Monthly Archives: October 2012

Hurricane Sandy hits… Cleveland

Hurricane Sandy hit the coast yesterday, and I’m sitting home watching news coverage on CNN (okay, that and alternating between the marathon of horror movies on AMC.  It’s nearly Halloween, after all!)  Why am I home at 11am on a Tuesday?  Because the power is out at our office.

I was on my way in to the hospital this morning to round on my patients who had surgery yesterday when my office manager rang in to let me know our office was one of the 7,700+ places in Mentor, OH without power, just another casualty of Hurricane Sandy.  And I’m grateful that our patients our generally being treated for non-emergency conditions, so rescheduling them isn’t a huge problem.  In fact, we only had a handful of people scheduled for today, as we were actually doing training for our new electronic medical record.  That would be tough without power.  So I’ll do my part and stay off the roads today.

How are you weathering the storm?

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Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.

The Skinny on Nonsurgical Fat Removal

It’s a girl’s dream machine- get massaged gently with a warm metal paddle for an hour a week, and melt your fat away.  I’m describing the VASER Shape, a device made by Sound Surgical Technologies which uses ultrasound to literally melt fat.  But does it work?

There are two ultrasound-based fat removal methods on the market today (there is another type of non-invasive fat removal which uses cold to rupture fat cells, but I’m going to stick with heat-based methods today). VASER Shape and Liposonix both use ultrasound energy to reduce fat.  VASER Shape claims to release fat from adipose cells.  The fat is then taken up by your lymphatics, the drainage system which processes extra fluid in our bodies.  There is one published abstract, which is a summary of a study, showing that lymphatic tissue does in fact have more fat in it after a VASER shape treatment, but there is no actual information on what happens to the fat from there.  (See a list of the clinical studies available on VASER Shape here.)   The fat could be removed by your body, as the makers of VASER Shape claim, or it could be processed by your liver and just redistributed to another fat storage area.  We just don’t know.

The makers of Liposonix claim that their type of ultrasound energy actually destroys the fat cells, which are then processed by the body and removed.  The papers published by the makers of Liposonix are available for download on their website.  The studies that are available do show actual fat cells ruptured by Liposonix.

So do these methods actually work for fat reduction?  Both VASER shape and Liposonix have published studies showing modest fat reduction (think 1-2 cm around the waist, after several treatments).  Price ranges in the $1500-$2500 dollar range, depending on what area you treat and how many treatments you have.  The biggest difference seems to be comfort level: VASER Shape is warm, but not uncomfortable, but treatment with Liposonix often requires pain medication.

I think the best overview of these devices comes from looking over real patient reviews- realself.com is chock-full of patient reviews and pictures.  I’ve read over the reviews for both VASER Shape and Liposonix, and they’re both about half positive and half undecided or negative.  I think if you want to try one of these devices, you certainly cannot expect anything near surgical results.  That being said, there is no other way to spot reduce without an invasive procedure.  One type of win-win situation is if you can find a surgeon that will apply the costs of your VASER Shape or Liposonix toward a surgical procedure, if you finish the course of treatment and decide the results are not enough of an improvement.

Have you tried one of these non-invasive treatments?  What was your experience?

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Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.

What is a Mommy Makeover?

I’m tired of lists, so today I’m approaching a different topic.  Often I’ll have patients ask me about topics from the popular press, and I find myself Googling the term (e.g. vampire facelift) just so I can understand what it is in medical terms before I explain it back to them in layman’s terms.  So today I’m going to explain a popular term that’s been around for several years- the Mommy Makeover.

courtesy of office.com

The term “Mommy Makeover” first entered the popular press around 10 years ago, although it’s difficult to pinpoint the exact origins of the term.  The phrase itself is directed at women who have just finished their childbearing years, and do not plan to have more children.  The idea is a single operation that restores them to their pre-pregnancy body.  So what is that operation?

That’s the tough part, because the answer is different for everyone.  In general, however, surgery addresses two main body areas: the abdomen and the breasts.

1. The abdomen.  After having kids, bellies get stretched out.  There’s often a little fat left in the lower abdomen, and the abdominal muscles themselves are further apart (the six-pack you would have if you went to the gym every day).  There are a couple ways to approach this:

  • A mini-abdominoplasty (or mini-tummy tuck).  This just removes the excess fat and skin below the belly button.
  • A full-abdominoplasty.  In addition to removing excess fat and skin, the abdominal muscles are tightened, and the belly-button is “transposed”.  It’s not actually moved to a new position, but so much skin is removed that a new opening is made for the belly button to come out through.

2.  The breasts.  Whether you breast-feed or not, the hormonal changes associated with pregnancy often cause the breasts to look deflated and flattened.  This can also be fixed in a couple of ways.

  • An augmentation with breast implants will replace lost volume.  Sometimes this extra volume is enough to raise the breasts back to where they were pre-pregnancy.
  • A mastopexy (or breast lift).  This procedure removes the excess, stretched skin, lifting the breasts to their pre-pregnancy position.  Sometimes a lift is enough to achieve that youthful, pre-pregnancy look.  Sometimes breast implants are still needed to replace volume, and this is done in combination with a lift.

As you can see, a “Mommy Makeover” is not a one-size fits all type of operation.  It’s more of a description of the problem areas that are approached.  Since the goal is to restore your body to what it looked like before you had children, it addresses the areas which change the most during pregnancy- the breasts and the abdomen.  But how these areas are addressed is specific to each individual patient.  And if you have other problem areas, for example saddle-bags in the thighs, these areas may be addressed as well with other techniques such as liposuction.

 

Are there other terms in the popular press that you have found confusing?  Would you like clarification on what these terms mean?

 

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Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.

A Freckle by Any Other Name….

I say freckle and you think cute little kid with a smattering of light brown spots over her nose, right?  Heck- I was once that little girl myself.  Freckles are adorable, until they become…. age spots. According to the dictionary, both freckles and age spots are “light brown pigmented spots, caused by the sun.  But “freckle ” is cute.  “Age spot”, aka liver spot…. definitely not so cute.

courtesy of office.com

Any skin pigmentation like a freckle is caused by the sun.  The melanocytes in our skin (cells that produce melanin, or pigment) start clumping together, instead of keeping their distance.  So how to get back to that creamy smooth skin of youth?

1) SUNSCREEN!  The cells that make pigment are stimulated by the sun.  If you don’t protect your skin from sun exposure, anything else you try is fighting an uphill battle.  See my recommendations for sunscreen here.

2) Topical products.  Even with prescription strength products, results take a minimum of 6 weeks.

  • Tretinoin causes those melanocytes to become more evenly distributed in your skin.  It can be very irritating, however, so I often recommend starting it every other day at first, just at night.  You can slowly work up to every day.
  • Hydroquinone causes the melanocytes to stop making melanin.  It can be used twice a day.

3) Attack the damage directly.  A broad-band light treatment (BBL), attacks the pigment directly.  Similar to a laser, the BBL uses specially filtered wavelengths of light that are absorbed by the melanin in your skin.  The treatment is administered in an office-setting, and is only mildly uncomfortable.  Afterward you may feel like you had a mild sunburn for an hour or two.  Over the next couple of weeks, the pigment in those sun-damaged areas will turn dark like coffee grounds or pepper, and migrate to the surface of your skin, ultimately flaking off.  Two or three treatments are often necessary, but each treatment takes less than an hour.  How long the results last depends on how good you are about staying out of the sun, and wearing sunscreen.  But most individuals need yearly treatments to maintain results.

Have you had a BBL treatment?  What was your experience like?

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Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.

It’s All in the Eyes

The eyes may be windows to the soul, but they’re also windows into our age.  The delicate skin surrounding your eyes is the thinnest in the body- only one or two cells thick in places.  And baby, does it take some abuse!  Between allergies, squinting in the bright sun, or just a full-on smile, the skin around your eyes has plenty of reasons to develope fine lines and wrinkles.  But delicate skin may not be the only reason your eyes are giving your age away:

courtesy of Office.com

Patients often complain about the sagging skin on their upper lids, but they don’t realize their drooping eyebrows are part of the problem.  Here’s a little test for you: go look in the mirror and stare at yourself while you relax your forehead.  Many people constantly and chronically raise their eyebrows to compensate for a sagging forhead.  So if you have horizontal wrinkles across your forehead, you might be raising your eyebrows without realizing it.  Once your forehead is completely relaxed, reach up and feel where your eyebrows are.  Are they at the edge of the bone at the top of your eye, or are they below it?  For women, eyebrows should be slightly above the bony rim of your orbit.  Men’s eyebrows should be right at the rim.  But with your forehead relaxed, you may find your eyebrows down below this bony rim.

So what does this mean?  If you find your eyebrows are a bit low, it just means that any surgical approach to making your eyes look younger, such as an eye lift (blepharoplasty), may need to take that forehead into account as well.

No another question- do you have bags under your eyes?  Are you tired of people asking you why you’re so tired?  Well once again, you may not have just your eyes to blame.  As we age, the fat and connective tissue that gives us those nice full cheeks begins to descend, resulting in hollowed out cheeks and making those bags under the eyes much more noticeable.  Thus restoring volume in the cheek will actually make the lower eyelid look younger.  There are a couple of ways to do this:

  • With fillers.  Using a filler such as Radiesse to plump up the cheek can really improve the look of the lower eyelids.
  • As part of an eyelift.  When I perform surgery on the lower eyelids, I resuspend that fat and connective tissue back where it was, giving your cheeks a much fuller look.

So now you know how areas like the forehead and cheeks can contribute to aging of the eyes.  In a later post, we’ll explore how the eyes themselves age, and what you can do about it.

 

Do you have any questions about aging eyes?

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Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.

How Many Ways Can you Skin a Cat?

I know I’ve talked about skin cancer before, but previous blogs covered mostly preventative terms.  Today I would like to explain some of the ways we treat it.  Doctors love their medical terms (and I’m no exception), but throwing out words like “Mohs”, “shave biopsy” and “punch biopsy” right after telling someone they might have skin cancer is more than a little confusing.  A little time here may save you from running to the dictionary next time you see your dermatologist or plastic surgeon.

 

courtesy of Office.com

Lets talk biopsies first.  A biopsy is a way to take a sample of a suspicious spot, or lesion.  We send the biopsy to the pathologist, who tells us if its cancer or not.  There are a couple ways to do this:

  • Shave it– using what is basically a razor blade to shave off the suspicious spot can often remove the entire area.  This is aptly called a shave biopsy.  These biopsy sites are usually covered with a Band-aid, and left to heal on their own.  This type of biopsy works very well, but sometimes you need to know how thick the spot is (particularly if you are worried it may be melanoma).  In that case you do what is called a…
  • Punch biopsy – this uses what basically looks like a tiny cookie cutter to remove a small piece of skin all the way through (full-thickness).  Sometimes I’ll put a stitch in these to close them, sometimes I let them heal in on their own.  The benefit of a punch biopsy, as I said above, is that it lets the pathologist see the whole thickness of the skin, which is important for melanoma.

So now we’ve sent the tissue to the pathologist, and he tells us it’s a skin cancer.  There are a couple different ways to treat it.

  • Wide local excision.  This means that the surgeon (me) takes off the skin cancer, with a margin of normal tissue.  Often I will send this to the pathologist for what is called afrozen section, meaning he or she will freeze that bit of tissue and look at it to make sure I got all the cancer.  This doesn’t work well for melanoma, and still isn’t 100% accurate for other types of skin cancer.  We only know for sure after the pathologist processes the tissue with chemicals and special stains, which takes a few days.
  • Mohs surgery.  This is named after the doctor who created it, and is only done by specially-trained Mohs surgeons, who are dermatologists.  This type of surgery is done in an office, using numbing medicine.  The difference between this and a wide local excision, is that the Mohs surgeon first takes out the cancer, then takes out just the rim of the wound and looks at that flat under a microscope himself (as opposed to sending it to a pathologist).  This concept is a little hard to explain, so check it out here.  The take-home point is that Mohs surgery takes a little longer, because the surgeon takes the cancer out in multiple steps.  But they remove as little normal tissue as possible, because they look at it under the microscope at each stage, and when you’re done with the Mohs surgery you know your cancer is gone.

So why use one surgery or another?  On the face, which is high-value real estate, I often refer patients to a Mohs surgeon unless the skin cancer is very small.  Then either he or I will close the resulting wound.  On other parts of the body, where the size of the scar isn’t as important, I will often take of the cancer myself, with just a little bit more tissue to make sure we got it all.  And of course I always discuss the options with the patient and let him or her decide.

Do you have any questions about types of treatment for skin cancer?

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Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.

5 Things You Might Not Know About Botox

Yep- I’m on a roll with my “things you might not know.”  But since this blog is a chance for me to share all the things about Plastic Surgery that I find fascinating, it’s a pretty convenient title.  Today I’m going to talk about a topic that is near and dear to Plastic Surgery- Botox.

Botox has been FDA-approved for over 20 years, and it’s first use was actually to treat muscle spasms around the eye.  It is derived from botulinum toxin- yep, the bacteria that grows in canned food gone bad.  Botulinum toxin prevents nerve cells from communicating, which makes it widely useful in medical terms.  It has been used to treat everything from heavy sweating to muscle spasm to wrinkles.

Botox is only one of several botulinum toxins available on the market.  Just like Xerox becoming synonymous with making copies, Botox has become synonymous with treating wrinkles.  But there are actually a couple different brands of botulinum toxin A on the market, including Xeomin (Merz), and Dysport (Medicis).  Doctors will offer these injectables at different prices, depending on what kind of special the manufacturer is offering them.  But there is actually not a lot of data out there giving comparisons between different formulations, especially regarding dosages.  So ask your doctor how long he or she has been using the formulation offered to you.  That way you can be sure they’re comfortable with the dosage of that particular medication.

The only FDA-approval Botox has for cosmetic use is for glabellar lines (those little wrinkles you get between your eyebrows).  Does this mean it should not be used for other wrinkles?  Not necessarily.  Seeking FDA approval is a long and complicated process.  Many drugs are used for “off-label” uses, meaning the use is outside the use for which the company sought FDA approval.  An example would be statins, the category of drugs that lower cholesterol.  Most of these drugs are FDA approved to lower cholesterol, NOT to prevent heart attacks.  We know that lowering cholesterol does prevent heart attacks.  But unless a company actually follows its patients to prove that they have a lower incidence of heart attacks, they cannot have their drug FDA-approved for this use.  It’s much easier to prove that your drug lowers cholesterol, as it would take many more patients and many more years to prove that your drug reduces the risk of heart attacks.  So just because Botox is only FDA-approved for the lines between your eyebrows does not mean that it can’t be safely and effectively used for other areas.

Botox lasts longer the longer you use it.  Well… technically the Botox lasts the same amount of time.  But the more regularly you use it, the weaker the muscles you’re treating get.  This means that the muscles which make those little wrinkles you hate get weak and wither away (just like your biceps would, if you quit going to the gym!).  The upside is that if you’re consistent about getting Botox as it wears off, you can save money later on by spacing out your treatments.

Botox is easy to inject, but hard to inject correctly.  Think about that- any medical professional who is handy with a syringe and needle can order Botox and inject it.  From dentists to gynecologists, many different types of medical professionals are trying to cash in on the lucrative market that Botox, and other botulinum toxin derivatives, provide.  But unless your doctor is trained in cosmetic surgery, he or she is unlikely to be intimately familiar with the underlying structure of facial muscles that Botox targets.  This means less effective treatments for you, and possibly a higher risk of complications.

 

Do you have any experience with Botox that you would like to share?

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Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.