Emerging and continuing trends in 2009 and beyond

The appeal of both aesthetic surgery and cosmetic medicine continues to spread, as plastic surgeons further tailor treatments to meet the distinctive needs of an expanding and varying populace. Disciplines such as Aesthetic Medicine have seen dramatic growth over the last decade and are predicted to increase significantly in the future.

 

While all the discussed trends are universal and so prevalent in the Middle East, they are adapted to reflect the different regions and countries. In the United Arab Emirates (UAE) male surgery is a trend that has only emerged in recent years, the figures are outstanding; surging from 12 per cent to 17 per cent since 2005.

 

The most sought after male surgery in the UAE remains liposuction and this is a trend that is mirrored worldwide. Men are more conscious now and opting for an aesthetic procedure is no longer looked down upon. Even nationals are changing their thoughts on procedures; nearly half of the men who opted for surgery last year were UAE locals.

 

Non-surgical procedures and cosmetic fillers such as Juvederm and Restylane are becoming more appealing as products evolve and new companies enter the market with alternative offerings. Botox continues to be the most popular non-surgical cosmetic treatment but we may see other forms of Botulinum Toxin Type A or similar products begin to enter pre-market clinical trials throughout the course of the year.

 

We of course cannot ignore the current global financial crisis, which will also have its impact on plastic surgery, with patients looking for a bargain on cosmetic procedures. This will undoubtedly lead to an increase in cosmetic medicine and cosmetic surgical procedures carried out by untrained or poorly trained practitioners.

 

This is not something that I see as a continuing trend however; as the world is becoming better educated about healthcare the certification of plastic surgeons, and accreditation of surgical facilities will play an even more important role in helping patients to choose the right plastic surgeon, which in turn will result in eliminating unqualified practitioners.

 

Following on from this we will also see cosmetic surgery ‘vacations’ becoming less popular as educated consumers begin to understand the safety and risk issues related with travelling for surgery as well as the importance of good follow-up care.

 

As health issues such as obesity and, particularly in the Middle East, diabetes are addressed weight loss and body contouring procedures will see an increase in 2009.

 

Experimental techniques for non-invasive fat removal (Smartlipo laser liposuction) as an alternative or adjunct to liposuction (lipoplasty) surgery continue to undergo clinical trials and I think we will begin to see a shift towards these types of procedures.

 

In turn, as the popularity of non-surgical and minimally invasive procedures grows, surgeons and manufacturers will develop new techniques and products that advance the science, produce even better results, and lessen recovery time.

 

Beyond 2009, I see the main emerging trends as further research into Fat stem cells applications in many areas of Medicine and tissue engineering and improvements in Anti-aging drugs meaning a reduction in the need for rejuvenation procedures. Of course, we will always treat trauma and accidents, but less congenital diseases in the future, as intra-uterine examination and treatments become more popular.

 

Since 2004, The Patients Advantage is fast becoming the largest matchmaker of board-certified plastic surgeons in the world and is recognized as a leading information source on cosmetic and reconstructive plastic surgery – matching over 9,000 people with plastic surgeons.

 

Ruptured Breast Implants

Patients present to us ruptured breast implants every week. Ruptured implants can occur for many reasons. They can occur due to trauma, blunt trauma, such as a seatbelt whiplash accident or even being assaulted. It can also occur simply due to wear and tear of an implant.

 

Smooth versus textured implants have different rates of rupture. The textured implants have a significantly higher rate of rupture because they develop fold creases within the shell, which will adhere to the tissue surrounding it and the capsule and with time will crack and leak. As a result, we prefer not to use textured implants any longer. Smooth implants can rupture as well. Rupturing can occur anywhere within the implant bag, the valve can leak or a small pinpoint rupture can occur along the circumferential periphery of the implant edge.

 

In any case, what do you do when you have determined that you have a ruptured implant? Saline implant ruptures are clinically obvious. The implant will completely deflate and the breast will look completely smaller and asymmetric from the other side. This should be taken care of as soon as possible because as the implant continues to deflate, scar tissue will trap and reduce the volume size of the pocket, causing collapse of the pocket. An open capsulotomy versus possible capsulectomy with implant removal and replacement should be done as soon as possible under general anesthesia. Only Board Certified Plastic Surgeons should do these operations in a Medicare and State Licensed Facility with a Board Certified Anesthesiologist, under general anesthesia.

 

Silicone ruptures can be silent in that they may not even be noticeable for many years and that the breast size may not reduce in size at all. MRI’s should be done whenever there is thought of a rupture or every two to three years per FDA requirements as of November 2006. Just as with saline, silicone implant ruptures should be immediately addressed. Now, silicone implant ruptures can lead to calcifications, silicone granulomas and silicone gel leakage to the axilla or other lymph nodes within the body and therefore should be immediately addressed surgically.

Since 2004, The Patients Advantage is fast becoming the largest matchmaker of board-certified plastic surgeons in the world and is recognized as a leading information source on cosmetic and reconstructive plastic surgery – matching over 9,000 people with plastic surgeons.

 

Scarring After Breast Enlargement Surgery

All surgeries carry with them certain risks and the potential for certain complications. When undergoing surgery, several factors can happen that may result in bleeding, infection, and problems with anesthesia. Breast augmentation is no different. As with any cosmetic surgery, breast surgery has its risks. The risk of scarring is just one of those risks.

 

A scar is our body’s attempt to heal a wound such as a cut, abrasion, burn or puncture. At the place on the body where the integrity of the skin was breached (incision site), tissue forms to fill in the gap. The tissue forms itself across the incision and eventually contracts to pull the edges of the wound tightly together. Over time, scars may shrink or fade, but this is not always the case.

 

Regarding breast enlargement incisions, there are four places where incisions may be made:

 

An axillary incision (armpit) is about one inch in length and can usually only be seen when the woman raises her arms above her head. In time, this scar will become a faded thin line.

 

For the incision under the breast crease, the incision will be 2-3 inches in length and will run underneath each breast, only very slightly above where the breast meets the chest wall. Your cosmetic surgeon, with this incision, will have a very clear view of his work. In time, the scar will only be a very thin faded line and only visible upon close inspection.

 

Regarding the incision that is made around the areola, the scar will be virtually invisible. Future breastfeeding is unlikely with this incision as the mild ducts and nerves are damaged with this incision.

 

Regarding the trans-umbilical incision, the incision is a little curve inside the navel. With this incision, only one incision is necessary for two implants. Your cosmetic surgeon will create a tunnel from the incision up to the implant site behind the breast tissue. The scar will be visible only upon very close inspection.

 

Since 2004, The Patients Advantage is fast becoming the largest matchmaker of board-certified plastic surgeons in the world and is recognized as a leading information source on cosmetic and reconstructive plastic surgery – matching over 9,000 people with plastic surgeons.

Freeing Muscles With Botox After a Stroke

After her stroke, Francine Corso, a software engineer who worked on NASA’s lunar lander, was housebound from 1992 to 2001. Her left arm was twisted up near her neck, making it difficult to pull on a blouse, and her fingers curled so rigidly that her nails buried themselves in her palm. When she finally learned to rise from her wheelchair, her contorted left leg had the so-called horse gait of many brain-injury victims — she stepped toe-downward, and then fought to keep her foot from rolling over.

 

Now, with injections of botulinum toxin every three months, she says, “I’m completely transformed — I drive, I volunteer, I take art classes.” Her fingers are so relaxed that a manicurist can lacquer her nails red.

 

Botulinum toxin, the wrinkle smoother best known by the brand name Botox, has many medical uses, some official and some off label. It helps dystonia victims regain control of spasming muscles, actors who struggle with flop sweat slow down the flow, and children with clubfoot avoid surgery.

 

Its use in stroke victims is still off label — that is, it is not approved for that purpose by the Food and Drug Administration. But it is so widely accepted that Medicare and other insurers will usually reimburse for its use.

 

Nonetheless, said Dr. David Simpson, director of clinical neurophysiology at Mount Sinai Medical Center in New York and a leading botulinum researcher, only about 5 percent of the stroke patients who could benefit from its use ever get it.

 

Primary care doctors who oversee nursing homes often do not know about it, he said. Relatively few doctors are trained to do the injections, which go much deeper than dermatologists do to erase frown lines. And most neurologists are in the habit of prescribing antispasticity drugs like tizanidine and baclofen, which are oral and inexpensive, but which cause drowsiness and weaken every muscle in the body, not just the target ones.

 

Ms. Corso, 66, never heard about the treatment from her first neurologist, whom she called “Dr. Bad News” because he told her family she would die and then kept telling her she would never walk. “I heard about it from Dr. Max Gomez on NBC,” she added. “That’s when I came into the city and found you people.”

 

In a Mount Sinai classroom with a broad view over Manhattan, Dr. Simpson stands behind two disembodied arms mounted on rocker joints. One looks pasty but muscular and is covered with needle tracks. Its partner is bright red and nothing but muscle; it is an anatomical model with all the skin and fat removed.

 

Dr. Simpson, who gets financing from three botulinum toxin producers — Allergan, which makes Botox; Solstice Neurosciences, which makes Myobloc; and Merz Pharmaceuticals, which makes Xeomin — is teaching residents how to find the harder-to-reach muscles, like the flexor pollicus brevis, which bends the thumb, and the pronator quadratus, which rotates the wrist.

 

The rubber arms have sensors that beep when the tip of his needle enters the right muscle. Human arms do not beep, of course, but Dr. Simpson had used a variant of the technology on Ms. Corso only an hour before. Just before the first needle sank in, she let visitors know how she felt about electromyography, which she calls “the stim.” The syringe was wired to an electric stimulator that pulsed a charge — up to a tenth of an amp — twice a second. When Dr. Simpson believed he had pierced the right muscle, he dialed it up. If the correct finger began twitching in sync, he knew he was there, and pressed the plunger. If not, he moved the needle and tried again. He did that several times in Ms. Corso’s arm and then in her leg. Within 45 minutes, Ms. Corso said her foot was hitting the floor more evenly.

 

Botulinum cannot restore the use of muscles when stroke has destroyed the brain region that controls them. But patients look and feel better and often find it easier to dress, hold objects and bathe themselves. Dr. Mark Hallett, chief of the motor control section of the National Institute of Neurological Disorders and Stroke, says he uses both electromyography and ultrasound when injecting patients. “A number of authorities feel that if they get close, that’s good enough,” Dr. Hallett said. “I don’t agree. I think it’s valuable to make sure you’re in the right place.”

 

So does Ms. Corso. For a while, she said, she was seeing another neurologist nearer her home in Fort Salonga, on Long Island, who injected botulinum but did not use electromyography. It did not work as well, she said. Now she has a friend drive her to the border of New York City, then takes a car service to the hospital.

 

“It’s a long way from Long Island,” she said. “But it’s worth it.”

 

Since 2004, The Patients Advantage is fast becoming the largest matchmaker of board-certified plastic surgeons in the world and is recognized as a leading information source on cosmetic and reconstructive plastic surgery – matching over 9,000 people with plastic surgeons.

 

Cosmetic Surgeons Applauds Obama Administration’s New Direction in Stem Cell Research

Plastic surgeons and their patients have personally witnessed the benefits of utilizing adult stem cells in their procedures. The Obama Administration’s recent reversal of eight years of stem cell research restrictions points to revolutionary era of medical innovation.

 

Many people do not realize that stem cells have been utilized in plastic surgery for decades now. Fat carries a good number of adult stem cells which have been utilized in modern plastic surgery procedures such as fat grafting, fat transfers and fat injections. Patients who receive fat injections from me look unbelievably younger in their one year follow-up. The reason is, the stem cells in the fat injections bond with the patient’s tissues in their face, adding to lost bone and muscle tissue while improving the quality of the skin.

 

With the Obama Administration embracing and allowing further research into this revolutionary medical technology, the sky is now the limit. The recent lift of stem cell research restrictions by President Barack Obama has been heralded by stem cell researchers across the nation. The action has reversed an eight year research ban and, to many, signifies the coming of a new era of potential cures for many debilitating diseases like diabetes, Parkinson’s, Alzheimer’s and many cancers. Among the advocates for stem cell research and technology are plastic surgeons who have seen the benefits of stem cell use first hand.

 

Stem cells are special cells that have the ability to become other types of cells, like skin, bone, nerve, or muscle tissues. Embryonic stem cells are the most well-known and controversial type. But there are other stem cells in the body called adult stem cells. Fat transfers and fat injections involve harvesting fat, sometimes called adipose tissue, from unwanted areas of the patient’s body. This harvested tissue is then injected into areas of the face to fill in wrinkles and areas that typically lose tissue mass as a result of aging. This method of injecting filler is often considered safer than other methods because the patient’s own tissue is being used.

 

Surgeons noticed unexpected benefits in their fat transfer patients. In Europe, surgeons process the fat to get a high concentration of stem cells. This supercharged stem cell fat is then used to rejuvenate the skin and the face. Fat stem cells have even been used in reconstructive plastic surgery. In 2004, surgeons in Germany used stems cells from fat tissue of a seven year old girl to help repair major damage to her skull. The large hole in the skull is now replaced by solid bone. In 2006, researchers in UCLA announced successfully transforming adult fat stem cells into smooth muscle cells, which help the normal function of a large number of organs like the intestine, bladder and arteries.

 

Since 2004, The Patients Advantage is fast becoming the largest matchmaker of board-certified plastic surgeons in the world and is recognized as a leading information source on cosmetic and reconstructive plastic surgery – matching over 9,000 people with plastic surgeons.

 

 

 

 

Eyelid Surgery Helps Rid the Feeling of Looking Older

Cosmetic eyelid surgery or blepharoplasty is done to improve the appearance of the upper or lower eyelids. The primary goal of upper eyelid surgery is to remove the excess skin and fat, whereas the goal of lower eyelid surgery is to remove mostly excess fat. The fat in the lower eyelids is a genetic trait and is referred to by many as puffiness. Typically, patients will say that they look older than they feel when they look in the mirror.

 

Upper and lower eyelid surgery can be performed alone or in conjunction with additional cosmetic surgery such as a facelift or rhinoplasty surgery. Eyelid surgery enhances one’s appearance and gives a look of being well rested. With the aging process, the skin tends to relax, muscles tend to weaken, and the fat around the lower eye tends to protrude and accumulate around the eyes, resulting in a puffy appearance.

 

The incision for an upper blepharoplasty procedure is made following the natural eyelid crease. After the precise measurement of fat and excess skin is removed, the incision is closed with dissolvable sutures.

 

The lower eyelid incision is on the inside of the lower eyelids. If there is excess skin on the outside portion of their lower eyelids, a small pinch is removed beneath the eyelash line. This is typically closed with a tissue glue adhesive. The incision is nearly imperceptible at three to four weeks after surgery.

 

Blepharoplasty may take one to three hours. For this procedure, the plastic surgeon makes incisions following the natural lines of your eyelids; in the creases of your upper lids, and just below the lashes in your lower lids. The incisions can extend into the crow’s feet or laugh lines at the outer corners of your eyes.

 

If you have a pocket of fat beneath your lower eyelids but don’t need to have any skin removed, your plastic surgeon may perform a transconjunctival blepharoplasty. In this procedure the incision is made inside your lower eyelids, leaving no visible scar. It is usually performed on younger patients with thicker, more elastic skin.

 

Your plastic surgeon will instruct you to keep your head elevated for several days. Cold compresses are used to reduce swelling and bruising. This lasts between several weeks to a month. Doctors recommend eye drops since your eyelids may feel dry at first and your eyes may burn or itch. For the first few weeks you may also experience excessive tearing and sensitivity to light and temporary changes in your eyesight, such as blurring or double vision. Once the stitches are removed the swelling and discoloration around your eyes will gradually subside.

 

Since 2004, The Patients Advantage is fast becoming the largest matchmaker of board-certified plastic surgeons in the world and is recognized as a leading information source on cosmetic and reconstructive plastic surgery – matching over 9,000 people with plastic surgeons.