Give Injectables a Try to Improve Your Looks

LIFE Pairing up for plastic surgery Vicky Markovitz 916 words May 25 2006 USA Today FIRST D.10 English

Lauren-Beth Kassinger says that if she bought a pair of shoes that looked good on her, her mom would "go out and get the same thing." So it wasn't such a stretch, after Kassinger decided to get plastic surgery, that her mom, Elvia Rabinor, decided to do it, too.

According to 2005 statistics released by the American Academy of Facial Plastic and Reconstructive Surgery, a specialty group for certified plastic surgeons who focus on the face, head and neck, 34% of those surveyed report that more people are getting plastic surgery with a companion. The pairings range from friends, sisters, husbands and wives, and mothers and daughters, to some more unusual cases.

"I had a divorced couple come in recently," says Jay Calvert, a plastic surgeon in Beverly Hills, Calif. "I guess they wanted to get freshened up for the next experience."

The tandem surgery experience was just one trend among many that emerged in 2005 as Americans continued their love affair with plastic surgery. Numbers gathered by the American Society of Plastic Surgeons (ASPS) show that in 2005 surgeons performed:

*More than 10.2 million cosmetic procedures, up 11% from 2004. Of those, the bulk (8.5 million) were minimally invasive procedures such as Botox injections and chemical peels. The rest were procedures such as liposuction and breast augmentation.

*More than 5.4 million reconstructive surgeries, such as laceration repairs and scar treatment, down 3% from 2004.

*A small number of so-called "fringe" surgery procedures. There were 793 vaginal rejuvenations, which repair damage caused by aging, childbirth or injury, or shape the vagina to match what a patient wants aesthetically; 542 buttock implants; 337 calf augmentations; 206 pectoral implants.

ASPS members are certified plastic surgeons. For their statistics, the group also surveyed doctors likely to perform plastic surgery.

Kassinger and her mother were seeking out relatively common nose reconstructions when they went shopping for surgery.

Kassinger, 31, who lives in Little Silver, N.J., says she always wanted to change her nose. A self- described"petite woman with smallish features," she says she never felt her long, thin nose fit her face. But, as a professional dancer, she couldn't take time off to recover. About two years ago, no longer dancing professionally, she decided to take the plunge. She had read an article on Andrew Jacono, a plastic surgeon in Great Neck, N.Y., that interested her. So Kassinger went with her father, who lives in Bayside, N.Y., to visit Jacono. After the consultation, Kassinger says, she "couldn't stop raving about" the doctor.

Her parents are divorced. Her mother, 52, lives in Arizona. "My mother and I are very close, and we look a lot alike," Kassinger says. "I must have triggered something in her that made her feel like she wanted to have (her nose) done, too."

On a leap of faith, Kassinger's mother flew in to have surgery the same day.

The ASPS statistics show that 42% more women and 44% more men had cosmetic surgery in 2005 than in 2000. Doctors say several factors contributed to the increase.

For one thing, new techniques and technology have reduced scarring and recovery time, making the prospect of surgery more attractive.

"You can do a face lift now with tiny little incisions, about the size of a straw, in the scalp," says Jacono, who wrote a book, Face the Facts, about facial plastic surgery procedures. "That is not something that was an option years ago."

Doctors caution that not all minimally invasive procedures work.

"We're concerned about complications," says Joseph O'Connell, a plastic surgeon in Westport, Conn. "And we're concerned about effectiveness, and we're not sure about the longevity of results."

Another factor driving the growth of cosmetic surgery is a widespread change of attitude. People are no longer reluctant to talk about having work done, which leads to word-of-mouth business for doctors.

"It's a very different attitude than 10 or 15 years ago, when everyone kept it under the radar," says Ira Papel, president of the American Academy of Facial Plastic and Reconstructive Surgery.

"People are doing it in groups now because it's not such a taboo," Jacono adds. "Everyone's doing it, so why not do it with a friend?"

Doctors say a benefit to couples having plastic surgery together is they can take care of each other. But some doctors don't like doing both surgeries on the same day. "I don't like to have them do it at the same time, because one helps care for the other during the recovery process," says Scott Chapin, a plastic surgeon in Doylestown, Pa.

For Kassinger and her mother, double surgery worked well. While bruising under their eyes healed and swelling lessened, the two women hunkered down at Kassinger's father's house, watching movies and E! True Hollywood Story episodes. "We saw, like, every character from 90210," she says.

Although Kassinger is happy with her new nose, she says she doesn't want any more major work done. "A little Botox, possibly, as I get older, but major surgery, no," she says. "My mom is another situation. She might consider doing work because with her nose, she went through the process, and she saw how good that made her look."

Will they get work done together again?

"Next time she comes to New York, that might be a possibility."

Document USAT000020060525e25p0000b Imaging a Nip/Tuck Nation How the sharp rise in plastic surgery affects you By Amy Storer

"Nip/Tuck," "Make Me Perfect," "The Swan," "Extreme Makeover" – with new television shows like these popping up on the tube, you're bound to see someone voluntarily subjecting themselves to the scalpel.

And life is imitating art. In fact, the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) says the nationwide number of facial plastic surgery procedures and injections increased 34 percent from 2000 to 2004.

Plastic surgery in the United Kingdom is also carving out a growing number of patients. According to the British Association of Aesthetic Plastic Surgeons, the number of people undergoing cosmetic surgery has gone up by a third in the past year in Britain.

While there are many answers to plastic surgeons' infamous question, "What don't you like about yourself?," there are even more reasons for why they think they need it. One common reason may surprise you: to be a cut above the rest at work.

According to AAFPRS, 22 percent of men and 15 percent of women who sought plastic surgery in 2004 did so for work-related reasons.

But regardless of whether or not people seek sutures for success at work, the sharp rise in plastic surgeries will undoubtedly affect the work you do and the radiology profession of tomorrow.

What's more, surgeries that require the most concern in the imaging world are also among the most frequently performed surgeries in America. A study published by the American Society of Plastic Surgeons (ASPS) ranks the top five cosmetic procedures among women in 2004 as: 1. Liposuction: 292,402 patients 2. Breast Augmentation: 264,041 patients 3. Eyelid Surgery: 200,667 patients 4. Nose reshaping: 195,504 patients 5. Facelift: 103,994 patients

And experts say liposuction, breast augmentation, facelifts and Radiesse injections – a non- surgical facial contouring filler – top out the list of procedures requiring attention and expertise in a post-op scan.

Liposuction Zachary E. Gerut, MD, FACS, a diplomat of the American Board of Plastic Surgery, says the most common and significant of all plastic surgery procedures affecting radiologic testing is breast augmentation. But one procedure that produces temporary effects and can distort an image is liposuction, as it leaves traces of air in the soft tissues.

"Clearly, air in the soft tissues is ominous [in] radiologic findings if [the] patient is being worked up for sepsis," Gerut says. "The history of recent liposuction must be taken into account in such cases."

Allen D. Rosen, MD, medical director of the Plastic Surgery Group in Montclair, N.J., says liposuction of the breast has recently become a frequently performed procedure. And as its popularity grows, so does the research about its after effects.

"At approximately one year, the scar changes seen in the breast following breast liposuction [is] usually within normal limits, [but] prior to one year's time, scar tissue or oil cysts may show up on mammographic evaluations," Rosen says. "Long-term calcifications from liposuction have not been predominant, [but] might be anticipated with greater application of this technique."

Nancy Elliott, MD, FACS, surgical oncologist and founder and director of the Montclair Breast Center (MBC) in N.J., says women undergoing any type of breast reduction surgery should have a mammogram and ultrasound immediately prior to their surgical procedure. "And if they are a high risk, they should have a breast MRI also," she explains. "A year later, when they have their annual screening mammogram, there will be changes apparent that may require a six-month follow-up."

Radiesse Injections

Radiesse injections are said to provide a longer-lasting result than many of its predecessors. This injectable filler is often used for reduction of smile lines and nasolabial wrinkles, cheek contouring, chin reshaping and jaw line contouring.

But be aware of this injection fluid, Gerut says, because Radiesse is made of artificial bone mineral. "These injections will appear as streaky calcifications, usually in the lips as it is injected for lip enlargement. In the lips, it usually lasts a year," he explains. "Most radiologists are familiar with the use of the substance for stress incontinence. Patients treated by urologists with this material will have a calcification of the bladder neck."

However, you might not have to worry about spotting this streaky injection on film for much longer. According to ASPS, the use of Radiesse injections is on the decline. From 2003 to 2004, statistics show a 9 percent decrease. But you may have to be on the lookout for permanent lip augmentation – which uses material other than injectables – as those procedures made a 44 percent jump over the past four years.

Facelifts

Women aren't the only ones getting facial plastic surgery these days. Rosen says a growing number of men are, too. "The population of men having surgery in 2004 was approximately 11 percent and the number in our practice [is] closer to 15 [or] 20 percent," he says. "These are professional men who are undergoing procedures like eyelid surgery, hair restoration and male breast reduction, as well as liposuction and face lift procedures." But, Botulinum Toxin, better know as Botox™, is quickly becoming the most popular option for reducing wrinkles on the face and neck such as crow's feet, brow furrow and forehead lines. The effects of Botox™ are only temporary, but the injections can be done quickly, require no recovery time and are not as complicated as many other cosmetic procedures for the face.

Over the past four years, ASPS says, Botox™ usage has hiked 280 percent. And as consumers choose this non-surgical injection option, the number of people getting facelifts decreases. But, the ASPS says approximately 114,000 facelifts are being performed each year as of 2004, which means it's still a concern of yours.

"Certain soft tissue anatomic landmarks will be affected by facelifts," Gerut says. "If the platysma is tightened to the anterior border of the sternomastoid muscle, the shape of that may also be temporarily distorted."

Breast Augmentation

Virtually any woman who must lose her breast to cancer can have it rebuilt through reconstructive surgery. But there are risks associated with any surgery and specific complications associated with this procedure.

Rosen says women – whether they're undergoing a reconstruction or simply wanting a boost with an augmentation mammoplasty – must be informed of the risks associated with implantable devices during their consultation.

Gerut recommends submuscular saline implants to all of his breast augmentation patients. "I tell my patients that if a breast implant is placed above their muscle, it will be very difficult for their mammogram to be read," he says. "I tell them that if a breast implant is placed under the muscle, it looks more natural, it feels more natural, and they will be able to get mammograms that will be readable as long as the Eklund maneuver is done."

Rosen says the Eklund, or oblique, mammographic views are sufficient in performing routine mammographic surveillance in women with implants in place. "We do advise patients to specifically let their mammographer know that they do have a breast implant in place so that these additional views and/or additional diagnostic studies may be performed as necessary," he adds.

But, it's not just the implant that's of concern. Tissue expanders used during breast reconstruction, for example, have metallic-based fill ports that will show up on plain film and may interfere with MRI exams. "Any radiologist looking at plain films or other exams with fill ports in place should know that the device does have metallic portions of it and take appropriate precautions," Rosen explains.

A breast MRI is the best imaging modality to check the integrity of silicone implants, according to Elliott. Yet, mammography is still the standard of care for early detection for women with or without implants. Instead of the traditional four views, Elliott says eight views need to be done if a woman has implants – four on each breast, in order to see the breast tissue.

Interestingly enough, several Canadian studies have shown implant patients having as good of surveillance for breast disease as non-augmented patients, if not better. Rosen says, "It was postulated that perhaps patients with implants are able to perform exams with more ease as the breast tissue is more compressed." In any case, Rosen says he tells women – despite the controversy over mammography quality with breast implants in place – it is generally accepted at this time that excellent mammographic surveillance can be achieved in patients with implants today.

"Women often ask me, "Does having implants obscure or make it difficult to detect cancer?'" says Elliott. "My response is [to go to] a facility that is trained to do mammography with implants." The mammography technique performed for women with implants is a special skill that a mammography technologist must thoroughly learn, she adds. That's where her facility's unique setup comes in handy.

An Image of the Future

Elliott's MBC shares its facilities with Rosen's practice, the Plastic Surgery Group. It is a multidisciplinary and comprehensive breast center offering screening, diagnosis and treatment under one roof. The facility operates with the help of two breast imagers and two breast surgeons, among a large number of other trained staff.

While it typically takes five to six weeks from noticing a breast disease-related problem to the time of the surgical procedure, MBC streamlines the mammogram, ultrasound and biopsy to approximately two hours. Also, even in the case of a large breast cancer, Elliott has immediate help with reconfiguring the breast, thanks to MBC's on-hand plastic surgeons.

"We have been successful in developing a center of excellence in the care and treatment of patients' breast health. This was a natural consequence of our close working relationship that developed out of the treatment of breast cancer patients requiring mastectomy and reconstruction," says Rosen. "This led to the development of a facility, whereby we were geographically and physically connected, and the presence of the diagnostic imaging, MRI, digital mammography and surgery center fell into place."

The ability for patients to be diagnosed by a surgical oncologist, have diagnostic testing at the breast center, obtain plastic surgical consultation regarding breast reconstruction, reduction, lift and augmentation, while having an adjacent surgical center where needle localizations and MRI lobe biopsies can be performed, has provided a surge to both practices, according to Rosen. And he thinks the vertical integration model from a business point of view is one that will soon catch on elsewhere.

"[It's] an outstanding center of excellence because of the personnel brought together during this endeavor," says Rosen.

"I do believe that there will be more and more examples of strategic partnerships forming in medicine that provide anchor tenants in a facility and internal network opportunities for practices that want to share resources, expertise and equipment."

— Amy Storer is the online editor of RT Image. Questions and comments can be directed to [email protected]

Give injectables a try to improve your looks

By MARIE KUECHEL and Dr. ROBERT SINGER newbeauty.com 09-MAY-06 Roughly 5 million injectable beauty treatments were performed in 2005, according to the American Society for Aesthetic Plastic Surgery. The reason they've become so popular is clear: Injectables are a great way to improve the signs of aging and enhance your natural features without surgery.

But bargain advertising is not a good reason to try injectables, nor should treatment be an impulsive decision. Most importantly, if you feel at all hesitant about the capabilities of the injector, about the injectable recommended for you, or about your health, safety and possible results, don't chance it.

Here's a rundown of the four most popular injectable beauty treatments _ treatments that are best performed in a medical office by a doctor with core training in injectables: a plastic surgeon, facial plastic surgeon, dermatologist or ophthalmic plastic surgeon.

Relax Wrinkles in the Upper Face

Botox prevents contraction of the muscles that can lead to expression-related creases: Stop the muscle contraction; stop the wrinkle. While approved for use in the frown lines between the brows, Botox can be safely and effectively used on the forehead, around the eyes and beyond. Pinprick injections in the area where you want to prevent the muscle contractions that create expression lines can be co mpleted in a matter of minutes. The effects of injections take hold three to 10 days after treatment and last three to four months. As soon as the muscle motion returns, so too do the expression lines. Repeat treatment is necessary to continue improvement.

Fuller More Luscious Lips

Lip augmentation with hyaluronic acid or collagen-based fillers is an easy way to plump your pout. By injecting filler directly into the lips, volume is instantly increased. Injectables can do more than create fuller lips; they can help restore the defined lip border associated with youth, and can be used to fill the lines around the lips caused by smoking, pursing and the aging process in general. Depending on the filler used, results can last from about 10 weeks to nine months.

Erase Under-Eye Circles

Although surgery is still the primary solution to the aging lower eyelid, it is no longer the only option. Using a hyaluronic acid, like Restylane to restore the padding in the lower eyelid can lessen dark circles in two ways: by reshaping the contours that produce the dark circles and by creating a buffer between thin skin and underlying darker facial veins. This is one of the most intricate of all of the injectable procedures and highly depends on the skill of the injector. One size does not fit all, so choose a doctor with demonstrated experience specific to treating the eyelids. It's not just a matter of filling in small depressions; it's a matter of reshaping the entire lower eye region.

Fill the Nasolabial Folds

Those crevices that run from the nose down to the sides of the mouth are a source of disdain for many women and men. As the cheeks lose fullness with age, the nasolabial folds get deeper. Addressing theses creases begins by restoring some fullness to the cheek with a deeper filler like Sculptra or a hyaluronic acid like Hylaform Plus. If that doesn't provide enough natural lift to smooth the folds, then the actual fold lines may be injected. But beware: Injecting too much into the folds can make the lower face look heavier.

With hyaluronic acids, you see the results immediately as the filler is injected. Sculptra may require more than one treatment to get the look you want. At present, Sculptra is used off-label for cosmetic purposes. While it is currently in federal trials for cosmetic use, it is approved to treat lipoatrophy (the loss of facial fat) in HIV-positive patients.

Marie Kuechel is an editor at New Beauty, a semi-annual magazine about cosmetic enhancement. Robert Singer is a medical doctor. Reach them at editors (at)newbeauty.com. For more columns visit www.scrippsnews.com)

Costa Rica: a new destination for medical care Americans head south for back surgery and face lifts -- at half the cost

By Melissa Francis Reporter CNBC Updated: 4:00 p.m. CT May 11, 2006

SAN JOSE, Costa Rica - Imagine a place where you receive the best care in the world from some of the best doctors in the world, while having access to some of the latest medical technology. It’s a short plane ride from the U.S. and it’s about half the cost.

Look no further than Costa Rica. Here, doctors limit themselves to the number of patients they can handle at one time, making the patient feel special.

“I have all sorts of American physicians visiting us and seeing patients getting care here. . .the patients enjoy it and that’s what they want,” said Dr. Eduardo Huertas, a neurosurgeon at CIMA hospital here.

Doctors in Costa Rica perform many of the same procedures that are done in the United States, everything from back surgery to face-lifts. Insurance companies with international coverage will honor many of the surgeries, making it even more appealing for those ready to go under the knife.

"Between 75 to 85 percent of my patients are American - either retired or coming here looking for the same quality with better price," said Dr. Huertas.

Cheaper, yes. But is it safe?

"Working in a hospital such as this one, we have all the same standards as you have in the United States," said Huertas.

It is those standards, along with highly educated and trained surgeons, that are drawing thousands of patients a year to Costa Rica – many of whom come for plastic surgery.

"People who come from the U.S. generally come for facial surgery -- eyes, lips, face-lift," says Huertas, "Mostly people come for a couple of procedures, it is very rare to see someone come for just one procedure." It isn’t just the quality of care attracting patients. Not looking forward to surgery? Imagine planning your recovery in paradise… whether its by the beach, or pool.

New hospitals are popping up next to some of the biggest resorts in Costa Rica, giving patients some of the best recovery rooms the world has to offer. Those recovering are often asked to stay at least 15 days, so doctors can be sure that the body has fully healed.

Facial suspension lifts are controversial

By MARIE KUECHEL and Dr. ROBERT SINGER newbeauty.com 23-MAY-06

As skin loses elasticity it begins to sag, resulting in droopy brows, a sagging mid-face and jowl, and marionette lines. Suspending the skin in a new, higher position can lift away a few years in your appearance.

Suspension lifts (also known as thread lifts) tighten slack skin by "gathering" excess skin on barbed sutures, and create a lift by suspending the skin to a higher position.

Specially designed sutures with little barbs or grippers are inserted in the skin through small incisions, generally within the hairline. The sutures are strategically placed to suspend the skin to a higher position, while barbs gather the skin to tighten and lift.

Among key features that make this option attractive: Suspension lifts generally require only a local anesthetic (sometimes with oral sedation), can be performed in a doctor's office and take about an hour. But contrary to popular belief, this procedure does require some downtime. Your face will be somewhat distorted after the procedure: It may appear too tight, or it may pucker. In addition, your doctor may place Steri-Strips on your face to hold the sutures in place for a week or more after the procedure, so keep a scarf and large-framed glasses handy.

Considering a suspension lift?

The suspension lift may be for you if you are only looking for a one- to two-year fix to achieve a higher brow, soften a sagging mid-face, smooth marionette lines or refine a drooping jowl.

But it's not for everyone: The suspension lift will cause extremely slack skin to pucker and dimple. Asymmetry is also possible _ when one side of the face looks different from the other. In some cases, this will resolve itself during the recovery process; in others it will not.

The suspension lift has no significant effect on underlying muscle and fat, which also contribute to sagging and an aged appearance. Suspension lifts do not improve the surface texture or appearance of skin.

For these reasons, thread lifts are not always a stand-alone procedure. Threads may be used in conjunction with a more extensive surgical lift. The suspension lift may also be used to complement a space lift (which employs a variety of pharmaceutical fillers), although they are generally not performed in the same session. The suspension lift may be used _ cautiously _ in conjunction with non-ablative light-based resurfacing or chemical peels. Not all thread lifts are the same. Different surgeons can use different techniques for suture placement. While many different barbed sutures are available, the only brand approved by the U.S. Food and Drug Administration specifically for cosmetic applications is Contour Threads. These differ from another widely used suture, APTOS threads: They work differently, they're placed using different techniques, and their results vary.

Most threads remain in the skin permanently and can only be removed surgically. Absorbable threads that are naturally absorbed within six to 12 months of insertion are being investigated for their potential advantages in suspension lifts.

Short term, long run

While the suspension lift may elevate your skin to a new position for a year or two, the underlying tissues continue to age and descend, causing changes to your appearance that you may not like.

Sutures may cause puckering and dimpling, or may extrude (be felt or seen on the surface of your skin). If you don't like the look, sutures can be removed without severe tissue damage within a week of placement. However, sutures that have been in place for longer periods of time will require major surgery to take out.

While more surgeons are starting to perform this procedure, many plastic surgeons feel that the suspension lift is controversial at best. It is still a very new procedure and only time will tell if it is truly effective for freshening the face.

Marie Kuechel is an editor at New Beauty, a semi-annual magazine about cosmetic enhancement. Robert Singer is a medical doctor. Reach them at editors (at)newbeauty.com. For more stories visit www.scrippsnews.com.