plastic surgery – Page 3 – Larry S. Nichter, MD, FACS

The Most Popular Plastic Surgery Procedures 2011

Dr. Larry Nichter would like to make blog readers aware of new statistical information about plastic surgery and cosmetic procedures in the United States.

The number of cosmetic surgical procedures in America increased by 1% in 2011, the statistical survey by the American Society of Aesthetic Plastic Surgery has shown. Over 1.6 million such procedures were done in the United States last year.

In the fifteen years since the survey began (1997), the overall number of cosmetic procedures done in the United States has increased 197%.

Liposuction was shown to be the most popular procedure. Two breast surgeries—augmentation and lift—were among the top five most popular cosmetic surgeries:

Liposuction — 325,332 procedures
Breast augmentation — 316,848 procedures
Abdominoplasty — 149,410 procedures
Eyelid surgery — 147,540 procedures
Breast Lift — 127,054 procedures

The survey also showed a 2% decrease in the number of nonsurgical procedures, although 7.5 million such procedures were performed (constituting 82% of all cosmetic procedures).

Botulinum Toxin Type A — 2,619,739 procedures
Hyaluronic acid — 1,206,186 procedures
Laser Hair Removal — 919,802 procedures
Microdermabrasion — 499,427 procedures
IPL Laser Treatment — 439,161 procedures

An analysis on the society’s website attributed this growth to the aging of the Baby Boomer generation as well as their children.

Some other interesting findings from the survey include:

91% of all cosmetic procedures were done on women (8.4 million procedures). This is a 208% increase over the last 15 years.
Of the 800,000 men who had cosmetic surgery in 2011, the most popular procedures were liposuction, rhinoplasty, blepharoplasty, breast reduction (for gynecomastia), and facelift.
About $10 billion was spent on cosmetic procedures in the United States, and of that $6.2 billion was spent on surgical procedures, the rest was spent on nonsurgical procedures such as injectables, skin rejuvenation, and laser hair removal.

Source: Babbitt, Adeena. “Celebrating 15 Years of Trustworthy Plastic Surgery Statistics.” ASAPS.

Care & Support after Plastic Surgery

One of the things I ask people in a pre-operative visit is, “Who will take care of you?”

Then I add, “You want to have somebody who’s really going to take care of you, who won’t say to you when you first get home: ‘What the heck did you do that for?'”

Get somebody who’s going to be really supportive and caring and who will be warm, because you’re really going to need that.

The emotional stages the patient is going through affect the caretaker too. At the end of the first week the support person may be tired and need to go back to work.

Cosmetic Surgery affects each person differently. The most common reaction is to be depressed on the third or fourth day. However, some patients say, “Well, not me. I don’t feel depressed.” But three weeks later, they may have a crying jag while driving to work.

Sometimes near the end of the second week they’ve begun to feel good. And there’s a day in there when they realize that they look magnificent.

Patients experience feedback, both positive and negative. Some people tell me that they’re a bit irritated because people are now paying them more attention than they did before. And I say to them, “Isn’t that why you had the surgery? Because you wanted to be more attractive?”

And they reply, “Yes, but why didn’t they like me the way I was?”

But eventually people start to really enjoy the extra attention.

Recovery from cosmetic surgery for most people follows a necessary and predictable course. Dr. Nichter believes that being knowledgeable about the normal recovery process will reassure you and make it less stressful. These transient emotional and physical reactions to cosmetic surgery will pass easily when you are prepared about what to expect. The last part of the recovery process is the fun part—get ready for all the compliments!

Bromelain: a pineapple extract may improve post-surgery healing

Many of my patients ask about supplements that can speed the healing process. One such supplement that I feel is efficacious, decreases bruising and speeds healing is Bromelain. Below is a summary that details some of its potential beneficial qualities.

Bromelain is a type of enzyme found in high concentrations in pineapple plants (and other plants of the plant family Bomeliaceae). Animal studies and anecdotal evidence of the medicinal properties of this pineapple plant extract have brought to light its therapeutic value. Bromelain has also been shown to have low toxicity and produces little to no undesirable side effects.

Evidence from decades of research suggests that bromelain is effective at:

reducing pain
reducing edema
reducing inflammation
improving the potency of antibiotics.

All of these properties are related to important aspects of post-operative healing.

The FDA in the United States recognizes bromelain as generally safe, and has categorized it as a food additive. It is commercially available in capsule, tablet, powder, and liquid forms for oral consumption. The recommended dosage varies between 500 to 1,500 milligrams per day.

Evidence from early studies indicate that bromelain may be an effective pain reducer. Healthy adults showed a dose-dependent response to the extract, which reduced acute knee pain and appeared to promote their general well-being. Bromelain reduced pain when applied directly to open blisters in another study.

Bromelain may reduce healing time for soft-tissue wounds. Patients in one controlled clinical trial who took Bromelain had bruising and faster reduction of edema than patients who did not. Analysis of the results, however, showed that the effect fell short of statistical significance. Results from another study showed that patients who took vitamin supplements containing Bromelain had shortened wound-healing time than those who did not.

Bromelain enhances the action of antibiotics. An early study suggested that Bromelain makes tissues more permeable to antibiotics but the results were not statistically significant. Another study, in children, found that Bromelain significantly reduced healing time for sepsis by potentiating the antibiotics.

Studies of Bromelain’s toxicity have found it to be very low. Some reports of “gastrointestinal problems, headache, tiredness, dry mouth, skin rash, and unspecified allergic reactions” have been cited as possible side effects of high doses of Bromelain. Then again, some of these symptoms are seen with placebos. Higher doses have been correlated with stronger side effects. Overall, there have been few reports of adverse effects.

More controlled clinical trials will have to return statistically significant results before Bromelain is accepted for therapeutic purposes. The extent of its efficacy and the mechanisms by which it works must be better understood. However, because of its potential, bromelain has caught the attention of the medical community and will be the object of future research.

I hope you have found this helpful and now understand why I recommend Bromelain to my patients.

—Larry S. Nichter, MD

Citations:

Orsini, Roger A. “Safety & Efficacy Report: Bromelain.” Plastic and Reconstructive Surgery 118.71 Dec. (2006): 1640-44. Print.

New Breast Implant on U.S. Market

Dr. Larry Nichter of the Pacific Center for Plastic Surgery would like to make prospective breast augmentation patients aware that the FDA has approved a new silicone gel-filled breast implant made by Sientra, Inc. for use in the United States.

The implants will be available for women at least 22 years old seeking augmentation surgery, and women of any age seeking breast reconstruction surgery.

Silicone gel-filled breast implants are medical devices implanted under the breast tissue or under the chest muscle for breast augmentation or reconstruction. These implants have a silicone outer shell that is filled with silicone gel. They come in different sizes and have either smooth or textured shells.

This approval introduces a third company into the U.S. breast implant market, which previously consisted only of Allergan and Mentor.

The deputy director for for science at the FDA’s Center for Devices and Radiological Health, Dr. William Maisel, commented that although silicone gel-filled breast implants have demonstrated consistent safety, “It’s important to remember that breast implants are not lifetime devices. Women should fully understand risks associated with breast implants before considering augmentation or reconstruction surgery, and recognize that long-term monitoring is essential.”

The approval of these new implants follows a 3-year study involving clinical trials of the implants on 1,788 women.

As a condition of the approval, Sientra will carry out five- and ten-year studies into the long-term health effects of their implants.

Source: FDA – FDA approves new silicone gel-filled breast implant

The true cost of medical tourism

Dr. Larry Nichter of the Pacific Center for plastic surgery would like to make prospective patients aware of the risks and downsides of medical tourism (traveling abroad to undergo elective surgery).

Medical tourism has becoming increasingly popular in recent years; patients have been flying out of the U.S. for plastic surgery, lured by lower prices.

However, a parallel trend has also appeared: plastic surgeons in the United States are finding themselves treating an increasing number of patients who plastic surgery abroad, correcting complications and errors. A survey by the American Society of Plastic Surgeons found that 80% of the responding doctors had treated American medical tourists for complications including infection, contour abnormalities, and hematoma.

Medical tourists are often led to believe that they will receive the same quality of care for a lower price in a foreign clinic. But while it is true that the cost of plastic surgery in some foreign countries is lower, this is often because the quality of care and surgery is compromised. Such patients also seem to neglect the possibility of complications and the need for a follow-up visit.

In addition to the risks posed by sub-standard medical care abroad, medical tourists must consider the risks of injections and implants in other countries. The recent crisis with French breast implant maker Poly Implant Prothese (PIP) exemplifies this problem. PIP used industrial- rather than medical-grade silicone on their implants in an effort to reduce costs, a measure which probably increased the danger of rupture. PIP implants have not been used in the United States since 2000. Removal of these implants has been recommended by the International Society of Aesthetic Plastic Surgery.

It is often the case that medical tourists end up spending more money because they have to pay to treat complications from their overseas surgery.

Source: The Cost of Medical Tourism – Medscape Medical News
Source: Official Statement on Faulty PIP and ROFIL breast implants – ISAPS

Body Dysmorphic Disorder and Plastic Surgery

Dr. Larry Nichter of the Pacific Center for Plastic Surgery would like to inform prospective patients about the rising concern of Body Dysmorphic Disorder as it relates to plastic surgery.

An article from the Mayo Clinic on Body Dysmorphic Disorder describes the disorder:

Body dysmorphic disorder is a type of chronic mental illness in which you can’t stop thinking about a flaw with your appearance — a flaw that is either minor or imagined. But to you, your appearance seems so shameful that you don’t want to be seen by anyone. Body dysmorphic disorder has sometimes been called ‘imagined ugliness.’
—The Mayo Clinic staff

Recent years have seen an increased awareness of plastic surgery patients with Body Dismorphic Disorder (BDD). One of the major concerns about patients with BDD is that they may not be competent to give an informed consent for the cosmetic procedures they elect to have.

A medical malpractice lawsuit involved a woman who, displeased with her abdominoplasty scars, claimed that she had been incapable of giving a genuinely informed consent because she had BDD. The case was later dismissed; the court ruled that the plaintiff’s surgeon had followed acceptable medical practice and did not have sufficient reason to refer the patient to a psychiatrist before surgery. The case does, however, highlight some of the problems BDD poses for informed consent when it comes to plastic surgery.

The legal definition of informed consent is rather broad, but it provides guidelines for determining the mental competency of the patient before they can consent to elective surgery. The law requires that doctors provide complete and accurate information about the procedure and its risks to the patient, and the patient must not be coerced or pressured in any way. Ultimately, a truly competent patient must be capable of refusing consent to surgery.

When a psychological disorder (such as BDD, dementia, a learning disorder, or a manic episode) prevents a patient from understanding the risks and likely result of a surgery they wish to have, the question arises as to whether their consent is legitimate. Although a patient’s consent cannot be retroactively revoked if they are diagnosed with BDD after surgery, plastic surgeons are always on the watch for signs of BDD when consulting with prospective patients. This is especially important in the field of plastic surgery because people with BDD are very likely to seek surgical solutions to what they believe is wrong with them.

At the Pacific Center for Plastic Surgery, our goal is to provide patients with lasting, satisfying results. An important step in achieving this goal is making sure that our patients are psychologically healthy enough to make an informed, rational decision in their choice to have plastic surgery.

Source: Informed Consent in Body Dysmorphic Disorder, Medscape Medical News

Information About Post Operative Nausea and Vomiting (PONV)

Post operative nausea and vomiting (PONV) is a serious problem for patients who are undergoing elective surgery. For facial aesthetic surgery PONV can lead to hematoma, delayed healing times, and other complications not the least of which is patient suffering.

Our focused interest in this problem was motivated by the progressive increase of PONV despite liberal use of antiemetics such as Odansetron (Zofran). At the same time we noted the increasing prevalence of antidepressant medications taken by our patients.

Based on our experience and extensive review of the literature we have established a perioperative treatment protocol that is beneficial to your patients and their well being.

Serotonin Syndrome is a poorly recognized but potentially dangerous condition which in its early stages may include nausea and vomiting (PONV) , hypertension, fever, tachycardia, agitation, restlessness, insomnia, mental status changes, diarrhea, etc. All of these are dangerous in the post operative healing period.

Serotonin Syndrome occurs when two or more drugs are taken together and cause too much available serotonin. Antidepressants (including selective serotonin reuptake inhibitors (SSRI), selective serotonin/norepinephrine reuptake inhibitors (SSNRI), and monamine oxidase inhibitors (MAOI); Migriane Triptan medications including Imitrex, Relpax and others. Pain medications: (especially Tramadol), opioids; antiemetics such as odansetron (Zofran); and even cough medicines with dextromethorphan have been implicated in Serotonin Syndrome.

When your patients, who have been appropriately prescribed these medications, are then given certain pain medications or antiemetics they may develop serotonin syndrome and PONV.

We are attaching a table listing some of the multiple drug classes that have been implicated in this syndrome. In order to keep Serotonin Syndrome from occurring in our patients, we use the protocol attached. This includes the use of Cyproheptadine (periactin) as prophylactic when serotonin medications are used.

We your taking note of these guidelines during the postoperative period and contact us directly if you have any concerns or suggestions.

Thank you for reading.

Best wishes,

Larry S. Nichter, MD, MS, FACS

Smoking and Plastic Surgery: a Bad Combination

In addition to its adverse effects on general health, smoking tobacco increases the chance’s of a plastic surgery patient having complications and can negatively affect her results.

Dr. Nichter at the Pacific Center for Plastic Surgery would like to advise prospective patients of the dangers of smoking as they relate to plastic surgery.

A good plastic surgery result relies on good blood flow. The nicotine, carbon monoxide, and hydrogen cyanide in the blood of smokers inhibits their blood’s ability to deliver sufficient oxygen to their healing tissues. Thus, patients who smoke are at greater risk of complications and poor wound healing.

A long history of medical studies have shown revealed the risks patients take when they smoke. A 1984 study, which followed 1,100 face lift patients, “found that a smoker was 12.46 times more likely to suffer skin loss than a patient who did not smoke.”

A more recent study in 2003 reviewed 132 abdominoplasty patients. The study “showed wound healing problems in 47.9% of smokers versus 14.8% of non-smokers.”

Whether a plastic surgery candidate smokes or not is a big factor in whether a surgeon will perform surgery on that person or not. At the Pacific Center for Plastic Surgery, patients will be asked about their smoking habits, if any, which will be factored into the doctor’s decisions in her/his case.

Source: Bulletin of the American College of Surgeons

Updated guidelines for avoiding skin cancer

The U.S. Preventative Services Task Force (USPSTF) recommends counseling to children and young adults (ages 10-24) with fair skin on the effects and dangers of ultraviolet (UV) light exposure.

Dr. Nichter of the Pacific Center for Plastic Surgery would like to make blog readers aware of this new recommendation, which is an update to USPSTF’s 2003 guidelines for physicians on counseling skin cancer patients.

Since 2003, the USPSTF has found evidence that counseling for children and young adults on the risks of UV light exposure is beneficial.

From the USPSTF:

Convincing evidence relates UV radiation exposure during childhood and youth to a moderately increased risk of skin cancer later in life; for adults, adequate evidence links UV radiation exposure to a small increase in the subsequent risk of skin cancer […] Individuals with a fair skin type are at greatly increased risk of skin malignancy.

Counseling encourages people to engage in behaviors that mitigate their UV exposure such as wearing effective sunscreen, reducing midday outdoor activities, wearing hats or UV-protective clothing, and avoiding the use of tanning beds.

Dr. Larry Nichter would like readers and patients to note that although questions remain as to the direct relationship between sun exposure to an increased skin cancer risk, the risk of premature skin aging (laxity, wrinkles, and an eventual leathery appearance) seems to be directly related to cumulative sun exposure without protection for all ages.

Prospective patients who are concerned about UV-induced skin aging should take a look at the skin rejuvenation treatments available at the Pacific Center for Plastic Surgery.

The importance of choosing a qualified plastic surgeon

American Board of Plastic Surgery

Last month’s news covered a slew of patients turning to illegal cosmetic surgery practices, many of them unaware of the dangers in being treated by someone not licensed to practice medicine.

Dr. Larry Nichter of the Pacific Center for Plastic Surgery would like to make prospective patients aware of the dangers of having surgery with someone who is not a surgeon. Patients can risk not only a bad result, but their health or their lives in the hands of someone who is not a licensed and certified plastic surgeon.

In Las Vegas last month, 55-year-old Jing Qu was arrested for operating an underground cosmetic surgery practice. The makeshift operating room was discovered when a neighbor knocked on the door and got a look inside. The woman Qu was performing a facial surgery on could have gone blind. Qu is in jail and is charged with two counts of practicing medicine without a license.

In a highly publicized case, Oneal Ron Morris was arrested in Miami—also for practicing medicine without a license. A woman came to Morris, who was actually posing as a real doctor, seeking buttock enhancement surgery. Morris filled her buttocks with cement, mineral oil, and flat-tire sealant. The truth about the victim’s surgery came to light when she went to the hospital with severe abdominal pains and sores on her buttocks.

There has also been an increasing trend of illegal buttock silicone injections. Plastic surgeons no longer use injectable silicone in any procedures today because of the health risks it poses. Underground practitioners often use silicone purchased from home improvement stores. Kimberly D. Smedley, of Atlanta, was arrested in Washington in October this year for injecting silicone into the buttocks of exotic dancers in a Baltimore hotel.

Many of these patients-turned-victims opted for an underground practice for financial reasons. But these patients often end up paying even more than they would have for a legitimate surgery; the illegal procedures leave them with serious medical problems that require expensive treatment. The risk they take with their health and their lives is not worth it.

At the Pacific Center for Plastic Surgery, our doctors are the polar opposite of the criminals in these news stories. Dr. Nichter is board-certified by the American Board of Plastic Surgery, the highest standard of certification for plastic surgeons. They stand among the most experienced and talented surgeons in the country.

To become a board-certified plastic surgeon, a doctor has to not only complete medical school and a residency, but also a plastic surgery-specific residency as well as intensive further education. In addition, doctors must keep up to date on the latest medical research and techniques in their field.

At the Pacific Center for Plastic Surgery you can expect the highest standard for surgical procedures and medical care.

Larry S. Nichter, MD, FACS

Plastic Surgeon | Orange County

Tag: plastic surgery