December 2010 Newsletter

December 2010 To My Patients, Another blistering fast year is about to end—can you believe it’s been 11 years since the eve of 2000, the paranoia of the new millennium, storing water and canned food, readying for the new millennium holocaust? It didn't happen, we're alive and we've struggled through another election last month. No more political ads for maybe another year-gracias a dios. Now it’s time to think of your sagging face and neck, your wrinkles and skin, your breasts, your belly and hip fat and what you can do to think better about yourself. Truly a horrible statement but it’s time to keep you up on new plastic surgical happenings and some cheap advice. I've had requests for opinions on procedures and topics and what I might think is advisable without looking at you. Again, if you hate these email newsletters let us know. I .Brow lift and Blepharoplasty: Several patients requested information regarding brow lifts which involves lifting up the brow and forehead from the eternal pull of gravity and removing excess eyelid skin, muscle and fat to get a brighter look. Moderate improvements can be completed with Thermage and injectables, but major permanent improvements can only be attained with surgery. The worst results that you may see in magazines, the look of Kenny Rogers, Joe Pesci, Carol Burnett and Joan Rivers who are all overdone. Kenny actually looks like he is sitting on a live rabid wolverine. When you acquire that puffy eyelid look, your skin hangs down to your lid margins, an upper blepharoplasty—excision of excess skin and muscle, is usually appropriate. In half of blepharoplasty cases, brows may need to be lifted as they, too, fall making you look a bit more haggard and tired. Brow lifts are wonderful procedures and I love to do them. Unlike 15-20 years ago, a large scar from ear to ear in your scalp was necessary. Now small incisions can be made, elevating your forehead over your brows subperiosteally and removing some of the frown line muscles completed on a general anesthetic outpatient basis. It takes several weeks to be publicly acceptable but rather marked results ensue. Most of my patients who have not seen friends or relatives for some time tell them that they look “so rested” and “the vacation did you well”. The Kenny R look can be avoided. Look up some of our pre and postoperative photographs on our website. You can look refreshed without looking frightened. II. Mesotherapy and/or LipoDissolve: Currently these treatments are dead, but efficacy is being investigated. LipoDissolve was performed through a series of microinjections of phosphatidylcholine deoxycholate to permanently dissolve fat. The hardened fat cells break down in a few weeks and contents are excreted through the body. Over the course of the treatment period, the fat cells in the target areas are permanently eliminated. This treatment has been under great consternation by our American Society of Plastic Surgeons and it currently is not recommended. I used it sparingly on some touchup liposuction patients with moderate results. Treating large areas of the abdomen, face, neck and arms is certainly not indicated and at times fraught with some great complications. All of the centers throughout the United States for LipoDissolve have closed and justifiably so. Our task force for LipoDissolve through the American Society of Plastic Surgeons is further investigating the efficacy of this treatment and it may be another year before any final recommendations are given. If someone recommends this treatment for you, your family or friends- run. III. Types of Physicians Performing Plastic Surgery: My not so red necked feelings against dermatologists doing facelifts, oral surgeons putting breast implants in, gynecologists completing liposuction procedures and podiatrists injecting LipoDissolve in fat ankles is the same. These docs simply do not have the expertise and are not trained well enough to perform these procedures. These specialists are crowding the field when in the past this was in the sole domain of plastic surgeons. Although the trends seem unstoppable, plastic surgeons still maintain higher standards than these noncore physicians and continue to take the lead in education and safety, not just for the patient, but for the physicians. So please let the buyer beware and check out who is manipulating your anatomy. Even though they may be doing these procedures at some cut rate discount, you may suffer the cut rate result. IV. Botox Boutiques: Aside from every type of physician, nurse, layman or priest who has ever had a syringe and a needle in their hand injecting Botox and fillers, many of the Botox boutique spas have been running rampant. Having your nails done, your hair puffed and your Botox injected may be advantageous including speed and convenience, but are the results reproducible and safe? Without the physician’s guidance, I’m concerned regarding the adverse effects of being treated by some noncore practitioner for safety concerns. Many of these mini med spas have trained injectors, off site physician sponsors and claim marvelous results at a lower cost. Many of them are unsuitably trained injectors using the cookie cutter approach to the face with a lower quality of aesthetic results. Granted, I’ve seen some good results from these sites and some disasters. These boutiques rely on turning over a high volume of patients to make up for the small margin of profit with a lower price for the injections. Our state and national medical societies are closely scrutinizing these medical treatments by non medical people. Lower prices do not always result in premium service. Be cautious and hesitant. Most people are willing to spend a little more money to make sure that the procedure is held to an optimum standard. Look at some of the Botox injection results on your fellow humans with paralyzed expressionless faces and the results on the overuse of fillers making lips look overblown and artificial. Hollywood is full of these plump fish lip looking starlets who couldn't purse their hardened lips if they were sucking on a lemon. So please seek conservatism. V. Amy’s Boutique Facial Packages: After all the above ranting, our trusty esthetician, Amy, is offering Thermage to the face, eyelids and neck by her and Botox and fillers administered by me. Check with our office for these little perks. We're not advertising it or pushing it, but you can save a few bucks by combining these treatments. Amy does Thermage treatments mentioned in our previous blogs, a noninvasive tightening by high radiofrequency wave treatment heads on various parts of the anatomy. It works in most cases. I've had my neck treated four times and now look more teen like or not. Lower Face Rejuvenation for $2000 includes: Eye Rejuvenation for $1400 includes: Thermage Thermage Juvederm (1 syringe) Latisse TNS Recovery Complex Botox Eye cream VI. Fat Injections in Breasts: There has been an increased interest in autogenous fat injections for breast augmentations since the early ‘90s. That is, injecting your own fat from areas of liposuction into your breasts to enhance their size and shape. This procedure has been controversial and in 1987 The American Society of Plastic Surgeons condemned autogenous fat transfer to breasts for cosmetic purposes. Now the wheel has turned and those physicians condemning this practice are slowly jumping on the bandwagon to improve results. I'm not jumping on that bandwagon with them until safety and efficacy is assured. The concerns have been survival of the fat grafts, cysts and fat necrosis, i.e. dead fat, interference with breast screening and modest results. Granted there have been great refinements in the harvesting and grafting of fat, but there have been no controlled trials and there is no standardized way in measuring the results. My greatest concern was the potential of mimicking and/or hiding a breast cancer due to calcification cysts and potentially undetectable tumors. Mammography has improved and to date there have been no increased incidences of breast cancer in very small studies, but only in very small studies. There needs to be some large, multi-center controlled trials to further investigate these issues. It will take years to perfect this if it is at all possible, so please don’t have this procedure now. Our saline and silicone breast implant patients will attest to their favorable and happy results. VII. New Mammography Guidelines: Since we operate on several hundred women a year for breast implants, we have been recently concerned regarding the United States Preventative Services Task Force (USPSTF) no longer recommending routine screening for women between the ages of 40 and 49 for yearly mammograms. The USPSTF stated last year and reiterated earlier this year that these routine mammograms do not rely on evidence based medicine and that they cause more harm than good. This has been a numbers game touted by professors of mathematics manipulating arithmetic into women’s survivability. Of course the government, trying to save money, jumps on these numbers. I hate their recommendations as do the American Cancer Society and the American College of Surgeons. As reported by the American Cancer Society, the breast cancer death rate for women younger than 50 has dropped over 3.2% each year since 1990. This is all not due to mammographic detection, but it has helped extensively. The older you get, the more efficient mammography is as the amount of breast tissue change is less solid and more fatty and easier to see through. But this is not a good enough reason to deter the 40 to 50 year olds. 23% of all breast cancers occur in women under 50 years old, the numbers of women life saving years saved by screening mammography is 40% using screening mammography alone and the remaining 60% of women life saving years saved is in women over 50 years old. None of the USPSTF has any practical experience in breast cancer and only issue an edict which is inane. Screening mammography starting at the age of 40 saves lives. Breast cancer is a serious health problem facing adult women and mammography is part of the solution beginning at age 40 for average risk women. So believe the recommendations of the American Cancer Society and the American College of Surgeons and start your mammography screening at the age of 40. If you have more concerns talk with your physicians. I'm convinced this is a benefit to my patients. VIII. Healthcare Reform: There are so many things about the current system that I like, and dislike, but my rantings may exceed my knowledge at this time. Read more about it, let your congressman know what you think (even though the elections are over, most of them are deaf to our wishes), raise a little hell. The new law is a riddle for all political analyst lawmakers and those for and against it. A couple of positives: insurers are now barred from dropping coverage after a beneficiary becomes sick; my son, the great dependent, can stay on our policy until age 26 and the lifetime limits on how much insurance plans will pay for treatment are gone. The great negative is my health care premiums have gone up 25%, and we've had no claims in two years. The communist bastard insurance companies are consolidating and remain low lifers with no concern for us, the common man. Autonomy in physician practices has decreased and healthcare costs have risen since the law was passed. No one has the answers. We need help. Conclusion: Let us know what you might like or dislike from these rantings or come by the office for some free advice. Have faith we'll dig out of this economic depression, count your blessings each day and focus on the good things about your life. Check out our website at www.geraghtymd.com and American Society of Aesthetic Plastic Surgeons at www.plasticsurgery.org. Healthy and safe holidays. Sincerely, Thomas Geraghty Amy’s Thermage Packages