Merry Christmas!!

Best wishes to all our friends for a happy and safe Christmas. Thank you all for your support and friendship during the past year. I hope that Santa will be good to all our friends!

Happy Holidays from Dr. F. and the entire team!

OT: Echinacea fails to improve common cold

According to a new study in the Annals of Internal Medicine, echinacea, the popular herbal remedy, was no better than placebo in helping the symptoms of the common cold.

In the study, 719 adult Wisconsin residents with early signs of a cold were assigned to receive placebo, nothing at all, or echinacea over a 5 day treatment course.

Sadly, the echinacea pills were not measurably better than placebo at speeding recovery time or reducing the severity of runny nose, sore throat, cough, and other symptoms.

So, if echinacea has effects on a cold, its effects are mild. There were no adverse effects reported in the study due to echinacea treatment.

Echinacea fans are disputing the findings. More details here at health.com:(link)

Another step closer to the "bionic man"?

This is like Luke Skywalker's artificial hand...except it's not a Hollywood special effect. There's some pretty cool research coming out of the University of Michigan, which one day, might allow amputees to control prosthetic limbs with their thoughts and own nerve impulses. My friend from residency, Dr. Paul Cederna, is one of the team working on this. His project, called a “bio-artificial neuromuscular junction,” connects a sophisticated robotic prosthesis directly to the peripheral nerves.

The key step is creating the junction between the remaining nerves which still work, and the device. And this is where a little high-tech cell biology comes in: Dr. Cederna’s team harvests muscle cells from the patients themselves and grows them in culture. The muscle cells are then transferred to a scaffold coated with an organic polymer called PEDOT, which conducts electricity. The whole device is then assembled together and attached to the end of a severed nerve. The device converts instructions from the nerve to an electronic signal that wirelessly controls the prosthesis.

“Because the device uses muscle tissue as its anchor, the nerve actually grows into it and reinnervates the muscle cells – just as it would if it were attached to a normal arm or leg,” adds Cederna. “After a few weeks, the nerves establish connections with the muscle cells and stabilize. In the end, we have long-term connection of nerve to muscle.”

So far, the peripheral nerve interface has remained stable for more than 18 months and counting in animal trials. Obviously, the real test will be how long they last in humans,” says Cederna, who is optimistic human trials will start within three years.

If connected to a high-tech prosthetic device equipped with sensors in the fingertips, Dr. Cederna’s device could also convert signals in the prosthesis into an electrical current that would feed into the sensory nerves and deliver that sensation back to the brain, so then the brain knows what the prosthesis is feeling.

“Really, the only limit would be how high-tech this prosthesis can be. If they can put a pressure transducer and light touch sensors in the prosthesis, someone might be able to reach down, grab a cup of hot coffee in a Styrofoam cup and pick it up without dropping it because they can feel how much pressure they have on the Styrofoam cup without crushing it. Even more exciting would be the ability to reach down and grab their child’s hand, feel the warm touch of the hand, and not hurt the child by closing the hand too tightly,” adds Cederna.

Nearly one out of every 200 people in the U.S. has an amputated limb, and more than 185,000 new amputations are performed every year. If this research comes to fruition, the prospects for both civilian and military amputees would be huge.

Fat grafting to the breast & Mammograms

Currently, one of the big controversies in Plastic Surgery is the topic of fat grafting to the breast, either for post-cancer reconstruction or cosmetic purposes. For years, there have been concerns about the changes that can occur if the injected fat doesn't take in the new location, creating scar tissue. The worry is, of course, that the lump of scar tissue in the breast can look and feel like a breast cancer. Certain scar tissue patterns, on a mammogram, can look just like a breast cancer, and require a biopsy to sort out.

So, any science (rare) as opposed to opinion (frequent) on this topic is welcome news.

At the recent IFATS meeting in Dallas, Dr. Peter Rubin and his team from the University of Pittsburgh presented an interesting review of mammograms following fat grafting to the breast versus mammograms after a standard breast reduction.

They looked at one of the most well-documented series of fat grafting patients, those of Dr. Yoshimura in Japan, who performed breast enhancement with fat grafts which were "turbo-charged" with additional stem cells from the Cytori Celution 800 machine. These 27 patients all had pre-op and 1 year post-op mammograms. These 27 were matched with one year post-surgical mammograms from 23 age-matched women who had undergoing breast reduction surgery.

Then, 8 University of Pittsburgh radiologists with experience in mammography
reviewed each of the 50 post-surgical mammograms without knowing the procedure that had been previously performed, and their comments were tabulated.

Results: Differences in abnormality rates were about the same between the two groups for the findings of oil cysts, benign calcifications and calcifications warranting a biopsy. Scarring and masses requiring biopsy were actually more common in the breast reduction group.

Based on this review, Dr. Rubin, who is a well-respected plastic surgeon and stem-cell researcher, felt that lipoaugmentation of the breast, when performed with Dr. Yoshimura's specific method, had mammographic results that were equal or better than the results after reduction mammaplasty, which is a well-accepted procedure.

Currently, Cytori is still waiting for FDA approval of their Cellution machine. Only surgeons who are using this machine can duplicate Dr. Yoshimura's technique. For all the other methods of fat grafting out there, questions about mammography still remain unanswered.

New version of our iPhone App is now out!

As promised, version 2.0 of our iPhone app, "Plastic Surgery with Dr. Fiala", is now available. You can find it online at the Apple store here. Over 6000 people have downloaded our app, making it one of the most popular plastic surgery-themed apps currently available.

New features & improvements in version 2 include:

- Improved Appointment Scheduler - Now when you add appointments, the appointments will automatically be saved into your iPhone/iPad/iPod Touch Calendar, rather than just inside the app itself.

- 2 Appointment reminders are set for each appointment, 24 hours before appointment and then 1 hour before appointment.

- Added Notes feature. Going to a Doctor's office and want to remind yourself which questions to ask? Now you can with our notes feature.

- eBook Feature - When you download our app you receive our free ebook about how to select a plastic surgeon, and preparing for surgery.

- new, prettier looking graphic interface.

- Video Gallery

...and more.

And of course, you can review before and after photos of common plastic surgery procedures, send us messages and photos directly, and keep track of important personal medical information, and all the other usual functions of version 1.0

Thanks to Dave Tessitore, our all-star app developer, for his work on this, keeping us in the technological forefront of plastic surgeons in Florida!

"Beauty Sleep" really does help!

According to a new study in the British Medical Journal (link), the concept of "beauty sleep" really is true. Investigators at the Karolinska Institute in Stockholm, Sweden compared standardized photographs of sleep-deprived adult volunteers (31 hours of wakefulness after a night of reduced sleep) versus photos of the same person after a normal night’s sleep (eight hours). The photographs were rated by untrained observers.

The results: Even though the differences were subtle, sleep deprived people were rated as being significantly less healthy and less attractive than after a normal night’s sleep. The decrease in rated health was associated with ratings of increased tiredness and decreased attractiveness.

It seems that we are quite sensitive to detecting the subtle sleep-related facial changes, even without consciously thinking about it.

I'm sure that parents everywhere are rejoicing in this news - now they have scientific proof to send their teenagers to bed earlier!

FDA panel recommends Lap-Band for "lighter" patients

Last week, an FDA advisory panel voted in favor of adjusting the rules under which the Lap-Band Adjustable Gastric Banding System, made by Allergan, can be used - potentially allowing more people to qualify for the weight reduction device.

Currently, the Lap-Band is an option for patients with severe obesity (BMI > 40, or a BMI > 35 with severe comorbid conditions) or for those who are at least 100 pounds heavier than their estimated ideal body weight.

The panel voted to liberalize the rules of use, allowing the device to be used for weight reduction in patients with a body mass index (BMI) of 30 to 40.

The FDA reviewed a new study of 151 patients with a BMI of 30-40, who had the lap-band surgery. The study found that 66% of the patients lost at least 50% of their excess weight at 1 year, or an average of 40 pounds of weight loss. These results were felt to be very significant by the FDA panel.

Reoperations were necessary in less than 5% of patients. The most common device-related adverse events were vomiting in 20.0%, trouble swallowing in 15%, and gastroesophageal reflux disease in 10% of the patients.

Now, we wait for the full FDA approval of the panel's recommendation...If it passes, this would significantly change the practice of bariatric surgery in the United States.

Plastic Surgery and break-ups

A recent Washington Post article (link here) discusses the phenomenon of getting plastic surgery to feel better after a break-up or divorce. While that certainly does happen, the obvious concern for me as a surgeon is that people would be potentially making big, life-changing decisions about undergoing surgery while they still may be pretty emotional or stressed. It's certainly better to let a little time go by. "I'll show him who's hot" is perhaps not the best reason to have surgery!

We also see the flip side of things - people in shaky relationships who separate sometime after the plastic surgery is completed. It's usually a case of a lady who suddenly feels a whole lot better about herself, and who realizes she has choices and options she didn't think she had before. Or maybe she feels that she doesn't have to put up with certain situations any more...

Sometimes the shot of self-confidence that plastic surgery brings can have unexpected consequences!

OT: a little travel humor

With the holiday travel season fast approaching, I've been thinking a bit about TSA's X-ray scanner. I'm all for effective security measures, but I'm not a fan of the travellers dilemma: TSA pat-down / assault versus the who-knows-whether-it's-really safe X-ray scanner run by non-medical people who have no idea what they're using.

Surfing the net, I found the perfect answer to express my frustration. It's a T-shirt, with the U.S. Constitution's fourth amendment on it - the one prohibiting unwarranted searches - but it's written in metallic ink.

It's a normal looking T-shirt, but when you go thru the TSA X-ray machine, the printed message on the shirt lights up like a Christmas tree on the TSA's computer view-screen.

The company also makes boxer shorts with the same message!

Cellulite: non-invasive treatment round-up 2010

Let's face it - if modern medical science had an effective treatment for cellulite, the world would beat a path to its door. Even slender women can have the dimples and irregular skin contours with this cosmetic issue. So what can be done about it?

Modern cellulite treatments really began with the Endermologie and later, the Synergie machines. Both of these combine massage by the treatment head of the machine with a gentle vacuum on the area being treated. The Endermologie machine has mechanical rollers, the Synergie does not. While these machines both temporarily help with cellulite, I feel their best application is to reduce swelling following liposuction.

The next major breakthrough was the addition of some form of energy to the treatment head. Energy can be applied to the skin and subcutaneous fat using ultrasound, radio-frequency (RF) energy or infra-red energy, or all of the above. All methods achieve the same goal - heating of the tissue, with activation of collagen production and tissue shrinkage. Early pioneers in this area were Thermage (RF energy) and Titan (infra-red). Some people got a reasonable improvement, others had little response - and frankly, it was hard to predict who would get which result.

Now, manufacturers are offering machines that combine treatment types. BTL's Exilis machine combines RF and ultrasonic energy. Smoothshapes combines mechanical massage with laser and light. Velashape II uses RF, infra-red and massage. The Vaser Shape MC1 combines modulated ultrasound and massage. Viora's Reaction combines several different RF frequencies and vacuum.

These companies, and the many others that are on the market, all have glossy websites that show some lovely before-and-after photos. All the machines work, to some degree. Most have FDA clearances, showing their safety. Each company has pitchmen-physicians that love and use their particular product. Often, there are corporate-sponsored studies that document some improvements due to treatment.

Yes, there are visible improvements in cellulite. However, I feel that the results shown are fairly mild, for most of the machines. It's better, but it's no magic wand. And of course, I'm sure the manufacturers are showing their very best results ever on their webpages. Scientifically, we don't really yet know which machine or treatment method is best - as there aren't any comparison, head-to-head type studies. We don't really know exactly how much energy or which ultrasonic or RF frequency is optimal. We don't really have a good handle on who will respond effectively to the treatments, something that is rarely discussed on a manufacturer's webpage!

I'm still waiting for the "new, improved world-champion" cellulite treatment device to come along. Currently, I'm continuing to evaluate the new technologies that are on the market - and I promise to keep PSB readers updated with any new or exciting developments I find here.

Does a vegetarian diet prevent cancer?

Bad news for those of you hoping to reduce their cancer risk by eating a diet rich in fruits and vegetables: it doesn't seem to work. The results of a decade-long epidemiologic study in the British Journal of Cancer (link) seem to suggest there is no protective effect between fruit and vegetable consumption and several of the most common cancers- such as lung, breast, colorectal or prostate cancer.

Initial studies in the 1990s appeared to show that those with a low intake of fruit and vegetables were at greater risk of developing cancer. More specific follow-up studies, however, have concluded that larger intakes of fruit and vegetables do not offer greater protection.

This study, from Oxford University, recommends that we should continue to include "at least a moderate amount of fruits and vegetables" based on basic nutritional principles, but that increasing this level would not have much effect on cancer rates. Instead, the study's author suggests that we need to really look at the adverse effects of obesity and high alcohol consumption rates.

However, my vegan friends need not despair: in a separate study, the incidence of coronary heart disease or stroke was 30% lower for those consuming five or more servings per day compared with those eating less than 1.5 servings of fruits and vegetables per day.

So once again, mom was right: an apple a day is a good thing. It just doesn't prevent cancer.

Personality types and Plastic Surgery

While the vast majority of our patients are lovely, well-adjusted people who I enjoy meeting and helping, Plastic Surgery certainly does attract some of the more unusual personality types... Sometimes, it's actually better for everybody not to operate.

When I was researching for this post, I found this wonderful piece by my colleague, Dr. Ramona Bates (link to blog). She has graciously allowed me to reproduce it here.

*****

Patients I need to watch for when doing aesthetic procedures - Dr. R Bates

1. Inflated Expectations

- Patient tends to be "deaf" to any attempt to educate them as to what their surgery will entail.
- They seem to have difficulty digesting the fact that there any major procedure carries some degree of inherent risk.
- Will use the results of computer imaging as a warranty, rather than the possibility intended. Computer imaging does not take into account healing quirks, skin thickness/elasticity, etc.


2. The Demanding Patient

- The patient who brings you celebrity photographs with modifications that they want you to duplicate even though the celebrity is a completely different body type (apple vs pear).
- The patient who brings you a picture of themselves with overlays of the changes they would like. If they can be made to understand that the human body is not clay, but tissue that heals with scars (sometimes predictable, but not always) then this can be a good start to a discussion.
- The patient who demands no scar. Plastic surgeons are not magicians. When skin it cut, there is always a scar.


3. The Surgiholic

- Patients who have had multiple (There does not seem to be a good number to put here. Is three too many or is six?) previous aesthetic surgeries.
- The patient who had multiple surgeons for their previous surgeries. You will be compared to Dr. X.


4. Marital or Family Disapproval

Yes, the adult patient seeking aesthetic surgery does not require anyone's approval or consent, but ... Secrecy from a spouse or significant other can add stress for both the patient and the surgeon. Someone will need to know how to care for them in the postop period. It helps if they know what was done.


5. Capitulation

The other side of the coin. No patient should be pushed into surgery to please someone else. That other person may not be around in five years, whether by divorce, separation, or death. Will the patient still be glad they had the procedure?


6. Incompatibility

There are some people with whom you just don't feel comfortable. This may be for a variety of reasons. And it may be true from the patient side also. Both may be "nice" people, but may not be comfortable with each other.


7. Body Dysmorphic Disorder

In its simplest definition, it is an obsessive preoccupation with a slight, imperceptible, or actually nonexistent anatomic irregularity to the degree that it interferes with normal adjustment within society.
This disorder may be present in varying degrees. It is the most common aberrant personality characteristic seen by the plastic surgeon.
When postoperative dissatisfaction occurs (and in most cases, it will), it almost always is based on what the patient understood rather than what was actually said.

The bottom line: Not everyone is a good candidate for aesthetic surgery. Sometimes the best decision is not to operate.

December Plastic Surgery specials & discounts

Everybody likes to get a deal, right? Here are our December specials....

- 20% Off Medical Spa Gift Certificates - for Non-Surgical Procedures, Spa Services and Products. Get a $100 certificate for $80! Makes a great gift! The Gift certificates must be purchased by December 31, 2010 and may not be redeemed the same day of purchase.

- Our fantastic 15% Cash Discount For Surgery has been extended due to popular demand, until the end of December. Surgery must be booked (and paid for) before the end of December and completed by February 28, 2011. Of course, I have to make sure that you are a good candidate for surgery, at a consultation.

- 50% Off IPL Laser special for the face, chest and hands has been extended...

- Also, as a "thank you" to our loyal injection patients, we are offering a "Loyalty Reward" special. If you spent more than $1,000 with us on cosmetic injections (Botox & fillers) during calendar year 2010 (usually with several treatments during the year), we're going to give you $150 towards your pre-holiday injection treatment - just to say "Thank you. We appreciate your business". The treatment must be completed by the end of December and is non-transferable.

More details here.

Ho! Ho! Ho! Merry Christmas!