Plastic Surgery 101's music endorsements

One of the nurses in the O.R. asked me what I was listening to on my IPOD. Today's detour from medical humdrum features the official Plastic Surgery 101 music endorsement post. I'm always into new music so if you have anything you'd like to suggest, drop it in the comments!

New England hipsters,Vampire Weekend's caribe flavored "A Punk"

The Duke Spirit - "The Step and The Walk"

Weezer's mind-blowingly clever "Pork and Beans" video.

Super songwriter, Steve Earle's definative song about hitting bottom in rehab "Goodbye"

Heavy-metal flamenco duo, Rodrigo y Gabriela tearing up "Diablo Rojo" on Letterman

British "new soul" prodigy, Adele's "Hometown Glory"

Bat For Lashes' trippy retro, "Whats a Girl To Do?". My kids love this BIZARRE video.

The Cardigans , best known for breezy 90's hit "Lovefool" from the movie Romeo & Juliet, bare their teeth on the "I need some fine wine and you, you need to be nicer!"

New Orlean's funk-rockers, Galactic with guest Lyrics Born "What You Need"


Sign of the Times - a short tort report!

Sorry for the "radio silence" over the past week! I've a couple posts in half finished drafts lying around which I plan to finish soon.

Meanwhile, for today's sign of the times:

According to US NEWS & World Report magazine, at the recent Mass Torts Made Perfect meeting, a who's who of class action lawsuit ambulance chasers, more then 1/3 of the audience excused themselves during a session title "Ethical & Liability Issues in Group Litigation"

Top Medical News of the World

Dementia in the Family? Get a Tummy Tuck!

Now, nobody ever said the way to prevent a case of Alzheimer’s later on in life is to rush out and get a tummy tuck . But it might improve the odds of keeping all, well okay, most of your marbles as an old timer.

Here’s how scientists found that belly fat can put bats in your belfry:

Kaiser Permanente in Northern California studied 6,583 of its patients and measured their stomachs between 1964 and 1973 when the study group was 40 to 45 years old.

Three decades later, the researchers went back and measured the same subjects’:

  • Waist sizes
  • Dementia rates

(SXC Photo)

Results? People with large bellies were 2.6 times more likely to develop dementia than people with a normal waist size. And the news got worse as study group stomachs grew larger. Obese study subjects with really large bellies -- on the order of a Santa Claus belly -- were 3.6 times more like to go bonkers as an old person.

Conclusion? Other than dieting and regular, hard exercise (whew! I get exhausted just thinking about it!). The only other way to cut down on belly fat seems to be via a tummy tuck (“abdominoplasty”).

Actually, most guys would consider the procedure if it were known as a “gut tuck” or maybe a “gut check.” There’s just something too delicate about the word “tummy.” Can you imagine anybody referring to the “beer gut” as a “beer tummy?” I should say not! It takes many years of dedicated, hard work to create a beer gut!

Obesity and Bad Breath

The bad news for overweight people never seems to end.

If being driven crazy by a little flab isn’t bad enough, Israeli researchers have found that obesity can cause bad breath, too. It’s sorta the same old story: take a group of people, study them and compare who’s got what. In this case, a study of 88 people found that the most overweight also suffered complaints about stinky breath! Nobody seems to know why yet. Maybe a tummy tuck fixes the bad breath thing, too! Read more.

Sleepy? Get a Nose Job!

Daytime sleepiness is a huge problem. Just check out living rooms at 9 in the evening and count the number of snoozers in front of a blaring T.V. Lack of z’s has also been blamed on a number of disasters from Three Mile Island to the Exxon Valdez oil spill to a massive failing of freshman English every year at most colleges and universities. (Well, okay, the colleges and universities, I attended, anyhow!)

(SXC photo)

Researchers in Taiwan studied 51 patients with symptoms of daytime sleepiness. The researchers accessed the patients a month before and three months after surgery. They found a significant drop in the rates of daytime sleepiness and blocked nasal airways.

Attention wives! Here’s the really good news: Most of the subjects also quit snoring!

One of the first things a plastic surgeon will do if you go in for a nose job will be to check on how well you breathe through your nose. Read more about sleepiness and having a nasal surgery.

Questions about breast reconstruction

I got a late question in the "mailbag" from a Plastic Surgery resident asking

"When I was applying to programs last year and traversing the country visiting programs, there were a few trends which enticed applicants, probably none more that microvascular breast reconstruction. I was curious whether you think this trend will persist, or do you think increased insurance skepticism and comparability of implant based reconstruction and rotational flap reconstruction will leave this procedure for the uber rich willing to pay the difference?"

One thing to understand with questions like this is that while quality in healthcare is applauded, it is not paid for in a vacuum. With rare exception, reimbursement for insurance will continue to be depressed as we creak towards some kind of "federal medicare for all". As the feds and 3rd party payers look at things, quality is measured in things like length of stay and total cost rather then measuring quality in terms of "Does this type of reconstruction look more like a breast?".

Microsurgical expertise is gradually being concentrated in fewer and fewer hands as it has become a financially unsustainable procedure for most surgeons. (you can witness the same phenomena in pediatric plastic surgery & increasingly, hand surgery btw) I don't think there exists a large population of "uber rich" to sustain the field in a robust fashion, and there really is no plausible stimulus pending (50% increase in RVU's for instance) for rekindling interest in free flap surgery when other options exist.


What do cosmetic surgery and Lesbians have in common?

Now that you've been roped in with a salacious post title, the answer is kind of boring and mundane.

So what do they have in common? Trademark issues.

This type of Lesbian on lesbian action involves the tiny Aegean Sea island of Lesbos, home to the ancient Greek poet, Sappho, who famously praised romantic love between women 2700 years ago and gave us the origin of the term lesbian, has been threatening to sue to protect it's name from being used by Gay rights groups.

Similar to other old world cities, and most often involving foodstuff or liquors, these areas do have some legal claims on words derived from the area if they've trademarked them in a concept known as "protected designation of origin".

Image Source: Slap Upside the Head Blog.

Think of things like

  • champagne - which can only come from certain areas of France

  • Bourbon whiskey - which has to come from Kentucky and be distilled a certain way

  • Roquefort cheese - cheese must be made from milk of a certain breed of sheep, and matured in the natural caves near the town of Roquefort in France, where it is infected with the spores of a certain fungus that grows in local caves (Ick!)

  • Budějovický Budvar beer from the Czech Republic city of Budweis which had brewed a budweiser (literally a "beer from Budweis") style of beer since the 13th century, had a 20 year lawsuit settled with American corporation, Anheuser-Busch Co. over their popular Budweiser brand. This Czech beer, praised by beer aficionados, is now available in the USA as the brand, Czechvar. (Good stuff!)

The concept of trademarking surgical procedures has caused a little controversy in recent years. In particular, a number of facelift variations have been given catchy monikers like QuickLift, ThreadLift, S-lift, MACS lifts, E-Z lift, Lifestyle lift, etc.... Some surgeons have even had enough gumption to send cease & desist letters claiming intellectual property violations for surgeons performing these procedures. They were actually asking for royalties to do these operations.

The "Lifestyle Lift", a minor variation of the "short scar" facelift procedures has been commercialized by a chain of clinics and is advertised heavily in print and media. There have been an inordinate number of complaints (see here) among patients with these clincs which may represent who is doing the surgery (often not plastic surgeons at these clinics) rather then some inherant flaw in the technique. You can get OK results in very modestly aged faces with these procedures, but I get the impression it's being used on people that need "real" facelifts. A popular variation (and one I like), the MACS lifts, is a little more powerful tool for trying to get by with shorter scars on some of these patients.

This practice goes against a long history of our profession disseminating ideas & innovations around the world. Cosmetic surgery is probably one of the only industries where businesses publish and lecture on their trade craft for free! In addition, many of these "new" surgeries have been described many times before if you know where to look. John McGraw, the father of modern reconstructive surgery, has quipped "If you think you've invented some new operation in Plastic Surgery, you probably haven't looked in German surgery journals from the 1920's!"


Top Ten “No-No” Herbs in Plastic Surgery

So you’re going in for a nip ‘n’ tuck to rejuvenate some sagging, drooping whatevers. Good for you! It will help you look and feel better.

But before you go under the knife, here’s a pearl of wisdom. (Not from me, of course; the information comes from some very smart doctors!)

Did you know that taking herbs can cause trouble during your surgery?

Sure, herbs are 100% natural but, hey, so are snake bites! And, to borrow a line from George Carlin, any time you’re talking about snake venom, all you need to know is: it’s bad for ya!

Insider hint: never confuse the word “safe” with “natural.”

Insider hint number 2: no known herb can create a breast augmentation, a face lift or remove fat from your body. But you’ll see tons of ads that promise just that. (Read more about overblown ads in cosmetic plastic surgery).

Turns out herbs are powerful medicines that vary in strength depending on if you consume the leaf or the root and the time of year the herb was picked.

Herb medley
SXC Photo

We mention all this because Plastic and Reconstructive Surgery, the leading professional journal for plastic surgeons, recently found that 55 percent of plastic surgery patients use herbs while only 24 percent of the general public take them. Read more.

You want to quit any herb at least several weeks before your surgery, according to top plastic surgeons Robert Kotler, M.D. in Beverly Hills and New Mexico plastic surgeon Patrick Hudson, M.D.

Surgeons bellyache because patients often forget to mention the herbs they take, thinking it makes no difference to their medical histories. And then things can get complicated or go south in the operating room (O.R.) when other meds interact with the herbs.

Here’s the list of verboten herbs before your plastic surgery procedure

1. Ginseng

Used to enhance energy levels, ginseng in the O.R. can cause high blood pressure or a racing heart if combined with some of the medicines used by the anesthesiologist. Ginseng can also slow blood clotting.

Sweet herbs
(Bura photo)

2. Ephedra (aka ma huang)

Consumed in many diet aids, ephedra increases blood pressure and, during surgery, may increase it too much when combined with common medicines.

3. St. John’s Wort

Used to treat depression and anxiety, St John’s Wort can prolong the effects of some narcotics and anesthetics. It also interacts with Demerol, a prescription pain reliever.

4. Ginko Biloba

Taken to increase circulation, ginko can cause excess bleeding in the operating room.

5. Feverfew

Often used to treat migraines, feverfew can also increase bleeding during surgery.

6. Garlic

Usually taken to lower blood fat levels, garlic can also cause too much bleeding during an operation.

Garlic chives
(jkingsbeer photo)

7. Licorice

Many people with stomach woes take licorice. But during surgery, it can cause liver problems and water retention.

8. Glucosamine

Consumed to ease joint distress, glucosamine contains chemical elements that mimic human insulin and may cause high blood sugar while you are under the knife.

9. Chondroitin

Often taken as a folk remedy for bone arthritis, chondroitin can cause excess bleeding if combined with doctor-prescribed blood thinning medications.

10. Valerian

Valerian acts as a mild sedative when you take it at home. But in the operating room, it can increase the effect of anesthesia and cause a deeper sleep.

Other herbs often mentioned in the same breath as “surgical complications” include echinacea, glucosamine, goldenseal, melatonin, kava and milk thistle.

Just remember: herbs. It’s bad for ya!

What’s Your Favorite Herb?

NEXT: Top Ten Fat-Sucking Tunes

Revisional cosmetic breast surgery - Dr O in print this month

I like to say that unlike most blogs by plastic surgeons, Plastic Surgery 101 really isn't about me, but today's post is actually about me.

I was asked by the editor of Plastic Surgery Products (PSP) magazine, an industry trade journal, to come up with something interesting to write about for his magazine. One of the questions that I'm always thinking about is "What are the things we do that really cause long term problems and how can I avoid that?".

Spending time as a fellow working with the world's best re-operative breast surgeon (for my money), Nashville's Dr. Pat Maxwell, really gave me a different kind of respect for some of the long term sequalla we can produce with cosmetic and reconstructive breast surgeries. There's a famous quote (attributed to former Houston Oilers coach Bum Phillips) about Alabama football coach Paul "Bear" Bryant, that he could "Take his'n and beat your'n, and then take your'n and beat his'n.". Well Pat could do the same with some of the most unfavorable or difficult to treat scenarios in breast surgery that you can imagine.

Anyway, I've kind of gotten an interest in this kind of patient and put some of my understanding and thinking on these issues down for PSP in an article entitled "Solid Strategies in Revisional Breast Surgery" which you can read here.

Thanks to editor Jeff Frentzen for the opportunity to contribute, however Jeff, I'm going to demand the cover story next time :)

Ok now back to posts definately "not about me".