Implant rotation: a problem for "gummy bear" implants?

In this month's issue of Plastic and Reconstructive Surgery, a new report describes a frequent problem with the McGhan style 510 implant: implant rotation.

The style 510 implant is not available here in the U.S. market, but is used extensively in Europe. It has a "teardrop" or "anatomic" shape, and is filled with two layers of form stable silicone gel. Some people call this a "gummy bear" implant, due to the thick consistency of this type of gel.

In a series of 73 breast augmentations with this implant, 12 (8.2%) patients had a problem with implant rotation, giving a peculiar breast shape. Of these, more than half (7) required re-operation to fix the issue. This is a high percentage for what is usually a rare problem.

There was no particular cause to explain the problem. It was unrelated to implant size, patient BMI or other obvious factors. Findings at re-operation did not explain the cause either. Based on this series, the authors have abandoned their use of the 510 style implant for cosmetic breast augmentation.

Of course, we're still waiting for the FDA to make up their mind about approving the "gummy bear" type of implants for the U.S. market. Once again, Europe and Canada are far ahead of the U.S. with this. On the plus side, they'll have worked out all the problems by the time we get to use the implants!

Vitamin B12 and folate fail to protect heart in new study

Background: For the last few years, cardiologists have been following a blood test called homocysteine, as a risk indicator for heart and stroke. Previous studies have showed an association between lower homocysteine levels and lower coronary heart disease. However, no studies have yet been able to prove a benefit (i.e. less heart disease) from interventions which lower homocysteine.

This week, in JAMA, the latest study on this topic was published. It was a double-blinded, randomized, placebo-controlled trial (the best kind) of 12,000+ people who had previously survived a heart attack. They were given vitamin b12 and folate supplements, which are known reduce homocysteine levels by about 30%. During the 6.7 years of follow up, it was found that even though the blood levels of homocysteine were lowered by about 28%, there were no apparent beneficial effects on major coronary events or other non-coronary vascular events. The vitamin supplements didn't cause any harm, though, with no changes in mortality or the appearance of other cancers.

Sadly, the vitamins didn't help. The homocysteine molecule itself doesn't seem to have a direct effect on the heart.

What does this mean? We have to focus on what actually has been proven to work when it comes to risk reduction for heart disease: lifestyle changes (like avoiding excessive weight gain and quitting smoking), controlling blood pressure and cholesterol, and so on. Vitamin B12 and folate supplements, unfortunately, are not the magic bullets.

Chocolate Milk: the new post-exercise drink?

This one sounds almost too good to be true, but it comes from a reliable source, and as a chocolate lover, I just have to pass it on! I'd certainly rather have a tall, cold glass of chocolate milk than an electrolyte-based sports drink after a work-out!

Source: MDLinx

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New research suggests drinking chocolate milk after a workout offers advantages for post-exercise performance and muscle repair

BALTIMORE (June 2, 2010) – One of the best post-exercise recovery drinks could already be in your refrigerator, according to new research presented at the American College of Sports Medicine conference this week. In a series of four studies, researchers found that chocolate milk offered a recovery advantage to help repair and rebuild muscles, compared to specially designed carbohydrate sports drinks.

Experts agree that the two-hour window after exercise is an important, yet often neglected, part of a fitness routine. After strenuous exercise, this post-workout recovery period is critical for active people at all fitness levels – to help make the most of a workout and stay in top shape for the next workout.

The new research suggests that drinking fat free chocolate milk after exercise can help the body retain, replenish and rebuild muscle to help your body recover. Drinking lowfat chocolate milk after a strenuous workout could even help prep muscles to perform better in a subsequent bout of exercise. Specifically, the researchers found a chocolate milk advantage for:

- Building Muscle
- Replenishing Muscle "Fuel"
- Maintaining Lean Muscle
- Subsequent Exercise Performance

Chocolate milk's combination of carbohydrates and high-quality protein first made researchers take notice of a potential exercise benefit. The combination of carbs and protein already in chocolate milk matched the ratio found to be most beneficial for recovery. In fact, studies suggest that chocolate milk has the right mix of carbs and protein to help refuel exhausted muscles, and the protein in milk helps build lean muscle. This new research adds to a growing body of evidence suggesting milk can be just as effective as some commercial sports drinks in helping athletes refuel and recover.

Milk also provides fluids for rehydration and electrolytes, including potassium, calcium and magnesium lost in sweat, that both recreational exercisers and elite athletes need to replace after strenuous activity. Plus, chocolate milk is naturally nutrient-rich with the advantage of additional nutrients not found in most traditional sports drinks. Penny-for-penny, no other post-exercise drink contains the full range of vitamins and minerals found in chocolate milk.

Tummy tuck or liposuction?

Wanting an attractive tummy is a popular request at our office. But many people are unsure about the differences between tummy tuck and liposuction. The two operations are quite different. Let me explain...

To start, we have to evaluate four different layers of the abdomen, and how they each contribute to the appearance of your abdomen. These are:
- the skin,
- the thickness and distribution of the subcutaneous fat,
- the abdominal wall,
- internal ("visceral" ) fat.

Then, we recommend the most appropriate surgical option.

Liposuction, for example, works very well to reduce the thickness of subcutaneous fat. And that's about it, in our 4 layer model. Liposuction is powerless to fix muscle wall problems, to treat visceral fat, or tighten skin. So - liposuction is the wrong tool to use if we find that the patient has any of these three issues.

A tummy tuck, works well to tighten loose abdominal skin. At the same time, muscle tightening is commonly done to repair "rectus diastasis", separation of the abdominal wall muscles. But the tummy tuck is powerless to treat internal (visceral) fat.

Visceral fat - that stubborn internal fat that gives us the "apple" or "beer-belly" shape - is the bad stuff. It's linked to diabetes, high blood pressure, heart disease and strokes. We can't get rid of it surgically. The only existing treatment is the hard work of low-fat diet and exercise. Once that internal fat is reduced in volume, then we can usually fix the rest. So, for some patients, the first step is getting their lifestyle under control, and getting down to a healthier weight.

How can you tell what part is subcutaneous fat and what part is internal fat? Here's an easy method: lie down on your bed on your back, and lift your head off the bed, as though your were about to start a sit-up. This tightens the abdomen. Now grab the tummy fat while keeping the muscles activated. You are now feeling your subcutaneous fat thickness. Anything else - unless you have a hernia - is behind the muscle wall, or internal.

Can you be addicted to tanning?

It's controversial, but some new studies suggest there may be people who have addictive behavior patterns when it comes to tanning and the use of UV tanning beds.

A recent study published in Archives of Dermatology, by researchers at Memorial Sloan-Kettering Cancer Center and the University of Albany, found that 27 percent of college students surveyed have a psychological dependence on tanning in UV-light beds and booths.

The researchers suggested that the "tanning addiction" includes symptoms that are really quite similar to those that alcoholics or smokers experience, such as tanning with ever-increasing frequency, having withdrawal issues, or trouble stopping the habit.

The college students who were addicted to indoor tanning were also more likely to have symptoms of anxiety and/or greater use of alcohol, marijuana, and other substances, than their peers who were not addicted to indoor tanning.

Tanorexia: now it's a recognized disease syndrome. Who knew?

Can anybody perform liposuction?

When it comes to crowded markets, Southern California has got to be tough for those offering liposuction. There's competition around every corner, it seems.

Recently, a study in Plastic and Reconstructive Surgery did a survey of liposuction providers in Southern California, and the results were eye-opening in terms of surgical training and experience.

They found that in the 45,000 square mile area encompassing Los Angeles and San Diego, there are 1867 cosmetic practitioners of all backgrounds.

- Of these, 834 offered liposuction.
- only 495 of the 834 were trained in plastic surgery,
- 140 were trained in ENT (ear/nose/throat),
- 63 were trained in dermatology.
- Most of the rest were primary care doctors, Ob-Gyn, Ophthalmologists or General Surgeons.

The study found that nearly 40% of liposuction practitioners in Southern California had no surgical training in liposuction before entering practice.

Not surprisingly, the mainstream media picked up on this. Here's the story presented in the LA Times. (link)

So it becomes a question of patient safety versus free-trade. Traditionally trained plastic surgeons, like myself, favor limiting liposuction to those specialties that have actual surgical training, and in particular, training in liposuction. After all, liposuction is an invasive surgery, with potential for real complications. Patient safety is certainly an issue. The non-surgical types, on the other hand, counter with cries of "turf battle" or "restraint of trade".

My opinion: Not just anyone should be allowed behind the controls of a 747. Do you want a Captain Sullenberger (miracle landing on the Hudson river) as your pilot, or do you want some guy who's seen the movie "Top Gun" a few times?

I know what my choice would be. Lawmakers and consumers need to make up their minds.

OT: The Longevity Game

Here's a fun little calculator that estimates your expected life span, based on your BMI, driving record, exercise and smoking habits, and so forth. It's from Northwestern Mutual, the life insurance people. (I have no business association with them.)

Click here for link

I don't have detailed information on the calculations used, but the initial page suggests that actuarial data was used to model the outcomes. Give it a try and see how your habits influence the numbers...

Thanks to Chuck Cooper for showing me this!

Could tobacco plants give us younger skin?

It's well-known that smoking tobacco ages the skin in an accelerated way. But now, a clever researcher has figured out how to make genetically-altered tobacco plants do something really cool - make collagen, which is the main protein in our skin. And that certainly gets my attention for potential cosmetic uses, even though this technology is at a very preliminary stage.

Here's the story, courtesy of Yahoo News....

Will tobacco plants provide the next cosmetic filler? Very possibly, according to findings recently published in the journal Biomacromolecules.

Researcher Oded Shoseyov of the Hebrew University of Jerusalem has figured out how to get tobacco plants to produce a human-like collagen. Collagen is the main protein in skin, tendons, cartilage, bone and connective tissue. It typically declines during the normal aging process, allowing cheeks to sag and wrinkles to set in.

While primarily being marketed for medical purposes - such as for bone and heart repairs - the new synthetic collagen may someday be used cosmetically.

"This is a very unique collagen," said Noa Lapido, assistant vice president of CollPlant, the company handling the patents coming from Shoseyov's laboratory. "It is very very similar to human collagen and, as it has not come in contact with any animals, it is much better and much safer than other collagens."

It is not that tobacco plants naturally have these beautifying or medical benefits. Producing human-like collagen from a tobacco plant is a technological feat, involving the simultaneous "turning on" of five specific genes in a genetically modified tobacco plant.

Cosmetic uses of the new collagen are currently unlikely, Lapido said, as the price is several hundred to several thousand times more expensive than other options. But it may become more reasonable, she said, "in a few years time."

Website beauties: models or actual patients?

Nearly all cosmetic surgeons now have glitzy, professionally-produced websites. They typically feature images of beautiful women, showing off toned tummies, sleek silhouettes or fabulous faces. It's the sizzle that sells the steak.

We have this on our website too...but there's an important difference. All the ladies you see on our website are our actual patients. They've all had cosmetic surgery performed by me.

Most websites instead use what's known as "stock photography", where the web designer goes to a photo bank, and gets a pretty-looking image to use. It's a professional model, not a patient of the surgeon's.

Scrupulous web designers will put in a little disclaimer - "model shown", "not a surgical patient" or something of that nature. But most do not. Admittedly, it is a little misleading and can raise unrealistic expectations, but it is, unfortunately, a common practice in the industry.

The next time that you are checking out an aesthetic website, whether it's a dermatologist, plastic surgeon, or some other provider, see if there's any disclaimers next to the images of the gorgeous supermodels.

I'll bet that 95% of the time, you won't see any.

Congratulations: Grace Medical Home

Once in a while, people get together and do something pretty special.

Here's a good example: a team of physicians, nurses and community-minded volunteers have joined together, and after years of planning, have opened a new medical facility in downtown Orlando, to serve low income (up to 200% of the federal poverty level) or uninsured people needing medical care.

It's called Grace Medical Home, and it's located at 51 Pennsylvania Street, near ORMC. They do both adult and pediatric care, and have onsite X-ray and lab facilities, too.

Congratulations to Dr. Marvin Hardy and Dr. Kirsten Carter, who are the driving forces behind this project, and who are "walking the walk", working at the center.

I'm told that the amount of support from the community, in terms of time, energy and donations, has been huge. Grace Medical Home will be meeting a real need in our community. Well done, everyone!

Read more at gracemedicalhome.org

Dysport: "Love or leave it" challenge extended thru September

Good news for patients who like Botox and Dysport: Medicis, the makers of Dysport, is extending their "Love it or leave it" challenge, which we detailed here, (link) until the end of September 2010. You can save up to $150 with the promotion, if you qualify for it.

According to the company, of the 49,000 people that have tried it, 90% reportedly voted "love it" for Dysport. Of course, that's a corporate press release...maybe they voted that way because of the cash rebate, we'll never know!

Questionable "experts" in tabloids

Recently, one of our favorite anesthesiologists brought in a tabloid magazine for our amusement. It features 3 buxom young females on its cover, with the breathless headline "Top 5 Hollywood Plastic Surgeons Tell All". (It certainly looks like all 3 ladies have had a little help from their local plastic surgeon.)

I wasn't particularly interested in the opinions, but I was quite interested to see who was selected as the "Top 5", as these rankings are usually purely arbitrary at best, and completely unreliable at worst. I started thinking about the surgeons I would recommend in Los Angeles, those with excellent reputations, stellar work, and real contributions to our specialty. Then I read the article. Much to my surprise, not a single surgeon that I thought of was in the tabloid's list!

The article listed 6 physicians. So, I spent a few minutes researching each of them by reading their CV, as posted on their own websites, to find their qualifications.

Of the 6 "Hollywood top plastic surgeons" in this article:

- only 2 are certified by the American Board of Plastic Surgery. Two others are ENT / facial plastic trained. Facial plastic surgeons are certainly reasonable to ask regarding comments on cosmetic surgery of the face, but not for comments on plastic surgery of the body, as it is outside their field of expertise.

- One is a D.O. who does not appear to be board certified in Plastic Surgery. The other is a chiropractor with no surgical training.

- Three of the 6 appear to have less than 10 years experience in practice.

- Two of the 6 aren't even practicing in California, let alone Hollywood!


Bottom line: beware of so-called experts in tabloid magazines. Once again, if you want a real plastic surgeon, check their credentials for Board Certification by the American Board of Plastic Surgery. If you are Canadian (like me!), look for certification by the Royal College of Surgeons and Physicians of Canada in Plastic Surgery.

If your doctor doesn't have one of those certificates hanging on the wall, and claims to be a board-certified Plastic Surgeon....then run, don't walk, to the nearest exit.