Nose Job Complication? Use Honey!

One of the possible complications of a rhinoplasty is a case of sinusitis. But there’s a, uh, sweet cure for it -- honey. Now, plastic surgeons must figure out the best way to spread the stuff inside your schnoz. (Read more about nose job complications.)


(Photo credit: sxc.hu/nkzs)

What’s more, honey in medicine is nothing new -- it has been used since the time of the ancient Egyptians as a natural anti-microbial dressing. Read more.

Back in present time, Canadian researchers, lead by Dr. Joseph G. Marsan at the University of Ottawa, used honey in the lab on the bacteria that cause sinusitis. The problem has always been that super-powerful germs hide inside the nose under a thick covering known as biofilms, which can’t be penetrated by “even the most power anti-microbials,” according to Dr. Marsan.

Plastic Surgery Procedures

Two certain types of honey, Manuka honey from New Zealand and Sidr honey from Yemen, are powerful enough to zap through the biofilm and kill the bacteria. (Read the whole report.)

So will plastic surgery procedures have fewer complications?

The next step: do you sniff, spread, inject, swallow, or hold the honey under your tongue to get it inside your snout? Don’t know yet. Hey, no worries, they’re working on it!

Oliver Plastic Surgery's new home (and name) - coming January 2009!


Sneak peak for today! 

My good friend and colleague, Dr. Jason Jack, and I are busy working on moving our practice to our new home in suburban Birmingham. Hopefully we're set to open in January 2009. What's exciting has been the chance to design from scratch, an office to accommodate a 21st century Plastic Surgery practice.

I've learned more about fire codes, environmental issues, work flow theory, electrical engineering, and architectural design ten I've ever wanted to know about.

One thing I'm particularly excited about is the ability to offer a state of the art office surgery suite which will offer us tremendous flexibility and convenience for our patients for cosmetic procedures. It also makes us less vulnerable to the random and often pernicious pricing patterns that hospitals and anesthesia groups have for cosmetic surgery in a hospital setting.





Rob

Britain's Plastic Surgeons ask for truth in advertising


A big Cheers(!) to our colleagues 'across the pond' who are encouraging more professionalism in the business of cosmetic Plastic Surgery.

The British Association of Aesthetic Plastic Surgeons (BAAPS) has made a position statement that digitally enhanced pictures of bikini-clad women in writhing poses should be banned in advertisements as they mislead patients about expected results. BAAPS has singled out one chain of cosmetic clinics for particularly egregious promotion, pointing to an ad by the West One Clinic franchise which used models in advertisements that are "anatomically impossible".

Below is the wasp-waisted model with gi-normous breasts that apparently started this discussion. It clearly looks to me like she's been "morphed" with Photoshop to narrow her waist in relation to her trunk.


A second promotion offers a £250 ($462.55 USD by today's exchange rate) discount to customers as an incentive to have the surgery quickly, while a third offers a "lunchtime facelift", which arguably plays a little fast and loose by with downtown and recovery for short-scar facelift procedures.

This education that BAAPS is not a call per se for limiting all cosmetic surgery procedures, but rather it is a desire to see a more safe, thoughtful, and informed process take place when someone is considering surgery. It is impossible to remove unrealistic body images from pop culture, as both men and women strive for whatever form is popular in their era. What we do owe patients are frank discussions about the limits and morbidity of surgery minus the "magic brush" function of computer photo editing.



Rob
There’s a standard list of questions a patient should ask when considering any type of breast surgery.

But, given that some places are now offering expensive dishes that contain mother’s milk, here are some more appropriate questions to ask plastic surgeons before a breast procedure:

1. If I have a breast lift, will my milk still mix well in a Crème Brule sauce for braised tenderloin tips and asparagus?

2. If I go ahead with a breast enhancement, will surgery do anything to the milk to spoil the appeal of curry in a nice breast milk creamy sauce with tender bits of Rock Island lobster tails?

3. Will a breast reduction affect the formulation and consistency of breast milk used in Bosomberry milk ice cream?

Here’s how it all came about:

Swiss Restaurateur Hans Locher, head honcho of the restaurant Storchen (Little Stork in German) intended to serve a special soup and a recipe calling for antelope steak with mother’s milk sauce. Another dish consists of small chunks of meat, also in a creamy milk sauce.


Hans Locher with his favorite recipes.
(Swiss Info photo)


For supply, Hans lined up some new moms who were willing to sell breast milk for $14.50 a quart.

Gastronomes were, ah, udderly delighted. But the authorities declared that mother’s milk for the public is verboten. Read more about Hans.

On the other side of the globe, the Chinese were not to be outdone in tapping a seemingly heretofore unknown market and started offering fresh poached abalone and perch in a human breast milk sauce. More.


Poached abalone and Perch in a creamy sauce.
(BBC News photo.)


Said the restaurant owner: “When customers are having the human milk banquet, they can experience maternal love at the same time.”

In the United States, a California entrepreneur first used his wife’s breast milk to create the following cheeses:

• Holy’s Original Blend

• Mothers’ Milk Maid Cheese

• Miss Cheese.

Care to guess what the not-so-shy guy named his business? Hooterville Farms!

You can even email them and inquire about other products like YoGoGirls yougurt or his Chunky Mammal and Bosomberry ice creams, also containing, well, hey, you’ve got the picture now.

Just go to http://www.hootervillefarms.com and check it out.

Okay, you’re a wonderful sport for hanging in there, but you’ve been had! I went for it too and quickly saw that Hootervillefarms.com is actually a shameless link farm that has nothing at all to do with mother’s milk. (But an off-kilter article says it’s the real deal. Read it just for fun.)

Nonetheless, the rest of our report is true! Really!

It seems Hans started something. PETA read about his restaurant and is now asking Ben & Jerry’s to give up cow milk for human breast milk in their ice cream. (We’re NOT making this up….read more.)

Now, here’s the disclaimer part: kill joy health inspectors say you should not actually consume any real dishes containing human breast milk because nobody knows the health status of the donor.

Now that we took care of that chore, I would like to point out that a McGill University study of 14,000 children reveals that breastfeeding results in a higher I.Q.
Read more.

If it works for babies, won’t it also help adults?


Robot Surgery: Like Playing a Video Game!

Gamers, check it out!

You have the manual dexterity necessary to become a top surgeon! Using a robot, no less.

Says a top surgeon: “Using the da Vinci surgical robot is almost like paying a video game, like Play Station 3.” So declares Michael Hibner, M.D., director of gynecological surgery at St. Joseph’s Hospital and Medical Center in Phoenix. Read more.



A game hip surgeon working a surgical robot.
(Arizona Republic photo)

Breast Augmentation

So hey, why continue in your present job when you can game all day? And help people, too. (Of course, you have to graduate from medical school but, hey, that’s only eight years or so.)

One surgeon already tried using a robot for breast augmentation but she says she could not get the results she wanted. More.

Dr. 90210 Plastic Surgeon as Artist?

Q: What type of plastic surgery starts with reading all the art books any art student must know?

A: High-definition LipoSculpture.


John Millard, M.D., one of the doctors seen on Dr. 90210, learned to combine art with medicine and sculpts not stone, but people.

So who needs it?

Fitness and iron pumping buffs who strain, toil and sweat for endless hours in the gym to create bulging muscles….that are hidden by just a little fat.

Most of us would be thrilled to look like the people in the doc’s before pictures. But people who have undergone high-definition liposuction look like a living Venus de Milo (with arms, of course!) or an Arnold Schwarzenegger in his heyday.

What does Dr. Millard do differently? He learned where the most arty places are on the human body and now uses his plastic surgery skills to allow those pumped up muscles to shine through in all their glory. Not to get too high brow here, but it’s a concept known as negative space. Read more about High-Definition Liposculpture and art concepts.

Before and After Plastic Surgery Photos

The before and after pictures below show a 43-year-old woman who works out in the gym five days a week.

Her after picture shows what a high-def LipoSculpture looks like when just the right amount of fat is taken from just the right places…exactly like you might find in an book for art students.


Before.


After

It works for guys, too. Pictured below is a 34-year-old firefighter who has been a body builder for about 15 years.


Before Hi-def LipoSculpture


After.

(Photos courtesy of John Millard, M.D.)

This is getting real old, but the American trial bar is once again attempting to establish a game plan for circumventing liability protection that the FDA grants drug and device manufacturers after going thru the FDA approval process. An important legal precedent was upheld last winter which I wrote about in a post "Trial lawyers' ability to second guess the FDA on medical devices neutered" which refused a plaintiff's motion to allow layperson juries to essentially second guess the proceedings of expert FDA panels on medical devices. Medicines curently do not have that same level of insulation, and trial lawyers are contributing in record numbers to the Democrats for the fall election expecting favorable amendments to the law allowing expanded liability.

In a New York Times story this week, "Drug Label, Maimed Patient and Crucial Test for Justices" the case of a patient who had an inadvertent injection by a allied health provider (not a doctor)of a widely used anti-nausea medication (phenergan) into an artery in her hand and eventually suffered an amputation as a result of complications. This drug has been used for decades, and is both safe and cheap. The manufacturer of the drug is essentially being sued for a labeling issue where they claim that warnings about her particular complication were not prominent enough.

This type of action is embarrassing for our legal system, and demonstrates the great American legal tradition of finding the deepest pocket and suing the hell out of it. In this instance, the medical center already settled with this patient, but they're going for the big $$$$. While this individual had a terrible thing happen, it's not even clear that true malpractice even happened. Fines and putative damages on industry in these cases should be paid to the feds rather then individuals so as to remove the financial incentive for these ridiculous cases beyond economic damages.


rob

Plastic Surgery is a Star in Burn after Reading

Plastic surgery is often in the movies in Korea; in fact, rejuvenation surgery is a constant theme. (Read our blog about one Korean plastic surgery flick.)

Now, plastic surgery drives the wacky plot of the current highest grossing U.S. movie, Burn After Reading.


John Malkovich stars in Joel and Ethan Cohen’s dark spy comedy, BURN AFTER READING, a Focus Features release. (Photo credit: Focus Features)

The movie starts as Linda, an aging gym instructor (played by Frances McDormand) sees a plastic surgeon and finds her basic rejuvenation is going to require four, “major” procedures. (READ: equal to the annual gross national product of the Isle of Man, the Kingdom of Yap and the Isle of Dogs.)

She decides on a combined breast lift and breast augmentation; liposuction, and a face lift, including rhinoplasty.

Linda’s gym sidekick and fitness instructor, Chad, who is played by Brad Pitt, is a charming but totally self-possessed dolt and all-round airhead.

Because the movie is set in Washington, D.C., a former C.I.A. operative, Osborne, (played by John Malkovich,) has penned a tell-all book about the morons who run the nation’s spy agency. But Osborne loses the book -- written on a CD -- at the gym, aptly named Hardbodies.

Costs of Plastic Surgery

The action then gets a kick in the pants when Linda lays her hands on the tell-all book and assumes it’s real, classified intelligence worth the GNP of several large nations. She and Chad then concoct a dopey scheme to blackmail the author, collect a mountain of cash and pony up for the costs of plastic surgery.

The rest of the movie is a riot of confused identities, deadly pratfalls, mistaken shootings, bedroom intrigues and a handful of bodies that need hiding, along with some stark raving madness, aptly performed by George Clooney who plays Harry, a U.S. Marshal who repeats about 20 times daily that he never fired his gun in 20 years on the job.

Before and After Plastic Surgery Pictures

The movie ends with a C.I.A. big-wig trying to figure out how it all happened, where to hide the bodies, how much payoff cash to allow, and what, if anything, the agency is supposed to have learned from the zaniness.

You’re probably wondering how Linda looks in her before and after plastic surgery pictures. But we are sworn never to give away the endings!

Does it make sense to screen asymptomatic breast implants with MRI?


One of the peculiarities of the USFDA process during silicone implant reintroduction in 2006 was the labeling on the devices recommending routine MRI surveillance of implants for rupture. When you step back and look at the proceedings and "unique" American history with breast implants, you can see that this was more a political concession to the anti-implant activist lobby then evidence-based medicine.

The FDA labeling currently suggests MRI's at 3 years post op and then every 2 years subsequently. It will be interesting with the coming form stable "gummy bear" implants whether or not this recomendation is still maintained.



Why 3 years for the first MRI?

That was the first data point with any ruptures reported in the FDA data during clinical trials. While there will be a certain failure rate associated with any manufactured device, it's likely that early failures of silicone devices were from missed trauma to the implant during insertion. Education courses on proper techniques for implant handling and insertion in recent years have emphasized ways to minimize this risk by suggesting larger incisions for gentler introduction and better visualization during closure.


But does it make sense to do this?

Clearly it does not. On this point, there's pretty much international agreement (USFDA excepted).

We've actually got a pretty good handle on rupture rates of 4th generation implants (conventional devices used for the last 15 years or so) up thru a decade, where it's pegged around 6-8% at 10 years based in two pretty solid studies on single devices by the two major implant makers Mentor & Allergan. If you take that and work backwards from the FDA recommendation, you're doing up to 4 MRI's during the first decade where the rupture rate is either almost nonexistent (years 3-7) or in the low single digits (year 9).



Whether you're screening an asymptomatic population for ruptured implants, colon cancer, breast cancer, or aortic aneurysms there's trade offs between costs and risk reduction. For tests to be effective for screening, they must satisfy both criteria. For a number of cancers, screening tests often fail this goal.

Take screening mammograms or breast self-exams for instance to detect breast cancer. In non-selected groups of women, both cancer detection modalities increase both cost and morbidity from unnecessary procedures without materially affecting death rates from breast cancer (arguably the whole point of screening). It's been persuasively argued when reviewing the data, that screening mammograms can be deferred to age 50 for low risk women (as opposed to the current recommendation for age 40) and perhaps discontinued altogether for women in their 70's with no affect whatsoever on breast cancer death rates. BTW, this same pattern of "dodgy logic" of routine screening also exists in regards to male prostate cancer and lung cancer screening in smokers.

Anyway, back to implants......

At the end of the day it's just hard to support screening implants for rupture in asymptomatic patients on either a cost basis or benefit basis. As it's been established that ruptured silicone implants (silent or otherwise) do not appear to correlate with systemic illness, the clear benefit of screening asymptomatic women is hard to establish. A team of doctor's from the world famous Sloan-Kettering Memorial Cancer Center agreed with this sentiment in a recent paper, Silicone Breast Implants and Magnetic Resonance Imaging Screening for Rupture: Do U.S. Food and Drug Administration Recommendations Reflect an Evidence-Based Practice Approach to Patient Care?


Rob

Plastic Surgery Stops Bullies in their Tracks!

When I was in grade school, no self-respecting kid would tolerate a bully, the weakest, whiniest and most puny kids not withstanding.

We weren’t tough guys; it’s just that any boy over the age of oh, 18 months, would get far worse when his dad found out his kid had succumbed to bullies and forked over his lunch money, baseball cap, pocket knife, the family IRA or whatever.

The standing rule was: face up to bullies and fight back, even if there were dozens trying to shake you down.

I think the Father’s Instruction Book had a chapter about one punch on a bully’s nose stopping the lot of them. The one exception about fighting back: if you were in an iron lung, wheelchair or in traction, your punching ability was somewhat restricted, making it understood you might miss the bully’s nose. But you had to fight back. According to The Father’s Instruction Book, there was no shame in fighting back and losing.

But in reality, I never did come across a bully who was put off by one -- or even one dozen -- punches in the nose. I think they became bullies in the first place because they were born without pain receptors. So logic for nine-year-old bullies was simple: “Hey, we can’t feel pain. Let’s just pick on people! So what if they hit us back?”


Your lunch money or your life!
(iynmeyer photo)


However, all of that was before plastic surgery stopped the assaults. In England, a new way of dealing with the problem is by rejuvenating the body parts bullies like to taunt other youngsters about.

Some British surgeons are giving children and teens surgical rejuvenation so that bullies won’t be picking on odd-looking features or making punch-deserving jokes about large noses or ears or small breasts. (Read more.)

(Disclaimer: kids’ lunch money may still be up for grabs, even after plastic surgery!)

Rhinoplasty

*Mr. Douglas McGeorge, head of the British Association of Aesthetic Plastic Surgeons (BAAPS,) recently revealed he had reshaped the nose of one youngster and supplied breast implants for others to stop teasing and bullying. For instance, one younger teen was picked on and bullied at three separate schools, because of an unattractive nose. Her parents were about ready to go “case-o” -- British slang for “going bonkers” -- before hitting on the idea of ponying up 3,500 Pounds (that’s $6121.50 U.S. dollars) for
rhinoplasty. Her parents say the problem was solved.

Breast Implants

Because some bullied teens are still growing, the thoughtful doc has put in expandable breast implants, which help to gradually expand the bosom. (Read about how expandable breast implants work.) Additionally, a nine-year-old in Scotland begged his parents for surgery to rid his face of a mole because school bullies called him “Moley” and beat him up after school because of his appearance. (More about mole removal.)

But the trend is not news. Back in 2006, it was reported that Britain’s National Health Service was springing for cosmetic plastic surgery for bullied youngsters in Scotland. (More.)

What do you think? Will plastic surgery stop U.S. bullies? Or, should we concentrate on pain receptor transplants for bullies?

*In the British Isles, M.D.’s are known as “Mr.”

WELCOME!


Welcome to our plastic surgery blog. Plastic surgery generates a great deal of interest, but there is much misinformation floating around. This blog is designed to provide real-time information about this rapidly evolving field, and allow for the exchange of ideas through questions, answers, and comments.

Thanks for stopping by!

Please send questions by email to info@rdps.com or find more information on www.RodeoDrivePlasticSurgery.com.

Artist Rakes in Money with Tattoos on Swine and People

A leading service among plastic surgeons is tattoo removal. It’s known as “labor intensive” because the patients must return to the plastic surgeon anywhere from two to six times and let the doc do erasing work with a laser.

Basically, the cosmetic surgeon zaps the ink in the tat with a laser. (Read more about cosmetic tattoo removal.)

But when a tattoo is considered art -- and fetches a king’s ransom -- you gotta think about leaving it on.

Wim Delvoye, a Belgian artist living in Beijing, China, started by tattooing eight pigs with designs reportedly similar to Louis Vuitton logos. (Animal lovers, chill! The porkers, shown below, were anesthetized!) A few swine were inked with Walt Disney characters.


Artist Wim Delvoye and his four-footed canvases
(Ananova.com photo)


After the oinkers have lived a long and productive life, the pig skins will be sold for $120,000 each. (Can you imagine -- a Louis Vuitton football? What a way to get more chicks into the NFL! Can’t you just hear the girl talk now? “They fumbled a Vuitton Beaubourg in the first quarter and then tried an on-side kick with a Mahina XXL clutch in the 4th!”)
(Read more about the tattooed pigs.)

Tattoo Removal

The following will make tattoo removal experts worldwide cringe, but Wim’s latest project was inking an elaborate tat of the Virgin Mary on the back of Tim Steiner, a 32-year-old Swiss man who is cashing in on his tattoo.

Here’s how: Wim did his usual masterful job and sold the artwork on Tim’s back to a German art collector for a cool $275,000. The cash is split among the art gallery that arranged the sale, Wim and Tim. More.


Tim Steiner, a two-legged canvas
(Paolo Foschini photo)


Then, not unlike the pigs, Tim hopefully goes on living a long and productive life. Now, I know what you’re thinking and that’s not it -- Tim does not -- repeat, NOT -- become a football!!

Plastic Surgeons Verboten

Instead, many decades from now, just before Tim is laid down for a dirt nap, the skin of his back is removed and the Virgin Mary tat becomes the sole property of the art dealer who can sell it if he wishes.

And that’s not all. Contractually, Tim must display his back in public three times yearly to art lovers worldwide.

However, plastic surgeons who know how to remove tattoos are verboten in the shows!

Plastic Surgery for Pooches

Yearly, some appearance-challenged canine is named top dog in the World’s Ugliest Dog Contest at the Sonoma-Marin Fair in Petaluma, California. (Read more.)

Gus, a Chinese Crested, won for 2008 even though he has had a rough row to hoe in life. He has lost one leg to disease, one eye in a cat fight, a handful of teeth due to chewing on countless bones, and a furry coat due to heredity; after all, he is a hairless Chinese crested dog. Gus was simply born to be as ugly as a mud fence.

Nonetheless, his owners think Gus, pictured below, is precious.


Gus relaxing at home
(iStock photo)


2007’s winner was even more revolting. Also a Chinese Crested, Elwood, pictured below, won that year, perhaps because he is even more crested and has even less hair than Gus. You have to admit that when it comes to looks, Elwood is also just a real dog.


Elwood, 2007’s Top Ugly Dog
(Canada News Photo)


A Plastic Surgeon for Dogs

Anyhow, there’s somebody we would like Gus and Elwood to meet -- Brazilian doctor Vet Elgado Brito, a big proponent of pet plastic surgery.

To the Brazilian way of thinking, if you make people beautiful, hey, why not make their “animal companions” beautiful, too? Works for me! (As long as the creature is house broken; there’s no way that beauty alone makes up for, well, you’ve got the picture by now.)

Botox and Breast Augmentations

Dr. Brito has used Botox to straighten inverted doggy eyelashes so that Fido’s eyeball is not irritated. Among other cosmetic surgery, the South America doc has even performed canine breast augmentation by tightening mammillae of female dogs before beauty contests so that the dogs could take part in the type of contests in which good looks -- and not vile features -- are judged. (Read more about Dr. Brito.)


The owners of this Sharpei wanted Botox
to remove the dog’s wrinkles
but could not afford 1,500 vials of Botox.
(iStock.xchng photo)


But if you look closely enough, others are making unsightly animals more attractive, too.

Rhinoplasty and Eyelid lifts

The Animal Medical Center of Southern California requires a medical reason for cosmetic treatments on animals; nonetheless, the work often results in an eyelift, facelift, rhinoplasty or abdominoplasty, a procedure we Homo Sapiens fondly call a “tummy tuck.” However, liposuction is out, partly because dogs don’t mind being fat.

If your “animal companion” is a Pug, Bulldog or a Boston terrier, breeds in which breathing problems are common, the mutt may be eligible for rhinoplasty. Sharpeis and Chows often have a congenital defect that make their eyelids roll inwards, causing the eye winkers to rub the eye, perhaps resulting in scratches. The solution? A canine style eyelid lift.

Lip Augmentation

And there is the heart-warming case of Feznick, a 75-pound gray kangaroo who lives at a farm for Hollywood animal actors. Feznick was bitten on the face by his neighbor, a wolf and fellow actor when he, Feznick, poked his snout into the next cage. That left the ‘Roo with a snarling lip and totally unsuitable for his close-ups. So, back in 2006, a vet named Dr. Wolff (really!) repaired Feznick’s lip with a little cosmetic surgery described much like the human procedure, “except with a lot more hair.” (Read more.)


This Kangaroo isn’t Feznick (we could not afford
his picture!) but another Kangaroo who is available
for movies and commercials. (His day job is being an
attraction at a petting zoo.)
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