The Dangers of Sun Exposure

Please tweet and retweet Tweet

In today's world the dangers of sun exposure as they relate to skin cancers and aging of the skin are common knowledge. The aging side of the issue was further supported by a case study published in the April edition of the New England Journal of Medicine. A patient seen at Northwestern Medical Center in Chicago was 66 years old on the right side of his face and 86 years old on the left side.

Nerve Freezing Alternative to Botox

Please tweet and retweet Tweet

Botox has been available for decades to treat fine wrinkles on the face but this involves injecting minute amounts of a poison to temporarily paralyze the nerves. An estimated six million doses of botox are now given every year so it is now the single most popular cosmetic treatment in the United States. Now a revolutionary new concept is being developed to replace botox. It involves freezing the nerve so it is temporarily damaged and therefore paralyzed for an equivalent amount of time as the botox injection.

Controlling Pain After Cosmetic Surgery

Please tweet and retweet Tweet

Pain control during surgery has been quite good for a number of decades. Refinements in recovery from anesthesia to lower the incidence of nausea, shaking etc. after surgery have been accomplished by adjusting the mix of anesthetics used and employing newer medications like propofol, toradol, zofran etc. More recently the focus has been on controlling pain after surgery to lessen the need for narcotics, shorten recovery times after surgery and improve surgical results in general. The opioid narcotic medications commonly used can become addictive, have small windows between effective and overdosing quantities that affect breathing and tend to be constipating.

Liposuction Can Result in More Fat Around Internal Organs

Please tweet and retweet Tweet

Plastic Surgeon researchers at the University of Sao Paulo in Brazil followed 36 normal-weight women who had liposuction to take away a small amount of superficial tummy fat. Beginning 2 months after surgery half of these women were placed on an exercise program (walking on a treadmill and doing light strength training 3 times a week), while the rest stuck with their usual lifestyle. None exercised regularly before surgery.

Four months later the women who did not exercise still had flatter tummies, but they had 10% more fat around the organs inside the abdomen. The women who did exercise had no such gain in this visceral fat. This the the first study showing increases in visceral fat after liposuction if you do not exercise.

Botox, Xeomin and Corporate Espionage

Please tweet and retweet Tweet

On Friday, March 9, US District Judge Andrew Guilford entered an injunction against Merz Pharmaceuticals in his Santa Ana, California court chambers. This prohibits Merz from selling filler products or Xeomin or soliciting the purchase of filler products or Xeomin in the facial aesthetic market for 10 months from the date of the order, except in limited circumstances. Merz has to also do a number of other things and report on these to the court in 6 month intervals for the next year in a half. This took place about a week before Merz was supposed to introduce Xeomin, a new direct competitor to Botox, at a major medical meeting in the US.

Treatment of Aging Hands

Please tweet and retweet Tweet

As you get older your hands lose fat and muscle volume. The skin develops brown spots (liver spots also know as sun spots), becomes more translucent and shriveled, thins and loses its elasticity. The skin doesn’t bounce back when you pinch it. The underlying veins, tendons and bones then become more visible.

Although we have botox, injectable fillers and facelifts to make our faces look younger as we age the hands frequently look much older than our treated faces. Joan Rivers, no stranger to plastic surgery, suggested to The Huffington Post after Madonna’s recent Super Bowl performance that she favored fingerless gloves because “she’s trying to hide those wrinkly old hands.” Madonna now usually makes public appearances wearing gloves.

Documentary of Plastic Surgeon Volunteer Treatment of Acid Burn Victims Wins Academy Award

Please tweet and retweet Tweet

Sharmeen Obaid-Chinoy was born in Karachi Pakistan, emigrated to Toronto, Canada and this passed weekend won an academy award here in Los Angeles for her short documentary film Saving Face. The film documents the plight of Pakistani women who are disfigured by having acid poured on them usually by relatives, husbands or rejected suitors. The acid damages the skin, sometimes exposes the underlying bones and often times causes blindness in one or both eyes. The film chronicles the efforts of a Pakistani born British plastic surgeon, Mohammad Jawad,  to reconstruct their faces and restore their dignity. It is the first win for a Pakistani film. A win that instills pride and shame at the same time. Over 100 such attacks occur in Pakistan each year. Most go unreported and the women live secluded lives due to the circumstances surrounding these attacks (in the case of husband attackers they do so out of fear for their children) so the number of victims could even be double that. In the course of the film a girl describes being burned at age 13 for rejecting the advances of her teacher. In the Western world that teacher would have been prosecuted. Although it is rare a female Pakistani lawyer took up the legal case of one of the victims in the film and successfully managed to have the perpetrator convicted. Sadly these women require multiple operations to regain some resemblance of normal appearance. There is a report of a New Delhi India girl who underwent 25 reconstructive operations to treat disfiguring from acid burns.

Woman's Body Swallows Breast Implant

Please tweet and retweet Tweet

A report from Johns Hopkins University in the December 2011 New England Journal of Medicine describes the swallowing of a breast implant into a woman's chest cavity. The patient had reconstruction of both breasts after mastectomy for breast cancer. She subsequently had minimally invasive heart surgery via the right mastectomy scar. Some time later while partaking in a Pilates class the right implant was swallowed by her body during a stretching exercise. The intact implant squeezed through a small hole between her ribs left from the heart surgery and ended up on top of her right diaphragm. It must have been scary to look down and see the implant disappear into her chest.

The implant was retrieved, the hole in the chest was closed with a mesh patch and the implant was put back in its original position. Now I assume she is back doing Pilates. This is one thing you don't see everyday.

Aaron Stone MD - Plastic Surgeon Los Angeles
Aaron Stone MD - twitter

Home Laser and Cosmetic Devices

Please tweet and retweet Tweet

A Google search on "home laser" yielded 154,000,000 website links overseas and 48,000,000 when searched in the US. Most of the initial listings are for hair removal devices but there are also ones for treating acne and for facial rejuvenation and others treat skin conditions like psoriasis, vitiligo and dermatitis. Many of these home laser and light or ultrasonic devices can be purchased on the Internet. Sellers tout the benefits of these products in treating acne, age spots, large pores, wrinkles, sagging skin, puffy eyes, rosacea, cold sores, and many other skin conditions. However, few of the devices have been studied or approved by the Food and Drug Administration. Some of them sound sort of scary and could be a waste of money or at worst harmful. Sales of home cosmetic devices totaled $500 million last year, and are expected to nearly double to $950 million in 2015. Women have been removing hair from their legs for quite some time. Now it is a multibillion dollar per year industry.

Slap Your Way to Larger Breasts

Please tweet and retweet Tweet

35 year old Bangkok, Thailand beautician Khemmika Na Songkhla also known as Khunying Tobnom claims to be able to enlarge your breasts without surgery—by slapping them. Her grandmother mocked her for wasting time rubbing her nipples with a miracle cream when she was in her early teens in hopes of sprouting big breasts. Her grandmother then advised her to rub them till they hurt and repeatedly push fat from her sides and abdomen towards her chest, and then douse the breasts with ice water. She claims that by following her grandmother's advice she boosted her breast size by 4inches and her confidence soared. Ms Khemmikka says that by using this non-surgical technique (squeezing, pinching and slapping fat and muscle on the upper chest, the sides of the torso, and the belly of clients with cream or gel for an hour over six 10-minute sessions for a total cost of $380) she has enlarged the breasts up to 4 inches in thousands of Thai women over the past 14 years without injections, chemicals or implants. After the treatment Khemmika instructs her customers in special exercise techniques and massage to keep their breasts in shape.

PIP Silicone Breast Implant Recall

Please tweet and retweet Tweet

The French company Poly Implant Prothese, or PIP manufactured breast implants and supplied a large portion of the European breast implant market. The company was based in the south of France and for awhile was the number 3 breast implant producer in the world. 80% of production was exported out of France. While having undisclosed financial problems it began to cut costs by using a cheaper industrial grade silicone in the implants rather than medical grade silicone. This cut manufacturing costs by up to euro 1 million ($1.3 million) a year. A lawyer for the company told authorities that the switch to cheaper silicone began in 1991, shortly after the company began production. These implants were also marketed under the name M-implant by the company Rofil Medical in the Netherlands and distributed in Germany by the company Rofil Medro. Affected Rofil implants are designated as IMGHC-TX, MX-IMGHC, and IMGHC-LS.

Dynamic vs. Static Wrinkles

Please tweet and retweet Tweet

This is a guest post by Stacie Morris, a writer for Botox Ottawa. Stacie’s primary concern? Wrinkles, of course! Her favourite treatment is a customized skincare regimen at home (which includes peptide-rich products) and Botox.

Did you know that there are two types of wrinkles on your face? You’ve got dynamic and static wrinkles.

Dynamic Wrinkles
Remember when you were younger, and your facial skin was pretty much smooth all over when you weren’t expressing any emotion at all? When your face was neutral, your skin had no trace of crease or line. But as soon as your facial muscles contracted to allow the conveying of an expression, like smiling and frowning, a wrinkle appeared. When your facial muscles contract, the skin overlying them stretches and creases to accommodate their movement.

Asthma - Reversible Lung Disease and Cosmetic Surgery

Please tweet and retweet Tweet

Obstruction to airflow in the lungs can be due to

1. fixed or irreversible lung disease (COPD)
2. reversible (responsive to medications) obstruction due to heart failure
3. reversible (responsive to medications) obstruction due to asthma

The obstruction can be due to just one of the factors or any combination of 2 or more factors.

In asthma the walls of the breathing tubes into the lungs swell (become inflamed), muscles surrounding the tubes contract squeezing the tubes and then increased mucus secretions inside those tubes plugs them. This results in obstruction to airflow with audible wheezing and a tight feeling in the chest as the individual tries to get the air through narrowed plugged tubes. Attacks can be mild resolving quickly with medication or severe and life threatening.

Tips for Bikini Line Laser Hair Removal

Please tweet and retweet Tweet

This is a guest post by Sachin from the Cosmos Clinic in Sydney Australia

Laser hair removal is a great way to get rid of hair on the bikini line, so follow these tips for the best results!

Are you tired of shaving your bikini line and seeing those red bumps and black spots? Does the idea of waxing down there seem way too painful to be worth it? Then you might want to look into Candela laser hair removal for your bikini line. Here are some general tips to choose a clinic, prepare for the removal and maintain the results.

Laser and Intense Pulsed Light (IPL) Safety

Please tweet and retweet Tweet

Different wavelengths of light penetrate to different depths below the skin surface and are absorbed by different skin or tissue components. For example CO2 and Erbium laser light is absorbed by the water in cells exposed to it. Flahslamp laser light is absorbed by red blood cells. Nd:Yag laser light is absorbed by skin pigment cell melanin and tattoo pigment. Since the eyes contain water, pigment cells, red blood cells etc they can be damaged if exposed to most laser lights either directly or indirectly (from reflected laser light). Even the laser pointers used by lecturers can damage the eye if pointed directly into the eye. Some lasers such as the CO2 have a beam whose wavelength is not visible by the human eye but they can still cause damage to the eye. The CO2 and Erbium will damage the cornea and surface of the eyeball first. Flashlamp and vascular lasers are absorbed by red blood cells and are the most damaging to the eye as they are absorbed by and damage the retina.

What is Botox?

Please tweet and retweet Tweet

This is a guest post by Sachin from the Cosmos Clinic in Sydney Australia

Botox here, botox there… it seems that all we hear about these days in the cosmetic surgery industry is botox. Hollywood stars use it, New York socialites swear by it… but what is it? If you’re like me, you don’t want to put something in your body if you don’t know what it’s made of. So I did a little research on botox and I want to share my findings with you.

Topical Botox Gel

Please tweet and retweet Tweet

A new topical gel botulinum toxin (Botox) is currently being studied. This will allow patients to apply the medication topically to erase crow's feet, frown lines and forehead wrinkles without the need for needle injections of Botox. 90% of patients in a phase 2 clinical trial treated with the experimental gel had visible reduction of moderate to sever crow's feet wrinkles compared to 28% of similar patients randomly assigned to a placebo group.

Effects of the gel last for about four months which is comparable to the effective duration of Botox injections.

Phase 3 studies are in the works to compare the gel to injected Botox.

It is not yet known when this will be available for public consumption but I think you will see this as an active ingredient available in cosmetic counter cosmeceuticals in the very near future.

Aaron Stone MD - Plastic Surgeon Los Angeles
Aaron Stone MD - twitter

Massive weight loss and breast reduction surgery

Please tweet and retweet Tweet

Obesity is another term for being overweight. It is medically defined as a weight to body surface ratio (BMI) of 30kg/m2 or more. Morbid obesity is defined as being 100 pounds or more above one's ideal body weight which in turn is defined relative to one's height. This correlates to a BMI of 35 to 45. Higher BMIs are referred to as super obesity. The incidence of obesity in general has been steadily increasing in North America, Australia, Europe, the Middle East and South America (i.e. worldwide) over the last few decades leading to a rise in weight loss surgery procedures performed and profitability of weight loss groups like Weight Watchers, Jenny Craig etc.

Some surgical and non-surgical techniques to treat cellulite.

Please tweet and retweet Tweet

This is a guest post by Sachin from the Cosmos Clinic in Sydney Australia.

Don’t believe the hype—there is no final cellulite treatment. Nothing but a genetic makeover could get rid of cellulite. Actually, 80 to 90% of women have cellulite at one point in their life, so you’re definitely not alone. But that also gives pharmaceutical companies and cosmetic surgery clinics an enormous clientele pool to help or abuse… depending on what treatment you choose.

While cellulite can’t be completely removed, there are ways to help reduce is appearance and even temporarily drain it away. Here are some of them.

Bleeding Disorders, Hemophilia, Antithrombin III Deficiency, Aspirin, Abnormal Platelet Count, Anticoagulation, Blood Clots and Cosmetic Surgery

Please tweet and retweet Tweet

Blood clot formation is a complex process involving first the accumulation of cells in the blood called platelets to form a plug and then a number of proteins/enzymes also called clotting factors that act upon one another in a specific sequence one after the other like dominoes dropping called a cascade to form a mesh that reinforces the platelet plug. The end result of which we see and call a clot. The platelets are the white circles in the video below. The cascade allows immense production of clot in a shorter period of time from a small amount of initiating stimulus so it has been programmed into our systems through evolution i.e.the organism that can stop bleeding the quickest after injury has the best chance of surviving. Along the way there are built in inhibitory enzymes at different parts of the cascade so that the cascade does not get out of control and turn your bloodstream into a solid clot.

Sickle Cell Disease and Cosmetic Surgery

Please tweet and retweet Tweet

Hemoglobin is the protein in red blood cells that carries oxygen. It is encoded by 2 genes in one's DNA, 1 gene from each parent. Either or both of these genes can have a sickle cell trait so that the hemoglobin produced by either or both as the case may be is abnormal. If only one gene is abnormal the individual is said to have sickle trait. If both are involved the individual has sickle cell disease. The sickle gene is most commonly found in those of sub-Saharan African descent. It is thought that that is because the sickle trait confers resistance to the malaria that is present there. 0.5% of the Afro-American population has both genes and 8% have the trait. Under low oxygen levels the sickle hemoglobin changes shape and makes the red blood cell it is in turn into a sickle shape. Conditions that make the abnormal cells sickle include lowered body temperature, infections, acidic metabolic conditions, dehydration and as mentioned lowered blood oxygen levels. The sickle shaped blood cells have a shorter life span and tend to get caught in the smaller blood vessels of the body. The manifestation of this depends on the percentage of total body red blood cells/hemoglobin that is abnormal. Those with only the trait (one gene) have an easier time. When the percentage is high it is associated with anemia, stunted growth, sores on the legs, heart problems, shortened life span, organ failure etc.

The effect on cosmetic surgery and the measures needed to ensure safe surgery depend on the percentage. At low percentages you do not need to do anything different from other patients. At higher percentages the patient may need pre-surgery treatment with one or more of the following supplemental oxygen, blood transfusion, over-hydration, folic acid supplementation, vaccinations etc. In some cases the abnormal cells are trapped in the spleen so the peripheral blood tests may only show anemia with immature red blood cells as the bone marrow compensates by ramping up production of red blood cells. The absence of visible peripheral sickle cells in such cases does not mean the patient is a lower risk for surgery. None of these patients should undergo prolonged operations and if necessary surgery should be staged. If the percentage is very high the patient should probably not be having elective cosmetic surgery. If you are prone to sickle cell crises or have sickle cell related skin sores you should not have any cosmetic surgery. Your surgeon needs to work together with a hematologist in order to ensure a smooth recovery after surgery.

Aaron Stone MD - Plastic Surgeon Los Angeles
Aaron Stone MD - twitter

Mommy Makeover Abdominoplasty with Pelvic Sling for Urinary Incontinence

Please tweet and retweet Tweet

Urinary incontinence (leaking of urine) can be problematic and embarrassing for women past their childbearing years. Pregnancy and/or the aging process weakens or damages nerves, muscles and/or their supporting structures in the pelvic area. This results in incontinence (inability to hold back urination). There are different types such as stress incontinence, urgency incontinence etc. After trials of non-surgical treatments such as injection of bulking agents around the urethra (tube extending down from the bladder that urine flows through) have failed sling or bladder neck suspension surgical procedures may be needed to treat stress incontinence.

Plastic Surgery and Mesothelioma Align

Please tweet and retweet Tweet

This is a guest post by Jackie Clark assistant to Heather Von St James, a cancer survivor.

When someone mentions plastic surgery, we tend to think of face-lifts and breast implants, but plastic surgeons are able too much more. What would burn and accident victims do if there were no plastic surgeons to repair their faces and bodies? What kind of life would a deformed infant have if there were no plastic surgeons to correct nature's mistakes? There are millions of people in the United States alone, not to mention the rest of the world, who feel they were not given the body or face they deserve. Being unhappy with one's looks can cause many problems like depression, low self-esteem and even suicidal tendencies. There are forms of cancer like mesothelioma, breast cancer and skin cancer that can kill if not treated by surgery.

Online Physician Rating and Ranking Services are Biased and Unreliable

Please tweet and retweet Tweet

A study of online physician review, rating and ranking services such as Angie’s List, healthgrades.com, RateMds.com, Vitals.com, and Yelp.com by professors of the University of Maryland’s Robert H. Smith School of Business and the School of Public Health at the University of Minnesota found that they are biased and unreliable. This is particularly worrisome as physician ratings are gaining popularity among patients and an increasing number of patients consult these rankings before making an appointment to see a prospective surgeon. According to a 2010 Pew Internet and Life Project survey,  59% of U.S. adults have looked online for health information.

Diabetes and Cosmetic Surgery

Please tweet and retweet Tweet

Diabetes in all its forms (diet controlled, medication controlled and insulin controlled) impacts all surgery patients.  Since diabetics are more prone to coronary artery disease and blood chemistry alterations they require more extensive lab work including electrocardiograms before surgery and should be medically cleared for surgery by their internist. After surgery their healing time is prolonged, fluid balance is altered and they are more prone to infection. Therefore care after surgery including insulin doses should be performed under the guidance of the physician who medically cleared the patient for surgery accounting for the type of surgery performed and the patient's condition.

The difference between panniculectomy and abdominoplasty - tummy tuck

Please tweet and retweet Tweet

Abdominoplasty or tummy tuck is a cosmetic procedure that involves placement of horizontal lower abdominal and around the belly button incisions. The abdominal skin is then tightened by separating the skin and fat layer from the muscle layer, pulling down the upper edge of the incision and creating a new hole for the belly button higher up on the skin that has now been stretched downward. In most cases suture tightening of the abdominal muscles is also performed. In some cases additional tightening for very loose muscle is achieved by placing additional vertical and/or horizontal rows of sutures. The result is frequently improved by liposuction peformed at the same operation. It is not a medically necessary procedure and therefore not covered by health insurance unless the excess skin and/or fat is required to close an open wound or reconstruct a breast after breast cancer surgery rather than being removed for cosmetic reasons.

Breast Implants and Bodybuilding

Please tweet and retweet Tweet

Female body builders in general have little body fat and the process can also melt away breast tissue. Refilling the breast skin envelope is then challenging in this situation because there is so too little fat or breast tissue to cover the edges of a breast implant placed on top of the muscle. So saline implants above the muscle are out of the question. Implants placed under the muscle are even more problematic because the pressures or forces applied to them during weight lifting can rupture the implant or more commonly shift them out of position. I saw one patient who while bench pressing squeezed her implant out of position so it formed an unsightly U-shape around the lower border of the pectoralis major chest muscle.

The only answer although not optimal is a cohesive gel breast implant placed on top of the chest muscle and in selective cases the addition of acellular dermal matrix to ensure the edges of the implant and rippling are not visible, although that is costly and is not be the right choice for all such patients.

Breast Implants Augmentation and a Natural Look
Aaron Stone MD - Plastic Surgeon Los Angeles
Aaron Stone MD - twitter