Take the Dysport Challenge until September 30

Dysport remains Botox's biggest competition.  Both are terrific for...

• frown lines
• forehead wrinkles
• crow's feet
• bunny lines
• eyebrow lifting

Why choose one rather the other?

1. Some patients like one rather than the other
2. • My wife actually prefers Dysport.
   • A few patients prefer Botox.
   • On the other hand, my mother thinks, "They are the same."
   • Most of my office staff agrees with my mom.
3. Price
   • Dysport is cheaper than Botox
   • Dysport comes with rebates

So, if Botox and Dysport are pretty similar, why not get $150 in rebates with Dysport?

• Receive treatment with Dysport by September 30, 2010
• Register at www.dysportusa.com
• Print the Dysport Coupon Rebate Form
• Mail the rebate form and the treatment receipt to Medicis Aesthetics (the Dysport distributors)
• Receive a $75 check
• If you loved the Dysport, get another treatment in 3-6 months, and get another $75 check
• Even if you prefer Botox, get your Botox in 3-6 months, and get another $75 check

That's confidence in the Dysport product!

Another American Dies During Plastic Surgery in Mexico

Another awful tale of a Southern Californian who died as a result of a botch job from a disreputable Mexican plastic surgeon.  From 10news.com...

Lourdes Trinidad Died After Liposuction Procedure Performed By Dr. Louis May Villanueva

CHULA VISTA, Calif. -- A local doctor who may have overstated his credentials is being held responsible for the death of a Chula Vista woman he operated on recently.

 

According to family members, 48-year-old Lourdes Trinidad underwent a liposuction procedure performed by Dr. Louis May Villanueva of Bonita.

 

Family members said Trinidad was a healthy and active pharmacy technician who opted for liposuction and went to May's Millennium Cosmetic and Laser Institute in Tijuana for the procedure.

 

"The doctor assured her it was real simple, it was a real simple procedure," said Trinidad's brother, Sergio Salazar.

 

It ended up becoming a deadly procedure, although Trinidad's family has yet to receive a good explanation as to why it turned out that way.

 

"We're just shocked and we're amazed that a doctor like that could just leave, could leave her there by herself," said Trinidad's brother, Bernard.

 

Trinidad's mother is warning others, not just because of her daughter's death, but what happened after. The family said May disappeared.

 

"He was nowhere to be found ... The doctor was gone," said Salazar.

 

The family said after Trinidad's accounts were frozen when she died Saturday, May still wanted his $2,000.

 

"On Monday, we get a call from the bank that said he tried to cash it. He had the nerve to try to cash the check that killed her," said Bernard Trinidad.

 

10News visited May's Bonita home for his version of events, but he was not there.

 

May said he is a member of the American Academy of Cosmetic Surgery, but 10News learned from academy officials that he is not a member.

 

Additionally, May also claims membership in the American College of Phlebology, but any member of the public who wants to learn about leg veins is allowed to join.

 

"We don't want any money from him. We want to stop him from doing this again to someone else," said Bernard Trinidad.

 

Trinidad's family will bury her Thursday, and they continue to question whether it was a complication or incompetence that led to her death.

 

10News contacted May's clinic and they said they did not have any information right now.

 

10news also contacted the Ministry of Health in Tijuana to determine if May is fully licensed, but there has been no response.

Please beware of plastic surgery in Mexico.  While there are many excellent physicians south of the border, it can be very difficult for an American to vet the qualifications of her Mexican doctor.  Even when tragedy doesn't strike, standard "botch jobs" end up costing the patient much more than she would have saved had she seen a Board Certified Plastic Surgeon in the USA.  Make wise choices.

Silicone Implants Now as Popular as Saline

In June 2009, I blogged about my surprise that the vast majority of Board Certified Plastic Surgeons still prefer saline to silicone breast implants....

http://www.pickartplasticsurgeryblog.com/2009/06/silicone-breast-implants-still-not-as-popular-as-saline.html

I am a big fan of silicone implants because...

• the newest generation of silicone implants have a safety profile equivalent to saline
• silicone implants definitely feel more natural
• silicone implants exhibit less rippling
• silicone implants usually look more natural
• silicone implants will probably be more durable

It looks like my colleagues are starting to agree.  According to statistics just released by the American Society of Plastic Surgeons, rates of use of saline and silicone implants are roughly equivalent.

• Saline Implants in 2009 - 139,221 pairs
• Silicone Implants in 2009 - 137,915 pairs

However, if you compare the numbers from 2009 to the 2008 data, the numbers are even more compelling.  In this tough economy, obviously there are fewer elective surgeries; the total number of cosmetic surgeries is down in 2009 relative to 2008.  However, interest in silicone continues to rise, while saline use declines.

• Total number of breast augmentations in...
• 2008 - 294,284
• 2009 - 277,136
• Saline Implants
• 2008 - 167,125
• 2009 - 139,221
• Silicone Implants
• 2008 - 127,159
• 2009 - 137,915

I use 10 silicone implants for every 1 saline implant.  I don't mean to disparage saline implants; they remain very good products.  They still have their niche because....

• saline implants are cheaper
• the incisions for saline implant placement are smaller
• the volume of saline implants can be very precisely adjusted

However, silicone is still going to be superior for most women, and I'm glad that my opinions are increasingly shared by other Board Certified Plastic Surgeons.

Few Breast Cancer Victims Opt for Reconstruction

Over the past few decades, plastic surgeons have documented that breast reconstruction improves the emotional well-being of breast cancer victims.  Creating an attractive breast mound after a mastectomy is not only possible, but is beneficial.  Some studies have even demonstrated that the decrease in depression that results from being "made whole" can minimize anti-depressant usage and maximize compliance with adjuvant cancer treatments, such as chemotherapy.  The net effect is increased longevity; breast reconstruction can help breast cancer victims live longer.

Recognizing the value of breast reconstruction, the State of California passed legislation in 1996 mandating insurance coverage for reconstructive surgery.  The federal government followed in 1998.

However, a number of recent analyses suggest that only about 20% of mastectomy patients opt for breast reconstruction.

Researchers from the City of Hope Medical Center, in Duarte, California, recently reported the problem is especially acute in...

• women older than 40
• certain ethnic groups (especially African Americans)
• public insurance (especially MediCal or Medicaid)
• smaller hospitals

Obviously, the results indicate that it is very important to get information out to patients about reconstruction options.  Breast reconstruction is a right!

I would suggest that most breast cancer victims at least consult with a plastic surgeon before cancer surgery.  They need to know that breast reconstruction does not delay cancer treatment, does not minimize the effectiveness of chemotherapy, and does not indicate that they are "vain."  I always want women to really think about their choices.

Interest in Plastic Surgery Grows, Despite the Economic Downturn

For the past 2 years, we plastic surgeons have been asking ourselves, "Where are the cosmetic patients?"

2004-2007 were banner years for plastic surgery, and the first half of 2008 wasn't too shabby either.  Then, the economy tanked in late 2008, and many of us lost about a third of our cosmetic business.

Now, don't cry for me!  Most of my colleagues and I are still doing just fine.  In my practice, I split my time between cosmetic surgery and reconstructive surgery.  Even if there are fewer tummy tucks and breast enhancements to do, there seem to be (unfortunately) a never-ending supply of skin cancers, facial injuries, breast cancers, burns, etc.  So, I do stay plenty busy.

Yet, I have been wondering whether the cosmetic slow-down is...

1. a by-product of the bad economy
2. representative of a decrease in interest in plastic surgery in general
3. indicative that we plastic surgeons have "fished out the pond" (meaning that we have done most of the cosmetic surgery that needs to be done in the population)

A survey released last week by Harris Interactive and Realself.com seems to suggest that #1 is correct.  The decline in plastic surgery is almost certainly due to the recession rather than a declining interest in cosmetic medicine.

According to the survey of 2,148 adults, consumer interest in cosmetic procedures is actually up in many cases.  More than two-thirds (69%) would choose to have cosmetic work done if money wasn’t an issue, which is 15 points higher than an earlier survey done in November 2009 (in which the figure was 54%).  Interest in plastic surgery amongst consumers is increasing.

Moreover, that 69% want big changes, rather than just minor nips and tucks.  Of those who would get cosmetic work done, almost one in three (29%) would choose a tummy tuck, 23% would want liposuction, and 13% would opt for a facelift.

I really can't wait until the economy finally turns around!  I know that there are ton of interested patients who would really like my help to make some positive changes.

Plastic Surgeon Sex Offender?

Over the past few years, I have ranted and raved that patients should search for Board Certified Plastic Surgeons.  While my reasoning has been sound, it hasn't been sufficient.  Even real Plastic Surgeons can have emotional problems.  Check out this article from the Orange County Register.

 

Plastic surgeon accused of sexual misconduct:  The state medical board is seeking to revoke the license of Dr. Mark Anthony Knight.

by Courtney Perkes

A Santa Ana plastic surgeon could lose his license over sexual misconduct allegations, including having sex with a patient while her husband and children waited outside.

The California Medical Board is seeking to revoke the license of Dr. Mark Anthony Knight. Knight, 41, declined to comment Tuesday until he consulted his attorney.

Legal documents made public Tuesday by the board give the following account:

In late 2008, a woman underwent a tummy tuck.  During a follow-up appointment last year, Knight told the patient, 32, to undress for the exam.  Her husband and children waited in the car.  While the patient was seated on the exam table, Knight kissed her and pulled down his pants, the documents allege.

After waiting for an "extended time," the patient's husband took the children inside the office to use the bathroom.  He heard noise from the exam room and opened the door to see his wife having sex with the doctor.  Knight allegedly pushed the door closed and told the husband, "I'm sorry, I'm sorry."

In a second instance, according to the documents, Knight is accused of sexual abuse of a woman, 36, who came to him in 2007 for breast implants and liposuction.  Knight sent her a text message to change her appointment time.  While her son waited in the lobby, the woman disrobed for the exam.  At one point, Knight kissed her without warning, the documents allege.  The woman pushed him away and told him he had the wrong idea.  He then continued with the exam before kissing her a second time, the documents allege.  She again rebuffed him.  After he tried to kiss her a third time, she got dressed and left the exam room.

Later, the documents show, the woman sent Knight a text message that said, "My view of our relationship is strictly doctor-patient. I would appreciate if you didn't come on to me like that again. You have made it a very awkward situation."

Knight wrote back that he understood. He then followed up shortly with a text that said, "Its ok with me...still feeling down...need open heart surgery now."

To check a California doctor's disciplinary record with the medical board or file a complaint, visit medbd.ca.gov.

Scary.  It's not enough for you to confirm that your cosmetic doctor is certified by the American Board of Plastic Surgery.  You better make sure that he or she is not a whack job!

Being Consistent with Botox Prevents Wrinkles Even with Less Frequent Dosing

According to recent research from Oregon Health Sciences University, consistent treatments with Botox or Dysport have a wrinkle preventing—or prophylactic—effect.  Patients who begin receiving injections every 3-4 months while in their 30's, 40's, and 50's are able to prevent wrinkles from forming and eliminate many existing wrinkles.

Moreover, after 2 years of treatment at 3-4-month intervals, patients can potentially cut the frequency of their Botox or Dysport treatments by half.  After patients receive Botox or Dysport every 3-4 months for 2 years, the frequency of the the injections can be changed to every 6 months and still achieve good results.

So what should the average person think about this study?

• Younger patients, even in their 30s, should consider starting Botox or Dysport to prevent hyperdynamic wrinkles.
• Patients should try to be consistent (every 3-4 months) for the first 2 years when using either Botox or Dysport.  While such frequent treatment may deter some patients from starting a regimen, eventually they should be able to achieve good results with broader treatment schedules and ultimately at a lower overall treatment cost.

Botox for Marionette Lines? Nope. Choose a Filler Instead

Hi, Dr. Pickart.  I was talking with someone about getting rid of marionette lines, and she was given Botox for that area.  Does that sound right to you?

Anyway, I was going to tell her about Sculptra.  Do you think that 1 vial may be enough for that area?

-Janet F.

Dear Janet,

Actually, the best treatment for marionette lines is NOT Botox.  I do sometimes use Botox to turn up the corners of the mouth, but Botox has NO EFFECT on the marionette lines themselves.
 
I would recommend a filler for marionette lines.  Sculptra is my favorite because it lasts the longest (at least 2-4 years).
 
Regarding how much Sculptra, it depends upon...

• the depth of the marionette lines - Shallow will obviously require less than deep.
• the patient's response to Sculptra - Younger patients respond more vigorously, with more collagen production, compared to older patients.

So, how many vials?  A young patient with mild folds and with a vigorous response to Sculptra might need just 1 vial.  However, an older patient with deeper lines and with less brisk collagen production might need 3-6 vials.  Make sense?
 
Sincerely,
Mike Pickart

A Full Tummy Tuck (With or Without Circumferential Extension) Will Best Correct the Upper Belly and Bellybutton

I've lost 100 lbs. after having a Lap Band put in nearly 4 years ago.  My stomach issues are very unique looking, which is why I'm having the difficulty in determining what procedure I need.  My unwanted fat and loose skin are mainly only above the bellybutton, like they're sitting on a shelf.  I am unsure of which procedure would benefit me the most among simple liposuction, a modified Tummy Tuck, a full Tummy Tuck, or extended.  I'm open to any other suggestions as well.  I believe my skin has shrunk back as much as it can already.  Thoughts?

First and foremost, congratulations on your weight loss!  What a wonderful transformation. In addition to your improved health, your figure already looks terrific.

Second, even though you might think that your tummy has "unique" issues, nothing could be further from reality. I see at least one patient per week whose tummy looks like yours.

Third, go for a full tummy tuck.

• After 4 years, your skin is not going to shrink on its own any farther--no matter how much exercise you do.
• Liposuction will not be helpful to treat the upper tummy (called the epigastrium) and bellybutton. Since liposuction is a fat removal technique (without any significant skin tightening), liposuction is the wrong answer.  You are already skinny!  The problem is too much skin without good tone, not excess fat.
• Mini tummy tucks are nonsense operations. I have never found the right patient for a mini tummy tuck--even after 8 years of practice!  A mini tummy tuck is for that very rare patient whose problem area is limited to her lower middle abdomen, just above her pubis.  Obviously, this is not where you are concerned.
• A standard tummy tuck will work.  To minimize "dog ear" formation on the bilateral hips, weight-loss patients generally get their best results when the tummy tuck is extended all the way around circumferentially.  Whether you choose to keep the surgery just in the front or all the way around will be your decision.  Both are good choices, but the circumferential technique generally produces better contours.
• Do not do a fleur-di-lis abdominoplasty.  The vertical portion of the scar is ugly, and the operation is now recognized as obsolete.  If any doctor offers you this surgery, run away!  He is out of date!!

Fourth, make sure that your lap band port is exchanged from a high-profile to a low-profile.  Now that you are thin, the low-profile port will be less visible.  You don't need that extra prominence to find the port anyway; you've got no subcutaneous fat.  (Congratulations again!)

Fifth, make sure that your surgeon is certified by the American Board of Plastic Surgery.  And, better yet, research whether he specializes in weight-loss patients.  I do a lot of post-bariatric contouring, and let me tell you that weight-loss patients are very different from "regular" plastic surgery patients.  Your surgeon needs the expertise only garnered from years of experience with your peer group.

Good luck!

Tissue Glue Rather Than Drains (?!)

There is an old surgical adage:

If a surgeon thinks that the patient might benefit from a drain, he should put it in.  A surgeon never regrets placing a drain.

Patients, however, hate drains.  They are a post-operative nuisance.  Most patients grudgingly accept drains because they minimize fluid collections (called seromata) and infections.

Since drains are so uncomfortable, there have been a number of products and techniques developed to obviate the need for drains....

• Quilting sutures beneath tissue flaps to minimize "dead space"
• Tissue glues

Biological tissues glues are particularly exciting because they are quick, effective, and precise.  Unfortunately, there have been no specific research studies which have rigorously documented the safety and efficacy of biological glues for plastic surgery.  A study published in Plastic and Reconstructive Surgery in 2008 proved the success of tissue glues in a canine abdominoplasty ("tummy tuck") model; however, dog and human tissues do respond differently, and the results of an animal model can not necessarily be generalized to human beings.

To investigate human plastic surgery patients' response to biological glues, Cohera Medical, Inc., has just enrolled its first few patients in a study of its TissuGlu.  The clinical investigation is a prospective, open-label, randomized study to investigate the safety of TissuGlu, its effect on wound drainage, and its relationship to complications.  The study will compare 40 abdominoplasty patients in Bonn, Frankfurt, and Freiburg, Germany, who will undergo...

standard wound closure techniques versus

standard wound closure techniques plus the application of TissuGlu

Currently, patients who undergo abdominoplasties require the insertion of one or more drains to remove fluids that accumulate under the skin at the surgical site.  (The old surgical adage remains true in tummy tucks!)  However, TissuGlu will hopefully adhere the flaps created during the procedure to reduce fluid accumulation, and, ultimately, the duration of use of surgical drains.  With the use of TissuGlu, patients may experience a reduction in fluid accumulation, a more comfortable recovery, and a quicker return to normal activity.

If the European trial goes favorably, Cohera will apply for a larger U.S.-based trial later this year.  Let's say our prayers that TissuGlu works!...