Sickle Cell Disease and Cosmetic Surgery

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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
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Mommy Makeover Abdominoplasty with Pelvic Sling for Urinary Incontinence

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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

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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

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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

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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

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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

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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
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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 - Plastic Surgeon Los Angeles
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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.

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 - Plastic Surgeon Los Angeles
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