Advanced microsurgical techniques are often instrumental in ensuring the best results from flap breast reconstructions. But are they being used often enough? A new report in the May issue of Plastic and Reconstructive Surgery indicates that only a small minority of breast reconstructions are performed using these new techniques.

What is Microsurgery?

Breast reconstruction with microsurgery involves using an operating microscope during the course of the procedure. This allows greater precision and more options in surgeries that use the patient’s own tissues for reconstruction. They also avoid some of the side effects and post-operative discomfort that result from conventional flap techniques.

What Did the New Survey Find?

• breast implants are the most common method of breast reconstruction and were used in 60.5 percent of patients
• 34 percent of reconstructions were done with conventional skin flap surgeries
• advanced microsurgical flap techniques accounted for only 5.5 percent of all breast reconstruction surgeries
• women who were younger, Caucasian, and/or Asian were more likely to receive breast implants
• women who were in their 50s, African-American, and/or Hispanic were more likely to receive flap techniques
• breast reconstruction using the patient’s own tissues was more likely

Why is Microsurgery Rarely Offered?

This technique requires special equipment that is not always available at every hospital, as well as special training that not every surgeon has received. As a result, microsurgical breast reconstruction “was more likely to be used at teaching hospitals and in women with private insurance.” The expense and expertise associated with this approach underlie its relative rarity.

The study suggests that surgeons and patients should carefully consider all options, and avoid being blinded by the limitations of demographics and individual hospitals. “Armed with this knowledge,” the authors write, “initiatives which minimize disparities can be made so that the technique of breast reconstruction is based solely on anatomic considerations and [patient] preference.”

Luscious lips are among the hottest trends in Hollywood, and for women who lack the lips of Angelina Jolie and Scarlett Johansson, larger lips can usually be accomplished through lip augmentation. This procedure, which uses dermal fillers or facial fat grafting techniques to increase and enhance the appearance of your lips, can be performed in less than an hour. But what happens when you take it too far?

“Trout pout” is the common term for the results of too much lip augmentation. These overdone lips can make you appear fishy. A recent article on the ASAPS website, which discusses the rise of the trout pout, offers advice on how to avoid this all-too-common problem.

A balance between size and form is crucial during lip augmentation, as lips begin to lose their distinctive shape as fillers are added. This balance can only be preserved through the careful attention of a conscientious plastic surgeon. However, writes the ASAPS, the appearance of the trout pout can result “from the union of a patient with bad taste and a plastic surgeon with bad taste.”

These results can last for roughly six months when using dermal fillers, such as Juvederm, or years with facial fat grafting techniques. They are most common among older patients whose lips have begun to thin out with age.

How can you avoid the trout pout? Your lips have a natural proportion that must be respected. According to one Detroit plastic surgeon who was interviewed on Today Health, “the lower lip should be one and a half times the size of the upper lip.” When patients push for larger upper lips and doctors give in, the upper and lower lips appear roughly equal, which creates the unnatural appearance of the “trout pout.”

Consulting with a board-certified plastic surgeon with experience in lip augmentation is important to ensuring the best possible results and avoiding the dreaded trout pout. Always ask to see before-and-after photos of previous patients before committing to the procedure.

Plastic surgery for migraines is becoming increasingly popular as patients seek treatments after all other options have been exhausted, reports the Boston Globe. The effectiveness and long-term benefits of these procedures could mean pain relief for millions of patients who have found no relief in pain medications or other approaches.

Although few plastic surgeons are currently performing these migraine-curing surgeries, increased public awareness and ongoing clinical studies are spurring many to action. Migraines affect roughly 10 percent of the US population and can include symptoms such as crippling headache, nausea, and visual disturbances. Their effects can be debilitating to sufferers.

Debra Haining, a 57-year-old Massachusetts woman, was one of these sufferers. The Globe writes:

“She was forced to spend nearly every day in bed with the curtains drawn. She could not tolerate light, smell, or sound. Typically she rose only to see her 12-year-old son off to school in the morning and in the afternoon when he returned. Until recently, she had an ice pack to her head and could not drive a car.”

Numerous interventions – including medications, pain clinics, and neurologists – all failed to help Haining. However, after searching online, she found a plastic surgeon at Massachusetts General Hospital who performs migraine-curing surgeries.

How can plastic surgery help migraine pain? By relieving the compression on facial nerves that often causes migraines. Surgeries such as blepharoplasty or brow lifts, which are usually performed for cosmetic purposes, can relieve this pressure and remove the cause of the migraines. Plastic surgeons can perform these procedures – which involves making necessary changes to bone and soft tissue – while leaving almost no signs that any surgery has been performed.

Since her surgery, Haining still experiences some sensitivity to light, but her pain has completely disappeared. “I spent the last two days enjoying the fact that I could dust the house and do laundry,” she told the Globe. “I’m grateful for every day.”

April 15, 2002: Botox Cosmetic receives FDA approval and officially enters the US market. Ten years ago, few could have predicted the new era of facial rejuvenation that would result, or the cultural impact that Botox would have on the American psyche. It has since become the most popular cosmetic procedure in the United States, far surpassing any other, with roughly 5.7 million Americans receiving Botox last year.

Botox, a refined form of botulinum toxin, has the ability to paralyze muscles by inhibiting their nerve signals. The product has been used for decades to treat muscle spasms, and has been shown to have other therapeutic applications, such as relieving migraines. With Botox, a plastic surgeon can target certain facial muscles, which relax and allow others to pull and erase the appearance of lines and wrinkles.

It even thrived during the economic downturn, according to a recent article on the WPTV website:

“When the down economy sent more expensive surgical procedures like breast augmentations and facelifts plummeting, more Americans turned to the less-costly magic found in a vial of Botox.”

Dr. Fredric Brandt, a dermatologist from Miami, says that Botox was “the biggest revolution in cosmetology and dermatology in the last 30 years.” It heralded the advent of other nonsurgical treatments, including dermal fillers, as it proved that dramatic results reminiscent of a facelift were possible through injections.

Thanks to Botox, facial rejuvenation without facelift surgery is now almost commonplace. Soft-tissue fillers made from collagen, hyaluronic acid, or fat can fill out the appearance of wrinkles without the need for skin tightening. With further developments in fat grafting and other techniques, the next ten years will likely prove to be even more interesting.

Facial procedures, both surgical and nonsurgical, inevitably require some time before the final results are fully apparent. With the approach of summer – the season of weddings, vacations, and beach parties – patients considering facial procedures should be sure to check their calendars and make sure that they have enough time between their procedure and the event.

For instance, let’s say that you’re attending a friend’s wedding on June 30. When is the latest that you should have certain facial procedures to ensure that you’ll look your best?

Injectable treatments usually offer results within a few weeks, so you should consider having them by June 8 at the latest. Botox usually takes about two weeks to become fully effective, but can take longer for a first-time recipient. It works by paralyzing certain muscles  in order to allow others to erase the appearance of wrinkles.

Dermal fillers typically provide instant results, but most patients will want to have the procedure 2–4 weeks before a big event so that any redness or swelling will have completely disappeared. If you’ve never received a dermal filler before, play it safe and book the procedure by June 1.

Facial fat grafting works by removing fat from one part of the body and transferring it to the face. Slight redness and swelling can persist for some time, but usually disappear completely by the 4-week mark, so you should consider a June 1 deadline when planning for your big event at the end of the month.

Some facial surgeries, such as implants and brow lift surgery, can take up to 8 weeks or more before the final results become apparent, so you should consider undergoing these procedures by April 30. More extensive surgeries, such as the facelift, may need to be delayed, since they can take a few months before final results.

Of course, these dates are only a general guideline and will naturally vary with each patient. Before consulting with a plastic surgeon, be sure to check your social calendar and determine when your final results should be apparent. This will help you when discussing your options.

While tissue expansion can be uncomfortable and time-consuming, an experimental breast tissue expansion device may soon provide a major alternative to traditional methods, according to a recent news report.

Mastectomy, or breast removal, is often necessary to prevent the recurrence of breast cancer. While breast reconstruction surgery can offer women the chance to regain breasts lost to cancer, the site of the mastectomy often lacks sufficient tissue to hold the implant. Tissue expansion involves gradually stretching the breast tissue and muscle so that the site will be prepared for an implant.

Tissue expansion often requires repeated visits to the doctor’s office in order to receive saline injections. However, an alternative method has been developed, using a device called the AirExpander. This device can be implanted in the chest and delivers bursts of carbon dioxide, which are triggered by a remote control. A study for Columbia University Medical Center examined the results that the AirExpander offered to a single patient.

Barbara Baxter, who received a mastectomy last year, received the AirExpander in preparation for breast reconstruction. She was able to create enough space for her implant in six days. “It’s a piece of cake compared to the other way I think,” Baxter told CBS. “I haven’t had the other way but it didn’t look that pleasant to me.”

According to Dr. Jeffrey Ascherman, who spoke with CBS:

“[Baxter] can do it through her clothes, she can be at work, she can be at home, she presses a little button and it releases a small dose of compressed CO2… She can do multiple small doses during each and every day. She has the potential with this to complete the process much more quickly.”

While not yet approved by the FDA, the AirExpander is currently being tested in clinical trials, and its producer will likely apply for FDA approval later this year.

Image source: Webster Lab/Brown University

There aren’t many great stars of the stage and screen who can boast that their looks have actually improved since the 1970s. One famous actress and superstar who has managed to maintain her appearance attributes her success to Botox injections. It might also help that she’s a puppet.

One of the most famous Muppets, Miss Piggy has had a long and distinguished career since she was fashioned from felt by Sesame Street creator Jim Henson. In the nearly 38 years since her television debut, she has become widely known for her charm, passion, and wild temper. Recently, during a segment on  Anderson Cooper’s new talk show, Miss Piggy admitted to having a Botox habit.

Botox is an FDA-approved injectable drug that has been used for cosmetic treatments since 2002. By temporarily inhibiting the movement of a particular facial muscle, Botox allows another muscle to stretch. This pulls the skin tight and erases the appearance of wrinkles.  During the Anderson segment, Dr. Sanjay Gupta, a neurosurgeon and CNN’s chief medical correspondent, discussed some of the potential side effects of Botox.

Miss Piggy revealed on the show that her continued youthful appearance is the result of repeated Botox injections. In fact, Miss Piggy said, she was perhaps “99 percent Botox,” although that might be “underestimating it.”

“There’s hardly a single expression I can make,” she told Dr. Gupta.

“I do think it’s possible to go overboard when it comes to plastic surgery or even Botox,” Dr. Gupta said. “Botox is something that can be safe, but one of the potential concerns is that if you use too much of it, your eyelids droop. It can cause headaches, it can cause other problems.”

Dr. Gupta is right to caution his viewers, especially since many practitioners lack the necessary skills and restraint to ensure the best results for their patients. Fortunately, the side effects of Botox can usually be avoided by a board-certified plastic surgeon who has trained in its use.

Lifestyle Lift is a nationwide group of 40 clinics that offers cheaper and less invasive facelifts to its patients. The company counters that the majority of its patients are satisfied with their surgical results, but this didn’t prevent at least 68 Floridians from filed complaints with that state’s attorney general over the past two years. Accusations levelled against the group include:

• employees were given quotas to sign up a certain number of patients each week
• the use of high-pressure sales tactics regardless of individual patient suitability
• false advertising

This isn’t the first time that Lifestyle Lift has been investigated for shady and dishonest business practices. In 2009, the company was found guilty of creating fake online reviews, and was forced to pay a $300,000 fine by the state of New York. Florida’s AG is investigating whether the company is still posting fake reviews.

In response, Lifestyle Lift denies that fake posting is still taking place and accuses at least one former employee of being a disgruntled liar. Even the company’s website seems geared to respond to its negative reputation. On a page entitled “Internet Critics,” the company says:

Even with the best care and results, no one can make everyone happy. While you may find complaints on the Internet, it’s essential to keep them in perspective…. Many Internet blogs may be written by the same person writing over and over, and posting on a variety of sites. We have also found that competing doctors and their staff members sometimes post negative and misleading blogs.”

It may surprise many readers to learn that the overlap between migraine treatment and cosmetic enhancement is decades old. Botox, the most popular cosmetic injectable in the US, was originally used for therapeutic purposes such as treating migraines before the FDA approved it for cosmetic use in 2002. The migraine-relieving benefits of this newer procedure, which is adapted from the traditional forehead lift, have been confirmed in a number of recent studies.

The study found that although most plastic surgeons are aware of migraine surgery, and many express interest in performing the procedure, there are nonetheless “significant barriers” to its increased use. Eighteen percent of survey respondents had previously performed surgery for migraine treatment; more than 80 percent of these said the surgery improved the patients’ symptoms.

Many surgeons reported that they didn’t feel sufficiently familiar with the technique to perform the surgery. However, 60 percent said that they would be interested in offering the surgery if a patient were referred to them by a board-certified neurologist. The survey also indicated that most surgeons didn’t know that migraine surgery is covered by major health insurers such as Medicare.

Dr. Kung and his colleagues argue that a greater awareness of migraine surgery is needed. “Increased referral of suitable patients by neurologists and improved familiarity with the concept and techniques of migraine surgery may motivate more plastic surgeons to perform migraine surgery.”

Dr. Sanusi Umar, the study’s author, argues that the traditional method of hair transplantation, which takes hair from the back of the head, has some significant drawbacks:

“That hair happens to be the thickest hair on the head… if you take it from there and put it in the hairline, despite your best efforts, it will end up slightly harsh and unnatural in the hairline. The other issue is that people bald or thin to varying degrees. You can have mild baldness or it can be very severe.”

For the last seven years, Umar has developed a surgical technique that draws hair from different parts of the body. “With this approach I can combine beard hair, chest hair and leg hair, depending on the person’s hair distribution,” Umar told MSN in an interview. “Mixing that with some thicker head hair as well, I can come up with about 20,000 to 30,000 hairs, which means I’m then able to tackle some very severely bald individuals.”

However, other hair transplantation experts have reserved some doubts. New Jersey plastic surgeon Dr. Barry DiBernardo is one of them.

“Finding hair from other parts of the body is not new at all,” he said to MSN. “But when you use body hair it can be a different thickness. It can have more curl to it than the original hair. So these reports sound fine. But the approach does raise the issue of a hair mismatch, which of course will depend on the person.”

He also pointed out that the potential for visible scarring on the legs isn’t an issue with the back of the head.