Summer 2010 Newsletter

To My Patients:
Once again this bias newsletter has been delayed a bit too long, but now I am ready to inform you of a few new things happening in this office and nationally in the plastic surgery field. Our last newsletter was generally well received except for the political comments on healthcare and the communist bastard insurance companies. Had a few calls and emails on these topics.
If you hate these newsletters or me, let us know and we will drop you from the list. However, any comments you have on my prejudice meanderings are welcome.
I. Thermage: As mentioned in the last letter, Thermage, a unique high radiofrequency technology that heats up deep layers in the skin, stimulating collagen and resulting in smoother, tighter and firmer skin in most patients, but not all patients, has recently improved. The technology and our Thermage machine has been upgraded, and we are actually excited about the improved results. Aesthetic facial rejuvenation is a commonly sought goal, and there has been a growing interest in pursuing nonsurgical options if clinically indicated. You can look up the Thermage treatment and more specific explanations at www.Thermage.com. I would like to give you my quick take on it.
Monopolar radiofrequency techniques, which Thermage implements, has been used to essentially tighten skin of the upper and lower face, eyelids, neck, arms, abdomen and even thighs in a noninvasive fashion. Our new machine can now deliver a higher energy with less pain and better results. Of course this technique is not for everyone nor does it work on 100% of the patients treated, but our statistics and our happy patient numbers are improving.
I evaluate all the patients to assess whether Thermage treatment is appropriate and/or surgical intervention is advised. Amy Boyd, our trusted aesthetician, completes the treatments as she is certified by the Thermage company and has treated hundreds of our patients.
She has treated my lower face and neck three times and actually this decaying surgeon has improved. I like the results.

We are also using Thermage on patients who have had suctioning of their neck fat followed by Thermage several months later to tighten up their skin. The treatment takes an hour or so, hurts a bit so you need some oral drugs and you are back at full throttle the next day. Amy has had no complications with our patients and is ready for the summer onslaught. The main disclaimer is that it does not work well for significant loose skin, fatty necks and abdomens nor in patients with poor skin contractility.
II. News from Amy: There are two new products that have arrived just in time to save your skin from unwanted sun damage this summer.
The first is from SkinCeuticals, sheer physical UV Defense SPF 50 is a wonderful sun screen that you won’t mind wearing every day. It is a transparent, mattifying fluid. It is the only zinc oxide formula that I have ever tried that I can honestly say does not feel heavy or greasy, and my make up goes on over it without any problem.
Next, is a new product from Nia 24, Rapid Exfoliating Serum. This product can be used daily because it is so gentle. It utilizes plant-based exfoliators to keep the skin smooth and bright. This is perfect for this time of year. Sun lovers should not use alpha hydroxyl exfoliators during the summer because they can increase sun sensitivity. This product also offers the added benefit of the Pro-Niacin molecule which repairs and prevents sun damage. This product is so new that it has not even shipped yet! Let me know if you are interested and I will hold one for you.

Please call or email me with any questions.
Amy Boyd, Aesthetician
816.616.7018 or Geraghtyskincare@yahoo.com Think Thermage.

III. Carcinogens and plastic surgery: If you are a smoker and like to lie around in the suntan booth, you are doing two things that will impair your general health. Both of these habits are carcinogenic (i.e. cause cancer) and not only have a harmful impact on your health, but will lead to crinkly, crusty skin that will make you look ancient. I know the puffers and the boother patients of mine are sick of hearing me harp at them.

Most techniques in plastic surgery rely on good blood supply to the tissues and tobacco compromises those outcomes, in addition to hastening your death and dying. Baking in a booth or under the sun leads to skin cancers and the old Miami Beach fried old hag look that you hate. Come on, stop these foolish habits.

IV. Health characteristics of women with breast implants: Since we are operating on several hundred patients a year for breast implant surgery, long-term health characteristics and quality of life in patients with breast implants are important issues in my practice. In a recent article from the Aesthetic Journal of Plastic Surgery, from the department of epidemiology at the University of Pittsburgh, 1257 women who had breast implant surgery and no prior breast cancer compared to 86,000 women in the study who did not have breast implant surgery and had no history of breast cancer was completed. The results of the women in the study that had breast implant surgery 20 or more years before being recruited into the study. Total mortality rates were substantially lower among women with breast implants as was the incidence of coronary heart disease. Women with breast implants in the study had a lower body mass index throughout their adult life and were more physically active than controlled subjects. The women with breast implants were overall healthier, more physically fit and less likely to be obese.

Results of a two year old study based in Sweden on over 6000 patients with silicone breast implants followed for over ten years were presented that revealed patients actually had a statistical lowering of breast cancer patients with breast implants. Of course, this may also be due to certain characteristics of the patients in the study from their age, their higher parity and lower body mass index. Basically, like the Pittsburgh study, I feel like women who have breast implant surgery have less breast tissue, are more apt to be in shape and follow a better diet which may lend to the fact that there is a slight decrease in breast cancer occurrence. We have known for years that the myth of an increased incidence of breast cancer with breast implants is false. Both of these studies were welcomed to ease patient’s worries.

V. Smart lipo, i.e. laser liposuction: For several years I thought I was too stupid to do smart lipo. Truthfully I felt like smart lipo or using lasers to enhance the treatment or skin shrinkage during liposuction was in fact a bit of a hoax. Using a laser concurrently with liposuction costs more, takes more time and there have been no good statistical studies to show that it works better. Of course, the men and women selling the machines and those surgeons who have purchased the expensive machines have other prejudices.

There is a welcomed letter from Dr. Mark Jewell, a former Kansas University medical school graduate and now a clinical professor of plastic surgery in Portland, Oregon. His commentary was published in the recent spring Aesthetic Journal.

The goal of lipoplasty or liposuction is both the reduction of volume of fat and potential tightening of the skin preserving good blood supply and lymphatic drainage to these structures. In the case with lasers, the use of frequencies that are designed to target vascular structures becomes a questionable benefit and has additional risks associated with this technology. There have been many other surgeons who have written about this topic of finding equivalent outcomes between conventional liposuction or lipoplasty and laser liposuction. Now it seems that commercialism and marketing to define the patients results As Dr. Jewell states “there seems to be a big rush to sell laser boxes and to promote the laser assisted lipoplasty, but the data that shows science, safety and improved outcomes over existing lipoplasty technologies and patient satisfaction are missing”.

I have improved my techniques since 1985 using smaller instruments with more gentle sculpting techniques. Having suctioned roomfuls of adipose tissue since 1985, I will continue to use the standard liposuction techniques until someone shows me convincing evidence that lasers indeed are better.

VI. Healthcare reform—oh, no—oh, yes: In my last correspondence I briefly brought up the need for healthcare reform for our burgeoning costs and the 50 million uninsured. I was all for it, but if I was in congress I would not have voted for the passage of this healthcare bill. It is going to be more expensive than represented and it is so complex, I do not think anyone understands it. We do need change, cost containment, tort reform and we need to penalize the communist bastard insurance companies. Now the health insurance companies are lobbying federal and state officials to ward off the strict regulations of premiums and profits under the new healthcare law. First they oppose the healthcare reform and now they are trying to influence how the new laws will be implemented. More than the fox guarding the hen house, it is more like the rat protecting the garbage.

My fellow physicians who rely on insurance reimbursement as well as Medicare and Medicaid payments are continuing to get screwed. For years overheads have increased, reimbursements decreased, making a profound effect on them. The fat has been cut out by the insurance company and many good surgeons and physicians are considering alternative careers.

We can only hope that some aisle crossing legitimate politicians who have the public good in mind will get together and come up with some simple and understandable solution. Today a simple legitimate plan for the public good does not exist.

Conclusion: Sorry, but had to get that healthcare stuff off of my mind temporarily as some of it enrages me. Before the summer ends, I am sending out a couple more of these newsletters. I hope you find this somewhat informative.

Next we will talk about fat injections in breasts, lipodissolve and Mesotherapy, mini lifts versus real face lifts and what types of doctors should be performing cosmetic surgery and other prejudiced thoughts. Please let us know if there is anything you would like to cover and/or if you wish to be off of this little email list. Exercise, eat right and put some sunscreen on for God’s sake.