Platic surgery

Plastic surgery From Wikipedia, the free encyclopedia Jump to: navigation, search Plastic surgeon Occupation Names Doctor, Medical Specialist Activity sectors Surgery Description Education required • Bachelor of Medicine, Bachelor of Surgery (MBChB) • Doctor of Medicine (M.D.) • Doctor of Osteopathic Medicine (D.O.)[1] Plastic surgery is a medical specialty concerned with the correction or restoration of form and function. Though cosmetic or aesthetic surgery is the best-known kind of plastic surgery, most plastic surgery is not cosmetic;[2] plastic surgery includes many types of reconstructive surgery, hand surgery, microsurgery, and the treatment of burns.

Contents [hide] 1 Etymology 2 History 2.1 20th century 3 Techniques and procedures 4 Reconstructive surgery 5 Cosmetic surgery 6 Sub-specialties 7 Plastic surgery obsession 8 See also 9 References 10 Further reading 11 External links Etymology [edit] In the term plastic surgery, the adjective plastic denotes sculpting, and derives from the Greek πλαστική (τέχνη), plastikē (tekhnē), “the art of modelling” of malleable flesh.[3] History [edit]

Walter Yeo, a British sailor, is often cited as the first known person to have benefited from plastic surgery. The photograph shows him before the procedure (left) and after (right) receiving a skin flap performed by Sir Harold Gillies in 1917.

Reconstructive surgery techniques were being carried out in India by 800 BC.[4] Sushruta, the father of Surgery,[5] made important contributions to the field of plastic and cataract surgery in 6th century BC.[5] The medical works of both Sushruta and Charak originally in Sanskrit were translated into the Arabic language during the Abbasid Caliphate in 750 AD.[6] The Arabic translations made their way into Europe via intermediaries.[6] In Italy the Branca family[7] of Sicily and Gaspare Tagliacozzi (Bologna) became familiar with the techniques of Sushruta.[6] British physicians traveled to India to see rhinoplasties being performed by native methods.[8] Reports on Indian rhinoplasty performed by a Kumhar vaidya were published in the Gentleman's Magazine by 1794.[8] Joseph Constantine Carpue spent 20 years in India studying local plastic surgery methods.[8] Carpue was able to perform the first major surgery in the Western world by 1815.[9] Instruments described in the Sushruta Samhita were further modified in the Western world.[9]

Aulus Cornelius Celsus, who lived in the first century AD, described plastic surgery of the face, using skin from other parts of the body The ancient Egyptians and Romans also performed plastic cosmetic surgery. The Romans were able to perform simple techniques, such as repairing damaged ears from around the 1st century BC. For religious reasons, they did not dissect either human beings or animals, thus their knowledge was based in its entirety on the texts of their Greek predecessors. Notwithstanding, Aulus Cornelius Celsus left some surprisingly accurate anatomical descriptions,[10] some of which — for instance, his studies on the genitalia and the skeleton — are of special interest to plastic surgery.[11] In 1465, Sabuncu's book, description, and classification of hypospadias was more informative and up to date. Localization of urethral meatus was described in detail. Sabuncuoglu also detailed the description and classification of ambiguous genitalia. [citation needed] In mid-15th century Europe, Heinrich von Pfolspeundt described a process "to make a new nose for one who lacks it entirely, and the dogs have devoured it" by removing skin from the back of the arm and suturing it in place.

However, because of the dangers associated with surgery in any form, especially that involving the head or face, it was not until the 19th and 20th centuries that such surgery became common.

Up until the techniques of anesthesia became established, surgeries involving healthy tissues involved great pain. Infection from surgery was reduced by the introduction of sterile techniques and disinfectants. The invention and use of antibiotics, beginning with sulfonamide and penicillin, was another step in making elective surgery possible.

In 1793, Chopart performed operative procedure on a lip using a flap from the neck. In 1814, Joseph Carpue successfully performed operative procedure on a British military officer who had lost his nose to the toxic effects of mercury treatments.

In 1818, German surgeon Carl Ferdinand von Graefe published his major work entitled Rhinoplastik. Von Graefe modified the Italian method using a free skin graft from the arm instead of the original delayed pedicle flap.

The first American plastic surgeon was John Peter Mettauer, who, in 1827, performed the first cleft palate operation with instruments that he designed himself. In 1845, Johann Friedrich Dieffenbach wrote a comprehensive text on rhinoplasty, entitled Operative Chirurgie, and introduced the concept of reoperation to improve the cosmetic appearance of the reconstructed nose.

In 1891, American otorhinolaryngologist John Roe presented an example of his work, a young woman on whom he reduced a dorsal nasal hump for cosmetic indications. In 1892, Robert Weir experimented unsuccessfully with xenografts (duck sternum) in the reconstruction of sunken noses. In 1896, James Israel, a urological surgeon from Germany, and in 1889 George Monks of the United States each described the successful use of heterogeneous free-bone grafting to reconstruct saddle nose defects. In 1898, Jacques Joseph, the German orthopaedic-trained surgeon, published his first account of reduction rhinoplasty. In 1928, Jacques Joseph published Nasenplastik und Sonstige Gesichtsplastik.

20th century [edit] In World War I, a New Zealand otolaryngologist working in London, Harold Gillies, developed many of the techniques of modern facial surgery in caring for soldiers suffering from disfiguring facial injuries. Varaztad Kazanjian and Blair, two men hired for plastic surgery by the United States army, learned from Gillies in England.[12] His work was expanded upon during World

War II by his cousin and former student Archibald McIndoe, who pioneered treatments for RAF aircrew suffering from severe burns. McIndoe's radical, experimental treatments, led to the formation of the Guinea Pig Club. In 1946, Gillies carried out the first female-to-male sex reassignment surgery.

Techniques and procedures [edit] In plastic surgery, the transfer of skin tissue (skin grafting) is a very common procedure. Skin grafts can be taken from the recipient or donors: • Autografts are taken from the recipient. If absent or deficient of natural tissue, alternatives can be cultured sheets of epithelial cells in vitro or synthetic compounds, such as integra, which consists of silicone and bovine tendon collagen with glycosaminoglycans.

• Allografts are taken from a donor of the same species.

• Xenografts are taken from a donor of a different species.

Usually, good results are expected from plastic surgery that emphasizes careful planning of incisions so that they fall in the line of natural skin folds or lines, appropriate choice of wound closure, use of best available suture materials, and early removal of exposed sutures so that the wound is held closed by buried sutures.

Reconstructive surgery [edit] Navy doctors perform reconstructive surgery on a 21-year-old patient "Reconstructive" redirects here. For other uses, see Reconstructive plastic surgery.

Reconstructive plastic surgery is performed to correct functional impairments caused by burns; traumatic injuries, such as facial bone fractures and breaks; congenital abnormalities, such as cleft palates or cleft lips; developmental abnormalities; infection and disease; and cancer or tumors. Reconstructive plastic surgery is usually performed to improve function, but it may be done to approximate a normal appearance.

The most common reconstructive procedures are tumor removal, laceration repair, scar repair, hand surgery, and breast reduction plasty. According to the American Society of Plastic Surgeons, the number of reconstructive breast reductions for women increased in 2007 by 2 percent from the year before. Breast reduction in men also increased in 2007 by 7 percent. Some other common reconstructive surgical procedures include breast reconstruction after a mastectomy, cleft lip and palate surgery, contracture surgery for burn survivors, and creating a new outer ear when one is congenitally absent.

Plastic surgeons use microsurgery to transfer tissue for coverage of a defect when no local tissue is available. Free flaps of skin, muscle, bone, fat, or a combination may be removed from the body, moved to another site on the body, and reconnected to a blood supply by suturing arteries and veins as small as 1 to 2 millimeters in diameter.

Cosmetic surgery [edit] Aesthetic plastic surgery, also called Medical aesthetics, involves techniques intended for the "enhancement" of appearance through surgical and medical techniques, and is specifically concerned with maintaining normal appearance, restoring it, or enhancing it beyond the average level toward some aesthetic ideal.

In 2006, nearly 11 million cosmetic procedures were performed in the United States alone. The number of cosmetic procedures performed in the United States has increased over 50 percent since the start of the century. Nearly 12 million cosmetic procedures were performed in 2007, with the five most common surgeries being breast augmentation, liposuction, nasal surgery, eyelid surgery and abdominoplasty. The American Society for Aesthetic Plastic Surgery looks at the statistics for thirty-four different cosmetic procedures. Nineteen of the procedures are surgical, such as rhinoplasty or facelift. The nonsurgical procedures include Botox and laser hair removal. In 2010, their survey revealed that there were 9,336,814 total procedures in the United States. Of those, 1,622,290 procedures were surgical (p. 5). They also found that a large majority, 81%, of the procedures were done on Caucasian people (p. 12).[13] The increased use of cosmetic procedures crosses racial and ethnic lines in the U.S., with increases seen among African-Americans and Hispanic Americans as well as Caucasian Americans. In Europe, the second largest market for cosmetic procedures, cosmetic surgery is a $2.2 billion business.[14] Cosmetic surgery is now very common in countries such as the United Kingdom, France, and Germany. In Asia, cosmetic surgery has become an accepted practice, and countries such as China and India has become Asia's biggest cosmetic surgery markets.[15] Thailand is also one of the main cosmetic surgery markets in Asia, in particular for affordable breast augmentation and sex reassignment surgery, with international patients coming from Australia, Europe and neighboring Asian countries.[16] The most prevalent aesthetic/cosmetic procedures include: • Abdominoplasty ("tummy tuck"): reshaping and firming of the abdomen • Blepharoplasty ("eyelid surgery"): reshaping of the eyelids or the application of permanent eyeliner, including Asian blepharoplasty • Phalloplasty ("penile liposuction") : construction (or reconstruction) of a penis or, sometimes, artificial modification of the penis by surgery, often for cosmetic purposes • Mammoplasty: • Breast augmentations ("breast implant" or "boob job"): augmentation of the breasts by means of fat grafting, saline, or silicone gel prosthetics, which was initially performed to women with micromastia • Reduction mammoplasty ("breast reduction"): removal of skin and glandular tissue, which is done to reduce back and shoulder pain in women with gigantomastia and/or for psychological benefit men with gynecomastia • Mastopexy ("breast lift"): Lifting or reshaping of breasts to make them less saggy, often after weight loss (after a pregnancy, for example). It involves removal of breast skin as opposed to glandular tissue • Buttock augmentation ("butt implant"): enhancement of the buttocks using silicone implants or fat grafting ("Brazilian butt lift") and transfer from other areas of the body • Buttock lift: lifting, and tightening of the buttocks by excision of redundant skin • Chemical peel: minimizing the appearance of acne, chicken pox, and other scars as well as wrinkles (depending on concentration and type of agent used, except for deep furrows), solar lentigines (age spots, freckles), and photodamage in general. Chemical peels commonly involve carbolic acid (Phenol), trichloroacetic acid (TCA), glycolic acid (AHA), or salicylic acid (BHA) as the active agent.

• Labiaplasty: surgical reduction and reshaping of the labia • Lip enhancement: surgical improvement of lips' fullness through enlargement • Rhinoplasty ("nose job"): reshaping of the nose • Otoplasty ("ear surgery"/"ear pinning"): reshaping of the ear, most often done by pinning the protruding ear closer to the head.

• Rhytidectomy ("face lift"): removal of wrinkles and signs of aging from the face • Browplasty ("brow lift" or "forehead lift"): elevates eyebrows, smooths forehead skin • Midface lift ("cheek lift"): tightening of the cheeks • Chin augmentation ("chin implant"): augmentation of the chin with an implant, usually silicone, by sliding genioplasty of the jawbone or by suture of the soft tissue • Cheek augmentation ("cheek implant"): implants to the cheek • Orthognathic Surgery: manipulation of the facial bones through controlled fracturing • Fillers injections: collagen, fat, and other tissue filler injections, such as hyaluronic acid • Laser Skin Rejuvenation or Resurfacing:The lessening of depth in pores of the face • Liposuction ("suction lipectomy"): removal of fat deposits by traditional suction technique or ultrasonic energy to aid fat removal

• Brachioplasty ("Arm lift"): reducing excess skin and fat between the underarm and the elbow[17] Sub-specialties [edit] Plastic surgery is a broad field, and may be subdivided further. In the United States, plastic surgeons are board certified

by American Board of Plastic Surgery and the American Osteopathic Board of Surgery.[18][19] Subdisciplines of plastic surgery may include: Burn Burn surgery generally takes place in two phases. Acute burn surgery is the treatment immediately after a burn.

Reconstructive burn surgery takes place after the burn wounds have healed.

Cosmetic Aesthetic surgery is an essential component of plastic surgery. Plastic surgeons use cosmetic surgical principles in all reconstructive surgical procedures as well as isolated operations to improve overall appearance.[20] Craniofacial Craniofacial surgery is divided into pediatric and adult craniofacial surgery. Pediatric craniofacial surgery mostly revolves around the treatment of congenital anomalies of the craniofacial skeleton and soft tissues, such as cleft lip and palate, craniosynostosis, and pediatric fractures. Adult craniofacial surgery deals mostly with fractures and secondary surgeries (such as orbital reconstruction) along with orthognathic surgery. Craniofacial surgery is an important part of all plastic surgery training programs, further training and subspecialisation is obtained via a craniofacial fellowship.

Hand Hand surgery is concerned with acute injuries and chronic diseases of the hand and wrist, correction of congenital malformations of the upper extremities, and peripheral nerve problems (such as brachial plexus injuries or carpal tunnel syndrome). Hand surgery is an important part of training in plastic surgery, as well as microsurgery, which is necessary to replant an amputated extremity. The Hand surgery field is also practiced by orthopedic surgeons and general surgeons (see Hand surgeon). Scar tissue formation after surgery can be problematic on the delicate hand, causing loss of dexterity and digit function if severe enough.

Micro Microsurgery is generally concerned with the reconstruction of missing tissues by transferring a piece of tissue to the reconstruction site and reconnecting blood vessels. Popular subspecialty areas are breast reconstruction, head and neck reconstruction, hand surgery/replantation, and brachial plexus surgery.

Pediatric Children often face medical issues very different from the experiences of an adult patient. Many birth defects or syndromes present at birth are best treated in childhood, and pediatric plastic surgeons specialize in treating these conditions in children. Conditions commonly treated by pediatric plastic surgeons include craniofacial anomalies, cleft lip and palate and congenital hand deformities.

Plastic surgery obsession [edit] Though media and advertising do play a large role in influencing many people's lives, researchers believe that plastic surgery obsession is linked to psychological disorders.[21] Body dysmorphic disorder is seen as playing a large role in the lives of those who are obsessed with plastic surgery in order to correct a perceived defect in their appearance.

BDD is a disorder resulting in the sufferer becoming “preoccupied with what they regard as defects in their bodies or faces.”

While 2% of people suffer from body dysmorphic disorder in the United States, 15% of patients seeing a dermatologist and cosmetic surgeons have the disorder. Half of the patients with the disorder who have cosmetic surgery performed are not pleased with the aesthetic outcome. BDD can lead to suicide in some of its sufferers. While many with BDD seek cosmetic surgery, the procedures do not treat BDD, and can ultimately worsen the problem. The psychological root of the problem is usually unidentified; therefore causing the treatment to be even more difficult. Some say that the fixation or obsession with correction of the area could be a sub-disorder such as anorexia or muscle dysmorphia.[22] In some cases, people whose physicians refuse to perform any further surgeries, have turned to "do it yourself" plastic surgery, injecting themselves and running extreme safety risks.[23] Hang Mioku, for instance, became obsessed with plastic surgery after working as a model, and when physicians refused to keep administering further treatment, she turned to using black market silicone, injecting herself, finally resorting to using cooking oil, when that ran out, ultimately disfiguring herself beyond recognition by her own parents. All this was to satisfy her obsession to have softer skin. 10 subsequent surgeries to return her appearances to normal have been a dismal failure.

Botulinum toxin From Wikipedia, the free encyclopedia (Redirected from Botox) Jump to: navigation, search Botulinum toxin

Clinical data Pregnancy cat. ?

Legal status Rx-Only (US) Routes IM (approved), SC, intradermal, into glands Identifiers CAS number 93384-43-1 ATC code M03AX01 PubChem CID 5485225 DrugBank DB00042 Chemical data Formula C6760H10447N1743O2010S32 Mol. mass 149,322 kDa (what is this?) (verify) Bontoxilysin Identifiers EC number

3.4.24.69 Databases IntEnz IntEnz view BRENDA BRENDA entry ExPASy NiceZyme view KEGG KEGG entry MetaCyc metabolic pathway PRIAM profile PDB structures RCSB PDB PDBe PDBsum Gene Ontology AmiGO / EGO [show] Search Botulinum toxin is a protein and neurotoxin produced by the bacterium Clostridium botulinum.[1][2] It is the most acutely toxic substance known, with an estimated human median lethal dose of 1.3–2.1 ng/kg intravenously or intramuscularly and 10–13 ng/kg when inhaled.[3] Botulinum toxin can cause botulism, a serious and life-threatening illness in humans and animals.

Popularly known by one of its trade names, Botox, it is used for various cosmetic and medical procedures.

Contents [hide] 1 History 2 Therapeutic research 2.1 Blepharospasm and strabismus 2.2 Cosmetic 2.3 Upper motor neuron syndrome 2.4 Sweating 2.5 Cervical dystonia 2.6 Chronic migraine 3 Chemical overview 4 Sources 5 Medical and cosmetic uses 5.1 Links to deaths 5.2 Side effects 6 Biochemical mechanism of toxicity 7 Treatment of botulinum poisoning 8 Manufacturers 9 See also 10 References 11 External links History [edit] Justinus Kerner described botulinum toxin as a "sausage poison" and "fatty poison",[4] because the bacterium that produces the toxin often caused poisoning by growing in improperly handled or prepared meat products. It was Kerner, a physician, who first conceived a possible therapeutic use of botulinum toxin and coined the name botulism (from Latin botulus meaning "sausage"). In 1897, Emile van Ermengem found the producer of the botulin toxin was a bacterium, which he named Clostridium botulinum. [5] In 1928, P. Tessmer Snipe and Hermann Sommer for the first time purified the toxin.[6] In 1949, Arnold Burgen's group discovered, through an elegant experiment, that botulinum toxin blocks neuromuscular transmission through decreased acetylcholine release.[7] Therapeutic research [edit] In the late 1960s, Alan Scott, MD, a San Francisco ophthalmologist, and Edward Schantz were the first to work on a standardized botulinum toxin preparation for therapeutic purposes.[8] By 1973, Scott (now at Smith-Kettlewell Institute) used botulinum toxin type A (BTX-A) in monkey experiments, and, in 1980, he officially used BTX-A for the first time in humans to treat "crossed eyes" (strabismus), a condition in which the eyes are not properly aligned with each other, and "uncontrollable blinking" (blepharospasm). In 1993, Pasricha and colleagues showed botulinum toxin could be used for the treatment of achalasia, a spasm of the lower esophageal sphincter.[9] In 1994, Bushara showed botulinum toxin injections inhibit sweating.[10] This was the first demonstration of non-muscular use of BTX-A in humans.

Blepharospasm and strabismus [edit] In the early 1980s, university-based ophthalmologists in the USA and Canada further refined the use of botulinum toxin as a therapeutic agent. By 1985, a scientific protocol of injection sites and dosage had been empirically determined for treatment of blepharospasm and strabismus.[11] Side effects were deemed to be rare, mild and treatable.[12] The beneficial effects of the injection lasted only 4–6 months. Thus, blepharospasm patients required re-injection two or three times a year.

In 1986, Scott's micromanufacturer and distributor of Botox was no longer able to supply the drug because of an inability to obtain product liability insurance. Patients became desperate, as supplies of Botox were gradually consumed, forcing him to abandon patients who would have been due for their next injection. For a period of four months, American blepharospasm patients had to arrange to have their injections performed by participating doctors at Canadian eye centers until the liability issues could be resolved.[13] The global botox market is forecast to reach $2.9 billion by 2018.[14] The entire global market for facial aesthetics is forecast to reach $4.7 billion in 2018, of which the US is expected to contribute over $2 billion. In December 1989, Botox, manufactured by Allergan, Inc., was approved by the US Food and Drug Administration (FDA) for the treatment of strabismus, blepharospasm, and hemifacial spasm in patients over 12 years old.[15] Cosmetic [edit] The cosmetic effect of BTX-A on wrinkles was originally documented by a plastic surgeon from Sacramento, California, Dr. Richard Clark, and published in the journal Plastic and Reconstructive Surgery in 1989.[16] Canadian husband and wife ophthalmologist and dermatologist physicians, JD and JA Carruthers, were the first to publish a study on BTX-A for the treatment of glabellar frown lines in 1992.[17] Similar effects had reportedly been observed by a number of independent groups (Brin, and the Columbia University group under Dr. Monte Keen[1]). After formal trials, on April 12, 2002, the FDA announced regulatory approval of botulinum toxin type A (Botox Cosmetic) to temporarily improve the appearance of moderateto-severe frown lines between the eyebrows (glabellar lines).[18] Subsequently, cosmetic use of botulinum toxin type A has become widespread.[19] The results of cosmetic procedures vary, but can last from 6 weeks to eight months.[20] The US Food and Drug Administration approved an alternative product-safety testing method in response to increasing public concern that

LD50 testing was required for each batch sold in the market.[21] [22] Upper motor neuron syndrome [edit] BTX-A is now a common treatment for muscles affected by the upper motor neuron syndrome (UMNS), such as cerebral palsy, for muscles with an impaired ability to effectively lengthen. Muscles affected by UMNS frequently are limited by weakness, loss of reciprocal inhibition, decreased movement control and hypertonicity (including spasticity). Joint motion may be restricted by severe muscle imbalance related to the syndrome, when some muscles are markedly hypertonic, and lack effective active lengthening. Injecting an overactive muscle to decrease its level of contraction can allow improved reciprocal motion, so improved ability to move and exercise.

Sweating [edit] While treating patients with hemifacial spasm at Southend Hospital in England in 1993, Khalaf Bushara and David Park were the first to show botulinum toxin injections inhibit sweating.[10] This was the first demonstration of nonmuscular use of BTX-A. Bushara further showed the efficacy of botulinum toxin in treating hyperhidrosis (excessive sweating). BTX-A was later approved for the treatment of excessive underarm sweating. This is technically known as severe primary axillary hyperhidrosis - excessive underarm sweating with an unknown cause which cannot be managed by topical agents.

Cervical dystonia [edit] Botulinum toxin type B (BTX-B) received FDA approval for treatment of cervical dystonia on December 21, 2000. Trade names for BTX-B are Myobloc in the United States, and Neurobloc in the European Union.[citation needed] Chronic migraine [edit] Onabotulinumtoxin A (trade name Botox) received FDA approval for treatment of chronic migraines on October 15, 2010. The toxin is injected into the head and neck to treat these chronic headaches. Approval followed evidence presented to the agency from two studies funded by Allergan, Inc. showing a very slight improvement in incidence of chronic migraines for migraine sufferers undergoing the Botox treatment.[23][24] Since then, several randomized control trials have shown botulinum toxin type A to improve headache symptoms and quality of life when used prophylactally for patients with chronic migraine[25] who exhibit headache characteristics consistent with: pressure perceived from outside source, shorter total duration of chronic migraines (<30 years), "detoxification" of patients with coexisting chronic daily headache due to medication overuse, and no current history of other preventive headache medications.[26] Chemical overview [edit] The seven serologically distinct toxin types are designated A through G. Additionally, six of the seven toxin types have subtypes with five subtypes of BoNT A having been described. The toxin is a two-chain polypeptide with a 100-kDa heavy chain joined by a disulfide bond to a 50-kDa light chain. This light chain is an enzyme (a protease) that attacks one of the fusion proteins (SNAP-25, syntaxin or synaptobrevin) at a neuromuscular junction, preventing vesicles from anchoring to the membrane to release acetylcholine. By inhibiting acetylcholine release, the toxin interferes with nerve impulses and causes flaccid (sagging) paralysis of muscles in botulism, as opposed to the spastic paralysis seen in tetanus.

Botulinum toxin is denatured at temperatures greater than 80 °C (176 °F).[27] Sources [edit] Botulism toxins are produced by the bacteria Clostridium botulinum, C. butyricum, C. baratii and C. argentinense.[28] Foodborne botulism can be transmitted through food that has not been heated correctly prior to being canned or food that was not cooked correctly from a can. Most infant botulism cases cannot be prevented because the bacteria that cause this disease are in soil and dust. The bacteria can be found inside homes on floors, carpet, and countertops even after cleaning. Honey can contain the bacteria that cause infant botulism, so children less than 12 months old should not be fed honey. Honey is safe for persons one year of age and older.[29] Food-borne botulism usually results from ingestion of food that has become contaminated with spores (such as a perforated can) that provides an anaerobic environment, allowing the spores to germinate and grow. The growing (vegetative) bacteria produce toxin. It is the ingestion of toxin that causes botulism, not the ingestion of the spores or the vegetative bacteria.

Infant and wound botulism both result from infection with spores, which subsequently germinate, resulting in production of toxin and the symptoms of botulism.

Proper refrigeration at temperatures below 3°C (38°F) retards the growth of Clostridium botulinum. The organism is also susceptible to high salt, high oxygen, and low pH levels. The toxin itself is rapidly destroyed by heat, such as in thorough cooking.[30] The spores that produce the toxin are heat-tolerant and will survive boiling water for an extended period of time.[31] Botulinum toxin can be absorbed from eyes, mucous membranes, respiratory tract or non-intact skin.[32] Botulinum toxin has been recognized and feared as a potential bioterror weapon.[33] Medical and cosmetic uses [edit] Although botulinum toxin is a lethal, naturally occurring substance, it can be used as an effective and powerful medication.

[34] Researchers discovered in the 1950s that injecting overactive muscles with minute quantities of botulinum toxin type-A would result in decreased muscle activity by blocking the release of acetylcholine from the neuron by preventing the vesicle where the acetylcholine is stored from binding to the membrane where the neurotransmitter can be released. This will effectively weaken the muscle for a period of three to four months.[35] In cosmetic applications, a Botox injection, consisting of a small dose of botulinum toxin, can be used to prevent development of wrinkles by paralyzing facial muscles.[36] As of 2007, it is the most common cosmetic operation, with 4.6 million procedures in the United States, according to the American Society of Plastic Surgeons. Qualifications for Botox injectors vary by county, state and country. Botox cosmetic providers include dermatologists, plastic surgeons, aesthetic spa physicians, dentists, nurse practitioners, nurses and physician assistants. The wrinkle-preventing effect of Botox normally lasts about three to four months, but can last up to six months.[36] In addition to its cosmetic applications, Botox is currently used in the treatment of spasms and dystonias, by weakening involved muscles, for the 60–70 day effective period of the drug.[37] The main conditions treated with botulinum toxin are: • Cervical dystonia (spasmodic torticollis) (a neuromuscular disorder involving the head and neck)[38] • Blepharospasm (excessive blinking)[39] • Severe primary axillary hyperhidrosis (excessive sweating)[40][41] • Strabismus (squints) • Achalasia (failure of the lower oesophageal sphincter to relax) • Local intradermal injection of BTX-A is helpful in chronic focal neuropathies. The analgesic effects are not dependent on changes in muscle tone.[42] • Migraine and other headache disorders, although the evidence is conflicting in this indication[43] • Bruxism: by injecting the toxin into the muscles of mastication, such as the masseter Other uses of botulinum toxin type A that are widely known but not specifically approved by the FDA (off-label uses) include treatment of: • Idiopathic and neurogenic detrusor overactivity[44] • Pediatric incontinence[45] incontinence due to overactive bladder,[46] and incontinence due to neurogenic bladder[47] • Anal fissure[48] • Vaginismus to reduce the spasm of the vaginal muscles[49] • Movement disorders associated with injury or disease of the central nervous system, including trauma, stroke,

multiple sclerosis, Parkinson's disease, or cerebral palsy • Focal dystonias affecting the limbs, face, jaw, or vocal cords[41] • Temporomandibular joint pain disorders • Diabetic neuropathy • Wound healing • Excessive salivation • Vocal cord dysfunction, including spasmodic dysphonia[41] and tremor • Reduction of the masseter muscle for decreasing the apparent size of the lower jaw • Painful bladder syndrome[44] • Detrusor sphincter dyssynergia and benign prostatic hyperplasia[44] • Allergic rhinitis[41] Treatment and prevention of chronic headache[50] and chronic musculoskeletal pain[51] are emerging uses for botulinum toxin type A. In addition, Botox may aid in weight loss by increasing the gastric emptying time.[52] Links to deaths [edit] In September 2005, a paper published in the Journal of American Academy of Dermatology reported from the FDA saying that use of Botox has resulted in 28 deaths between 1989 and 2003, though none were attributed to cosmetic use.[53] On February 8, 2008, the FDA announced Botox has "been linked in some cases to adverse reactions, including respiratory failure and death, following treatment of a variety of conditions using a wide range of doses", due to its ability to spread to areas distant from the site of the injection.[54] In April 2009, the FDA updated its mandatory boxed warning cautioning that the effects of the botulinum toxin may spread from the area of injection to other areas of the body, causing symptoms similar to those of botulism.[55] In January 2009, the Canadian government warned that Botox can have the adverse effect of spreading to other parts of the body, which could cause muscle weakness, swallowing difficulties, pneumonia, speech disorders and breathing problems.[56][57] Several cases of death have been linked to the use of other chemicals as substitutes for Botox,[58] one of the causes of death listed on the Spike TV show, 1000 Ways to Die. Side effects [edit] Side effects, which are generally minor and temporary,[36] can be predicted from the mode of action (muscle paralysis) and chemical structure (protein) of the molecule, resulting, broadly speaking, in two major areas of side effects: paralysis of the wrong muscle group and allergic reaction. Bruising at the site of injection is a side effect not of the toxin, but rather the mode of administration. In cosmetic use, this can result in inappropriate facial expression, such as drooping eyelid,[36] double vision,[36] uneven smile, or loss of the ability to close eyes. This will wear off in around six weeks. Bruising is prevented by the clinician applying pressure to the injection site, but may still occur, and will last around seven to 11 days. When injecting the masseter muscle of the jaw, loss of muscle function will result in a loss or reduction of power to chew solid foods.[53] All cosmetic treatments are of limited duration, and can be as short as six weeks, but usually the effective period lasts from two to three months. At the extremely low doses used medicinally, botulinum toxin has a very low degree of human and animal toxicity.

Other adverse events from cosmetic use include headaches, dysphagia, flu-like syndromes, blurred vision, dry mouth, fatigue, allergic reactions and swelling or redness at the injection site.[53][59] A petition by Public Citizen to the FDA has requested regulatory action concerning the possible spread of botulinum toxin (Botox, Myobloc) from the site of injection to other parts of the body.[60] Individuals who are pregnant, have egg allergies or a neuromuscular disorder are advised to avoid Botox.[36] Botox takes away or dampens the emotional feelings in a particular situation. That may be due to less interaction between facial muscle movement and brain. According to David Neal, a psychology professor at the University of Southern California, “if muscular signals from the face to the brain are dampened, you’re less able to read emotions.”[61] One way botox might affect emotional feelings is by dampening the relay of signals from the face to the amygdala and brainstem centers for autonomic arousal.[62] The mental effects of botox may extend beyond emotional feelings to the ability to understand language about emotions. An experimental study suggests the cosmetic use of botulinum toxin for treatment of glabellar lines affects human cognition.

Havas and colleagues[63][64] asked subjects to read emotional (angry, sad, happy) sentences before and two weeks after Botox injections in the corrugator supercilii muscle used in frowning. Reading times for angry and sad sentences were longer after injection than before injection, while reading times for happy sentences were unchanged. This finding suggests facial muscle paralysis has a selective effect in human cognition, and shows Botox hinders the ability to understand language. According to the lead researcher in this study, "[B]otox causes a kind of mild, temporary, cognitive blindness to information in the world, social information about the emotions of other people."

Biochemical mechanism of toxicity [edit]

Target molecules of botulinum (BoNT) and tetanus (TeNT) toxins inside the axon terminal.[65] The heavy chain of the toxin is particularly important for targeting the toxin to specific types of axon terminals. The toxin must get inside the axon terminals to cause paralysis. Following the attachment of the toxin heavy chain to proteins on the surface of axon terminals, the toxin can be taken into neurons by endocytosis. The light chain is able to cleave endocytotic vesicles and reach the cytoplasm. The light chain of the toxin has protease activity. The type A toxin proteolytically degrades the SNAP-25 protein, a type of SNARE protein. The SNAP-25 protein is required for vesicle fusion that releases neurotransmitters from the axon endings (in particular acetylcholine).[66] Botulinum toxin specifically cleaves these SNAREs, so prevents neurosecretory vesicles from docking/fusing with the nerve synapse plasma membrane and releasing their neurotransmitters.

Though it affects the nervous system, common nerve agent treatments (namely the injection of atropine and pralidoxime) will increase mortality by enhancing botulin toxin's mechanism of toxicity.[citation needed] Attacks involving botulinum toxin are distinguishable from those involving nerve agent in that NBC detection equipment (such as M-8 paper or the ICAM) will not indicate a "positive" when a sample of the agent is tested. Furthermore, botulism symptoms develop relatively slowly, over several days compared to nerve agent effects, which can be instantaneous.

Treatment of botulinum poisoning [edit] If the symptoms of botulism are diagnosed early, an equine antitoxin, use of enemas, and extracorporeal removal of the gut contents can be used to treat the food-borne illness. Wound infections can be treated surgically. Information regarding methods of safe canning, and public education about the disease are methods of prevention. Tests to detect botulism include a brain scan, a nerve conduction test, and a tensilon test for myasthenia gravis to differentiate botulism from other diseases that manifest in the same way. Electromyography can be used to differentiate myasthenia gravis and Guillain-Barré syndrome, diseases that botulism often mimics. Toxicity testing of serum specimens, wound tissue cultures, and toxicity testing, and stool specimen cultures are the best methods for identifying botulism. Laboratory tests of the patient's serum or stool, which are then injected into mice, are also indicative of botulism.[67] The faster way to detect botulinum toxin in people, though, is using the mass spectrometry technology, because it reduces testing time to three or four hours and at the same time it can identify the seven types of the toxin.[68] The case fatality rate for botulinum poisoning between 1950 and 1996 was 15.5%, down from about 60% over the previous 50 years.[69] Death is generally secondary to respiratory failure due to paralysis of the respiratory muscles, so treatment

consists of antitoxin administration and artificial ventilation until the neurotoxins are excreted or metabolised. If initiated on time, these treatments are quite effective, although antisera can not affect BoNT polypeptides that have already entered cells.[70] Occasionally, functional recovery may take several weeks to months or more.

Two primary botulinum antitoxins are available for treatment of botulism. â&#x20AC;˘ Trivalent (A,B,E) botulinum antitoxin is derived from equine sources using whole antibodies (Fab and Fc portions). This antitoxin is available from the local health department via the CDC in the USA. â&#x20AC;˘ The second antitoxin is Heptavalent (A,B,C,D,E,F,G) botulinum antitoxin, which is derived from "despeciated" equine IgG antibodies, which have had the Fc portion cleaved off, leaving the F(ab')2 portions. This less immunogenic antitoxin is effective against all known strains of botulism where not contraindicated, and is available from the United States Army. On June 1, 2006, the US Department of Health and Human Services awarded a $363 million contract with Cangene Corporation for 200,000 doses of heptavalent botulinum antitoxin over five years for delivery into the Strategic National Stockpile beginning in 2007.[71] Manufacturers [edit] In the United States, Botox is manufactured by Allergan, Inc. for both therapeutic and cosmetic use (100-unit). In 2011, Allergan required less than one gram of raw botulinum toxin neurotoxin to "supply the world's requirements for 25 indications approved by Government agencies around the world".[72] In the United States, Xeomin (manufactured in Germany by Merz) is available for both therapeutic and cosmetic use. Dysport, a therapeutic formulation of the type A toxin developed and manufactured in Ireland, is licensed for the treatment of focal dystonias and certain cosmetic uses in the US and worldwide in 100-, 300- and 500-unit packages. Lanzhou Institute of Biological Products in China manufactures a BTX-A product, producing 50-unit and 100-unit type A toxin.[73] Neuronox, a BTX-A product, was introduced by Medy-Tox Inc. of South Korea, in 2009.[74] In America, Neuronox is also known as Siax. Solstice Neurosciences, LLC, a wholly owned subsidiary of US WorldMeds, LLC sells their product under the names Myobloc or Neurobloc, although it contains botulinum toxin type B, not the common type A found in Botox.

The Asian Face and the Rise of Cosmetic Surgery Posted: 03/21/2013 3:04 pm

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Almost 4 decades ago, fresh from the refugee camp of Vietnam, I was first made acutely aware of my own Asian looks by a schoolyard bully in my junior high in Colma, California. He pulled the sides of his eyes back to make them look slanted and sang the well-known bully's ditty "Ching Chong, Ching Chong, Chinaman."

I never thought of how I looked living in homogenous Saigon, but in America, as an outsider barely speaking English, I was fodder for teasing and racist epithets. In the bathroom one night some years later, as a teenager wanting to fit in, I used a toothpick to push up my epicanthic folds. They held for a few seconds, giving me the appearance of rounder eyes, and a glimpse of what I might look like with double eyelids. I had contemplated cosmetic surgery, and for a few months, even saved money for the purpose.

I never went through with the surgery, but my experience is hardly unique. The pressure to alter one's features and body is endemic in every group and ethnic community in America, and in Asia it is as routine as having one's wisdom teeth pulled. But the number of minorities getting plastic surgery is apparently on a steep rise.

According to a survey by the American Society of Plastic Surgeons (ASPS), in 2005 Asian-Americans had 437,000 cosmetic surgeries. In 2010, the number has risen to 760,691 - almost doubled in 5 years. One only needs to open a Vietnamese or Chinese or Korean language magazines Orange County to see the onslaught of ads for cosmetic surgery: eyebrow tattoos, dimple and split chin fabrications, laser treatments for skin blemishes, facelifts, breast augmentations -- you can have it all and with an easy-to-pay credit plan. But the most popular are nose and eye surgeries. In the online business directory of Little Saigon in Orange County, where the largest Vietnamese population in the United States resides, there are more than 50 local listings for cosmetic improvements and surgery.

Looking at some of these ads, I must admit that I find both the "before" and "after" pictures slightly disturbing. In the "before," which is often out of focus, the woman is displayed in a downtrodden, bereft look -- a mess of misery to go with her messy hair. But in the "after" picture, she is all smiles, well-dressed and coiffed.

She poses in a kind of exaggerated cheerfulness -- cheerful, I suppose, because her features have been altered. Apparently along with the surgery, the image suggests, her outlooks on life has dramatically changed as well.

I wish happiness were so easily obtained. While I am not against it, and have friends and loved ones who have had plastic surgery, I can't help but find that there's an inherent complex attached to altering one's facial features -- especially for an Asian-American. After all, I have never heard of someone who goes under the knife to have a double-eyelid reversal surgery or his classic roman nose flattened.

For a long time plastic surgeons worked with the Anglo-Saxon ideal of beauty, and medical schools a few decades ago did not acknowledge racial distinctions when it came to plastic surgery. Going under the knife in the name of beauty was, for a long time, a move toward having a Caucasian face.

Indeed, Asia's relationship with the West has been traditionally schizophrenic and contradictory when it comes to self-image.

Vietnamese children of mixed parentage born of American GIs during the war, for instance, were a permanent under class, and their conditions worsened after the war ended. Perceived as children of the enemy, they were often derided, chastised and beaten. But these days those mixed children's features are coveted by many wealthy people in Saigon and Hanoi. They want

their noses, eyes, lips, and would save a fortune to go under the knife to look like them.

Or take Japanese animation. While Japanese cartoons and comic books are taking the world over by storm -- and are a source of pride for Japan -- on closer inspection, one wonders if such pride is fully justified.

The author a few years ago at Petra, Jordan Characters in popular animes like Inuyahsa or Naruto, just to name a few, all have round, large eyes that are often blue or green, and their hair is blond, brown or red. Japan, even as it struggles to make itself a global political player, by the look of its manga and anime, seems strangely beholden to the visage of their World War II conquerors.

In Korea, one in five women has gone under the knife. Seoul, in fact, has become the cosmetic surgery meccas for East Asians, if not the entire world, where those who could afford it, fly to South Korea to spend a fortune for a complete make over.

China, since a ban on cosmetic surgery was lifted in 2001, is now experiencing a boom in the cosmetic surgery industry. There are more than 10,000 medical institutions for cosmetic surgery and the industry is thriving. There is even, since 2004, a Miss Plastic Surgery beauty contest.

However, there is a new "Look East" movement underfoot -- a growing Asian social consciousness in the United States and Asia.

Plastic surgeons have begun to develop techniques to preserve ethnic characteristics and retain their identity. The changes are now more subtle: the nose is no longer as pointy, and doctors are not removing as much fat near the lower eyelid to avoid "the Caucasian look."

"Ethnic correctness" is the new catch phrase in cosmetic surgery, noted Audrey Magazine, a fashion magazine for AsianAmerican readers. "With a growing appreciation for diversity and a higher social awareness come advances in technique and deeper understanding of the anatomy of the Asian eye, resulting in more ethnically sensitive procedures."

The above Chinese woman was sued by her husband who didn't know that she has had extensive cosmetic surgery in South Korea before they married.

A Chinese-American friend, who has had excess fat removed from her eyelids, told me she never thought she wanted to "look white." "In fact, I wanted to look natural but better. So if no one noticed I had it done, then that's great." It was the older generation, she said, that was obsessed with "looking like Audrey Hepburn and Kim Novak."

It also helps that many young Asian entertainers have resisted cosmetic surgery. Korean pop stars have been the rage in Asia as well as among Asian immigrants in America, and on top of that food chain is the 27-year-old superstar Rain, whose classic Korean features haven't deterred fans in the least. He's often thought of as the Michael Jackson of Asia, sans the plastic surgery knife. And, of course, there's Psy, whose Gangnam Style video became the biggest hit in Youtube history, who doesn't seem very concerned very much with the standardized ideas of beauty.

And Zhang Ziyi ("Crouching Tiger, Hidden Dragon"), Sandra Oh ("Sideways" and "Grey's Anatomy") and Lucy Liu ("Charlie's Angels"), to name a few, are famous actresses with very distinctive Asian features.

Plasticsurgery.org noted that Asians like "to maintain their ethnic identity. They do not want to lose important facial features that exhibit racial character. For instance, the typical Asian patient who has eyelid surgery desires a wider, fuller eye that is natural looking to the Asian face and maintains an almond shape."

These days I am comfortable in my own skin, and I take comfort in knowing that there are more people who look like me in the world than not. Having traveled throughout Asia over the years, my sense of beauty has become pluralized, and is no longer limited to a singular ideal.

The above article has been updated from another version written for New America Media. Andrew Lam is an editor at New America Media. He is the author of "Perfume Dreams: Reflections on the Vietnamese Diaspora" (Heyday Books, 2005), which won a Pen American "Beyond the Margins" award, and "East Eats West: Writing in Two Hemispheres". His latest book, "Birds of Paradise Lost," a collection of short stories about Vietnamese immigrants struggling to rebuild their lives in the Bay Area after a painful exodus, was recently published by Red Hen Press. He has lectured and read his work widely at many universities.

Plastic Surgery Blamed for Making All Miss Korea Contestants Look Alike I Can't Stop Looking at These South Korean Women Who've Had Plastic Surgery There's a full-length mirror and a scale on every single floor of the all-girls high school where Julia Lurie works. She's an American… Read…

It's an accepted truism that all beauty pageant contestants have a certain similar "look," but one Japanese blog has touched off a firestorm of speculation that South Korea's plastic surgery craze may have taken that cliché too far.

It's an established fact that South Korea has one of, if not the highest rate of plastic surgery per capita in the entire world, and a Japanese blog covering South Korean topic recently wondered out loud if the phenomenon hasn't unintentionally turned the country's Miss Korea beauty pageant into a clone parade.

Photos posted on the site claim to show Miss Korea 2013 contestants [see corrections below] before and after their "transformation," but it remains unclear if the apparent similarities stem from surgery or from something far more banal such as makeup or photoshop.

Still, the Twilight Zone-sh quality of the result, along with a group photo showing several beauty pageant hopefuls "pretransformation" has sparked significant dialog concerning South Korea's "plastic surgery problem."

"You arent racist," one local wrote in a Reddit post on the topic. "Those women in fact do look unnervingly similar and yes, Koreans think so too. This is because they all get the exact same plastic surgeries and the surgeons follow the same formulas for noses and eyes and everything else theyve had done."

"Girls here consider eye surgery just like using make up," another Korean Redditor chimed in.

Others, however, weren't entirely in agreement.

Another user claiming to be from Korea insisted the entrants "dont look the same, but they look eerily similar."

And one top comment pointed out that much the same could be said about Miss USA 2013 contestants, several of whom could be mistaken for each other.

"Even in a country as diverse as the US you'll see a lot of similar looking women in these pageants because there's a certain aesthetic they're looking for (styled or shopped) that changes with what's considered attractive to that particular culture at that point in time," wrote user adlauren.

Blame Photoshop for Korea's Beauty Queen "Clones"?

This week, photos of Korean contestants surfaced online. The photos all seemed eerily similar. Plastic surgery was blamed for these "clone… Read…

Correction: A few clarifications, courtesy of our sister-site Kotaku and a number of tipsters: The contestants shown above are participating in the Miss Daegu 2013 beauty pageant, and the winner will go on to participate in the Miss Korea pageant.

The women seen in the "before" photo above are contestants in the Miss Seoul 2013 pageant. You can click over to Kotaku to see the real "before" photo of the Miss Daegu contestants.

Has plastic surgery made these beauty queens all look the same? Koreans complain about pageant 'clones' • A picture of 20 beauty queen hopefuls went viral on Reddit • More than 3,000 users debated the wisdom of plastic surgery

By STEVE NOLAN PUBLISHED: 13:10 GMT, 25 April 2013 | UPDATED: 15:45 GMT, 25 April 2013

• 0 shares 299 View comments South Korea's growing obsession with plastic surgery became apparent when pictures of a group of aspiring beauty queens posted online prompted claims that cosmetic procedures have left all the contestants looking the same.

Pictures of the 20 Miss Korea 2013 finalists were posted on Reddit fuelling speculation that many of them had undergone surgery and prompting users to criticise the Asian nation's growing trend to go under the knife.

South Koreans currently have more plastic surgery than in any other country according to recent figures, with the craze particularly popular among 19 to 49-year-olds.

Beauty queen hopefuls: A picture of the Miss Korea 2013 hopefuls went viral after a Reddit user posted it online claiming that plastic surgery had left all the finalists with the same look

Beautiful: The Reddit post spoke fierce debate on Reddit with more than 3,000 users choosing to comment The popularity of surgery, particularly among the young, has been blamed by some on a desire to look more 'western' fuelled by an obsession with celebrity culture.

All of the women vying for the crown of Miss Korea 2013 have dark, perfectly trussed hair, either tumbling over their shoulders or neatly tied up, pale skin, bright eyes and a perfect bright white smile.

And their apparent similarity prompted Reddit user ShenTheWise to post their pictures online, suggesting that many of those vying for the Miss Korea title this year have had similar surgery.

He captioned the image: 'Korea’s plastic surgery mayhem is finally converging on the same face.'

More...

•

Louise Mensch finally admits 'I had a facelift': Former Tory MP ends speculation about her cosmetic surgery

The post saw more than 3,000 people comment in response, debating the merits of widespread plastic surgery.

Reddit user HotBrownie, who claims to hail from Seoul, said: : 'Those women in fact do look unnervingly similar and yes, Koreans think so too.

'This is called the Korean plastic face look. In certain areas of Seoul, you would think all the women are sisters because they look so similar due to same surgeries.

'Without the plastic surgery, korean women are very diverse looking and easily can be told apart.

Finalists: All of the finalists have similar coloured hair and bright smiles

Debate: Many questioned the wisdom of plastic surgery and blamed an obsession with celebrity culture for an upsurge in procedures in the country 'The surgery takes away their individuality and uniqueness and its sad. Most are beautiful without it but telling them that their Korean ethnic features are in fact lovely is as effective as screaming at a brick wall.

'They wont believe you because they've been brainwashed to think westernization of their features is superior, I don't think they want to look white, but a mix of white and Asian and definitely less Korean.'

Another Reddit user, Forevertraveling, added: 'I live in Korea and older women complain how girls don't look Korean anymore because of all the plastic surgery.

'It's so common to the point if I meet a girl, I just assume she has had something done.

Stunning: Two of the Miss Korea 2013 hopefuls are pictured

Beautiful: A montage of all of the contestants for Miss Korea 2013 was posted on Reddit 'Girls here consider eye surgery just like using make up. ' But others on the social networking site said that all the pictures served to prove was that there is a 'cultural divide' between the east and west in terms of plastic surgery.

HerpDerpDrone commented: 'Western women want to exaggerate their features with plastic surgeries (fuller lips, bigger boobs, bigger butts) while Asian women want to refine their features (smaller chins etc) so there is definitely a cultural divide when it comes to plastic surgery.'

Miss South Korea Yu-Mi Kim admitted having cosmetic surgery saying: 'I never said I was born beautiful' The pageant sparked controversy last year when pictures emerged of winner Kim Yu-Mi before she had undergone plastic surgery, with many claiming that cosmetic procedures give contestants an unfair advantage.

The student revealed her plastic surgery secret after photos emerged of her looking very different at school, but she said she hadn't misled anyone.

But she defended her crown telling the Korean media: 'I never said I was born beautiful.'

South Koreans have more plastic surgery than any other nation according to figures released in January.

Those in the Asian country have more treatments per members of the population, with one in every 77 turning to the knife or needle.

The figures, from the International Society of Aesthetic Plastic Surgeons (ISAPS), show that in 2011, 15 million people across the globe turned to plastic surgery to enhance their looks.

While the popularity of cosmetic surgery in South Korea may come as a surprise to many, the industry there is in fact booming.

Last year, 20 per cent of women aged 19 to 49 in the capital city of Seoul admitted to going under the knife.

One of the most popular surgical procedures is double eyelid surgery - which reduces excess skin in the upper eyelid to make the eyes appear bigger and make them look more 'Western'.

It is believed that the rise of the country's music industry is behind the boom, and many patients visit clinics with photos of celebrities, asking surgeons to emulate American noses or eyes.

Singer PSY, whose song 'Gangnam Style' became a global hit, said his record label had urged him to get plastic surgery.

Welcome to our website and thank you for your interest in the IPRAS activities and services 37,000 Plastic and Aesthetic Surgeons, 35,000 residents in training, 30,000 Hand Surgeons, 1,000 Micro Surgeons and 1,000 Burn Specialists from 99 nations are united in IPRAS. Plastic, Reconstructive and Aesthetic Surgery is a young and innovative specialty. Due to the rapid development of microsurgery, we now have the chance to cure patients with large defects such as transplantation of the limb and face.

Training in aesthetic surgery is inseparably related to reconstructive surgery. This is why many European nations only allow plastic surgeons to perform aesthetic surgery.

With great joy, we present the humanitarian work of IPRAS. The majority of our members are involved in charitable projects: they spend their vacations doing volunteer work in third world countries. IPRAS has a new initiative, Women for Women that aims to supply help by female surgeons to patients suffering from disfiguring and socially excluding sequalae of trauma that often occurs out of ethnic or social traditions or typical environmental conditions that women in several countries are subjected to.

Membership in an IPRAS-recognized society means an obligation to practice our high ethical standards.

Wherever you go for your plastic surgery, you are in good hands with IPRAS members.

What is plastic surgery?

Plastic surgery has two main components: reconstructive plastic surgery which is all about restoring appearance and function to the human body after illness or accident and aesthetic (often called “cosmetic”) plastic surgery which is done to change the appearance from choice.

Although you hear people mostly talking about cosmetic plastic surgery, the main work of nearly all plastic surgeons is reconstructive: covering all aspects of wound healing and reconstruction after congenital, acquired and traumatic problems, with aesthetic surgery playing a smaller but important part in their working week.

At BAPRAS, we know that our extensive experience of reconstructive plastic surgery techniques informs our practice when we engage in aesthetic surgery. In turn, our work on form and appearance helps us when we are carrying out reconstruction. It is better for patients and all those concerned to know that the expertise of their plastic surgeon works across the range of plastic surgery techniques for the restoration of function and appearance.

Modern plastic and reconstructive surgery is the combination of various surgical skills and techniques and works closely with many other disciplines. In this section of the website, we explain how plastic surgeons work with colleagues in other disciplines, both within and outside the NHS, inside and outside the UK. We explain the clinical guidelines in place, how plastic surgery is commissioned and regulated and detail the UK plastic surgery units and clinics.

Mastopexy From Wikipedia, the free encyclopedia (Redirected from Breast lift) Jump to: navigation, search Mastopexy Intervention Breast lift: the pre-operative aspects of mild breast ptosis (left), and the post-operative aspects of the correction, the lifted bust (right).

ICD-9-CM 85.6 MedlinePlus 007402 Mastopexy (Greek μαστός mastos “breast” + -pēxiā “affix”) is the plastic surgery mammoplasty procedure for correcting and for modifying the size, contour, and elevation of sagging breasts upon the chest. In a breast-lift surgery to re-establish an aesthetically proportionate bust for the woman, the critical corrective consideration is the tissue viability of the nippleareola complex (NAC), to ensure the functional sensitivity of the breasts for lactation and breast-feeding. The breast-lift correction of a sagging bust is a surgical operation that cuts excess tissues (glandular, adipose, skin), overstretched suspensory ligaments, and excess skin from the skin-envelope, and transposes the nipple-areola complex higher upon the breast hemisphere.

In surgical practice, mastopexy can be performed as a discrete breast-lift procedure, and as a subordinate surgery within a combined mastopexy–breast augmentation procedure; moreover, mastopexy surgery techniques also are applied to reduction mammoplasty, which is the correction of oversized breasts. Psychologically, mastopexy to correct breast ptosis is not indicated by medical indication (physical reason), but by the self-image of the woman; that is, the combination of physical, aesthetic, and mental health requirements of her Self.[1][2] Contents [hide] 1 The patient 2 Breast ptosis 3 Surgical anatomy of the breast 3.1 Composition 3.2 Blood supply and innervation 3.3 Mechanical structures of the breast 4 Surgical procedures 4.1 Mastopexy of the sagging breast 4.2 Mastopexy of the augmented breast 4.3 Contraindications

5 Surgical techniques 5.1 General 5.2 Evaluating severity 5.3 Repairing false ptosis 6 Mastopexy procedures 6.1 Mastopexy with medial pedicle flap 6.2 Mastopexy with B-pedicle 6.3 Mastopexy technique observations 7 See also 8 References The patient [edit] The usual mastopexy patient is the woman who desires the restoration of her bust (elevation, size, and contour), because of the post-partum volume losses of fat and milk-gland tissues, and the occurrence of breast ptosis. The clinical indications presented by the woman — the degrees of laxness of the suspensory Cooper’s ligaments; and of the breast skin-envelope (mild, moderate, severe, and pseudo ptosis) — determine the applicable restorative surgical approach for lifting the breasts. Grade I (mild) breast ptosis can be corrected solely with breast augmentation, surgical and non-surgical. Severe breast ptosis can be corrected with breast-lift techniques, such as the Anchor pattern, the Inverted-T incision, and the Lollipop pattern, which are performed with circumvertical and horizontal surgical incisions; which produce a periareolar scar, at the periphery (edge) of the nipple-areola complex (NAC), and a vertical scar, descending from the lower margin of the NAC to the horizontal scar in the infra-mammary fold (IMF), where the breast meets the chest; such surgical scars are the aesthetic disadvantages of mastopexy.[3] Breast ptosis [edit] Main article: Ptosis (breasts) Etiology The gravity of the Earth is the most common cause of breast ptosis, the prolapsation — the falling forward and the sagging — of the breast tissues (glandular, adipose, skin) from the woman’s chest, relative to her habitus, her body build and physical constitution.

• In the young woman with large breasts the sagging occurs because of the volume and weight of a bust that is disproportionate to the woman’s body type, and because of the great elasticity of the thin, young skin envelope of each breast.

• In the middle-aged woman, breast ptosis usually is caused by the postpartum hormonal changes to the maternal body, which depleted the quantity of adipose fat tissue and atrophied the milk glands, and because of the inelasticity of the skin envelope, which was overstretched by the engorgement of lactation.

• In the post-menopausal woman, besides gravity, such breast ptosis atrophy is aggravated by the inelasticity of overstretched, aged skin.[4] Pathophysiology and presentation In the course of a woman’s life, her breasts change in size and volume as the skin envelope becomes inelastic, and the Cooper’s suspensory ligaments — which suspend the mammary gland high against the chest — become loose, and so cause the falling forward and the sagging of the breast and the nipple-areola complex (NAC). Moreover, additional to tissue prolapse, postpartum diminishment (involution) of the voluminous milk glands in the breast aggravates the looseness of the suspensory ligaments, and of the inelastic, overstretched skin envelope. Mastopexy corrects said degenerative physical changes, by elevating the (internal) parenchymal tissues, cutting and re-sizing the skin envelope, and transposing the nipple-areola complex higher upon the breast hemisphere. The degree of breast ptosis of each breast is determined by the position of the nipple-areola complex (NAC) upon the breast hemisphere; ptosis of the breast is measured with the modified Regnault ptosis grade scale.

Mastopexy: Breast ptosis, the progressive prolapsation (falling forward) of the breast.

The Regnault ptosis grade scale • Grade I: Mild ptosis — The nipple is located below the inframammary fold (IMF), but remains located above the lower pole of the breast.

• Grade II: Moderate ptosis — The nipple is located below the IMF; yet some lower-pole breast tissue hangs lower than the nipple.

• Grade III: Advanced ptosis — The nipple is located below the IMF, and is at the maximum projection of the breast from the chest.

• Grade IV: Severe ptosis — The nipple is far below the inframammary fold, and there is no lower-pole breast tissue below the nipple.

Additional mastopexy considerations Pseudoptosis — The indication is the sagging of the skin of the lower half (inferior pole) of the breast, featuring the nipple located either at or above the inframammary fold (IMF); as such, pseudoptosis is a usual consequence of postpartum milk-gland atrophy. The nipple is located either at or above the IMF, while the lower half of the breast sags below the IMF. Pseudoptosis usually occurs when the woman ceases nursing, because the milk glands have atrophied, and so reduced the volume of the breast, thus the sagging of the breast-envelope skin.

Parenchymal maldistribution — The lower breast lacks fullness, the inframammary fold is very high under the breast hemisphere, and the nipple-areola complex is close to the IMF. Such indications of the maldistribution of parenchymal tissues indicate a developmental deformity.[5] Surgical anatomy of the breast [edit] Main article: Breast Composition [edit] Surgically, the breast is a milk-producing apocrine gland overlaying the chest; and is attached at the nipple, and suspended with ligaments from the chest; and which is integral to the skin, the body integument of the woman. The dimensions and the weight of the breasts vary with the woman’s age and her habitus (body build and physical constitution). Hence, small-tomedium-sized breasts weigh approximately 500 gm or less, and large breasts weigh approximately 750–1,000 gm. Anatomically, the breast topography and the locale of the nipple-areola complex (NAC) on the breast hemisphere are particular to each woman; thus, the statistically desirable (mean average) measurements are a 21–23 cm sternal distance (nipple to sternum-bone notch), and a 5–7 cm inferior-limb distance, from the nipple to the inframammary fold, where the breast joins the chest.[6] [7][8]

Mastopexy: the surgical anatomy of the mammary gland: 1. Chest wall 2. Pectoralis muscles 3. Lobules 4. Nipple

5. Areola 6. Milk duct 7. Fatty tissue 8. Skin envelope.

Blood supply and innervation [edit] The arterial blood supply of the breast has medial and lateral vascular components; it is supplied with blood by the internal mammary artery (from the medial aspect), the lateral thoracic artery (from the lateral aspect), and the 3rd, 4th, 5th, 6th, and 7th intercostal perforating arteries. Drainage of venous blood from the breast is by the superficial vein system under the dermis, and by the deep vein system parallel to the artery system. The primary lymph drainage system is the retromammary lymph plexus in the pectoral fascia. Sensation in the breast is established by the peripheral nervous system innervation of the anterior and lateral cutaneous branches of the 4th, 5th, and 6th intercostal nerves, and thoracic spinal nerve 4 (T4 nerve) innervates and supplies sensation to the nipple-areola complex.[9][10] Mechanical structures of the breast [edit] In realizing the breast lift, the mastopexic correction takes anatomic and histologic account of the biomechanical, loadbearing properties of the three (3) tissue types (glandular, adipose, skin) that compose and support the breast; among the properties of the soft tissues of the breast is near-incompressibility (Poisson’s ratio of ∼0.5).

1.

Rib cage. The 2nd, 3rd, 4th, 5th, and 6th ribs of the thoracic cage are the structural supports for the mammary glands.

2.

Chest muscles. The breasts lay upon the pectoralis major muscle, the pectoralis minor muscle, and the intercostal muscles (between the ribs), and can extend to and cover a portion of the (front) anterior serratus muscle (attached to the ribs, the rib muscles, and the shoulder blade), and to the rectus abdominis muscle (a long, flat muscle extending up the torso, from pubic bone to rib cage). The body posture of the woman exerts physical stresses upon the pectoralis major muscles and the pectoralis minor muscles, which cause the weight of the breasts to induce static and dynamic shear forces (when standing and when walking), compression forces (when lying supine), and tension forces (when kneeling on four limbs).

3.

Pectoralis fascia. The pectoralis major muscle is covered with a thin superficial membrane, the pectoral fascia, which has many prolongations intercalated among its fasciculi (fascicles); at the midline, it is attached to the front of the sternum, above it is attached to the clavicle (collar bone), while laterally and below, it is continuous with the fascia.

4.

Suspensory ligaments. The subcutaneous layer of adipose tissue in the breast is traversed with thin suspensory ligaments (Cooper's ligaments) that extend obliquely to the skin surface, and from the skin to the deep pectoral fascia. The structural stability provided by the Cooper’s ligaments derives from its closely packed bundles of collagen fibers oriented in parallel; the principal, ligament-component cell is the fibroblast, interspersed throughout the parallel collagen-fiber bundles of the shoulder, axilla, and thorax ligaments.

5.

Glandular tissue. As a mammary gland, the breast comprises lobules (milk glands at each lobe-tip) and the lactiferous ducts (milk passages), which widen to form an ampulla (sac) at the nipple.

6.

Adipose tissue. The fat tissue of the breast is composed of lipidic fluid (60–85% weight) that is 90–99 per cent triglycerides, free fatty acids, diglycerides, cholesterol phospholipids, and minute quantities of cholesterol esters, and monoglycerides; the other components are water (5–30% weight) and protein (2–3% weight).

7.

The skin envelope. The breast skin is in three (3) layers: (i) the epidermis, (ii) the dermis, and (iii) the hypodermis. The epidermis is 50–100 µm thick, and is composed of a stratum corneum of flat keratin cells, that is 10–20 µm thick; it protects the underlying viable epidermis, which is composed of keratinizing epithelial cells. The dermis is mostly collagen and elastin fibers embedded to a viscous water and glycoprotein medium. The fibers of the upper dermis (“papillary dermis”) are thinner than the fibers of the deep dermis, thus the skin envelope is 1–3 mm thick. The thickness of the hypodermis (adipocyte cells) varies from woman to woman, and body part.[11] Surgical procedures [edit] Indications

Mastopexy corrections: Lollipop incision (vertical scar) and Anchor incision (inferior pedicle) breast-lift procedures; these incision plans also are applied to reduction mammoplasty.

Mastopexy: foremost is the tissue viability of the nipple-areola complex; it also hides a periareolar scar in the skin-color transition at the areolar periphery.

The surgeon–physician evaluates the woman requesting a breast-lift operation to confirm that she understands the health risks and benefits of the mastopexy procedure. The surgeon confirms that her ideal body image (aesthetic goal) corresponds to what can realistically be achieved with the plastic surgery options available. The following conditions are indications for mastopexy.

• Sagging breasts, which prolapsed (fell forward) consequent to postpartum milk gland diminishment, menopause, gross weight-loss, et cetera.

• Post-explantation ptosis, the sagging of the inelastic skin envelopes, once emptied of the breast implants.

• Congenital ptosis and pseudoptosis, as observed in conditions such as tuberous breast deformity (constricted breast).

• Acquired or relative ptosis, as seen in the post-mastectomy breast reconstruction of a bust that is of natural and proportionate size, look, and feel.

Mastopexy of the sagging breast [edit] The following descriptions of the full breast-lift and of the modified breast-lift techniques are limited to the surgical incisions used to address the skin envelope of the breast, not the internal parenchyma, the substance of the breast.

Full breast lift The sagging bust is lifted using the circumvertical- and horizontal-incision plan of the Anchor mastopexy (also Lexer pattern, inverted-T incision, Wise pattern, inferior pedicle), which features three incisons: • The Anchor ring: a circular incision at the upper-edge of the periphery of the nipple-areola complex.

• The Anchor shank: a vertical incision from the lower edge of the nipple-areola complex to the inframammaryfold incision.

• The Anchor stock: a horizontal incision along the inframammary fold, where the breast joins the chest.

In cutting the folds of excess skin from the sagging, inelastic skin-envelope of the breast (and occasionally reducing the nipple-areola complex diameter), the three-incision technique of the Anchor mastopexy allows maximal corrections to the breasts, thereby producing an elevated bust with breasts of natural size, look, and feel. Moreover, each of the three scars to the breast hemisphere produced by the Anchor-pattern mastopexy has a characteristic healing pattern: • at the periareolar area — the edge of the nipple-areola complex — the surgical scar is concealed by the light-to-dark skin color at the pigment transition, where the light-color breast skin becomes the dark-color areola skin (the ring of the Anchor pattern) • the medial vertical scar (the shank of the Anchor pattern) extends from the lower edge of the nipple-areola

complex to the inframammary fold; the shadow of the breast hemisphere hides it • the horizontal scar (the stock of the Anchor pattern), which follows, and is hidden in, the inframammary fold.

Post-surgically, of the three breast-lift surgery scars, the scar to the inframammary fold exhibits the greatest tendency to hypertrophy, to thickness and large size. Although the coloration of mastopexy scars fades with the full maturation of the tissues, they do remain visible.

Modified breast lift The incision plans of the techniques for modified breast lift feature fewer cuts and fewer scars, but limit the plastic surgeon by allowing fewer changes to the skin envelope of the breast. In surgical praxis, the modified breast lift often is a sub-ordinate surgery within a mastopexy–breast augmentation procedure, the simultaneous lifting and enlarging the bust.

Moreover, these incisions are applied to correct the ptosis discussed above; some technical variants of the modified breast lift are: 1. the periareolar lift (crescent lift), featuring a crescent-shaped incision, above and at a variable portion of the nipple-areola complex perimeter, allows the cutting and removal of a crescent of flesh, thereby facilitates the elevation (transposition) of the nipple-areola complex to its higher (new) locale upon the breast hemisphere.

2. the circumareolar lift (Benelli breast lift, donut lift), featuring the cutting out of a concentric ring of flesh from around the nipple-areola complex, limits the size and diameter of the circular scar.

3. the circumvertical lift (lollipop lift, vertical scar), featuring a circumareolar incision, around the circumference of the nipple-areola complex, and a vertical incision from the lower edge of the nipple-areola complex periphery to the inframammary fold.

Mastopexy of the augmented breast [edit] Women who have undergone breast augmentation also are susceptible to breast ptosis; which incidence might be induced by the physical and mechanical stresses exerted by the breast implants upon the internal tissues and the skin envelope; such overstretching thins the skin and atrophies its elastic qualities.[12] Statistically, breast augmentation and mastopexy are plastic surgery operations with low incidence rates of medical complications; yet, when performed as a combined breast-repair procedure (mastopexy–augmentation), the physiologic stresses upon the health of the woman increase the risks of incisionwound infection, breast-implant exposure, damage to the breast and nipple nerves leading to sensation changes, malposition of the nipple-areola complex, and malposition of the breast implant in the implant pocket. Therefore, a mastopexy–augmentation procedure features increased surgical complication rates, when compared to the lesser complication rates of breast augmentation and mastopexy as discrete surgical operations; likewise, the individual incidence rates of surgical revision and complications, when compared to the revision and complication rates for the combined mastopexy–augmentation procedure.[13] Recent studies of a newer technique for simultaneous augmentation mastopexy (SAM) indicate that it is a safe surgical procedure with minimal medical complications. The SAM technique involves invaginating and tacking the tissues first, in order to previsualize the final result, before making any surgical incisions to the breast.[14][15] Contraindications [edit] The contraindications for mastopexy are few: aspirin use, tobacco smoking, diabetes, and obesity are medical and health conditions associated with increased incidences of nipple necrosis. In resolving the perceived ptosis of a woman with encapsulated breast implants, the surgeon determines her suitability for a breast lift procedure after explantation, which facilitates assessment of the true degree of ptosis present in the explanted breasts; likewise the assessment of the effects of a combined breast-lift and revision-augmentation procedure, featuring the removal and the replacement of breast implants.

For the woman who is at high risk for developing breast cancer (primary or recurrent), the mastopexy might alter the histologic architecture of the breasts, which tissue change might interfere with the accurate MRI detection and subsequent treatment of cancer; the risks and benefits will be discussed in that setting.

Surgical techniques [edit] General [edit] In realizing a breast lift, a conservative surgical technique produces the fewest, least visible scars after excising (cutting) excess folds of skin from the skin-envelope, when either replacing or rearranging or augmenting the internal breast tissues (parenchymal and adipose). Breast lift techniques are known according to the number of scars produced, which is related to the achievable degree of breast-lift. Pre-operatively, the patient and the surgeon decide upon the appropriate surgical technique (superior, medial, or inferior pedicle) that will achieve the best degree of breast lift. Generally, breast ptosis (sagging) is determined by the locale of the nipple-areola complex upon the breast; the lower the nipple-areola complex, the greater the degree of breast prolapsation (ptosis). Nonetheless, in breast-lift surgery, the primary consideration is the tissue viability of the nipple-areola complex, so that the outcome is a functionally sensate breast of natural size, contour, and feel.

Anchor pattern mastopexy: the pre-operative aspect, sagging breasts afflicted with Grade I: Mild ptosis (above), and the post-operative aspect, the lifted bust (below).

Evaluating severity [edit] The surgical management of breast ptosis is evaluated by the degree of severity.

• Grade I: Mild breast ptosis, which can be corrected with breast implant augmentation, or with a periareolar skin resection (crescent lift), with or without breast augmentation.

• Grade II: Moderate ptosis, which can be corrected with a circumareolar donut mastopexy technique featuring Benelli cerclage suturing; and with circumvertical-incision (lollipop mastopexy) techniques such as the Regnault B Mastopexy (and the Lejour–Lassus breast reduction).

• Grade III: Severe ptosis, which usually can be corrected with the circumvertical and horizontal incisions of the Anchor mastopexy (inverted-T incision), regardless of the type of pedicle used (inferior or superior).

Repairing false ptosis [edit] Pseudoptosis, or false breast prolapse, can be addressed two ways: • With a breast augmentation, or with a skin excision, or with both procedures; and without transposing the nipple-areola complex, which requires cutting the skin of the lower pole of the breast.

• With the circumareolar suturing that encircles the nipple-areola complex. To achieve the desired degree of breast lift in accordance with the woman’s anatomy, the circumareolar mastopexy technique (circumvertical lift) can be modified with an additional vertical incision. The extra skin-envelope tissue remaining after a vertical-incision technique can either be gathered in a series of pleats, along the vertical limb of the incision, or can be resected, cut and removed, at the inframammary fold, thereby producing a horizontal incision of varying length, as in the circumvertical and horizontal breast lift.

Mastopexy procedures [edit] Pre-operative matters The plastic surgeon delineates the mastopexy incision-plan upon the patient’s breasts and torso; the principal corrective consideration is the correct level of the nipple-areola complex upon the breast hemisphere. In most women, the nipple should be located at, or slightly above, the inframammary fold, because emplacing it too high might later lead to a difficult revision surgery. The proper topographic locale for the nipple is determined by transposing the semicircular line of the inframammary fold to the face of the breast (anterior aspect), thereby configuring a circle, wherein the nipple-areola

complex is centred. After determining the nipple locale, the surgeon delineates the remaining skin incisions of the correction, while maintaining the inferior limit of the vertical-incision at a distance above the pre-operative inframammaryfold, which precaution avoids extending the surgical scar to the chest wall after the lifting of the breast and the inframammary fold.

Intra-operative matters The sole application of breast augmentation mammoplasty to correct minimal breast ptosis (Grade I) usually is effected with a breast implant prosthesis. The dual application of mastopexy and of breast augmentation surgeries — as one surgical procedure — requires thorough planning, because of the required resections of the parenchymal tissues. The periareolar incision lends itself to breast prosthesis implantation and to nipple-areola complex transposition, whilst maintaining the tissue viability of the nipple-areola complex.

Mastopexy by internal surgical approach applies to the woman who has undergone explantation of breast prostheses. In operative praxis, the plastic surgeon elevates the flaps of the cut breast-implant capsules, and folds them in order to increase the volume of the internal mass of the breasts — thereby increasing the projection of the bust from the chest surface. The nipple-areola complex is elevated with plication sutures, and requires no skin resection when there is no excess skin.[16] Pedicles — superior, inferior, and medial Although the aforementioned descriptions are of the incisions used to address the breast skin envelope, the surgical management of the breast tissue (parenchyma) is a separate consideration, including maintenance of the neurovascular integrity of the nipple-areola complex. The degree of hemispheric elevation of the nipple-areola complex determines the type of pedicle (superior, inferior, medial) that will provide the best venous and arterial vascular supply to the nipple-areola complex. Therefore, the application of the superior pedicle approach affords the surgeon greater procedural flexibility in determining the incision site for emplacing the breast implant, but it limits the possible degree of elevation of the nipple.

Application of the inferior pedicle approach affords a greater degree of nipple-areola complex elevation, but makes difficult emplacing the breast implant, and the subsequent contouring of the breast. Application of the medial pedicle approach preserves breast sensation with a reliable venous and arterial vascular supply, and avoids the technical and procedural limitations of the superior pedicle and the inferior pedicle approaches.

Post-operative matters After the breast-lift surgery, wound care is minimal when the sutured closure is subcuticular (under the epidermis), and reinforced with strips of absorbable adhesive tape (butterfly stitches) applied to maintain the wound closed.

Post-operative surgery scars upon the breast hemisphere can alter the way that the woman conducts her breast self-examination for cancerous changes to the tissues; thus exists the possibility that masses of necrotic fat might be mistakenly palpated as neoplasm lumps; or might be detected as such in the woman’s scheduled mammogram examinations; nonetheless, such benign histologic changes usually are distinguishable from malignant neoplasms.

Complications General medical complications of mastopexy include bleeding, infection, and the secondary effects of the anaesthesia.

Specific complications include skin necrosis, and dysesthesia, abnormal changes in sensation (numbness and tingling). Serious medical complications include occurrences of seroma, a pocket of locally accumulated serous fluid, and occurrences of hematoma, a local accumulation of blood outside the vascular system. Necrosis of the nipple and necrosis of the skin flap (or both), when it occurs, can either be partial, and heal imperceptibly with wound care, or can be complete, and necessitate reconstruction. A complication of the Anchor mastopexy is the tension-caused wound breakdown at the junction of the three limbs of the incision, yet the scars usually heal without undergoing hypertrophy. Asymmetry of the bust is usually present pre-operatively, and the breast-lift surgery usually does not definitively eliminate it, regardless of the applied mastopexy technique or of the plastic surgeon’s operative expertise. Moreover, a combined mastopexy–breast augmentation procedure can make the surgical revision of breast asymmetry more difficult because of the overstretched tissues of nipple-areola complex.

Moreover, a possible, undesirable outcome of the periareolar mastopexy (circumareolar incision) is the underprojection of the corrected breast from the chest wall.

Mastopexy with medial pedicle flap [edit] Pre-operative matters To realize a breast lift using the medial pedicle technique, the surgeon delineates the incision plan upon the breasts, chest, and torso of the woman: 1.

The breast meridian for the length of the sternum bone (from the sternal notch at the lower-throat) to the xiphoid process (at the lower tip).

2.

An ellipse, centered upon and bisecting, the breast meridian line on the sternum.

3.

The form and dimensions of the medial pedicle skin-flap, the base of which is above the midline of the ellipse. A 6 centimetres (2.4 in) long pedicle-base will provide an adequate vascular supply of venous and arterial blood to ensure the tissue viability of the nipple-areola complex.

4.

A semicircle at the superior face of the ellipsis — either a hemisphere (1/2 circle) or a crescent (3/4 circle) — to indicate the transposed locale of the nipple-areola complex. The top of the semicircle is marked at 21 centimetres (8.3 in) from the superior margin of the sternal notch. In surgical praxis, the incision plan is modified to the woman’s anatomy (height, weight, degree of ptosis), and the treatment of the parenchymal tissue.

Operative technique Incision plan After delineating the surgical incision-plan that establishes a technically reliable central axis of the front torso, and before cutting into the breast(s), the plastic surgeon confirms the topographic accuracy of the delineated incision plan, by triangulating the measures at the upper sternum and at the umbilicus, and modifying the incisional lines, if required.

Afterwards, the surgical incision lines are infiltrated to the breast skin with a local anaesthetic mixture (lidocaine 1.0% and epinephrine 1:100,000) that constricts the pertinent vascular system to limit bleeding.

Pedicle skin-flap After establishing the dimensions of the new nipple-areola complex, the surgeon de-epithelializes the medial pedicle skinflap that provides the venous-arterial vascular system for the nipple-areola complex. The first incisions are through the parenchymal tissue, and separate the medial pedicle. The incision is effected to avoid undercutting the skin pedicle and so preserve the nipple-areola complex blood-supply vessels. Hence, the tissue volume of the pedicle flap is essential for establishing the adequate projection of the upper pole of the breast, where the breast originates from the chest. The surgeon resects (cuts and removes) an almost-triangular segment of tissue below the medial pedicle. Finally, for emplacing the nipple-areola complex, the incisions are completed by cutting the ellipse and the tissue adjacent to the medial pedicle.

If the incisions to the breast are satisfactory, the patient’s homeostasis is feasible at that juncture of the mastopexy operation. The surgeon then evaluates the tissue-thickness of the medial pedicle flap, and its physical capability for rotating in a superomedial direction (above and to the center) with no resultant torsion tension to the tissue of the inferior portion of the pedicle; afterwards, the surgeon reduces the tissue thickness of the skin pedicle. Once positioned superiorly, the pedicle tissue thickness is reviewed to ascertain that it fits into the new position, without undue pressure or constriction; thus are assured the tissue viability of the medial pedicle and of the nipple-areola complex.

Symmetry The critical procedural step in forming the new breast is the collecting and the joining of the three folds of breast tissue (the medial pillar and the two lateral pillars) of the lower pole of the breast, where it meets the chest. The suturing is

critical to supporting and shaping the flaccid breast tissues into a hemispheric breast-mound that well projects from the chest wall — a lifted breast. The supine patient then is elevated to a sitting position so that the breasts drape naturally, and the surgeon then delineates upon them the incision plan for the resection (cutting and removing) of the excess folds of skin from the lower sides (inferolateral) and the lower midline (inferomedial) of the new breast. Afterwards, the patient is laid supine, and the excess breast skin is cut; to avoid a scar at the inframammary fold, a purse-string closure gathers the excess folds of skin at the lower pole of the breast; in due course, the three joined pillars of skin will integrate to the inframammary fold. Again, the supine patient is elevated to a sitting position so that the surgeon can ascertain the size, shape, and symmetry, or asymmetry, of the corrected breasts. If the degree of breast-lift is satisfactory, the patient is relaid to the operating table, and the plastic surgeon sutures the incision wounds.[2] Post-operative matters During the initial post-operative period, the plastic surgeon examines the patient for occurrences of hematoma, and to evaluate the histologic viability of the breast-pedicle skin flaps and of the nipple-areola complex.

During the first three (3) weeks of post-operative convalescence, the surgeon monitors the healing of the mastopexy wounds during weekly consultations with the patient. Depending upon the wound-healing progress of the woman, more or fewer follow-up examinations shall follow.

Complications Tissue necrosis of the nipple-areola complex is the principal mastopexy medical complication. To prevent nipple-areola complex necrosis, the surgeon monitors and evaluates the viability of the transposed tissue; by the presence of oxygenated, bright red arterial blood demonstrates the proper functioning of the nipple-areola complex vascular system. A more common post-operative nipple-areola complex complication is dysesthesia, manifest as an abnormal sensation of numbness, and as a sensation of tingling, that perdures for the wound-healing period, yet it diminishes as the full functioning of the breast’s innervation resumes the full sensitivity to the nipple-areola complex; nonetheless, permanent numbness of the nipple-areola complex is rare.

Tissue necrosis of the medial pedicle flap is a potential, but rare, complication of mastopexy procedures. Moreover, the occurrence of hematoma also is possible; in post-operative praxis, a large hematoma is drained immediately, whereas a small hematoma can be observed for self-resolution, before draining.

Wound dehiscence, the bursting of a surgical wound at the line of closure sutures, is a medical complication resulting from the poor healing of the wound. Unless wound dehiscence aesthetically compromises the breast-lift outcome, it is managed conservatively.

Breast contour irregularities occurred when the tissues of the inferior part of the incision are gathered to avoid forming a scar at the inframammary fold. If the complications do not self-resolve, if the tissues do not flatten, or become smooth, they are revised with additional surgery.

Mastopexy with B-pedicle [edit] B mastopexy or Regnault mastopexy technique The B mastopexy (breast lift) is a variation of the circumvertical approach that features an inverted, upper-case letter-B incision, which, when performed with simultaneous breast augmentation via submuscular or subglandular implantation of the breast prosthesis, restores the natural contour and appearance of the breasts. Moreover, the B mastopexy technique can procedurally include the simultaneous microliposuction to reduce the lateral parenchymal and adipose tissues in order to achieve the correct size, volume, and contour of the corrected breasts. The B mastopexy can correct several types of breast deformity, every form of breast ptosis, and breast hypertrophy; it usually has low incidence rates of hypertrophic scarring, and of loss of sensation in the nipple-areola complex; furthermore, the B mastopexy technique also applies to reduction mammoplasty, the correction of oversized breasts.[17][18] The technical and procedural efficacy of the B-technique mastopexy was established in Clinical Techniques: B Mastopexy: Versatility and 5-Year Experience (2007), a retrospective study of a 40-woman mammoplasty cohort upon whom were performed 13 breast-lift procedures without breast augmentation, and 27 procedures with simultaneous breast augmentation, using a mediumsized breast implant. The cohort reported no medical complications, only one (1) woman underwent scar-revision surgery; and each of the 40 women was satisfied with her mastopexy outcome.[19][20] Surgical consultation — The plastic surgeon explains the technical and aesthetic considerations of the breast lift operation to the woman. That the B technique mastopexy yields improved aesthetic results with a breast-skin pedicle created with a curvilinear incision (an inverted, upper-case letter-B). That said curvilinear incision technique eliminates the medial vertical incision of the Anchor mastopexy, and so creates a lifted bust with breasts of natural size, appearance, and contour, and few surgical scars. The consultation includes detailed, pre-operative, post-operative, and healing-stage photographs that illustrate the nature and extent of the mastopexy incisions and the resultant scars. That the full healing (scar maturation) might require approximately one year to establish the final contour of the lifted breasts, after the suspensory ligaments and the parenchymal tissue have settled into and upon the chest as an aesthetically satisfactory bust of natural size, appearance, and contour.

Pre-operative matters To the standing patient, the plastic surgeon delineates the mastopexy incision-plan to the chest, breasts, and torso of the woman. The distance from the suprasternal notch (atop the sternum) to the nipple is measured and recorded to the medical record; the level of the inframammary fold is identified and delineated to the front of the breast (anterior aspect), which indicates the elevated locale to which the nipple-areola complex will be transposed. The medial aspect of the new nippleareola complex locale is marked approximately 10 to 11 centimetres (3.9 to 4.3 in) from the midline, along the mid-breast; and a semicircle with a 38-mm-diameter is delineated around the nipple; the distance of the semicircle from the ptotic nipple-areola complex indicates the new locale of the nipple-areola complex upon the breast hemisphere.

Operative technique Incision plan With the patient laid supine upon the operating table, the surgeon performs a free-hand, curvilinear delineation of an inverted, upper-case letter-B pattern to the breast. Then, per the landmarks of the initial incision-plan, a semicircular pattern is delineated around the nipple-areola complex. The vertical and horizontal component-incisions of the B mastopexy are created with a tapering, curvilinear incision that begins from the lower margin of the areola to the lateral crease of the breast. The B-pattern incision results in a vertical closure 5 to 7 centimetres (2.0 to 2.8 in) long, from the bottom margin of the nipple-areola complex to the inframammary fold.

Wound closure The surgeon tests the closure tension of the wound sutures by in-folding the breast over the index finger, and towards the transposed nipple-areola complex, to observe if the skin blanches (whitens) or over-stretches, afterwards, the nipple-areola complex-area dermis is de-epithelialized. In the combined mastopexy–augmentation procedure, wherein the breast prosthesis is emplaced to a submuscular implant pocket, an anaesthetic tumescent solution is injected along the marked incision line. When the breast implant will be emplaced to a subglandular implant pocket, the hypodermic needle penetrates un-resisted into the anatomic plane above the pectoralis major muscle; the tumescent solution anaesthesia allows blunt dissection. After establishing anaesthesia, the surgeon de-epithelializes each edge of skin by undermining it 3 to 4 mm (0.12 to 0.16 in), with a razor scalpel, thereby facilitating the closing of the surgical wound without tight sutures. In a mastopexy–augmentation, the breast-implant pocket (locale) determines when the surgeon performs the de-epithelialization of the B pedicle; for submuscular implantation, the skin pedicle de-epithelialization is performed after the emplacement; for subglandular implantation, the skin pedicle de-epithelialization is performed before the emplacement.

If the mastopexy includes simultaneous breast augmentation with submuscular emplacement, the surgeon observes that the pectoralis major muscle is divided from the sternum and the ribs. After cutting the implant pocket, the surgeon then deepithelializes the B-pedicle. To facilitate the dermal closure (joining the wound edges) with minimal tension to the sutures, the breast implant either is displaced up, into the implant pocket, or is partially deflated. For the subglandular emplacement of breast implants, the technique is different; the de-epithelialization of the pedicle dermis is performed initially, after which an incision is made through the de-epithelialized dermis, at the base of the vertical limb of the mastopexy, and then, by means of blunt dissection, an implant pocket is cut above the pectoralis major muscle.

Symmetry During the dermal closure, the nipple-areola complex is transposed to its new locale, as determined by the skin pedicle. To create the curvilinear scar, the deep dermal closure is accomplished by rotating the lateral flap down and then medially. The deep dermis is approximated (joined) with sutures, in a simple, interrupted fashion. The key suture is emplaced at the junction where the apex of the vertical incision meets the nipple-areola complex — because it is the skin area of the breast subject to the greatest tension(s). The subcutaneous dermal closure is effected with interrupted sutures. As required, the final adjustments before suturing the skin closed, might include either micro-liposuction or additional de-epithelialization.

After the dermal closure, a suture is emplaced to achieve the continuous approximation of the nipple-areola complex to the adjacent skin edge, and to the lower skin incisions.

Post-operative matters Convalescence — Post-operative care is minimal after a mastopexy procedure; the lifted breasts are supported with a porous, soft elastic tape, which is removed at 7–10 days post-operative, and then is reapplied to the mastopexy incisions for an additional 1–2 weeks during convalescence. For comfortable healing of the wounds, the woman wears a surgical brassière, and avoids wearing an underwire brassière until the breast implants have settled into position. The mastopexy outcome is photographed at 2–3 months post-operative.[21][22] Mastopexy technique observations [edit] Mastopexic correction results in surgical scars on the lifted breasts; the periareolar mastopexy outcome often is a breast of bottom-heavy appearance, with puckered surgical scars; and the Anchor mastopexy outcome is an aesthetic breast of natural size, look, and feel, but with many scars.[23] Whereas, advocates of the mechanical principle of the B technique mastopexy propose that the creation of a rotational pedicle (with an elevated epidermal flap that rotates around the nipple-areola complex), lifts the breasts with an incision plan with vertical and horizontal incisions that eliminate the medial incision (and its vertical scar), whilst providing good projection of the corrected bust from the chest, and a viable nipple-areola complex.[24] Furthermore, advocates of the B technique mastopexy report that it usually does not require secondary correction, because it allows for the better transposition of excess lateral tissues of the breasts by means of curvilinear incision (inverted, upper-case, letter-B) to the skin envelope SOUTH KOREAN PARENTS ARE MAKING THEIR KIDS GET PLASTIC SURGERY

By Camille Standen A South Korean woman who's had both nose and eye plastic surgery. Image via As I'm sure you'll know by now, plastic surgery is a pretty big deal in South Korea. Remember last week when those photos popped up of all the South Korean beauty-pageant contestants who looked exactly the same? Everyone was all, "Hey, those guys sure do love their surgery," with a brief chuckle, before moving on to autotuned Charles Ramsey videos and forgetting about the whole thing. Then, of course, the internet lost its shit in a monsoon of moral outrage and started to scrutinize why Korean girls are trying to look more Western, saying how awful that all is.

I decided to call up my girl Sparkles (not her real name), who recently returned to live in her home city of Seoul, to find out what the reaction there was like to all this commotion. Turns out the plastic surgery trend has already become a running joke, with girls laughing about the fact that they probably all have the same doctor and teasing one another about not having their eyelids torn apart enough.

She also told me something else slightly worrying. Parents are pressuring their daughters into having cosmetic procedures. It all starts to get a little dark when weapons-grade stage moms are guilt-tripping their daughters into splicing up their faces. Anyway, here's that chat.

A plastic-surgery advert on the side of a bus in South Korea. Image via VICE: What's the surgery scene like nowadays?

Sparkles: We have trends, like to tear the inner corner of the eye so it's more almond-shaped. Or, for a while, it was liposuction and putting that fat into your forehead. It's hard to say if they're conforming to a Western ideal of beauty, though—no one will take a photo of a caucasian celebrity to the surgeon and ask for that. That idea may have started off only because white people generally have taller noses and larger eyes, so it's easy to describe it as a Western look, but no one in Korea will say they want to look Western. In Korea, we call doing your eyes and nose the "basics." They're the standard procedures.

That sounds like you're ordering a burger: "I'll just get the basics, thanks."

Yeah. Like, "Oh, you haven't even gotten plastic surgery yet? You should get the basics!" That's nothing. So many people do it that it's got to the point where people say things like, "But you only got your eyes and your nose done, it's not a big deal."

Do you have friends who have had plastic surgery?

I don't think I have a single friend who hasn't had some kind of procedure done. Everyone has something. Normally they pay for it themselves, but there are a lot of mothers who will pay for their daughters. Everyone is getting prettier and prettier and some parents don't want their child to be the ugly one. It's like in the 90s if you got a Discman because your parents didn't want you to be the only kid at school without one.

Why did you decide to have surgery yourself?

It wasn't my idea. My mum kept saying, "It's not that big of a deal, just close your eyes, go to sleep and it's done. You wake up and it's with you for the rest of your life." She started saying that when I was in high school. She wanted me to get my nose done because she wanted that transition time before college.

A South Korean surgeon showing before and after plastic surgery photos. Image via Why did she want you to do it?

The main reason was—and this is true—that, in society, there's an idea that the prettier you are, the more benefits you get.

People tend to be more inclined toward attractive people when they make decisions like with jobs. That's the standard of beauty here, so everyone wants to be that way. The culture has made it normal. A lot of people don't think too deeply about it. They're like, "Oh I wish my eyes were bigger—OK, I'll go get it done."

Do you notice these benefits now that your face has changed?

I personally—not only in Korea, but while traveling—have noticed that people are nicer to me. I feel that I can get away with more.

You're going to rob a bank, are you?

No, I'm not saying I take advantage of it, but I feel like the way people treat me is different. It makes me feel like people were right. I read somewhere that, psychologically, people trust prettier people more.

Was it weird seeing your face for the first time?

I was on pain meds and sleeping medication for a week when I had my nose done, so I literally just slept. When I first saw it, it was really weird. I thought it looked too tall, I didn't like it and I didn't think it suited my face. When I got used to seeing myself with my new nose, though, it was that feeling like when you go shopping and get the perfect outfit and you're happy that it's yours and you can't wait to wear it. It's that feeling times a million—just so amplified.

And your dad wanted you to get your ears done too, right?

Yeah, one was smaller than the other. He was very emotional about the fact that I would one day feel self-conscious at my wedding when I put my hair up. So weird.

Have you had anything else done?

I've had my eyes done, and that's really freaky because you have to stay awake. They use local anaesthetic on your eyelids and below your eyes. It was horrible because you can feel something going through your skin, like when they're tugging thread through it. I was covered in sweat because I was so nervous. I had it done at the same time as my nose, but it didn't heal well, so I got it done again. Initially it was my mom who wanted me to do that.

Were you scared before surgery?

I was mostly worried that people would be able to tell. I kept saying to the doctor, "Please can you do my nose as natural as possible?" And he sort of got annoyed at me and was like, "Why don't you just not do it then? Why would you get surgery if you don't want anyone to know?" His consultant told me not to worry and that humans are creatures of adaptation, which is true; I can't imagine my face before. It was meant to be eyes first then nose, but since I was so scared they just put me to sleep and did my nose first.

Do you ever look at old photos of yourself?

It's shit. Like I said, I can't even imagine my old face. Around the house, that's also a very lighthearted joke in our family. I'll say I have to set the photos on fire and my dad will throw me a lighter. The presurgery photos I've kept on Facebook aren't closeups or in focus. At first I didn't care, but then I started making new friends, so I thought I should delete them. If someone asks me if I've had my nose done, I won't lie, but I'm not gonna be like, "Hi, I'm Sparkles, I got my nose done," you know? It's not a very common topic socially—people are more interested in which procedures you had done and where.

Are you more confident?

Definitely. The exciting thing was that I could change my hair for the first time. I always had long and wavy hair because different facial types suit different hair, so when I got it done I cut it all off. Also, with single eyelids it's very hard to wear make up. Eyelashes look shorter and eyeliner and eyeshadow aren't visible. Now that I've got double eyelids I can do so much. It's fun!

The influence of plastic surgery "reality TV" on cosmetic surgery patient expectations and decision making.

Crockett RJ, Pruzinsky T, Persing JA. Source Section of Plastic and Reconstructive Surgery, Yale University School of Medicine, New Haven, CT 06520-8062, USA. Abstract BACKGROUND: The aim of this study was to survey first-time patients seeking cosmetic surgery and examine what role "reality TV" played in their perception of the risks and benefits of surgery and their overall decision-making process.

METHODS: Information on demographics, television viewing patterns, and patients' self-assessed plastic surgery knowledge was collected from 42 patients. They were asked how similar they believed the shows were to real life and what degree of influence the shows had on their decision to pursue cosmetic surgery. Patients were then divided into groups by program viewing intensity.

RESULTS: Fifty-seven percent of patients were "high-intensity" viewers of plastic surgery reality television shows. When compared with low-intensity viewers, high-intensity viewers believed themselves to be more knowledgeable about plastic surgery (p < 0.05) and believed the shows were more similar to real life (p < 0.05). Overall, four of five patients reported that television influenced them to pursue a cosmetic surgery procedure, with nearly one-third feeling "very much" or "moderately" influenced.

CONCLUSIONS: Plastic surgery reality television plays a significant role in cosmetic surgery patient perceptions and decision making.

Patients who regularly watched one or more reality television show reported a greater influence from television and media to pursue cosmetic surgery, felt more knowledgeable about cosmetic surgery in general, and felt that plastic surgery reality television was more similar to real life than did low-intensity viewers.

Reality TV Linked to Teen Cosmetic Surgery

By RICK NAUERT PHD Senior News Editor Reviewed by John M. Grohol, Psy.D. on August 2, 2010 Body image has always been a concern for teenagers. Now, it appears that some reality TV shows tout happiness as just a nip and tuck away.

A Rutgers–Camden psychologist has found that teens fond of these kinds of programs are more likely to join the millions who go under the knife each year. For bodies – and minds – still in development, these drastic decisions could have implications way after prom.

Charlotte Markey, an associate professor of psychology at Rutgers–Camden, with husband Patrick Markey of Villanova University, recently published research on this topic in the academic journal Body Image.

“When we think of cosmetic surgery, we don’t think of it as a lifetime issue. There is lots of pressure to look a certain way and I don’t blame them for succumbing; we’re all guilty of feeling vulnerable. But what young men and women think of their bodies now will culminate over time and contribute to their overall health,” notes the Rutgers–Camden psychologist.

“What troubles me is that there’s no conclusive data that cosmetic surgery even makes people happier, what has been documented is that it makes repeat customers.”

The wife-and-husband team surveyed nearly 200 participants with an average age of 20 on their immediate responses to an ‘extreme makeover’ program or a show on home improvement – incorporated specifically to mask the intent of the study.

Both men and women were included in the study and the procedures examined were ones either gender could pursue.

As the Rutgers–Camden researcher suspected, women were more likely to want cosmetic surgery than men and viewers of the cosmetic surgery show were more inclined to consider the procedure for themselves than those who didn’t tune in.

What still shocks Markey are the handwritten responses to the cosmetic surgery show, including comments like “inspirational” and “I saw an unhappy girl get her dreams.”

This saddens Markey because outward appearance seems to be the sole avenue to self satisfaction and this road, she believes, is circular.

“If plastic surgery makes you feel better about yourself, then why do you keep getting it done?” she asks. “This mindset is very similar to that of an anorexic wanting to lose just five more pounds.”

While ABC’s “Extreme Makeover,” which led to the “Extreme Makeover-Home Edition,” was cancelled in 2007, it sparked the development of several other similarly themed shows like Fox’s “The Swan,” the drama “Nip/Tuck,” MTV’s “I Want a Famous

Face,” E’s “Dr. 90210″ and Oxygen’s recent “Addicted to Beauty.”

The impact of reality television as a new media influence – regardless of topic – also raises many questions about what is being portrayed to viewers as real and indicative of everyday life.

“There is a cultural context to never be satisfied with our physical selves. It’s the rare person who is either completely oblivious or has developed such a strong counter-message to not be affected, “notes Markey, the mother of a 4-year-old boy and a 3-year-old girl.

“We need to teach children to be critical of the messages we’re receiving and tell them positive things now to foster selfesteem.”

Markey brings these cultural dialogues into her own home by explaining to her young children why Barbie is banned. “I tell them ‘no one you will ever meet in real life will ever look like her,’” she says.

“There are so many messages out there telling us that we need to fix ourselves, but at an early age we need to tell our kids: ‘I love you just the way you are.’”

Is Reality TV Influencing Teens to Get Plastic Surgery?

Teen girls face peer pressure to be pretty and thin. So what happens when an unrealistic standard of beauty is reinforced by the reality TV stars they look up to?

From Kim Kardashian to Jersey Shore's JWoww, young reality TV stars are no strangers to plastic surgery. But are these glamorous starlets sending the not-so-subtle message to their young female fans that you need a boob job or Botox to be beautiful and feel better about yourself?

According to a briefing paper from the American Society of Plastic Surgeons (ASPS), teenagers often have plastic surgery to improve physical characteristics they feel are awkward to look similar to their peers. Adults, on the other hand, tend to have plastic surgery to stand out from others.

In his New York City rhinoplasty practice, Robert A. Guida, MD, FACS, works with teens trying to fit in. "Oftentimes a teen will say, 'I'd like my nose to look like a celebrity's nose, like [Gossip Girl's] Leighton Meester,” says the double-boardcertified plastic surgeon, who uses computer imaging to show his clients how a certain celebrity's nose would look on their face. "I always try to counsel my patients that they should look for an effect that helps them achieve their goals while still looking natural and real.”

The American Society of Plastic Surgeons reports that in 2010, nearly 219,000 cosmetic plastic surgery procedures were performed on people ages 13-19. But what is the recommended age for a young person to consider plastic surgery?

Dr. Guida says his youngest female rhinoplasty patient was 13. "If there is a facial issue that is causing a true social impact on a teen, then I advocate helping them change that,” explains Guida. "However, until a teen is through puberty his or her face will change – sometimes a great deal. I believe it's always best to wait until they've passed those growth years before a plastic surgery procedure.”

Gregory P. Mueller, MD, FACS, a board-certified plastic surgeon in Beverly Hills, California, agrees that celebrities influence women of all ages to get plastic surgery. But young women, he says, may be more impressionable. "Teenage girls succumb to the pressure of being beautiful and thin, and when they see these celebs have surgery, they seek it out more than before,” explains Dr. Mueller. "Hopefully they go to a good doctor for a natural look. You have to know when to say when. I tell patients you have to remember where you started.”

A glaring example of a young reality star who went too far is former The Hills star Heidi Montag, who at age 23 underwent 10 cosmetic procedures in one day. "People look up to those folks,” says Mueller. "A young person could be influenced by that.”

Mueller's youngest nose-reshaping patient was 18. "Any younger than 18 is hard for me to swallow. Patients need to be old enough to understand what they're doing,” he says. "[My patient] was a beautiful young lady, but her nose was genetically large. She was being called names at school and it affected her psychological state.”

Although Mueller believes that when it's done tastefully, cosmetic procedures like rhinoplasty and breast augmentation can help boost a teen's self-esteem, research published in the academic journal, Body Image, found that there was no conclusive data to prove that cosmetic surgery makes people happier.

"What has been documented is that it makes repeat costumers,” says Charlotte Markey, an associate professor of psychology at Rutgers-Camden who conducted the research.

Reality TV played a major role in Markey's study. The psychologist and her husband Patrick of Villanova University surveyed nearly 200 participants (men and women) with an average age of 20 on their immediate responses to an "extreme makeover” program or a home improvement show – incorporated specifically to conceal the focus of the study.

As Markey suspected, women were more likely to want cosmetic surgery than men, and viewers of the cosmetic surgery show were more inclined to consider the procedure for themselves than those who had not watched the show.

"There is a cultural context to never be satisfied with our physical selves. It's the rare person who is either completely oblivious or has developed such a strong counter message to not be affected,” Markey notes in her study. "We need to teach children to be critical of the messages we're receiving and tell them positive things now to foster self-esteem.”

Teens who do seek plastic surgery (with the consent of their parents) should make sure their plastic surgeon is certified by the American Board of Plastic Surgery (ABPS). All ABPS-certified physicians have graduated from an accredited medical school, completed at least six years of surgical training with at least three years in plastic surgery and passed comprehensive written and oral exams. When it comes to any potential patient, however, Mueller stresses that plastic surgeons must be willing to say no.

"When you have someone who comes in and they already look good, it's our job to make sure the patient is seeing what's really there,” he says.

Extreme Makeover From Wikipedia, the free encyclopedia Jump to: navigation, search Not to be confused with Extreme Makeover: Home Edition.

Extreme Makeover Genre Reality Television Created by Howard Schultz Written by Louis H. Gorfain Directed by Shanda Sawyer Presented by Sam Saboura Country of origin United States

Original language(s) English No. of seasons 4 No. of episodes 54 (52 aired, 2 unaired) Production company(s) Lighthearted Entertainment Broadcast Original channel ABC Original run December 11, 2002 – July 16, 2007 Chronology Followed by Extreme Makeover: Weight Loss Edition Related shows Extreme Makeover: Home Edition Extreme Makeover: Wedding Edition Extreme Makeover is a television program from ABC in which individuals volunteered to receive an extensive makeover in Hollywood. The show was created by television producer Howard Schultz. It first aired as a television special. It began airing in 2002 on Thursday nights at 8pm. A total of 55 episodes were produced. The show's first surgeon was Dr. Garth Fisher of Beverly Hills, California; after the pilot show the first six shows included Beverly Hills plastic surgeon Jon A. Perlman, M.D. FACS, Dr. Malcolm Lesavoy and Dr. Harvey Zarem as part of the original "Extreme Team," along with Dr. Bill Dorfman and Dr. Robert Maloney. Other doctors were selected for the next three years in addition to the above.

Borrowing heavily from the reality television genre, the show depicts ordinary men and women undergoing "extreme makeovers" involving plastic surgery, exercise regimens, hairdressing and wardrobing. Each episode ends with the participants' return to their families and friends, showing the reactions of their loved ones, who have not been allowed to see the incremental changes during the participants' absence.

Extreme Makeover: Home Edition, which debuted in 2003, is a spin-off of Extreme Makeover. The home edition ended up becoming far more successful than the plastic surgery edition. Extreme Makeover: Wedding Edition was also piloted as a one-time special, but did not achieve sufficient ratings to be made into a series.

In its first season, Extreme Makeover ranked 40th in the yearly ratings and averaged 11.2 million viewers per episode.

However, viewership suffered huge drops over the next three seasons.

On May 15, 2007, Extreme Makeover was officially canceled by ABC. The show's final three episodes were broadcast on Mondays starting July 2, 2007.[1] A later spinoff, Extreme Makeover: Weight Loss Edition, premiered in ABC's 2011 summer season.

Confessions of an Extreme Makeover Plastic Surgeon The television show Extreme Makeover was a hit and a pioneer in reality TV that premiered in 2002 and featured individuals who were transformed over a six-week period through diet, exercise and plastic surgery. Changes in hairstyle, makeup and clothing completed the process. The show followed these individuals throughout a six week process, documenting each step, from the initial consultation with the "Makeover Experts" to the final "Reveal," when the participants returned home to their friends and family for a party to show off their makeover.

In 2003 the show traveled to NYC from LA and I was one of the plastic surgeons who participated in that episode and I would like to share the experience with you.

First off: Why did they choose me? I mean I was flattered and all, but I was not one of the famous plastic surgeons in NYC who rubbed elbows with the elite of society and performed their surgery. I did not have a publicist and was never featured in the beauty magazines. All the other surgeons selected were from LA and known for their work on movie stars. When I pressed the producer, he told me that I was chosen because I am Board Certified, passed the background check and had no "skeletons" in my closet. That, he explained, was vital because the show was being aired on ABC network, which is owned by Disney, who is very concerned about maintaining a clean image. Wonderful, Micky Mouse liked my work!

My next thought: Is this a good idea? What if something went wrong? I could see the headlines: "Plastic Surgeon Botches Operation in Prime Time!" After controlling my hyperventilation and calming down, I reasoned that I was confident in my ability and certain that my conservative approach and meticulous preparation towards surgery would serve me well in front of the cameras. Also, in the event of catastrophe, I could always move to Tijuana and open a clinic there!

My thought process continued. What if the opposite occurred? What if I was a big hit and became famous? Patients would be banging down my door, begging for my services, changing my life forever. I might become the Dr. Oz of plastic surgery! Wait a minute...I didn't have Dr. Oz's boyish good looks, wit or charming personality! I would be a disappointing T.V. failure because I have the face only a mother could love!

I had my concerns when I was first approached by the show's creator, Howard Schultz. Who were the participants? Would I have complete autonomy in the patient selection process and more importantly, the surgical procedures to be performed by me? I did not agree with several of the "mega-operations" performed in previous shows in which the patients were on the OR table in excess of 8 to 10 hours. Mr. Schultz assured me that I could select the patients and choose the procedures as I saw fit. He explained that I would review videos submitted by aspiring participants, choose 5 possible candidates who would be flown into NYC for consultations by me, which would be filmed, and 2 would be chosen for the show. After reviewing scores of submitted tapes, I chose 9 candidates, just to be sure. That required filming each consultation in my office over a two day period.

What he failed to explain was that the consultations would be attended by the show's associate producers who tried to influence me in the selection process to choose candidates with the most dramatic storyline or most dynamic transformation possibility. I had to temper their enthusiasms for the dramatic with the reality of patient and procedure selection; things like patient health, anatomy, desires and expectations. I had to choose patients that required a reasonable surgical plan that I deemed safe and realistic.

Unfortunately, some participants had to be excluded for health issues and others because I felt that the procedures that they requested or needed to accomplish their goals were too lengthy to accomplish at one sitting required by the show. The truth is that many "makeovers" require two or three stages or operations to safely accomplish the set desires. To their credit, the producers granted me final say and I chose my 2 candidates.

Now the fun began. The first patient, Samantha, a survivor from the Columbine High School shootings, was slated for a facelift, brow lift, fat transfer to eyelids, laser resurfacing and lip augmentation. She also required dental work. She was a wonderful candidate because she had gorgeous facial bone structure and very realistic expectations. The second candidate,

Denise, was slated for rhinoplasty, mini-brow lift, breast augmentation and chemical peel of her face. She too was a fine candidate.

On to the operating room. Samantha went first. I must admit that initially, I was a bit nervous. There was one stationary camera filming the entire operation and a second hand held camera to be used intermittently for a different angle. Once we started, and I became immersed in the surgery, I felt more comfortable and everything proceeded according to plan. The producer asked me to explain what I was doing at certain points and I discussed the key maneuvers of the operation. Denise had her surgery the following day without incident. They tried to film the patients while in the recovery room, but my very protective nurse forbid contact to allow the patients to wake up from anesthesia safely and with dignity.

The following weeks were the hardest for me. During the post-operative period, every single contact with each of the patients had to be filmed, which lengthened each encounter and that became tiresome because we all were very aware that we were on camera. The sessions felt staged and artificial. During that time the other makeover specialists did their thing during the following weeks. The surgery always went first to allow post-operative swelling to decrease in time for the unveiling. This was also frustrating because in reality, complete resolution of swelling takes longer, 3 to 6 months. What life lessons did I take away from the experience? I have always tried to dispel the notion that cosmetic surgery is trivial, and that it should be taken seriously, as complications can occur. I am not sure that my participation, even with a very conservative approach towards surgery, adequately accomplished that goal. Also, cosmetic surgery should not be viewed as the only alternative to a "life makeover", because true beauty starts on the inside and emanates outward. I have learned my lesson and now I preach that to my patients. In the end, everything turned out reasonably well, and both ladies were pleased with their makeovers, and their "Reveal" parties were a success. My practice reverted back to normal and I must say that I was glad to return from "Reality TV." I was grateful to participate in the show, but realized that Hollywood was not for me. When you have a face that only a mother could love, it is better to put that face behind a surgical mask, instead of in front of the camera!

Sexual Cosmetic Surgery Should cosmetic surgery on your lady parts be banned?

By Arianne Cohen

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Never mind nose jobs. Women are increasingly opting for a much more radical form of cosmetic surgery--on their genitals. But, says Marge Berer, editor of the medical journal Reproductive Health Matters, these procedures, which are aimed at "beautifying" the labia, are tantamount to female genital mutilation - the shockingly primitive surgery performed on women in places like Africa and the Middle East for religious and cultural reasons. Hysterical overstatement? Berer says no.

MC: First of all, why do MB: They see pictures of abnormal if theirs are a beautify themselves - or doctors.

women want this surgery? women on the Web whose labia appear to be almost nonexistent, and they are concerned that they are different size. We're talking about women feeling sexually inadequate and seeing this as a way to at least that's how it's being sold to them. I find the whole thing unethical on the part of the

MC: But how is that female genital mutilation?

MB: The definition of FGM, according to the World Health Organization, includes any cutting of the labia, as well as part of or all of the clitoris. It is much more severe than what is being done by these plastic surgeons. But in all cultures, using a surgical procedure to conform to an external definition of what a woman's genitals are supposed to look like is mutilation.

MC: But nobody makes Western women do it.

MB: Societal pressure makes mothers and grandmothers in other cultures societal pressure here of a different kind is making young women think that at a time when a woman's right to express her sexuality has never mutilated. And some advertising genius called it "cosmetic surgery" to

put their daughters through FGM, and I believe they should have their labia cut off. The irony is been greater, young women are choosing to be sell it to them.

MC: What would you say to a Western woman who claims it's her right to have it done?

MB: I would try to get her to understand that it is a form of self-mutilation. If you damage nerve endings in a very sensitive place such as the labia, you could be in for a lot of discomfort for a very long time. I find it ironic that if an African woman goes to a provider asking for this for traditional reasons - for her daughter or even for herself - it is refused and considered a criminal offense. Yet if a woman thinks her own genitals are an abnormal shape or size, the surgery is provided.

MC: So do you think this surgery should be banned?

MB: Yes.

Aesthetic Plastic Surgery Center in Bangkok, Thailand About PAI Asst.Prof.Dr.Preecha Tiewtranon, MD’s start his professional by managing his own clinic "Chollada Clinic, Sukumvit soi 1" from 1978 - 2002. He was a Faculty of Chulalongkorn Medical University, Former chairman of Society of Plastic and Reconstructive Surgeons Thailand, Former Society of Aesthetic Plastic Surgeons Thailand, and Former Chairman Plastic Surgery Unit Chulalongkorn Hospital Medical School.

During periods, he met many professional colleagues in plastic and reconstructive surgeon and forming the best plastic surgery center in Bangkok Thailand. The Aesthetic and reconstructive center can be trust and respect highly professional in cosmetic and reconstructive surgery center in Thailand called Preecha Aesthetic Institute, Bangkok Thailand.

Preecha Aesthetic Institute (PAI) is established in 2002 offers a full range of Cosmetic surgery and Reconstructive surgery by the renowned Preecha Tiewtranon, MD, a plastic surgeon with over 30 years experiences and one of the best international standard private clinics, Thailand. Preecha Aesthetic Institute is the first multidisciplinary Aesthetic and Reconstructive center and the pioneer in Sex Reassignment Surgery, Thailand since 1980.

Preecha Aesthetic Institute (PAI)’s form by the renowned Asst.Prof.Dr.Preecha Tiewtranon, MD, Asst.Prof.Dr. Sirachai Jindarak, MD, Asst.Prof.Dr.Prayuth Chokrungvaranont, MD, Dr.Sattha Siritantikorn, MD, Asst.Prof.Dr.Apichai Angspatt, MD, Dr.Sutin Khobunsongserm, MD, Dr. Burin Wangjiraniran MD. FRCS, and highly qualify best plastic surgeon colleagues Thailand whom also highly qualified from internationally renowned institutions. The theory center is to ensure safety and satisfaction with the outcome of procedures. Each surgeon must specialize in their special area for cosmetic and reconstructive surgery.

The quality of PAI member, each plastic surgeon’s undergo year of surgical specialty training, pass qualifying and certifying examinations in their respective (Board certification), and member in good standing in their societies of plastic and aesthetic surgery as well as agree to abide by the high ethical standards of these societies.

Preecha Aesthetic Institute, Bangkok center is being one of the best known as Aesthetic Plastic Surgery, rhinoplasty, breast augmentation, breast lift, breast reduction, blepharoplasty, tummy tuck, facelift, body contouring as well as reconstructive surgery FtM, MtF, and FFS. With long experience in plastic and reconstructive surgery, our group of surgeon have been performed (MtF), SRS (Penile Skin Inversion) 4,459 cases, SRS by Sigmoid Colon 975 cases and FtM surgery, 1,820 cases since 1980-2009. The percentage of MtF and FtM patient is 90% are foreigner included American, Australian, European, Japanese, Singapore, and Middle East. The number of success rate is over 95% without any complications and have been increasing yearly.

The center advanced 10 consultation rooms, 6 operation rooms fully equipment leading Aesthetic Plastic Surgery completed with recovery rooms and the internationally accepted standard of hygienic system.

In coming year, Preecha Aesthetic Institute (PAI) ‘s a plan to trains foreigner surgeons and gives lectures worldwide about our techniques and research as well as spread to the world that Thailand is leading number one in Aesthetic Plastic surgery and Reconstructive Surgery.

When to have sex after cosmetic surgery

The timing of sex post surgery

By the time my cosmetic plastic surgery patients come in for their third post operative visit, a couple of weeks after their plastic surgery procedure, I see a familiar look on their romantic partners’ faces.

It’s a forlorn look that shouts out “I’ll never have sex again!”. After all, the poor partner has up till now received no benefit from the cosmetic surgery the other has had, and cannot possibly see what benefit they will ever have. In fact, they have been probably abused by a demanding patient they have had to take care of, whose every whim they have had to please and whose bursts of emotional lability they have had to endure. They have been confused, confounded and are now consumed. If only they could release some of their tension through a little sex…

I always tell my patients, in a matter of fact way, that they can resume their sexual life “ when they feel comfortable”; this applies of course to most surgeries but not to vaginoplasties or other genital rejuvenation surgeries where a healing period of up to 6 weeks is needed.

Hesitancy to have sex on the patient’s side After cosmetic plastic surgery patients initially are understandably not interested in having sexual relations. During the first few days, they may be swollen, have pain and generally feel miserable. Sex is not on the radar. After a few days however, when the patient is typically off narcotic medications and things are returning to normal, some desires may return.

The patient is by no means healed yet but sexual activity would not really cause any problems if judicious. Some plastic surgeries actually require the patient’s partner to help in massaging a back or breasts after breast augmentation, or an abdomen after a tummy tuck. This type of massage relaxes the patient, increases lymph and skin blood flow and may act as foreplay leading to other things. Obviously surgeries of the lower parts of the body may cause swelling and temporary bruising of the pubic areas and vagina which would make for some discomfort, but if your plastic surgeon okays it, you can start to try to get sexual pleasure.

Hesitancy to have sex on the partner’s side Often though it is the patient’s partner who is hesitant to perform lest they harm their loved/desired one. Sometimes the partner is actually turned off by the site of bandages and scars and may not be able to get in the “mood”. Nevertheless, after some time the sexual urge becomes too great and the subject is approached. The partner is now in an uncomfortable position. They want -need- sex but do not want to seem callous or selfish in asking the patient who may still be hurting .

On the other hand, I have seen some patients actually use sex to manipulate their partner during this healing period…

When to have sex after plastic surgery?

The decision to re-start sexual activity after cosmetic plastic surgery is one that should be reached after discussion with a board certified cosmetic plastic surgeon, the patient and their partner. The plastic surgeon will tell the patient when it is medically safe to have sex. After that, it is between the patient and their partner to decide when to start relations. The patient must be assured that no pain or medical complications will occur during the act; so it is ultimately when the patient decides.

Napoleon Bonaparte apparently often said “Not tonight Josephine” in response to Empress Josephine’s sexual advances. How about that for a nuanced code phrase when you are not quite ready for sex?

Cosmetic Buttock Lifts

If you have read any of my previous blogs about bums, you know that I have a particular fondness for the Brazilian buttock lift. In fact it’s not even a real lift but rather a filling of the buttocks with fat liposuctioned from somewhere on the body which gives a “lift” to the general shape.

Other types of Buttock lift Sometimes though, the plastic surgeon really does need to lift the buttocks. There are two main types of surgical buttock lifts; but it all gets confusing because what we call a cosmetic procedure sometimes is not what we really mean…

Buttock lifts from above If you stand in front of a mirror and look at your bum, and pull the skin up towards your waist, you are giving yourself a buttock lift from above.

This procedure which is usually part of a “circumferential tummy tuck’ or “ complete body lift”, is sometimes performed for patients who have had massive weight loss.

The loose skin hangs around the waist area and the buttocks droop. Cutting the skin above the buttocks and pulling the skin up, leaves the patient with a horizontal scar across the back and does remove some extra skin.

In my hands the results are always wanting. Both the cosmetic patient and the plastic surgeon are left wanting more. The large scar is just not worth it. What both patient and surgeon really wanted was a fuller buttock with no loose skin – that is not what they get. The skin at the lower end of the bum still looks like your grand- mother’s bum.

Buttock lifts from below The loose skin that hangs in the lower area of one’s buttocks when you have had a great weight loss or just become a little older is of particular concern to many patients.

The only way to really treat this is to remove the skin by cutting along the posterior buttock crease with incisions going towards the front of the groin.

I typically just remove the top layers of the skin and keep the dermis of skin to fold it in so as to keep some bulk in the buttocks.

The scar is inconspicuous and though at times the wound will separate during the healing, the final result is acceptable; and infinitely better than the approach with the scar on top of the pelvis.

Even though the scar ends up in the same place as for a thigh lift, where droopy thigh skin is elevated up, the results are much better as there is no significant weight of skin and muscle pulling on the scar.

In summary there really is no single plastic surgery procedure that works every time to give the cosmetic patient a lovely round bum but there are a number of plastic surgeries that together may get us closer to full buttocks.

Free Silicone injections Every few months the news has another story about a disaster occurring somewhere in the US with a patient who has been injected with silicone. Usually the patient gets a terrible infection from the silicone injections and many go on to develop chronic problems. The worst part of silicone injections is that there is no treatment or way to remove the silicone once it has been injected under the skin.

The perpetrators are invariably lay people or doctors who have no training in cosmetic surgery. The victims are typically in the south east of the US, and looking for a quick fix.

The areas of assault are silicone injections into the buttocks, or injections into the breasts for augmentation of these areas. Sometimes the face has been injected. In the most recent case that led to the death of the patient, someone actually injected a mixture of silicone and cement into the buttocks!

Silicone Silicone is a ubiquitous material on the planet. After all it is the main constituent of sand. It has been used extensively in our modern world. Silicone is used to lubricate machinery, as a sealant around doors and windows, placed in cosmetics to make them smoother, covered onto Styrofoam cups to make them slicker and placed in breast implants for cosmetic breast surgery enlargement, among other uses.

It is a wonderful material! When used in the correct way, in the correct volumes and in the correct level of purity, it has real benefice. Problems occur when silicone is used in a manner not intended.

Cosmetic uses of silicone Liquid Silicone injections When I was training as a cosmetic plastic surgeon in the early 1990s, a bête noire of the cosmetic surgery field was a certain Dr. Orenstein, a dermatologist in Florida I think, who was notorious for injecting silicone into patients’ facial lines and lips. This was thought of as heresy by most plastic surgeons and as a specialty plastic surgeons have shied away from any injections of silicone. Interestingly, there are still practioners from other disciplines who have no qualms about injections of silicone.

Silicone Breast implants Cosmetic plastic surgeons have been using silicone in the form of implants for many years. Silicone gel implants have been used for breast augmentations since the 1970s. Breast implants had a silicone gel in a silicone shell. The consistency was that of honey and if a silicone breast implant ruptured it was a mess to clean up. More modern breast augmentation implants have a harder gel, almost like Gelatin, which when cut does not ooze but rather stays in place.

Silicone facial and body implants Another form of silicone that is used in implants in plastic surgery is a solid silicone implant. These types of implants are much firmer than breast implant materials. These implants are constructed to approximate hardness of bone when used in the face as implants for cheeks, nasal implants or chin implants. A consistency of muscle is required for implants for buttock enlargement, chest enlargement in men and calf implants.

The Body reacts to silicone Whenever our body comes into contact with silicone, it recognizes it as a foreign material and tries to block it off by formation of a capsule around the silicone. These capsules can be large such as those around breast implants or tiny such as those around the beads of silicone injections into the face.

The body actually seems to handle the microscopic beads better than larger injections. Patients with silicone injections for breast augmentation or buttock enlargements seem to do the worst. Free silicone lumps coalesce together and move around under the skin. They then form capsules which become particularly, inflamed, and painful. It is these patients that call every so often begging for a plastic surgeon to do something to rid them of the rocks under their breasts and buttocks- and it is always the saddest of days when the plastic surgeon has to say there is nothing that can be done. Worst still is that the surgeon cannot even give them hope- it’s a disaster.

Just this week there has been a new look at this problem by the US government following the number of atrocities committed by lay people. In one case silicone from the hardware store was injected into some one’s buttocks with disaster in hot pursuit.

Big fat bums

For information about Brazilian Buttock enlargement look here; http://www.tavmd.com/buttock_enlargement.html

The world is the sort of place where those who have one thing are clamoring for another which they do not. If you have curly hair you want it straightened and if it is straight, you curl it. If your buttocks are small you want buttock enlargement; if they are big you want them …bigger? Well yes, in some cases.

Size of buttocks

Size of bums is determined more by their shape than their actual volume. Buttocks look big if they are long and wide; long in terms of length from the upper hip to the lower end of buttocks, and wide in terms of distance from the central bum crease to the outermost parts of the hips or saddle bags. In my cosmetic plastic surgery patient’s before photo below, notice how much distance there is between the back crease and lower part of the buttocks. In the after photo, this distance appears shorter. By the way that is her result a week after a natural buttocks enlargement with belly fat transfer!

Before Brazilian enlargement with fat. After buttock augmentation with fat liposuction from abdomen waist is brought down.

What patients want for their buttocks Most patients want to have buttocks that are shapely, round or full- Sometimes that is confused with size/volume. Buttocks enlargement means different things.

Round full bottoms offset by a small narrow waist will look bigger; sometimes even liposuction of the waist will give the impression that bottoms have been made larger. For men who want larger or fuller buttocks, waists cannot be narrowed as much as for women.

Some patients have paucity of fat in the lateral (outside) part of bums. Those patients need fat to be filled in those areas in order to get a rounder bum.

How to do buttocks enlargement In previous posts, I have discussed larger buttocks with silicone implants or with a Brazilian Buttocks enlargement technique. See here http://thecosmeticplasticsurgeon.com/category/plastic-surgery-procedures/buttocks-lifts-plastic-surgery/ My preference is for a Brazilian buttock enlargement or natural buttock enlargement in which fat is suctioned from other body areas such as the belly/ abdomen. Next, a fat transfer and injection into the buttocks is performed. This procedure is gaining in popularity. I have taught several of my cosmetic plastic surgeon colleagues how to do this surgery. There are a number of companies that sell cosmetic plastic surgeons different materials to allow easier or quicker harvest of fat but I find that these don’t really help. Liposuction with fat transfer under buttocks skin and muscle in multiple lines gives the best result.

How long does fat injection to buttocks last?

When I first started performing this cosmetic procedure years ago, I would tell my patients what I had been told to say by the plastic surgery authorities at the time; “We don’t know, but it should last at least two years”. I now know that I still don’t know but results can sometimes last for almost a lifetime; it might disappear when you are getting on a bit.

Risks of Brazilian Buttock enlargement ▪ Infection- can be devastating and eat away all the fat injected.

▪ Bleeding – very rare.

▪ Loss of volume – sometimes occurs unpredictably.

With more and more cosmetic plastic surgeons performing surgery to enlarge buttocks, results are becoming better and more predictable. So whether you are a man or a woman, a nice round big bum is hopefully within your reach…

DIY Cosmetic Surgery

I’m the type of person who likes to work with my hands. That may well be one of the main reasons I became a plastic surgeon who performs cosmetic surgery. I like to think that I use my brain also, but I get enjoyment from using my hands. When at home I am forever tinkering with things in the house or garden, plastering, painting, fixing and am an avid Do-It-Yourself type of fellow. However as the posting below supplied to me by from the American society for Aesthetic plastic surgery shows, DIY may not be the best thing for cosmetic surgery unless you really are a board certified plastic surgeon. I certainly no longer do complicated electrical or plumbing work! Mind you I’ve tried in the past and always failed.

Here is a recent article about what you DO NOT WANT TO DO in terms of Do-it-yourself plastic surgery http://www.modernmedicine.com/modernmedicine/article/articleDetail.jsp?id=780154&cid=COSM While the high cost of some plastic surgery procedures has caused some people to seek dangerous alternatives such as using unlicensed individuals and potentially dangerous ingredients, others have chosen to perform them on their own at home, which also poses serious risks says reports from ABC news and CBS Pittsburgh.

The low cost and ease of buying a do-it-yourself kit for a non-surgical cosmetic procedure such as microdermabrasion, laser hair removal or a chemical peel is causing many to try these treatments out on their own. However, doctors warn that they may end up doing more harm than good.

Plastic surgeons and cosmetic dermatologists are seeing an increase in individuals who have had to endure pain and long-term skin damage due to some at-home treatments.

“We’ve had patients come in the day before their daughter’s wedding and done an at-home chemical peel and come in with second degree burns,” a cosmetic dermatologist told the news.

Experts say that although prescription-strength acids used for chemical peels can be found online and obtained without a prescription, consumers should avoid them.

“If you stumble upon a website selling prescription-strength retinoid, that should be a red flag and [you should] seek professional help first… because there are certain reactions that can happen and certain products you don’t want to mix together with those.”

Caution also needs to be used when trying a do-it-yourself laser hair removal, as misuse can cause burning, redness and scarring. In-office treatments are also likely to be much more successful.

“The companies say after five treatments you have a 50 to 70 percent reduction in hair growth,” an industry expert told ABC News about at-home laser removal. “I expect 70 to 100 percent from office devices.”

Permanent damage can also result from microdermabrasion kits and scrubs that promise to exfoliate the skin and produce a more glowing complexion. Over-scrubbing can result in pain and bleeding. ”They start to think if a little bit is good, more is better, so, they start to do more for their skin and that can really damage the barrier function of the skin.”

Whether you want to restore a more youthful glow to the skin or get rid of unwanted hair, consulting with a licensed, boardcertified cosmetic plastic surgeon is recommended in order to achieve the desired result and maintain safety.

New Breast implant shapes better

I have written in the past about breast augmentation with saline and silicone implants and even about the different shapes of breast implants. Here are some of those blogs http://thecosmeticplasticsurgeon.com/2011/09/16/breast-augmentation-implant-shapes/ http://thecosmeticplasticsurgeon.com/2013/03/22/silicone-breast-implants/ http://thecosmeticplasticsurgeon.com/2012/01/08/silicone-breast-implants-in-the-news/ http://thecosmeticplasticsurgeon.com/2011/12/16/changing-breasts-implant-size/

Moderate profile implants

For many years cosmetic plastic surgeons only has the option of one shape of breast implant for breast augmentation surgery.

Breast implants that are contoured and used mainly for breast reconstruction are another subject all together.Whether the breast implant was saline or silicone implant did not matter. There was only one shape- a round 360 cc breast implant had ratio of 13.6 cm in diameter (width of the breast) and 3.3 cm of projection (how far the breast comes forward). Cosmetic plastic surgeon did not know it then, but these were moderate profile implants.

High profile breast implants

The two major breast implant manufacturers, Mentor and Allergan then began making High profile implants. These implants have a narrower diameter and more projection. For example a 350 cc implant has a diameter of 11.7 cm and projection of 4.8 cm.

These breast implants were ideal for patients who wanted larger breasts but had narrow bodies with no hips. A wider implant would have made them look top heavy but a high profile implant is ideal for this body habitus.

Moderate Plus profile implants

The final addition to the breast implant shapes possible, and my current favorite shape of breast implant, is the moderate plus breast implant. This breast implant is in between the other two in terms of diameter and shape. A 350 cc moderate plus implant has a diameter of 12.5 cm and a projection of 3.9 cm. Women who want a cosmetic breast augmentation have either never developed breasts or have lost breast tissue after pregnancy or weight loss. Those women who have breast fed or had weight loss will also tend to have a droop of their breasts. A moderate plus profile is perfect for the many women who have a bit of hip and a droopy breast. It is the best of both worlds.

Breast augmentation surgery can be performed with saline implants or silicone breast implants. The many different breast sizes and shapes as well as the two different materials ( silicone and saline) lead to hundreds of permutations of breast implants that are available for cosmetic breast surgery patients. One difficulty in all of this is that there just is not enough room in a cosmetic plastic surgeon’s office to show breast surgery patients every different implant available on the market!

New Breast implant shapes better

I have written in the past about breast augmentation with saline and silicone implants and even about the different shapes of breast implants. Here are some of those blogs http://thecosmeticplasticsurgeon.com/2011/09/16/breast-augmentation-implant-shapes/ http://thecosmeticplasticsurgeon.com/2013/03/22/silicone-breast-implants/ http://thecosmeticplasticsurgeon.com/2012/01/08/silicone-breast-implants-in-the-news/ http://thecosmeticplasticsurgeon.com/2011/12/16/changing-breasts-implant-size/

Moderate profile implants

For many years cosmetic plastic surgeons only has the option of one shape of breast implant for breast augmentation surgery.

Breast implants that are contoured and used mainly for breast reconstruction are another subject all together.Whether the breast implant was saline or silicone implant did not matter. There was only one shape- a round 360 cc breast implant had ratio of 13.6 cm in diameter (width of the breast) and 3.3 cm of projection (how far the breast comes forward). Cosmetic plastic surgeon did not know it then, but these were moderate profile implants.

High profile breast implants

The two major breast implant manufacturers, Mentor and Allergan then began making High profile implants. These implants have a narrower diameter and more projection. For example a 350 cc implant has a diameter of 11.7 cm and projection of 4.8 cm.

These breast implants were ideal for patients who wanted larger breasts but had narrow bodies with no hips. A wider implant would have made them look top heavy but a high profile implant is ideal for this body habitus.

Moderate Plus profile implants

The final addition to the breast implant shapes possible, and my current favorite shape of breast implant, is the moderate plus breast implant. This breast implant is in between the other two in terms of diameter and shape. A 350 cc moderate plus implant has a diameter of 12.5 cm and a projection of 3.9 cm. Women who want a cosmetic breast augmentation have either never developed breasts or have lost breast tissue after pregnancy or weight loss. Those women who have breast fed or had weight loss will also tend to have a droop of their breasts. A moderate plus profile is perfect for the many women who have a bit of hip and a droopy breast. It is the best of both worlds.

Breast augmentation surgery can be performed with saline implants or silicone breast implants. The many different breast sizes and shapes as well as the two different materials ( silicone and saline) lead to hundreds of permutations of breast implants that are available for cosmetic breast surgery patients. One difficulty in all of this is that there just is not enough room in a cosmetic plastic surgeon’s office to show breast surgery patients every different implant available on the market!

New Breast implant shapes better

I have written in the past about breast augmentation with saline and silicone implants and even about the different shapes of breast implants. Here are some of those blogs http://thecosmeticplasticsurgeon.com/2011/09/16/breast-augmentation-implant-shapes/ http://thecosmeticplasticsurgeon.com/2013/03/22/silicone-breast-implants/ http://thecosmeticplasticsurgeon.com/2012/01/08/silicone-breast-implants-in-the-news/ http://thecosmeticplasticsurgeon.com/2011/12/16/changing-breasts-implant-size/

Moderate profile implants

For many years cosmetic plastic surgeons only has the option of one shape of breast implant for breast augmentation surgery.

Breast implants that are contoured and used mainly for breast reconstruction are another subject all together.Whether the breast implant was saline or silicone implant did not matter. There was only one shape- a round 360 cc breast implant had ratio of 13.6 cm in diameter (width of the breast) and 3.3 cm of projection (how far the breast comes forward). Cosmetic plastic surgeon did not know it then, but these were moderate profile implants.

High profile breast implants

The two major breast implant manufacturers, Mentor and Allergan then began making High profile implants. These implants have a narrower diameter and more projection. For example a 350 cc implant has a diameter of 11.7 cm and projection of 4.8 cm.

These breast implants were ideal for patients who wanted larger breasts but had narrow bodies with no hips. A wider implant would have made them look top heavy but a high profile implant is ideal for this body habitus.

Moderate Plus profile implants

The final addition to the breast implant shapes possible, and my current favorite shape of breast implant, is the moderate plus breast implant. This breast implant is in between the other two in terms of diameter and shape. A 350 cc moderate plus implant has a diameter of 12.5 cm and a projection of 3.9 cm. Women who want a cosmetic breast augmentation have either never developed breasts or have lost breast tissue after pregnancy or weight loss. Those women who have breast fed or had weight loss will also tend to have a droop of their breasts. A moderate plus profile is perfect for the many women who have a bit of hip and a droopy breast. It is the best of both worlds.

Breast augmentation surgery can be performed with saline implants or silicone breast implants. The many different breast sizes and shapes as well as the two different materials ( silicone and saline) lead to hundreds of permutations of breast implants that are available for cosmetic breast surgery patients. One difficulty in all of this is that there just is not enough room in a cosmetic plastic surgeon’s office to show breast surgery patients every different implant available on the market!

Treatment of abnormal breast pain after breast augmentation

Breast pain after breast augmentation surgery can take many forms. I have blogged about abnormal pains and their treatments here http://thecosmeticplasticsurgeon.com/2012/10/29/pain-after-breast-augmentation-abnormal-pains/

Desensitization training First,the experts in desensitization are doctors who practice Physical medication and Rehabilitation, pain specialists or neurologists. If these simple exercise below do not help you, you should see your cosmetic plastic surgeon to get a referral to one of these specialists.

The concept of desensitization is to retrain the nerves.

The recently damaged nerve or recently repaired nerve may not be able to convey the correct sensations the body is feeling.

Hence, the rub of a shirt on the skin may cause astounding pain! Desensitization teaches nerves to get back in line and do what they are supposed to do.There is no exact best schedule known for application of these methods but the idea is to perform them a few times a day for a few minutes.

1. Breast Massage after augmentation Massage of the whole breast will help considerably not only with establishing correct sensation patterns but also in preventing capsular contracture. Massage will move the implant and muscle to allow a more natural shape also. Massaging your breasts while in shower or bath will be particularly easy as the muscles naturally will relax with heat. here is a video of how to massage breasts http://thecosmeticplasticsurgeon.com/2012/09/29/how-to-massage-breasts-after-implants/

2. Hot and Cold application The nerves that transmit the sensation of hot and cold are different than the fibers that transmit other types of pain.

Applying ice in a plastic bag and alternating that with a warm washcloth (one that you place under hot water tap – not the microwave!) will help. Do this three times a day for 5 minutes at a time.

3. Application of different materials The nerves need to learn to differentiate between soft and rough stimuli also.

Take pieces of each of the following and rub them over the skin of the breasts and nipples 3 times a day for 5 minutes.

Things soft and smooth ▪ Piece of velvet or other soft cloth ▪ Cotton wool ▪ Tissue paper ▪ Feathers Things a bit rougher ▪ Piece of wool ( like a scarf) ▪ Towel ▪ Guaze ▪ Spandex ▪ crumpled up paper

Things rough ( Watch out here) ▪ Tree bark and twigs ▪ Leaves like those of leland cypress ▪ Sandpaper or pumice ▪ Keys With the rough things be careful not to cause an abrasion of your skin or you will end up with even more pain. The idea is for the skin to learn to feel the difference between soft and rough.

Treatment of breast implant capsular contracture

Capsular contracture after breast implant placement for breast enlargement occurs in a minority of patients undergoing breast

augmentation . Its occurrence though is a disappointing for the cosmetic patient, and frustrating to treat for the plastic surgeon.Two modalities exist for treatment of a breast implant capsule that has begun to harden, a medical treatment and a surgical one. Preventing capsular contracture is the best method all together and though an inexact science involving massages after surgery, antibiotics and steroids during surgery, it is the best way to proceed.

Medical treatment of breast capsular contracture Quite by serendipity a few years ago, some plastic surgeons noted that their patients who had developed breast capsule contractures began to have improvement of their contractures when they were placed on treatments for asthma. In asthma, the smooth muscle cells that are around the bronchi (breathing tubes in the lungs) contract on stimulation by an allergen. That brings about the asthma attack; the tightening of the muscles decreases the amount of air passing through to the lungs and the “ attack “ is under way. Asthma drugs such as Accolate and Singulair decrease the reactivity of the smooth muscles and their contracting force. They do the same thing in breast implant capsules- the drugs decrease the contracture of the cells and the breast capsule relaxes- in 80% of patient. The other 20% need surgery.

Surgical Treatment of breast capsule contraction When a patient is unresponsive to the medical treatment for capsular contracture, the surgical procedure of capsulectomy can be performed. In my practice about 1% of patients need to have this surgery at some point. This surgery is a procedure whereby the capsule and the implant within it are removed from the chest and a new implant is placed. The surgery can take anywhere from 1-2 hours depending on how tightly the capsule is attached to the surrounding tissues. In the best of cases such as the one below, the capsule is removed in its entirety with the implant still inside. The hard and round shape of the capsule and implant mimics the shape of the breast with capsular contracture; hard and round.

Obviously the body will the make another scar tissue capsule around the new breast implant and yes, the capsular contracture can occur again but this time with the fore-knowledge of the patient’s susceptibility, the drugs such as Accolate and Singulair can be started right away and the patient placed on a more aggressive massage regimen to ensure the largest possible breast implant pocket. For some reason that no one knows it seems to work.

Drug mules use Plastic surgery breast implants

A recent news article from Spain about breast implants being used to transport drugs caught my attention. A passenger from Latin America arriving in Madrid was searched and after bloody bandages were found next to incisions on her breasts. Customs officials became suspicious. An X-ray showed “breast implants” that were found to contain about $80,000 worth of cocaine!

Here is a photo of her “breast implants”.

Breast implants filled with cocaine This story made me think of a number of different issues What type of a doctor would do the surgery?

What type of a breast implant was used?

Where else on the body do drug dealers hide drugs?

What are some adverse effects of transporting drugs inside the body?

Plastic surgeons working for Drug cartels?

Someone obviously placed these plastic bags filled with cocaine(breast implants) under this poor girl’s breasts. I doubt it was a board certified cosmetic plastic surgeon.

Most of these “ drug mules” ( persons carrying drugs) originate their trip from South America. Interestingly, few countries in South America have standard residency training programs in plastic surgery. Many plastic surgeon in South America learn techniques not through a formal training program but rather as an apprentice- if anything at all. With a lack of governing bodies for Board certification, any doctor can call themselves a plastic surgeon. Many just perform cosmetic surgery procedures with no training at all. ( Unfortunately like many in the US also!) Consequences are obviously not good for ”patients”.

Breast implants for drug transport As the photo shows drugs were being transported in plastic bags that were placed in tissues under breasts. As such they were not real breast implants. Theoretically cocaine could be diluted with saline used to fill saline breast implants but I doubt a drug lord would go to the trouble of getting real, sterile breast implants for the lesser amounts of drugs that could be transported in solution.

Drugs transported in body cavities This case was interesting to me because of the novel use of breast implants to carry drugs. Usually drugs are hidden in body cavities though risks of death are much greater for “mules”. Typically drugs are placed in a double layer of condoms which are either swallowed or placed through the anus into the colon. Drugs are retrieved after the mule has a bowel movement.

In a particularly macabre case a few years ago, drug traffickers filled bodies of dead tourists being repatriated to the US with drugs!

Complications of transport of drugs in the body Often severe and deadly complications occur from transporting drugs in the body or in implants. Complications include ▪ rupture of bags and overdose and death of persons ▪ infection of surgery site ▪ bleeding of surgery site ▪ intestinal blockage (if transported in the colon) Despite the significant risks, transport of drugs using plastic surgery techniques is on the rise. The profits that drug lords make are so enormous, and the risks of being caught or ever convicted so so small that the death or capture of a “mule” here or there is inconsequential.

How many calories are there in foods?

Those of you who follow this blog regularly may have noticed my interest in diets, weight loss and a crusade for nutrition literacy. i.e. knowing how many calories are in any food. here are a few blogs on weight loss and healthy eating. http://thecosmeticplasticsurgeon.com/2011/05/19/what-to-eat/ http://thecosmeticplasticsurgeon.com/2011/05/16/rules-for-eating/ http://thecosmeticplasticsurgeon.com/2011/05/12/choices-in-eating/

Irrespective of your beliefs, or lack of, regarding the importance of calories in dieting and weight loss, I have always maintained that most people know more about trigonometry than caloric content of foods. Without the knowledge of how many calories there are in a handful of any particular food, we are doomed to getting fat through ignorance.

Calories are a measure of the heat given off (energy) when food is burned. If you are lying in bed in a room at perfect

temperature, the amount of Calories you need to be kept alive and keep your organs working is about 1000 calories. This is called a Basic Metabolic rate (BMR). The larger you are there more calories you need and the higher your BMR and your daily caloric requirements.

Our bodies typically need about 2000 calories a day to function at a normal level; working, a bit of exercise, walking around etc. Manual workers or athletes will need closer to 3000 Calories and Diabetics (who must watch their weight) need about 1800 calories.

Most diets try to limit your caloric intake to between 600- 1000 calories a day. For example, the new 5-2 Diet lets you have 600 calories per day for two days a week.

Why is this important to a cosmetic plastic surgeon? Well, apart from a basic interest in my cosmetic patient’s health, it is important for them to be eating healthy diets before and after surgery.

A healthy diet before plastic surgery will ensure that the patient has adequate stores of protein, vitamins and trace elements needed for the healing process and scar formation. Vitamin C is essential to forming a scar- and healing.

After surgery the requirements for calories actually increase as our bodies heal and good sources of protein are essential to the process.

So how much is 200 calories?

The best thing I have seen to show you that is this little video which I am re-posting. Sometimes it is not necessary to reinvent the wheel and these chaps have done a great job. So enjoy and learn so you can make healthy choices.

Caveat; the video also shows you many things you should not eat! Three Cinnabons a day will give you 2000 calories but is not a good food choice!! A varied diet rich in protein, vegetables, and some fat but with less carbs (Donuts and french fries) is best. See the blogs at the start for ideas.

Swelling after surgery

All cosmetic plastic surgeries will produce swelling as a normal body healing reaction. Some cosmetic surgeries like tummy tucks and liposuction will disrupt the natural body conduits more by the sheer area of the body that undergoes surgery. Other body areas such as the nose have different types of swelling which persists for up to a year after a rhinoplasty and some procedures like a face lift will have swelling stay around for up to six months. I have discussed in the past some of the ways to reduce swelling after surgery http://thecosmeticplasticsurgeon.com/2012/11/13/how-to-decrease-swelling-aftercosmetic-plastic-surgery/ Today I want to specifically discuss the use of lymphatic drainage massage as a way to reduce swelling after cosmetic surgery such as liposuction and abdominoplasty.

What is lymph and what are lymphatics?

Most people know that our bodies have a series of vessels that carry blood from our heart to tissues (arteries and arterioles) and others that carry blood back from tissues to our heart (veins and venules). What most people do not know is that there is a whole other system of vessels, running parallel to arteries and veins, that transport lymph throughout our body.

These are lymphatics and they carry around lymph! You have all seen lymph when you have burnt yourself and your skin has formed a blister. Lymph is essentially blister fluid!

Lymph is a yellow liquid that can be thought of as fluid in which blood cells travel. The combination of blood cells and lymph (plasma) is blood. When blood arrives at our tissues, oxygen is released from red blood cells and is dissolved in lymph which, because of pressure differentials between arteries and veins, is distributed into tissues. While most of this fluid goes back into the blood vessels, a small portion, about 3 Litres a day, stays around the tissues and is then collected in lymphatic vessels and taken back to be re-introduced into our bloodstream in three main areas after going through a series of collection areas…lymph nodes. Each side of our body, thigh and leg empties into our femoral vein on each side of our groin, and the lymphatics of the head and neck drain into the subclavian vein on the left side of our neck.

Injury and lymphatics When a body area gets injured, there is an increase in permeability of blood vessels in that area, and more lymph spills out into tissues. We see this as swelling in an injured area. The more “injury” to an area, such as after a tummy tuck with liposuction, the more swelling and lymph in tissues. In some surgeries like abdominoplasty where skin is elevated from underlying abdominal muscles, lymphatics are necessarily cut and must re-establish continuity and grow together before they can remove the fluid from the area. If that does not happen fast enough and lymph hangs around, you have what is known as a seroma.

When there is an injury or infection, the increased amount of lymph and increase in white blood cells that get recruited to the area of injury will lead to enlargement of lymph nodes. That is why you feel lymph nodes when you have a cold!

In surgeries where lymph nodes are removed for disease, as occurs after breast cancer mastectomy, injury to lymph node and lymphatics can lead to accumulation of fluid within the limb or area of injury; a condition known as lymphedema ( swelling due to lymph).

While providing a series of channels for white blood cells and body defenses to get to areas of injury or trauma, the lymphatics also provide for a way for infection to spread through our bodies. Red streaks up an arm after an injury to a finger are a sign of infection in the lymphatics !

Lymphatic drainage Most swelling that a cosmetic plastic surgeon sees after surgery such as a tummy tuck or liposuction is expected. There are a number of techniques to decrease swelling such as garments, elevation of body part and icing of an area to decrease the amount of blood coming and hence the amount of swelling. Once swelling is there though, massage can help greatly. Lymphatic drainage is a type of massage to help empty lymphatics in area of surgery of retained lymph. It is a very superficial massage and is more like a firm stroke rather than a deep tissue muscle massage. Lymph is pushed through lymphatics and swelling decreases.

Lymphatic drainage is a useful and beneficial ancillary procedure to cosmetic surgery procedures such as tummy tucks and liposuction where there are large areas of damage to lymphatics.

For smaller areas of cosmetic surgery such as the nose after Rhinoplasty or face after a facelift, patients can massage themselves but for larger areas help from a massage therapist trained in lymphatic drainage is well worth any cost.

Laser liposuction complications Laser liposuction is apparently nothing more than a short-lived fad. In fact it appears that this technique of liposuction may actually be causing irreparable harm to many patients irrespective of whether a board certified plastic surgeon is performing the procedure or not!

It’s like they say- “All good things come to an end”- and in this case all bad things are coming to an end also! Here is some information on

http://www.tavmd.com/liposuction.html and here is a link to more blog articles about liposuction http://thecosmeticplasticsurgeon.com/category/plastic-surgery-procedures/liposuction-surgery/ How Laser liposuction works The concept of fat removal by laser liposuction is to melt the fat under the skin by laser energy and then to suck the molten fat out. Laser energy is essentially heat energy which dissipates under skin to cause a burn of fat and unfortunately also skin. This very burn of the skin is touted by the companies selling the machines for $100,000+ as the cause of skin tightening in excess of that obtained by gentler methods of liposuction. Touted…as there is no proof! What there is proof of ,is unfortunately, the sequels of scarring, un-evenness and skin irregularity, and burnt skin.

▪ Complications of Laser liposuction ▪ Scarring of skin ▪ Seroma (fluid) collection ▪ Skin irregularity ▪ color changes these complications are in addition and more pronounced than the usuall complications of liposuction which also include ▪ infection ▪ bleeding ▪ numbness The way that our bodies react to burns that occur under our skin after laser liposuction is similar to skin’s reaction to an outside burn ▪ There is a zone of cell death centrally where tissues are vaporised and melted ▪ An outer zone is one of cell damage where a variable number of cells will die depending on many factors ▪ A large amount of fluid is drawn into the area of damage – so called “blister fluid” ▪ White blood cells and other cells and chemicals involved in the inflammatory response come to the area of injury ▪ Months of healing are necessary including changes that occur to skin color and texture At a recent meeting of “complications in Plastic surgery” in Washington DC that was organised by the American society of aesthetic surgery several surgeons showed the results of patients following laser liposuction that now needed corrective surgery with fat grafting and other procedures. The final results, though improved, were not great. The damage done by laser liposuction seems to be permanent!

How much fat can be liposuctioned?

Liposuction, the removal of fat from under the skin, is one of the most common cosmetic surgical procedures performed by plastic surgeons.

Liposuction can be performed in the office under local anesthesia when small amounts of fat are to be suctioned from specific areas, and under general anesthesia in a surgery center when larger amounts of fat need to be removed.

But how much fat to remove?

For more liposuction information http://www.tavmd.com/liposuction.html

Types of liposuction Plastic surgeons divide major lipo into two main types groups based on volume of fat removed.

Large volume liposuction This surgery involves removal of more than 7 liters of fat. Some plastic surgeons have removed as much as 10L or even 15 L of fat at one sitting from a cosmetic patient.

This type of plastic surgery requires general anesthesia AND a hospital stay overnight.

The volume of fat that is removed is so great that the patients needs to be monitored overnight in a hospital setting. Large fluid shifts will occur with removal of so much fat and the patient can become severely dehydrated if aggressive intravenous fluid replacement is not performed.

How often do I do this type of liposuction? Never.

As a board certified plastic surgeon patient safety is my first concern and removal of so much fat, even under a controlled environment of a hospital, is just not worth it when compared to the risks that the patient will be going through. People who die from liposuction have invariably under gone large volume liposuction.

Regular liposuction volume This cosmetic surgery is the one we commonly hear about when someone has a liposuction. Tow or three areas of the body are suctioned at one time with about 5 to 7 litres of fat being removed at one time by the plastic surgeon.

The surgery is performed under general anesthesia but is an outpatient procedure with the patient going home the same day. The risks from fluid shifts are much smaller and as long as the patient drinks a few extra glasses of water recovery from this type of liposuction is smooth.The cosmetic plastic surgery patient must be informed about options in liposuction and consider safety to be the most important aspect of any plastic surgery. See some lipo photos here http://www.tavmd.com/liposuction_abdomen_photos_DC.html Although significant amounts of fat can be removed, it is better to remove fat in two settings, at different times, rather than risk disaster trying to do liposuction every ounce of fat at one time.

Arm liposuction Some people are born with fat arms, some get them with time, and almost everyone ends up with some arm laxity and a little wobble sooner or later. The distribution of fat into the arms is, like all other fat distributions, determined by our genetics. We are programmed from birth to store fat, at different times in our lives, in different areas. Typically the primary storage areas are the thighs and the abdomen. Fat storage in the arms is usually a secondary storage area but one that has much more cosmetic visibility than other areas. Requests from patients to cosmetic plastic surgeons to reduce the fat are quite common.

Where is the fat in the Arms?

Arm fat is distributed around the whole circumference of the arms but usually is more pronounced in the triceps area (the back of the arms). The area over the deltoids (back of the shoulder) also seems able to hold a good amount of fat. In contrast even though there may be a little fat below the elbow that is not an area that I have ever liposuctioned.

How is the fat removed?

Liposuction is the best method to remove fat from the arms. I usually perform the lipo in the office under local anesthesia.

One 5 mm incision is made at the elbow and another in the arm pit to allow placement of local tumescent anesthesia.

Liposuction is then performed using small cannulae of 2mm and 3mm diameter, taking out fat in little “cylinders”. The skin becomes loose by the end of the surgery as fat is removed.

After surgery, arms are wrapped for a day or two and I tell my cosmetic patients to sleep with their hands elevated to reduce

swelling. All bracelets and rings must be taken off prior to surgery and not placed back on for several days till swelling is gone.

Healing after liposuction I allow my patients to remove their dressings and place themselves in a T shirt with long sleeves. The idea is to just have a little support to decrease the discomfort from swelling.

Exercise can be started in two weeks and patients are encouraged to stretch the arms and massage them regularly until they feel fine again- sometimes about 2-3 months after the surgery!Liposuction provides a relatively quick, efficient, and effective treatment for fat arms. Patients can once again enjoy wearing short sleeved shirts and dresses and not have to worry about hiding their arms.

Liposuction of the back Unfortunate as it is, after a certain number of years on this planet and by virtue of being made of what we are, our bodies shift and flounder. That is when cosmetic plastic surgeons jump on your back if you let them.

Hormonal changes in particular lead a redistribution of fat into areas which were, in younger days, firm and taut. Their appearance in these areas is particularly disturbing and the back is one of such areas.

The Back of the body The skin on our back is the thickest skin in the body. Though not very surgeon like, I always imagine we were designed that way so that when we were a little bit more hunched over, we had a bit more protection from sharp animal teeth biting into our backs. With age skin becomes more loose but still maintains its relative thickness.

When we are young there is little fat on our backs; if we over-indulge we will eventually accumulate fat there also but typically the back is not a primary fat storage area and hence not of any cosmetic surgery concern.

Lack of exercise and advancing age will eventually lead to atrophy of the muscles of the back, but the fat stays.

The fat rolls on the back Given the redistribution and increase in fat and the weight of thick and less elastic skin, it is easy to understand how fat rolls develop on the back. To make matters worse tight bras force fat to typically rear out from under and over bra straps and where the skin is tightly held to the underlying tissues, a fold forms over which fatty skin drapes like velvet.

Removing fat rolls by Liposuction Lipo is my preferred method for removing the fat rolls of the back. I usually use a power assisted liposuction or ultrasound liposuction in this area since the fat is more tightly held to the surrounding tissues than for example, abdominal fat. I usually make a central incision and two other incisions on the sides of the body to be able to get to all of the back fat – It is a large cosmetic area of the body after all.

Cosmetic Patient expectations in liposuction of the back No matter how much fat is removed- and only a certain amount can be aspirated in any area by your plastic surgeon to ensure survival of the skin and maintain blood supply- it is almost impossible to remove all the lines/folds. We are designed to have a little laxity in the skin of the back so we can bend over without tearing apart. The cosmetic patient has to be educated by their plastic surgeon to accept some remnant folds- without much fat.

Cosmetic liposuction surgery of the back fat rolls removes vestiges of changes that time hath brought and can take us back to a thinner, more streamlined, and aero-dynamic silhouette.