According to the aesthetic society, overall demand for cosmetic treatments dropped only two percent in 2009. While plastic surgeons were clearly affected by the recession, many around the country are seeing strong demand in their communities and are therefore very optimistic.

Here in Fairfax, Dr. Hess says that in 2009 his practice saw an increase of 11.5 percent over 2008.

Doctor Robert Grenley of Seattle Plastic Surgery says his practice saw fewer patients during late 2008 and early 2009, followed by increasing demand and then the busiest winter in the 24-year history of his practice. “Although the economy continues to have problems, particularly in terms of unemployment, patients who desire to have cosmetic surgery are finding a way to have it done,” said Dr. Grenley.

In Boston, plastic surgeon Fouad Samaha offered a very similar account of the economic factors affecting his practice:

“Many of our patients felt the economic squeeze in late 2008 and 2009, mostly due to financial insecurity and limited access to credit. Over the past several months, we have seen a strong resurgence in patient interest and volume that appears to be well ahead of economic indicators. I believe that this is testimony to the high level of motivation that people have for self-improvement, feeling better about their appearance, and increasing their self-confidence.”

The general consensus appears to be that various non-surgical treatments and continued interest in breast augmentation are the “recession-proof” offerings keeping doctors busy.

Breast Augmentation Top Surgery 2nd Year Running

For the second year in a row, breast augmentation was the most frequently performed cosmetic surgery, with 311,957 estimated procedures nationwide. Doctors have suggested several reasons for the continued success of breast augmentation:

To the Wall Street Journal, Dr. Renato Saltz mentions the reintroduction of silicone gel breast implants as a factor pushing breast augmentation procedures to the top.

Although Dr. Hess agrees, he says, “most young women who are getting breast augmentation were only toddlers when the moratorium on silicone gel implants came down; to them it’s ancient history and they don’t really know what went on.”

The latest statistics show that breast implants are indeed favored among younger women. For patients 19-34 years old, it was the most chosen surgery, while patients age 35-50 actually chose liposuction more frequently.

More statistics for 2009 will be released in the coming weeks from other professional groups. We look forward to comparing them and continuing this discussion of cosmetic surgery trends.

Read the ASAPS press release

The duration of results

Prevelle Silk is composed of hyaluronic acid, just like the popular fillers Juvederm and Restylane.  The difference lies in the HA concentration, which is slightly lower in Prevelle Silk, meaning the results of Prevelle Silk will probably wear off quicker.

That might sound like a drawback, but it’s not:  a filler with short-term results is actually a great way to “test drive” this type of treatment.  Dr. Hess says the results of Prevelle Silk will usually last 2 months at most, and if you like the results, you can return for treatment with a comparable, but longer lasting wrinkle filler.

The addition of lidocaine

Prevelle is one of the latest fillers to be manufactured with lidocaine as a component.  While the significance of this addition may be exaggerated somewhat in the marketing for these new fillers, when combined with traditional pain management techniques it may enhance the comfort level of your injection.  According to the Prevelle website, clinical trials demonstrated a significant improvement over the filler Captique:

In the clinical study, 69% (29) of the 42 patients who responded to the questionnaire preferred treatment with PREVELLE Silk over Captique. Of these 29 patients, 97% (28) preferred PREVELLE Silk because it was less painful.

You can find more information (prices, treatment areas, etc) about Prevelle Silk with these links.

• Mentor Corp: Prevelle Silk
• Prevelle Silk official Website
• Prevelle Silk at Hess Plastic Surgery Fairfax

Basically all cancers, whether breast, brain or blood, start when a single cell’s DNA gets a mutation or is damaged.  This means that a normal gene, that produces a protein that goes on to provide a certain function, becomes abnormal.  This abnormal gene produces an abnormal protein.  Now our cells are really smart and there are other proteins that detect abnormal genes and remove them or even signal for the entire cell to be destroyed.  However, it’s often these removing genes, known as tumor suppressor genes,  that are abnormal.  This prevents the cell from removing the other abnormal genes or proteins.  When the cell divides the abnormal gene is passed on to the next cell.  Both cells divide again passing along the abnormal gene and so on and so on.  This is very basic so all you molecular biologists just relax.

The problem is that it’s usually not the same abnormal gene in each patient.  So although the end result may be the same, e.g. invasive breast cancer, the starting point is different.  Some cancers have virtually the same starting point.  This is the premise behind “silver bullet” research.  These therapies aim to exactly target the cells with the abnormal protein while leaving all other cells alone.  This is the goal of all researchers for all diseases-find the “silver bullet.”

What Lance Liotta and Emanuel Petricoin are doing at George Mason University is unique.  They are determining what the initial abnormal protein is for each patient with metastatic breast cancer.  Then they will figure out which of the many drug therapies best attacks those specific cells.  It’s analogous to using a smart bomb vs carpet bombing.  Although, in theory, there will still be some collateral damage it will be significantly less if all works as suspected.

What really struck me with this research is that Liotta and Petricoin get “it.”  They understand that we need to continue the fight even when the cancer is metastatic.  In fact, we need to step up our attack on the disease.  So often metastatic cancer patients are written off for dead.  Why?  Just remember, Lance Armstrong was a metastatic cancer patient.  By all rights he shouldn’t even be alive.  And yet not only did he survive but went on to win the Tour de France 7 times!!  And why did he survive?  It was the research behind the treatment that made things possible.

We’ll continue to track the progress of Liotta and Petricoin and let you know how their study goes.  Let’s keep our fingers crossed.

According to the Pittsburgh Tribune-Review, doctors and plastic surgeons at the University of Pittsburgh Medical Center are now seeking approval to perform a similar operation. UPMC surgeons apparently have experience performing hand transplants — procedures that require advanced techniques to reconnect tissues, veins and blood vessels.  A face transplant however  may require donation of organs that are very difficult to procure.

Read more at the Pittsburgh Tribune Review

Do breast implants really need to be replaced every ten years?

Breast implants do not have an expiration date and there is no requirement to have them replaced at ten years. However, according to the Institute of Medicine, the average life expectancy of a breast implant is 16 years. FDA studies of silicone breast implants suggest that most implants last 7-12 years. However, some breast implants clearly last much longer. So, there really is no definitive recommendation. Speaking for myself, I am at 25 years and counting. My breast implants have far outlasted my marriage!

According to an article by The National Research Center for Women & Families, “the likelihood of rupture increases every year.” But as long as the breast implant is intact and you are not experiencing any complications, there is no real need to have a breast implant revision.

After 25 years, I am not experiencing any major complications or significant positioning problems, even after two pregnancies and breastfeeding, however I am considering breast implant replacement. I want to be proactive and avoid any complications, but I also want to benefit from new technology and use this opportunity to achieve a new look.

What is Breast Implant Revision?

Breast implant revision involves the removal or replacement of your current breast implants. Plastic surgeons recommend an evaluation and possibly replacement of breast implants around 15 years after breast augmentation. Evidence shows that some time between 10 and 20 years after surgery, most women will either be experiencing some type of complication or desire an improved appearance of the breast. Over time, positioning changes may occur due to accidents or natural causes. Breast implant revision surgery can resolve these concerns and provide a more satisfactory breast appearance.

Some of the common reasons one might consider a breast implant revision surgery are as follows:

1. Encapsulation, i.e. capsular contracture, which consists of excessive scar tissue development that can place pressure on the implant
2. Folding or wrinkling of the implant
3. Improper implant positioning
4. Implant rupture or leakage
5. Desire to improve breast appearance
6. Desire to use improved implant technology
7. Aging and potential weakening of the breast implants

A revision surgery offers the patient a chance to alter shape and size; after all, it is a whole new decade and your lifestyle is quite likely different than when you originally chose to get breast implants.

Got a question or comment about Michelle’s post? Email Her

As I’ve said, I’m the youngest of four.  The “baby” of the family is the end of reproductive life of the mother.  So my theory is that the youngest gets spoiled because the mother sees this and wants to hold onto her vitality.  No matter what the reason I was the envy/irritation of my siblings – a true “black sheep.”

There are four years between each of my siblings, except for my sister and me — there’s 13 months.  Dad never wanted two children in college at the same time.  Remember I told you he was an engineer (very logical people).  I was unplanned, yes, but often the best things are.  (The great thing about having a blog is that you can stroke your own ego).   According to Dalton Conley, author of ‘The Pecking Order: Which Siblings Succeed and Why, the youngest tends to be the most creative and can be very charming (I like this) — even manipulative (not so much).

Famous youngests include:  Cameron Diaz, Jim Carrey, Drew Carey, Rosie O’Donnell, Eddie Murphy and Billy Crystal so I’m in good company (well maybe except for Rosie).  Whether you are the youngest or know one, you can probably appreciate the pervasive power the youngest child possesses.

Like most boys I hated school.  So I really enjoyed anything but school.  I was always the “busy” child.  My grandmother on my mother’s side disliked me immensely because of this.  (No shock to any one who read the last post.)  I  did the usual things: baseball (which I wasn’t good at),  soccer (the same) and scouting (where I did actually get my Eagle Scout).  But mostly it was the theater that I loved.  I doubt I was any good at it but it was my mother’s main interest as well so I kept doing it.   This connected us during my childhood.  It’s interesting because the first play I ever did was the Princess and the Frog which is in theaters as a movie now.   By the time I turned 16, I had performed in numerous plays and musicals even a paid part at a dinner theater.  So as a junior in high school, I had to decide on my future.

Academics was definitely not my forte (just what you want to hear your surgeon say); more on this later.  I grew up in a lower-mid/middle class town, in Delaware, that was forever carried by a steel company that died a slow painful death and took the town with it.   The high school system reflected this.  In addition, the state decided that busing suburban kids into the worst schools of Wilmington, DE and vice versa would create racial harmony, but it actually created racial riots and a lousy school system.  Forcing love-of-thy neighbor never works.  So although I gleaned from my father that college was a necessity, it wasn’t for me and fortunately mom and dad supported my desire to do New York theater…

Man this one was boring, wasn’t it?  Now it gets interesting.

—-

Catch up with Part 1 and Part 2

I wondered when exactly she would decide she was “old enough” for Botox.

That perfect age probably comes when you have disposable income and those frown lines start to become very prominent – though surely there are exceptions to that rule. According to Bay Area plastic surgeon Sirish Maddali, “many patients understand that using Botox at a younger age can be preventative and therefore start earlier.”

How many young people decide to take these early steps to preserve their appearance? Lets look at some 2008 statistics from the American Society of Aesthetic Plastic Surgery:

2,464,123 Botox treatments were performed

• 0.3 percent of patients were 18 and under
• 15.4 percent of patients were 19-34 (379,582 procedures)
• 49.1 percent of patients were 35-50
• 27.3 percent of patients were 51-64
• 7.9 percent of patients were over 65

Draw your own conclusions about these stats, but the number of treatments chosen by people under 35 is undeniably large.  Are you in that age group and have you undergone a Botox treatment?  Tell us about your experience.

In the mid-1960’s the modified radical mastectomy came into existence. This surgery involved removal of everything that the radial mastectomy did except the pectoralis major muscle.  As minimal as it may seem this was a huge surgical advance and allowed for much better reconstructive possibilities.  This surgery was the standard of care well into the 1990’s.  But in the late 70’s and 80’s innovative surgeons introduced the skin-sparing mastectomy that removed the nipple areola complex and used a much smaller incision.

Finally, in the mid-1980’s the nipple sparing mastectomy was introduced.  However, as with many procedures the indications for its use had to be determined and therefore it was not widely used.  Finally we have understanding and indications for its use.

The nipple sparing mastectomy is the greatest advance in breast cancer surgery.  We have gone from removing everything associated with the breast and chest wall to only the breast tissue.  This leaves the nipple areola complex, an excellent breast skin envelope and all of the muscles of the chest wall.   In addition it may or may not be combined with a sentinel lymph node dissection.   The incision for the nipple sparing mastectomy can be as short as 6cm, hidden in the inferolateral inframammary fold or breast crease (see the picture).  This incision is only one centimeter longer than an incision used for a primary silicone breast augmentation!  With this surgery an immediate breast reconstruction may be done with an acellular dermal matrix and tissue expander or permanent breast implant.  I do not use a permanent breast implant in this setting because the final result will never be as good as a two-stage procedure using an expander first followed several months later by exchange to the permanent implant.

So why don’t we always do this fantastic surgery?  The reason is tied to anatomy.  Invasive ductal breast cancer means that the cancer has started in the milk duct of the breast and has spread through the duct into the surrounding tissue.  All ducts are connected to the nipple so theoretically there could be cancer cells in the nipple.  Remember this is only theory.  Therefore current dictum (and lack of tort reform) states that all of the breast tissue and the nipple areolar complex should be removed to remove any possibility of recurrence.  Therefore the current indications for nipple sparing mastectomy are really limited to DCIS (ductal carcinoma in situ), prophylactic mastectomy or non-cancerous breast disease.  DCIS is cancer that has not mutated enough to become invasive through the milk duct wall.  Given time it will.

Ten years ago DCIS was not considered cancer, but since we now know that if given time it becomes invasive cancer, then by definition it must be cancer (just not invasive).  Other researchers and surgeons believe that the nipple sparing mastectomy should be considered even for patients with invasive cancers of less then 2cm in size, located at least 2.5cm from the areola (see indications).  While this remains to be determined what is important is that we have outstanding surgeons like Dr. Virginia Chiantella, of Reston VA that are on the forefront of breast cancer surgery.  Few surgeons can perform a thorough and complete mastectomy through such a small incision.  It is this level of understanding, skill and caring that allows plastic surgeons like me to give patients, like our 31 year old, breasts that are imperceptible from normal breasts.

2. Better Fat redistribution is in the works. There are procedures intended to redistribute fat and turn an apple into pear.  But aside from aesthetic benefits, it’s difficult to say if doing so would allow you to realize the purported health benefits.

3. What your body wants: protein and exercise. Citing studies conducted on the effects of training on waist size, medical researches advocate incorporating at least 30 minutes of physical activity five days per week, and two days of strength training; and cutting calories by 500 to 1,000 daily. Also important is to eat 25 grams of fiber and 60 to 70 grams of protein daily. Added protein and strength means more muscle and less fat.

4. Love the curves you have and strive for your idealized self. Before and after plastic surgery, diet and exercise remain the key to maintaining your figure and your health. Combine a healthy lifestyle with body contouring and you may be able to have your cake and eat it too. Literally.

Related Links

• BBC News: Big Bum, Thighs is Healthy
• Body Shape, Fat Distribution May be Predictor of Health Risks