Hero of the week: Paul Vanek, MD

I'd like to recognize the humanitarian efforts of one of my longtime friends, Dr. Paul Vanek. Paul, who is a double-boarded plastic surgeon and general surgeon, and I trained together in Plastic Surgery, at the University of Michigan, more than a few years ago.

When the earthquake struck Haiti, Paul knew what he had to do. He called CNN, and found about a medical relief team called Project Medishare. Leaving his practice and family in Ohio, Paul flew to Haiti, with 2 nurses and an aesthesiologist and joined the effort....and started to work.

His background in trauma surgery came in handy, as he dealt with infections & abscesses, major limb issues, crush injuries and the like - all in very primitive conditions, with the most basic of equipment. According to Paul, it was more basic than TV's "MASH" series. What they didn't have in equipment, they improvised. For 8 days, the surgical team slept on the ground, ate MRE's, and operated day and night on the injured multitudes who needed help, until they ran out of supplies.

That's heroic.

You can read about Dr. Vanek's work with project Medishare here, or in numerous local papers (link)

Paul is humble about his role in the experience. Ever philosphical, he is now back at home in Ohio with his family, and is grateful for life's blessings. He's continuing to raise money for Project Medishare and the Haiti relief effort.

Well done, my friend!

A new laser treatment for stretch marks? Maybe.

When patients come in with stretch marks, we've traditionally had little to offer them. Retin-A cream helps somewhat. IPL and vascular lasers can be used if the stretch marks are red or purple in color. But that was about it, unless the stretch marks were on the lower portion of the abdomen - and the patient wanted a tummy tuck, which would surgically remove the entire zone of stretch-mark laden skin.

Well, guess what. Just this month, Palomar Medical Technologies announced that their Lux1540 laser handpiece has received clearance by the FDA for the treatment of stretch marks. As you might expect, the company, their accountants and their stockholders are all very excited about this, as now they can market this laser to the millions of women worldwide who have unwanted stretch marks.

As we've discussed before, FDA approval for devices doesn't necessarily imply that the gadget is effective - just that it is reasonably safe. So does this laser really do what it claims?

The Lux 1540 isn't that new - it's a fractional, non-ablative "erbium-glass" laser that's been previously used for skin resurfacing and the treatment of scars. What's new here is the official indication for use in stretch mark therapy. According to the data submitted to the FDA, clinical studies with the Lux1540 achieved an average improvement of between 51% and 75% in the appearance of stretch marks, over a three month time period. Of course, that's corporate-sponsored research. I haven't seen any peer-reviewed, independent studies as yet.

So, the stretch marks got better with the treatment, but did not vanish. Nevertheless, this could represent an improvement over the previous non-surgical therapies we've had for striae....we'll have to see how it pans out in independent trials.

Bottom line: cautiously optimistic.

Dr. Fiala now has an iPhone app

Yes, it's true - we're entering the age of the iPhone.

My friend, Dave Tessitore, has programmed an iPhone app for us, and it's now available through the Apple app store. Look for "Plastic Surgery with Dr. Fiala", or just click here (link). Currently, it's a free download. We're one of the first plastic surgery practices in the country with this new feature!

In addition to making it easy to make and keep track of your appointments with us, the app also helps you to remember any medications / supplements that you take, your physician contact list, allows direct email access to us, has links to our website and blog, and a number of other cool features.

An FAQ section will be added in an upcoming version. If people have suggestions for improving the app, let me know, and we'll see if we can add them in!

A Big "Thank you" to Dave Tess and Dashy Apps for their work on this project.

Women: Exercise now for good health later!

A new study published in the Archives of Internal Medicine gives further evidence to the linkage between exercise and good health. The study, entitled "Physical Activity at Midlife in Relation to Successful Survival in Women at Age 70 Years or Older" looked at 13,500 women, who were part of the Nurses' Health Study who had survived to age 70 years or older, without any of 10 major chronic diseases, open heart surgery or cognitive or physical impairment.

The Nurses' Health Study, just to give a little background, is considered the "grandmother" of women's health studies and represents the single largest "cohort" study of women, in which the same patients were followed and monitored over many years. It has resulted in more than 265 published scientific papers. The study was established in 1976, with the initial idea of studying the relationship between oral contraceptives, cigarette smoking and the risk of major illnesses. Thanks to the dedication and commitment of the participants, the scope and range of the study has broadened over time to evaluate other lifestyle factors, as well.

Using data from this group, the Harvard-based researchers found that higher physical activity levels at midlife were significantly associated with better odds of successful survival. Regular walking also was found to have a beneficial effect, but not quite as much as more vigorous exercise. Women in the upper 40% of activity were between 1.34 and 1.99 (for the top 20%) times more likely to successfully make it to age 70 without major health issues, compared to women in the lowest 20% of activity.

Now, if we could just find a way to make exercise fun!

Breast implant exchange surgery

It's not uncommon for women who have already had a breast augmentation some years ago to come and consult with us about an implant exchange. Most commonly, this is for reasons of wanting a different size; most often a little bit larger, sometimes a little smaller. People do change their minds about the look they want, compared to their original implant choice, and we understand that.

In situations like these, where the breast is soft (doesn't have capsular contracture) and the pocket where the implant sits is in good shape, we can do what's termed a "simple" implant exchange surgery.

This involves helping the patient select the desired new size and shape, and going to surgery to replace the older implants. There's definitely a skill to selecting the new implant - and we've got a few little tricks for this!

With the resurgence in popularity of silicone gel implants, many women who first had breast implant surgery back in the "saline-only" era often consider switching to silicone gel implants. Here at our Orlando practice, four out of five patients who have experienced both types of breast implants tell me that they far prefer the gel implants. Gel implants also help to reduce wrinkle and ripple problems in the slender patient with saline implants. Using a different implant shape can also be a helpful suggestion. This keeps the implant width proportional to the patient's frame, but allows more (or less) fill up front, where most patients want it.

At surgery, we can typically use the same surgical incision - so there are no new scars. And if the old scar has widened out, we get a chance to revise it during surgery, and hopefully get a nicer looking scar.

Most women are pleasantly surprised: the recovery from a "simple" implant exchange is usually very easy, with little pain, bruising or swelling. Since the pocket for the implant is already present, and only few small adjustments need to be made to the tissue pocket, the recovery is much quicker.

More complex implant exchange surgeries involve the correction of tissue stretch or pocket expansion, or the correction of scar tissue / capsular contracture issues. As the name suggests, these surgeries are much more involved. But that's a topic for another day. Cheers!!

Allergan "LashPerks" - save $20 on Latisse

If you are a fan of Latisse, the eyelash lengthening treatment from Allergan, now you can sign up with the company's LashPerks program, on their website (link) - and get a $20 rebate from Allergan. :)

Offer only for first-time registrants to the program. Expires 5/4/2010.

Spring Specials 2010

Yes...they're here!! Plastic Surgery specials for Spring 2010 (Feb - Apr).

You can find all the details on our website (link)

Included are discounts on breast augmentation, Botox, Juvederm, microdermabrasion and laser hair removal.

Now you can get the best - for a little less! Yay!!

Juvederm XC announced - more comfortable injections

Allergan, Inc. announced today it has received approval from the U.S. Food and Drug Administration (FDA) for JUVÉDERM® XC, which is JUVÉDERM with a little xylocaine added in. Xylocaine, known in the U.S. as lidocaine, is a local anesthestic agent used for numbing the skin, and this should make the injection process significantly more comfortable for our patients.

JUVÉDERM® also received their "one year indication" from the FDA, which means they are now permitted to advertise as having "the first and only hyaluronic acid dermal filler approved by the FDA to last up to one year from initial treatment".

In the clinical study comparing JUVÉDERM XC (with lidocaine) to regular non-lidocaine JUVÉDERM, 93 percent of patients reported less pain when treated with the new formulation of JUVÉDERM, while maintaining a similar safety and effectiveness profile to the non-lidocaine formulation of JUVÉDERM®.

Of course, don't use this product if you have a lidocaine allergy.