By: Carolynn Grimes
ThePlasticSurgeryChannel.com

Unapproved and potentially dangerous breast implants sold overseas stir debate over the safety and risks associated with aesthetic plastic surgery.

According to the author Alexander Edmonds, the recent scandal involving unapproved and potential dangerous breast implants sold by a French manufacturer should raise questions about the safety and risks surrounding all aesthetic surgery.  Edmonds received a PhD in anthropology from Princeton and has written on the social dimensions of plastic surgery.  He is the author of “Pretty Modern: Beauty, Sex and Plastic Surgery in Brazil,” and is assistant professor of anthropology at the University of Amsterdam. Edmonds says, “With most surgeries, the risks are weighed against expected health improvements. But aesthetic procedures, by definition, do not improve health.”

Dr. Jeffery Kenkel, President of the American Society of Aesthetic Plastic Surgery (ASAPS) disagrees. “What would be next? Will physicians be banned from performing procedures on cleft lip children because it doesn’t prevent or cure disease?”

According to reports, the recent breast implant scandal could affect up to 300 thousand women world wide.  The French manufacturer, Poly Implants Protheses (PIP) has admitted to authorities it was producing and distributing breast implants with a cheaper industrial grade silicone instead of a medical grade silicone which could be harmful according to officials. The implants have also shown to have a high rate of rupture. Edmonds says, “The fact that a surgeon is putting in implants sends a subtle message that they are safe.”

Edmonds points out that one response to the PIP scandal is a ban on doctors performing cosmetic breast augmentation altogether. He says, “It’s well known that breast implants of many types can cause burning pain, loss of sensation, hardening of breast tissue and serious infection.”     Breast implant expert, scientist and  Vice President of  The Aesthetic Society Education and Research Foundation (ASERF) ,  William P. Adams, Jr, MD says he  does not  agree with this conclusion,  “it  appears he is  quoting the  exceptions and not the rule, in fact the science and data says when implants are used with modern techniques that outcomes are optimized, patients have very few issues and have  an extremely high degree of satisfaction.”

The FDA says both saline and silicone breast implants in the U.S. are safe.

He quotes the FDA’s 2011 ‘Update on the safety of silicone gel-filled breast implants’, which states that: “Frequent complications include implant rupture, wrinkling, asymmetry, scarring, pain, and infection, among others.” But Kenkel says, “That’s not true.”  Last year the FDA (Food and Drug Administration) concluded that the silicone-gel implants are safe as long as women understand they come with complications.  According to Kenkel, “Breast implants are one of the most studied medical devices in the history of the FDA. Both saline and silicone implants that are manufactured in the U.S. are safe.”

However, Edmonds says the FDA made clear that local complications are not uncommon. He quotes the FDA’s 2011 ‘Update on the safety of silicone gel-filled breast implants’, which states that: “Frequent complications include implant rupture, wrinkling, asymmetry, scarring, pain, and infection, among others.”

Kenkel says Edmonds is confusing the issue of an unethical manufacturer using non-medical grade silicone and the legitimacy of plastic surgery. “When surgery involves a medical device that was fraudulently manufactured, it’s more logical to question the manufacturer than question the patient’s motivation for wanting the surgery.”

Dr. Leo McCafferty, President Elect for ASAPS says, “Cosmetic Surgery, if performed by a board certified plastic surgeon in a properly licensed and accredited facility has never been more safe.”   Dr.  Adams  agrees. He says, “If we look at the benefits of cosmetic and plastic surgery procedures to patients, it’s very well documented that patients have incredible elevation of their quality of life, and there’s data to support that.”

From 2009-2010, there was almost a 9% increase in the total number of cosmetic surgical procedures, with over 1.6 million surgical procedures this year, according to ASAPS. It is also reported that the number of breast augmentations alone have tripled during that same time frame with a 90% plus satisfaction rate.

Edmonds says his goal in the piece was to add to the already extensive debate about the risks of cosmetic procedures and whether consumers are adequately informed about them.  Drs. Kenkel and Adams , both Board Certified Plastic Surgeons in Dallas, Texas,  agree that patients need to be more educated on procedures and say patient education by qualified Board Certified Plastic Surgeons is a top priority in their practices.  In the end, they say,  an informed and educated plastic surgery patient results in a better outcome for the patient.

McCafferty states that anyone considering plastic surgery should “seek properly trained Plastic Surgeons certified by the American Board of Plastic Surgery and members of ASAPS and ASPS (American Society Plastic Surgeons). These surgeons operate in accredited, licensed facilities using safe effective FDA approved products, devices, implants and equipment.

ThePlasticSurgeryChannel.com

Cosmetic gynecology is no longer taboo and has become a hot topic among plastic surgeons in the last few years. In fact, cosmetic gynecology is one of the fastest growing segments in cosmetic surgery today.

Most common procedure in cosmetic gynecology

Vaginal rejuvenation surgeries such as labia reduction surgery known as labiaplasty, are becoming increasingly popular, according to the AmericanHealthAndBeauty.com. Dr. Christine Hamori, a board certified plastic surgeon from Boston says, one of the reasons behind this growing trend is current styles in fashion and the media depicting celebrities in sheer undergarments.

Dr. Hamori says more and more women are coming into her office and requesting an alteration to the appearance of their labia.  Hamori says, many women don’t want any of the inner labia extending beyond the outer labia.  She says this sagging process can result from a number of things including childbirth, weight gain or loss and the sagging that occurs naturally with age. “Many women who are bothered by this condition say they feel sexually incompetent,” according to Hamori.

Cosmetic reasons are not the only reason this segment of plastic surgery is growing.

Hamori says, women will undergo labiaplasty for daily life functioning reasons, such as discomfort when wearing tight-fitting clothing, when exercising or during intercourse.

“The treatment is basically trimming a small amount of the labia minora, so that it doesn’t show much beyond the labia majora,” says Hamori.  She says, another option for older or peri-menapausal women is to inflate the labia majora.  “As we age, just like the face loses weight, your labia majora deflates,” states Hamori.  She says in order to build up the labia majora we can use injectables to puff up the area. Some of the injectables Hamori uses are Sculptra and Radiesse.  Hamori says, “This gives women who are concerned about this area more confidence and can affect their emotions and their intimate relationships.”

Because this is a relatively new field of plastic surgery, Hamori advises that anyone who is considering a procedure of this type should first consult with a board certified plastic surgeon who is well-trained and regularly performs these types of procedures.

What is non-surgical fat removal?

Dr. Bruce Van Natta, a board certified plastic surgeon from Indianapolis, Indiana says, “For the most part the patient gets up after the one hour treatment to an area, walks out and they can play tennis, work out or go the kids soccer game and really not have any downtime, so clearly there some appeal.” He says not only is there no incision or downtime, but these new procedures are mostly pain free. Instead of typical fat removal surgeries where an incision is required, these procedures use invisible ultra sound and radio frequency technology.

Recently approved by the FDA is a new non surgical fat removal technique called Zeltiq that involves chilling the fat.

Dr. Christine Hamori, a board certified plastic surgeon from Boston, Massachusetts says, “The best candidate is someone that has some fat and the skin is a little loose. How the machine works is it’s an external suction device that slurps the skin in and chills it.  The chilled fat cells are found to be more sensitive to cold than the nerves, muscles and any other cells.” Hamori says it’s very effective for both men and women especially for the area around the waistline.

The treatment takes only a couple of hours depending on the size of the area being treated, and patients should see results in about three to eight weeks. However, according to Dr. Van Natta, these new treatments may not be for everyone. “There are limits here, there’s still a place for full blown liposuction. If you have a big area, or big saddle bags, these treatments aren’t going to do the trick,” says Van Natta.

Dr. Peter Fodor, a board certified plastic surgeon from Beverly Hills, California says the gold standard for fat removal is still liposuction, but says there is definitely a future for these new techniques. Fodor states, “I think we should keep an open mind. I think initially, non-surgical techniques will be used mostly for patients who need very minor corrections or somebody who needs a little bit of a touch up after regular liposuction.”

These doctors agree, the best advice for anyone considering non-surgical fat removal procedures, is do your homework and go to a board certified plastic surgeon who can help you decide what the best treatment for is for you.

In today’s media-saturated culture, aging gracefully is a dying art. Women find themselves competing with images of young Hollywood starlets – or even erstwhile starlets who, now in their 40s, 50s and 60s, have undergone artful cosmetic procedures to maintain the image of youth. Consequently, more and more middle aged women – and men, too – are considering a little nip and tuck themselves to stay forever young.

But when a facelift goes wrong — and they often do — the mistakes are very visible. People on the lookout for signs of plastic surgery are familiar with the stretched skin, “cat-like” face that shows evidence of a surgeon’s tampering. And, few would volunteer to have the tightly pulled visage of a Jocelyn Wildenstein or Joan Rivers, or the perpetually surprised demeanor of Sly Stallone.

“There are reasons why these [things] happen, and there’s a way to prevent this from happening,” notes Dr. Daniel Man, a board certified plastic surgeon in Boca Raton, Florida. In his practice, Dr. Man strives to create a natural-looking face through surgery. And what he avoids, most often of all, is giving his patients the “pulled-skin look” that would draw attention to their time under the knife.

During an interview at the 2009 meeting of the American Society of Plastic Surgeons, Dr. Man explained the common pitfalls of facial plastic surgery, and shared some little-known trade secrets for avoiding them.

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During the typical facelift operation, the patient’s ears are subjected to a lot of tension, which causes some drooping of the ear canal, Dr. Man notes. And as the surgeon adjusts the patient’s facial skin and muscle during the face lift, the altered ear drops down, producing extra skin to deal with and dispose of. Patching the patient back up from this usually means producing the “pulled” look. Signs of surgery are conspicuous, as well.

“If they have a lot more skin to remove, the incision is longer,” he says. “And if it’s longer, it’s visible.”

Dr. Man’s method – published in July 2009 in the Aesthetic Surgery Journal – is to use a surgical technique that slightly elevates the patient’s ear and prevents it from drooping. From there, he uses a bit of the patient’s transplanted fat to build up the mid-facial area.

“So, we do two things,” he explains. “The ear is little higher and there’s more volume. We still do the muscle work, but is there less or more skin? There’s less. And if there’s less skin, the incision is shorter and can be hidden inside the ear.”

Dr. Daniel Man’s result: A facelift that doesn’t so strongly resemble a “lifted” face, and whose surgical evidence is well-concealed. It also offers the patient slim chance of ever being confused with the family cat.