Our blog honored by Plastic Surgery Practice magazine

In the July 2010 issue of Plastic Surgery Practice magazine, is an article by editor Jeffrey Frentzen selecting the best plastic surgery-related blogs on the Internet. (link)

I am delighted and pleasantly surprised to say that of the nine websites listed in the article, PSB - the Plastic Surgery Blog was listed as one of the best blogs, receiving an honorable mention.

Thank you, Mr. Frentzen and Plastic Surgery Practice magazine! We'll continue in our efforts to educate the public, expose the myths, and tell people what really works in the world of aesthetic plastic surgery.

Congratulations to the authors of the other 8 plastic surgery blogs, particularly my surgical colleagues Ramona Bates, Tony Youn and Rob Oliver, Jr.

Selphyl: a filler you make yourself

Selphyl is a new facial filler that's getting a lot of buzz. It's made on site at the doctor's office, using a few vials of your own blood. Twenty minutes later, after processing, an amber-colored liquid is ready to inject into facial wrinkles. While it's not a filler itself, the liquid contains platelets and platelet-derived growth factors, which stimulate your tissues to produce more collagen. At least, that's the theory.

This technology has been around for a while, but previously was limited to reconstructive applications. The Selphyl people have come up with an easy system to make it a convenient, standardized, in-office technique, and have taken it through the FDA approval process. The product is designed to be used in the correction of facial lines and wrinkles.

This stuff, however, isn't for someone looking for a bargain. A typical Selphyl treatment costs about $2000, about 3-4 times the cost of our typical fillers. The company claims the duration of the treatment effect is 2 years - and so that makes it cheaper in the long run, compared to Restylane or Juvederm.

It also works differently than many other fillers. Restylane or Juvederm directly fill the area with their gel. Instant gratification. Selphyl, on the other hand, fools the body into making extra collagen by means of growth factors. It's the new collagen which then gradually fills the area. Because of the lag time in collagen production, it takes 2 -3 weeks to see the desired results. If your body doesn't make much collagen, you won't see much effect. Selphyl is not recommended for patients over age 65 for this very reason.

So far, I've only seen 3 papers on Selphyl, all by the same author. So much of the data is still preliminary. We don't yet know how long the effect lasts; the longest duration data I've seen on Selphyl is only out to 12 weeks.

Many practices are promoting it as a facelift-replacement, which as you can see is a patently silly claim. Selphyl will help to volumize an area, and the platelet-derived growth factors may have some other, as yet unknown, rejuvenative effects on the quality of the skin - but that's it. There's absolutely no reason to expect tightening of loose necks, lifting of jowls, or the other typical effects that we get with a surgical facelift.

Bottom line: interesting product, but need to see more data before I start using it.
Pros: autologous filler;
Cons: Pricey. About 10% of people get no significant benefit from it, even if they are under age 65.

Opinion: Are 61% of doctors bad?

According to recent data from the American Medical Association, by age 55, 61% of American doctors have been sued for medical malpractice.

That's pretty much like saying that nearly 2 out of 3 doctors are negligent, are performing demonstrably below the "standard of care", and deserve to be punished with a crushing financial blow that could ruin their life and wipe out their savings.

In some specialties, the numbers are even higher. For example: in both Obstetrics and Gynecology, and in General Surgery, 69.2% of these specialists have been sued. Of course, those are high-risk specialties, by the very nature of what these doctors do. At the other end of the scale, only 22.2% of psychiatrists have been sued.

Wake up, everybody! These percentages are absurdly high, especially in what is arguably the best medical system in the world.

Why does this happen in the American legal system? In my opinion, two main reasons: the potential for a multi-million dollar payoff if you happen to win your case, and no downside to you personally if you don't win. It's a jackpot system, which encourages people with minor issues to try to sue.

There's plenty of data showing how frivolous lawsuits add to the cost of health care. Now that the costs of health care are a major issue, it really is time to consider answers to this problem.

Some experts favor changing the existing law in one simple way. Make it "loser-pays" - the losing party would pay the legal fees of both parties. (link to report) That way, people with a legitimate beef can still have all their legal rights to proceed with their actions, but the frivolous ones will be appropriately discouraged by the potential of the major costs involved, if their complaint is bogus. This system is used in Canada, Australia, the United Kingdom, and interestingly, the State of Alaska.

Others feel that a loser-pay system would just increase the size of the monetary awards involved, and not actually reduce the number of frivolous lawsuits.

I'm certainly no legal scholar. But surely, 61% of doctors do not deserve this kind of beating up.

Non-surgical rejuvenation of the eye area

While our surgical operations for the upper and lower eyelid can yield some pretty impressive improvements, not everybody wants to jump directly to surgery right away. Many patients want to know, "Doctor, what can you do for me without getting invasive?"

the answer: quite a lot, actually. The secret is to combine several non-invasive techniques in an artistic way.

For example, when we look at the eye area, we commonly see the combination of:
a) crow's feet,
b) texture changes in the lower eyelid skin,
c) lowering of the brow position, and
d) the "tear-trough" groove, running diagonally downward from the inside corner of the eye, around onto the top of the cheek.

We can use non-surgical methods to address each of these concerns. The combination is synergistic - working together nicely better than any one treatment by itself.

Crow's feet can be significantly reduced with the use of Botox or Dysport. A small dose of Botox (or Dysport) just beneath a low lateral eyebrow can elevate it in a subtle way. Filler injections, such as Prevelle Silk, can be used to fill in the valley of the tear trough area, making it much less prominent. Finally, a light chemical peel or laser can be used to resurface the lower eyelid skin, improving the texture.

Naturally, these options may not be as powerful as their surgical counterparts, but for many thirty and forty-somethings, it's really all they need at the moment.

And none of these options requires a trip to the operating room under anesthesia!

New look for the blog

Hey! The blog got a facelift!

Hope you find the new layout and color scheme easier to read, and more user-friendly.

New scientific data on biofilms & breast implants

We've talked about this before: one theory about why some breast implants become hard and distorted is related to a low-grade infection, called a biofilm, which triggers inflammation and fibrosis (scar tissue formation). Until now, the biofilm theory of capsular contracture was pretty much based on circumstantial evidence and by looking at similar reactions in other implants. No longer.

This month, in Plastic & Reconstructive Surgery, is a well-performed animal study from Australia that finally shows a clear link between capsule formation and a Staph. epidermidis biofilm. Miniature breast implants were implanted in a pig; some of them were purposely dosed with a low dose of the bacteria, enough to cause a biofilm, but not enough to cause outright infection. Thirteen weeks later, the animals were inspected for capsules, and a careful analysis of any capsule or biofilm found was performed.

Of the implants that had a biofilm, 80.6% formed a major capsular contracture (Baker III or IV). Statistical analysis showed that biofilm formation was associated with a four-fold increase in the risk of capsule formation.

Interestingly, a few of the implants that were not purposely inocculated with bacteria also went on to form a capsule. 80% of these also showed the presence of a biofilm. In these cases, the animal's own skin bacteria were the biofilm-forming organisms, despite excellent surgical technique.

Bottom line: this is one of the first experimental studies that I've seen that clearly links biofilm with capsular contracture in a breast implantation model. We've certainly suspected this for a while - now we've got some good scientific evidence.

Now the million dollar questions: what's the best way to minimize biofilm formation for breast implants? And how can we best treat biofilms if they've already become established?

Condolences

Condolences to the friends and family of fellow Plastic Surgeon, Dr. Frank Ryan. Dr. Ryan, an L.A.-based surgeon, became known in the media for his work with several high profile celebrities. He was killed in a car accident yesterday, at age 50.

Xeomin approved: but for functional uses only

Xeomin - another botulinum A toxin product - was approved earlier this month by the FDA. In an interesting twist, the FDA approved the drug for certain muscle spasm syndromes - cervical dystonia and blepharospasm - but not for cosmetic purposes yet. That all-important cosmetic approval will probably come at a later date.

Dystonias are neurological movement disorders featuring involuntary twisting and repetitive movements or abnormal postures. About 3 people per 10,000 have this problem, according to epidemiology studies.

What's interesting about Xeomin is that it doesn't have the associated complexing proteins previously needed for Botox and Dysport. The lowered protein load may theoretically reduce the incidence of allergic reactions and the potential for antibody formation.

According to Merz Pharmaceuticals, the manufacturers of Xeomin, more than 84,000 patients have been treated with Xeomin worldwide since 2005. The U.S. is the 20th country to approve the drug for the treatment of cervical dystonia and blepharospasm.

One week only: botox & filler discounts galore

Here's an incredible deal for our loyal readers and friends: 25% off of your next Injectable service for you and your friends. But act fast - this fantastic special is good from now only until August 20, 2010!

This special may not be combined with any other specials or discounts. The minimum purchase is for 25 units of BOTOX Cosmetic, an equivalent amount of Dysport, or one full syringe of the filler of your choice.

Please call to set up your appointment (407) 339-3222, or email us at: theteam@drfiala.com.

It's like a Back-to-School sale on beauty!

Tampa doctor's license suspended after liposuction fiasco

As reported in the St. Pete Times, a family doctor in Tampa who was performing liposuction had his medical license suspended for a year and was fined $50,000 by the Board of Medicine, after multiple rule violations were found.

According to the news report (link), State health officials said Dr. Yves Jean-Baptiste allowed two people unlicensed to practice medicine - his assistants - to perform the liposuction on the patient. Additionally, the patient's medical records didn't show a proper patient examination before the procedure, how much anesthesia was used, or the amount of fat removed. And Jean-Baptiste hadn't registered his office as a surgical facility, as required by State regulations.

Jean-Baptiste is not a plastic surgeon or dermatologist, and reportedly has no formal surgical background or training. About two years ago, he began to perform cosmetic procedures at his north Tampa practice after completing a three-day "intensive, hands-on training course". Three days of training....it's mind-boggling!

Jean-Baptiste said he had performed more than 250 liposuction procedures.

The Board of Medicine's action was a move to address the growing concern about physicians with limited cosmetic surgery training working in medical spas. "This is really scary," Brigitte Goersch, an Orlando businesswomen and consumer member of the board, said while rejecting claims that the fines were excessive. "If you want to practice medicine again, then you need to do it safely for the citizens of Florida."