Quitting Smoking Has Its Benefits

In a study published in the January 2006 issue of Plastic and Reconstructive Surgery, plastic surgeons found that smoking during pregnancy increases the risk of having a child with excess, missing, or webbed fingers and toes.

Study author Benjamin Chang, MD, says reconstruction to repair limb, toe, and finger abnormalities represents a large portion of his practice.

“Parents would ask why this happened to their child, but I didn’t have an answer,” Chang says. “This study shows that even minimal smoking during pregnancy can significantly increase the risk of having a child with various toe and finger defects.”

Researchers examined the records of more than 6.8 million live births in the United States during 2001 and 2002 and found 5,171 children born with digital anomalies to mothers who smoked during pregnancy and had no other medical complications. They discovered that pregnant women who smoked one to 10 cigarettes per day had a 29% greater risk of having a child with a toe or finger deformity than nonsmoking women.

According to Chang, the researchers didn’t expect the results to be so dramatic.

“Smoking is so addictive that pregnant women often can’t stop the habit, no matter what the consequences,” Chang says.

Another study published in the February 2006 issue of Anesthesiology found that surgical patients who are nonsmokers, or who stop smoking prior to surgery, have a better recovery period than smokers. The study also revealed that anesthesia is safer for nonsmokers, because their hearts, blood vessels, lungs, and nervous systems function better than smokers’ do.

“Abstaining from cigarettes promotes faster healing and less risk of wound infection. Plus, the patient may be in an ideal position to avoid some of the problems with nicotine withdrawal and other discomforts associated with quitting,” says David O. Warner, MD, a Mayo Clinic anesthesiologist. “This increases the chance for long-term success with smoking cessation.”

Bariatric Surgery Among Youth On the Rise

Researchers at the University of Michigan Health System, Dearborn, found that from 1996 to 2002, bariatric surgery increased seven-fold nationally and more than tripled among youths younger than age 20. Eighty percent of the younger individuals were female. They also reported that in 2002 alone, hospitals charged more than $2 billion in total for the surgeries. Private insurers picked up more than 80% of the tab.

In the study, individuals who had undergone bariatric surgery were characterized according to their gender, age, and medical conditions other than obesity. Their hospitalization was categorized by length of stay, average hospital charges, expected primary payor, and in-hospital mortality.

“The study suggests that, in addition to medical factors, there are likely some social factors playing into the decision to undergo bariatric surgery that leads to young women being more likely and young men less likely to have the procedure,” says Matthew M. Davis, MD, MAPP, lead author of the study.

Davis’s research found that in 2002, the most common comorbidities of obese youth were depression, high blood pressure, esophageal reflux, sleep apnea, chronic gallstones, and asthma.

Buttocks Augmentation Gains Popularity

According to the American Society of Plastic Surgeons, the number of buttocks-augmentation surgeries increased 158% between 2000 and 2004.

“The use of fat grafting has revolutionized buttocks augmentation,” says George Lefkovits, MD, a New York City-based, board-certified plastic surgeon. “Com­pared to buttocks implants, it is safer and requires less operative time. It has less pain and discomfort postoperatively, and requires minimal recuperation. An additional benefit is that in removing fat from the donor site to be used for the grafting, such as the abdomen, the patient also benefits from a modified liposuction to the donor site.”

In the Brazilian Butt Fill™, fat is injected through two very small incisions, then layered through the tunnels throughout the buttocks. In 30% of patients, repeat fat grafting is necessary because of significant absorption of fat. An important consideration for the procedure is the availability of extra fat in different parts of the body. Fat is usually abundant, but there are patients in whom no extra fat is available. For those patients, buttocks augmentation by fat grafting is not feasible.

According to Lefkovits, newly shaped buttocks usually feel natural after the healing process. Because the additional shape is created by the patient’s own cells, the result will look and feel normal, and patients cannot distinguish the areas that have been grafted.

Patients are encouraged to have massage and ultrasound sessions beginning 1 week after surgery to minimize swelling and hardness, and to accelerate the healing process. Most patients resume preoperative activities after 6 weeks.

Few Women Have Breasts Rebuilt After Mastectomy

In a letter published in the January 25 issue of the Journal of the American Medical Association, Amy K. Alderman, MD, MPH, writes that, despite the mandated insurance coverage of breast reconstruction after mastectomy, fewer than 20% of women undergo the procedure. Disparities exist in its use among certain races, including African Americans, Hispanics, and Asians.

The findings, from a University of Michigan Health System study conducted between 1998 and 2002, indicated that, of the 51,184 women with breast cancer treated with mastectomy, only 16.5% underwent reconstruction.

“We know that women who undergo breast reconstruction gain large improvements in their emotional, social, and functional well-being, and hoped the law would increase use of reconstruction following mastectomy, since prior to the law, insurance companies did not cover the procedure,”  Alderman says. “But our study found that the law has done nothing to improve usage among women. And with such large variations of use by geography and race, it brings up a lot of questions as to whether there is a problem, and if there is, how do we correct it?”

The study revealed that African Americans were half as likely to undergo reconstruction as Caucasians, as were Hispanics and Asians. The findings also showed that where a woman lives can factor into the likelihood that she will undergo reconstruction. Reconstruction rates were high in Detroit and Atlanta, but low throughout Iowa and Connecticut.

“Race seems to be a big predictor of whether or not a woman will undergo reconstruction,” Alderman says. “So we need to find out if certain races simply are not getting the knowledge they need to make an educated decision.”

To uncover factors beyond insurance that may be driving patient patterns with breast reconstruction, Alderman calls for further research into breast cancer patients’ knowledge and preferences about reconstruction and access to reconstructive surgeons, especially among women of different races and ethnicities.

Thread Lift Combats the Signs of Aging

The thread lift, also known as the feather lift, has emerged as one of the most requested procedures in plastic surgery. The minimally invasive procedure has become popular with Baby Boomers who are leery of the “taut-skinned” appearance that is associated with a facelift.

“At first I was skeptical, but patients have been very happy,” says Craig A. Vander Kolk, MD, associate professor of plastic surgery at the Johns Hopkins University School of Medicine, Baltimore, who has performed about 25 thread lifts. “I think they provide a result many people are looking for.”

While some plastic surgeons are enthusiastic about the thread lift, others say that the procedure has not been adequately studied and is being performed by too many physicians who lack the necessary skills. Even in the hands of a board-certified plastic surgeon, the threads can bunch up, break, or protrude through the skin. Detractors also say that once the swelling has disappeared, so does the youthful appearance.

“I’m extraordinarily reluctant to jump on the bandwagon until this has stood the test of time,” says Robert W. Bernard, MD, past president of the American Society for Aesthetic Plastic Surgery. “I would tell patients to wait a couple more years. The quick fix has got to work, be safe, and do what it’s supposed to do.”

FDA Program to Strengthen Medical-Device Safety

The US Food and Drug Administration (FDA) is launching a program to transform and strengthen the way it currently monitors the safety of medical devices after they reach the market. The FDA Center for Devices and Radiological Health (CDRH) Postmarket Trans­for­mation Initiative will protect the public’s health by allowing the FDA to identify, analyze, and act on problems more quickly, including alerting the public sooner of potential medical-device issues.

“Over the next decade, medical-technology innovations will fundamentally transform the health care and delivery system, providing new solutions with medical devices that will challenge existing paradigms and revolutionize the way treatments are administered,” says Scott Gottlieb, MD, the FDA’s deputy commissioner for medical and scientific affairs. “Under the leadership of our device center’s expert staff, we are working to develop even better ways to evaluate new technologies to maximize benefits and minimize risk, including more efficient ways to develop more effective postmarket systems that can support safer medical practices as well as continued innovation.”

To guide this process, the CDRH established the Postmarket Trans­forma­tion Leader­ship Team, which consists of senior- level FDA managers and consultants who are experienced in device safety and product regulation. As its first step, the team will review CDRH’s Medical Device Postmarket Safety Program report and accompanying recommendations for possible ways to address areas that need improvement.

Areas on which the initiative will focus include: working toward an electronic reporting system for adverse-medical-device events; ways to identify medical devices, including standardized and globally accepted names; ways to improve device information in patient records; improved internal collaboration on postmarket safety issues; and identifying opportunities to improve the safety of medical devices through collaborative efforts with professional organizations and the medical-device industry.

The Postmarket Transformation Lead­ership Team is expected to provide recommendations to CDRH within 4 months.

What Causes Stretch Marks?

Data published in the November/ December 2005 issue of the Aesthetic Surgery Journal suggest the potential for developing therapies to predict, prevent, and treat stretch marks. This problem, most commonly associated with pregnancy, weight gain, or extreme weight loss, occurs when the skin is overstretched and the fibers in the elastic middle layer of the skin are torn. Researchers report that the incidence of stretch marks varies widely among women at similar risk levels.

“The question of why some women get stretch marks and others don’t has vexed specialists and patients for many years,” says V. Leroy Young, MD, FACS, associate editor of the Aesthetic Surgery Journal and the subject of this month’s cover story. “Now that we have identified these metabolic and biochemical differences in the skin, we may soon be able to take steps to help women effectively and reliably prevent stretch marks, something many women have been waiting for a long time.”

The study found that cells in samples taken from healthy-looking skin in women with stretch marks could not quickly reproduce or repair stretch-dependent skin injuries. The skin of women with stretch marks also had pronounced deficiencies of total DNA and total protein, unlike the skin in women without stretch marks.

The report also states that skin biopsy can be used to identify those at risk. In addition, it showed that the cells responsible for the skin’s resilience are metabolically and biochemically im­paired in both the normal and stretch mark–affected skin of women with stretch marks, compared to women without the condition.

Scarless Approach to Eyelid Surgery

Plastic surgeons are using a different approach to eyelid surgery: transconjunctival blepharoplasty, or no-scar laser eyelid surgery. Unlike traditional surgery that may take a long time to heal, this procedure allows patients to return to work in 7to 10 days.

During transconjunctival blepharoplasty, the surgeon pulls the lower lid forward and makes a tiny incision inside it. Next, excess fat is removed using fine forceps. There is minimal bleeding, and the incision does not need to be closed with sutures. The site generally heals within 48 hours.

According to Michael Omidi, MD, the procedure does not remove excess skin. However, surgeons can use a laser to resurface the outer skin and eliminate the appearance of wrinkles.

Side effects of the scarless approach include pain, swelling, bruising, eye dryness, burning, itching, sensitivity to light, and temporary vision problems. It can take patients 2 to 3 days to be able to read comfortably.