The doctor conducted a 30-patient clinical trial for this off-label application, demonstrating that botulinum toxin type A can help physicians address post-operative pain of breast reconstruction.

A temporary tissue expander is often used during breast reconstruction, which is placed between layers of the chest muscle and filled with water to create a pocket for the breast implant. Pain can result from muscle contractions and spasms in response to the gradual tissue expansion.

Dr. Gabriel, along with his collaborator Dr. G. Patrick Maxwell, theorized that Botox injections could offer relief by temporarily paralyzing the muscle so that fewer spasms occur, thereby reducing pain and discomfort.

They designed a clinical trial with 30 breast cancer patients, who all planned a mastectomy and subsequent silicone implant breast reconstruction.  They were divided into 2 groups: one received Botox injections in the chest muscle and the other received injections of saline solution as a placebo.

After reconstructive surgery, the women who received the Botox injections were reportedly more comfortable than those who received placebo. The doctors measured patient responses 3 times during and after the procedure, noting that during days 7 to 45 of the recovery period, those that received Botox injections used significantly fewer doses of narcotics and muscle relaxants.

Read more on Medscape

An unfortunate reality is that many patients don’t undergo breast reconstruction because they’re not educated about their options and not aware about universal health insurance coverage for the procedure.  Under the new law, hospital physicians are required to have a discussion of breast reconstruction options with each patient, thereby increasing the number who choose the surgery (improving quality of life).

There appears to be a stark contrast in resources between breast reconstruction patients of different backgrounds.  Evidently, some are making decisions about treatment with a relative lack of information, while others are independently seeking out advanced microsurgical procedures.

According to a recent study in Plastic and Reconstructive Surgery, a growing number of breast cancer patients are using the Internet to find a reconstructive surgeon on their own, and many are choosing advanced microsurgical breast reconstruction procedures.

Blepharoplasty, or eyelid surgery, was the third most popular plastic surgery procedure internationally, also breaking the one million mark according to survey results.  Rounding out the top most popular procedures were rhinoplasty, abdominoplasty, or tummy tuck, and breast reduction, which were each performed on more than half a million patients across the globe in 2009.

It is not surprising that patients seek these body contouring and facial plastic surgery procedures above all others regardless of their nationality, as problems like stubborn fat deposits, loose abdominal skin, small breasts, drooping eyelids and nasal imperfections are truly universal and occur as a natural result of aging in men and women in every part of the world.

Patients in the U.S. were most likely to undergo plastic surgery last year, and U.S. plastic surgeons performed more than 15 percent of the world’s surgical procedures.  More than one million patients sought surgical procedures in not only the U.S., but also in China and Brazil, however the U.S. ranked first for total procedures performed by plastic surgeons in 2009 with 1.3 million.

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

Unlike plastic surgeons in most other countries, U.S. plastic surgeons performed more non-surgical procedures than surgical procedures in 2009, including Botox and Dysport injections, laser hair removal, Juvederm and Restylane injections and vein treatments.

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 last year, but other injectables, including Radiesse, Sculptra and collagen products were not as popular.

This statistical data was collected from surveys sent to more than 30,000 plastic surgeons in 25 countries by the ISAPS organization.

Criminals targeting doctors’ offices and dubbed “Beauty Bandits” by popular media have made-over the old dine-and-dash routine and use it to steal thousands worth of cosmetic services from physicians.

These so-called bandits fill out new patient intake forms at doctors’ offices, giving fake names and phony contact information, then receive cosmetic treatments for facial rejuvenation and lip augmentation with injectables.

Treatment with a single injectable typically costs only a few hundred dollars in a single session, however cosmetic crooks often seek comprehensive treatment with a combination of injectables, such as Botox, Dysport, Juvederm, Radiesse and others.

After treatment is complete, “Beauty Bandits” claim they need to withdraw cash from an ATM, retrieve their purse from the car or check on a waiting child, then take off without paying their bill.  More subtle forms of fraud are also used by patients who want a free ride, such as writing bad checks knowing there are insufficient funds to cover the cost of treatment.

“I’ve had it occur,” said Dallas plastic surgeon Dr. Rod Rohrich, Chairman of Plastic Surgery Department at UT Southwestern.  “It’s mostly in patients I’ve never seen before. The best way [to prevent it] is to have all new patients pre-pay.  In this way, we prevent the ‘runners,’ as we call them in Texas.”

Preventative approaches to this problem of bold theft and resulting revenue loss are catching on among physicians who offer cosmetic services, as greater numbers have begun asking that patients pre-pay for services using cash or a credit or debit card.

With upfront payment, not only can doctors protect their businesses, they can also devote their full attention to performing cosmetic procedures without being distracted by a nagging fear of being defrauded and foster a doctor-patient relationship built on trust, so don’t be offended if your first visit starts with a transaction.

Getting the business out of the way will allow you to relax and even enjoy working with your doctor to improve your appearance.

The Celution System has not only made possible new applications for reconstructive fat grafting, it can also be used for fat graft preparation in cosmetic fat grafting procedures, such as facial fat transfer for volume restoration and wrinkle treatment and buttocks augmentation.

Fat grafting with the Celution System

The fat grafting process first requires that fat tissue be removed from some part of a patient’s body, such as the abdomen or thighs, prior to being injected or transferred to another location on the patient, such as the face or buttocks.

Once the fat has been harvested in this manner, it is introduced into a machine like Cytori’s PureGraft System, which is an FDA-approved device that purifies fat grafts of 50 to 250 mL by removing excess and unwanted fluid, lipid, blood cells and debris in a controlled manner.

The Celution System then takes over, extracting stem cells from the purified fat graft.  Once the regenerative and stem cells have been extracted, the Celution System multiplies them and reintroduces them into the fat graft.

Celution System European trials

Prior to receiving the CE mark, the Celution System underwent trials wherein the majority of patients and physicians were satisfied with results six months and one year after breast reconstruction via stem cell-enriched fat grafting.

Satisfaction rate after six months (51 patients):

• Patients – 73%
• Physicians – 84%

Satisfaction rate after one year (30 patients):

• Patients – 70%
• Physicians – 90%

There is still significant research to be done on the viability of stem cell-enriched fat grafting for breast reconstruction, however these initial results look promising.

The future of stem cell-enriched fat grafting

Some surgeons are already experimenting with fat grafting as a means of breast augmentation and breast reconstruction in the U.S., however this is still highly experimental and much more extensive testing will be required before aesthetic outcomes are considered consistent enough to replace currently accepted methods of breast augmentation and breast reconstruction.

All breast reconstruction procedures require a tremendous amount of skill to perform effectively and produce pleasing, natural-looking aesthetic outcomes.  Be sure to seek a highly experienced Manhattan plastic surgeon with proven breast reconstruction expertise before considering reconstructive breast surgery after full or partial mastectomy.

British Extreme Makeover winner Nicola Stratton (Photo courtesy of the Daily Mail)

A recent article in the Orange County Register offers prospective breast augmentation patients some interesting insights regarding stories of breast implant disaster, suggesting that highly publicized botched boob jobs offer valuable lessons to women wishing to avoid experiencing a plastic surgery nightmare.

Choosing a breast surgeon: Credentials and training

The article’s first cautionary tale illustrates the importance of choosing an experienced board certified plastic surgeon for breast augmentation and underscores why price should be the last consideration in the surgeon selection process.

Unfortunately, botched boob job survivor and mother of four Kenyatta Brown had to learn these lessons the hard way after nearly dying on the operating table of an Atlanta eye doctor offering discount breast augmentation.

Brown’s attempt to save cash by having breast augmentation done by an ophthalmologist with little to no plastic surgery training nearly cost her life, which serves as a reminder that you often get what you pay for.

Additionally, Brown’s ordeal illustrates that just because a licensed physician is legally allowed to practice any specialty area of medicine does not mean that they are qualified to do so.  You wouldn’t go to a plastic surgeon for an eye exam, so don’t go to an eye doctor or any other physician practicing outside his or her specialty for breast surgery.

Breast augmentation revision and follow up care

British Extreme Makeover winner Nicola Stratton provides the second lesson for would-be breast augmentation patients, pointing out the importance of having access to your original breast augmentation surgeon for follow up care and revision surgery should complications arise.

Stratton flew to Los Angeles for over 30 hours of plastic surgery on the hit TV show, but when she experienced common saline breast implant complications after surgery, she was unprepared for the required travel and expense of her breast revision surgery.

Setting realistic cosmetic surgery goals

The most “high profile” of the recent breast implant disasters featured was that of Sheyla Hershey, who traveled to Brazil to achieve a 38KKK bustline using silicone breast implants so large they are illegal in the U.S.

The gigantic implants didn’t last long, as a near-fatal staph infection forced doctors to remove them shortly after they were implanted.  Hershey may also lose all or part of her natural breasts as a result of the infection and will likely have to undergo additional breast revision surgery in the future.

The moral of the story here is to set reasonable and realistic breast augmentation goals and seek a breast implant size that fits your frame and lifestyle.

Additionally, Hershey’s story illustrates that traveling abroad for plastic surgery can be risky in large part due to the fact that many countries outside the U.S. and Canada do not have laws regulating plastic surgery safety protocols, such as limits on the size of breast implants that can be used.

If you’re considering breast augmentation, avoid experiencing a botched boob job nightmare by learning from the experiences of the Kenyatta Brown, Nicola Stratton and Sheyla Hershey and choose a breast augmentation surgeon who is:

• Certified in plastic surgery by the American Board of Plastic Surgery or the Royal College of Physicians and Surgeons of Canada
• In compliance with U.S. health care regulations and standards of ethical practice
• Accessible for follow up care and appointments
• Skilled at revision breast surgery

Board certified New York plastic surgeon Dr. Tracy Pfeifer uses her considerable experience performing breast augmentation and revision breast surgery to achieve natural breast enhancement results that meet each patient’s unique cosmetic goals.

This is good news for doctors and patients in the U.S. because not only does the introduction of new injectable fillers and toxins on the market mean more options, improved product technology and better results, it also typically means more competition and lower prices.

Some next generation hyaluronic acid (HA) injectable fillers that are rumored to be contenders for the U.S. marketplace include:

• Belotero (Merz) – Hyaluronic acid filler available in soft, basic and intense formulas
• SubQ & Voluma (Medicis & Allergan) – Thicker, heavier HA fillers for contouring larger areas
• Restylane Vital & Juvederm Hydrate (Medicis & Allergan) – Thinner, lighter HA fillers for areas that have been historically difficult to correct
• Derma Veil (Medinter) – A pure collagen stimulator similar to Sculptra Aesthetic
• Novabel (Merz) – Filler formulation derived from brown sea algae

More plumping, less lumping

Belotero, an HA filler similar to Juvederm that is less likely to cause post-injection lumps and bumps, has already been filed with the Food and Drug Administration (FDA), and may be available later this year.

SubQ and Voluma are large volume injectables used for facial contouring, such as chin augmentation and cheek augmentation, throughout Europe.  Derma Veil is also used for cheek augmentation and restoring facial volume by increasing collagen production.

Unlike the other fillers used for adding volume to large facial areas, SubQ is also reportedly used by some for breast augmentation and buttock augmentation.

Innovative fillers for hard-to-treat areas

The lighter HA fillers being introduced by Medicis and Allergan, Restylane Vital and Juvederm Hydrate, are ideally suited to treat areas that have been historically difficult to correct with fillers, such as the back of hands, décolleté and neck.

These fillers also purport to increase skin hydration and elasticity to offer wrinkle prevention effects, and Restylane Vital even boasts a specialized automatic injection pen that regulates product injection volume and speed for more precise results.

While Restylane Vital may offer the most advanced injection technology, Novabel certainly offers the most unique composition and formulation of the new injectable fillers.

Unique formula for thin skin

Novabel’s biocompatible alginate composition is said to make injection easier and reduce swelling, while the patented Geleon technology used in its formulation reportedly improves skin elasticity.  These factors make Novabel ideal for adding volume to facial areas with thin skin, such as the eyelids and tear troughs.

Better than Botox?

In addition to the European injectable filler products being considered for U.S. crossover, two new botulinum toxin type A products that may offer an advantage over Botox and Dysport are poised for introduction to the U.S. marketplace as well.

Theoretically, Xeomin, made by Merz, and PurTox, made by Mentor, would offer the same wrinkle-relaxing properties as Botox and Dysport, but with decreased chance of allergic reaction and development of blocking antibodies in patients.  Xeomin and PurTox may also work faster and last longer than Botox and Dysport, however these theoretical benefits have not yet been proven.

More than 97 percent of patients reported their face lift outcome was “very good or beyond expectations” one year after their face lift, and more than 68 percent of face lift patients felt they looked 10 years younger and said their results continued to be “very good or beyond expectations” 10-15 years after face lift surgery.

A minority of patients (31 percent) who participated in the study indicated that they were disappointed by some aspect of their long-term face lift outcome, which suggests a majority of face lift patients experience a high degree of satisfaction with face lift results many years after surgery.

Each patient who participated in the study had a superficial musculoaponeurotic system–platysma face lift, or SMAS face lift, performed between January 1, 1994 and January 1, 1999.  The study, which included total 89 face lift patients of study senior author Dr. John Owsley, is reportedly the first to measure long-term face lift patient satisfaction rates.

The SMAS facelift technique typically involves surgical repositioning and tightening the SMAS, which is a sheet of muscle and connective tissue on the cheek that contributes to facial expression.

A SMAS facelift offers patients more natural and longer lasting results than a subcutaneous, or skin-only, facelift, and is typically recommended to correct sagging skin and jowls.  An extended SMAS facelift offers the same benefits as a SMAS facelift, in addition to correction of nasolabial folds.

When considering facelift surgery, it’s important not to get caught up in the catchy names, marketing terminology and particular surgical techniques.  The most important step you can take to ensure optimal facelift results is to choose a highly experienced New York facelift surgeon who can customize your facelift procedure to achieve your unique facial rejuvenation goals.

The recalled PIP implants were found by the French Society of Plastic, Reconstructive and Aesthetic Plastic Surgeons to contain an untested, unapproved silicone gel that led to abnormally high rupture rates.  As a result, the implants were recalled, but now thousands of women may need to consider undergoing revision breast surgery.

Although ruptures sometimes do occur in the safe, FDA-approved silicone breast implants used for breast enlargement in the U.S., there is usually no immediate health risk, so women have a choice about when and how to address implant malfunction.

Most women choose a breast augmentation revision to replace their implants, while others choose to undergo breast explant surgery, or 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 stretched by the breast implants.  Occasionally, women may even choose not to seek corrective breast surgery if their ruptured breast implants do not cause health problems or breast deformity.

Ruptures are easy to detect in saline breast implants, as the implants deflate and noticeably lose volume, while an MRI is necessary in order to detect a rupture in silicone breast implants.

If you think one or both of your breast implants have ruptured, don’t panic.  Consult an experienced female breast revision surgeon who can show you before and after photos of satisfied patients and present you with all available options for breast surgery revision.

A recent study published in Aesthetic Surgery Journal compares results achieved with each breast implant and studies the potential processes that may improve breast augmentation with gummy bear implants.

The authors evaluated data such as:

• Breast characteristics
• Patient’s quality of life
• Patient / Surgeon satisfaction with outcome
• Adverse events

After breast augmentation with highly cohesive silicone gel implants, doctors followed up on patients 16 to 77 months later. “The outcome data indicate that these devices produce natural-appearing breasts with extremely low aggregate reoperation rate (4.2%), writes study author Mark Jewell M.D.  Between the two breast implant manufacturers, the study showed measurable differences in the incidence of visible implant rippling.  Read the abstract to learn more.