Prophylaxis Reduces Risk of Blood Clots

According to an article on the prevention of venous thromboembolicsm (VTE) events published in the March/April issue of the Aesthetic Surgery Journal, plastic surgeons who do not properly implement preventive measures may be risking their patients’ safety.

“The importance of prophylactic measures for deep vein thrombosis (DVT) and pulmonary emboli (PE) cannot be overstated, particularly in the face of elective surgery,” says Marguerite Aitken, MD, FACS, from Plastic Surgery Associates in Grand Rapids, Mich. “Each patient’s risk for DVT/PE is different, depending on their family history, personal medical history, current health status, and the procedure performed and length of time under anesthesia.

“It is important to stratify the risk for each patient preoperatively and weigh the risks and benefits associated with prophylaxis. The range of intervention includes from simple positioning of the patient, to sequential compression devices, to preoperative anticoagulation medications such as low-molecular weight heparin.”

VTE is a disease that includes two serious conditions that may cause fatal consequences: deep vein thrombosis (DVT) and pulmonary embolism (PE). DVT occurs when a blood clot forms in one of the large veins, usually in the legs, and partially or completely blocks circulation. DVT can lead to complications, including PE, which is the leading cause of preventable death following surgery. PE can occur when a fragment of a blood clot breaks loose from a vein wall and lodges in the lungs, blocking a pulmonary artery or one of its branches. If the clot completely blocks a vessel, it can lead to death.

DVT occurs in approximately 2 million Americans each year. Of those who develop PE, as many as 200,000 die annually. Only about one third of patients who contract DVT or PE experience any symptoms.

Physicians should discuss DVT with their patients and provide them with an evaluation of their individual risks.

Body Contouring Gains Appeal

With the growing popularity of gastric-bypass surgery to treat morbid obesity, postbariatric body contouring has become a focus of the plastic surgery community. Previously, many plastic surgeons would not perform body-contouring procedures after gastric bypass surgeries because of their high complication rates. However, newly developed or improved surgical techniques make the procedure safer and are increasing its popularity.

“Body contouring after massive weight loss may not be for every individual who has had significant weight loss,” says George John Bitar, MD, a Northern Virginia plastic surgeon. “For those individuals bothered by the excess skin that appeared since they had lost the weight, surgery can offer a huge physical, emotional, and psychological relief.”

According to the American Society of Plastic Surgeons (ASPS), 106,000 body-contouring procedures were conducted in 2004, 77% more than in 2000. Massive-weight-loss patients, who accounted for nearly 56,000 procedures, continue to drive the growth of body- contouring surgery.

According to Ernest Manders, MD, who practices in Pittsburgh, body contouring after gastric bypass surgery is safe and can be performed with significantly fewer complications than previously thought.

“Before bariatric surgery and body contouring, many of my patients were not even able to work, often did not have good self-images, and didn’t participate in life as most of us do,” Manders says. “After a panniculectomy [a procedure that removes excess skin and fat below the abdomen], I’ve seen many patients ready to be employed again, go shopping, and even take care of grandchildren. This surgery isn’t just a ‘beauty’ surgery—it rehabilitates people so they can have a full life.”

For most severely obese people, bariatric surgery is not aesthetic; it’s lifesaving. According to Stanley Hoehn, MD, FACS, a Shawnee Mission, Kan, bariatric surgeon, it’s important for plas­tic surgeons to discuss body-contouring procedures with these types of patients.

“I’m very upfront about it,” Hoehn says. “It is a matter of fact. If you lose 150 pounds from an elastic organ such as skin, you’re going to have saggy skin.”

Upcoming Workshops

The American Society of Plastic Surgeons (ASPS) offers coding-education workshops that will take place July 14–16, 2006, in Atlanta and December 1–3, 2006, in Chicago. Industry leaders will cover plastic surgery cases; provide tips on how to speak the carrier’s language; and show how to audit-proof surgical documentation, how to write an effective appeal, and how to collect reimbursements that physicians have already earned.

The ASPS also offers the “Build a Winning Practice” workshop, to be held June 23–24, 2006, in Chicago. This workshop will teach plastic surgeons how to maintain a successful practice and will provide tips and techniques on how to improve all facets of a practice, including consultation, marketing, human resources, and financial management.

For additional information about the workshops, contact the ASPS at (800) 766-4655 or visit www.plastic

Are Some Procedures Overhyped?

Vaginal rejuvenation, pectoral im­plants, buttock implants, and calf augmentation have been touted in the media as the “hot” procedures that are taking plastic surgery by storm. However, according to statistics released in March by the American Society of Plastic Surgeons (ASPS), these unconventional procedures are performed less frequently than mainstream aesthetic procedures such as liposuction, rhinoplasty, breast augmentation, and abdominoplasty.

“Many of the mainstream procedures performed in plastic surgery are based on sound principles and have withstood the test of time,” says Loren S. Schechter, MD, FACS, who practices in Morton Grove, Ill. “Procedures that are ‘overhyped’ tend to promise either unrealistic results or minimize ‘downtime.’ You cannot expect the same results from a thread lift or thermage as you would a facelift. Although these less-invasive procedures have a role in aesthetic surgery, they also have limitations. In my practice, I tell my patients that the less-invasive procedures typically involve less ‘downtime’ and less risk, but also produce less-dramatic results.”

Reports of the public’s growing interest in vaginal rejuvenation began in 2004. On the basis of these reports, the ASPS tracked this and other touted procedures to determine whether reality equaled the hype. According to ASPS statistics, only 793 vaginal-rejuvenation procedures were performed in 2005. Other “fringe” plastic surgery procedures tracked for the first time in 2005 were buttock implants (542), calf augmentations (337), and pectoral implants (206). The number of these procedures is dwarfed by mainstream procedures such as liposuction (324,000), nose reshaping (298,000), breast augmentation (291,000), eyelid surgery (231,000), and abdominoplasty (135,000).

Stem Cells Show Promise in Facial Rejuvenation

Joseph Grzeskiewicz, MD, FACS, the medical director of Luminesse Medical Spa in Poway, Calif, sees great promise in the “Frozen in Time” treatment, which uses stem cells to help old skin transform itself into a fresh and radiant complexion. The treatment was discovered by Swiss scientists, who found that a young cell, when it comes into contact with an old cell, can reprogram it by sharing the genetic information contained in its DNA.

The “Frozen in Time” treatment uses cells medically extracted from bovine amniotic fluid that are filtered and separated to create a population of stem cells. The cells are then frozen, allowing them to stay alive and maintain their enzymes, proteins, and other functional molecules. The cells are thawed before application and applied to the skin over the face, neck, and eyelids in a cold liquid. The young cells share their youthful genetic information with the older cells in the skin to improve skin health and erase fine lines, wrinkles, and sunspots.

The treatment is suitable for all skin types. A series of six treatments at weekly intervals is recommended to obtain the desired results.

Miami Plastic Surgeon Named ASAPS President

At the annual meeting of the American Society for Aesthetic Plastic Surgery (ASAPS), which took place April 20­–26 in Orlando, Fla, James M. Stuzin, MD, was appointed the society’s president. In addition to running his own practice in Miami, Stuzin is a clinical assistant of plastic surgery at the University of Miami School of Medicine, Coral Gables, and on staff at Mercy Hospital in Miami.

“With the proliferation of plastic surgery stories in the media, public education in plastic surgery is now more important than ever,” Stuzin says. “Over the next year, and through the foreseeable future, the ASAPS will continue its ongoing effort to inform the public about the benefits and serious nature of plastic surgery, as well as the overwhelming advantages in seeking a board-certified plastic surgeon.”

Stuzin received his medical degree from the University of Florida in Gaines­ville. He served his internship and general surgery residency at the Uni­versity of Washington in Seattle. He completed a plastic surgery residency at New York University Hospital in New York City, followed by two fellowships in craniofacial surgery at the University of Miami and the University of California, Los Angeles. He was certified by the American Board of Plastic Surgery in 1989. Stuzin is a co-editor of the Journal of Plastic and Reconstructive Surgery.