Sunday, April 10, 2011

Bite a breast implant and die

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An Israeli model Orit Fox, 28, was doing a photo shoot for Spanish television network Telecino in Tel Aviv that required her to embrace a snake. Shortly after starting the shoot she licked the snake's head with her tongue. It then recoiled and bit her left breast containing a silicone breast implant. An assistant then rushed in to remove the snake from her breast. The model was taken to a nearby hospital where she received a tetanus shot. The snake died from silicone poisoning. No autopsy is planned for the snake and apparently no charges will be filed. Snake bites are a more common occupational hazard of modeling than I had previously thought.

Aaron Stone MD - twitter
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Tuesday, March 29, 2011

Awake Cosmetic Surgery - Surgery Without Anesthesia

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The new and aggressively marketed Awake cosmetic surgery is performed under local anesthesia only without even an IV. Some doctors will add a mix or cocktail of oral medications such as valium. These procedures are heavily advertised as a cheaper, safer and more medically advanced alternatives to liposuction, abdominoplasty and breast enhancement surgery, especially liposuction. Awake surgery ads promise that patients remain lucid throughout the operation able to interact with their doctor and even voice opinions about such things as breast implant size at prices less than half of conventional surgery with general anesthesia. They may even propose surgery a doctor’s cozy office, not in an intimidating outpatient surgical center or hospital, which is dangerous distortion of the facts.

Friday, March 25, 2011

Mixed Martial Arts MMA and Plastic Surgery

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When most people think about plastic surgery and mixed martial arts (MMA), boxing etc they think of broken noses, facial bone fractures, cauliflower ears, skin abrasions and cuts. In unarmed fighting the skin is torn open when an outside blunt force pushes that skin against the edge of a bone. You see this frequently in boxing matches with skin around the eye socket being torn open. In boxing they put pressure on the tear while the boxer is in the corner to stop the bleeding. Some fighters have a facial bone structure with less edges or flatter surface contour. These fighters are less susceptible to having tears in the skin when struck. For both boxers and MMA fighters these tears are usually sutured by non-plastic surgeons who just suture the outer layer of the skin. After these heal there is a thinner layer of tissue between the skin surface and the edge of the bone. This condition leaves the fighter more susceptible to another tear in the skin when it is struck. The blow could even be an otherwise inconsequential one.

Some of these fighters are now undergoing surgery to rasp or burr down these bone edges. At the same time the deeper layers that separated at the time of the initial injury are repaired and/or the surgeon inserts an acellular dermal matrix (commercially available human skin collagen without skin cells) to increase the tissue between the skin surface and the bone. This so to speak softens the blow.

The question remains whether athletic commissions will allow this or will they consider this performance enhancement comparable to anabolic steroids and ban it.

Aaron Stone MD - twitter
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Tuesday, March 22, 2011

Cosmetic Surgery for Men Increased in 2010

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Statistics released this week by the American Society of Plastic Surgeons revealed increases in male patients undergoing plastic surgery in 2010.

The noted percentage increases for surgical (denoted by *) and non-surgical procedures were:
1) Facelift* – 14% Increase
2) Ear Surgery* (Otoplasty) – 11% Increase
3) Soft Tissue Fillers – 10% Increase
4) Botulinum Toxin Type A – 9% Increase
5) Liposuction* – 7% Increase
6) Breast Reduction in Men* – 6% Increase

2010 Top Five Male Cosmetic Surgical Procedures were:

1) Nose Reshaping (64,000)
2) Eyelid Surgery (31,000)
3) Liposuction (24,000)
4) Breast Reduction in Men (18,000)
5) Hair Transplantation (13,000)

2010 Top Five Male Cosmetic Minimally-Invasive Procedures were:

1) Botulinum Toxin Type A (337,000)
2) Laser Hair Removal (165,000)
3) Microdermabrasion (158,000)
4) Chemical Peel (90,000)
5) Soft Tissue Fillers (78,000)

Aaron Stone MD - twitter
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Wednesday, March 2, 2011

Medical Tourism - Going Abroad for Discount Plastic Surgery

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Medical tourism refers to patients traveling far from home for plastic surgery, usually to another country, for discounted services or perceived care that cannot be obtained at home. A 2008 survey by the consulting firm Deloitte, estimated that 750,000 Americans traveled abroad for medical care in 2007 and projected that the number would rise to 1.6 million annually by 2012. There is nothing inherently wrong with doing this. I as well as many of my colleagues here in Los Angeles receive patients from many parts of the world such as China, the middle east, Europe, Latin America etc. Although you can find good doctors and appropriate care all over the world as a prospective patient you have to do your due diligence before committing yourself to plastic surgery anywhere be it India, Thailand or even the United States. Surgeon and facility qualifications outside your home country may not be verifiable. Vacation destinations may not have formal medical accreditation boards to certify physicians or medical facilities. The criteria you use to search for a surgeon should not change just because he/she is in a different country. (see my web page how to choose a plastic surgeon) Above all else do not let the price tag blind you to the quality of care. Devices and products used may not meet U.S. standards. Cosmetic surgery products or devices used in other countries may not have been tested, proven safe and effective, or been approved by the U.S. Food and Drug Administration (FDA). For example, an implant used in the United States must meet standards of safety and effectiveness, a process regulated by the FDA. Other countries may not have similar regulations.

I recently saw a patient who had breast implants placed in Mexico. Although the implant manufacturer made implants that were FDA approved for use in the USA her specific implants were not. They were only legal in Mexico. Breasts implants at a quarter of the price in your home country may sound to good to pass up but if you do not do your due diligence in researching the care it could end up costing you a lot more than surgery at home. It can even cost you your life.

Sunday, February 6, 2011

Breast Implants and Lymphoma Cancer

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Patients with either saline- or silicone gel–filled breast implants may have a very small but significant risk for a rare cancer called anaplastic large-cell lymphoma (ALCL), a cancer of the immune system, adjacent to the implant. This is currently under investigation and its existence should be considered if there is a build up or collection around the implant (seroma) years after the original surgery. Because the risk is very small the current policy is one of data collection only and no changes have been recommended for the use of breast implants or the frequency of follow up after breast implant surgery. The FDA continues to state that breast implants are "safe and effective when used as labeled."

Friday, January 28, 2011

Skin Necrosis with Dermal Fillers

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The skin necrosis after dermal filler injection is due to direct injection into an artery or compression of an artery by the filler preventing blood flow. This is the only reference I could find "The most serious side effect is localized tissue necrosis, which is induced by mechanical interruption of local vascularity, though it occurs very rarely (nine in 10,000 patients who underwent collagen implantation)". This was a review of collagen fillers done some years ago. When injected with proper technique the incidence should be zero. Certain areas like the area between the eyebrows are at higher risk because of the architectural layout of the blood vessels under the skin. The incidence of heart attack from injection of a skin filler should be close to zero.

The most import thing besides proper injection technique is that if you experience inappropriate pain after filler injection and/or see significant skin discoloration beyond a little bruising your doctor needs to go into emergency mode. That could involve application of nitropaste to the skin surface, application of warmth, injection of a filler dissovling agent, hyperbaric oxygen etc. All of these modalities will minimize the amount of skin necrosis.

With appropriate care and some luck the skin necrosis will be very superficial and heal without visible scarring as in these photos.

Addendum December 13, 2012:
A recent survey of British Association of Aesthetic Plastic Surgeons members found that 69 percent of surgeons reported seeing patients with complications from temporary fillers in the previous 12 months. 49 percent reported seeing patients with complications due to semi- or permanent fillers. More than half of the surgeons saw 1 to 3 patients with these problems in the previous 12 months. Some saw 4 to 6 patients with these complications. The majority of patients seen with semi- or permanent filler complications required corrective surgery or had an irreversible complication. These same surgeons felt the complications were due to incorrect administration by unqualified practitioners.

 Addendum May 28, 2015:
After reviewing information suggesting unintentional injection of soft tissue fillers into blood vessels in the face can result in rare, but serious side effects the FDA issued an alert to health care providers and consumers that unintentional injection into blood vessels can block those blood vessels and restrict blood supply to tissues. Sometimes this can result in embolization where the filler material has traveled to other parts of the body causing vision impairment, blindness, stroke and damage and/or death of the skin (necrosis) and underlying facial structures. 
Their recommendations for consumers were:
  • Before deciding to have soft tissue filler injections, talk with your health care provider about appropriate treatment of injection sites and the risks associated with the procedure.
  • Be aware that FDA reviewed and approved different products for use in certain areas of the face. The FDA may not have reviewed the use of certain soft tissue fillers for all locations in the body.
  • Ask your health care provider about their training and experience injecting soft tissue fillers in the face.
  • Read and discuss the patient labeling for the specific filler you are receiving. Your doctor can provide this information, or you can find it on the FDA’s website.
  • Seek immediate medical attention if you develop symptoms such as unusual pain, vision changes, a white appearance of skin near the injection site, or any signs of a stroke (including sudden difficulty speaking, numbness or weakness in your face, arms, or legs, difficulty walking, face drooping, severe headache, dizziness, or confusion) during or shortly after the procedure.

Radiesse injectable dermal filler for nasolabial folds
Injectable Fillers - Collagen, Restylane et al
Aaron Stone MD - Plastic Surgeon Los Angeles

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Wednesday, January 19, 2011

Skin Bleaching

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In many countries worldwide including the Philippines, India and South America, lightening your entire face or large areas of your body is a common goal to make one's self more competitive in the marriage or job market. A lighter complexion is often seen as a way to climb up the social ladder, make new contacts, find a spouse, get a job etc.

hydroquinone skin bleaching
In late 2009 Dominican-born Chicago Cubs baseball player Sammy Sosa showed up at the Latin Grammies with skin lightened by several shades. Sosa admitted to using creams to lighten his skin as well as getting bleaching treatments.

Tuesday, January 4, 2011

The drooping nasal tip - drooping tip of the nose

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Drooping nasal tip is a term used to describe downward movement of the nasal tip with smiling. More severe forms of this include shortening of the upper lip with the appearance of a horizontal crease and elevation of the outer lower edge of the nostril in the same motion.
drooping nasal tip
Drooping Nasal Tip With Upper Lip Shortening and Horizontal Crease on Smiling

This appearance is created by the actions of the levator labii superioris alaeque nasi and depressor septi nasi muscles.

drooping nasal tip>
Muscles That Cause Drooping Nasal Tip

The treatment is to prevent the actions of the muscles. This is achieved by cutting the depressor septi nasi via an incision in the floor of the nose or the inside of the lip and transecting the outer portion of the tip cartilage with a portion of levator labii superioris alaeque nasi so that it can no longer raise the outer lower edge of the nostril.
drooping nasal tip

The commonly performed trimming of the tip cartilage also helps to rotate the tip upward.

Correction of the Pinched Nasal Tip

Aaron Stone MD - twitter
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