Do Combined Procedures
Increase Risks?

A study conducted by Grant Stevens, MD, director of Marina Plastic Surgery in Marina del Rey, Calif, has found that there is no significant increase in minor or major complications when multiple procedures are performed in one operation or with prolonged anesthesia.

“There are many advantages to combining procedures,” says Stevens, who studied the complication rates in patients who underwent aesthetic plastic surgery in the last 10 years to determine whether multiple procedures posed additional complications. “A single recovery period and reduced surgery costs are two examples, but the biggest might be faster patient gratification. A changing medical environment in conjunction with the high patient demand really encouraged the advancements that made combined procedures possible.”

During the study, Stevens classified 248 patients who received abdominoplasty surgery from him into four groups: those who had abdominoplasty only, abdominoplasty with breast surgery, abdominoplasty with facelift surgery, and abdominoplasty with both breast and facelift surgery. The complications he studied included seroma, hematoma, infection, small-wound infection, large-flap necrosis, the need for blood transfusions, deep-vein thrombosis, pulmonary embolus, and myocardial infarction.

Stevens found no significant differences in morbidity or complication rates among the four groups. Accord-ing to Stevens, the results show that combined procedures may yield higher patient satisfaction, allow patients to see their results more quickly, and require less time off work.

He stresses that patients should research a surgeon’s accreditations and qualifications before they undergo a combination of procedures. They also should insist on using a surgeon certified by the American Board of Plastic Surgery and an anesthesiologist who is a board-certified physician.

Vanity Tax Kindles Mixed Feelings

Following New Jersey’s enaction of a vanity tax that added a 6.5% surcharge to the cost of aesthetic surgical procedures, six more states—Arkansas, Illinois, New York, Tennessee, Texas, and Washing­ton—are currently debating whether to enact their own versions of the tax. Some of the discussion revolves around practical issues, such as how much money the tax will bring in, but the most heat is generated because the tax disproportionately affects women.

“We cannot have a tax that is carried on the backs of women,” says Phillip Haeck, MD, a Seattle plastic surgeon and editor of Plastic Surgery News, who has been leading the campaign against the tax in his home state and across the country. “This tax is unfair to women, it violates their privacy, and it’s just wrong. These are women who are saving their money over long periods of time to be able to get these procedures.”

According to New Jersey Assembly­man Joe Cryan (D, Union), the tax does not discriminate because more men are undergoing aesthetic surgery. However, physicians refute Cryan’s view by pointing out that the state tax has hurt their businesses.

“Many women I’ve met with are finding that they can’t afford the additional taxes for not only the procedure but for the added taxes assessed on the anesthesiologist and surgical room fee,” says Phil Hetzler, MD, a New Jersey plastic surgeon. “The legislatures misjudged the people getting the surgeries as well. They thought they were the wealthy, and that’s not the case.”

In New Jersey, projections about how much the vanity tax will raise in its first year have been lowered to $7 million—less than the $25 million lawmakers had predicted when the bill was enacted in September 2004.

In the meantime, the American Society of Plastic Surgeons hopes to make an impact.

“We’re educating our patients and encouraging them to write their state senators and other lawmakers,” says Haeck, who is also chairman of the ASPS health policy committee. “These bills need to be stopped before they open the gates to taxing by all 50 states.”

Plastic Surgery Can Help Mentally Disabled Children

A report in the August 2005 issue of Plastic and Reconstructive Surgery, the journal of the American Society of Plastic Surgeons, notes that craniofacial plastic surgery to correct abnormalities of the face, skull, and neck in children with mental disabilities can help them attain a better quality of life.

“Calling these surgeries cosmetic demeans the benefits these children gain,” says Steven Buchman, MD, ASPS member surgeon and author of the report.By fixing their deformities, we positively change the way others interact, react, and relate with them, helping shape how well they learn, socialize, and adapt to the world around them.”

According to the report, people may use the facial characteristics of a child with a mental disability to form opinions about the child. Other children may react negatively and refuse to play with him or her, causing the child to withdraw socially.

In addition, the report states that teachers may underestimate the intellectual abilities of children with facial deformities and have low expectations for their achievement. By addressing these deformities, the subconscious bias of teachers, parents, and other adults may diminish, which may increase the child’s learning capability.

Unfortunately, increasing insurance denials and restrictions on covered procedures are forcing some children and adults to live with their deformities. According to the ASPS, the reduced access to care contributed to a 10% decline in reconstructive plastic surgery procedures from 2000 to 2004.

Surgeons Discover Promising Tissue-Growth Method

A research team at Linkoping University in Sweden has discovered a method that repairs wounds using the patient’s own cells. By injecting tiny balls of gelatin, the researchers have managed to induce various cells to grow spontaneously in areas where new tissue needs to be generated.

According to the researchers, many types of cells, including skin cells, connective-tissue cells, cartilage cells, early-stage fat cells, and mammary-gland cells, grew well in the gelatin balls. The injection of spheres containing connective-tissue cells and fat cells under the skin also led to good tissue regeneration.

The researchers found that it is not necessary to cultivate the cells in advance. When spheres were injected into the upper arms of healthy volunteers, tissue regenerated inside the spheres, which subsequently degraded and disappeared. There were no signs of rejection. Hyaluronic acid and saline-solution controls produced no new tissue generation.

“Our findings open up tremendous potential for the repair of soft body parts,” says Fredrik Huss, a participant in an international research conference on tissue engineering arranged by Linkoping University. “It is a simpler and more dependable method than the fat transplants carried out today.”

Ferndale Laboratories Expands

Ferndale Laboratories Inc, Ferndale, Mich, has introduced a new division, Biopelle, which is entirely devoted to discovering and developing aesthetic medicines to heal, protect, and beautify the skin, and to helping plastic surgeons better meet the needs of their patients.

“Biopelle products will be based on sound science that provides beauty benefits,” says Douglas Noland, Biopelle’s business unit director. “Our vision is to be a trusted partner for doctors to turn to for products that deliver a valuable experience for the patient.”

Women Want Better Lives, Seek Surgery

A survey of 2,000 women by the French magazine Top Santé found that women feel that their body images are preventing them from living the life they want and that their careers would progress faster if they were more attractive. As a result, growing numbers of women are considering aesthetic surgery.

According to the survey, two thirds of the women would change their lifestyles if they had a better body image; more than four out of 10 would change their careers; and more than 1 in 10 would change their partners.

Weight problems were also surveyed; 92% of the respondents expressed their wish to be slimmer by an average of 9 pounds. Respondents were also terrified of looking old: six out of 10 were jealous of younger women.

However, it’s not just men who are pushing the women to extreme measures: 78% of the surveyed women stated that other women were more critical of their weight and shape than men.

The survey revealed that the parts of the body that caused the most unhappiness in women included the hips, thighs, stomach, and breasts.

Is It “Plastic” or “Cosmetic” Surgery?

According to a study conducted by members of the head and neck surgery department of the University of Iowa Hospitals and Clinics in Iowa City, the public finds many differences between “cosmetic” and “plastic,” or “reconstructive,” surgery.

The study, which included 220 adults (66% women) reported that the public views “cosmetic” surgery as more temporary and technically less difficult than “plastic” or “reconstructive” surgery. The study also found that the public thinks that “cosmetic” surgeons require less specialized training than “plastic,” or “reconstructive,” surgeons, and that “cosmetic” surgery was believed to be less risky, with shorter recovery times and less pain. However, in terms of cost, the three procedure categories were viewed similarly.

“From a brand perspective, plastic surgery appears to be the better value in terms of accurately depicting the surgery and the surgeon,” said the researchers.

Plastic Surgeons Help in New Orleans

Keith Davis, MD, of Augusta, Ga, and five friends, including three physicians from Fayetteville, NC, traveled to New Orleans to help those in need after Hurricane Katrina. The men turned an athletic center into an operating room and performed life-saving procedures.

“We made an operating room, and we operated,” says Davis. “We were able to operate on neurological, plastic-surgery, and general-surgery problems, and that’s what we did.”

According to Andy Jones, an Augusta car dealership owner who accompanied Davis on the trip, the region was plagued with death and destruction.

“They had morgues set up at the airport,” says Jones. “They had ‘premorgues’, which have people that aren’t dead and they can’t do anything for them. It was something.”

Davis and Jones say that it was a great opportunity to lend a helping hand to the victims of the hurricane, and it was the right thing to do.

Less-Invasive Procedures Are Becoming More Popular

• A less-invasive type of facelift is proving to be beneficial to people in their 40s. The procedure, the endoscopic forehead midface lift, treats the middle portion of the face—around the cheeks, where the muscles start to loosen and the skin starts to drop. Botulinum toxin Type A can’t reach this area.

“It was created because when people had facelifts in the past, they would lift the jawline and the neck but leave this part of the face out, which creates the nasal libia grooves between the corners of the nose and the mouth,” says Andrew Jacono, MD, of the New York Center for Facial Plastic Surgery, Great Neck, NY. “What it accomplishes is a lift of the central portion of the face.”

Tiny cuts are made using microinstruments and magnifying devices. Unlike the typical facelift, the aging midface is addressed.

A typical candidate for an endoscopic forehead midface lift is a patient between the ages of 40 and 60. Some patients have the procedure done earlier to correct sun damage.

• Nonsurgical rhinoplasty, a minimally invasive, less expensive, and safer alternative to traditional rhinoplasty, is gaining popularity among Asian patients.

“We’ve noticed that one of the major cosmetic concerns of our Asian clientele is the appearance of their nose,” says Alexander Rivkin, MD, of the Westside Medical Spa in Los Angeles. “This population typically desires more definition to the height and bridge of their nose, as well as a more prominent and defined tip.”

The nonsurgical procedure avoids the complications of a conventional rhinoplasty. The procedure consists of several strategic injections of a dermal filler to elevate and define the bridge and upper dorsum of the nose while the patient is conscious. The filler is injected into the deepest layers of the skin, and there is no effect on the breathing passages. Because the bones and the cartilage are not affected, there is minimal swelling and redness, and no bruising, pain, or downtime. The procedure’s effects last 2–3 years.

• Cosmetic acupuncture performed at St Alexius Center for Integrated Medicine, Bismarck, ND, can help patients look years younger without aesthetic surgery.

During the 30-minute procedure, 80 small needles are placed under the epidermis to stimulate collagen and blood supply to the targeted areas; larger needles are used to stimulate “chi,” or energy, throughout the body.

Although the results are not as drama­tic as aesthetic surgery, patients can expect to see smoother skin and the disappearance of faint wrinkles.

Asians Seek Plastic Surgery in South Korea

As Korea’s pop culture booms, Chinese and Japanese women head to South Korea for plastic surgery, encouraged by Korean actresses.

After the television program “Daejanggeum (The Jewel of the Palace)” started airing in Hunan Province this year, Chinese women began flocking to plastic surgeons, according to Taiwan’s Zhongguo Shibao (China Times). Armed with pictures of Lee Young-ae, the star of the soap, they asked the surgeons to make them look like her. They coveted the Korean star’s huge eyes, high nose, and small mouth.

The Korean plastic surgery boom is also expanding to Japan. Reporters from Japan’s Nihon TV visited a skin clinic in Shinsa-Dong and found that the women were mimicking the hairstyles, outfits, and laser treatments of Korean actresses.

Cynics say the boom won’t last. Kim Si-wan, director of medical consulting firm OpenDoctors, said, “Chinese plastic surgery skills have developed, so more and more Chinese doctors perform operations using Korean techniques in their hospitals in China.” In other words, it is the Chinese clinics that reap the rewards of the Korean wave when they put up pictures of Korean stars in the reception area as a marketing gimmick.

MediCor Will Acquire Implant Firms

MediCor Ltd announced that it has signed a definitive agreement to acquire British breast implant manufacturer Biosil Ltd and implant supplier Nagor Ltd for cash and stock.

“The acquisition of these companies, combined with our existing Eurosilicone breast implant product line, will further strengthen the position of MediCor as the third-leading manufacturer and distributor of breast implants worldwide, with Inamed Corporation and Mentor Corporation in first and second position worldwide,” says Theodore R. Maloney, MediCor’s CEO. “This acquisition continues the execution of our long-term strategies of assembling the most experienced management team and acquiring and expanding businesses in the global aesthetic, plastic and reconstructive and dermatology markets.”

MediCor intends to retain the current Biosil and Nagor employee base and to expand their operations, which are located in Scotland, England, and the Isle of Man. MediCor also intends to build upon and expand its business lines—primarily in the plastic, reconstructive, aesthetic, and dermatology markets.

The acquisitions are expected to close by the end of the year.