Plastic Surgery

Heidi Montag's Plastic Surgeon Killed in Car Crash

2010-08-17T19:30:50Z

Dr. Frank Ryan - the Beverly Hills plastic surgeon who famously performed 10 plastic surgery procedures on Heidi Montag in one day -- has died.

According to TMZ, he was killed after his jeep went over the side of Pacific Coast Highway Monday at 4:33 p.m.

Ryan, who reportedly was 50, was trapped in the vehicle and suffered major head injuries, TMZ reports. "The Ventura County Fire Department tried hoisting Ryan using a helicopter, but the attempt was called off," says the site. "Ryan was pronounced dead at the scene."

Minutes before the crash, he Twittered, "After 25 years of driving by, I finally hiked to the top of the giant sand dune on the pch west of Malibu. Much harder than it looks! Whew!"

The surgeon - who performed on celebs including Gene Simmons, Shauna Sand and Vince Neil - came under fire this year for altering Montag's appearance so drastically.

"I am devastated to hear the news of Dr. Frank Ryan's death," Montag, 23, wrote on Twitter. "He was the most amazing person I have ever known. He was an angel and changed my life and the lives of everyone he met. He was the most brilliant talented surgeon who will ever exist. Dr. Frank Ryan changed the world. My thoughts and prayers go out to his mother, family, friends, and anyone who was ever blessed enough to meet him. He is in a better place."

Last fall, The Hills star underwent nose, cheekbone and chin jobs, as well as an eyebrow lift, breast enlargement and fat injections, among other procedures.

PHOTOS: How The Hills stars have changed

In March, she told Jay Leno she wanted bigger breasts, but "I legally can't right now. The limit is 800cc and I have 700cc." As for other surgeries, she said, "I think I've reached the point [where I can stop]. I think I'm good for awhile. I'm surger-ied out."

A month later, E!'s Dr. 90210 (real name: Robert Rey) told UsMagazine.com he wouldn't have performed more than three surgeries on the reality star.

"What worries me is the commentary she is making to young girls," he told Us.

Dr. Rey didn't slam her surgeon. "The issue of too many procedures in the operating room have [been debated] and forth," he said, "but he is a great surgeon -- that's not the issue."

Montag filed for divorce from husband Spencer Pratt last month, citing "irreconcilable differences."

You can read Dr. Ryan's tweets minutes before the crash @DrFrankRyan.

Heidi has updated her Twitter: "I am devastated to hear the news of Dr. Frank Ryan's death. He was the most amazing person I have ever known. He was an angel and changed my life and the lives of everyone he met. He was the most brilliant talented surgeon who will ever exist. Dr. Frank Ryan changed the world."

Surprise! your face doesn't age evenly

2010-07-14T21:54:25Z

Plastic surgeons are tossing out the old-school belief that gravity is the primary culprit for facial aging. A study in June's Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS), reveals the human face is made up of distinct fat compartments that individually change with age and the degree to which our faces age is dependent, in part, on how these compartments change over time.

"Contrary to popular belief, the human face does not age uniformly," said Joel Pessa, MD, ASPS Member Surgeon and study lead author. "We thought facial fat was one confluent mass that eventually got weighed down by gravity, creating sagging skin. However, we were shocked to find not only is the face made up of individual fat compartments but these compartments gain and lose fat at different rates."

According to Dr. Pessa, the face is a three-dimensional puzzle with fat partitioned into discrete units around the forehead, eye, cheek and mouth. A youthful face is characterized by a smooth transition between these compartments, but as we get older abrupt contour changes occur between these regions due to volume loss, volume gains, and repositioning of the compartments. These changes lead to tell-tale signs of facial aging such as sagging or hollowed skin and wrinkles.

With this breakthrough, plastic surgeons will be able to more accurately pinpoint trouble areas and use injectable fillers to add volume to individual sections of the face, creating a more effective way to turn back the clock.

According to the study, this discovery may also benefit cancer and trauma patients who require reconstructive plastic surgery. The authors uncovered that the individual fat compartments have boundaries between them that act like fences. These fences allow the face to maintain its blood supply should it become injured. This anatomical discovery may allow for better results for reconstructive plastic surgery patients. In addition, plastic surgeons can begin to use this new way of thinking to better understand facial deformities, such as cleft lips and vessel tumors.

"Much of facial anatomy remains a mystery," said Dr. Pessa. "This discovery will undoubtedly play a role in how we view aging and how we approach facial reconstructive surgery."

Stem Cells and Reconstructive Surgery making progress together

2010-07-14T21:48:29Z

Plastic surgeons have been busy researching ways to repair wounds and extreme facial trauma. From stem cells to facial transplantation, plastic surgeons published a number of studies showing leaps in helping patients heal, according to a recent issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).

"Plastic surgeons are making impressive steps in finding better ways to heal wounds," said ASPS President Roxanne Guy, MD. "Diabetics may soon have more choices to battle foot sores and leg ulcers, while surgical patients of all kinds could heal faster and forgo extensive pain medication because of this groundbreaking research."

Two new findings could greatly benefit diabetics. On one front, researchers have found a subpopulation of bone marrow stem cells that may heal patients faster than utilizing the whole stem cell. On the other, plastic surgeons may have found a workable scaffold that will allow them to mold and hold stem cells prior to injecting them into the body, allowing patients to "grow" their own tissue graft right on the wound site. These leaps in medicine could offer quicker, better relief for diabetic patients.

Any surgical patient, from breast reconstruction to a tummy tuck, may experience less pain and heal faster with pulsed magnetic fields, according to another study. Low-frequency magnetic fields are directed at the wound with a small, portable device to aid cells in healing the body. In a world where patients are discharged quickly and are impatient with the healing process, this promising treatment may get them back on their feet much faster.

Are we ready to move facial transplantation into mainstream medicine? Perhaps, according to another article in PRS where physicians probe the remaining hurdles to routinely performing facial transplantation. Looking at the various psychological and social consequences of being disfigured, such as discrimination and self-esteem issues, physicians agree the extreme and devastating psychological implications of being disfigured overshadow surgical and immunological issues.

"These studies show the ways plastic surgeons may soon help people get back to their daily lives quicker - whether transplanting a face for a patient that allows them to live at ease among society again or helping a woman who's had breast reconstruction heal faster," said Dr. Guy.

Does Fat-Melting really work? Hype or Reality?

2010-07-14T21:44:40Z

Whether their effectiveness is fact or fiction, non- and minimally-invasive techniques to remove fat are making headlines. But are these procedures really ready to be a part of mainstream plastic surgery? Plastic surgeons will discuss if these are cutting edge new discoveries or just "buyer beware" marketing hype this week at the American Society of Plastic Surgeons (ASPS) Plastic Surgery 2007 conference in Baltimore.

"Plastic surgeons may be looking at a new era in cosmetic plastic surgery if non- and minimally-invasive procedures and new technologies to melt unwanted fat are shown to be more effective in the future," said Brian Kinney, MD, ASPS Member Surgeon and panel presenter. "It is important to note that FDA approval is needed prior to introducing new technologies. Liposuction is still the only proven, safe and effective way to remove fat. The next great challenge is to shape, mold and metabolically alter fat for a complete body contouring solution."

Reducing, shattering and melting fat and cellulite are the buzz words, along with promises of fast and efficient procedures with minimal bruising, swelling and no down-time. Plastic surgeons will look at the science and the hype behind creams, and non- and minimally-invasive ultrasonic lasers, light therapies, and acoustic pulse treatments, such as Liporeductyl®, Theophyllisilane C, Acoustic Wave Therapy™, LipoSonix®, Mesotherapy, Lipodissolve, UltraShape®, and Smartlipo™.

"While there are many promising possibilities, it is important for plastic surgeons to fully evaluate new technologies before recommending them to patients," said Peter Rubin, MD, ASPS Member Surgeon and panel moderator. "Non- and minimally-invasive options may prove useful to achieve moderate differences, with less risk for patients who aren't ready for surgery, or may be used in combination with surgical options to achieve optimal results."

More than 302,000 liposuctions were performed in 2006, according to ASPS statistics. In addition, 9.1 million minimally-invasive cosmetic procedures were performed last year, up 66 percent since 2000, illustrating the growing demand for non- and minimally-invasive procedures for all areas of the face and body.

# # #

Note: Many of the procedures and technologies presented above are currently under investigation and presented for research and educational purposes. More scientific study is needed to determine efficacy and success rate. The ASPS and the Plastic Surgery Educational Foundation do not endorse the procedures or technologies presented in the panels and recommend that any reporting of the presented information be done responsibly with full disclosure of their unproven nature.

Snoring may be a thing of the past - Corrective Surgery for Sleep Apnea

2010-07-14T21:41:25Z

Millions of men who suffer from sleep apnea may sacrifice a good night's sleep because they don't know where to get treatment, don't realize relief is available, or are too embarrassed to get help. However, comfort may be as close as their local plastic surgeon's office. Plastic surgeons at the forefront of identifying and treating sleep apnea will discuss the latest surgical advances today at the American Society of Plastic Surgeons (ASPS) and American Society of Maxillofacial Surgeons (ASMS) Plastic Surgery 2007 conference in Baltimore.

"Men over the age of 40 are the most common sufferers of sleep apnea due to their heavier build and shorter necks; however, women, children and overweight people are not immune," said Stephen Schendel, MD, ASPS Member Surgeon and lecture presenter. "Many men are extremely embarrassed to get help for sleep apnea even though it can lead to serious health issues."

Sleep apnea is a temporary inability to breathe during sleep, which can occur dozens; sometimes hundreds of times per night. Although someone may not be aware they have the condition, it can significantly disrupt their quality of sleep. According to the National Institutes of Health, sleep apnea is as common as adult diabetes and affects more than 12 million Americans.

"Left untreated, sleep apnea can cause high blood pressure and other heart disease, memory problems, mood swings, impotency and headaches," said Andrew Wexler, MD, ASMS President. "The condition can also lead to serious work injuries and car accidents because sufferers are drowsy and fall asleep."

Sleep apnea can occur when soft tissues of the nose and mouth relax - which may restrict air flow. Plastic surgeons open the airway by removing excess tissue in the nose. The tongue is also shortened and pulled forward preventing it from slipping into the throat while sleeping. The disorder is also seen in patients with less pronounced facial features, such as a small chin, because they often have smaller airways. Plastic surgeons move the upper and lower jaws forward, creating a larger airway for these patients. Being overweight can also restrict the airway; however, the best treatment for these patients is weight loss.

Non-surgical options may not be as effective or as long-term as surgery. The most common non-surgical treatment is a Continuous Positive Airway Pressure (CPAP) machine, which some equate to sleeping with a scuba mask on, can often fall off during the night and forces the user to sleep on his back. Radiotherapy is another option that has moderate success; however, it may be only appropriate for people with minor conditions and requires multiple treatments.

"Treating sleep apnea is one of the less talked about ways plastic surgeons are helping to restore health and proper function to patients," said Richard D'Amico, MD, ASPS President. "After all, quality sleep is an integral part of how we function properly."

Pectoral Implants Viable Option for Men [STUDY]

2010-07-14T21:37:48Z

For men with mild gynecomastia or excess breast tissue, the shame of their pecs can be paralyzing. Pectoral etching is proving to be a viable option for men who do not want pectoral implants but want to feel more comfortable with their chest, according to a study in December's Plastic and Reconstructive Surgery® (PRS), the official medical journal of the American Society of Plastic Surgeons (ASPS).

"Although not common, requests for pectoral etching are increasing slowly," said Henry Mentz, MD, ASPS Member Surgeon and study co-author. "Many men simply don't know the procedure is even out there let alone that it's a safe, effective option for them."

During pectoral etching, targeted liposuction is used along the lower and outer edges of the chest muscles. A modest fat pad is left over the pecs, creating a noticeable contrast outlining the muscle.

Many patients who want the procedure suffer from minor gynecomastia or have lost weight but still have a more feminine-looking chest. Other patients are serious athletes that, despite working out and eating right, cannot develop the masculine, muscular chest they desire. To get a balanced look, these patients often have both abdominal and pectoral etching.

Unlike pectoral implants, etching leaves virtually undetectable scars, has no potential rejection issues and offers permanent results. Of the more than 200 men who had pectoral etching, only four experienced minor complications, according to the study.

"Pectoral etching can be a life-altering experience for patients," said Dr. Mentz. "For 74 years, one patient wouldn't remove his shirt in public. Last year he proudly spent his vacation on the beach in Hawaii."

In a recent study presented at Plastic Surgery 2007, the annual scientific meeting of the ASPS, all study participants who had abdominal etching, a similar procedure, reported an improvement in appearance. In addition, 86 percent reported they were satisfied with their surgery.

More than 1.1 million men had plastic surgery in 2006, up 8 percent since 2000, according to ASPS statistics. More than 400 pectoral implant procedures were performed on men last year, up 99 percent since 2005.

World Economy Down - Plastic Surgery Proceedures UP! [REPORT]

2010-07-14T21:32:03Z

Showing sensitivity to weaknesses in the U.S. economy, plastic surgery was not spared from the recession's grasp. According to the newest national procedural statistics report from the American Society of Plastic Surgeons (ASPS), in 2008, doctors performed over 12 million cosmetic plastic surgery procedures -- encompassing both surgical and minimally-invasive procedures. Surgical numbers dropped nine percent and minimally-invasive numbers rose five percent. Nearly 5 million reconstructive plastic surgery procedures were performed, slightly more than the previous year.

"Like most sectors, plastic surgery is feeling the effects of the economic downturn," said John Canady, MD, ASPS president. "However, repeat patients and those putting off surgery, likely sustained demand for some minimally-invasive procedures. Growth in demand will likely return as the recession eases and baby boomer's offspring begin to explore surgical options."

The following are the top-line 2008 National Plastic Surgery Statistics:

    * 12 million total cosmetic plastic surgery procedures; up three percent versus 2007
          o 1.7 million surgical cosmetic procedures; down nine percent versus 2007
                + Top 5: Breast augmentation (307,000; 12 percent decline), Nose reshaping (279,000; two percent decline), Liposuction (245,000; 19 percent decline), Eyelid surgery (221,000; eight percent decline), Tummy tuck (122,000; 18 percent decline)
          o 10.4 million minimally-invasive cosmetic procedures; up five percent versus 2007
                + Top 5: Botox (5 million; eight percent increase), hyaluronic acid fillers (1.1 million; six percent increase), chemical peel (1 million; two percent increase), laser hair removal (892,000; two percent decline), microdermabrasion (842,000; six percent decline)
    * 4.9 million reconstructive procedures; up three percent versus 2007
          o Top 5: Tumor removal (3.8 million; five percent increase), laceration repair (307,000; seven percent increase), scar revision (163,000; eight percent increase), hand surgery (100,000; 13 percent increase), breast reduction (89,000; 16 percent decrease)

"Although many obstacles remain in patients acquiring insurance coverage for reconstructive procedures, it is promising to see, for the first time in several years, a gain in reconstructive plastic surgery procedures," said Dr. Canady.

ASPS procedural statistics are collected through the first online national database for plastic surgery procedures, Tracking Operations and Outcomes for Plastic Surgeons (TOPS). This data, combined with the annual survey sent to American Board of Medical Specialties certified physicians most likely to perform these procedures, results in the most comprehensive census on plastic surgery.

View the entire 2008 National Plastic Surgery Statistics Report on the ASPS web site, www.plasticsurgery.org. Visitors can also find information on procedures and referrals to ASPS Member Surgeons.

Women with Breast Cancer not being told about Reconstructive Options?

2010-07-14T21:27:56Z

Despite the increase of breast reconstruction procedures performed in 2008, nearly 70 percent of women who are eligible for the procedure are not informed of the reconstructive options available to them, according to a recently published report. Newly released statistics by the American Society of Plastic Surgeons (ASPS) shows there were more than 79,000 breast reconstruction procedures performed in 2008 - a 39 percent increase over 2007. But in spite of this, current research suggests that many breast cancer patients are missing out on a key conversation that should take place at the time of diagnosis.

"Women need to understand all of their options to make an informed decision," said ASPS President John Canady, MD. "Those who are diagnosed should be immediately referred to a full team of physicians that can provide breast care, and plastic surgeons need to be included as part of that treatment team."

Taking the position that every woman deserves the right to choose which, if any reconstruction option is best for her, the ASPS is launching an ongoing effort to bring public awareness to breast reconstruction issues, including education, access, and a team approach. Because early involvement by plastic surgeons and other physicians can allow development of an optimum treatment plan for each individual patient, collaboration amongst specialties is essential. As such, ASPS suggests that primary care, general surgery, radiology, pathology, oncology, gynecology, and plastic surgery be available from the onset of treatment to ensure the greatest possible outcome for the patient.

It is also important that patients actively participate in their treatment. Though a common misconception, eligible patients should not assume that anyone other than a board-certified plastic surgeon affiliated with an accredited facility is qualified to perform breast reconstruction. While technology has made breast cancer diagnosis, treatment, and reconstruction better than ever, it does not negate the need for medical expertise within each specific area of care.

Among the factors contributing to patient awareness and understanding, specific education regarding the options for breast reconstruction is often lacking. Therefore, in the coming months, ASPS will reach out to women through a variety of materials, ranging from information cards and online videos, to an ad campaign featured online and in the waiting-room publication produced by the American College of Obstetricians and Gynecologists.

"We know that there are many issues surrounding breast reconstruction and that addressing them all will take time, but this is a very important first step," said Dr. Canady. "Our goal is to make sure that those women who are not getting breast reconstruction are doing so of their own accord and not because they are uneducated or uninformed about their options."

More people getting Plastic Surgery Proceedures [REPORT]

2010-07-14T21:10:23Z

A decline in Americans undergoing cosmetic surgery and treatments, as reported by the American Society of Plastic Surgeons (ASPS) today, appears to be a pause triggered by the recession rather than a wholesale change in attitudes toward cosmetic makeovers. According to a new online survey by Harris Interactive of 2,148 adults on behalf of cosmetic treatment community RealSelft.com, consumer interest in cosmetic procedures is up - way up, in many cases. More than two-thirds (69 percent) would choose to have cosmetic work done if money wasn't an issue, up 15 points from November 2009 (54 percent), signaling interest among consumers is climbing.

Additionally, the desire for invasive plastic surgery procedures, many of which require substantial recovery time, suggests people want big changes, not just minor nips and tucks. Of those who would get cosmetic work done, almost one in three (29 percent) would choose a tummy tuck, 23 percent would want liposuction, and 13 percent would opt for a facelift.

Interest in other treatments includes:

Procedure	% of Total	% Female	% Male
*Cosmetic Minimally Invasive*
Teeth Whitening	48	46	51
Hair Removal	27	35	18
Cellulite Treatment	14	21	3
Wrinkle Filler (e.g., Juvederm, Restylane)	12	15	7
Microdermabrasion	10	14	4
Hair Replacement	9	5	16
Botox	7	9	4
*Cosmetic Surgical*
Tummy Tuck	29	40	15
Liposuction	23	26	18
Face Lift	13	17	8
Breast Lift	15	26	1
Breast Augmentation (i.e., implants)	6	10	2
Breast Reduction	6	8	2
Rhinoplasty	4	5	4

*Note: Findings in the chart are based on adults who would get cosmetic work done if money were not an issue.

"We were curious to learn whether the reported decline in cosmetic surgery and procedures in 2009 was due to factors beyond the economy, such as a cultural shift away from cosmetic treatments," said Tom Seery, president of RealSelf.com. "The survey found that this is not the case, and that interest in cosmetic makeovers is significant and expanding, especially by those seeking solutions to aging and body contouring, specifically post-pregnancy. This is in line with what we've seen in the RealSelf.com community, where traffic by consumers considering cosmetic procedures is up 70 percent from last year."

Women Want to Make the Best of Their Bodies

Tummy tucks are most popular among women aged 35-44 - almost half (46 percent) would choose to tone their midsection if money wasn't an issue, compared to 34 percent of women 18-34. More than one-third (34%) of women aged 35-44 would undergo a breast lift, and 28 percent would opt for liposuction, possibly thinking ahead to swimsuit season. Liposuction is also popular among men 35-44: 29 percent would undergo this fat removal procedure. These three procedures are most often associated with "Mommy Makeovers."

Fighting the Clock - Antiaging Treatments Popular

According to the data released by the ASPS, minimally invasive procedures like Botox and wrinkle fillers are up 99 percent since 2000. The survey by RealSelf backs this anti-aging trend, especially among women aged 55+: of those who would choose cosmetic work if money wasn't an option, one third (33 percent) would opt for wrinkle filler and 14 percent would choose Botox.

Facelift surgery is of high interest by baby boomers: among those 55+ who would choose to get cosmetic treatments if money wasn't an issue, more than one-third of women (36%) and one in 10 (11 percent) of men would choose a facelift in an effort to retain their youth. Yet, among men aged 35-44 interest is also high - one in five (16 percent) would choose a face lift if money wasn't an issue, compared to just 6 percent of men aged 45-54.

Cosmetic makeovers people intend to undergo in 2010

The survey also looked at which treatments people planned to undergo within the next 12 months, providing insight into what types of procedures will be popular in the months ahead. More than half of people (50 percent) who are planning to undergo a minimally invasive procedure plan to get their teeth whitened, and one in five (23 percent) will go through a hair removal procedure. One in 10 (11 percent) will have a wrinkle filler injection (e.g., Juvederm, Restylane), while only 3 percent noted they will have Botox injections in the coming year.

Among cosmetic surgical procedures, one in four (27 percent) will have eyelid surgery and 18 percent will undergo hair replacement. Facelift (13 percent), tummy tuck (12 percent) and breast lift (12 percent) round out the top five procedures people have planned for the next 12 months². Tummy tuck and facelift are also among the top five Worth It procedures on RealSelf.com. The RealSelf Worth It Index measures levels of satisfaction with procedures from actual patients, noting whether or not the results were "worth it."

The Worth It Index ratings and average costs for treatments in the survey include:

Procedure	% Planning to Undergo in 2010²	RealSelf Worth It Index	Average Cost
Mommy Makeover	7	97	$12,532
Tummy tuck	12	85	$8,722
Vision correction	N/A	83	$3,139
Breast implants	8	77	$6,591
Facelift	13	73	$11,471
Hair removal	N/A	68	$1,520
Botox	3	64	$475
Teeth whitening	50	63	$380
Wrinkle filler (Juvederm)	11	59	$743
Liposuction	8	58	$5,660
Laser skin treatment	9	51	$2,443
Hair replacement	18	45	$17,390
Cellulite treatment	6	32	$2,271

¹Harris Interactive® fielded the survey on behalf of RealSelf.com from March 23-25, 2010 via its QuickQuery^SM online omnibus service, interviewing a nationwide sample of 2,148 U.S. adults aged 18 years and older. Data were weighted using propensity score weighting to be representative of the total U.S. adult population on the basis of region, age within gender, education, household income, race/ethnicity, and propensity to be online. No estimates of theoretical sampling error can be calculated.

² Results associated with the surgical procedures planned for next 12 months should be interpreted with caution due to small sample base size.

Can Botox Ease Nerve Pain? [REPORT]

2010-07-14T21:06:02Z

Made popular for its ability to smooth wrinkles when injected into the face, Botox - a toxin known to weaken or paralyze certain nerves and muscles - may have another use that goes beyond the cosmetic.

Johns Hopkins researchers have found that patients with a painful and debilitating nerve compression disorder called thoracic outlet syndrome (TOS), which studies suggest may occur in up to 8 percent of the population, reported a significant reduction in short-term pain after receiving a single, low-dose injection of Botox in a muscle located in the neck.

Though the study, published in the April issue of the journal Pain Medicine, was small, researchers say it suggests Botox is a safe, noninvasive alternative to the syndrome's treatment of last resort: surgery to remove the first rib and sever one of the muscles in the neck.

"There haven't been many alternatives to the use of surgery to treat this syndrome," says Paul J. Christo, M.D., M.B.A., an assistant professor of anesthesiology and critical care medicine at the Johns Hopkins University School of Medicine and the study's lead author. "Botox seems to be an effective treatment that avoids surgery's obvious drawbacks, such as its invasive nature and long recovery time."

Christo says his latest work significantly improves on previous studies in which TOS sufferers received several Botox injections or injections were made more blindly, without the aid of a CT scan.

TOS is caused by a compression of nerves in the lower neck, which occurs when there is not enough room in the cavity between the base of the neck and the armpit (the thoracic outlet) for nerve impulses to freely pass through. Symptoms often develop in the neck or head and tend to shoot down the arm, causing often excruciating pain, numbness and/or weakness in the limb and extremities. The condition is typically caused by the trauma of a motor vehicle accident, but can also be caused by sitting in the wrong position at a computer for long periods of time, by weightlifting or by an extra rib that is sometimes present in the neck. Treatments include physical therapy, anti-inflammatory medications or surgery.

Christo and his colleagues evaluated 27 patients who were candidates for surgery to treat their TOS and for whom physical therapy and anti-inflammatory medications failed to help. Each was given a 20-unit injection of Botox, a brand-name drug that contains botulinum toxin, made from the same bacterium that causes botulism, a paralyzing and life-threatening form of food poisoning. Christo used a CT scanner to guide the placement of the needle in the patient's anterior scalene muscle in the neck. Each session lasted around one minute, requiring minimal radiation, he says.

Patients experienced a significant decrease in pain in each of the first two months after the injection. At three months, patients still felt a 29 percent decrease in their TOS-related pain as measured on a scientific pain scale.

"This modest amount of pain reduction can have a significant impact on a patient's life," says Christo, a pain medicine specialist. "For many, it allows them to do what they couldn't do before - brush their hair, brush their teeth, hold their child."

Christo says the Botox works to temporarily relieve the pain of TOS in many patients because its paralyzing function decreases the tension and spasms of the muscle, relieving pressure on the nerves as more room is made for them to pass through the thoracic outlet. He says the drug may also decrease pain by reducing the number of neurotransmitters that notify the brain that the body is in pain. Though the study just looked at pain, Christo says some patients appeared to also have increased arm and shoulder function as a result of the Botox injections.

The effects of the drug begin to wear off in a few months, as they do when Botox is injected into facial wrinkles. Christo says patients should be able to receive repeated injections of Botox into the muscle over time, though some could develop antibodies to the compound with excessive use, which would mean the toxin would no longer block pain.

In the study, 48 percent of patients went on to have surgery. Christo says that is because many of those who agreed to participate in the Botox study did so only as a bridge of pain relief before they could get a date in the operating room. Others tried the Botox technique in the hope that they could avoid having surgery, he says. Not all patients are candidates for Botox.

Christo says he would like to do further research into the use of Botox for TOS, following up longer term with patients who are injected with the toxin.

Hopkins researchers Julie A. Freischlag, M.D., and Dana K. Christo, Ph.D., also worked on the study, along with Adam J. Carinci, of Massachusetts General Hospital.

- Johns Hopkins Medicine

French Breast Implants show signs of Rupture and Weakening [REPORT]

2010-07-14T21:02:13Z

A group of UK plastic surgeons has issued new guidance urging women who have the controversial French breast implants known as Poly Implant Prostheses, or PIPs, to have them checked in the next six months for signs of rupture or weakening.

The British Association of Aesthetic Plastic Surgeons (BAAPS) announced the new guidance on Friday following clarification from the French Society of Plastic, Reconstructive and Aesthetic Surgery (SOFCPRE) who conducted a detailed investigation into France's controversial PIP implants.

Although PIP implants are not popular with BAAPS members, the not for profit public education organization estimates some 50,000 women in the UK have this type of implant and urges them to undergo an ultrasound scan within the next six months to check for rupture or weakening. If there is, then both implants should be removed, they said.

It is understood that PIPs were one of the cheaper types of implant and SOFCPRE started investigating it after French surgeons reported they were rupturing more frequently than other types.

The investigation found that since 2005, the company that made the PIP implants, which has now gone into administration, stopped applying a protective barrier to the implants. Not only this, but the silicone gel they used in the implant was illegal: it was not the one submitted in premarketing tests required to meet EU consumer safety, health or environmental requirements (the CE test).

According to the BAAPS statement, SOFCPRE asked the gel manufacturers to forward studies on how the altered gel might react with the human body, but they said there weren't any and understood the material was going to be used in mattresses.

BAAPS President Nigel Mercer, a consultant plastic surgeon, told the media that the investigation concluded the surgeons were not to blame in these cases as they had acted in good faith.

"There was no way of knowing the gel was untested or that the protective envelope, which adds strength and restricts the gel from travelling into the body, had been dispensed with," said Mercer.

He said there was no serious cause for alarm. The substituted gel is undergoing further tests, and in the meantime he urged women who have had breast augmentation to contact their surgeon and check what type of implant they have.

"If it's PIP they should have an ultrasound in the next six months to establish whether there is any weakening or rupture. At present removal is recommended in these cases, but if there is one ruptured implant, the contralateral one should be taken out as well, as a preventative measure," said Mercer.

According to AFSSAPS, the French Health Products Safety Agency, investigations so far show risks to health from having PIP implants are no different than those normally encountered with other types of implants. However, a higher rate of ruptures and local inflammation following ruptures have been observed. These reactions are not serious and the recommended treatment is to have the implants replaced.

In most cases a ruptured implant has no symptoms and the only way to find out is with a clinical examination. AFSSAPS said this was why regular follow up was important.

If there is no rupture, and everything looks fine, the French agency said current information does not justify preventative removal of PIP implants but women with this type of implant should continue to have regular check ups and undergo an ultrasound scan every year.

The Ministry of Health, alerted by the French authorities after detecting fraud in its preparation, ordered yesterday to schools and health professionals to stop implanted immediately, a model of French breast implants manufactured by Poly Implant Prothese.

"We assume that these implants have a premature rupture rate of 1 percent and a number of women will have to replace them," said Jean Claude Ghislain, the Agency for Health Product. It was this government agency which sounded the alarm, to verify, during an inspection, the silicone gel used was not stated, but another to weaken the coverage of the implant ruptures and multiplied, eventually resulting inflammation.

The prostheses have been distributed in Spain by the Spanish subsidiary of the company, Poly Implant Spain, which ceased operations in December 2009. Nevertheless, the Spanish Agency for Medicines and Health Products alert to schools and health professionals who may have such prosthesis "must immediately cease its implementation."

Similarly, the Competent Authority warns all people who carry breast prostheses must, through the card or report clinical implementation of the intervention, if your denture correspond to the PIP.

If this were the case, or if in doubt, recommend an appointment at the center which performed the surgery or the surgeon to plan for proper monitoring by annual ultrasound to check the status of the prosthesis.

Although the rupture of these prostheses is free of health problems or serious disruption to the wearer, if they break, they should be removed and to others.

- BAAPS, AFSSAPS.

Botox DOES Weaken Emotional Experiences [REPORT]

2010-07-14T20:56:59Z

US researchers suggest that people who have undergone Botox treatments not only change their appearance but may also have a weakened ability to experience emotions.

Joshua Davis and Ann Senghas, professors of psychology from Barnard College at Columbia University in New York, and colleagues, wrote about their findings in a paper published online in the journal Emotions on 10 June.

Although it has been over a century since William James, an American pioneer of psychology proposed a theory of emotion that stated unless it can be expressed physically in the body it doesn't really exist, nowadays referred to as the facial feedback hypothesis (FFH), attempts to test it have been inconclusive.

That is until Botox came along, because it paralyzes face muscles used to express emotion (thus reducing wrinkles) and so you can use it to test FFH by comparing its effect with that of a cosmetic filler that does not affect facial muscles: this is essentially what the researchers did.

"With the advent of Botox, it is now possible to work with people who have a temporary, reversible paralysis in muscles that are involved in facial expressions," Davis told the press, according to a report by UPI.

A person who has received treatment with Botox can respond to an emotional event, for instance a sad scene in a movie, but their facial muscles will be less active, and this sends less feedback to the brain about what the face is expressing.

"It thus allows for a test of whether facial expressions and the sensory feedback from them to the brain can influence our emotions," explained Davis who said Botox enabled them to design a study where they could "isolate the effects of facial expression and the subsequent sensory feedback to the brain that would follow from other factors, such as intentions relating to one's expressions and motor commands to make an expression".

For the study, Davis, Senghas and colleagues examined two groups of participants: one received Botox treatment and the other, the control group, received Restylane, a cosmetic filler that does not paralyze facial muscles.

The participants filled in questionnaires about their emotional experiences to watching positive and negative video clips before and after treatment.

The researchers wrote that results from the Botox group showed no changes between the pre- and post-treatment emotional responses to the most positive and negative video clips, but when they compared the two groups they found that the Botox group showed an overall significant decrease in the strength of emotional experience.

They said these results were due to two effects: a pre- versus post-treatment decrease in responses to mildly positive clips in the Botox group and a surprising increase in responses to negative clips in the control group.

They concluded that:

"These data suggest that feedback from facial expressions is not necessary for emotional experience, but may influence emotional experience in some circumstances."

The researchers recommend further studies be done to clarify the relationship between expression and experience.

For example, one avenue to explore would be how specific emotions relate to individual muscle groups and how this influences expressions like frowns and smiles.

"The effects of BOTOX injections on emotional experience."
Davis, Joshua Ian; Senghas, Ann; Brandt, Fredric; Ochsner, Kevin N.
Emotion, Volume 10, Issue 3, June 2010, Pages 433-440
DOI:10.1037/a0018690
- Catharine Paddock, PhD

Cosmetic Foot Surgery Warning [REPORT]

2010-07-14T20:52:10Z

The American Orthopedic Foot and Ankle Society is warning patients to avoid "foot facelifts."

Cosmetic foot surgery includes narrowing the foot to better fit high heels; shortening the second toe so it's not longer than the big toe and making the little toe shorter and skinnier to accommodate high heels.

"The risks of such surgeries -- including infections, pain, scarring and nerve damage -- are much greater than the benefits," said Loyola University Health System foot and ankle surgeon Dr. Michael Pinzur.

"I hope patients will follow the Foot and Ankle Society's recommendation that surgery never be performed just to improve the appearance of the foot," Pinzur said.

Pinzur is a professor in the Department of Orthopedic Surgery and Rehabilitation at Loyola University Chicago Stritch School of Medicine.

On June 23, 2010, the Foot and Ankle Society reiterated its earlier position statement that advised against cosmetic foot surgery.

- Loyola University Health System

How to Overcome Body Dysmorphic Disorder

2010-07-14T20:47:06Z

A nose job to treat a mental health problem? Teeth whitening to overcome a severe anxiety disorder? These are just two procedures that people with body dysmorphic disorder (BDD) have traditionally turned to in order to deal with body-related concerns. The excessive use of (and dissatisfaction with) cosmetic treatments, along with obsessive rituals and social isolation, is what scientists from the Fernand-Seguin Research Centre of Louis-H. Lafontaine Hospital, affiliated with the University of Montreal, are hoping to fight with a novel therapy to treat BDD.

BDD is not a well-known disease: it is characterized by a significant dissatisfaction with one's appearance, particularly with perceived flaws. Included in the category of obsessive-compulsive disorders, this mental health problem leads to ritual behaviors and social isolation. Although any part of the body may become the subject of these obsessions, those who suffer from BDD most often focus on their skin, eyes, nose, teeth, buttocks, stomach, hair or chest.

Kieron O'Connor, director of the Obsessive-Compulsive Disorder and Tic Disorder Studies Centre at Louis-H. Lafontaine Hospital, said that people coping with BDD seek out in particular plastic surgeons, orthodontists and esthetic professionals to alleviate their suffering. "However, what they really need is psychological support and assistance," said Dr. O'Connor, who is also a researcher at the University of Montreal Department of Psychiatry and the Université du Quebec en Outaouais Department of Psychology.

To help people struggling with BDD, Dr. O'Connor and Annie Taillon, a doctoral student in psychology, developed a specialized and innovative cognitive behavioral therapy in collaboration with their team at the Fernand-Seguin Research Centre of Louis-H. Lafontaine Hospital. "Our preliminary results are very promising," explained Ms. Taillon. "We observed a clear decrease in appearance-related fixations among participants and a reduction by more than half in ritualized behaviors. Nearly one third of the depressive symptoms associated with these fixations also disappeared."

The benefits of this therapy are very real; however, too few people dare to ask for help. By the nature of their illness, these patients are reluctant to go out in public, making a visit to the clinic a significant hurdle.

Kimberly is a woman who has benefited from the program. Speaking under an assumed name, she agreed to share the scope of her daily suffering: "I was ashamed to go out in public; I avoided all social activities. When I heard about this research project, it was a great relief for me. Finally, there was an explanation for my problems and, above all, a solution. This therapy helped me break free of my fixations and go back to work. I highly recommend it. "

Although BDD is little known, the disease is thought to affect over 350,000 Canadians, all of whom experience the same suffering, fears and turn to the same rituals and cosmetic procedures to avoid addressing the real nature of their illness. Nevertheless, these attempts to solve their problems reflect a true desire to end their suffering. Hair salons, dental offices, cosmetic surgery centers or a psychologist's chair? For people with body dysmorphic disorder, knocking on the right door is the true challenge.

Body Dysmorphic Disorder (BDD)

    * Over 350,000 Canadians are estimated to suffer from BDD
    * Specific populations: students (2 percent to 13.1 percent); clients of cosmetic surgery clinics (6 percent to 20 percent)
    * Affects both men and women
    * Rates of suicidal ideation (57.8 percent) and suicide attempts (2.6 percent)

Preliminary findings

    * Specialized therapy for a period of 20 weeks
    * Average reduction of 46 percent in appearance-related fixations
    * Average reduction of 53 percent in ritualized behaviors associated with these fixations (e.g., looking in the mirror, applying makeup, skin picking at the location of a perceived imperfection, etc.)
    * Average reduction of 34 percent in associated depressive symptoms

Researchers are currently seeking participants for their Montreal-based study.

- Catherine Dion / University of Montreal

Heidi Fleiss Plastic Surgery - Good Bad or Just Plain Ugly?

2010-06-25T21:48:43Z

Heidi Lynne Fleiss (born December 30, 1965) is a famous former American madam, and also a columnist and television personality regularly featured in the 1990s in American media. She is often referred to as the "Hollywood Madam".

What the heck happened here? Her surgeon might need to be questioned. Did she go through a drive-thru plastic shop??