Surgery Alleviates Hammer Hand

According to a study conducted by plastic surgeons at the Mayo Clinic (Rochester, Minn), bypass grafting surgery alleviates hand pain, tingling, numbness, and cold sensitivity associated with hypothenar hammer syndrome, also known as hammer hand.

“In the past, treatment of hypothenar hammer syndrome has been controversial, and physicians have been searching for some way to treat it,” says Craig Johnson, MD, chair of the Mayo Clinic’s Division of Plastic Surgery and the lead study investigator. “From our study, it’s clear that people with this syndrome shouldn’t be treated with medication or other treatments, but with surgery.”

In the study, Johnson studied 115 hands in 101 patients, mostly laborers. Of the 41 patients treated with medication or sympathectomy (surgery to interrupt the nerve pathway), 5 showed improvement, 7 experienced worse symptoms, and 29 showed no change in symptoms.

Two types of excision operations were used for the remaining 60 patients. In 4 of them, the damaged portion of the ulnar artery or surrounding vessels was excised, followed by ligation or binding. Symptoms in 3 of these patients were unchanged postsurgery.

In the remaining 56 patients, the damaged ulnar artery or surrounding vessels were surgically excised, followed by bypass grafting. From this group, 78% showed improvement. Of those patients who showed no change or whose symptoms worsened following bypass grafting surgery, almost all were smokers.

According to Johnson, quitting smoking is a key to a long-term effect of the bypass grafting surgery. “Smokers do well for a while, but over time, their bypass graft gets clotted,” Johnson says.

The cause of hypothenar hammer syndrome is unknown. Johnson says that further research into the origins of this syndrome is necessary.

Plastic Surgeons Seek to Educate

The American Society of Plastic Surgeons (ASPS) is educating potential plastic surgery patients through a campaign that promotes safety and the importance of using Board-certified surgeons when seeking plastic surgery.

“The reality shows have educated people about procedures,” says Nancy Ryan, director of public relations at ASPS. “The concern we have is about safety for patients.”

The $2 million integrated campaign has been created by Reingold Inc, a marketing and communications service. To convey the importance of safety, Reingold has created print ads that will appear in magazines such as Cosmopolitan, Allure, Fitness, Self, and Woman’s Day. These ads will direct potential patients to the association’s Web site,, for the information they need on procedures of interest.

Throughout the campaign, ASPS member surgeons will serve as “ambassadors” within their communities by educating their patients and displaying brochures and posters in their offices. The campaign will continue through the end of this year.

Mark Your Calendar

Make plans to attend Plastic Surgery 2005: The Premier Educational Experience, which will take place September 25–27, 2005, at McCormick Place Lakeside Center in Chicago.

The annual meeting will feature dynamic speakers who will offer new insights regarding tort reform, acute injury management, gel implants, and body contouring after massive weight loss.

 In addition, more than 300 companies will showcase the latest in lasers and other  instruments, cosmetics and skin care, computer software, Internet services, wellness programs, practice management, literature, and numerous other products and services related to the artistry and science of plastic surgery.

For more information on Plastic Surgery 2005, visit www.plasticsurgery. org.

Buttock Augmentation Gains Popularity

Whether they’re due to the influence of popular celebrities, cultural crossover, or a response to fashion trends, lower-body curves have made a comeback. Plastic surgeons are developing new techniques to address their patients’ desire for firmer, higher, and rounder buttocks.

“One issue for the massive-weight-loss patient is postoperative loss of gluteal projection, resulting in a flattened buttock contour,” says Ozan Sozer, MD, of El Paso, Tex.

One procedure for enhancing gluteal contours is autologous fat injection, in which fat cells are removed via lipoplasty and then are injected into layers into the buttocks. Another is implants. This procedure involves making an incision in the fold between the buttock cheeks and inserting a solid silicone implant into the pocket below the gluteus muscle and above the pelvic bone.

Buttock implants are not effective for treating sagging buttocks, which may occur after significant weight loss.

According to statistics from the American Society for Aesthetic Plastic Surgery (ASAPS), more than 2,100 buttock-augmentation procedures and almost 6,000 buttock lifts were performed in the United States in 2004.

Iranians Go for Rhinoplasty

In Iran, where the female form is kept under wraps, women prefer to spend their money on something they can show off—their noses.

 For more than 20 years, strict social rules have required Iranian women to dress modestly and to cover their hair. Even lipstick is frowned upon and confiscated. However, Iranians have found many reasons to join the current plastic surgery trend, such as a long-standing desire for facial beauty.

“Nose procedures have become an obsession for young Iranians,” says Elahe Shirali, a teenager who sports bright red lipstick under her bandaged nose. “It’s such a trend that even if people don’t get a nose job, they will wear tape for the attention it brings.”

Although no official statistics exist, it is estimated that nose specialists in Iran perform 35,000 procedures per year. “The concept of beauty differs in every nation and culture,” says Siavash Safavi, MD, a plastic surgeon who specializes in rhinoplasty. “Most of my patients desire to change their nose from the age of 12, and wait 4 years until they’re 16. The result can be unbelievable and improves every emotion and mood. For people in poor areas, the idea is the same. Sometimes I charge half price for them, if a girl needs it emotionally.”

Women are not the only ones seeking rhinoplasty; many men are also joining the plastic surgery craze. “Iranians in general have big noses, and that’s why this surgery is so popular,” says Ali Bahrami, who insists he had the operation for medical purposes.

According to Safavi, it’s very important for Iranian girls to be beautiful by the time they reach adolescence. “It’s a value in our culture,” Safavi says. “There is education and everything else, but beauty is right up there, in every case.”

Qualified rhinoplasty surgeons in Iran charge about $1,000 per nose job.

Noninvasive Procedures Are On the Rise

According to data released by the American Society for Aesthetic Plastic Surgery (ASAPS), the number of surgical and nonsurgical aesthetic procedures performed in the United States increased 44% from 2003 to 2004. The larger increase, 51%, occurred in nonsurgical procedures.

“The main reason for the increase perhaps could be that patients in general want to achieve maximum results with no downtime, and for a very low fee,” says Peter Fodor, MD, past ASAPS president, and associate clinical professor of plastic surgery at the University of California–Los Angeles. “Injectables are associated with two of these three goals.”

Currently, treatments with botulinum toxin Type A and hyaluronic acid–based fillers rank at the top of patients’ wish lists and allow them to return to work the same day.

“Cosmetic procedures in general are more readily accepted,” Fodor says. “They’ve really come out of the closet.”

More Surgery for the Young and Old

The American Society of Plastic Surgeons (ASPS) reports that the number of aesthetic plastic surgery procedures performed on children and teens rose by 9% in 2004 compared to 2003.

According to Scott Spear, MD, president of ASPS, aesthetic procedures are generally performed to help the child in much the same way that a parent takes a child to the orthodontist for teeth straightening, or helps a child with diet or exercise to lose weight.

ASPS data indicate that 8,978 botulinum toxin Type A injections were administered to patients 18 years or younger in 2004, an increase of 60% from 2003. Spear says it is likely that the injections were used to treat migraines or muscle spasms, rather than wrinkles.

Also according to ASPS statistics, rhinoplasty was the number one surgical procedure for teens (51,931 performed in 2004), followed by otoplasty.

Spear points out that plastic surgeons do not operate on every teen who wants a straighter nose or bigger breasts. The teen is typically referred by a pediatrician and is accompanied by a parent to the surgeon’s office.

Teens aren’t the only ones seeking plastic surgery. A survey by the British Association of Aesthetic Plastic Surgeons (BAAPS) has found that the elderly are also visiting plastic surgeons to “turn back the clock.”

“My oldest facelift is 81 and the oldest eyes 82,” says Douglas McGeorge, consultant plastic surgeon and BAAPS president-elect. “Although some teenagers do inquire about cosmetic surgery, I can’t say that the numbers are large or noticeably increasing.”

According to the BAAPS, 16,367 plastic surgery procedures were performed on elderly Britons in 2004—an increase of 10,738 from 2003. Although 92% of the procedures were performed on women, plastic surgery is becoming more popular among men.

“We live in a well-off society where people now retire to start a new life,” McGeorge says.

Facial-Implant Workshops

The Masters Educational Series presents an in-depth lecture and cadaver dissection by experts in facial implants and facial contouring September 9­–10, 2005, at the Practical Anatomy and Surgical Education facility on the St Louis University campus. 

William J. Binder, MD, FACS, and Edward O. Terino, MD, FACS, will share their extensive experience in facial implants and facial contouring to teach surgeons the latest techniques and to help them obtain the best outcomes. The course will include lectures, videos, and hands-on surgical  demonstrations using cadaver heads.

For additional information or to register by phone, contact Patricia Garcia at (800) 733-0833 or [email protected].

Neck-Rejuvenation Techniques Revealed

Acording to a study published in Plastic and Reconstructive Surgery, the journal of the American Society of Plastic Surgeons (ASPS), neck rejuvenation is an option for patients seeking to lose neck “wattle,” or loose skin, without the invasiveness or downtime of facelift surgery.

“Not every patient who seeks to correct facial aging wants or requires a facelift,” says James Zins, MD, author of the study. “Today’s patients are extremely active and may not want to undergo invasive surgery, after which they are unable to work or play for several weeks. With this alternative, many patients look younger without the financial cost and downtime associated with a standard facelift.”

During the study, 33 patients were treated using neck-rejuvenation techniques in which fat is removed through an incision under the chin and behind the ears, the muscles are tightened, and skin is freed from the muscle. Twenty patients experienced moderate improvement to the neck region, and 12 patients experienced a marked improvement.

“Approximately 1 in 10 patients is a good candidate for neck rejuvenation,” Zins says. “These techniques are targeted specifically for the neck and chin areas only. The midface and upper face are clearly not improved by these procedures.”

Arm-Lift Surgery Is Generally Safe

According to a study be James Knoetgen III, MD, and Steven Moran, MD, plastic surgeons at the Mayo Clinic (Rochester, Minn), arm-lift surgery is a safe procedure. However, surgeons and patients should be aware of its complications.

“Overall, the complication rate is relatively low, and the large majority of complications are minor,” says Knoetgen, the lead study investigator. “The only concerning complication we encountered in our study was injury to or irritation of sensory nerves in the arm that can cause numbness in the forearms, and rarely, pain in the hand and forearm.”

During the study, Knoetgen’s team of plastic surgeons investigated complications in 40 female patients who had arm-lift surgery. They found that after the surgery, patients experienced fluid collection under the skin (four), poor scarring (four), skin infection (three), abscesses under the skin (one), and wound separation (three). Two of the patients had nerve injuries, one experienced prolonged numbness of one forearm and hand, and another developed pain in one forearm and hand. None required additional surgery.

According to the American Society of Plastic Surgeons (ASPS), 9,955 arm-lift surgeries were performed in the United States in 2004. Knoetgen attributes its increased popularity primarily to the growth of weight-loss surgery.