The Plasticologist

Is Canda Right About Cosmetic Surgery?

admin — Fri, 18 Apr 2008 21:24:08 +0000

Ontario, Canada – The death of a 32-year old real estate agent who underwent a botched liposuction performed by a family physician led Ontario’s College of Physicians and Surgeon to amend its rules restricting the practice of cosmetic surgery to trained surgeons who are formally recognized by regulatory bodies.

Dr. Preston Zuliani, president of the College, explained to Toronto Star, “The regulation that was passed today is strictly about title, what they can call themselves… Today’s regulation was primarily to protect the public by providing clarity about what the qualifications are.”

It makes one wonder when the US will begin to take steps to protect by what is compared to Canadian standards, a largely unregulated cosmetic surgery field.Â At this point in time in the US any MD can perform any operation they so choose regardless of training.Â Â There are some restrictions which come from insurance companies (malpractice) and hospitals as to what they will cover or allow physicians to do in their facilities based on their training but these are largely moves to protect the insurance companies and hospitals from liability from mishaps from doctors performing operations they are not trained to do.

The liposuction victim was Krista Stryland, who died after the procedure was performed on her by Dr. Behnza Yazdanfar at a North York clinic by and family practice doctor.

Jogging or Running with Breast Implants

admin — Thu, 10 Apr 2008 13:00:34 +0000

Running (Jogging) and Breast Implants

Many patients have asked me to comment on their ability to run after breast augmentation or breast reconstruction using implants. I thought Id use this forum to comment on our perspective. If you are a runner or jogger considering breast implants or one who has implants you may find some useful facts below.

As always:Disclaimer: consult your own physician about breast implants and running. The views on this page are ours at plasticologist.com. And while we are board certified plastic surgeons – this web page (or any other) is not a substitute for a one on one consultation with your plastic surgeon or physician.

Pre-operative breast augmentation/implant reconstruction considerations for runners

Back pain or difficulty exercising associated with large breasts

People getting breast implants often wonder about why theres a segment of women looking for breast reduction – and of course vice-versa. Heres the problem with large breasts: Breasts can be heavy and can cause back, neck and shoulder pain as well as cause difficulty exercising. Typical breast reductions remove about a pound to a pound and a half of weight from each breasts and usually significantly improve back pain, neck pain and shoulder grooving. With this in mind, it is easy to imagine that large implants may lead to similar discomfort. Typically this is seen in later years as we get older but is still an important consideration. Running typically subjects the body to the shock of the feet hitting the ground – this force is transmitted through the knees, spine and pelvis. Large implants may increase this force over time as you as supporting additional weight, especially in the shoulders and spine.

Arm movement and breast implants

Getting breast implants which are too big can get in the way of efficient arm movement. Part of running is the forward and back movement of both arms as we run. Typically this can be an issue with more established runners as theyre patterns are more difficult to change.

Post-operative Breast Augmentation/implant breast reconstruction considerations for runners

Post op recoveryWhen can one run again after breast augmentation?What kind of weight lifting can I do right after breast augmentation?

Typically I recommend that a patient do no type of strenuous physical activity after surgery.It isnt just about avoiding usage of the pectoralis muscle as some have stated. Its also about avoiding strenuous activity that may raise your blood pressure and cause bleeding as well as avoiding situations where injury may occur when youre under the influence of pain medication.Typically I recommend no exercise for the first week to ten days and then a gradual increase in things like walking. I avoid all upper extremity exercise for at least three weeks.Usually people can begin activities like running or jogging at 6 weeks with appropriate support garments like sports bras.

Are cruches ok?

This question struck me as a little odd as most joggers dont need crutches after breast reconstruction or augmentation. I typically I do not recommend my patients use crutches after sub-pectoral implants for breast augmentation (or breast reconstruction for that matter) as one of the major muscles supporting crutch usage is the pectoralis muscle. This can lead to increased chance of bleeding, pain and delayed healing as well as long term capsular contracture.

What about sweating?

Studies show that typical surgical wounds are largely sealed from the outside world in 24-48 hours. Breast augmentation places synthetic material in your body which can be more susceptible to infection so most surgeons are more cautious. Typically most doctors will recommend you avoid getting the incisions wet (same as heavy sweating) for the first week to ten days. After that, although the incisions are still healing, most consider them immune to water. It is important to remember that this time may be extended if you have drains in place.

When Im back to running again, what other precautions should I take?

Start back slowly. Any surgery requires a period of time where your body will not be at its physical peak. The recovery time may take as long as six weeks.Definitely wear a supportive sports bra whenever possible. Without the extra support you will have a greater risk of damaging the parts of your natural tissue that suspend your breasts – this can lead to ptosis – the medical term for sagging breasts. Use a sports bra to protect your augmented breasts while jogging.

As always – as techniques and individual practices vary it is important to have a conversation with your surgeon about these issues.

Hopefully this gives you a little insight.

How many plastic surgeons fail the boards?

admin — Wed, 23 Jan 2008 20:16:50 +0000

The American Board of Plastic Surgery – the only true governing body for “Board Certified Plastic Surgeons” has released numbers about how many of their applicants fail the boards each year.

Â Plastic Surgery board certification is somewhat clouded by other health care professionals trying to cash in.Â As more patients begin to recognize the importance of board certification less scrupulous practioners fill their ads with certifications from other specialities or non-accredited boards.Â It’s like applying to a job with several “prestigious degrees from non-accredited institutions”.Â There is only one certifying body for Board Certification for Plastic Surgery.

Â The board requires plastic surgeons to take a written exam, collect and submit all cases they perform for an 8 month period, have their advertising and practices reviewed and then take an oral exam based on their cases and unknown cases.

Â So how do practicing plastic surgeons who want that extra seal of excellenceÂ do?

Â The American Board of Plastic Surgery reports the following:

For a ten year period, each year an average of 288 people took the written exam each year
On average 21% of the people taking the exam fail – the board does acknowledge that people who are “repeat testers” fail more often than people taking the written boards for the first time.

Â If the plastic surgeons make it through this stage they collect all of their cases for 8 months and may be able to take the oral part of the boards.Â The board reports that candidates can take the oral boards as many times as they need but must collect new cases for the a new 8 month period each time.Â (The written exam must be passed within a certain number of attempts.)

So how did they do on the oral exam?

The Board reports for a ten year period:

Each year an average of 252 people took the oral exam
Each year an average of 19% failed the exam – again people taking the exam for the 2nd or more time failed at a higher rate than first time takers.

Interesting numbers.

Comments welcomed.

Fig LipoDissolve Clinic Bankrupt

admin — Mon, 21 Jan 2008 22:58:25 +0000

Lipodissolve clinic chain “Fig” who started treating patients with lipodissolve in 2005 has closed shop by report.

This has left some patients who paid for services in a bit of a lurch. Fig has responded saying “In cases where money was paid for services not received, consumers may file a claim against fig through the bankruptcy process to seek to recover the appropriate amount. Further details will be made available next week.”

Disheartening to say the least.

The Houston clinics have found someone to continue treatments whereas clinics elsewhere in the country are still trying to find solutions. There were 17 clinics in 8 states.

Lipodissolve has been somewhat controversial in that the FDA has not approved the combination of chemicals used. There was also attention put on it when the Kansas State Board of Healing Arts banned the practice of injecting the combination of phosatidylcholine and sodium dioxycholate although a judge reversed the ruling.

American Society for Aesthetic Plastic Surgery Reports Data

admin — Fri, 23 Nov 2007 02:49:38 +0000

As reported by the American Society for Aesthetic Plastic Surgery, 11.5 million Americans went under the knife in 2006 for cosmetic surgery. A new study shows that this statistic is largely due to the baby boomers becoming a larger portion of the older population.

A recent study showed that the majority of women, ages 35 to 69, wanted their faces to look 13 years younger and wished there was a quick fix to get rid of wrinkles and sagging skin. (Results as you might expect – something akin to asking someone if they want a free lunch.)

The study also found that there are many misconceptions about plastic surgery.

Surgery Misconceptions

The study found that there were five main misconceptions that the women had regarding plastic surgery its process.

The misconceptions highlighted were:
Â· Patients think there are scar free surgical procedures
Â· Procedures can achieve perfection and last forever.
Â· All aesthetic or cosmetic surgeons are plastic surgeons

All three of these points demonstrate the need for better education of potential patients.

The study also showed:
Â· A â€œminiâ€ facelift will give you the same results as a full facelift

Also not true.

Kanye West’s mother’s plastic surgeon – trouble before it began

admin — Wed, 14 Nov 2007 03:28:27 +0000

Any surgery can have complications. These complications can be serious as, if the reporting is true, they were in this tragic case. By report, Dr. Jan Adams had recently operated on Donda West performing combined procedures of an abdominoplasty and a breast reduction. She died two days later from what coroners are calling medical complications.

Plasticologist has researched the headlines and comments on some of the reported facts:

Warning Sign #1 Website TMZ reports that the medical board wanted to suspend Dr. Adams’ license this past April following multiple DUI convictions.

- Practicing surgery requires focus and discipline. Social and legal infractions can point to larger problems in a surgeons life. Inquiries regarding medical license suspension is a serious warning sign as are legal infractions – especially when they come in multiples.

Warning Sign #2 – It has been reported that she underwent a breast reduction and abdominoplasty and that the operation took 8 hours – twice as long as it was booked for.

- Combined procedures can include risks. They involve greater blood loss, increased anesthesia time, more fluid shifts and be associated with higher complications than any one procedure done alone. Always have a discussion with your surgeon about the risks of combining certain procedures.

Surgeries that take longer than planned are also associated with increased complications.

Certainly surgery can have things that make it more difficult but many plastic surgeons would agree that if there are complications that double the OR time and certainly operations that take as long as 8 hours should not be sent home and are best monitored in a hospital or convalescent setting by health care professionals.

Warning Sign #3 – Dr. Jan Adams has faced multiple law suits (he lost 2 in 2001, 2 in 2005, one in 2007) . The scariest of which may have been one that TMZ reports “The plaintiff alleges that after a botched tummy tuck and arm lift, Dr. Jan Adams paid house calls. While she was medicated from the surgery and intoxicated, he told her he loved her, had sex with her and got her pregnant. That suit settled out of court.”

In a litigious society there are more and more surgeons that are facing suits, some with merit, some that are without merit. However, many lawsuits or lawsuits that have been litigated and lost with charges of criminal or seriously unethical behavior you should be cautious.

Warning Sign #4 – Dr. Adams was not only not board certified but alleged to have falsely claimed to be board certified.

- Board certification (that is – and this is important – being “Board Certified by the American Board of Plastic Surgery”) doesn’t prevent complications but it means that your potential surgeon has taken a rigorous written exam and then approximately one year later undergone a second oral exam where plastic surgery experts review cases that are collected in a several month period. The examiners are looking for unethical behaviour as well as incompetency in the operating room, in the pre and post-operative period.

Again being board certified doesn’t mean bad things can’t happen. But it is a good step towards preventing this type of tragedy.

Female Genitalia Procedures Increasing in Popularity

admin — Fri, 02 Nov 2007 12:59:09 +0000

The secretary answered the phone, it was an ordinary day in an ordinary plastic surgery practice.Â “I’m interested in a labiaplasty.”Â

The secretary had been in the medical field for a long time so she adeptly tried to get more information from the patient, “Of course, wereÂ you injured or have you had a problem with your lips since birth?”

“Uh…Â well I don’t think I’ve been injured.Â They just have kind of stretched out.Â I haven’t done anything strange or anything, I just don’t like the way they look when I’m in a bathing suit.”

“They stretched out?”

Of course the conversation deteriorated from there.Â Â The confusion of course stems from the fact thatÂ vaginalÂ labiaplasties haveÂ begun to hit the mainstream public as another juicy item on the plastic surgery menu.Â Dr. Ricardo Rodriguez in Plastic SurgeryÂ News states, “They just have a desire to look neat.Â Most of my labiaplasty patients groom that area, which makes it more visible.Â Once it becomes visible, they want to take care of it.”

Perhaps more to the point however, there is a growing body of literature that reports to physical discomfort from excessively large labia that is probably outside the realm ofÂ cosmeticÂ plastic surgery.Â Whether this literature is growing secondary to the public’s interest in the procedure is unclear. In more a more reconstructive realm there are many women who have suffered tears of the labia minora during childbirth and have been too embarrassed or not known the proper channels to follow to pursueÂ surgical correction.

In fact there is a great deal of discussion in the plastic surgery world aboutÂ a spike in the popularity of labiaplasty and other female genital procedures.Â Â Some purport the increase in popularity to television shows likeÂ controversial Dr. 90210 or to the mainstreaming of adult entertainment.Â It seems that the trend of the popularization of this procedure followsÂ similar patterns to previous new cosmetic trends.Â That is it begins in more metropolitan areas.Â Â But this is true of most new cosmetic surgery procedures.

It will be interesting to see if the growth in this area of plastic surgery continues over the next several years.

Why So Much Sag?

admin — Thu, 18 Oct 2007 16:30:25 +0000

Gravity is an immutable law of physics.Â ManyÂ people seek plastic surgery services secondary to the constant pull of gravity.Â There’s a new study released describing the affect that gravity has on breasts, especially during exercise.Â There are many factors that contribute to breast shape including skin envelope, patient weight, previous pregnancy, etc.Â However, once substantial stretch is applied (many factors can contribute including weight gain, pregnancy, implants) the connective tissue (Cooper’s Ligaments) and skin can be permanently disrupted resulting in “sag”.

While brassieres have evolved throughout history from body-binding corsets to cleavage-enhancing “miracle” bras, only recently have researchers injected a dose of science into the design of undergarments that go beyond just improving appearance.

“It is only recently that bra design has turned to science,” said Joanna Scurr, a biomechanics professor at the University of Portsmouth in England. “There was no research. Itâ€™s like designing a car or kitchen equipment without first thinking ‘what is the purpose of this?’”

Scurr will presented her research at an annual meeting for the British Association of Sport and Exercise Sciences in Bath.

Methods (How was the experiment conducted?)
Scurr recruited 70 women, including students and faculty from the University of Portsmouth, with bra sizes ranging from A-cup to extra-large (DD, E, FF, G, H, HH, J and JJ were included).

Each woman walked, jogged and ran while wearing different bra types. During the exercise, Scurr took biomechanical measurements, including the amount of breast movement in three directions: up-and-down, side-to-side and in-and-out.

Findings
During walking exercise, the women’s breasts moved relatively the same amount in all directions. When study participantsÂ ran orÂ jogged, their breasts moved proportionally more in some directions than others: More than 50 percent of the total movement was in the up-down direction, 22 percent side-to-side and 27 percent in-and-out.

The overall pattern of the movement resembled a figure-8.

Typically, bras are designed to minimize up-and-down motion and not the other two dimensions of breast movement found in Scurr’s study.

For all cup sizes, the so-called encapsulation bras in which each cup is separately molded provided the most support, beating out the compression bras, which limit only the up-and-down motion. The encapsulation bras limit some of the movement in the other directions as well.

Breast motion reduction with sports bras showed similar results regardless of the cup size.Â In A-cup women, wearing a sports bra reduced overall breast movement by 53 percent, compared with a 55-percent reduction for G-cup women.

Discussion
While the suspensory system of the breast has received a great deal of attention it is not clear that better bras will prove more protective.Â It is also not clear that better bras, even if they do prevent damage to the portions of the breast that provide support, will prevent sagging through other causes.Â It does provide a basis for interesting future research.

The Forgetful Patient

admin — Fri, 17 Aug 2007 21:08:22 +0000

A survey conducted in January 2007 concludes that of over 300 adults surveyed after their cosmetic procedure less than half remember the complications that their physicians warned them of.Â For example, 42% remembered that the physician mentioned nausea and vomitting as a possible complication, 48% remembered bleeding as a possible complication, etc.Â

The survey also found that 30% were uncomfortable asking the physician questions before surgery.

73% felt the doctor completely addressed the potential side effects and complications before surgery.

These numbers suggest that in an effort to perform safe surgery on informed patients there is significant benefit to providing additional written material about details of the planned surgical procedure.Â A patient may quickly forget things that you mention.Â A patient may also be refer to materials at home and find the confidence to ask the physician questions they would otherwise ignore.

Simple steps can improve the physician-patient relationship and pave the way for a better understanding of the procedures and risks.

Mommy Makeovers

admin — Tue, 07 Aug 2007 17:08:30 +0000

As the US population as a whole has increasing numbers of mothers having birth at older ages the noticeable upswing in the trend of post-pregnancy surgery has occurred.

The ASPS documents an 11 percent increase in breast augmentation, abdominoplasty and mastopexy procedures between 2005 and 2006.Â And while the data does not stratify the post-partum status of the patient ithe increases (especially for tummy tucks) are solidly up for women in their 30s and 40s.

There are specific considerations for post-partum plastic surgery including:
1. Are you planning on having additional children?
2.Â Are you currently breast feeding (in addition to having significant impact on breast shape and wound healing will post-op meds interfere with your ability to breast feed?)?
3.Â Have you returned to your post-partum weight?
4.Â Are there issues of post-partum depression or new trouble at home (ie what’s the motivation for a cosmetic procedure)?
5.Â Are there support systems at home during any potential post-op period (try lifting a 1 year old 2 days after a tummy tuck or getting kicked in your mastopexy by your toddler post-op day 1)?

Your plastic surgeon should address these issues as well as all the standard questions and parts of the interview and exam if you’re looking for a little surgical improvement after the baby.