Tightening up Florida liposuction requirements - it's about time!

According to the Sun-Sentinel, there is a bill working its way through Tallahassee which will make some improvements to safety standards for office-based liposuction.  Honestly, it's about time!

The bill would require liposuction of more than 1000 cc of fat to be done in surgery suites inspected by the state, and would require doctors to have life-support training.  Currently, many low-cost providers perform liposuction in unregulated physician offices, and lack ACLS training.

I think this is definitely a step in the right direction!  All surgery, in my opinion, should be performed in an accredited setting, with appropriate anesthesia, monitoring, and emergency equipment.  For example, we are inspected and certified by AAAASF.  In addition to myself, an MD anesthesiologist, two registered nurses and a surgical tech are present for all surgeries.  Everyone has an up-to-date ACLS certification.  We have hospital-grade anesthesia monitors and a crash cart with an AED and emergency medications.  Thank goodness, we've never had to use all of this emergency equipment - but we sure are prepared, "just in case".

The bill last week cleared the Senate Health Regulation Committee and now goes to the Senate Budget Committee, where it is expected to pass. This would close the loophole in current Florida surgery regulations that permit physicians to do procedures in an unregulated, non-inspected office setting if they are only using local anesthesia, and the patient is not sedated.

And often, these same practices have the nerve - the sheer audacity - to claim that they are "safer", despite the fact that they have not passed a safety inspection, lack emergency equipment, don't have an ACLS-trained staff member, and don't have the benefit of a trained anesthesiologist present in case of an airway problem!  Talk about spin and marketing B.S!

While this bill is an improvement for Florida patient safety, it could certainly be a lot stricter.  There's still a lot of unregulated med-spa type offices out there that do other surgical procedures, and these are not covered by this bill.

Happy Holidays!

I'd like to wish our friends, family, patients and staff every happiness this holiday season and throughout the coming year.

The best part of this season is remembering those people who make the holidays meaningful. May your holidays be filled with joy and peace.

All the best,
Dr. Fiala

More trouble with PIP, the French implant company

Although this doesn't apply to us here in the U.S., you might remember hearing about some troubles with the French implant maker PIP.  The news initially broke last year that PIP had been using a cheaper industrial grade silicone in their silicone gel breast implants, rather than medical grade silicone.  They were promptly shut down by French regulators.  Now, there's some more news...

This week, the French health ministry said that these PIP brand implants were much more prone to rupture and leakage than normal, and recommended implant removal (and replacement with new, better implants) as a precautionary measure.  They stated there was no evidence of a cancer link due to these implants.  The French government says it will cover part of this cost for patients under their healthcare plan.  (They'll pay to have the implant removed - but not to replace it.)

It is thought that some 30,000 French women, and even more in other parts of Europe and South America have these PIP brand implants.  That's a lot of patients who are potentially going to need surgery.  PIP, now bankrupt, was once the world's #3 manufacturer of breast implants.

The implants we use in our practice, made by Allergan and Mentor, are FDA-approved, and have an excellent track record.  I've been to the Mentor manufacturing facility in Texas, and it is a top-notch facility run using ultra-sterile "clean rooms" with the employees in those "Intel-inside" type sterility suits.

Fortunately, PIP implants were not used in the United States.  However, if you happen to have had your breast implants done in Europe or South America, check to see if you have PIP brand silicone implants.  If you do have them, please come and talk to us about an implant exchange.

Valeant Pharmaceuticals buys Sculptra

In a $425 million deal, Valeant Pharmaceuticals has purchased the dermatology unit of Sanofi-Adventis.  For us, this means that Valeant will now be in charge of marketing Sculptra, the facial injectable filler agent.

Sculptra is different than other dermal injectable fillers, like Restylane or Juvederm. It stimulates your body to produce some lost collagen, which can gradually improve the quality of the skin and reduce wrinkling and deep hollows. It also lasts up to two years. It's been quite helpful in restoring hollow cheeks and temples, as well as improving deep naso-labial folds. It's quite popular here at our Orlando office.

According to our Sculptra rep, we may be seeing more direct-to-consumer marketing of Sculptra with the new owners, but little else will change.  So far, we haven't heard about any pricing changes, either.

Sanofi, apparently decided to divest its dermatology business with the intention to further concentrate on its core products.

How can we get upper pole fullness without using breast implants?

Upper pole fullness is the term plastic surgeons use to describe the desired shape of the upper part of a breast.  Many women like the look of some upper pole fullness.  The challenge for us is how to make this shape during surgery, and have it stay there.

Certainly, breast implants are a proven way to get upper pole fullness.  Moderate and high profile implants, whether they are saline or silicone gel filled, clearly create that fullness and roundness.  I  call this "the implant look".

Fact is, it is a real challenge to get the uplifted "implant look" without using breast implants.  Not that surgeons haven't tried:  if you look at the literature on breast lifts and breast reductions, there are literally dozens of strategies that have been tried.  There are the "internal bra" methods, the internal suture methods, internal tissue re-arrangments, and many more.  These may very well work for the first month or two, especially while the breast is still swollen from surgery - but the real question is, do they last once the swelling has gone?

Dr. Elizabeth Hall-Findlay, the talented plastic surgeon from Canada and author of a textbook on surgery of the breast, did her own experiment on this problem.  She tried virtually every sensible method during breast lift surgery to try to solve the mystery of how to get persistent upper pole fullness without an implant.  She presented her results at a recent plastic surgery conference.  She found that, although the results looked promising initially, by 6-12 months after surgery, the shape of the breast returned to what it was pre-operatively, and that the fullness was lost.  Nothing really worked; all of the methods she tried failed to give lasting upper pole fullness.

This month, in PRS, comes a new study reviewing 82 major previous publications in breast lift surgery.  Careful photometric analysis was done of the techniques.  Once again, it's a disappoinitment.  With the possible exception of fat-grafting to the breast, the author found that  upper pole fullness "was not increased by any of the mastopexy / reduction techniques, or by the use of fascial sutures or autoaugmentation techniques".

In other words, all the methods touted for upper pole fullness failed to work.  So put internal lifting sutures, auto-augmentation, and the "internal bra" on the scrap-heap of discredited methods.

What does this mean for patients?  Simple:  if you want the "implant look", you have to have an implant.  Fat grafting might be an option, too - but we're still waiting for the studies on that one.

Fibrin glue doesn't prevent seromas after tummy tuck

Seroma - a post-operative fluid collection - is the most common complication after a tummy tuck.  It happens in about 5-10% of abdominoplasties.  Surgeons generally try to prevent this problem by using one of three strategies - suction drains, internal "quilting" sutures or fibrin glue. Each technique has its advocates, and arguments about which technique is best persist at the plastic surgery meetings.

So, a comparison study of the techniques was inevitable. In the study I'm reviewing today, published in Aesthetic Plastic Surgery, 43 tummy tuck patients were divided into 3 groups, receiving either drains, quilting sutures or fibrin glue during closure of their tummy tuck. Ultrasound scanning was then used to check for the presence or absence of fluid at 15 and 30 days post-op.

Results: both quilting sutures and drains worked significantly better than fibrin glue.  Seromas were less common at 30 days than at 15 days in all treatment groups.

Comment:  This result pleases me, since I use one of the better techniques (drains) when I perform a tummy tuck.  Also, fibrin glue is quite expensive,so avoiding its use saves some money for the patient.  The fibrin glue, even though it sounds high-tech and modern, failed to perform here.  The results of using fibrin glue during facelift surgery have also been unimpressive in other studies.

In general, seromas are more common if:

- liposuction is performed at the same time as a tummy tuck,

- in patients that are having an abdominoplasty following gastric bypass surgery with massive weight loss

Fortunately, most of the time, even if a seroma appears, it's a minor, short-term nuisance, and is easily handled.

Dr Fiala submits article to Aesthetic Surgery Journal

Observant readers will have noticed that I recently took a little break from blogging- and you're right.  I've been working on a manuscript for the Aesthetic Surgery Journal, which is one of the most respected journals in our specialty... and I just finished it and submitted it to the journal today.  Hopefully, with a little luck, the editors will like my paper, and we'll be seeing it in print in a few months!

So now, I can get back to blogging about new and cool developments in plastic surgery, as we usually do here at PSB: the Plastic Surgery Blog.  New stuff coming soon!