Proven: liposuction and tummy tuck improve Quality of Life

In the "Seems Like an Obvious Result" Category, here is a study from this month's issue of PRS, showing good outcomes and improved quality of life and self-esteem with tummy tucks and abdominal liposuction, either separately or in combination. Here's the summary, courtesy of PS News.


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Dr. Eric Swanson, a plastic surgeon in Kansas, formally evaluated quality of life and other outcomes in 360 patients undergoing liposuction and/or abdominoplasty to remove excess abdominal fat. About 60 percent of patients underwent liposuction alone, while 35 percent underwent a combination of liposuction and abdominoplasty. The rest underwent abdominoplasty alone.

The patients' average age was 42 years; 85 percent were women. Thirty percent of patients underwent other cosmetic plastic surgery procedures (such as face lift or breast augmentation) at the same time. Outcomes were assessed an average of four months after surgery.

Patients undergoing liposuction alone had shorter recovery times: average time off work was about six days, compared to 16 days with abdominoplasty (with or without liposuction). The liposuction-only patients also had less discomfort: average pain score 6 out of 10, compared to 7.5 for those undergoing abdominoplasty.

Combined Procedure Yields Best Results

Patients undergoing abdominoplasty rated their cosmetic outcomes higher than others: average score 9 out of 10, compared to 8 out of 10 with liposuction only. Liposuction plus abdominoplasty produced the highest patient satisfaction rate-over 99 percent-with no increase in pain compared to abdominoplasty alone.

Ninety-eight percent of patients undergoing liposuction plus abdominoplasty said they would undergo the procedure again and 99 percent that they would recommend it to others.

Overall, 86 percent of patients reported an improved sense of self-esteem after surgery. About 70 percent reported improved quality of life, more commonly after liposuction plus abdominoplasty.

Quality of life is an increasingly important focus measure of effectiveness for all types of medical and surgical treatments. Even though liposuction and abdominoplasty are among the most frequently performed cosmetic surgery procedures, few studies have formally evaluated their impact on quality of life and other patient-reported outcomes.

"Liposuction and abdominoplasty, individually and in combination, produce high rates of patient satisfaction and reliably improve self-esteem," Dr. Swanson writes. By formally assessing these important outcomes in a large number of patients, he hopes his study will provide a clearer picture of the expected results and recovery times associated with these widely performed cosmetic surgery procedures.


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Editor's note: We find similar results in our Orlando practice. Tummy tuck, with or without liposuction, makes a dramatic improvement in self-esteem and quality of life, according to our patients.  Kudos to Dr. Swanson for formally documenting this finding.

ASAPS 2011 Cosmetic surgery stats are out - part I

Every year, we look forward to seeing the statistics from ASAPS.  They act as a barometer, refelcting the total volume of procedures in the U.S., and also help us to identify trends in what's popular, and what's not.

Here are some highlights from their report.

1.  If you combine the surgical and nonsurgical cosmetic procedures, there were over 9 million procedures performed in the United States in 2011. Surgical procedures accounted for 18% of the total number of procedures and nonsurgical procedures made up 82% of the total number of procedures.  Women had 91% of the total. The number of cosmetic procedures for women has increased over 208% since 1997.

2.  From 2010-2011, there was almost a 13% increase in the total number of liposuction procedures, with over 300,000 procedures performed. For the first time in three years, lipoplasty has surpassed breast augmentation, returning as the most popular cosmetic surgical procedure in the United States.

3.  The top five cosmetic surgical procedures in 2011 were:
-  liposuction (325,332 procedures)
-  breast augmentation (316,848 procedures)
-  abdominoplasty (149,410 procedures)
-  blepharoplasty (147,540 procedures)
-  breast lift (127,054 procedures).
It's interesting to note that rhinoplasty, which used to be a top 5 procedure, is no longer present.

4.   The top five nonsurgical cosmetic procedures in 2011 were:
-  Botox (2,619,739 procedures)
-  filler injections with restylane, juvederm (1,206,186 procedures)
-  laser hair removal (919,802 procedures);
-  microdermabrasion (499,427 procedures)
-  IPL laser treatment (439,161 procedures).

No surprises here.  Botox and fillers remain popular on the minimally invasive side of things, while breast augmentation, liposuction and tummy tucks are still very popular on the surgical side.

Insider espionage: Allergan wins injunction against Merz

Allergan, the makers of Botox, have announced that they recently won an injunction against Merz Pharmaceuticals and Merz Aesthetics. The injunction prohibits Merz from selling Xeomin, a Botox competitor, in the U.S. for 10 months.

U.S. District Judge Andrew J. Guilford wrote in his decision that Merz misappropriated trade secrets belonging to Allergan.  He wrote, "there is overwhelming circumstantial and direct evidence" that Merz stole the trade secrets and that "Allergan faces a substantial threat of impending injury as a result of this misappropriation."  Allergan claimed that Merz hired seven former Allergan sales reps in 2010, who provided this insider information.

Since the U.S. Botox / Dysport / Xeomin market is very lucrative for these manufacturers, this represents a big setback for Merz.

More consolidation in the laser industry

Big laser companies just keep getting bigger....

This week, Cutera, the California based laser company, announced that it had acquired laser competitor Iridex for $5+ million, adding Iridex and Laserscope-branded devices to their stable of lasers.

Just a few months ago, Solta Medical, the makers of Thermage radiofrequency units and Fraxel lasers, purchased Liposonix, the new FDA-approved fat melting technology, for $35 million.

No wonder those darn lasers are so expensive!

photo credit:  laserfest.org

US adult obesity figures released, 1999-2010

The latest numbers in the American obesity epidemic were released in this month's issue of  JAMA.

Here's the one bit of good news:
-  American women, overall, aren't getting any bigger than they were during the last study, which looked at the 1999-2008 data, but 35.8% of US women still fit the BMI-derived definitions for obesity.  The average age-adjusted BMI was 27.3

The bad news:
-  More American men are obese than before, with 35.5% nationwide (more than one-third) being obese.  Average age-adjusted BMI was 28.7.

By comparison, in England, the prevalence of obesity is considerably less:  22.1% for men, and 23.9% for women.

photocredit: cslacker.com

Mentor updates its moderate profile implant line

Mentor, the breast implant manufacturer, has announced a few minor changes to its line of moderate (low-profile) silicone gel implants.

Effective immediately, the "Moderate" profile line will now be called "Moderate classic".  They've also added a few more in-between sizes, to allow women greater choices.  The shapes have also been slightly updated - they are now slightly more rounded and a little more narrow than before - making them pretty comparable to the Allergan Style 10 implant, in my estimation.

The older "moderate" implant family will be phased out.  No rationale was given for this change.

There have been no changes in the design of the Mentor "Moderate Plus" implant (the most popular one at our Altamonte Springs office), or their high profile implant.

Editor's note:  This minor change should not significantly affect people who are considering the Mentor moderate implant for their breast augmentation - the differences between the old and the new are very subtle.

FDA approves Restylane (officially) for lip augmentation

The U.S. Food and Drug Administration (FDA) has approved another use for Restylane Injectable Gel: this week the agency gave its official blessing to use the filler for lip augmentation.

Restylane was previously approved to treat facial wrinkles. While we have long used it for lip augmentation, this was known as an unofficial or "off-label" use. Restylane is the first filler to get the FDA's approval for this particular use, something that Allergan, the makers of Juvederm, are probably jealous about!

In the multi-center study that Medicis, the makers of Restylane, presented to the FDA, Restylane was found to be highly effective for lip augmentation, for up to 6 months. It did not have any serious side effects. About 80% of patients liked the results so much that they signed up for a second treatment after 6 months.

This is certainly our experience here at our Altamonte Springs office: both restylane and juvederm work very nicely to shape and fill the lips in a pleasing and natural-looking way. Patients love it!

Can liposuction help reduce my cholesterol level?

In a word: no. Liposuction doesn't seem to have any affect on cholesterol.

But a new study, just presented at the ASPS meeting in Denver, suggests that liposuction may help patients who have an abnormally elevated triglyceride level, which is also a risk factor for cardiovascular diseases, such as heart attack and stroke.

Triglycerides (review) are a type of lipid found in your blood. When you eat, your body converts any calories it doesn't need right away into triglycerides, for storage in your fat cells.

The study measured triglyceride and cholesterol levels in 322 patients undergoing either liposuction or a tummy tuck. Triglyceride levels in patients with normal pre-operative levels saw no benefit. However, those patients with elevated triglyceride levels (≥150 mg/dl) experienced an average 43 percent reduction in triglyceride levels after surgery. This occurred in both men and women, and is about double the effect of typical drug therapy for elevated triglycerides.

Study author, Dr. Eric Swanson, said "Patients not only look better, but may be healthier too."

There were no changes seen in total cholesterol, LDL cholesterol, or HDL cholesterol levels after liposuction.

According to the ASPS, liposuction is the fourth most popular procedure in plastic surgery, with more than 203,000 procedures performed last year in the U.S.

Congrats, USA Today

Recently, a series of excellent articles on cosmetic surgery has appeared in USA Today.
I think they're well worth reading, and would like to be among the first to congratulate reporter Jayne O'Donnell on this series. It really highlights the need for careful research when considering cosmetic surgery. Unfortunately, some of the major problems reported in the articles have happened here in Florida. Once again, caveat emptor!


The titles, with links, are:

9/14/11 Cosmetic surgery gets cheaper, faster, scarier

9/14/11 Lack of training can be deadly in cosmetic surgery

9/13/11 Some non-plastic-surgeons disciplined for disastrous results

9/13/11 What to ask when picking a plastic or cosmetic surgeon

When an article on cosmetic surgery makes the top of Page one of USA Today, you know you're dealing with an important topic!

First face transplant in U.S. performed

As reported in detail on CNN.com, the first whole face transplant in the U.S. was successfully performed at Boston's Brigham & Women's Hospital last week.

The transplant recipient, a 28 year-old Texan named Dallas Wiens, had suffered devastating full facial burns following a high-voltage electrical accident in 2008. This left him blind and with a badly disfigured face, one without obvious facial features, despite skin grafting. He was a good candidate for the face transfer procedure, (even though it does not restore his vision) which took a team of 30 doctors about 15 hours to complete.

The surgery has replaced the nose, lips, skin and muscles as well as the nerves that power them and provide sensation. According to the medical team, he is making good progress with his recovery.

Amazing stuff!

Smoking Cessation and surgical complications

Want to prevent 2 million complications of surgery, just in the United States alone? Have smokers quit smoking for at least a month prior to surgery.

In the United States, approximately 8 to 10 million procedures requiring surgery and anesthesia are performed on cigarette smokers each year, out of the estimated 50 million that are performed in total, nationwide. A recent study (click here) estimated that, if all patients were offered a smoking-cessation intervention before surgery, and assuming a 25% cessation rate, this could result in 2 million complications avoided.

The meta-analysis was done by reviewing all of the randomized trials evaluating the effect of smoking cessation on postoperative complications, and performing statistical calculations to examine the impact of time, in weeks, on the magnitude of effect.

Results:
Smokers that quit smoking before surgery had 41% fewer complications. The researchers found that each week of cessation increases the effect by 19%.

Trials of at least 4 weeks' smoking cessation had a significantly larger treatment effect than shorter trials (P = .04).

Smokers that quit had lower rates of total complications, fewer wound healing complications, and fewer pulmonary complications.

Comment:
In plastic surgery, smoking also can cause higher rates of flap necrosis (where the skin turns black and dies - as shown in the black area of this mastectomy patient). As you might imagine, this is a major problem for patient and surgeon alike, and can result in bad scarring, a poor cosmetic result, and functional problems.

Both cosmetic and reconstructive surgical procedures have been found to be affected by smoking, including: facelifts, tummy tucks, breast reductions, breast reconstructions after mastectomy, microsurgical free tissue transfers, flaps and grafts of many varieties, and finger replantation after trauma.

Even for surgery performed in the head and neck area, where there is usually a very good blood supply, smokers show a 8X increase in wound healing complications, compared to their non-smoking brethren.

There is no safe minimum number of cigarettes that you can sneak before surgery. Even a couple can do you in...

My recommendation is to totally avoid smoking (all kinds) and nicotine (all sources) for two complete months before surgery. This is especially important for facelifts, tummy tucks and breast lift surgeries.

OT: FDA Pulls 500 Cold Medicines From the Market

Source: WebMD.com

March 2, 2011 -- The FDA today announced steps to remove more than 500 prescription cold, cough, and allergy products from the market because of potential safety concerns.

The FDA asked companies to stop manufacturing the 500 products within 90 days and stop shipping them within 180 days. Some manufacturers must stop making and shipping their products immediately, the FDA warns.

Here is the list of banned products.

The FDA does not know if these prescription drugs are safe or not largely because they were grandfathered in before changes to the FDA’s drug approval process were enacted.

“We don't know what they are, whether they work properly, or how they are made,” said Deborah M. Autor, director of the FDA’s Office of Compliance at the Center for Drug Evaluation and Research (CDER) in Silver Spring, Md., during a teleconference. “The problem is that we don’t know what the problem is.”

For example, some of these cough, cold, and allergy drugs are labeled as “time-release.” These are complicated to manufacture, and the FDA has not reviewed whether the active ingredient is released in a consistent matter over a period of time, she says. “They may be released too slowly, too quickly, or not at all.”

Others contain an “irrational” combination of the same types of products, such as two or more antihistamines, and some are inappropriately labeled for use by infants and young children, she says. Many contain the same ingredients as the over-the-counter cough and cold products that are no longer supposed to be used in kids under 2.

Yolandra Hancock, MD, a pediatrician at Children's National Medical Center in Washington, D.C., praises the FDA’s move.

“The new FDA decision supports modern-day pediatric practice to avoid cough syrups in children under 2 because they do more harm than good,” she says. Some may slow down breathing, and others decrease cough and allow mucus to sit in the chest, where it can cause other problems such as lung infection, she says.

“I fully support the FDA’s move in controlling access to these medications in children; it is highly appropriate and long overdue,” she says.

As to the risks these drugs pose, “for the most part, [these adverse reactions] are not serious,” says Charles E. Lee, MD, medical officer of the division of new drugs and labeling compliance at the CDER.

After the FDA crackdown on the use of over-the-counter cough and cold medicine in children younger than 2, the number of emergency room visits for adverse events decreased by 50%, he says.

To find out whether a medication you are using is FDA-approved, click this link, and enter the name of the medication in the search box. If it shows up, it is FDA approved, and is safe to use as directed.

An FDA flyer for consumers about this action can be viewed here.

WSJ: Plastic Surgery decreased in 2009

Nice summary of 2009 plastic surgery trends in the Wall Street Journal, showing the effect of hard economic times on elective plastic surgery volume.

I've reproduced it, below. I've added some editorial comments in parentheses.

In addition, you can see the latest ASAPS statistics on plastic surgery, by clicking the link here.

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By ANJALI ATHAVALEY, Wall Street Journal

The number of cosmetic-surgery procedures in the U.S. sagged for the second year in a row in 2009, according to an annual survey released Tuesday by a plastic surgeons' association.

There were 10 million surgical and nonsurgical procedures last year, down 2% from 2008, according to a survey of 928 board-certified physicians by the American Society for Aesthetic Plastic Surgery, a Garden Grove, Calif., group of plastic surgeons specializing in cosmetic surgery. (ASAPS is the largest, most important group of cosmetically-oriented plastic surgeons.)

Driving the decline was a 17% drop in surgical procedures, to 1.5 million surgeries. "People just couldn't go for the big items," said Renato Saltz, the association's president.

Tummy tucks, rhinosplasty and other surgical procedures can cost thousands of dollars more than nonsurgical measures, and they require a longer recovery. (But of course, the surgeries do much more than any non-surgical alternative.)

Indeed, fear of job loss is the main reason people are putting off their surgeries, says Phil Haeck, president-elect of the American Society of Plastic Surgeons, a separate group that has yet to release its annual survey. Dr. Haeck, a plastic surgeon in Seattle, said that marks a shift from last year when consumers cited cost as a primary hurdle. This year, "job priority is number one, cosmetic surgery is number two," he said.

Breast augmentation beat out liposuction as the most popular surgical procedure for the second year in a row. Dr. Saltz attributes renewed popularity of breast augmentation to the 2006 Food and Drug Administration decision to lift the ban on cosmetic use of silicone breast implants. Breast augmentations numbered 311,957 last year, down 12% from 2008; liposuctions numbered 283,735, down 17%.

Nonsurgical procedures, such as injections of Botox or hyaluronic acid to fill facial wrinkles, were flat, inching up 0.6% to 8.5 million.

Two surgeries are surging in popularity. Buttock lifts, which involve reshaping of the bottom, increased 25% to 3,024 procedures, and buttock augmentations increased 37%, to 4,996. Increasingly, people want to reshape their rears after losing weight, Dr. Saltz said.

The procedures, costing from $4,000 to $5,000, are fairly new, with both benefiting from recent technique improvements, he added. As the economy recovers, more baby boomers are expected to seek procedures, and more physicians will likely offer nonsurgical options. Surgical procedures have increased by 50% since 1997, while non-surgical procedures grew 231%. Places like health clubs and spas are already offering minimally invasive procedures. (Not recommended!) Cosmetic-surgery associations recommend that consumers seek out procedures that are conducted under the supervision of a board-certified physician.

They should also do research before going overseas for cheaper rates for surgical procedures, which physicians say is a growing trend. "Right now, there is not an association that verifies that the physician is appropriately trained to do what they are doing," said Dr. Haeck. "Very few of the countries where these are being offered have anything that approximates the rigorous boards in the United States." (Canada is one exception - their training standards are equivalent to the U.S.)

New Dysport promotion: save up to $150

Dysport, as most readers of the Plastic Surgery Blog know, is the new competitor to Botox. Like David taking on Goliath, they have announced an exciting new marketing promotion, called the "Dysport Challenge". It just started March 1, and runs until April 30, 2010.

It's actually quite a deal, especially if you are someone who likes the wrinkle-fighting effects of either Botox or Dysport.

Within 14 days after your first Dysport treatment, you must sign up for the Dysport Challenge, download your Dysport Coupon Rebate Form from dysportusa.com (link) and mail the rebate form and itemized receipt.

If you love it, you can get another $75 rebate on your second treatment of Dysport. Even if you didn't like Dysport for some reason, and prefer the effect of Botox, you can still get a $75 Rebate Check from Medicis, the makers of Dysport, on your Botox treatment!

Technicalities:
You must wait a minimum of 3 months between your first and second treatments.
First treatment must occur between March 1 and April 30, 2010.
Your second treatment must occur between June 1 and September 30, 2010.
Itemized receipts must be submitted with forms.