Why does the world need another Plastic Surgery Blog?

Posted on October 4, 2009 under General Plastic Surgery

If you google “plastic surgery blog”,  you will get more than 3 million hits.  How do we expect to make a difference with one more blog?  Let me count the ways:

1- Honesty

Dr. Vath and I are well known for a no-nonsense approach to Plastic Surgery and all the hype that surrounds it.  If something works, we want to tell you about it.  If it doesn’t, or is unproven, we’ll tell you about that, as well.

2- Relevance

This blog will comment on issues that are relevant to anyone interested in Plastic Surgery.  Current events in the specialty, hot topics, breakthroughs, etc, are all going to be a focus.  I’m not going to comment on so-and-so’s new rhinoplasty unless it brings up salient points which bear further discussion.  The world may need one more Plastic Surgery blog, but I really doubt it needs another celebrity rag.

3-Interactiveness

We would love to have this site become an active forum for all topics related to our diverse specialty.  Dr. Vath and I are both avowed Plastic Surgery geeks, and will be prompt and thorough in responding to any questions you may have.

So feel free to peruse the site, and please comment on any topics that interest you.  We’ll be eagerly awaiting the discussion.

Dr. Wolfe

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The No-Drain Tummy Tuck

Posted on September 18, 2009 under Abdominoplasty, Body

Abdominoplasty surgery remains a popular and effective choice for improving the appearance of a protruding, saggy midsection. Now Colorado abdominoplasty surgeons Dr. Steven Vath and Dr. Andrew Wolfe are offering a variation on the traditional tummy tuck, which uses progressive tension sutures to eliminate the need for post-surgical drains during recovery.

Abdominoplasty is one of the most frequently performed plastic surgeries, and is particularly popular among weight loss patients and women whose abdomens have been overtaxed by pregnancy. However, until recently, abdominoplasty has required that suction drains be left in place for several days after surgery to prevent seromas (fluid accumulation). These plastic drainage tubes are sutured to the skin causing marked discomfort and limiting patients’ mobility after surgery.

“There is no question that the surgical drains were the biggest cause of discomfort for most patients following abdominoplasty at our Denver plastic surgery center,” say Drs. Vath and Wolfe. “The vast majority of calls we received from patients in the days following their abdominoplasty involved issues with their drains.” These issues include concerns about the drains becoming dislodged, pain or irritation at the drain site exiting the skin, and limitations on movement and showering.

In a traditional abdominoplasty procedure, drains are used to prevent fluid accumulation in the “open space” created beneath the abdominal flap (skin and fat) and above the muscle. Through a fairly simple modification of the surgery- the use of progressive tension sutures – Drs. Vath and Dr. Wolfe can eliminate this space, as well as securely advance the flap with tension distributed over a broader area. “The addition of the sutures is an improvement to an already effective surgical procedure,” they report, adding, “Surgical time is marginally increased by five to ten minutes, and the result is well worth it.”

The use of progressive tension sutures secures the abdominal flap to the underlying fascia, distributing tension over a larger area. This prevents seroma formation as there is no longer any space in which fluid can accumulate. Furthermore, with this technique, tension is spread out, rather than concentrated at the wound closure site. According to Drs. Vath and Wolfe, “Not only does this approach allow for the procedure to be done without drains, it decreases the risk of other complications associated with having most of the tension on the wound closure, such as hypertrophy of the scar.”

Drs. Vath and Wolfe have achieved excellent results through incorporating progressive tension sutures into his abdominoplasty procedures. There is mounting evidence within the plastic surgery research journals and at international meetings supporting this method of avoiding drain placement during tummy tucks. Since Drs. Vath and Wolfe have abandoned the use of drainage tubes, they have found no increased risk of seroma formation. Their patients report fewer post-operative concerns, and are significantly more comfortable and mobile during the first week following their surgery.

According to Drs. Vath and Wolfe, only a small number of plastic surgeons nationwide are beginning to offer the no drain abdominoplasty. However, “with results that are so overwhelmingly positive, this technique may become the standard for abdominoplasty in the years ahead.”

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The Demise of Threadlifts?

Posted on September 11, 2009 under Face, Face Lift

A recent study performed by Dr. Rima Abraham of Albany Medical College in New York caught my eye, and confirmed what many experienced facelift surgeons have long suspected: Thread Lifts, which purport to lift the soft tissues of the face through the use of barbed sutures inserted under local anesthesia, don’t really work, and shouldn’t be used at all. (See the Reuters story here).

This is yet another example of a new Plastic Surgery technique promoted to an unsuspecting public by the lay press and a number of overeager, under-informed physicians. It goes something like this:

  • New technique is developed, often with backing of large technology corporation
  • With aggressive advertising, both to the public and physicians, buzz is generated regarding said new technique
  • New technique is featured on Oprah/Today Show/local news
  • Patients begin requesting this technique from their surgeons, who may or may not choose to perform it
  • Non-surgeon physicians, enticed by the lure of self-pay patients and the aggressive nature of the marketing campaigns aimed at them, (”why let the surgeons do all the facelifts?”), may take up the new technique with gusto
  • Many patients will be treated, by surgeons and non-surgeons alike
  • Limitations of the technique begin to appear, and physician/patient enthusiasm may wane
  • Actual research into the effectiveness, safety, and durability of the results derived from the new technique is done

Now, in some cases, the new technique has real merit, and gets added to the armamentarium of many surgeons. In others, however, the results are not what were promised and the technique falls into disuse. In the case of Thread Lifts, the study showed that newer was not better. Complications were relatively common and included dimpling of the skin, visible threads, and facial asymmetry. More significantly, the improvements in facial shape that were seen were short-lived.

THE BOTTOM LINE: Our challenge, as physicians first and purveyors of procedures second, is to make sure that any procedure we offer our patients has been proven both safe and effective by independent research and that the procedure is right for that particular patient. If we stray from this standard, we risk both patient safety and our own credibility. Early adoption of new technology can have its benefits (our iPhones really did change our lives) and we are delighted to learn and use the latest surgical techniques – after we’re sure they work.

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Market-Driven Plastic Surgery: Trend or Tragedy?

Posted on September 11, 2009 under General Plastic Surgery

Patients sometimes come to our Denver plastic surgery practice asking for a “quickie face lift” or a particular kind of lipo like “Smart” lipo that they have heard about on TV or the internet or at another physician’s office. It’s normal to want the newest thing, because technology has brought us great things.

I was one of the first to jump all over the iPhone, but I confess that I’m not the first to take on new, market-driven procedures, and here’s why: good plastic surgery practice is based on research and proof that a new way of doing a procedure is based on checks and balances, studies on thousands of patients, and general agreement by other plastic surgeons that this change is positive and longer-lasting or in some quantitative way, better than the way it was previously performed. However, this goes against the public’s desires: they want a new technique that seems better, and they want to find a surgeon who will do it.

Note to consumers: Plastic surgery techniques change slowly. The techniques employed by board certified plastic surgeons are based on years of research and evaluation to make sure that what we deliver to our patients is both safe and effective. Even with all the research and effort to make these changes, they are usually  small, subtle advances; little differences that help someone get the best result.

Advice to consumers: Find a surgeon who’s not just up-to-date on the best technologies, but does a better job than others. Check their photos. Check their testimonials. Perform due diligence. And, if a surgeon doesn’t meet with you until the day of surgery, it’s bad medicine. Run. Quickly.

THE BOTTOM LINE: It doesn’t matter what you call a procedure. A rose by any other name is still a rose. It matters how you look after it’s performed. The proof is in the results. Legitimate results aren’t based on the latest procedures, but the best hands and minds in the plastic surgery business.

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Gummy Bear Implants: The Same, but Different

Posted on September 11, 2009 under Breast, Breast Augmentation

Patients occasionally ask us about “Gummy Bear” implants: what are they? Are they safer? Are they better? Can I have them? Should I have them?

It’s normal to want the latest, greatest thing—after all, Americans are hot for innovation, and both of us are committed to investigating and validating the latest and best technologies, devices and techniques for use in our practice. However, just because something is “new” doesn’t mean it’s “better”. Let’s briefly compare current silicone-gel implants with this new “gummy bear” implant.

What is a gummy bear implant?

The phrase “gummy bear” is a consumer-friendly name for an implant that is a “form stable cohesive gel”. They are firmer than current silicone implants and are pre-shaped in a tear-drop profile meant to look “more natural” in the breast.

Who makes them and what is their medical name?

  1. Mentor – Contour Profile Gel (CPG) implant
  2. Inamed/ Allergan – The style 410.
  3. Silimed/ Sientra – Silimed cohesive gel implants.

Are they safer? Are they better?

Safety: Current silicone implants are quite safe, and if they rupture (which is rare), any extruded silicone generally remains in the pocket surrounding the implant itself, unless the breast sustains significant trauma. Gummy bears are, literally, like their candy-referenced name: when sliced, nothing comes out. Therefore, you might say the 410’s are safer than silicone-gel in the same way a Prius getting 50 mpg is a better car than a Civic getting 46 mpg, ie, silicone-gel implants are safe or we couldn’t use them; it’s not as if the 410’s will replace an unsafe implant.

  • Longevity: Studies show that the form-stable gel implants have a lower rupture rate compared with standard silicone gel implants. Assuming the same outer shell, this would suggest that the 410’s would last longer.

  • Speed of Recovery: The recovery won’t be easier or more rapid compared with current implants; it will be the same.

  • Postoperative discomfort: as with speed of recovery, it will be the same.

  • Cost: as with any new product, they may initially be more expensive than current silicone-gel implants. We’ll have to wait and see if they become competitively priced with silicone-gel.

  • Appearance: Although most women seeking breast augmentation wish to have larger breasts, most still wish them to appear as close to “nature” as possible, ie, not obviously implants. The firmness of the 410’s may make them look slightly less natural when the women lies on her back or side. Their tear-drop shape may look more natural than silicone when she is upright. We think the “feel” of silicone gel implants may be preferable, as the gummy bear implants are firmer and, therefore, feel less like normal breast tissue.

Are they better? We don’t know yet. They are extremely popular in Europe and Asia, some very good breast surgeons prefer them and we’ve seen some very nice cases in the literature. Once they are accepted as primary implants we’ll have a better idea about performance.

Can you have them?

Gummy bear implants (we use the 410’s) are available in our office as replacement implants, not yet for primary (first-time) augmentation. They are also approved for breast reconstruction and repair of breast deformities as replacement implants.

After they are approved, we might or might not prefer Gummy Bear implants over silicone-gel implants, depending on our assessment about their aesthetic result—in other words, if they actually look better or perform better than the current cohesive gel implants we’re using now.

THE BOTTOM LINE: Suggesting that the gummy bear is safer simultaneously suggests that the current silicone gel implants are not safe. They are, or we wouldn’t be using them. Gummy bears are a different option that may become the standard. Time will tell.

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