Posted Wednesday, September 22, 2010 New Beauty Magazine

Many who have experienced massive weight loss are uncomfortable with their appearance after such a drastic change, and many look into body-contouring surgery to eliminate excess skin and refine their results. However, not everyone who has lost a lot of weight is an appropriate candidate for these procedures.

Several 2008 ASPS studies highlighted which patients face high complication risks during post-weight-loss contouring surgery. One looked at patients who had lost a significant amount of weight but whose body mass index still categorized them as obese. Even at a lower weight, patients who hadn’t reached their goal BMI were found to be at high risk of post-op problems. The study authors state that waiting a little longer and reaching a healthy BMI will make surgery much safer.

Another study looking at gender found that men who had lost a massive amount of weight were three times more likely to experience hematoma and almost twice as likely to experience fluid collection (seroma) after body-contouring surgery.

A third study found that the means of weight loss—whether through bariatric surgery or diet and exercise—did not make a significant difference in the risks one may face in body-contouring surgery. However, a fourth study shed light on the malnutrition either type of patient may be afflicted with, and how this could pose a problem during body-contouring recovery. Those who were prescribed a nutritional supplement program to counteract malnutrition experienced much better wound healing, scar quality and energy.

What the Expert Says…

Dr. Michael A. Epstein | Plastic Surgeon
There is little question that these patients are a higher risk when compared to the general population. It is important that the surgical procedures on these patients are well planned out and the surgeon has plenty of experiance with these procedures.

Posted September 27, 2010 11:50 AM

By ANGELA CHARLTON (AP) – 4 days ago

Dr. Laurent Lantieri, a surgeon at Henri-Mondor hospital in Creteil, France, performed a full face transplant on a 35-year-old man with neurofibromatosis. “The most difficult part of the operation was to connect the tear duct that goes through the bone,” Lantieri said. The procedure could eventually be used to help burn victims. For more information click here:  Google/The Associated

Boy undergoes 19th facial reconstructive surgery at Ellis Health Center

A surgeon at Ellis Health Center in New York performed the 19th surgery on an Iranian boy born with no nose, one eye — in his temple — and his mouth at a 45-degree angle. Dr. Lucie Capek created a right nostril for young Mohammad Karimi. “Putting a smile on his face is so rewarding. He was so excited to have a nostril which was like a big big deal,” said Capek, who donated the surgery. WNYT-TV (Albany, N.Y.)

Dr. Epstein’s response:

At its very core, this is what Plastic Surgery is all about. Being innovative, using surgical skills to reshape, reform, and restore normal anatomy.  When we figure out how to control the immunological response to the transplanted tissue, then the possibilities are endless. Interestingly enough the first two articles are very much related. The more success we have with these full face transplants, the more people like the child in the second story will be able to be restored to a normal life.

Jaclyn Trop / The Detroit News

Though people are wary of spending full throttle again, they’re slowly opening their wallets for personal care, according to local dentists, orthodontists and plastic surgeons.

“I think they feel it’s stabilizing, whereas a year and a half ago they were concerned about their jobs,” said Dr. Michelle Hardaway with Aesthetic Plastic Surgery & Laser Center in Farmington Hills.

Hardaway said more clients are coming in for consultations and more are opting to have surgery, though her practice isn’t as busy as it was before the recession.

Many patients still have trouble getting financing for their surgeries and are often declined by third-party credit services.

While liposuction, rhinoplasty and breast augmentation remain popular, patients are also choosing cheaper nonsurgical procedures, including Botox, injectable fillers, laser hair removal and laser treatments for the face, Hardaway said.

Dr. Gregory Roche, a cosmetic surgeon in Bloomfield Hills, said appointments for surgical and nonsurgical procedures increased 50 or 60 percent this year over the same six-month period last year.

“People want to improve their image to get back to work or get a job, or they’re doing interim procedures as they wait,” Roche said.

Meanwhile, the Birmingham-based orthodontics firm Tyler Dumas Reyes credits its six-figure investment in new technology and training for its growth, including a third location set to open in Novi next month.

But patients aren’t as freewheeling as they used to be, Dr. John Dumas said.

“It used to be that they’d come in, sign on the dotted line and get going.”

Now, he says, they are more cautious before committing money.

jtrop@detnews.com (313) 222-2300

Dr. Epstein’s Thoughts

Cosmetic Surgery has definitely been on the slow but steady rise over the last year despite the meager growth in the general economy. I believe that this can be explained by the fact that people find it more acceptable to invest in themselves rather than on other items that may not seem like such a necessity. I also believe that even though financing is harder to obtain, people are saving for these procedures and paying for them with money in hand.  Prices may be slightly lower too.  Furthermore, some of this can be explained by pure numbers, especially in the Midwest.  I believe the numbers of people wanting and having elective cosmetic procedures in these areas are on the rise because they have always lagged behind the more traditional cosmetic surgery focused areas, like California, Southern Florida, and the East Coast.  It has generally become more acceptable now in the more conservative parts of the nation.

It doesn’t take a doctor to see that men and women carry fat differently. Men tend to pack it on in the belly, whereas women will find fat accumulating in their hips, butt and thighs. But while the difference may be apparent, the reason hasn’t been.

Researchers at the University of Texas Southwestern Medical Center recently analyzed fat genes in mice, who have a similar sex-based fat distribution pattern to humans. They found that male and female mice have very few fat genes in common. Therefore, male and female fat cells behave in completely different ways, giving way to dimorphic fat placement.

Women do have an advantage when it comes how where our fat tends to build up. Fat on the hips, thighs and butt is subcutaneous and therefore treatable with liposuction. However, belly fat in men is typically visceral and too deep to be treated with liposuction. The only way to reduce this kind of fat, which is considered a health risk, is with diet and exercise.

What the Expert Says…

Dr. Michael A. Epstein | Plastic Surgeon
There is no question that there is a clear difference in the way men and women tend to collect fat deposits on the body. I believe that these differences are anthropological in nature. Women tend to put fat on the upper, outer and inner thighs as well as the hips(waistline) and the lower abdomen to protect the womb for child bearing. Fortunately for them this fat is more accessible and therefore treatable by various body contouring operations. Although it is almost unheard of for a man to have a female fat distribution pattern, I have seen the occasional woman with more typical male fat distribution. There is another difference between fat on men and women and it actually pertains to the quality or intrinsic makeup of this fatty tissue. While the subcutaneous fat that is retrievable in most of the female population is more loose and globular, the typical male fat seems to be more dense and more entrenched in a richer fibrous network making it more difficult to remove by liposuction.

Message from the American Society of Aesthetic Plastic Surgery President Renato Saltz, MD…

On behalf of the American Society for Aesthetic Plastic Surgery (ASAPS) and the Aesthetic Surgery Education and Research Foundation (ASERF), I cordially invite you to attend The Aesthetic Meeting 2010, “A Capital Experience with a Global Perspective”, April 22-27, 2010 at the Gaylord National Hotel & Convention Center, Washington, D.C.

Aesthetic Plastic Surgery’s Global Scale and Scope: Leveraging the Specialty’s Core
The Aesthetic Meeting 2010 is the gateway of cutting edge education, collaboration and international networking opportunities for all who attend.  What distinguishes this meeting from the rest is that You will have exclusive access to a highly interactive and engaging educational forum with the complete scale and scope of Aesthetic Plastic Surgery and advances in Cosmetic Medicine.  It’s the right time to become engaged and empowered by investing in your education, connecting and participating with colleagues and others from around the world. We encourage you to visit the impressive lineup of technical exhibits to learn more about the latest products and services showcased by our valued exhibitors and corporate supporters. You will be able to equip yourself with effective tools and key strategies to enhance your practice to successfully compete in the global arena of Aesthetic Plastic Surgery and Cosmetic Medicine.

In response to the recent New York Times article that seems to glamorize performing breast augmentation surgery under a local anesthetic, I can only tell you that “things aren’t always as they seem”.  On first glance, it would seem as though having any surgery under local anesthesia would be a plus.  I can tell you with no uncertainty, that the subspecialty of anesthesia medicine exists for a reason.  That reason is to allow patients to have surgery more comfortably and more safely.  Breast augmentation surgery should not be taken lightly.  Typically, this surgery is done most commonly on a thinner woman where the proposed breast implant pocket is very close to vital structures. Furthermore, most breast augmentations are placed in the submuscular pocket.  When this is the preferred placement, it is imperative that the muscle and the patient is relaxed.  Finally, one should never underestimate the potential side effects of larger volumes of local anesthetic and benefits of having another healthcare professional in the room that is highly trained in caring for the patient’s physiology.  This in turn allows the surgeon to concentrate on the anatomy and the surgery at hand.

Posted Wednesday, April 14, 2010  – New Beauty Magazine

Acne scars come in a variety of types, from raised, red marks to deep pockmarks that can take on a pitted or dented appearance. Smaller, superficial scars can often be reduced with a combination of treatments that remove dead skin cells and help resurface the skin, but fillers like Juvederm or Restylane can be used to treat more severe scars.When scars create a wavy contour, they can be easily corrected with fillers, which fill the empty space under the scar and help support it. Fillers used in acne scars last longer than when fillers are placed in other areas, like the lips or cheeks, because they are not a dynamic part of the face that is constantly moving.

Keep in mind, fillers are not suitable for “ice-pick” scars because they have a tendency to collect in the skin almost like a blackhead due to their depth.

What the Expert Says…

 Dr. Michael A. Epstein | Plastic Surgeon

Fillers are a great tool to use to help hide acne scarring. Acne scarring is often such a difficult problem that it needs to be treated with multiple modalities. Skin resurfacing with a laser and structural fat grafting are 2 treatments that I often employ in my practice.

]]> http://maeplasticsurgery.com/2010/04/fillers-for-acne-scars/feed/ 0 http://maeplasticsurgery.com/2010/04/fda-to-medspas-your-lipodissolve-claims-are-misleading/ http://maeplasticsurgery.com/2010/04/fda-to-medspas-your-lipodissolve-claims-are-misleading/#comments Tue, 13 Apr 2010 05:36:45 +0000 Dr. Michael A. Epstein http://maeplasticsurgery.com/?p=1369 FDA to medspas: your lipodissolve claims are misleading

Posted Friday, April 09, 2010 New Beauty Magazine

After countless medical professionals have expressed concern over lipodissolve and the people performing it, the FDA has decided to start cracking down on medspas that offer this unproven “fat-melting” treatment.

Lipodissolve involves injections of phosphatidylcholine and sodium dioxycholate, often with vitamins and often compounded right on the premises, that purportedly dissolve fat deposits. However, this procedure and its pharmaceutical composition has not been proven effective or safe. Regardless, it is offered by many facilities that advertise it as an alternative to liposuction, and it is often administered by staff with little to no medical training.

This week, a handful of medspas around the country offering lipodissolve received warning letters from the FDA stating, “The claims made for your lipodissolve products are false and misleading in that they are not supported by substantial evidence or substantial clinical experience.”

The FDA has yet to see credible scientific evidence of lipodissolve’s benefits, but they’ve seen plenty of complaints from consumers who were left with lumps, scars and deformities after undergoing the treatment.

In addition to citing the medspas, the FDA has also sent warnings to a Brazilian company that offers the mixtures. Almost immediately, the company put up a message on their websites stating, “Due to the current facts,” they “do not sell Lipodissolve vials anymore.”

The medspas have two weeks to stop what they’re doing and notify the FDA of their efforts to correct their violations.

What the Expert Says

Dr. Michael A. Epstein | Plastic Surgeon
Lipodissolve has been an effective treatment in our office medspa for the last 2 years. This treatment is performed by myself or one of my registered nurses and we have not only not had any significant long term problems with the treatments, but we have had many satisfied patients with their results. If expectations are set appropriately and the treatment is performed by a competent provider, this can still be a useful tool in our aesthetic procedure armament. Many treatments that physicians provide in medical practices are not FDA approved. Medspas outside of a trained physician’s office should only be performing very controlled and limited treatments.

Posted Tuesday, March 23, 2010 New Beauty Magazine

An interesting study by the American Society of Plastic Surgeons shows that cosmetic surgery procedures can act as a mood and confidence enhancer. The research focused on 362 patients, 61 of whom were taking antidepressants at the time of their surgery.

Six months after surgery, the number of patients on antidepressants dropped to 42. Additionally, a whopping 98% of patients said that cosmetic surgery had markedly improved their self-esteem.

While it would be a stretch to say that plastic surgery alone is responsible for the decrease in antidepressant use, it is evident that the surgery factor warrants deeper investigation. It’s also imperative to share your full psychiatric history with your surgeon, as some clinically depressed patients may not be good candidates for surgery.

What the Expert Says…

Dr. Michael A. Epstein | Plastic Surgeon
On a superficial level, it is easy for me to say with confidence that elective cosmetic surgery does indeed have a positive effect on one’s self-esteem. I see this time and time again in my own practice. I am also very well aware of the fact that not all depression and not all depressed patients can be “cured” by cosmetic surgery. It is imperative that the surgeon identifies the true motivation behind the patient’s desire for surgical enhancement to a specific facial or body part. The surgeon must do his or her best to ensure that there are no underlying secondary desires that come along with the patient’s wishes for cosmetic surgery. The surgeon must also do his or her best to identify those patients who are under-treated or not treated at all for their depression. I truly believe that if the patient and the surgeon can come together and clearly identify the goals of the proposed surgical procedure, and the expectations for outcome, plastic surgery can be a very rewarding.