New Implant Provides Natural- Looking Breasts
A clinical study has found that a new type of silicone gel breast implant offers more natural-looking breasts and has a low complication rate. The new implant is awaiting approval by the US Food and Drug Administration (FDA).
“The more cohesive gel implants are going to play a major role in aesthetic and reconstructive breast surgery if they are approved for sale in North America,” says Mitchell Brown, MD, the study’s author. “We have already seen their potential through studies in Europe. Now, through our own research, we are finding with these implants that reoperation is rare, the complication rate is low, and patients are extremely pleased with their outcome.”
According to the study, the implant’s gummy consistency decreases its likelihood of rippling and provides greater safety. Because the gel is more solid than silicone fluid, silicone is less likely to escape from the implant’s shell if it ruptures. In the study, only 3.4% of the 118 breast-augmentation patients experienced complications, which included hematoma, capsular contracture, and asymmetry. Only 19% of the 32 breast-reconstruction patients experienced minor complications, and only one patient required reoperation.
Other advantages of the implant, according to the study, include its textured shell, which gives it a natural and proportionate breast shape, and the availability of a wide variety of shapes and sizes that more closely match natural breast shapes and chest dimensions.
The FDA has not yet convened a panel hearing to discuss the implant’s approval.
Correction of Cocaine-Injured Nose Offers Hope
Robert Walton, MD, professor of plastic surgery at the University of Chicago, has developed a microsurgical technique for repairing noses injured by cocaine abuse. The technique is performed from inside the mouth so that it does not leave external scarring.
“The cocaine causes blood vessels to constrict, and if you continue to use cocaine on a regular basis, the blood vessels will stay in a constricted state, depriving the tissue of blood circulation,” says Walton. “What happens is that the tissues die and are replaced by scar tissue. Everything shrinks and shrivels, and the cartilage melts away.”
Walton’s technique involves removing the diseased tissues from the face and replacing them with skin from the forearm, including blood vessels. According to Walton, the design of the template of the missing tissue taken from the forearm is based on computerized models of the patient. He first draws the template on the forearm and trains the forearm blood vessels to go to the template by creating a surgical injury. He then cuts the blood vessels in the forearm and transfers the vessels and the tissue to the nose, where everything is assembled anatomically and circulation is re-established.
Short-Scar Facelifts Are Safer
Short-scar facelifts are a safer alternative and impose less downtime than traditional facelifts, according to William Lindsey, MD, a clinical assistant professor at George Washington University, Washington, DC. Although the changes are more modest than for traditional facelifts, patients can be happy with these facelifts for the rest of their lives.
The short-scar facelift, which is performed under local anesthesia, involves periauricular incisions and sharp elevation of the skin flaps. When liposuction is performed, Lindsey makes an additional submental incision and uses a blunt-tipped 4-mm liposuction cannula in the neck to clean the superficial muscular aponeurotic system (SMAS) and sculpt the jowls.
No cases of postoperative bleeding or facial nerve injury occurred, and extrusion was the most frequent complication. Four localized hematomas occurred, as well as three hypertrophic scars behind the ear. Two of the patients responded to steroid injections, whereas the other patient required revision. Overall, four revisions and three minor touch-ups were required.
Most patients do not experience much pain with the mini-facelift. However, patients are prescribed postoperative antibiotics for 5 days; patients who smoke are prescribed antibiotics for 7 days.
Turning Back the Hands of Time
According to a study conducted by the American Society of Plastic Surgeons, a new and quick procedure—laser ablation—erases unwanted hand veins, sun-damaged skin, loose skin, and age spots to reduce womens’ concerns with aging hands and boost their confidence.
“Previously, if patients wanted to eliminate unsightly hand veins, their only options were to have the veins completely removed—which causes scars—or to undergo sclerotherapy, which leaves hands feeling tender and causes tiny capillaries to appear through the skin,” says Asad Shamma, MD, who practices in Beirut, Lebanon, and is a coauthor of the study. “With laser ablation, women can raise their hands with confidence without experiencing the negative side effects associated with other procedures.”
In laser ablation, a laser is placed on the tip of a wire, which is then threaded into a vein. As the wire is pulled out, the energy from the laser heats the vein and blood cells, damaging the inner lining of the vessel wall. Once the wire is removed, a tight dressing is placed on the hand, which clamps the tissue down and collapses the vein. The vein eventually dies, leaving a smooth hand. Recovery takes about 2 weeks, during which time patients are required to wear a compression garment to decrease the swelling.
In the study, 60 veins were treated on eight women. Of those treated, only one vein did not respond to laser ablation and required more invasive surgery to remedy it.
Fat Grafting Helps Rejuvenate Hands
According to Sydney Coleman, MD, of New York City, fat grafting is the only way to rejuvenate hands. The objective of fat grafting, he says, is to make the dorsum look fuller, not fatter, and thereby conceal the tendons and veins.
Coleman is a leading expert on fat grafting and the inventor of LipoStructure, a technique that uses a patient’s own fat as a natural, living filler to achieve precise structural alterations wherever it is placed. To perform this technique, Coleman first employs a double wrist block for sedation; the first injection is done just proximal to the planned level of infiltration, and the second is done 2 cm proximal. He also uses 25-gauge needles to inject 1% lidocaine with a very small amount of epinephrine at each of the six to eight incision sites per hand.
Coleman places fat under the dermis and places additional filling, if needed, in the intermetacarpal and web areas. The entire procedure, from fat harvesting to completion, takes up to 11¼2 hours for both hands.
“Patients can use their hands right away,” says Coleman. “At 2 months, what you see is what you get in terms of fullness.”
Skin texture also improves over a 5-year period, he says.
Plastic Surgeon Develops Nonsurgical Eyelift
L. Mike Nayak, MD, director of facial and plastic reconstructive surgery at St Louis University School of Medicine, has developed a new nonsurgical eyelift technique that uses fillers to eliminate the “valley” beneath the undereye bag and has the same effect as eyelid surgery with a much shorter recovery time.
The minutes-long procedure is performed with a topical numbing cream. According to Nayak, the primary risk of this technique is that patients will experience a little bruising or swelling.
Another problem, says Nayak, is overfilling the depression. If it is overfilled with a permanent filler, the overage can be massaged out in the first 2 weeks. If a nonpermanent filler is used, the overfilled area will gradually decrease and eventually disappear.
The nonsurgical eyelift is aimed at patients who have large amounts of fat under their eyes. According to Nayak, the effects of this technique can last from 3 to 18 months, depending on the filler used.
Facial Surgeons Use Perioperative Antibiotics
A Web-based national survey, conducted by David Reiter, MD, a facial plastic surgeon and professor of otolaryngology and head and neck surgery at Jefferson Medical College, Philadelphia, found that facial plastic surgeons are using perioperative antibiotics to lower the risk of surgical-site infection. Reiter and his colleagues looked at all procedures considered to be in the realm of facial plastic and reconstructive surgery, including facelift, otoplasty, rhinoplasty, and liposuction of the neck.
“Most published guidelines for antibiotic use are similar,” says Reiter. “I found that the vast majority of our academy members responding did in fact practice within acceptable standards. We identified some areas in which a change in the antibiotic might make a minor improvement, but I was quite pleased that most of our members were practicing the way they should be.”
Reiter and his colleagues found that although surgeons differed in their choices of antibiotic, dose, and duration, nearly all of those who responded to the survey used antibiotics in a manner consistent with the criteria of the Centers for Disease Control and Prevention and the Joint Commission for Accreditation of Health Care Organizations. Almost all of the facial plastic surgeons used a first-generation cephalosporin, the most common antibiotic recommended for facial plastic and reconstructive surgery.
Fewer than 10% of the respondents were not within guidelines, most often because they did not have formal policies for administering and documenting the antibiotics they used. According to Reiter, none of the respondents used the perioperative antibiotics recklessly or inappropriately.
The one concern that Reiter had is that patient demand might tempt physicians to use more expensive, but less effective, medications.
“There is no such thing as a ‘stronger’ antibiotic,” says Reiter. “Rather, it is the spectrum of action that is important: Will it kill the bacteria that you are likely to run into?”
Are Women More Sensitive to Pain Than Men?
According to a report published in the October 2005 issue of Plastic and Reconstructive Surgery, women have more nerve receptors, which cause them to feel pain more intensely than men.
“Eighty-seven percent of the 9.2 million cosmetic surgery procedures performed last year were on women,” says Bradon Wilhelmi, MD, author of the study. “The ability to minimize pain often affects a patient’s perception of their results. We hope this data will give new perspective on how to better treat postoperative pain in women.”
According to the study, women have, on average, 34 nerve fibers per square centimeter of facial skin, whereas men have only 17. These findings illustrate that women’s lower pain threshold and tolerance are physical.