This week it was reported that six New Jersey women were hospitalized for complications related to the injection of non-medical grade silicone into their buttocks by apparently unlicensed persons. According to a representative of the New Jersey Poison Information Center, the six women were treated by one or more unscrupulous individuals who injected what appears to be BATHROOM CAULK into their "gluteal region" in a back alley version of a buttocks augmentation.  The victims were admitted to the hospital, all were operated on to remove large abcesses and required antibiotics.  Although I am confident that none of the agelessandcosmeticblog.com readers would ever seek out cosmetic treatment from such non-qualified practitioners, this bizarre story underscores the need to be ever-vigilant about:

1-the qualifications and experience of all your medical providers, 

2-the devices with which they want to treat you, and

3-the medications and injectibles that they prescribe. 

Dr.Rothaus is pleased to announce that he is now on Facebook. You can find him at Rothaus Plastic Surgery. We look forward to being your "friend"!

Although I usually don't care to comment on celebrity plastic surgery, after hearing about Heidi Montag and her "transformation", I feel I must.  I was somewhat horrified at the idea of a healthy and, by all assessments, attractive 23-year old woman undergoing ten procedures in one day. From a psychological and physiological perspective, in my opinion this is neither good medicine nor good surgery. According to her account, Ms. Montag spent 10 hours in surgery.  Considering that her "before" photos are what most women would consider to be excellent "afters", this seems incredibly dangerous and excessive.  I understand that "all the celebrities are doing it", but if all the celebrities were taking a dangerous drug, would that make it acceptable?  

The February 2010 issue of Allure magazine had a great article addressing new developments in breast implant technology. One of these was "natural breast augmentation" using fat transfer or liposculpture in which the patent's own fat is injected directly into the breast. This is a technique that has only been in use in larger numbers for a few years and I have many reservations.  There are no long-term studies on the safety of fat transfer to the breasts.  Fat is a hormonally active substance and as the development breast cancer is known to be influenced in part by hormones, it seems premature to place a tissue that will alter the local hormonal environment into susceptible breast tissue without full-knowledge of its effects.  Fat transfer has been well-studied in Japan and it appears to be safe in that population in these relatively short-term studies. This data is not easily transferrable to an American patient population. Not only do Japanese women have smaller breasts (and, thus, require less fat to be injected), they have a much lower incidence of breast cancer than American woman (5 times less in some studies). This may be related to dietary, environmental or genetic differences.  It is of interest, however, that the incidence of breast cancer among culturally assimilated Japanese-American woman is rapidly increasing.  This may be related to changes in diet or other influences.  It is difficult, therefore, in my opinion, to extrapolate a safety profile for American woman from the experience in Japan. Until long-term studies have been done on American women, I will not be employing fat transfer to perform breast augmentation in my practice.

Last week the New York Times published an article on two new devices in development, both of which target fat without internal intervention.  The first, the Zeltiq, uses an externally placed cooling device that selectively freezes the fat in a process know as cryolipolysis.  The second, Zerona, uses low level laser energy applied to the skin that heats fat cells subcutaneously causing them to lyse. Both companies claim that there is no damage to the skin and that only fat cells are targeted.  The devices have not yet been approved by the FDA for safety and efficacy and the article implies that patients are having mixed results. While I am enthusiasticallly in support of non-surgical options, my personal experience has led me to be somewhat cautious in the introduction of similar devices in my practice. For example, I use SlimLipo for laser lipolysis. A fiber is passed beneath the skin and a 924 nm laser selectively "melts" the fat. When we first started using SlimLipo we would measure the internal temperatures of the treated area and the temperature of the skin above the area being treated.  We were very surprised to find that there was a not only a large difference in the internal and external temeperatures, but also they did not appear to be correlated in any way. Typically, the internal temperature was much hotter then the external temperature.  We concluded that the external temperature is NOT indicative of what is happening under the skin.  Therefore, my own clinical experience leads me to be cautious of devices that are treating deeper structures without a means of monitoring them simultaneously. Thus, although these are both very interesting technologies and may, in the future, prove to clinically and aesthetically efficacious, I will reserve my judgement on Zeltiq and Zerona until many more patients have been treated in IRB studies and more data and clinical follow-up becomes available.

An estimated 90% of women have stretch marks as a result of the rapid growth of the skin associated with pregnancy, weight gain and puberty.  Although they are completely benign, they are often aesthetically unpleasant and a source of profound irritation. Notoriously difficult to treat, women have long struggled with ways to make them appear more cosmetically acceptable. Unfortunately, very few treatments have proven effective. Now, however, women have a new tool to add to their stretch mark arsenal.  The FDA has recently approved Palomar's fractional laser for the treatment of stretch marks.  This 1540 laser treatment delivers energy deep into the dermis and epidermis, creating small areas of a controlled injury. As these areas heal, new collagen and elastin is generated, promoting the growth of healthier looking skin.  We have been using the 1540 factional laser at the office for years for facial resurfacing, treatment of brown spots, and scar revision with great results and high patient satisfaction. Although I think it is still early in the experience curve of the use of this device for the treatment of stretch marks,  I am very encouraged by its FDA approval and am I looking forward to, hopefully, helping my patients with similar problems..

The New York Times ran an article on January 20, 2010 entitled: Skin Deep – Should Surgeons Meet Patients Online?  

 http://www.nytimes.com/2010/01/21/fashion/21Skin.html?scp=1&sq=plastic%20surgery%20consultation%20online&st=cse   

The article discusses the many sites that are available where patients can do online consultations.  The article presents interviews pro and con such an approach to establishing a doctor-patient relationship and the value of the consultation received.  The advantages for the patient seemed to be that it was convenient, “empowers them with knowledge”, and may be more cost effective than seeking multiple consultations.  The advantage for the physicians who participate in such a site is obvious – it is a form of marketing that brings them patients from a distance they probably would not have otherwise seen.

 

Reading about these services gives me a feeling similar to chalk screeching on a blackboard. It is my experience that there is enough information on the internet that patients can come to an initial, face-to-face consultation already “empowered with knowledge”.   Secondly, I have found patient photographs to be notoriously unreliable as they are often off as far as color and focus and are lacking all the appropriate views.  Even professional photographs do not tell the whole story.  There is no substitute to seeing and examining the patient in person.  That is part of the art of surgery.

 

Furthermore, a patient who has scheduled and paid for a procedure based on a virtual consultation may be reluctant to change plans the day of the surgery, undergo an more extensive procedure (and recovery), or be subject to additional financial responsibilities even if the surgeon now states that the ideal procedure for the patient is not the one they agreed upon online.  One would hope that the physician has the ethics and fortitude to stand by the recommendations of his or her in-person consultation. Nevertheless, the physician is in the unenviable position of having to cancel surgery and deal with a very unhappy patient.

 

The article points out other problems with such online consultations including security, privacy, legality and professional liability.

 

There are times in a surgeon’s career where he will have to initially consult with a patient from a distance.  In my experience, these are former patients who are seeking consultation for a new problem or patients referred by a colleague. Even in these cases, where some sort of relationship exists, the path from initial consultation to possible surgery has to be followed slowly and carefully.  In my opinion, these sites increase the chances of violating that important medical maxim of “physician do no harm.”

   

I do not usually talk about products in this blog but two of my smartest colleagues who also happen to be very good friends have just launched new products for skin care and the treatment of headaches.  

Dr. David  Vasily an internationally renown dermatologist and laser surgeon who practices in the Lehigh Valley of Pennsylvania, has spent 9 years developing a new skin care product for the treatment of aging skin, DermaChromatic(TM).  The unique, active ingredient, phytochromatic(TM), which is derived from plants, is a patent-pending topical which is combined with antioxidants, vitamines, retinol, and a peptide. DermaChromatic (TM), according to Dr. Vasily, evens skin tone, reduces fine lines, decrease the appearance of pores and targets blotchiness and age spots.  Unfortunately, DermaChromatic(TM) is currently only available in Dr. Vasily's office but it soon should be dispensed in limited number of plastic surgery and aesthetic dermatology offices around the country. 

Dr. Alexander Mauskop who is the director of the New York Headache Center in Manhattan is a renown neurologist and pain physician who specializes in the treatment of patients with headaches and migraines.  He has developed, Migralex, a new over-the-counter product ( http://migralex.com) which is apparently a unique combination of aspirin and magnesium.  According to Dr. Mauskop, low magnesium levels are an important contributing factor to the development of headaches.  Dr. Mauskop apparently has put the ingredients together in a unique way that makes Migralex effective.  According to Dr. Mauskop, Migralex works in many ways to reduce headaches.  These include relieving pain, reducing inflammation, inhibiting the clumping together of platelets, and relaxing blood vessels.

As a disclaimer, I have no financial interest in either product and I do see my patients in Pennsylvania in Dr. Vasily's office.  Furthermore, I hope to be able to offer DermaChromatic to my patients as soon as it is more widely available.