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..