Otoplasty

I came across the press release below and found it interesting. It notes that otoplasty of all plastic surgery procedures, skews the youngest.  This is not a surprise in itself, and this procedure is similar to rhinoplasty in that sense.

Below is the press release on the study—-

Children ages 13 to 19 received 27.7% of otoplasties, according to a recent study released last week by the American Academy of Cosmetic Surgery. The organization’s 2008 Procedural Survey also found that otoplasty has the youngest mean age of both invasive and less invasive cosmetic procedures, at 29.

“While cosmetic surgery is not for all adolescents, there appears to be a trend in otoplasty for younger patients,” states Patrick McMenamin, MD, president of the AACS. “The bottom line is that if the teen is of appropriate psychological and physical maturity, then the teen can reap the benefits of an early-age otoplasty. In my experience, it is the youngster who comes in adamantly requesting the procedure.”

Generally, ears reach their full growth potential by age 6, which is drastically earlier than other parts of an adolescent body. In fact, it is preferred to have an otoplasty at a younger age because the cartilage is extremely flexible, thereby permitting greater ease of shaping and a better result.

Springtime and Plastic Surgery

Many people plan on having a procedure done by a Los Angeles plastic surgeon in the spring, so they look great for summer.  Certainly this is very common and it makes a lot of sense.  If you are going to do something to improve appearance, why not do it prior to getting out and about in the good weather?

One thing to consider in planning is for the recovery.  In most procedures, people do not see results immediately.  It can take a few weeks or even months to see the dramatic change one is looking for.  For liposuction, we like to have six weeks of recovery prior to even making initial judgments about the results.  This also holds for many skin procedures.

So if you are planning on that new look for the beach, it is best to do some careful planning about the timing of your procedure!  This way you are most likely to be delighted with the results.

Large Volume Liposuction

Liposuction offers the promise of removing unwanted fat, usually from the areas that the body clings to the hardest and are most resistant to diet and exercise.  No wonder so many people seek the procedure!  It can provide great improvements in body shape and thus in self esteem.

A variation of the procedure is large volume liposuction.  With this procedure, large volumes of fat are removed (as might be expected from the name).  What this means is that for people who do have extra fat, this procedure can begin a process of lifelong change and improvement in appearance and health.

With this procedure, recovery may be longer than standard liposuction.  Therefore careful planning is needed.  People who have this procedure should be in very good health overall.  For the proper candidates this technique offers the chance for life-changing improvements.

Laser Procedures

As plastic surgeons, we often tend to dismiss noninvasive procedures as often only subtle benefits.  With current technology, nothing could be farther from the truth.  We see enormous improvements in appearance from such procedures as Beverly Hills Botox, laser treatments, and skin fillers.  Lasers are especially coming into their own lately.  Technology is advancing quickly, and one example is fractional laser treatments.  The difference in facial appearance, with freshing and tightening of the skin, removal of wrinkles and lines and other improvements can be truly amazing.  So plastic surgery is no longer just about surgery.  In many cases, we can create marked improvements without doing any cutting at all.  And this often means less recovery, shorter times off from work, and the elusive “lunchtime” procedures are really becoming reality.

Recovery from Rhinoplasty

Many people ask about recovery from plastic surgery.  And they are right to do so.  It is important to make plans for recovery prior to undergoing any procedure. For example, people should arrange for time off of work following rhinoplasty in Los Angeles. They should make plans for about a week off, in most cases. People should arrange to help them around the house, at least for the first day or two and certainly for the first night following this sort of California cosmetic surgery.  People may be antibiotics following the procedure, and they may have some discomfort which is eased by pain medicine.  It is best to get all prescriptions filled prior to surgery, as waiting in line in a pharmacy is just no fun following any procedure.  It is also important to realize that while some changes in appearance can be seen immediately, in most cases the full results of nose surgery take months to see.

Plastic Surgery During the Economic Downturn

A recent press release, reprinted below, notes that plastic surgery is on the rise in the UK even with the economic downturn.  We have seen some slight downward trends in cosmetic surgery but are remaining busy.  As a Los Angeles plastic surgeon, I’m finding that people are still interested in plastic surgery.  Below is a reprint of the press release—

People are still splashing out on looking good despite the economic downturn, according to new figures.

Data from the British Association of Aesthetic Plastic Surgeons (BAAPS) showed a rise in the number of people going ahead with operations in 2008.

Men seemed particularly keen on some aspects of the surgery, with a 44% rise in the number having a breast reduction to correct their so-called “moobs”.

Male breast reduction moved into the top five procedures for men, rising from 224 procedures in 2007 to 323 in 2008.

In 2003, just 22 breast reductions were carried out on men.

There were 34,187 operations on men and women in 2008, up 5% on the 32,453 in 2007. that is more than triple the 2003 figure, when 10,700 plastic surgery operations were carried out.

All the data related to private clinics in the UK.

Women had 91% of all cosmetic procedures in 2008 (31,183, up from 29,572 in 2007).

The top five procedures in women were Breast augmentation, eyelid surgery, face/neck lift, tummy tucks and breast reduction.

The top five procedures for men were nose jobs, eyelid surgery, ear-pinning, liposuction and male breast reduction.

First Impressions

A recent study looked at the use of an injection to make a better first impression.  Here is a summary of the press release, which is interesting and amusing—

According to researchers, first impressions of a person are influenced by facial appearance and improved by cosmetic surgery. They wanted to determine whether or not the use of botulinum toxin A would contribute to a person receiving higher scores on a variety of first impression scales.

Photos were taken of the study participants before and after the treatment with the botulinum toxin A, then the photos were randomly divided into books with each subject represented only once per book. Blinded evaluators completed a survey rating their first impression on various measures of success for each photo in the book.  Findings were that use of the injection improved first impressions.

Plastic surgery does have positive effects on self image, with any procedure such as Los Angeles breast implants.  It may be that treated people simply feel more confident and give off this impression following their procedure.  We do find this with many procedures, including

Recovery from Breast Augmentation

Before doing any cosmetic surgery procedure, it is important to plan for recovery.  Obviously knowledge of recovery allows you to make these plans.  Following California breast augmentation, you will have dressings in place when you leave the surgery center.  Most of the time you will leave these in place until you see your doctor in a few days.  Then you should think about your activity levels.  Most of the time you can return to normal light activities in a few days.  But take care with exercise too soon, and you should not shake your breasts (such as with running) for a few weeks at least.

High Wind and Wildfires

This week we have had real effects from our locally famous Santa Ana Winds.  We have seen lots of fires with real effects.  The skies are hazy and breathing is difficult.  At times like this, it is important to take steps to keep ourselves feeling good.  And when we feel good, we look good.  People have suggested drinking lots of water to stay hydrated.  Certainly we suggested this at all times to our patients, especially after surgery such as Los Angeles breast implants.  This goes for both saline and silicone breast implants.  Others suggest staying inside if it looks too hazy.

Changes in our environment effect both our health and appearance.  It is important to be aware of what is happening around us, and take steps to maintain our health.

Sunscreen Safety

I came across this short article from Cosmetic Surgery Times about people who have a reaction to sunscreens.  We recommend sunscreen to all of our plastic surgery patients, so we found this very informative—-

Many patients say they do not wear sunscreens because they cause acne. Is this a real or imagined phenomenon? I believe that sunscreens may, indeed, cause an acneiform eruption in some patients, but not true acne.

Most patients who claim acne onset after sunscreen use will state that the breakout occurred 24 to 48 hours after use. This is insufficient time for comedone formation or follicular rupture. Closer examination of the patient will reveal the presence of perifollicular inflammatory papules, which the patient interprets as acne.

In reality, I believe this represents a follicular irritant contact dermatitis, which may be due to sunscreen use. All liquid sunscreens contain emulsifiers, which can emulsify sebum on the skin surface, as well as the intercellular lipids. This emulsification may lead to irritation in susceptible individuals.

It is also possible that some patients are experiencing miliaria rubra from sunscreen use that mimics acne. Water-resistant sunscreens are designed with polymers that stick to the skin, decreasing removal by rubbing or water contact. The polymers can adhere to the eccrine duct ostia, interfering with the release of perspiration onto the skin surface. This may force sweat into the surrounding tissues, causing inflammation and resulting in miliaria rubra formation. This problem is common with the water-resistant gel sunscreens that have a rapidly evaporating alcohol vehicle.

Increased sweating may be a problem with some sunscreens. Sunscreens containing organic filters provide photoprotection by taking UV radiation and converting it to heat, which is radiated off the skin. The heat generated on the skin surface may also contribute to increased sweating, and the formation of miliaria rubra.

Furthermore, the increased sweating enhances stratum corneum permeability, allowing sunscreen ingredients epidermal access to produce irritation.

Patients who experience acneiform eruptions when wearing sunscreens can minimize the problem by selecting products with inorganic filters, such as titanium dioxide and zinc oxide, that do not produce heat as a byproduct. Sunscreen-containing moisturizers are also an excellent choice, since they are not water-resistant and do not cause problems with ostia occlusion.

As a Los Angeles cosmetic surgeon, I believe that sunscreen is crucial for all people.  But it may take some work to find the best formula for each individual.

Face Transplant News

Facial transplantation was much in the news a few years ago.  There some controversy when the procedure was first performed in France.  There were technical and ethical concerns at that time — the issue was much more controversial than other procedures, such as Los Angeles breast augmentation.

In the interim, the procedure has been performed more frequently, but is still far from routine.  This is not like some sort of Beverly Hills liposuction, transferred to another body part.  Below is an interesting article about recent trends on this procedure.

Face transplantation is still an unusual and emerging field of surgery that often conjures up images from science-fiction movies. But major advances in recent years mean the surgery is moving from the realm of novelty to a more common procedure that promises to enhance quality of life significantly for individuals with extreme deformities.

But one major obstacle threatens further developments: Few people are willing to donate their faces after they die, according to a report published today in The Lancet.

“People are still unsure about it,” said Laurent Lantieri, head of the department of plastic surgery at Henri Mondor Hospital outside Paris. “People are thinking, ‘Maybe I’m going to see my husband or my son or my sister walking the street after she’s dead.’ That’s not the case.”

Although still in its infancy, face transplantation has been performed by surgeons around the world on several disfigured patients. It is making plastic surgery news.  The procedure involves attaching a donor’s facial tissue to reconstruct the deformities on the patient.

Dr. Lantieri conducted a face transplant last year on a man who was severely disfigured as the result of a facial tumour. The procedure, as well as its aftermath and the complications that arose, are documented in one of two articles in the medical journal.

In the second case, doctors in China conducted a transplant on a man who lost part of his face when a bear tore it off in a 2004 attack. The 2006 surgery involved connecting arteries and veins, as well as repairing the man’s nose, lips and sinuses.

Although face transplantation is a difficult and complex procedure that is inevitably followed by complications, including rejection of the new facial tissue, recent medical advances have made it a feasible option to help people suffering from severe disfigurement, according to the articles.

“Facial transplantation could be successful in the short term, but the procedure was not without complications,” says the article by Chinese surgeons at the Institute of Plastic Surgery at Xijing Hospital, Fourth Military Medical University. “However, promising results could mean that this procedure might be an option for long-term restoration of severe facial disfigurement.”

Three major challenges are involved in face transplantation procedures.

One is the type of technique used to remove tissue from a donor and transplant it successfully to the recipient’s face so that the individual is able to feel heat, cold and other sensations once the surgery is complete.

Another challenge is medical complications after surgery. Dr. Lantieri said all face transplant patients experience some form of rejection that must be handled with a variety of drugs.

The third issue is the psychological impact on the patient.

There was originally major concern that patients would be left emotionally traumatized once they were given a new face – and essentially a new identity.

But Dr. Lantieri wrote that his patient, who received a face transplant last year, went from feeling like “a monster” to experiencing himself as “an anonymous person in the crowd.”

“You’re dealing with a patient that has no more face,” Dr. Lantieri said in a telephone interview. “They have no more face and no more human appearance. What we’re trying to do is give them back human appearance.”

But widely held misconceptions and trepidation about this groundbreaking surgery are major factors in the public’s resistance to the idea of facial donation, Dr. Lantieri said.

He said people often mistakenly think of the popular movie Face/Off, in which an FBI agent has a radical surgical procedure to take on the appearance of a criminal and infiltrate his organization.

But in reality, people who have facial transplants do not resemble the donor once the procedure is complete, Dr. Lantieri said. That’s partly because an individual’s unique bone structure plays a significant role in appearance.

“Nobody volunteers. Nobody knows about face transplants,” Dr. Lantieri lamented. “What we’re doing is trying to repair those patients, but we need donors.”

Cosmetic Surgery Predicted to Rise

A recent study looked at trends in cosmetic surgery to predict future trends.  It found that surgical procedures such as California breast augmentation and noninvasive procedures should continue to rise.

While today’s economy reflects a slow-down in plastic surgery procedures, the specialty will weather the current decline in economic growth just as it has previous declines, such as the stock market correction after the 2001 Internet bubble,” said ASPS President Richard D’Amico, MD. “This prediction for 2015 is exciting” and would also apply to tummy tuck Beverly Hills.

While the study’s findings are, of course, great news for the plastic surgery industry, ASPS suggests caution to current and future patients. While cosmetic procedures seem lower risk than ever and are easy to access, they are not a cure-all for many patients, and choosing an ASPS Member Surgeon with the training to perform all procedures, from non-invasive therapies to surgery, can mean the difference between achieving desired results and requiring more procedures down the road.

“Our concern is that with predicted growth and interest in the broad spectrum of cosmetic procedures, patients will look to the closest, easiest solution,” said D’Amico. “Potential patients, however, need to know that board-certified plastic surgeons are uniquely qualified with an in-depth medical knowledge of the entire human body. They have the training necessary to accurately assess your individual needs and map health and beauty goals for your entire lifetime.”

In the study, the authors analyzed annual ASPS National Clearinghouse of Plastic Surgery statistics from 1992 — 2005. They also analyzed the ability of economic and non-economic variables to predict cosmetic surgery procedure volume. Finally, they used growth rate analyses to construct models with which to predict the future growth of cosmetic surgery.

The study found the next decade of growth in cosmetic surgery will continue to be driven by the growth of non-surgical procedures. Between 1992 and 2005, the compound annual growth rate was 7.5 percent for surgical procedures and 27.9 for non-surgical procedures, the study noted. In 2005, 34 percent of procedures performed by ASPS Member Surgeons were surgical procedures and 66 percent were non-surgical. In 2005, for non-ASPS members 9.5 percent of their procedures were surgical, while 90.5 percent were non-surgical.

A New Way to Check for Skin Cancer

I recently came across an interesting article related to plastic surgery (no, not plastic surgery financing).  It is about using light to diagnose skin cancers.  Here is a summary—

“The standard way physicians do a diagnosis now is to cut out a mole and look at a slice of it with a microscope,” said Warren Warren, the James B. Duke Professor of chemistry, radiology and biomedical engineering, and director of Duke’s new Center for Molecular and Biomedical Imaging. “What we’re trying to do is find cancer signals they can get to without having to cut out the mole.

“This is the first approach that can target molecules like hemoglobin and melanin and get microscopic resolution images the equivalent of what a doctor would see if he or she were able to slice down to that particular point,” Warren said.

The distributions of hemoglobin, a component of red blood cells, and melanin, a skin pigment, serve as early warning signs for skin cancer growth. But because skin scatters light strongly, simple microscopes cannot be used to locate those molecules except right at the surface. Although laser methods have been developed to probe deeper down for some other molecules that can be made to glow, both melanin and hemoglobin remain dark and inaccessible using those methods.

Warren’s group has now developed a technology for coaxing both hemoglobin and melanin inside questionable skin moles to emit light by exciting them with highly controlled laser pulses.

The innovation uses a delicate interplay between two laser beams, each emitting a different color of light. To keep the skin from overheating in the process, the lasers must also be able to pulse on for only femtoseconds — a thousand trillionths of a second — at a time.

The glow of the hemoglobin- and melanin-bearing structures can be magnified by a microscope outside the skin and manipulated by computers to create cellular-scale images. The noninvasive technique could enable doctors to see as much as a millimeter below the skin’s surface — more than enough for diagnosis, Warren said.

In the future these techniques might be useful for other implications, such as within Beverly Hills cosmetic surgery.

The Latest Skincare News

Now that summer is here, we get many questions about refreshing skin.  We mostly tell our Los Angeles cosmetic surgery patients, “Sunscreen, Sunscreen, Sunscreen.”  There is nothing more important to youthful skin than protecting it from the harsh rays of the sun.  This is especially so here in Southern California.

A recent scientific study looked at some of the common skincare treatments and how they help improve the appearance of skin.  The article is interesting.  Here is a summary—

The researchers report an emerging picture of collagen collapse and possible renewal, based on more than a decade of studies, in the May issue of Archives of Dermatology.

The article draws on dozens of studies since the early 1990s, conducted primarily by U-M dermatologists, to explain why three types of available skin treatments are effective: topical retinoic acid, carbon dioxide laser resurfacing and injections of cross-linked hyaluronic acid.

These treatments all improve the skin’s appearance – and its ability to resist bruises and tears – by stimulating new collagen. Collagen is a key supporting substance, plentiful in young skin, that’s produced in the sub-surface layer of skin known as the dermis. The U-M findings show that the breakdown of the dermis’ firm, youthful structure is a very important factor in skin aging – a much more straightforward thing to fix than genetic factors that others theorize may be involved.

Good skin appeals to everyone, even those coming to our office for unrelated procedures such as liposuction.

A New Technique to Treat Breathing Disorders

I recently returned from Brazil, where my father and I performed a specialized surgery to help people who have breathing disorders. We inserted a phrenic nerve pacemaker on someone who is quadriplegic. My father, Dr. Abbott Krieger has developed an innovative surgical technique to reanimate the diaphram in severly injured patients, freeing them from a lifetime confined to a ventilator. The procedure provides phrenic nerve injury treatment.

The phrenic nerve pacemaker can be used for people who have a nonworking diaphragm. If the phrenic nerve was injured, the pacemaker stimulates it to in turn cause the diaphragm to pull air in the lungs. This is the “breathing circuit” that allows us to breathe on our own. The injury can come from previous surgery. It often comes from a spinal cord injury, resulting in paralysis. The phrenic nerve is always quiet, and never sends it signal to the body to breathe.

This was the case for the procedure we performed last week in Brazil. A man was shot in the neck, injuring his spinal cord. He could not breathe without a ventilator. The hope now is that with time the pacemaker will allow this man to breathe on his own, without a ventilator or a breathing tube.

The research behind the procedure and its development was done by Dr. Abbott Krieger, the father of Rodeo Drive Plastic Surgery’s Medical Director. Dr. Abbott Krieger did basic research on the concepts for this revolutionary surgery. He then pioneered its use clinically. The procedure uses a nerve transfer technique to allow the phrenic nerves to once again stimulate the diaphragm to move air, allowing patients to breathe without the need for a ventilator.

This is obviously not the usual plastic surgery, such as a breast augmentation procedure. But plastic surgery also includes doing specialized procedures on nerves, and this is the case with this breathing surgery in which the treatment is performed for injury to the phrenic nerve.

Here is some more background on this sort of breathing surgery:

Breathing pacemakers are indicated for patients with diaphragm paralysis who would otherwise be completely or partially dependent on mechanical ventilation so long as the phrenic nerve(s) and diaphragm(s) are intact. Patients with diseases in which there is progressive demyelination of the phrenic nerves (such as ALS) or weakening of the diaphragm muscle (such as muscular dystrophy) are generally poor candidates for diaphragm pacing.

Careful preoperative evaluation (phrenic nerve conduction studies, pulmonary function tests, etc.) would be indicated in all cases. Benefits of diaphragm pacing for diaphragm paralysis include:

• Improved respiratory function since the inhaled air is drawn into the lungs by the diaphragm under negative pressure, rather than being forced into the chest under positive pressure.

• Lower infection rates due to the reduction in suctioning, elimination of external humidifier and ventilator circuits, and the potential removal of the tracheostomy tube.

• Improved mobility, normalized breathing and speech patterns, ease of eating and drinking.

The Latest in Skin Care

We have started offering a new product to our plastic surgery patients interested in skin care.  We have been impressed with the results!  Remember:  good skin care is for everyone.  We offer it to our patients who have all procedures, including Los Angeles tummy tuck.

Here is a summary of one of its elements, the facial scrub:

This all-in-one cleansing scrub gently removes dead skin cells. Pro-Niasomes™, which are spherical Jojoba Beads infused with Pro-Niacin™, help wash away skin’s visible imperfections.

NIA 24™ Benefits

• Stimulates cell turnover
• Improves dry patches
• Smoothes and evens skin texture
• Soothes the skin
• Prepares the skin for maximum absorption of Skin Strengthening Complex.

NIA 24™ Key Ingredients

• Formulated with Pro-Niasomes, spherical Jojoba Beads encapsulated with Pro-Niacin.
• Sunflower Oil moisturizes the skin
• Oat and Sage calm and soothe the skin
• Chamomile has anti-irritant, soothing and antioxidant properties.

Questions About NIA 24™ Physical Cleansing Scrub

What is the exfoliating ingredient in the NIA 24™ Physical Cleansing Scrub and will it tear my skin?

The exfoliating action comes from the Pro-Niasomes™ which are Jojoba beads encapsulated with Pro-Niacin™. As they exfoliate the skin, they break apart, releasing Pro-Niacin™ for absorption into the skin. The spherical beads found in the NIA 24™ Physical Cleansing Scrub do not have jagged edges and therefore do not tear the skin.

What is the origin of jojoba beads?

Jojoba is a shrub native to the desert and is used fairly frequently in cosmetics as a moisturizer and carrier oil, as it is easily refined to be odorless, colorless, and oxidatively stable. The beads within the Physical Cleansing Scrub are jojoba beads encapsulated with Pro-Niacin™ and thus, are known as Pro-Niasomes™.

Will the particles in the Physical Cleansing Scrub tear down the Skin Barrier that the NIA 24™ products are trying to build?

No, the Physical Cleansing Scrub is washing away dead skin cells, not the skin barrier and the spherical beads do not tear the skin. The mechanical action of this physical scrub is also increasing the cell turnover rate, revealing newer skin.

Can the NIA 24™ Physical Cleansing Scrub be used in combination with chemical exfoliates (AHAs and BHAs)?

Yes. You may find that the efficacy of the NIA 24™ products enables you to reduce the amount of AHA’s or BHA’s that you are using while still achieving the same result and minimizing irritation and potential sensitivity to the sun.

Can you use the Physical Cleansing Scrub immediately after surgeries or skin rejuvenation therapies such as chemical peels or microdermabrasion?

No. Based on the severity of the procedure, allow the skin 2-3 weeks recovery time prior to re-introducing the Physical Cleansing Scrub. Use of the Skin Strengthening Complex and 100% Mineral Sunscreen should be tolerated by the skin. However, should redness occur, apply a cold compress to the skin and reduce application of the NIA 24™ products for several days.

Why do you recommend using the Physical Cleansing Scrub only 2-3 times per week?

The objective of using a scrub or exfoliate is to keep the skin free of dead skin build-up, and prime the skin for more optimal use of other products. Using the Physical Cleansing Scrub 2-3 times per week is all that is necessary.

Will the Physical Cleansing Scrub remove my makeup?

Because the Physical Cleansing Scrub is an exfoliant that removes dead skin cells and cleanses the skin, it can be used to remove make-up. However, it should not be used around the eye area to remove eye make-up for those who are interested in San Diego cosmetic surgery.

Plastic Surgery for Men

A recent study found what we have seen in the office here in Beverly Hills:  When men receive anti-wrinkle treatment, they need larger doses than women.  This is in keeping for all plastic surgery procedures:  men are just plain different than women.  This holds for facial aesthetics and liposuction and everything in between.  Here is a summary of the article—

There has recently become a growing interest in cosmetic procedures by men. Although most practices see a majority of women, the number of male patients who seek treatment is slowly increasing.

Men often require more units of Botox than women which may be because men have a greater muscle mass than women. Similarly, it has been a common clinical observation that larger, stronger men need more units per treatment area than slender, small-boned men. The most common cause of inadequate results in male patients is under-dosing, which may lead to men requiring additional Botox injections.

“Various areas of the male face can be treated with Botox and injections need to keep in mind the greater muscle mass in men,” the author notes.

When Is a Mole Skin Cancer?

Whenever we see patients for cosmetic surgery, we do a full exam for for skin cancer. After all, when we do plastic surgery California, we are doing medical procedures involving the body, face, and skin. Now, a recent study looks at when a mole becomes a skin cancer. This is interesting, because we all have moles, and skin cancer is a growing problem.

Below, is a summary of the recent study—

In trying to tease out the answer to this simple question, Howard Hughes Medical Institute (HHMI) researchers have uncovered a protein that stops the growth of melanoma, a cancer that develops from pigment-producing cells in the skin called melanocytes. HHMI investigator Michael Green and colleagues at the University of Massachusetts Medical School reported their identification of the genetic underpinnings of a new way to thwart one of the deadliest forms of cancer in the February 8, 2008, issue of the journal Cell.

Green and his colleagues began by designing experiments that would help them determine what separates melanomas from ordinary moles at the genetic level. Moles, also known as nevi, and melanoma often result from the same genetic mutation, and the biological pathway that differentiates the two had been a mystery. The new study uncovers a relatively unknown protein that regulates the melanocyte’s “decision” to ward off cancer by either entering a programmed hibernation or committing suicide.

According to the American Cancer Society, 60,000 people in the United States developed melanoma in 2007, and more than 8,000 died of the disease. Melanoma is caused by the uncontrolled proliferation of melanocytes, whose pigment, melanin, protects the skin against the sun’s ultraviolet rays. Nevi, which are benign, are also caused by abnormal growth and differentiation of melanocytes.

While nevi are, by definition, non-cancerous, more than half the time the same mutation is at fault in melanoma and nevi: a single amino acid change in a protein called BRAF. BRAF is part of a signaling system that is important for cell growth and proliferation. The BRAF mutation found in nevi and melanoma increases the activity of the BRAF protein, prompting cells to multiply abnormally. In some melanocytes with this mutation, the proliferation cannot be stopped, and cancer develops.

But sometimes when the mutated BRAF gene is expressed in melanocytes, those cells go into a state of permanent hibernation via a process known as senescence. These cells form nevi, not melanoma. This, according to Green, indicates that the genetic checks and balances within those cells are working correctly. “The cell has sensed this oncogenic influence–activated BRAF–and that induces an anti-cancer mechanism to throw the cell into this frozen state,” he said. Green added that sometimes cells simply commit suicide instead of senescing.

Cancer results when something blocks this failsafe mechanism, said Green. “While this phenomenon was known, the components and the pathways involved were not,” he said.

Plastic surgery may seem to be all about such procedures as breast augmentation California, but it does include skin cancer and other issues.  So always have your skin checked by your dermatologist or plastic surgeon.

Figures Reveal European Interest in Plastic Surgery

Recent figures show that the UK leads the pack of Euopeans having plastic surgery. I recently returned from travel in France, and as a cosmetic surgeon in California, I found it interesting that there is great interest in plastic surgery but also that people do tend to remain “in the closet” when discussing procedures. Judging from the number of media questions we receive about new trends in plastic surgery, it does appear that the British are quite fascinated by the topic.

Here is an article describing British interest in plastic surgery:

The UK’s spending on cosmetic procedures is the highest in Europe, figures have shown.

In 2006 the cost of having nips, tucks and Botox hit nearly

£500 million, according to analysts Datamonitor.

This was more than treble the amount paid for cosmetic enhancements in Italy, which had the second-highest spend of the seven European countries surveyed.

France came third in the 2006 cosmetic surgery spending at £141.8 million.

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Germany came fourth at £129 million followed by Spain in fifth position at £70.4 million.

Europe’s combined spending on cosmetic surgery in 2006 was £1.251 billion, Datamonitor found.

This figure was dwarfed by the £5.792 billion spent on cosmetic surgery in the US that same year.

Datamonitor said consumers’ desire to improve their personal appearance was on the rise.

“However, the fastest growing area of cosmetic surgery has been minimally invasive procedures, such as Botox injections, which have soared over the last decade,” Datamonitor said in a statement.

Spending on cosmetic surgery in Europe and the US combined will top £14.28 billion by 2011, Datamonitor predicts. This includes all procedures, such as breast augmentation.

 

A New Approach to Controlling Bleeding

A new treatment is available to help minimize bleeding during surgical procedures.  This might be an important option in large general surgery and other specialty operations.  Time will tell if there will be benefit to those having such plastic surgery procedures as breast augmentation Beverly Hills.

Here is a release from the FDA:

On Jan. 2, the U.S. Food and Drug Administration (FDA) expanded the indication for a liquid fibrin sealant to help control bleeding during general surgery. Fibrin is a protein that helps blood clot.

The sealant, called Evicel, is sprayed or dripped on small, oozing blood vessels. Once applied, it forms a covering that helps stop bleeding. Evicel was previously approved for use during liver and vascular surgery. This approval expands Evicel’s indication to include general surgery applications.

“This approval provides a new option to help control bleeding during general surgery, when other approaches and techniques are ineffective or impractical,” said Jesse L. Goodman, M.D., M.P.H., director of FDA’s Center for Biologics Evaluation and Research.

Evicel contains fibrinogen and thrombin, two proteins involved in the production of fibrin. Fibrinogen and thrombin are found in human plasma, the liquid portion of blood. The plasma used to manufacture the product is collected from donors who have been screened and tested for blood-transmitted infections. The fibrinogen and thrombin also undergo a two-step process to further reduce the risk for the transmission of potentially contaminating bloodborne viruses. While the potential risk for infectious disease transmission is remote, it cannot be eliminated.

A study of 135 patients undergoing abdominal surgery showed Evicel to be safe and effective in controlling bleeding. Adverse events reported during the clinical trial included anemia, abdominal abscess, blockage of the small intestine, and loss of urinary bladder tone, when the urinary bladder does not empty effectively, which can cause discomfort and infection.

As far as can be seen, these treatments still need testing in various Los Angeles plastic surgery procedures.  One issue that is related is fluid that develops following surgery that is not bleeding but rather excess normal body fluid that can accumulate.  This happens sometimes following such procedures as Los Angeles tummy tuck.  And since there is not much bleeding in the procedure, it is likely not useful in Beverly Hills liposuction.

Smoking and Plastic Surgery

We make a big about smoking for our patients.  While not smoking is good for overall health, the stronger reason we lecture about smoking to our patients is that smoking increases the risks of wound healing problems.  This is true for all the plastic surgery procedures we do, including Los Angeles breast augmentation.  For some procedures, smoking has even more risks associated with it and these include breast reduction, tummy tuck, and facelift.  These last procedures have complex and extensive wounds that the body needs to heal and impairing this healing ability can cause real problems.

 

Below is a summary of smoking and wound healing problems written by a surgery journal:

 

The association between cigarette smoking and delayed wound healing is well recognized in clinical practice, although extensive controlled studies have yet to be performed. The documented effects of the toxic constituents of cigarette smoke–particularly nicotine, carbon monoxide, and hydrogen cyanide–suggest potential mechanisms by which smoking may undermine expeditious wound repair. Nicotine is a vasoconstrictor that reduces nutritional blood flow to the skin, resulting in tissue ischemia and impaired healing of injured tissue. Nicotine also increases platelet adhesiveness, raising the risk of thrombotic microvascular occlusion and tissue ischemia. In addition, proliferation of red blood cells, fibroblasts, and macrophages is reduced by nicotine. Carbon monoxide diminishes oxygen transport and metabolism, whereas hydrogen cyanide inhibits the enzyme systems necessary for oxidative metabolism and oxygen transport at the cellular level. Slower healing has been observed clinically in smokers with wounds resulting from trauma, disease, or surgical procedures. The reduced capacity for wound repair is a particular concern in patients undergoing plastic or reconstructive surgery. Compared with nonsmokers, smokers have a higher incidence of unsatisfactory healing after face-lift surgery, as well as a greater degree of complications following breast surgery. Smokers should be advised to stop smoking prior to elective surgery or when recovering from wounds resulting from trauma, disease, or emergent surgery.

Anyone considering Beverly Hills plastic surgery must understand the risks associated with smoking prior to going forward.

Current Thoughts on Tummy Tuck Recovery

Many people are concerned about when they can eat following a Los Angeles tummy tuck.  We tell people to eat as much or as little as they like in the days following this plastic surgery procedure; we only demand that people drink plenty of water and juice.  In the past, there was hesitation about allowing people to eat soon following surgery.  But we have found no problems at all, and in fact people often feel better if they eat.

Now, a recent large study confirms the safety of our approach.  Below is a media summary of the plastic surgery study:

According to the study’s author, one of the major advantages of this new approach is that those patients who immediately begin diet post-op may, theoretically, be able to have their I.V. removed sooner and could also be discharged sooner, which could save patients in hospital-related costs. Several factors would determine just how soon patients who are fed immediately following a full abdominoplasty can be discharged and would vary from case to case. But according to the study’s author, some patients could conceivably go home the same day as having a tummy tuck. “The point here is that by having these patients fed, you have those options,” he explains. “Each patient and each situation is different, but…from our study, we found that early feeding in patients undergoing abdominoplasty was clearly feasible and safe.” THOUGHT SHIFT? The traditional approach and a rule of thumb in surgery dictate that patients who undergo abdominal surgery should not be sent home until they pass gas and only then should they be fed and/or discharged. The rationale behind the practice of NPO following abdominoplasty is to diminish the effects of nausea and vomiting caused by paralytic ileus. According to the study’s author, however, it has not been demonstrated that abdominoplasty slows gastrointestinal motility. “I think like many things in medicine, we see incremental changes in behavior in surgery — and very often it is not a paradigm shift — that, taken together, can advance the science of surgery.” In fact, he says that this early post-op feeding movement could make shorter hospitalizations and out-patient surgery a reality. “I believe that many surgeons may even be using this approach already,” he adds. According to the study’s author, who was the senior author on the paper, “the group that we compared where we did not feed them [the patients] has made me a believer.” He now uses this approach with his patients and believes that surgeons should consider possibly adopting it as a new dogma in post-op care. “In the end,” he states, “it is advantageous and safe.” HYDRATION IS KEY According to the study’s author, this new approach is safe, assuming the patients are getting adequate hydration — an important point. He says that some people choose not to eat, despite the fact that they are allowed to eat. “This is probably because these patients may be uncomfortable, might not want to eat, may be fearful of eating post-op or may be tired. Here, it is important to continue their I.V. But in those patients who want to eat and can maintain adequate hydration, it allows them to,” he says.

We use the same approach to almost all of our procedures, including Beverly Hills liposuction.

 

One Year of Silicone Implants

It has now been one year since the FDA approval of wide usage for silicone breast implants.  We are starting to see more interest in silicone as we do Beverly Hills breast augmentation.  At this point, we do still use saline implants the majority of the time, but this may change in the future.  One issue is that silicone implants are signifantly more expensive than saline.  It will be interesting to see if the implant manufacturers bring the price point more in tandem.

Below is a reprint of the announcement approving silicone implants:

After rigorous scientific review, the U.S. Food and Drug Administration (FDA) today approved the marketing of silicone gel-filled breast implants made by two companies for breast reconstruction in women of all ages and breast augmentation in women ages 22 and older.  The products are manufactured by Allergan Corp. (formerly Inamed Corp.), Irvine, Calif., and Mentor Corp., Santa Barbara, Calif.

“FDA has reviewed an extensive amount of data from clinical trials of women studied for up to four years, as well as a wealth of other information to determine the benefits and risks of these products,” said Daniel Schultz, M.D., Director, Center for Devices and Radiological Health, FDA.  “The extensive body of scientific evidence provides reasonable assurance of the benefits and risks of these devices.  This information is available in the product labeling and will enable women and their physicians to make informed decisions.”

Now that the products have been determined to be safe and effective, FDA will continue to monitor them by requiring each company to conduct a large postapproval study following about 40,000 women for 10 years after receiving breast implants.  FDA often requires postmarket studies to answer important questions that can only be answered once a product is in broader use, such as the incidence of rare adverse events.

FDA’s decision to approve these implants was based on a thorough review of each company’s clinical (core) and preclinical studies, a review of studies by independent scientific bodies and deliberations of advisory panels of outside experts that heard public comment from hundreds of stakeholders.  In addition, FDA conducted inspections of each company’s manufacturing facilities to determine that they comply with FDA’s Good Manufacturing Practices.  Some of the complications reported in the core studies included hardening of the area around the implant, breast pain, change in nipple sensation, implant rupture and the need for additional surgery.  However, the majority of women in these studies reported being satisfied with their implants.

In the past decade, a number of independent studies have examined whether silicone breast implants are associated with connective tissue disease or cancer.  The studies, including a report by the Institute of Medicine, have concluded there is no convincing evidence that breast implants are associated with either of these diseases.  However, these issues will be addressed further in the postapproval studies conducted by the companies.

“The silicone breast implant is one of the most extensively studied medical devices,” said Schultz.  “We now have a good understanding of what complications can occur and at what rates.  We also know that women who get these devices will probably need to have additional breast implant surgery at least once.  This is valuable information for women who may be considering these products.”

Full information about the risks and benefits of the devices can be found in the package and patient labeling mandated by FDA.  The patient labeling outlines some of the important factors women should consider when deciding whether to get silicone gel-filled breast implants.  Some of these factors are: breast implants are not lifetime devices and a woman will likely need additional surgeries on her breast at least once over her lifetime; many of the changes to a woman’s breast following implantation are irreversible; rupture of a silicone gel-filled breast implant is most often silent, which means that usually neither the woman nor her surgeon will know that her implants have ruptured; and a woman will need regular screening MRI examinations over her lifetime to determine if silent rupture has occurred.  The device labeling states that a woman should have her first MRI three years after her initial implant surgery and then every two years thereafter.  The cost of MRI screening over a woman’s lifetime may exceed the cost of her initial surgery and may not be covered by medical insurance.  The labeling also states that if implant rupture is noted on an MRI, the implant should be removed and replaced, if needed.

FDA approved the silicone gel-filled breast implants with a number of conditions, including requiring each company to: conduct a large postapproval study; continue its core study through 10 years; conduct a focus group study of the patient labeling; continue laboratory studies to further characterize types of device failure; and track each implant in the event, for example, that health professionals and patients need to be notified of updated product information.

The postapproval studies will continue to gather information about the safety and effectiveness of the implants.  Information will be collected about rates of local complications, rates of connective tissue disease and its signs and symptoms, rates of neurological disease and its signs and symptoms, potential effects on offspring of women with breast implants, potential effects on reproduction and lactation, rates of cancer, rates of suicide, potential interference of breast implants with mammography, and MRI compliance and rupture rates.

The postapproval studies will be closely monitored by FDA.  FDA anticipates that data from the studies will provide important information for patients and physicians, and may lead to improvements in device labeling.

We will keep you updated on the interest in silicone breast implants in Beverly Hills.

An Interesting Finding About Breast Reduction

A recent study has found dramatic improvements in quality of life for women who have relatively small breast reduction procedures.

Following is a reprint of the summary of this plastic surgery study:

The finding runs counter to the policies of most U.S. health insurance companies, who typically do not reimburse women for these smaller mammoplasties because insurance companies deem them to be only of cosmetic value.

“Smaller women are going to have proportionally smaller breasts, but for their particular frame, their breasts may still be far too large and uncomfortable,” the study’s author explains.

The study, appearing in the Sept. 15 issue of Plastic and Reconstructive Surgery (already available online), found that breast reductions of less than 500 grams per breast greatly eased women’s back, neck and shoulder pain. The procedures also improved their quality of life by allowing them to exercise more, play sports and choose from a wider variety of clothing.

None of the women in the study had ever undergone any form of breast augmentation before.

On average, the mammoplasties involved the surgical removal of 415 grams of breast tissue per breast (830 grams total), for an average breast reduction of just over 2 cup sizes. Seventeen of the women had less than 750 grams total of breast tissue removed—an average decrease of 1.7 cup sizes.

Three months and then one year after their surgery, the women were asked about changes in pain and quality of life. They were asked to rate their pain from a score of 1 to 5 (5 being highest).

Scores fell dramatically after the reduction mammoplasties—in categories including lower-back pain, neck pain, headache and bra-strap “grooving.”

This is very much in keeping with what we find when we do Los Angeles breast reduction.  While 500 gms of tissue removal, or more, might be required by insurance companies, women with less than this removed often have dramatic improvements in their self-esteem and symptroms from overly large breasts.

Rodeo Drive Plastic Surgery Welcomes Nip/Tuck to the Neighborhood!

Nip/Tuck is joining Rodeo Drive Plastic Surgery on our famous street.  This is an exciting development for us, since we are the only real-life plastic surgery center on Rodeo Drive.  Now TV’s most famous fictional plastic surgeons are coming to our location.  It will be interesting to see how the stories develop, and if fiction matches our reality here at Rodeo Drive Plastic Surgery!

This is how the story was reported about Nip/Tuck moving to Rodeo Drive:

After having worked on every beautiful face and body in South Beach, the McNamara/Troy plastic surgery duo have packed their bags and said their good-byes to sunny South Florida for the silicon valley that is Beverly Hills. FX’s highly rated drama, “Nip/Tuck” is to premier its new season next Tuesday from its new location in Southern California.

Doctors and long-time friends Sean McNamara and Christian Troy, played by Dylan Walsh and Julian McMahon, are both trying to make it big in a town that has already probably seen every plastic surgery ever performed in a city in which almost every resident has had work done at one time or another.

The show’s creator, Ryan Murphy, says of the relocation: “I was very interested in the idea of what happens when you hit 40 and suddenly you go from being the big fish in a small pond to the opposite.”

“The show is really about them suddenly on Rodeo Drive and surrounded by dozens of other plastic surgeons who have been here forever,” Murphy adds.

Last season featured guest stars such as Kathleen Turner, Larry Hagman, Peter Dinklage, Brooke Shields, Catherine Deneuve and Alanis Morissette. Most notably, though was Rosie O’Donnel’s recurring role as lottery winner Dawn Budge.

It will be interesting to see if the boys do a Beverly Hills liposuction and tummy tucks the way we do here at Rodeo Drive Plastic Surgery!   Check in our plastic surgery blog for more news on all this.

New Trends in Liposuction

Liposuction continues to evolve.  On the one hand, the basic technique of liposuction, using the tumescent technique of fluid injection, now is used in essentially all patients undergoing this procedure.   But there have been recent innovation in technique.  As the procedure has been developed and refined, several variations have been introduced.Fluid Injection, a technique in which a medicated solution is injected into fatty areas before the fat is removed, is now used by basically all plastic surgeons. The fluid — a mixture of salt solution, a local anesthetic and epinephrine (a drug that works to prevent bleeding) — helps the fat be removed more easily, reduces blood loss and provides pain control during and after surgery. Fluid injection also helps to reduce bruising.

Large volumes of fluid — sometimes as much as three times the amount of fat to be removed — are injected in the tumescent technique.  When liposuction is performed without anesthesia, using just a local anesthetic, usually takes significantly longer than traditional liposuction (sometimes as long as 4 to 5 hours). However, because the injected fluid contains an adequate amount of anesthetic, additional anesthesia may not be necessary. The name of this technique refers to the swollen and firm or “tumesced” state of the fatty tissues when they are filled with solution.

The super-wet technique is similar to the tumescent technique, except that lesser amounts of fluid are used as part of this . Usually the amount of fluid injected is equal to the amount of fat to be removed. This technique often requires IV sedation or general anesthesia and typically takes one to two hours of surgery time.  This of course depends on the number of areas treated and how much fat is removed.

Ultrasound-Assisted Lipoplasty (UAL). This technique requires the use of a special cannula that produces ultrasonic energy. As it passes through the areas of fat, the energy explodes the walls of the fat cells, liquefying the fat. The fat is then removed with the traditional Beverly Hills liposuction technique.
We also recently did liposuction using a laser, which is thought to help tighten the skin following the procedure.  The manufacturer was good enough to bring the laser machine to our center so we could try it out.  We’ll see if this adds real value to patients, but it does look promising.

We also now do a lipo technique that helps people jump start a more prolonged lifestyle and dieting program.  Patients have been delighted with this approach which provides dramatic body changes.  As a cosmetic surgery Los Angeles specialist, I’ve been gratified that this approach worked to well for them.  Also remember, that in some cases, a Los Angeles tummy tuck will achieve the best results for you.

A New Model for Faster Tummy Tuck Recovery

Is it alright to eat after your tummy tuck? We always say YES. And now a scientific study backs this up.

A recent medical study has confirmed quicker recovery for people who eat soon after their tummy tuck procedure. In fact, on major surgery society now states that withholding oral intake of food in patients after abdominoplasty (“tummy tuck”) may not be necessary, and that feeding patients earlier could allow for quicker discharge after surgery. Findings from a study investigating the impact of early feeding after tummy tuck on the occurrence of postoperative nausea and vomiting is published in the May/June 2007 issue of the Aesthetic Surgery Journal, the Society’s official peer-reviewed journal. These findings are important because tummy tuck is a popular cosmetic surgical procedure. This would seem to also hold, in our experience, for when we do our Rodeo Drive Mommy Makeover procedure. This includes not only a tummy tuck, but also often a breast augmentation or breast lift and liposuction.

Postoperative nausea and vomiting (PONV) is among the most disagreeable experiences associated with surgery, causing dehydration and retching, which can lead to poor wound healing, among other adverse effects. While postoperative management of patients undergoing tummy tuck has traditionally involved withholding food until patients demonstrate evidence of bowel activity, this practice requires patients to remain in the hospital for the administration of intravenous fluids to prevent dehydration. However, no literature exists to support this practice. Our standard is not to do this, whether for our tummy tucks or for our Beverly Hills liposuction procedures.

Although the findings are promising, physicians remain cautiously optimistic about a full transition to ambulatory tummy tuck. It does not diminish some of the benefits of postoperative hospital admission. Adequate pain control, maintenance of a semi-flexed position, and patient and surgeon preference are important variables to consider when choosing between admission and discharge. We have found this to be the case for all patients, not just when we do celebrity plastic surgery.

“This study demonstrates that early feeding of tummy tuck patients may prevent the need for postoperative hospital admission for intravenous hydration—at least in those patients who can maintain adequate hydration with oral intake alone—and allow for faster hospital discharge,” said a plastic surgeon in New York, NY, lead author of the study. “While there may be other reasons for admission, routine postoperative admission to prevent dehydration may not be necessary. These findings could change the way we care for our postoperative plastic surgery patients, improving their comfort and safety, and saving on health care costs.” As a Beverly Hills cosmetic surgeon, I have found similar results in my practice.

A Different Way to Liposuction

We believe that liposuction can be used to create immediate and dramatic lifestyle changes. We have developed a program to provide Beverly Hills liposuction on a dramatic scale, to create a first step to changing body appearance. Where liposuction has generally not been used to create weight loss, it has been used to treat full areas in people who overall are in very good shape. On the other hand, large volume liposuction has had some issues that make it unattractive to surgeons and patients. People must be admitted to the hospital following liposuction of greater than five liters. This is because liposuction on this scale can be dangerous.

But we think that people can have liposuction on a scale to jump-start their body change on a large and impressive scale. We call the program, Your First Year of Your Diet in a day. This new liposuction approach takes people who need to lose weight and helps them get a strong start. Following the procedure, they look much better. The feel better. And their confidence is improved. They are in a position to take things to the next level with diet and exercise. They are in a position to make great changes in their lives.

The program is not for everyone. They must be in good overall health. They must be in touch with their plastic surgeon following the procedure for frequent visits following this innovative liposuction in Beverly Hills. They must be prepared for a longer period of swelling following the procedures, and that results will not be visible for quite a few weeks following this liposculpture.

We believe that people struggling with their weight can have a plastic surgery option. It will allow them to get a strong and running start on making positive changes in their appearance, lifestyle, and health. It is not the final step. But this sort of Beverly Hills liposuction is a powerful first step to greatly improved body appearance and self-esteem. It works for qualified candidates, and not just for celebrity plastic surgery.

Liposuction Facts and Techniques

There are several different techniques currently in use for Los Angeles liposuction. It is best to have the exact approach tailored to your individual needs

Tumescent Technique – This technique is the method of giving a large volume of local anesthesia to the patient. The diluted epinephrine in the tumescent solution intensely contracts the patient’s capillaries, thus preventing the surgical loss of blood that may sometimes cause complications. Tumescent liposuction is now the basis of essentially all liposuction currently performed in the US. It is the type of Beverly Hills liposuction we perform every day.

Dry Technique – This method is no longer used in liposuction due to excessive blood loss during the procedure. In this technique the fats removed contain 30% blood, and general anesthesia is administered prior to operation.

Ultrasonic Assisted Liposuction – Your Beverly Hills plastic surgeon uses general anesthesia in this method, and a metal paddle administers an ultrasonic energy wave in order to break up fat cells. The approach can be useful for thick, dense areas of the body such as the male chest.

Power Assisted Technique – PAL is an electronic device that aids the surgeon in operating and removing fat during liposuction. This device is powered by an electric motor which creates a spinning motion to the suction cannula (or sucking tube) which makes removing the fat somewhat easier.

Wet Technique – This is another version of the now standard technique, in which fluid is inected into the tissues prior to performing the procedure. Your cosmetic surgeon determines the exact mixture of the components to this fluid.

Because local anesthetic is injected as part of the solution, most patients experience very little pain following the procedure. We find that most of our patients do not even use any pain medication. Depending on the size of the procedure, most patients return to work just a few days following their liposuction. More information is at http://www.rodeodriveplasticsurgery.us .

 

Plastic Surgery After Massive Weight Loss

With more people undergoing weight loss surgery such as Lap Band and gastric bypass, we are seeing a large increase in the number of body contouting procedures we are doing following these procedures. Loose skin needs to be removed and other areas benefit from tightening, and people who lose large amounts of weight benefit greatly from these sorts of procedures. However, a new study reports that only a small percentage of massive weight loss patients seek out this sort of follow-up care. This is a loss, because many are missing out on the improved shape they were seeking in the first place.

Following is a report from the plastic surgery society on this issue:

Bariatric surgery to treat morbid obesity is poised to become the most prevalent major surgery in the United States. However, while most bariatric patients consider plastic surgery to re-contour their bodies after losing weight, less than 15 percent of patients will actually have it, according to a recent review study.

“Bariatric surgery is a useful tool for treating obesity and many patients benefit from completing their weight loss journey with plastic surgery every year. However, the data shows that more patients could be helped by these procedures,” said the recent study’s lead author. “Major obstacles to surgery for patients include cost, difficulty in receiving insurance coverage and reluctance to have additional surgery.”

After massive weight loss many patients develop large amounts of loose, sagging skin. Left untreated, the excessive skin can be physically restrictive, lead to chronic infections, and cause psycho-social health related issues.

“This is serious surgery that may involve multiple procedures performed over many months, significant recovery time and a financial commitment; however, the benefits are incredibly positive,” said chair of Post Bariatric Task Force. “Removing excess skin is not only necessary to achieve optimal body shape, but it’s also helpful in improving overall health and quality-of-life. Because of these benefits and the rising number of bariatric procedures being preformed, we expect to see a continued increase in the number of patients who have these procedures.” For these patients, plastic surgery indeed does offer real benefits.
Body contouring procedures which include extended tummy tuck, lower body lifts, arm lifts, thigh lifts, and breast lifts are commonly used to remove the excess skin. In fact, nearly 66,000 body contouring procedures after massive weight loss were performed last year, up 18 percent since 2004, according to ASPS statistics. At our center, we also often Beverly Hills liposuction to help remove some remaining fatty areas. And despite the findings of this study, in our case we are seeing more and more of these patients coming to see us for plastic procedures. Despite our location, we do more than just celebrity plastic surgery and these sorts of procedures are an example of this.

Understanding Your Recovery from Plastic Surgery

When people come to us to consider Los Angeles plastic surgery, they often ask about recovery. We believe that is an important issue and best understood in detail before going ahead with any cosmetic surgery procedure. We With good planning, recovery from plastic surgery should be easy and without too much inconvenience, and perhaps most criticial, with minimal discomfort. The key is to understand what the procedure entails, and what should and should not be done during your various stages of recovery.

First off, pain: We take steps so you will be comfortable after your procedure. This includes larger procedures such as a tummy tuck or even our Rodeo Drive Mommy Makeover. We place pain medicine in all areas where we work during the procedure. This long-acting local anesthetic is so effective that many of our patients tell us they never have to take pain medicine following their procedure. This is the case with small procedures as well as the larger ones. But we do provide strong narcotics just in case there is discomfort.

The next thing people ask about is going to the gym, walking, running, pilates, and other forms of working out. Following most procedures, we can have you doing some exercise within a week or two of surgery. We will work with you and, if you want, your trainer on this issue. There are specific things you can do and others you should avoid for various periods following the various cosmetic surgery procedures. We will tell you in great detail the safe things and those that you should avoid. Good communication on these sorts of issues will get you back to your routine quickly and safely. This comes up for all of our patients, including plastic surgery for men.

Many people ask us when they can go back to work following their procedure. In some cases it is just a day or two. After a rhinoplasty or Beverly Hills breast implants or liposuction we usually tell people to arrange for about 5-7 days off from work. From a tummy tuck it is about 10-14 days.

Recovery from plastic surgery is key to a good result. But it does not need to be something that you fear!

Liposuction Techniques Described

As liposuction becomes ever-more popular, there are an increasing number of techniques used to perform the procedure. When we see patients seeking Los Angeles liposculpture, they often know about a few of the techniques. It is useful to understand the range of options available prior to undergoing the procedure. The following is a summary of the various liposuction techniques available. It should help you understand some of the options available, and give you the background you need to work with your plastic surgeon on planning your procedure.

Tumescent Technique – This technique involves the infusion of a large volume of fluid containing local anesthesia to the areas being treated with liposuction. The solution also contains diluted epinephrine in the tumescent solution which contracts small blood vessels. Constricted blood vessels bleed less, so this allows for increased safety during and after the procedure. Essentially all modern liposuction techniques involve this overall approach. The technique is sometimes called the “wet” or “superwet” approach to lipo.

We do all of our procedures with Los Angeles tumescent liposuction. Some people offer this technique done solely by the surgeon and not a full surgical team. We believe this is cutting corners at the potential expense of patient safety. Having a registered nurse and a physician anesthesiologist as part of the surgical team affords more professionals attending to your comfort and safety. Similary, we do all of our procedures in our certified surgery center, with all safety equipment and staff, rather than in a procedure room or an exam room since this provides for maximum safety.

Dry Technique – This method is no longer used in moden liposuction operation due to excessive blood loss during the procedure. In this technique the fat removed contains 30% blood, and this creates undue risk for complications.

Ultrasonic Assisted Liposuction – Surgeons use general anesthesia in this method, and by using tumescent fluids through a metal paddle ultrasonic energy is delivered to the patient’s subcutaneous fat. It is inserted into the fat using a somewhat large incision. Th e technique works to break up fat with ultrasound waves and is sometimes useful for fibrous or thick areas of tissue. We perform Los Angeles ultrasonic liposuction, but only in select cases. There is a risk of skin burns from the ultrasound energy and also of fluid collections under the skin following the procedure.

Power Assisted Technique – PAL is an electronic device that aids the surgeon in operating and removing fats in liposuction. This device is powered by an electric motor with compressed air that pushes and sucks fats out of the patients body. A cannula is attached to it, therefore providing a spinning rotation to the instrument that aids in inserting it into the body. We occasionally use Los Angeles power assisted liposuction though the indications for the technique are becoming less frequent because of other available approaches.

Microliposuction–In this approach, very small caliber cannulas or sucking tubes are used to remove the fat. The advantage of this approach is more precision during the procedure, and less trauma to the tissues. It tends to create a smoother overall result, with less recovery time. Because of these advantages, we do essentially all of our procedures with some form of Beverly Hills microliposuction.

There are now many techniques for liposuction available. The key is to match the technique to your actual needs. A careful exam and discussion of your goals prior to you lipo should allow your plastic surgeon to determine the best technique for you.

 

Silicone Breast Implants: Summer Update

As July unfolds and we begin one of our busiest seasons for plastic surgery, it is worth revisiting the trends in breast augmentation.  Specifically, silicone breast implants have now been approved by the FDA for general usage for more than six months.  It does seem the thought that there would be an explosion in the use of silicone breast implants has been overstated.  We are seeing some patients interested in them, but in general most people are still most comfortable with saline implants.  There is just not a groundswell for silicone as people seek breast augmentation California.

There are a few reasons for this.  The price difference between saline and silicone implants is very real.  The extra costs involved are enough to turn some people off.  There is lingering (but usually nonspecific) concern that silicone implants are unsafe.  This notion has been disproven, but remains present in many people’s minds.  The lengthy consent which recommends frequent MRI scans following the breast augmentation California does add to this feeling.  And many patients who seek breast enhancement have friends who already underwent the procedure.  The frame of reference is saline implants.  Since most people are very happy with their results, they advise their friends to go with saline.

We will see if any of these factors change over the coming months.  But for now, silicone implants are a great option that still has not gained real traction within what we are seeing as a plastic surgeon Los Angeles.

’tis the Season for Tummy Tucks

As we head toward summer, that means more free time with lots of barbecues and outings to the beach. This is the time of year when we do a lot of Beverly Hills tummy tuck surgery. People want to look their best, and most people who are good candidates for tummy tuck procedures tend to have excess skin focussed on the belly. Exercise and diet will rarely work when there is loose skin. And the fat beneath this sort of loose skin tends to be very stubborn

A tummy tuck offers the opportunity to get this fat and skin off forever. The surgery is not a small one. It requires general anesthesia and should be done at a fully certified outpatient surgery center. An anesthesiologist should administer the anesthesia — this way you have two doctors taking care of you and not just one. At our center we do all of our tummy tucks with an anestesiologist.

There is some scarring created in the procedure. But the scar is low and usually well-hidden in the bikini line. There is not much discomfort following the procedure because we administer long-acting local anesthetic as part of the procedure. But you must avoid heavy lifting for about four to six weeks at least.

In some cases, there is not loose skin but just some extra areas of fat build-up. In this case, Beverly Hills liposuction can often do the job. The advantage is that there is less recovery than a tummy tuck and less scarring. The skin has to shrink following the procedure to give the best results, so during your examination we will assess the quality of your skin for this.

With summer just around the corner, many people find that now is the time to get their bodies in shape. And a tummy tuck or liposuction can often make for an enormous improvement.

Plastic Surgery Statistics Show Continued Growth

The rate of plastic surgery and cosmetic surgery continues to grow nationally.  Nearly 11 million cosmetic plastic surgery procedures were performed in the United States in 2006, up 7 percent from 2005, according to statistics compiled by the plastic surgery society. In addition, more than 5.2 million reconstructive plastic surgery procedures were performed last year.

As a cosmetic surgeon, I found it interesting that surgical cosmetic procedures increased 2 percent, with more than 1.8 million procedures performed in 2006. The top five surgical procedures were breast augmentation (329,000), rhinoplasty (307,000), liposuction (303,000), eyelid surgery (233,000), and tummy tuck (146,000). For the first time, breast augmentation is the most popular surgical procedure.  This might be partly because of the publicity surrounding silicone breast implants, which recently were approved by the FDA for general usage.
Certainly we are seeing similar trends here in Beverly Hills.  We continue to do more Beverly Hills breast augmentation surgery, and we also are doing ever-more frequent Botox treatments.  We also are seeing large increases in our tummy tuck procedures, which also do as part of our Rodeo Drive Mommy Makeover combination.  We often do this procedure with a breast lift or implant and liposuction.

Reconstructive plastic surgery, which improves function and appearance to abnormal structures, decreased 3 percent in 2006. The top five reconstructive procedures were tumor removal (3.9 million), laceration repair (313,000), scar revision (165,000), hand surgery (156,000) and breast reduction (104,000).  As a cosmetic surgeon, I am pleased to perform these sorts of reconstructive procedures for my patients.

But the biggest jump was in noninvasive procedures.  Minimally-invasive cosmetic procedures jumped 8 percent to more than 9.1 million procedures in 2006. The top five minimally-invasive procedures included Botox^® (4.1 million), chemical peel (1.1 million), laser hair removal (887,000), microdermabrasion (817,000), and hyaluronic acid fillers (778,000). Skin and soft tissue fillers (Restylane^®, Hylaform^® and Hylaform Plus^®) debuted in the top five, bumping out sclerotherapy (treatment of spider veins) which had been among the top five minimally-invasive procedures for the previous three years.

Plastic Surgery Blogs

There is certainly a lot of information floating around about plastic surgery!  There are TV shows (reality and documentary), advertisements in newspapers and on television, and of course people seem to often tell their own plastic surgery stories.  This sort of information can lead to clutter, and lot of marginal information.  One way to cut through the clutter is to have a look at some plastic surgery blogs.  You’re reading one right now!  Some of these blogs are written by plastic surgeons (like this one) while others are written by related experts in plastic surgery and cosmetic surgery.  A good plastic surgery blog goes a long way to bring you up to speed on the specialty.  This sure helps if you are considering a specific procedure such as Los Angeles liposuction.

Like anything, it is good to do some comparison shopping.  Read more than just on cosmetic surgery blog.  Check out the web sites from the plastic surgery specialty medical societies.  Read some good web sites for plastic surgery practices.  If you do your research, you will have more information to lean back on as you consider if plastic surgery is for you and when you do go in for a plastic surgery consultation you will be doing so from a position of knowledge.  This way you can have your questions answered on a much higher level as you make your decisions.

One of our plastic surgery blogs, http://bhplasticsurgeon.blogspot.com/, is actually a collection of articles written by Dr. Lloyd Krieger (the founder and Medical Director of Rodeo Drive Plastic Surgery in Beverly Hills) that describe many of the most common plastic surgery and cosmetic surgery procedures.  The articles talk about what types of procedures work to address which specific issues, who is a candidate for the various procedures, how they are performed, and what sort of recovery is necessary.  This is the sort of information you need to make an informed decision about plastic surgery.  And with this background, you can begin to consider how plastic surgery might fit into your future plans.  When you do go in for that plastic surgery consultation you can ask the right questions to get the answers you are looking for.

Plastic surgery is a big decision.  It definitely pays to do your homework before going under the knife (or needle, or laser).  So take some time, do some reading, compile your research, make a list of questions, and do the work required from your end to see if plastic surgery is right for you.  The best educated patients have the best results.  They know what to expect.  They know what plastic surgery can and cannot accomplish.  And so they get what they are looking for out of plastic surgery.  Here are another couple of plastic surgery blogs that are worth checking out— http://plasticsurgeryinbeverlyhills.blogspot.com/ and http://rodeodriveplasticsurgery.blogspot.com/.  This last blog is the main blog for Rodeo Drive Plastic Surgery in Beverly Hills.

Springtime Plastic Surgery

Spring is here and summer is on its way.  This is the busiest time of year for plastic surgery.  People are getting ready for summer and want to look their best.  They go now for plastic surgery they may have been considering for a long time as they prepare for the beach and summer vacation and weddings, among other July and August events and rituals. 

The procedures we do the most at this time of year are the classic body surgery procedures — liposuction and breast augmentation.  These procedures make very visible changes in people’s body shape.  They also have fairly short recovery periods, so people who have these procedures in May and June are very ready for bathing suits (with their new body shapes) by July.  At this time of year, because we are so busy, we add on extra surgery days to accomodate our spring rush for plastic surgery.

We also do other plastic surgery in the springtime.  We do a great deal of Botox, as people get ready for various events and want to smooth out lines and wrinkles on their face.   But overall we do the greatest number of liposuction and breast augmentation procedures at this time of year.

Liposuction has the advantage of getting rid of unwanted fat with minimal downtime and scarring.  If people have nagging areas of excess fat, the procedure is quite effective in removing them.   The results can be dramatic.  We do a lot of chin liposuction and neck liposuction in both men and women.  For women we do a lot of lipo in the abdomen or tummy and the inner and outer thighs.  For men, we do it frequently in the chest and the love handles or flanks.

With breast augmentation, the approval of silicone breast implants has created more options for women seeking breast enlargement.  While we still do most of our breast augmentation procedures with saline implant, we likely will be using more silicone implants in the future.

Winning the Battle of the Bulge Sometimes Takes a Tummy Tuck

People often focus their beauty ideals onto their stomachs instead of their faces, and it can be frustrating when a bulging belly ignores your active and healthy lifestyle. Although weight loss can be healthy, it will not necessarily lead to a smooth firm stomach. In fact, weight loss or recovery from multiple pregnancies will leave you with stretched skin that hangs and bulges.

If you are in this situation and truly want to attain a smoother contour for your abdomen, then tummy tuck surgery is worth considering. Abdominoplasty, better known by its cuter name the tummy tuck, is a major surgery that carries with it the normal risks associated with surgery. Serious complications are rare, however, and the results are generally pleasing and impressive.

<b>What Happens During Tummy Tuck Surgery</b>

A complete abdominoplasty takes about two to four hours to perform. The time range is so wide because body sizes and shapes vary and this determines how much time the procedure will take. To begin, the plastic surgeon will make a long incision along your lower abdomen from hip to hip. Every effort is made to place this incision in a place where the future scar will be hidden by underwear or bathing suits.

Next the plastic surgeon separates your abdominal skin from the underlying tissue and lifts it all the way up to your ribs. This action reveals the muscles underneath. The plastic surgeon will pull the muscles closer together and stitch them in order to create a firmer and flatter stomach. At Rodeo Drive Plastic Surgery, when we do our California tummy tuck we contour these muscles to create a nicer looking waist.

Once the muscles have been adjusted and secured into their new contour, your skin flap will be stretched over them. A new navel will also be created in the proper location and stitched into place. At Rodeo Drive Plastic Surgery, we use this step to create our specialized Rodeo Drive Belly Button. Excess skin will be removed, which ends the problem of loose hanging skin and lessens bulging. Finally, the incision is stitched and dressed. If necessary, small tubes will be used for drainage.

The procedure is often done as an outpatient, and you can return home several hours following the tummy tuck surgery. It is very important that you get up and walk around following the surgery. This helps to alleviate swelling and lower your risk of blood clots. Typically, in the first days, you will not be able to stand entirely straight up, but this is temporary.

As you continue your recovery, you will be able to resume all normal daily activities within a few days. A supportive post-surgical garment will likely replace your dressings after a few days. Once a week or so goes by, your plastic surgeon will see you again, remove drains if they have been placed, and you will find you can do essentially all normal physical activities. The only remaining restriction will be no heavy lifting. Your surgeon may advise you not to do heavy lifting for six weeks or so following your tummy tuck.

If you are a good candidate, you may find that a tummy tuck in Los Angeles greatly improves your quality of life.

Breast Implant Revision

Breast implants can provide real improvements to body image and self esteem.  But it is important that women with breast implants keep in mind that like the majority of medical devices, breast implants are not designed to last a lifetime.  Body shapes change with time, as do tastes and preferences.  Therefore, is should be said that California breast augmentation does not last forever.

In most cases, women with implants may need to have at least one or more surgeries for routine implant replacement. Often times women will come up with additional reasons for having revision surgery other than just to replace the breast implants.  They might be seeking other plastic surgery in Los Angeles and choose to revise their breast augmentation at this time.
Leakage is a common reason why women may need more surgery, which can occur in both saline and silicone devices. With saline implants it may be easier to notice a leak as the breast becomes softer and smaller. Silicone gel implants may not be as apparent as with saline implants. Leaks in silicone implants are usually self-contained and leak out in the capsule or pocket of the implant. It is highly recommended to have a mammogram or possibly an ultrasound to help detect any possible leakage.  Your California plastic surgeon can advise you about these issues.

How We Approach Ethnic Rhinoplasty

People of different ethnic groups often come to a plastic surgeon seeking to refine the appearance of their nose. Modern rhinoplasty techniques like those done at Rodeo Drive Plastic Surgery stress preservation of ethnic appearance along with overall facial balance. The nose should match the rest of the face. Ethnic rhinoplasty or nose job works to achieve this while providing the improvements and enhancements sought in the nose.

Ethnic groups often tend to have certain characteristics to their noses, both in terms of their outer appearance and of their internal structures. For this reason, it is best to address the noses of various ethnic groups such as African Americans and Hispanics and Asians individually. “Cookie cutter” approaches to rhinoplasty rarely work well, and this is especially the case with non-caucasian nose surgery.

There are many examples of how this individualized approach offers the best outcome in ethnic rhinoplasty. For instance, many people of Asian and African and Latino descent have noses with wide bases and broad tips. They often also have thick skin at the tip of the nose. This can give the tip a rounded or “bulbous” appearance. Non-caucasian noses often also have a bump at the bridge, along with a wide and flat bridge.

Because of these anatomic tendencies, ethnic noses frequently require extensive work on their internal structures to create the desired appearance. This includes using plastic surgery to change the shape of the bone and cartilage inside the nose, while working to create little or no external scarring. Since this internal structural work is extensive, it can have important effects on the function as well as the appearance of the nose. For this reason, the Rodeo Drive Breathe Easy Rhinoplasty^TM technique — which works to improve both the appearance and the breathing function of the nose – is especially well-suited to providing good results in ethnic rhinoplasty.

Some rhinoplasty and plastic surgery techniques are commonly used for African American, Hispanic, and Asian noses. The flatter noses common in many ethnic people can be addressed by grafting cartilage from elsewhere in the body to shape the skin of the nose’s tip more finely, and provide it with a refined appearance. In some cases, the nostrils are noticeably wide and benefit from direct steps to narrow them during surgery.

Prior to your procedure, you will meet with your plastic surgeon to discuss your goals from rhinoplasty. It is important to have clear ideas of what you want to change about your nose so we can come up with the best plan for your nose surgery.

How to Get the Fat Out – A Description of Liposuction

Liposuction is a commonly performed plastic surgery procedure. It is a very effective technique for removing areas of fatty bulge that are non-responsive to diet and exercise. California liposuction can be performed on a wide variety of body locations such as the abdomen, thighs, hips, arms, chin, and “love handles.”

If you have an area on your body with more fat than you would like, then liposuction may be a viable option for you if a plastic surgeon deems you to be an appropriate candidate. But before you can make a serious decision about pursuing liposuction, you naturally want to know something about it. Essentially, how does California liposuction get the fat out?

During a liposuction procedure, the area of your body that is going to be treated will have a fluid injected into the fat tissues in order to make it easier for the plastic surgeon to sculpt the tissue and remove fat. Of course, anesthetic is injected into the same area as well so you don’t experience pain during the procedure and also helps to keep you comfortable following the procedure. A third set of ingredients uses a blood vessel constricting medicine that reduces bleeding.

Once the body area has been prepared, your plastic surgeon will make multiple small incisions to access the fat tissues beneath the skin. The incisions are strategically located in natural skin folds to reduce the visibility of scars. Through the incisions, small tubes are inserted to pull out the fat.

Beyond the basics of the liposuction procedure, there are various techniques that your plastic surgeon may employ on a case-by-case basis depending on what you may need. Examples of types of liposuction are microliposuction and ultrasound-assisted liposuction. Many liposuction approaches are available and more techniques are being developed all the time. Your plastic surgeon will help you consider your options based on your body and what you hope to achieve from liposculpture in Beverly Hills.

For the most part, liposuction is an outpatient surgery. The extent of your liposuction surgery and your preferences along with your surgeon’s judgment will determine whether you have a general or local anesthesia. It is also quite common for long-lasting local anesthetics to be injected into the surgery site to reduce pain for a couple days while you ease into recovery.

As you consider liposuction, it is important that you accept that liposuction is not a cure-all for weight problems. In fact, liposuction is best applied to people of normal or near-normal weight who want to address fatty areas and smooth away bulges.

Rodeo Drive’s Specialized Patient Programs

At Rodeo Drive Plastic Surgery, we believe that Los Angeles plastic surgery should be a smooth process – before, during, and after your actual procedure. In order to make this happen, we have created a series of unique patient programs. Each of these programs works to make the overall process of plastic surgery easy, so you can enjoy your result with minimal discomfort and downtime. Some of them focus on the unique needs of certain groups of patients. Others work to help you enhance the improved lifestyle we hope begins with your plastic surgery at our Beverly Hills Center.

While it is difficult to make any surgery completely pain free, we have succeeded in making our procedures very low pain. This allows patients to be comfortable from the moment the procedure is completed and our nurses take care of them in the recovery room, to when they continue their recuperation at home. Our goal is to make post-procedure pain something akin to the soreness that accompanies a very strenuous workout at the gym.

Below are descriptions of the patient programs we have developed with your needs and desires in mind. Most of our programs were developed after listening to the suggestions of our patients. So if you have any ideas of what we can do to help fulfill your needs, please let us know. Please click on the link at the start of each description to read more about each of these programs.

Minimal Pain Program: Many of our patients are concerned about discomfort following plastic surgery. This program works to minimize any discomfort, so you feel like yourself shortly after your procedure.

Back to the Gym Program: Some people really like working out, and don’t want to take too much time out from their exercise routine – even when they have plastic surgery. This program helps you get back to exercising as quickly as possible, while still guarding your safety and ensuring optimal results from surgery.

Patient Safety Program: Your safety is our number one priority during and after plastic surgery. This program formalizes the steps we take to maximize safety in every procedure we do.

Traveling for Plastic Surgery: Many of our patients come from out of town and often from out of the country. This program works to make visiting us for plastic surgery smooth and relaxing.

Scar Reduction Program:Nobody likes scars. This program includes pre-emptive steps to make your scars appear as minimal as possible.

Art Shows on Rodeo Drive: We hope that plastic surgery will be your first step to enhancing your overall lifestyle. Our art shows bring together our patients, local stylemakers, and other interesting members of the community to experience fine art at our offices.

Plastic Surgery for Hispanics: Many of our patients are Hispanic and this program works to meet their unique needs to assure the best possible results from plastic surgery.

Plastic Surgery for Men: Men need their own specialized approach to Los Angeles plastic surgery. Our approach to men ensures that their distinctive

Patient Privacy at Rodeo Drive Plastic Surgery

Plastic surgery is a private undertaking and a very personal decision.  At Rodeo Drive Plastic Surgery, the first and only plastic surgery center on world-famous Rodeo Drive, we have developed a unique patient privacy program to assure the utmost discretion for our clients. Because of our unique location and relationships, our plastic surgery center caters to members of the entertainment industry. But when it comes to privacy, we adhere to the same standards for celebrity plastic surgery as for all of our patients.

The program starts with the physical layout of our offices and on-site surgery center. We built a hidden back entrance — far from prying eyes of celebrity photographers — that leads to a discreet service elevator.  This elevator opens deep in the building’s parking structure and also on the alley behind Rodeo Drive. Our back entrance is unusual among medical offices and assures discretion.  This novel feature of our design and layout has been featured in Elle magazine, Denmark’s Q magazine and on France’s Télévision Française 1,France’s most popular TV network.

Our plastic surgery staff, in our offices and our operating rooms, is thoroughly trained in patient privacy issues.  Our organization has a designated privacy officer to oversee the routine work of the staff and confirm that our strict confidentiality policies are enforced. No member of our staff will discuss any aspect of patient care (or even that someone is receiving care) with anyone at any time, unless that person have given us permission to do so.  Each employee signs an agreement to maintain patient privacy at all times — again, this applies to celebrity plastic surgery and for all patients who go our plastic surgery center. Patients also are asked to designate how they would like to be contracted (such as cell phone only), so communication is always done in the manner that makes the patient most comfortable and allows for the most discretion.

These steps offer reassurance to all patients that their confidentiality will be maintained. And since we treat every patient like a celebrity, we take firm steps to maintain discretion and safeguard confidentiality for all our patients.

Surgical Innovations of Abbott Krieger, MD

For patients left paralyzed from a spinal cord injury in the cervical or neck area, breathing is a constant challenge that threatens one’s independence, emotional well being and health. For the first time, a procedure is available to regenerate the damaged phrenic nerve, which cues the diaphragm to move the lungs.

Abbott Krieger, MD, a neurosurgeon in private practice in Livingston, New Jersey, and Beverly Hills, California (where he works with his son, Beverly Hills plastic surgeon Dr. Lloyd Krieger) has been working for more than 20 years to repair the phrenic nerve, re-animate the diaphragm muscles and free quadriplegics confined for life to ventilators.  Abbott Krieger, MD presented the results of his research to more than 2,500 neurosurgeons and allied health professionals at the Congress of Neurological Surgeons 49th Annual Meeting.

“This procedure will open up a tremendous opportunity for patients who have lost the ability to move and breathe on their own – without the aid of a respirator – due to spinal cord injury or disease, or damage to the phrenic nerve,” said Abbott Krieger MD. “It marks the first time that nerve restoration surgery has been used to free permanent prisoners of a ventilator from their misery.”

The procedure, which has been successfully performed in six patients with dead or damaged phrenic nerves, works by grafting a living, intercostal nerve into the phrenic nerve. After approximately six months, nerve regeneration occurs and takes over the electrical functions of the phrenic nerve. A pacemaker is inserted to help the fused nerve send the correct “breathe” signal to the brain.

The pacemaker, similar to the ones used in cardiac patients, consists of electrodes sutured to the phrenic nerves, radio receivers implanted into subcutaneous pockets, and an external transmitter/antenna that provides power to the system via 9-volt batteries. The external transmitter and antenna send energy and stimulus information to the receiver implant, which are translated into radio waves, or stimulating pulses, and delivered to the phrenic nerve via the electrodes. The repetitive stimulus patterns to the phrenic nerve results in smooth, rhythmic contractions of the diaphragm, which allow the patient to breathe on his or her own.

“Pacing the phrenic nerve is not new, per se; it has been done for more than 20 years on patients with an intact phrenic nerve, but in whom the spinal cord is not sending appropriate signals,” said Abbott Krieger, MD. “This trial, however, marks the first time nerve transfers have been used to re-animate the phrenic nerve in patients with damage to the nerve itself or with damage to the nerve cells in the spinal cord.”

Approximately 450,000 people in the United States have sustained spinal cord injuries, with more than 10,000 new cases emerging each year. Overall, more than half of all spinal cord injuries result in quadriplegia, leaving victims dependent on ventilators to breathe.

“Breathing through a ventilator wears on the body and makes quadriplegics more susceptible to fever, infections and pneumonia — the primary case of death in quadriplegics,” said Dr. Krieger. “This procedure eliminates the brute force of the ventilator and reproduces the smoothness of the natural breathing process, thereby prolonging the lifespan of many quadriplegics.”

Dr. Abbott J. Krieger plans to continue his research in this area and explore how neurotrophic factors can be used to speed the healing process in patients with phrenic nerve grafts. “Given the success of this research, I plan to look at ways to use this technique to make the phrenic nerve procedure a quicker, safer, and more routine operation, so that more patients will be eligible to receive its benefits.”  He notes that some procedures can be done at the Beverly Hills surgery center where he also works and where he also assists his son doing such procedures as the Los Angeles tummy tuck.

Choosing an Outpatient Surgery Center

Times have changed in surgery. About fifteen years ago, just about all surgery – no matter how routine or small the procedure – was done in the hospital. Now, the majority of all surgical procedures are performed in outpatient surgery centers. These facilities are usually freestanding and are not attached to the hospital.

Now, even relatively complex and lengthy procedures are performed in outpatient surgery centers. These facilities are sometimes also called ambulatory surgery centers. More than 90% of all plastic surgery procedures such as breast augmentation and liposuction are performed in outpatient facilities. This is especially the case with California plastic surgery such as California rhinoplasty.

This shift puts the burden on the patient or consumer to choose wisely. Surgery of all kinds has never been safer or more effective. But it is still a serious undertaking and the facility where it is performed is a key component of overall safety.

There are several things to look for when evaluating whether you should use a particular outpatient surgery center. The most important issue is safety. You should check on the certification of the outpatient surgery center. Some states offer licensure of these facilities, while others do not. There are certifying organizations that inspect facilities. Some of these include AAAHC and Medicare. When a facility has these sorts of certifications, they have been thoroughly inspected for their physical layout, staff training, safety equipment, and emergency protocols to assure they have the highest level of professionalism and safety.

You should ask your surgeon why he chooses to use the given surgery center. Has he found the surgery center to be safe and convenient for patients? You should ask if the surgery center has a transfer agreement with a local hospital. In case of a problem, this confirms that you can get quick access to emergency care in the hospital setting. You should ask about the safety equipment on hand at the facility. Following your procedure in an outpatient surgery center, you likely will go home. You should ask your surgeon what provisions are made for contacting him and her with questions and concerns during off hours. You should also ask who will be performing your anesthesia. Is the anesthesiologist or nurse anesthetist experienced in outpatient surgery? You might also ask to receive any prescriptions for post-procedure medications prior to your surgery day, so you need not go to the pharmacy following your surgery.

Outpatient surgery is now routine and safe. But it is important to check on the outpatient surgery center prior to deciding where to have your procedure performed.

An Unusual Approach to Rhinoplasty

The nose is the center of our face. As such, it always grabs the attention of those who look at us. Its appearance helps create our overall facial harmony. The nose also has an important functional component. It does our breathing. Its function is complex, and any alterations done to the nose can have profound effects on our ease of breathing.

Among plastic surgery procedures, rhinoplasty is perhaps the most challenging. This procedure is often called a nose job. Paying attention only to aesthetics can lead to problems with breathing following this plastic surgery procedure. Paying attention only to breath flow can compromise aesthetics. To best deal with these issues, our plastic surgeons work to overcome these potential difficulties by using their different perspectives to focus simultaneously on improving both appearance and function.

Because of its equal importance in appearance and breathing, our specialists have developed The Rodeo Drive Breathe Easy Rhinoplasty. Our two plastic surgeons do all of our rhinoplasties as a team. We have different but complementary training and backgrounds that they apply to your rhinoplasty. This interdisciplinary approach provides you with the benefit of a broad perspective and skills during your evaluation and treatment. We give equal focus to the cosmetic and functional aspects of rhinoplasty Los Angeles.

During nose surgery, people sometimes want to remove the bump in their nose, make the nose more narrow, help with breathing, make the nose less crooked, or refine the tip. It is important that people communicate their concerns about their nose to the surgeon in order to obtain the best outcome.

The Rodeo Drive Breathe Easy Rhinoplasty is beneficial for all rhinoplasties, and that’s why we always bring this approach to nose surgery. But in some cases, we believe it is especially useful. Some of these complex situations where our approach brings added benefit include ethnic rhinoplasty, revision rhinoplasty, and rhinoplasty for men. These types of procedures can be especially challenging and this approach serves to help provide the best possible results.

The recovery from rhinoplasty varies for each person, just like for any plastic surgery procedure such as liposuction or tummy tuck.  Sometimes there will be some bruising for a week or so. We sometimes put packing in the nose for a few days, and you will have to breathe through your mouth during this period. You may have a plaster or silicone splint on your nose for about a week. Most people have very little discomfort following the procedure. Almost everyone tells us that the improvements in their appearance and function are well worth any short-term inconvenience!

Silicone Breast Implants Add Choices For Women

After more than ten years of controversy and scientific study, the US Food and Drug Administration has approved silicone gel breast implants for general usage. They are now available to all women ages 22 and higher for both reconstructive and cosmetic breast surgery including breast augmentation.

The availability of silicone implants will greatly expand the options for women seeking cosmetic breast augmentation. In many situations, they have real advantages over saline breast implants. They tend to look and feel more natural than saline implants. They are less prone to rippling or crinkling which can sometimes be felt and occasionally can become visible under the skin. They are lighter than silicone implants. However, they are thought by some to have a higher rate of capsular contracture, which is scarring around the implant and can make the breasts hard.

In countries where both silicone and saline implants have been available the vast majority of patients and surgeons select silicone implants. This is testimony to their advantages. In the US, we are likely to see a large number of patients select silicone breast implants for their breast augmentation.

But there will still be a place for saline implants. Some people might simply prefer not to have silicone placed in their body. Silicone implants are more expensive than saline implants. In some cases, the implant is used as a sort of platform to elevate the normal breast tissue rather than to give the breast the entirety of its shape. In this situation, saline implants function just about as effectively as silicone implants.

Silicone implants have not been shown to cause autoimmune diseases such as arthritis and lupus, as had been feared. But patients should realize that any breast augmentation procedure is essentially temporary. Body shape and anatomy can change, there might be problems with healing or the body’s reaction to the implant. At some point, it is likely that additional procedures may be necessary.
At Rodeo Drive Plastic Surgery, we are already doing quite a few breast augmentations with silicone implants. I expect we will see many more people interested in the procedure in the next few months as we do breast augmentation in California.

Creating the Elusive “Lunchtime Facelift”

The “lunchtime facelift” has been the holy grail in plastic surgery for quite a while. The idea of providing facial rejuvenation with no downtime appeals to both plastic surgeons and patients. Get your treatment, look improved and freshened, and immediately go back to work, out on the town or, for some of our entertainment patients here in Beverly Hills, head over to the red carpet at an awards show. Who wouldn’t want to get their facial rejuvenation and then have no recovery?

Essentially all of the so called “no downtime facelifts” or “lunchtime facelifts” simply did not live up to their billing. As a plastic surgeon, I know that surgery involves recovery. It is just the way the body responds to a surgical procedure. Traditionally, if the body did not react to the procedure, nothing much was really done and few changes were visible when all was said and done.

But now we have many nonsurgical techniques that can create instant facial freshening — removing or smoothing wrinkles, plumping lips — with no recovery. Botox, Restylane, Juvederm, Radiesse, Sculptra and other new products provide facial rejuvenation and do not create scars or undue swelling. They can help achieve that elusive goal of improvements without downtime. This is perhaps the biggest revolution in plastic surgery in thirty years.

These products work very differently. When we do Los Angeles Botox we are using the medicine to paralyze some of the tiny muscles in the face. The twitching of these muscles creates a skin wrinkle on the skin that lies above it. If the muscles lay quietly, they do not tense and cause a wrinkle in the skin above. Botox is extremely safe, its results are predictable, and it can create fantastic improvements in facial appearance. My sister recently had it for the first time, and it dramatically improved and freshened the look of her face – just like I have seen it do for countless other of my patients.

The we use Los Angeles skin fillers skin fillers such as Restylane and Juvederm we work to provide bulk under the skin to fill in wrinkles from below. They are very effective for both small lines and larger ones, such as the nasolabial folds which run from the sides of the nose toward the outside edges of the side of the mouth and the so-called marionette lines that go along the side of the chin.

Each person’s face is different, so each person will do best with a different noninvasive treatment and nonsurgical skin rejuvenation. But the various procedures do provide fast changes with little or no recovery. Where in the past the “weekend facelift” was illusory, it is now possible to create dramatic changes without downtime.

New Web Site Provides Plastic Surgery Information

A new web site has been published that provides the facts about plastic surgery.  The goal of Plastic Surgery 101 is to provide people with detailed plastic surgery information so they can make informed decisions as they consider having cosmetic surgery.

Plastic surgery and cosmetic surgery are topics of growing interest. Television shows featuring Beverly Hills plastic surgeons and their patients are increasingly popular. More and more plastic surgery procedures are being performed every year. Once only for the wealthy, today people from all walks of life are having plastic surgery because of the great enhancements it can provide to quality of life.

New plastic surgery techniques are constantly being developed and introduced. Unfortunately, there is not a lot of clear information about plastic surgery easily available to consumers and potential patients. Confusion about the real facts of plastic surgery is very common.

About www.PlasticSurgery101.net
This web site provides educational information for people considering plastic surgery. It offers facts about specific plastic surgery and cosmetic surgery procedures so people can make informed decisions. The material on this site was compiled by a Beverly Hills plastic surgeon with the goal of providing clear and current Los Angeles plastic surgery information. The site includes details about the various procedures, recovery, expected results, and before and after pictures. It is a great resource for people seeking to gain understanding of plastic surgery options.  Some of the covered procedures include