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Body contouring procedures are typically performed after a person achieves a significant weight reduction.  One increasingly popular method of achieving this is bariatric weight loss surgery.

According to a recent study, doctors say that bariatric surgery patients may need careful evaluation for nutrient deficiencies before proceeding with body contouring surgery.

An article, which is available for free in Plastic and Reconstructive Surgery, takes a fresh look at the nutritional needs of bariatric surgery patients by examining 100 people, 98 who had undergone gastric bypass and 2 who had undergone lap band surgery.

Of the subjects who were evaluated, nearly 18 percent showed protein intake levels that were lower than the recommended intake.  Additionally, 39.7 percent showed low iron intake and 11 percent had low intake of vitamin b12.

Why is Protein Important for the Post-Bariatric Patient?

Protein intake is important for general health reasons as well as surgical reasons.  Protein aids the healing process during recovery from body contouring and its deficiency has been linked to problems such as “decreased wound tensile strength and increased rates of skin and fascial wound breakdown.”

The authors found certain predictors of low protein intake in their subjects. Those with increasing age and those who underwent a greater change in BMI after bariatric surgery were more likely to have a low daily protein intake.  Because food intolerance is relatively common in post-bariatric patients, a higher daily protein allowance may be recommended, the authors suggest.

Read more

Nutritional Assessment of Bariatric Surgery, Patients Presenting for Plastic Surgery: A Prospective Analysis

Naghshineh, Nima; O’Brien Coon, Devin; McTigue, Kathleen; Courcoulas, Anita P.; Fernstrom, Madelyn; Rubin, J. Peter.  Plastic & Reconstructive Surgery. 126(2):602-610, August 2010.

A team of 6 doctors and 14 fellows at the Jewish Hospital Hand Care Center completed a double hand transplant last Wednesday, replacing the hands of a patient who had suffered severe burns and loss of hand function.

According to courier-journal.com, the lead hand surgeon says he hopes the patient can recover 80 to 90 percent of his hand function and “reasonably good grip strength.”

During the 17-hour operation, a non-participating physician in the OR sent out periodic Twitter updates on the progress of the transplant, which you can see at twitter.com/jewishhospital.  Interesting Tweets like the following were posted:

“Tendon suturing nearing completion. Nerve repair to follow. This includes suturing nerves of each finger from donor to recipient.”

“Surgeons are working on connecting nerves in the right hand from the donor to the recipient.”

“Skin graft on right hand finished and hand is completely closed. Starting cleansing and bandaging.”

The surgery was “complex” but successful. The doctors said Twitter updates would have continued even if they had encountered complications during surgery.

Related Links

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• Surgeons salvage hand nerves of double hand transplant patient at Jewish Hospital

The da Vinci Surgical System by Intuitive Medical is a robotic surgical device that represents a tremendous technological advance in medicine.

As the availability of da Vinci robot technology increases, it will eventually allow plastic surgeons to perform more precise, less invasive plastic surgery procedures that achieve better surgical outcomes in patients.

Although the da Vinci robot was originally FDA approved for abdominal surgery, it was recently approved to remove oral tumors and has successfully been used to perform delicate procedures on the prostate and gynecological areas, as well as reconstructive hand surgery.

A Baltimore surgeon was reportedly the first to use the da Vinci System to repair the heavily-scarred hand of a 20-year-old patient whose nerves had been cut in half as the result of an accident wherein that patient put his hand through glass.

The da Vinci robot purportedly allowed the surgeon to place incisions with greater ease and precision, eliminating the risk and variability of tremors and movements of the human hand, all while providing superior surgical outcomes and reducing the pain and blood loss experienced by the patient.

Gabby Gutierrez, a 15-year-old Jacksonville, NC patient, also recently underwent surgery at the robotic hands of the da Vinci robot in a two-hour procedure to remove a noncancerous tumor from the base of her tongue.

Instead of making an incision from the patient’s chin to neck and cutting through her jawbone to reach the tumor, the surgeons were able to remove the tumor through the patient’s mouth, greatly reducing her recovery time and visible scarring.

The da Vinci System is equipped with robotic arms to make perform necessary surgical techniques, a high-definition video screen that relays the video camera’s view into the area being operated on and a console where the surgeon sits to manipulate the device’s hand controls and look into the viewfinder.

While these video and robotic components certainly don’t replace the need for a skilled surgeon, this new technology certainly offers benefits to both surgeons and patients that were unheard only a short time ago.

As Gabby’s mother Kathy Gutierrez put it, “For all those parents who worry their kids are playing Nintendo too much, they can back off that, huh?”

The International Society of Aesthetic Plastic Surgery recently released 2009 plastic surgery statistics collected from surveys sent to more than 30,000 plastic surgeons in 25 countries.

Survey responses imply that despite the U.S. economic downturn in 2009, plastic surgery and other cosmetic medical treatments continued to be collectively more popular in the U.S. than in any other country last year.

The plastic surgery industry has remained nearly as lucrative for surgeons in Brazil and China, which seems only natural considering that the greatest numbers of plastic surgeons worldwide reside in each of these three countries.

More than 1.3 million procedures were performed by U.S. plastic surgeons in 2009.  The only other countries wherein surgeons surpassed the million procedure mark were Brazil and China.  Given the popularity of plastic surgery in the U.S. and the sheer volume of procedures performed in 2009, it comes as no surprise that U.S. plastic surgeons perform more of the world’s plastic surgery procedures (over 15 percent) than surgeons from any other country.

India and Mexico are ranked fourth and fifth, respectively, for total procedures performed by plastic surgeons in 2009, however plastic surgeons in each of these countries performed more than half a million fewer procedures than plastic surgeons in third-ranked Brazil.

Among the most popular plastic surgery procedures performed worldwide are body contouring favorites liposuction and breast augmentation, which were each performed over one million times internationally by plastic surgeons in 2009.  Tummy tuck surgery also made the top five with more than 600,000 procedures performed worldwide.

Blepharoplasty, or eyelid surgery, procedures were also performed internationally in excess of one million times last year, and rhinoplasty, or nose surgery, followed close behind.

Wrinkle-relaxing injections with Botox and Dysport, as well as hyaluronic acid filler injections were the most popular non-surgical procedures administered internationally by plastic surgeons in 2009, but other injectables, including Radiesse, Sculptra and collagen products were not as popular and did not make the top 10.

German pharmaceutical company Merz recently announced that Xeomin, its wrinkle-reducing injectable botulinum toxin type A product, has been FDA-approved for use in the U.S.

Although the FDA approved Xeomin only for treating neuromuscular conditions, such as cervical dystonia and blepharospasm, it is widely assumed that Xeomin will be used off-label to treat frown lines and forehead wrinkles.

This off-label cosmetic use of Xeomin would put it in direct competition with Botox Cosmetic and Dysport, other injectable botulinum toxin type A products used for wrinkle treatment.

When Dysport was FDA-approved in April 2009, many speculated that this first-ever Botox competitor would force a decrease in the cost of Botox.

However, Botox treatment prices have remained relatively unchanged, and Dysport prices are essentially in line with Botox prices.  Thus, it cannot be assumed that the introduction of Xeomin to the U.S. market will have any effect on the cost of other injectable wrinkle relaxing treatments.

Like Xeomin, Botox and Dysport are both FDA-approved for treating cervical dystonia and blepharospasm.  However, Botox and Dysport are also FDA-approved for cosmetic use in treating dynamic wrinkles between the eyebrows, whereas Xeomin is not yet FDA-approved for any cosmetic use.

Xeomin (incobotulinumtoxinA) is a slightly different botulinum type A toxin formulation than Botox (onabotulinumtoxinA) and Dysport (abobotulinumtoxinA) that is free of complexing proteins.  This difference may give Xeomin an advantage over Botox and Dysport in treating neuromuscular conditions, since the higher doses necessary can be given without resulting in antibody formation.

It is unlikely Xeomin will have any advantages compared to Botox or Dysport when used for cosmetic wrinkle treatment.  In fact, some physicians are concerned that it may be more difficult to control spreading or migration of Xeomin, which may lead to muscle relaxation that causes undesirable aesthetic outcomes.

Botox, Dysport and Xeomin are all measured in units, however units of Botox and Xeomin are purported to be the same volume and share a 1:1 ratio, whereas units of Dysport will continue to be a lesser volume than Botox and now Xeomin.  Thus, more units of Dysport are typically required for treatment as compared to Botox and Xeomin.

Xeomin will be distributed in 50-unit and 100-unit vials that, unlike Botox and Dysport, do not need to be refrigerated prior to reconstitution.  Xeomin has been available for use in Europe since 2008 and will be available in the U.S. as of late September 2010.

Unlike any other specialty area of medicine, the lucrative, cash-upfront industry of cosmetic medicine seems to attract an alarming number of unqualified and unscrupulous practitioners who draw in patients by offering deep discounts then make headlines with their botched jobs.

The recent stories of Kenyatta Brown and Mayra Contreras, two women who underwent low-cost cosmetic procedures with disastrous results, illustrate just how much havoc a medical practitioner with inadequate training and experience can wreak.

Doctors practicing outside their area of medical specialty

Atlanta-area mother of four Kenyatta Brown nearly bled to death during a routine breast augmentation procedure because her surgeon, an Atlanta eye doctor practicing far outside his specialty area of ophthalmology, did not have the expertise and skill necessary to perform the procedure.

Situations like Brown’s occur all the time when patients seeking discount cosmetic surgery or other procedures ignore a doctor’s training and credentials, or lack thereof, in an effort to save a few dollars.

Brown escaped her ordeal with her life, however her aesthetic outcome was poor did and will likely require that she spend far more money on breast augmentation revision than it would have cost her to seek breast augmentation with a qualified plastic surgeon.

It is important to note that medical authorities, such as state licensing boards, do not monitor or restrict specialty practice, so any licensed physician is legally allowed to practice plastic surgery or any other medical specialty regardless of his or her training or experience level.

Back-alley body contouring

Unlike Brown, 22-year-old Mayra Contreras did not survive her discount cosmetic treatment and died of apparent respiratory failure a few days after having her buttocks enhanced with injectable silicone at an unlicensed “clinic” being operated out of the San Fernando Valley home of sisters Guadalupe Viveros, 53, and Alejandra Viveros, 50.

The Viveros sisters, who escaped arrest by fleeing to Mexico, did not have any recognized formal medical training and were not licensed to practice any form of medicine, yet the draw of inexpensive cosmetic enhancement and body contouring was enough to get unsuspecting customers in the door.

Before seeking breast augmentation, buttock enhancement or any other cosmetic procedure, it is important to research your medical practitioner to determine whether he or she is qualified to provide cosmetic medical treatment.

• Check with your state medical board to verify the doctor’s license is active and unrestricted
• Confirm which area of medical specialty your doctor is board certified by searching the online database of the American Board of Medical Specialties (ABMS) or the Royal College of Physicians and Surgeons of Canada (RCPSC)
• Talk to your doctor’s past patients about their experiences and review their before and after photos
• Ask your doctor how much experience he or she has performing your desired procedure
• Do not proceed with treatment until you feel confident that your doctor is competent and capable of helping you achieve your cosmetic goals

Dr. Christopher Hess is a highly experienced, board certified plastic surgeon in Fairfax, VA with significant experience performing breast augmentation, injectable filler treatments and a host of other cosmetic surgery and skin care procedures.

Two new medical devices designed to expand the applications of autologous fat transfer and improve the efficiency of fat graft preparation were recently granted the CE mark of approval in Europe.

The PureGraft System, which was also FDA-approved for use in the U.S. in 2010, and the Celution System represent breakthroughs in stem cell-enriched fat grafting and were developed by medical manufacturer Cytori Therapeutics.

Improvements in fat graft preparation

The PureGraft System is a membrane-based tissue filtration device that can be used in tandem with the Celution System or as a standalone fat graft preparation product.

When combined with the Celution System, the PureGraft System allows fat tissue used in autologous fat grafting procedures to be processed more quickly and in greater quantities, while independent use of the PureGraft System results in efficient, reliable production of optimal graft tissue for use in autologous fat grafting procedures.

Compared to other fat graft preparation devices, the PureGraft System works faster, taking only 15 minutes to purify a fat graft ranging from 50 to 250 mL by removing excess and unwanted fluid, lipid, blood cells and debris in a controlled manner.

Stem cell-enriched fat grafting

Cytori’s revolutionary Celution System not only offers advanced wound-healing applications, it also makes stem cell-enriched fat grafting a viable breast reconstruction option for breast cancer patients who have undergone partial mastectomy.

Celution’s European trials indicated that one year after breast reconstruction with stem cell-enriched fat grafting, the satisfaction rate of the first 30 trial patients was 70 percent, while physician satisfaction of the same patients’ results was 90 percent.

The Celution System works by extracting stem and regenerative cells from a patient’s own fat tissue and then multiplying the stem cells and reintroducing them to the fat graft.

In addition to its application for fat graft preparation in wound healing and breast reconstruction, the Celution System is approved for digestion of fat tissue to extract, wash and concentrate a patient’s stem cells and other associated cells for use in autologous fat grafting procedures including Brazilian Butt Lift and fat injection for wrinkle treatment and facial volume restoration.

While the Celution and PureGraft systems improve the efficiency and increase the applications of autologous fat grafting, it is important to remember that the success of fat grafting is greatly dependent on the skill and technique of your surgeon.

Seek a highly experienced Fairfax plastic surgeon should you decide to pursue any fat transfer procedure.

Breast surgery procedures performed in Ambulatory Surgery Centers (ASC) are faster and more efficient than breast surgery procedures performed in hospitals, according to a study published by the American Journal of Surgery.

After reviewing the surgical records of 92 patients who had breast surgery in an ASC between January 2004 and December 2005 and comparing them to the surgical records of 92 patients who had breast surgery in a hospital starting in January 2006, the study found that performing breast surgery in an ASC rather than a hospital saved 69 minutes on average.

Factors in ASC efficiency

Most of the time savings possible in an ASC facility was attributable to decreased preoperative time, or time spent preparing for surgery.

The type of anesthesia used during surgery can also affect discharge time, or the time from when surgery is complete to when a patient leaves the hospital or surgical facility, however this did not significantly affect overall start to finish time of surgery from the preparation stage to the patient discharge stage.

Time-saving benefits of an ASC facility

• • Smaller physical ASC facility that makes it easier to move patients and equipment
  • Avoidance of unscheduled add-on and emergency surgical cases common in hospitals
  • One surgeon assigned per room to allow for better case flow
  • Smaller, more consistent ASC staffing

Although preoperative time-savings are significant in an ASC, the study also noted that breast surgery patients spend an almost identical amount of time in an ASC and a hospital once they reach the operating room.

So, while the study certainly supports the common perception that outpatient surgery can be far more efficiently performed in dedicated outpatient surgical centers outside of hospitals, it identifies that the time savings benefits of an ASC are only offered during the preoperative, or preparation, stage of a breast surgery procedure.

Outpatient breast surgery study details

The study was pursued by authors Drs. Terrence Trentman, Jeff Mueller, Richard Gray, Barbara Pockaj and Daniel Simula after their surgery practice ASC was closed in 2005.  This prompted the doctors to alternatively perform all breast surgeries in a hospital setting, then compare the amount of time breast surgery patients spent in the hospital facility versus the ASC facility.

All patients whose cases were reviewed in the study were women of similar age, with similar recovery room times, and all of the breast surgeries were performed by the same two salaried surgeons who did not receive additional bonus pay for productivity.

Swiss-based medical device developer, manufacturer and distributor Anteis S.A. released the Anteis Injection System, an automated soft-tissue filler injection pen, in 2010.

The Injection System electronically controls and regulates the volume and injection speed of the dermal filler as it is injected into the skin, which according to physicians using the system in Europe, results in more precise and consistent injectable filler results.

According to Anteis, the Injection System also offers a number of other benefits to injectors, and thus patients, including:

• Improved handling
• Greater freedom of movement
• Decreased muscle fatigue
• Increased focus on filler product placement rather than injection technique

Additionally, patients have reported less pain during treatment, decreased social downtime and fewer and less severe side effects, such as post-injection bruising, swelling and redness, with Anteis Injection System treatment vs. conventional manual filler injections.

Facial creases and folds, volume loss, feature asymmetry or disproportion, and skin depressions, such as cellulite, may all be correct using hyaluronic acid filler administered by the Anteis Injection Pen.

The Anteis Injection System looks like a promising innovation in cosmetic dermatology based on its apparent success in Europe. However, it is important to remember that the device has not been appropriately tested or approved by the FDA and is not yet available in the U.S.  for that reason.

Furthermore, the injection device was designed to work with Anteis-brand hyaluronic acid gel fillers that are also not available in the U.S. and has not been tested with other brands of hyaluronic acid fillers, such as Juvederm and Restylane.

The Injection System also has not been tested with wrinkle-relaxing injectables, such as Botox and Dysport, or injectable fillers made of non-hyaluronic acid substances, such as Radiesse or Evolence.

If you’re considering facial rejuvenation with injectable fillers, seek an experienced injector with superior injection technique to administer your treatments, and remember that when it comes to your face, nothing can replace the finesse and artistic eye of a skilled plastic surgeon.

The British Association of Aesthetic Plastic Surgeons issued a guidance warning an estimated 50,000 British women to have their French-made Poly Implant Prostheses (PIP) breast implants checked for ruptures or leaks within the next six months.  The guidance was issued in response to an inquiry conducted by the French Society of Plastic, Reconstructive and Aesthetic Plastic Surgeons, which uncovered that PIP implants contain an untested, unapproved silicone gel and lack the protective barrier necessary to prevent implant rupture.

Although ruptures are uncommon in FDA-approved breast implants used in the U.S., the PIP implant recall serves as a reminder that it is important for breast augmentation patients to understand how to handle breast implant ruptures that may be caused by implant malfunction or trauma to the breast.

First, detecting a rupture in saline breast implants is simple, as the implants typically deflate and noticeably lose volume.  In silicone breast implants, on the other hand, ruptures aren’t as obvious and require an MRI to detect.

If you discover a rupture in one or both of your breast implants, you have several options.  Some women choose to have a breast augmentation revision to replace their implants, while others choose to undergo breast implant removal but do not have their ruptured implants replaced.  When breast implants are removed and a breast augmentation revision is not performed, a breast lift may be performed to remove skin that has stretched or sagged since the initial breast surgery.  Some women may even choose not to seek any breast revision surgery if their ruptured breast implants do not cause health problems or breast deformity.

Most importantly, remember that when an FDA-approved breast implant ruptures, there’s no need to panic, as a ruptured breast implant poses no immediate health risk.  Consult a board-certified plastic surgeon with extensive experience performing breast revision surgery for guidance and help choosing the best breast revision option for you.