longevity while the angle of chin to neck (the neck outline) changes deteriorated the most during this time frame. This is probably why neck revisions after facelift surgery are more common than revisions above the jaw line. The study does not tell us how long all of the changes last only that they last to some degree for more than 5 years.

One of my male facelift patients in his 60s did not require anything but a laser resurfacing a few years after facelift surgery and sculptra dermal filler injections 8 years after facelift surgery to maintain his results.

Facelift
Male Facelift
Face and Neck Lift1
Face and Neck Lift2
Mini Facelift-Lifestyle Lift-Quick Lift
Aaron Stone MD - Plastic Surgeon Los Angeles
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