Physicians Study Nutrient Deficiencies After Bariatric Surgery

August 30th, 2010

When bariatric surgery patients lose weight, they often become prone to numerous nutrient deficiencies.  A new post-bariatric body contouring dietstudy takes a fresh look at this problem by studying 100 bariatric surgery patients who sought body contouring procedures from a plastic surgeon.

The article “Nutritional Assessment of Bariatric Surgery, Patients Presenting for Plastic Surgery: A Prospective Analysis” is available for free on the website of Plastic and Reconstructive Surgery, the official journal of the American Society of Plastic Surgeons.

In this study of 98 gastric bypass patients and 2 lap band patients, nearly 18 percent of the subjects showed protein intake levels that were lower than the recommended intake.  Additionally, 39.7 percent showed low iron intake and 11 percent had low intake of vitamin b12.

Why is Protein Important for the Post-Bariatric Patient?

Protein intake is important for general health reasons as well as surgical reasons.  Protein aids the healing process during recovery from body contouring and its deficiency has been linked to problems such as “decreased wound tensile strength and increased rates of skin and fascial wound breakdown.”

The authors found certain predictors of low protein intake in their subjects. Those with increasing age and those who underwent a greater change in BMI after bariatric surgery were more likely to have a low daily protein intake.  Because food intolerance is relatively common in post-bariatric patients, a higher daily protein allowance may be recommended, the authors suggest.

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Unqualified Liposuction Doctor Suspended, Fined for Violating Florida Regulations

August 12th, 2010

After a 2009 liposuction patient of Dr. Yves N. Jean-Baptiste filed a complaint with the Florida Board of Medicine, an investigation was launched that resulted in the emergency suspension of the physician’s medical license for one year, as well as the issuance of a $50,000 fine.

Dr. Jean-Baptiste was penalized by the board because he allowed two of his employees, who were unlicensed medical assistants, to perform liposuction on the patient in an unregistered surgical facility.  In addition, the doctor’s record-keeping was deemed inadequate, as he failed to document important surgical details including the amount of anesthesia used and the amount of fat removed during the liposuction procedure.

Another problem in Dr. Jean Baptiste’s case was the fact that the doctor not only wasn’t certified in plastic surgery but rather was certified in family medicine and had undergone only a brief liposuction training seminar.

“I think he’s in a lot of trouble because he doesn’t have a surgical background,” said board member Dr. Trina Espinola, a St. Petersburg surgeon.

Frequently in cosmetic surgery, doctors who are not board-certified plastic surgeons take short weekend classes to learn the basics of a particular plastic surgery procedure then perform the procedure on unwitting patients to make a quick buck in the lucrative, cash-only aesthetic medicine industry.

“This kind of case underscores how a weekend of coursework doesn’t prepare physicians to perform procedures such as liposuction,” said Chris Nuland, a Jacksonville attorney representing Florida’s plastic surgeons and dermatologists, who all too often must correct the mistakes of unqualified cosmetic medicine practitioners.

The firm, decisive action taken by the Florida Board of Medicine against Dr. Jean-Baptiste will likely set the precedent among family doctors and other unqualified, untrained medical professionals that compromising patient welfare and ethical practice standards to cash-in on cosmetic surgery is unacceptable and may jeopardize your ability to practice medicine, at least in the state of Florida.

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Doctors Take Precautions To Avoid Getting Caught In A Prick-And-Run

August 6th, 2010

Crimes resembling a high stakes version of the old dine-and-dash routine have cropped up in several unrelated incidences across the U.S., as con-artists reportedly give doctors’ offices the new prick-and-run routine.

Dubbed “Botox Bandits” or “Beauty Bandits” by popular media, these criminals give doctors’ offices a fake name and phony contact information, then undergo facial rejuvenation and lip augmentation treatments with Botox, Juvederm, Restylane and other injectable treatments worth anywhere from a few hundred to a few thousand dollars.

When it’s time to pay the bill, the crooks make up an excuse to leave the office after their treatment is complete, such as needing to withdraw cash from an ATM, retrieve their purse from the car or check on a waiting child, then take off without paying up.  Other patients wishing to get out of settling their tab write rubber checks, knowing they don’t have the funds to cover them.

Doctors in Florida, Texas, Arizona, Nevada and California cities have reported being defrauded by “Beauty Bandits.”  Some have even been hit multiple times.

“I’ve had it occur,” says Dallas plastic surgeon and American Society of Plastic Surgery past-president Dr. Rod Rohrich.  “It’s mostly in patients I’ve never seen before. The best way [to prevent it] is to have all new patients pre-pay.  In this way, we prevent the ‘runners,’ as we call them in Texas.”

Although Florida law enforcement caught local perpetrators of these crimes, including the highly publicized cases of Jaime Merk and Maria Chrysson, doctors in other cities haven’t been so lucky.  Some doctors say they don’t even bother reporting these crimes any longer because catching the perpetrators is not a priority for police.

As a result, Dr. Rohrich’s preventative solution of asking new patients to pre-pay for cosmetic services is being adopted by more and more physicians who wish to safeguard their practices against potential fraudulent activity and revenue loss.  Many physicians also no longer accept checks.

Upfront payment may sound a bit unwelcoming to some, but a patient-doctor relationship built on trust is hardly fostered when your physician fears of getting bilked out of revenue they need to keep their business afloat.  Given the recent influx of “Beauty Bandit” criminals, don’t be alarmed if your doctor asks for cash, credit or debit card payment before doing a round of Botox injections.

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Buyer Beware When Cosmetic Surgery Prices Are Too Good to Be True

July 29th, 2010

It’s been said countless times, yet the men and women who manage to forget all too often must learn the hard way that cosmetic medicine is a “buyer beware” industry full of unqualified, unscrupulous characters promising eternal youth for prices so low, you might think they’re too good to be true—and they usually are.

A recent story featured by CBS Atlanta reminded consumers of the risks involved with seeking discount cosmetic surgery by telling the story of Kenyatta Brown, a mother of four who nearly bled to death during a routine breast augmentation procedure she had performed by an Atlanta eye doctor.

The doctor, obviously practicing outside his specialty area of ophthalmology, did not have adequate plastic surgery training; however like so many physicians, he advertised drastically reduced breast augmentation prices and attempted the surgery in hopes of cashing in on the lucrative, cash-only cosmetic medical industry.

In some cases, people who are not even licensed medical professionals attempt to practice cosmetic medicine, operating low-cost, unlicensed clinics and promising unsuspecting victims body contouring and cosmetic enhancement for a fraction of the usual cost.

According to the Orange County Register, Mayra Lissette Contreras, 22, of Pacoima, Calif. was duped into seeking treatment at one such back-alley cosmetics clinic run by sisters Guadalupe Viveros, 53, and Alejandra Viveros, 50, of Sylmar, Calif.

After receiving what can only be assumed were silicone injections for buttocks enlargement, Contreras became ill and eventually died of apparent respiratory problems.

The Viveros sisters are wanted by police but may have fled to Mexico to avoid being prosecuted for Contreras’s death.

Do your research before seeking cosmetic treatments

It is important to research both your medical practitioner and educate yourself about the cosmetic procedure(s) you desire before seeking treatment.  Use your common sense, and if any warning bells go off, trust your gut.

Hopefully, these cautionary tales will help prospective cosmetic surgery patients to remember that deep discounts for cosmetic treatments are probably too good to be true.

It’s not worth risking your life to save a few dollars on improving your bustline or derriere, and even if you do not experience health problems as a result of undergoing a suspiciously inexpensive cosmetic procedure, there is a good chance that the results will not be worth your money and may leave you worse off than you started.

In cosmetic medicine, you typically get what you pay for.

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Bio-Tech Innovations in Plastic & Reconstructive Surgery

July 22nd, 2010

Although medical technology is constantly developing, there have been some recent breakthroughs in research and production of new products affecting the world of plastic and reconstructive surgery that show great promise, including:

  • Novabel, a unique new injectable filler
  • Endoform Dermal Template, a newly approved skin tissue substitute
  • Fly-inspired surgical tape in research stages at the University of Utah

Novabel injectable filler

One of the most exciting recent innovations in cosmetic medicine is Novabel, the new dermal filler launched in Europe by German pharmaceutical company Merz.  While most of today’s popular injectable fillers like Juvederm and Restylane are made of hyaluronic acid, Novabel is composed of an entirely unique substance extracted from marine brown algae.

From the algae, scientists created Geleons, spherical, flexible structures that reportedly make Novabel injections quite easy to administer and virtually pain-free.

The consistency of the patented Geleon technology purportedly makes Novabel ideal for filling areas of thin facial skin, such as the lower eyelids and tear troughs, and causes less swelling than other injectable dermal fillers.

Endoform Dermal Template skin substitute

Award-winning New Zealand research and development company Mesynthes recently announced the release of Endoform Dermal Template, a tissue substitute FDA-approved for wound care and dermal reconstruction.

The new sci-fi skin product will be ideal for repairing flesh wounds and tissue damage in reconstructive surgery patients who have been marred by severe burns or trauma from an accident.  Endoform Dermal Template has the potential to replace skin grafting, or the process of transplanting skin from one body area to another, as the new gold standard in skin regeneration.

Endoform Dermal Template is composed of extracellular matrix material, which provides a unique mix of biological macromolecules that actively promote the cell regeneration and blood vessel formation to improve wound healing.  This feat of biochemistry is what allows the product to effectively re-grow skin.

Decreased healing time is also a purported benefit of the Endoform Dermal Template product, which in turn promises shorter hospitals stays and decreased medical expense after reconstructive surgery, in addition to improved skin reconstruction results.

Due in large part to the FDA approval of the Endoform Dermal Template, another Mesynthes product called Endoform Infection Control is also on the fast track to receiving FDA approval.  The Endoform Infection Control is designed to prevent post-operative infection in high risk cases.

Silk-spinning fly spawns plans for stronger surgical tape

Researchers at the University of Utah scientists believe that the silk spun by caddisfly larvae may inspire the development of a stronger surgical tape that closes incisions similarly to surgical sutures but is engineered to mimic the sort of “wet Band-Aid” properties achieved by the caddisfly’s silk.

This twist on “fly tape” would offer dramatically increased adhesive bond strength and would potentially lower incidence of suture failure in plastic surgery patients.

Eugene plastic surgeon Dr. Michael Workman is vigilant about staying up-to-date on the latest research and technology in the reconstructive and plastic surgery industry, as scientific discovery and innovation are an important part of providing patients with the most effective cutting-edge treatments designed to achieve the best aesthetic results.

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Study Finds Ambulatory Surgery Centers Allow For Faster Breast Surgery

July 18th, 2010

When compared to hospitals, ambulatory surgery centers (ASC) allow for faster, more efficient breast surgery procedures according to a study published by the American Journal of Surgery.

Most of the time savings possible in an ASC facility was attributable to decreased preoperative time, or time spent preparing for surgery, although the study noted that breast surgery patients spend an almost identical amount of time in an ASC as a hospital once they reach the operating room.

ASC vs. hospital

Unlike a hospital, an ASC has static, single surgeon per room outpatient breast surgery case assignments, as well as the ability to avoid unscheduled case additions, such as emergencies and add-ons.

An ambulatory surgery center is also smaller than a hospital, so there is less physical distance to move patients and equipment, and smaller, more consistent long-term staff typically allows an ASC to operate more smoothly than a hospital.

ASC before and after breast surgery

The type of anesthesia used during surgery can also influence how long before a breast surgery patient can leave the hospital or surgical facility after the surgical procedure, however this did not significantly affect overall start to finish time of surgery from the preparation stage to the patient discharge, or release, stage.

So, while the study certainly supports the common perception that outpatient surgery can be more efficiently performed in dedicated outpatient surgical centers outside of hospitals, it identifies that the time savings benefits of an ASC are only offered during the preoperative, or preparation, stage of a breast surgery procedure.

Outpatient breast surgery study details

Authors Drs. Terrence Trentman, Jeff Mueller, Richard Gray, Barbara Pockaj and Daniel Simula began this study in 2005, after their surgery practice ASC was closed.  All outpatient breast surgeries then needed to be alternatively performed in a hospital setting, which allowed researchers to compare the amount of time breast surgery patients spent in the hospital facility versus the ASC facility.

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Innovative Injection Pen Penetrates European Market

July 11th, 2010

Anteis Injection SystemIn 2010, an automated soft-tissue filler injection pen called the Anteis Injection System was released by Anteis S.A., a medical device developer, manufacturer and distributor based out of Switzerland.

The Injection System is now being used by aesthetic physicians in Europe to administer cosmetic injections with apparent success to achieve more precise and consistent results with gel-based dermal filler injections.

The Injection System electronically controls and regulates the volume and injection speed of the filler as it is injected into the skin, which according to Anteis, offers a number of benefits to injectors and thus patients, including:

  • Improved handling
  • Greater freedom of movement
  • Decreased muscle fatigue
  • Increased opportunity to focus on filler product placement rather than injection technique

Physicians who use the Injection System have also said that their patients have reported less pain during treatment, decreased social downtime and fewer and less severe side effects, such as post-injection bruising, swelling and redness.

In addition, the Injection System works effectively for administering injectable fillers to correct a variety of conditions, including facial creases and folds, volume loss, feature asymmetry or disproportion, and skin depressions, such as cellulite.

Based on its apparent success in Europe, the Anteis Injection System appears to be a promising innovation in cosmetic dermatology.  However, it is important to note that it has not been appropriately tested or approved by the FDA and is not yet available in the U.S.  The injection device was also designed to work with Anteis-brand hyaluronic acid gel fillers that are also not available in the U.S.

The Injection System has not been tested with other brands of hyaluronic acid fillers, such as Juvederm and Restylane, nor has it been tested with wrinkle-relaxing injectables, such as Botox.

If you’re considering facial augmentation or wrinkle reduction with injectable fillers, seek an experienced injector with superior injection technique to administer your treatments, and remember that when it comes to your face, no amount of innovative automation can replace the discerning eye and artistry of a skilled plastic surgeon.

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Breast Revision Surgery Advised For Faulty French Implants

June 30th, 2010

The British Association of Aesthetic Plastic Surgeons issued a guidance advising an estimated 50,000 British women to seek corrective surgery if their French-made Poly Implant Prostheses (PIP) breast implants are found to have ruptured.  The guidance was issued after an inquiry by the French Society of Plastic, Reconstructive and Aesthetic Plastic Surgeons revealed that PIP implants lack a protective barrier that makes them more prone to rupture, a potential health risk since the implants were filled with an unapproved silicone gel that had not undergone safety tests.   

Although ruptures are uncommon in the safe, FDA-approved breast implants used in the U.S., breast augmentation patients should be aware of the options that exist to correct ruptured breast implants and know how to detect a rupture in their breast implants if implant malfunction or trauma occurs.

Options for corrective surgery include:

  • Breast augmentation revision, or implant exchange
  • Breast explant surgery, or implant removal
  • Breast lift with breast implant exchange or removal

Many women who experience a rupture in one or both breast implants choose to undergo breast augmentation revision, or implant exchange, while others choose to simply undergo breast explant surgery, or implant removal, and do not have their implants replaced. 

A breast lift, or mastopexy, is typically recommended when implants are removed and not replaced in order to remove any stretched, excess skin left by the breast implants.  A breast lift may also be recommended in combination with breast augmentation revision, or implant exchange, if breasts have begun to sag since the initial breast augmentation surgery. 

In order to detect a rupture in silicone breast implants, an MRI must be performed.  However, it is obvious when saline breast implants have ruptured, as the implants deflate and experience noticeable volume loss.

If you discover your breast implants have ruptured, remain calm, as there is no immediate health risk.  Consult a board-certified plastic surgeon with significant breast revision surgery experience to help you decide whether breast augmentation revision or breast implant removal, with or without a breast lift, is the best option for you.

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Latisse Wishes Challenge Campaign for Make-A-Wish

June 16th, 2010

A new Latisse promotion just began, and once again it’s planned to benefit the Make-A-Wish Foundation. In the Latisse Wishes Challenge, Allergan Inc is asking people to donate $20 or more to the Make-A-Wish foundation in exchange for a Latisse free trial certificate.

Only the first 10,000 people who donate will receive the Latisse free trial certificate. You may remember last year’s campaign led by Brooke Shields. This year, the campaign is led by lifestyle designer Kathy Ireland, professional ballroom dancer Chelsie Hightower and style guide Bobbie Thomas. Watch the video to learn more about the campaign and see important product information about Latisse.

“With approximately 1.5 million bottles sold since launching the product a little more than a year ago, LATISSE is giving back by helping the Make-A-Wish Foundation grant the wishes of children. Through the campaign, we will double each individual’s donation, with a maximum donation of $250,000, through October 31,” said Robert Grant, President of Allergan Medical, a division of Allergan, Inc.

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Breastfeeding Patterns of Surgery Patients Studied in Brazil

June 14th, 2010

A study recently published online in the Jornal de Pediatria discusses the breastfeeding patterns of women who undergo breast augmentation and breast reduction surgery.

The World Health Organization recommends exclusive breastfeeding for the first 6 months of life, meaning breast milk without additional food or water.  Given this recommendation and the various documented benefits of breastfeeding, the authors sought to first examine the habits of women who underwent cosmetic breast procedures and then compare it to women who had no surgery.

Of the 74 patients who were studied at a single hospital in Brazil, “the probability of an infant being on exclusive breastfeeding at the end of the first month of life was 29% in women with reduction surgery, 54% in those with augmentation surgery, and 80% in women who had no surgery.”

Responding to these statistics, the authors recommend that women undergoing cosmetic breast surgery be cared for by qualified professionals who are aware of potential lactation difficulties.  “These women should be encouraged to breastfeed, as many of them do not believe this is possible,” writes the author.

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