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 - Plastic Surgeon Los Angeles
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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.

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."

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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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.


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.

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 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.

>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.


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

Rhinoplasty
Correction of the Pinched Nasal Tip
Aaron Stone MD - Plastic Surgeon Los Angeles
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Treatment of Vitiligo, Hypopigmentation and Hypopigmented Scars.

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Lighter colored (hypopigmented) areas of skin can be due to skin damage with scarring or for unknown reasons. When the cause is unknown the process is called vitiligo and is presumed to be due to an autoimmune phenomenon or a viral infection. Vitiligo affects 1 to 2% of the people in the world, 2 to 5 million in the US alone. Have of these affected people developed it before the age of 20. Regardless of the cause the common factor between all of them is white patches of skin where the skin pigment cells called melanocytes have been killed. If the line width of the area is in the order of a few millimeters application of a tattoo needle without tattoo pigment or application of an excimer laser has corrected the problem. Tattoos have also been employed but this is impractical when the hypopigmented patches are large. Tattooing a skin color into the white patch has not been reliable as the approximation of any given individuals native skin color is very difficult. Of course cover make up has been around for centuries and can provide adequate camouflage but has to be repeatedly applied.

Botox Resistance or Fatigue

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Botox resistance or fatigue occurs when the injection does not last as long or is ineffective. If the botox is fresh and effective this can be due to circulating antibodies against Botox formed by the body in response to previous injections or changes in the muscle itself over time.

Zytaze (a zinc and phytase prescription medication) given in oral capsule form 2 capsules a day for 4 days (total 10 capsules) prior to Botox injections to patients who responded poorly to Botox injections improved the effect of the Botox injections or how long they last. It is dispensed as 10 per box. This was studied in patients with uncontrolled eyelid twitching (blepharospasm) treated with Botox but should also hold true for Botox administered solely for cosmetic reasons. The mechanism as to why this supplement would be effective or how it works are not known.



Contraindications to botox injections include pregnancy, breast feeding, allergies to components in the botox (human albumin), neuromuscular disorders (myasthenia gravis, Eaton-Lambert syndrome, amyotrophic lateral sclerosis) and use of medications that strengthen the effect of botox (quinine, calcium channel blockers and aminoglycoside antibiotics).

Aaron Stone MD - Plastic Surgeon Los Angeles
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Stem Cell Face Lifts

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Stem cells are cells that can turn into any one of a number of cell types hence the term pluripotential. Some stem cells can only turn into one of a specific cell type (multipotent, oligopotent etc). The majority of cells in an embryo have not fully differentiated or turned into their final cell type be that a skin, liver, heart or muscle cell. The majority of cells in an adult person have turned into their final cell type. Furthermore that final cell type if it is a dividing cell will only produce more of the same cell type. Stem cells can divided into more stem cells or turn into different types of cells such as skin, muscle etc. Much media exposure has been given to the embryonic stem cells, mostly those that would otherwise be discarded at fertility clinics rather than implanted. This blog is about those stem cells found in an adult human. Apparently many of these stem cells are located in the fat layer that covers the body just under the skin layer and they can be harvested by a simple liposuction procedure. Stem cell treatments have been proposed for everything from spinal cord injuries to stroke, alzheimer's, diabetes, parkinson's, arthritis, organ or limb regeneration etc. The can fix anything including the kitchen sink.

New Botox Available in US in September 2010

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A new type of Botox called Xeomin (Merz Pharmaceuticals] will become available in the US in September 2010. The drug was approved by the FDA in August 2010 for treating certain neuromuscular conditions, such as blepharospasm (chronic blinking), cervical dystonia (tight neck muscles that distort the head's position). It is not yet approved for cosmetic purposes to treat dynamic wrinkles between the brows and on the forehead. Such use would be considered off label but Botox was used in such an off label fashion for years before it received FDA approval for cosmetic use.

That means we will now have 3 products available, Botox, Xeomin and Dysport to treat aging wrinkles of the face. More Dysport has to be injected to get the same results as Botox but since the per unit price is cheaper the end cost to achieve a given result is the same for Botox and Dysport. Xeomin is formulated differently in that it does not contain the complex proteins found in the other 2 formulations. It is too early to say if this is a positive or negative attribute. It could lead to migration of the Xeomin away from the injection site with more side effects or it could mean you will not form antibodies or develop resistance to the medication after many injections.

Since the price of Botox did not change after the introduction of Dysport is likely those prices will not change after the introduction of Xeomin. That may be due to Dysport's failure to steal market share from Botox but only time will tell.