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Breast Reconstruction Underutilized

Breast Reconstruction Underutilized

Pink ribbons remind most of us that October is National Breast Cancer Awareness Month. But many women know little about one part of the breast cancer experience, breast reconstruction after a mastectomy or partial mastectomy. To combat this, a national campaign has started to educate women about the options available. The kick off for this is October 17th, BRA Day (Breast Reconstruction Awareness Day).
Recent studies have shown that 7 out of 10 women undergoing some type of mastectomy are not made aware of breast reconstructive options. Thus, there are thousands and thousands of women walking around without one or both breasts, because they don’t know the options available to them. In fact, only 1 in 5 women with a mastectomy undergo reconstruction. Although some of those that do not have reconstruction do so by choice, the majority do not do so due to ignorance of their choices.

One of the most common reasons for women’s ignorance is that their doctors neglect to inform them. Some mistakenly think that reconstruction at the same time as the mastectomy can reduce the chance of cure. Others believe wrongly that recurrences of breast cancer can’t be diagnosed if reconstruction is done. Some may be practicing where there are no plastic surgeons at their hospital and, thus, assume that the cancer treatment and reconstruction cannot be coordinated. Some just may not realize that reconstruction is an option.

All of this is in spite of national legislation, the Women’s Health and Cancer Rights Act of 1998. This was intended to increase the options available to women with Breast Cancer and encourage Breast Reconstruction. It required any insurance company that pays for a mastectomy, to also cover breast reconstruction surgery. This included Medicare and Medicaid. The law further stated that the company’s clients must be told about the coverage. By doing so it defined breast reconstruction as not simply cosmetic surgery, but a medical necessity for the physical and emotional well-being of breast cancer patients. In the fourteen years since this law was enacted there has been almost no increase in breast reconstruction after mastectomy.
Why is breast Reconstruction deemed to be so important? Very simply, loss of the breast causes both mental and physical problems. From around the age of 10 the breast is synonymous with femininity and part of what defines womanhood. I am frequently told they “no longer feel attractive,” or that they were “outgoing and now have become an introvert.” Additionally, the asymmetry of weight can lead to shoulder, neck and/or back pain and difficulty sleeping. Although Dr. Buchanan has worked for years to make breast reconstruction available to women, some regional hospitals are now also recognizing this.

To correct this, there are a number of options. These can be divided into two major choices, timing and method. Timing is either immediate or delayed. With immediate reconstruction, the initial reconstructive surgery is done at the time of the mastectomy. This restores a mound (though sometimes not to the final volume) and reduces the number of surgeries and the time to complete restoration of the breast. It also prevents the skin from contracting and making any reconstruction harder. Data has shown that it does not interfere with cure of the cancer or reduce the acceptance of the new breast into the woman’s psyche. Delayed reconstruction can be anywhere from 24 hours to many years.

There are basically two reconstructive methods, use of an implant or use of one’s own tissue. Each has variations and the two can be combined. Occasionally, especially with large breasts, an implant can be placed under the tissues after the mastectomy and the reconstruction of the mound is complete. The nipple/areola is reconstructed a later time. If the remaining tissues are too tight to allow the final volume to be inserted initially, an expander (an implant containing a valve) containing a smaller volume is placed and then expanded, thus stretching the overlying skin safely to the final size. It is then exchanged for the proper sized implant.

Because the scar around the implant can contract and make the implant feel firm and some women’s desire not to have anything foreign, one’s own tissue can be used. Most commonly this is taken from the abdomen or back. Occasionally, at some specialized centers, tissue from the buttocks is used, reattaching the tissue microsurgically. When taken from the back the tissue is simply transferred from the back to the chest based on a long artery and vein. Frequently an implant is also used to reduce the scar to the back. Using the tissue from the abdomen is probably the most common and the most aesthetic, since one gets a tummy tuck at the same time as the reconstruction. This can be done by leaving the flap attached by its vasculature and just rotating it, or it can be done microsurgically. Both methods have pros and cons.

Since a true reconstruction requires the two breasts to match, and some breasts just cannot be matched by reconstruction, remodeling of the other breast to match the reconstructed one is also mandated by the 1998 law. This is very frequently required with implant reconstruction and commonly needed with tissue reconstruction.

As I said earlier, October 17th is BRA Day. For more information, go to The spokesperson for this effort is the singer Jewel. To further education of women about breast reconstruction, she released the single “Flower” on August 12th, and part of the proceeds goes to this effort. This song can be downloaded from iTunes.

Dr. Buchanan has extensive experience in breast reconstruction and is presently on the Breast Reconstruction Work Group of the American Society of Plastic Surgeons writing clinical practice guidelines for physicians around the country. He works year round in Highlands at the Center for Plastic Surgery.

Plastic surgeon Robert Buchanan gives lecture on ‘Turning Back the Clock’

Below is the text of an article appearing in the Highlands Newspaper and the Highlander the week before Labor Day.

Everyone wants to stop aging or at least, prevent the visible signs of aging. Although there are no miracle creams or magic drugs that will stop the body’s internal aging process, living a healthy “optimal” lifestyle can limit or slow the inevitable,” said Highlands-Cashiers Hospital’s Board Certified Plastic Surgeon, Dr. Robert Buchanan.

Earlier this month, Dr. Buchanan presented “Turning Back the Clock – Anti-Aging Secrets” to nearly 50 community residents, providing education and tools to live a healthy and long life.

“Proper medical care and body modification are proven strategies that can improve and extend our life, improve our looks or both,” said Dr. Buchanan. “Most importantly, diet, regular exercise, stress control and the avoidance of negative influences can reduce and sometimes eliminate the development of chronic diseases such as diabetes, heart disease, stroke, and some cancers. Eating a moderate calorie balanced diet of no more than 40% carbohydrates and the rest lean protein with good fat and minimal salt can maintain healthy blood pressure and prevent insulin spikes, allowing the body to burn already stored fat, reducing the waistline.”

Dr. Buchanan stressed that healthy eating plays a large role in anti-aging as does the commitment to live a healthy life style. “We all have to change our “taste,” change our mindset, train our brain and body to crave natural healthy foods and avoid sugar, salts, and bad fats. Sugar substitutes can do as much damage as the real thing and also prolong the body’s dependence on sweets and sugary foods. Modifying your lifestyle should be a gradual process in which diet and negative lifestyle habits are slowly changed over the course of weeks or several months. Your body and brain will accept the new routine and the willingness to continue will grow. Dieting with sudden change in habits is the cause of “yo-yo” weight loss and regain.” Dr. Buchanan offered helpful eating tips listing “things to have in your frig” which included: 1% or 2% milk, fresh fruit, fresh herbs for flavor instead of sugar or salt, organic eggs with yolk, greens, and water. A list of “things to have in your pantry” included: nuts, dark chocolate, legumes, seeds such as flax, steel cut oatmeal/barley, dried herbs and peanut butter. And a list of “things to have in your medi- cine cabinet” included: baby aspirin (recommended 2 per day), omega 3, vitamin D, multivitamins, and calcium. He noted to avoid vitamin E, which can cause increased bleeding, and most over the counter supplements.

Dr. Buchanan also advised the audience on the importance of exercise and how daily/weekly schedules of both aerobic and anaerobic activities can promote health, disease prevention and longevity. “Exercise is crucial; studies show that walking just one mile per day can help you lose 10 lbs. per year and walking 2 miles per day can reduce your chance of death from all diseases by an incredible 50%. Three hours a week can reduce a woman’s chance of developing breast cancer by 30%, and just one additional hour can reduce her chances of breast cancer by 60%.”
“Along with a healthy diet and exercise, sun screen with UVA and UVB protection should be applied each and every day to reduce skin damage. Limiting one’s alcohol intake to one glass per day or less, avoiding smoking and others who smoke will boost one’s optimal health.”

Dr. Buchanan ended the lecture by explaining how cosmetic procedures performed these days have age defying, long lasting results. Minimally invasive treatment such as a rejuvenative skin care routine prompts new skin cell growth and reduces the appearance of wrinkles. IPL (Intense Pulsed Light), an in office procedure, can remove brown age spots as well as red discolorations/blotches on the skin’s surface. The Zerona® laser can melt fat without pain, incision or downtime.

“We are using better injectables such as Botox, which reduces muscle function and, thus, wrinkles and others that fill in soft tissue including Juvéderm®, Radiesse® that offer immediate results, reducing lines, wrinkles or contour deformities,” said Dr. Buchanan. “And these are now administered with less discomfort.”

As for surgical procedures, Dr. Buchanan explained how various “lifts” can markedly reverse the outward effects of aging. “Today’s Facelift”, the facelift technique performed by Dr. Buchanan, maintains facial fat and achieves a more natural result. The technique, unlike older facelifts, prevents the pulled or “windswept” look leaving the neck and face looking refreshed, rested, and healthy.

Sun Protection

Almost all of us will agree with the concept of sun protection. After all, we know that the sun causes sunburn, aging and cancers of the skin. The problem is that most of what we are told and have used will not accomplish the protection we need. A portion of the Sun’s emitted electromagnetic spectrum, namely radio waves, some infrared, visible light and some UV waves, penetrates the atmosphere to strike us. All but UVA and UVB are considered harmless.

For the last 30 or 40 years, we have worried about UVB rays because we could see their effects. They are absorbed easily by the atmosphere and anything else they hit. They are, therefore, strongest when they come straight through the atmosphere, down south, midday in the summer. If they strike us, they are absorbed quickly within the outermost part of the skin where they make our skin feel hot, and, if we get enough, cause sunburn. The first sunscreens were developed to block UVB and prevent sunburn. They did a good job at this, some better than others. To inform us how good each was, the FDA created a system that rated their performance. This is known as SPF or Sun Protection Factor.

For years, we thought that the heating and burning of the skin was what caused all the damage and eventually led to skin aging and cancer. This caused us to hypothesize that, since most sunburns occurred when we were young, all the damage was done then. We now know better. UVA penetrates the atmosphere almost as well as light. It is, therefore, present dawn to dusk, summer and winter and from North Dakota to South Florida. It also makes up 97-98% of the UV Rays that hit the earth and us. It is not absorbed well by anything, and penetrates clouds, glass and clothing to reach us. When it hits the skin it penetrates and is absorbed slowly. Though it does not cause sunburn or heat the skin, it does cause direct cell damage.
It is, thus, UVA that causes most of the damage to our skin. It is almost all of the UV radiation that actually hits our skin. It is present all the time. Though we no longer lay in the sun, we are still getting UVA radiation, even in the house, in cars and through our clothes. If we do get a sunburn from UVB, much of the damaged cells are shed. We have also shown that damage is cumulative over a lifetime. What we get now is additive to what we have already gotten to further skin aging or stimulate skin cancer production.

So, how do we protect ourselves? Since SPF only indicates our protection from UVB and sunburn, it is worthless in determining whether we are protected from UVA. The FDA has tried four times over about 14-15 years to create a standard to indicate UVA protection similar to Australia and Europe. Their latest attempt was to go into effect in July of this year. Implementation has now been pushed back to December. So, how do you know how to protect yourself? In spite of the lack of present standards, there is an easy way.

Of the sun protection products presently available, there are only two that block the full spectrum of UVA. One of these, avobenzone (including Helioplex by Neutrogena), as far as we now have data, only lasts about an hour or two and takes 30 minutes to start working. Since we need to reapply it hourly, it is impractical. The other is Zinc Oxide. It, too, was impractical, since it made you appear white. However, new formulations of Zinc Oxide now go on clear and still protect from both VUB and UVA. We, therefore, recommend you look for a product containing at least 5-11% Zinc Oxide. (This amount protects but still goes on easily. Just turn the container over and look under the ingredients. If it does not have a percentage, it does not contain enough.) This has been somewhat hard to find. With the looming new requirements, it is now much easier. Even so, we stock five different brands in our office. We recommend, since UVA is constantly present, that you apply it daily year round to any exposed areas, reapplying if you wipe it off. In the US, because Vitamin D is in so many foods and multivitamins, we, do not have to worry about Vitamin D deficiency.

What about non-exposed areas? Since UVA goes through regular clothing, there is now sun protective clothing available at the Highland Hiker and other retailers. You can also wash your present clothing in Sun-Guard by Rit, available, for your convenience, at our office as well as elsewhere. This is used in the washer and imparts sun protection to the washed garments for 20 washes (about 6 months).

For more information call the Center for Plastic Surgery at 828-526-3783, or toll free 877-526-3784, or go to “Contact Us” elsewhere in this site.

Anesthesia Options

If we are to have any type of surgery, whether cosmetic or not, some type of anesthesia is required. In simplest terms this means eliminating the pain of the procedure. In practical terms, this also means reducing or eliminating the anxiety and other sensations surrounding the procedure.
There are several ways to define anesthesia depending on what is used, how it is administered and what the goal is.

Strict local anesthesia is the simplest. It blocks the nerves from sending back information on painful stimuli. This can be accomplished several ways. Topical application of a nerve blocker (local anesthetic) works best inside the mouth, but also reduces the sensation from injections through the skin. I use this for Botox® and filler injections. Some fillers now come with a local anesthetic mixed with the filler or we can mix them. By using topical to prevent feeling the initial needle stick, the anesthetic in the filler eliminates the feel of the injection itself.

The same or similar medication can be injected into the skin or around nerves to numb either a small area or an entire body part (local or regional anesthesia). To remove small skin lesions, I generally numb only the area where the lesion is. This can be expanded to very large areas. This is what we do for liposuction; the skin is injected to allow insertion of an injection canula which injects the numbing solution into the fat. If I am injecting a filler or fat harvested from the above area into the area around the mouth or under the eyes, I generally block the nerves that go to that area. This is a type of what is called a regional block. By selecting the nerves to be blocked, we can block the entire face for peels and laser or an extremity. Much of the hand surgery I do is done with just the arm numb. This has the added advantage of providing prolonged pain control postoperatively.

Although it is possible to do almost any surgery under only a block of some kind, this is seldom done for any significant surgery. The reason is that the numbing process can be uncomfortable and most people are too anxious to sit still enough during the procedure and would prefer to not know what is going on. There are two ways to handle this problem when using nerve block anesthesia. One is sedation, simply using a small dose of a drug to make you less apprehensive. This is usually an oral medication and can be used safely in non-certified facilities such as the office. We do this quite frequently for peels, laser, larger office based surgery and some filler injections. The second is what is called conscious sedation. This takes you to where you do not care about or, frequently, are not even aware of the surgery. This state of sedation not only reduces your awareness but depresses your normal reflexes and, occasionally your desire to breathe. Because of this, it requires careful monitoring in a certified facility such as the hospital. This is the type of sedation used frequently for colonoscopies and what I use in the hospital with regional blocks. It is usually achieved with IV (intravenous) administration of the sedative medication (the case when rules for use of conscious sedation were written), but can be accomplished with oral meds. In fact, many non-board certified Plastic Surgeons are using oral conscious sedation to get around the strict rules requiring this type of sedation be done in a certified OR. This is cheaper for the patient but risks his or her life.

The other method of anesthesia, general anesthesia, is what most people are familiar with. This uses some IV agents and an inhaled gas. It causes total loss of consciousness, and sensation. Depending on the gas and how much is used, you may or may not lose your reflexes or the desire to breathe. Continuous monitoring by a certified provider is essential.

Each type of anesthesia has advantages and disadvantages. The trick is to find the one that will work best for you and the procedure you are to have and be the safest. For small things that create little anxiety, I usually use pure local, or add oral sedation for minor nervousness or apprehension. For procedures on extremities I use either a regional nerve block or general anesthesia for the surgery and a local block for postoperative pain relief. For most other procedures I prefer general anesthesia and, if possible, a block. I believe this is the safest type of anesthesia, and works best for most of what I do, especially here in the mountains. Patients quickly recover because the gases rapidly exit the body through the lungs. Thus most of the drugs that can cause nausea and other problems are quickly out of the body. IV sedation and narcotics require time for the body to metabolize them, occasionally 24-48 hours. We, therefore, try to use them as little as possible. The depth of general anesthesia is also easily controlled using new monitors. With many cases, including almost all facial procedures, the gas is used so you do not feel the local anesthetic injection and then lightened just to the minimal sedation necessary for safe surgery.

Frequently people today are sacrificing safety for cost, occasionally not even knowing it. Many physicians, some not even surgeons, doing cosmetic procedures are heavily advertising that they do their procedures under local anesthesia which is safer. There are several problems with this. First, it would be safe if the procedure were done under pure local using safe amounts of the local anesthetic agent. Most, however, either use too much of the local anesthetic agent or use heavy sedation in a non-certified facility. Both of these are quite unsafe. The reason they are touting this method is that they do not have privileges to do the procedures they do in a hospital or other certified facility and no anesthesiologist will work with them in their office OR’s. Use of local anesthesia is, thus, the only option they have available. As they say, “buyer beware.” Before consenting to surgery, always inquire about the anesthesia available and who will provide it. Insist that all types of anesthesia be available and that a certified anesthesiologist provide anything requiring significant sedation.

The Present State of Quackery

In the late nineteenth and early twentieth centuries quackery was personified by the Snake Oil Salesman. Just what was he? And, for that matter, what is Snake Oil? Snake oil is a traditional Chinese medicine made from the Chinese Water Snake (Enhydris chinensis), which the Chinese used to treat joint pain. When translated to our culture, it was never effective in controlling pain or anything else for which it was eventually sold. Therefore, the most common usage of the phrase is as a derogatory term for quack medicine. The expression is also applied metaphorically to any product with exaggerated marketing but questionable and/or unverifiable quality or benefit. In simplest terms, the Snake Oil salesman was a peddler who sold an unproven remedy for medical problems people had. They preyed on the unsuspecting who desperately wanted a cure for what ailed them, even if none existed.

Are there such people today? We would like to think not. We live in a scientific society and are sophisticated and knowledgeable. It should be hard to fool us. Besides, the FDA (Food and Drug Administration) was created in 1906 just to protect us from such. The unfortunate answer is that they are everywhere, just in different guise.

Today, exaggerated marketing for therapies, procedures, diets or products abound. These transcend all of medicine, but a large percentage of them are in the areas of cosmetic rejuvenation and lifestyle enhancement. This is partially because these areas are where people are already willing to spend their own money. The question is why they still exist. The answer lies in two basic facets of our present society and how complex it has become. We all need shortcuts in making decisions. Otherwise, we would never get anything done. One of the shortcuts we use is to trust authority. This works well as long as we are trusting real authority and what that authority is telling us is, indeed, factual. If the authority is not who he claims to be, or what he tells us is not factual, our shortcut fails us. The other problem is the sheer complexity of medicine itself. Here, the shortcut of consistency fails us. If a therapy or ingredient can do one amazing thing, to be consistent, we tend to believe it can do many other related things, when, in fact, it cannot.

Excellent examples of the latter are lasers and stem cells. Because lasers are extraordinary machines for some procedures, like resurfacing the skin to rid us of wrinkles or spots, when told they can also tighten loose skin and improve facelifts, breast lifts, tummy tucks or liposuction, we tend to believe they can. The truth is, they cannot tighten skin and those procedures done with the laser are no more likely to give a good result then those done other ways. Unfortunately, many of these myths get perpetrated by normally real authorities who have relied on another “authority” (the company selling the machine and the hype around it) without first checking the real data available.

Stem cells, too, are amazing cells and have fantastic, though yet to be proven, potential. Because Stem Cells have been found in liposuctioned fat, there is now a readily available source of them. Even then, they are quite sparse, concentrating them is very difficult and there is no data yet about what they are really capable of doing or, even, how to use them. Unfortunately, everyone has jumped on the Snake Oil Wagon and is touting wonderful rejuvenation, including Facelift, from the few cells injected, even without data that they make any difference.

In a similar vein, multiple hormonal therapies are offered based on one of their properties. Though not as popular as it once was, HGH (Human Growth Hormone) has been touted to build muscle and reduce weight. These are things it does help do, but only in conjunction with an exercise program and proper diet, which will accomplish your goals without the exogenous hormone. The new Snake Oil is HCG (Human Chorionic Gonadotropin) for weight loss. Again it is probably the accompanying diet alone (or the cost of the injections that cause you to adhere to the diet) that accomplishes your goal. The main problem with both these is the ancillary, unwanted effects they cause.

There are also multiple other unproven therapies out there, like Telomere Analysis, Mesotherapy, Ozone therapy, Platelet Rich Plasma for hair restoration and other things, and a multitude of “Marvelous” machines. These are all proffered by “authorities” in the field of cosmetic rejuvenation and lifestyle enhancement. They all have fancy certificates attesting to their expertise. The real question, as I said in a previous article, is who grants the certificate and, therefore, how much expertise do they really have.

So, since our normal shortcuts can fail us in this area, what do we do? To start, we need to question the expertise of the “authority.” How did they learn to do what they do, and who granted them their authority. Was it an American Board of Medical Specialists Board, such as the American Board of Plastic Surgery, or some other invented “Board?” Next, ask about the scientific data supporting the treatment, procedure or product. Has it been shown in multiple comparative studies to really be superior and to do what is claimed? Is the data specific for how it is now being used? If there are pictures, ask if they are typical and what else was done between the before and after. Also ask if the pictures are of the practitioner’s work. Remember, if it seems too good to be true, it frequently is.

Myths About Plastic Surgery

As Plastic Surgery becomes more popular, many misconceptions arise. Part of this is due to popular media that does not always research their subjects thoroughly before publication and how TV and the movies portray it to make their plots work better. I thought that I would try to deal with some of the most prevalent ones.

  1. All “Board Certification” is the same. In fact, it isn’t. If I wanted to create a
    “Board,” say for “Laser Zit Removal,” it would cost me just a few dollars in Raleigh. I could then issue “Board Certification” to anyone I wished. The original Boards, of which the American Board of Plastic Surgery is one, are certified by the American Board of Medical Specialties (ABMS). The only other Board certifying any cosmetic surgery is the American Board of Otolaryngology for facial cosmetic. The American Boards of Facial Cosmetic Surgery and Cosmetic Surgery are not overseen by the ABMS. Certification by an ABMS Board requires meeting vigorous, ongoing standards.
  2. Only surgeons certified by the American Board of Plastic Surgery can legally do Plastic Surgery. In fact, anyone with a medical or dental license can advertise and perform Plastic Surgery. This is almost always done outside a hospital, since most hospitals require some certification in the procedures performed. Highlands-Cashiers Hospital requires certification by an ABMS board in the procedures done.
  3. All Plastic Surgery is performed in a facility certified as safe. As stated above, many physicians, in order to avoid hospital privileging, do their surgery in an office setting. Many of these facilities have no oversight, since certification of the facility is expensive and requires hospital transfer agreements and physician privileging. Both the American Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery require their members to do all surgery with sedation or anesthesia in a certified facility. Highlands-Cashiers Hospital maintains Gold Seal Approval by the Joint Commission, the oldest certifier.
  4. Plastic Surgery is only for the rich and famous. While this was somewhat true in the beginning, most people having Plastic Surgery are just like you. We now have ways of dealing with whatever bothers you that fit every pocketbook.
  5. Extreme Makeovers are routine. Though TV has made it seem like remaking the entire body is the norm, in fact, it is quite rare and most people have only one area treated at a time.
  6. It is disrespectful to ask the surgeon tough questions. Most physicians expect hard questions. We look upon them as an indication of how involved you are with your care. With surgery, especially, we see it as further proof that you understand the procedure and that your consent is truly informed.
  7. It is inappropriate to speak to former patients. While simply giving you the names of patients to call violates patient confidentiality, many patients are quite happy to discuss their procedure with you. We encourage this if you are having trouble deciding about a procedure, as it gives a totally unique prospective.
  8. It is inappropriate to ask about results and risks. Not only is this NOT inappropriate, it is imperative that you do. The only way you can decide between several options that are frequently available, is to know everything you can about each. Also, choosing a surgery or procedure really entails making sure the benefits outweigh the risks, The only way to do this is to understand both. It is also important to know what a particular surgeon’s problems have been, as they sometimes vary from surgeon to surgeon. We keep before and after pictures available so you can evaluate the possible results, but you must translate these to what the procedure can do for you.
  9. Plastic Surgery procedures cost the same no matter who performs them. Not true. They vary greatly, but you generally get what you pay for. Recently a number of people died or were hospitalized because they sought cheap Botox. The “Botox” used, to reduce the cost, was a nonstandard fake. Where I used to live, a family practitioner did Breast Augmentation cheaper than anyone in town. He did this by using poor quality, non-approved implants in a non-certified, unsanitary OR, and allowing only three visits. If his patients had a problem or question, he told them to “see a Plastic Surgeon.”
  10. Plastic Surgery is based on looks, not science. This is really not true. Most Cosmetic Surgery procedures are based on reconstructive ones. All those are based on extensive research. Plastic Surgery has, for many years, led the way in developing new procedures and techniques. Plastic Surgery developed tissue transplant technology in an effort to improve wound coverage. Presently, we have discovered that the fat removed during Liposuction contains multipotential stem cells. Research is trying to determine how we can best use their potential. Even “standard” procedures are changing as we examine our results and change our methods based on those findings. This is why I totally changed my Facelift technique nine years ago. I went to a technique that did not result in the problems I saw with the “standard” one. I continue to evolve it based on further observation.
  11. Silicone Breast Implants have not been scientifically proven safe. This was the contention in 1992 when they were withdrawn from the market. After more than fourteen years and exhaustive research that proved them safe, they were released again. There is now more data on these than on almost any other medical device known.

Minimally Invasive Procedures

I have previously talked about how you can improve your outer appearance using new less invasive surgery or noninvasive methods. What we use depends on what has caused your particular problem. The causes are a combination of sun damage, loss of skin support including fat, gravity and/or muscle action. Use of injections to fill wrinkles, creases or depressions or stop muscle action; skin peels to reduce wrinkles or correct other problems; and the use of different machines can give added benefit to both the non-invasive rejuvenation methods and surgery or correct enough of the signs of aging that we can forestall surgery.

We can reduce early, non-permanent wrinkles especially between the eyes and around the eyes caused by muscles with a relaxer such as Botox® and, now, Dysport®. They prevent muscle contraction and, thus, wrinkle formation on average for 5-6 months. Early treatment prevents the wrinkle from becoming permanent and requiring filling or a peel. With regular use, the muscle atrophies and your need for further treatment decreases. Even used late, we can improve the effectiveness of the fillers. These products are also useful to treat abnormal sweating and some migraine headaches.

Gravity also causes creases and depressions to occur. The most common areas are under the eyes, between the lips and cheeks, below the mouth corners, in front of the jowls and in the mid cheek. Filling these can restore normal anatomy or disguise the problem. Restylane™ (hyaluronic acid, a precursor of collagen that supports the skin) was introduced seven years ago, is easy to use, safe, reliable, and lasts about five-six months. Since then multiple new fillers have become available. Another hyaluronic acid is Juvéderm®, which lasts almost twice as long as Restylane™. Radiesse® (calcium hydroxyapatite, another natural body precursor) is useful for the larger folds and depressions and lasts an average 18 months. There have been problems with permanent fillers, though a new one, Artefill®, shows promise.

I use the hyaluronic acids for lines in the top level of the skin and around the mouth and Radiesse in folds and to correct contour irregularities. There have been few problems reported for any of these, in spite of millions of injections yearly. Another filler is fat. We harvest this as live cells from an area where you have extra, and use it to fill contour irregularities. New techniques have markedly improved reliability and longevity. This makes it an excellent alternative to correct those areas where loss of fill causes you to look older and as an adjunct to surgery.

Administration of most fillers is done with regional numbing using techniques similar to blocks by dentists. Newer products can be mixed with numbing or come ready-mixed to decrease discomfort. Down time is minimal, if any. The worst problem is occasional bruising, but this is easily coverable with camouflage makeup. We can also decrease this bruising with peri-injection medications.
Filling subcutaneously under small wrinkles can eliminate them. These can also be eradicated with different peels or laser. Both remove the outer layer of the skin, including the wrinkles, much like skinning one’s knee. When new skin grows back, the skin is smoother and tighter. Newer peel methods and lasers have reduced the healing time, minimized the red that occurs after such a procedure and made them safer (less likely to scar). Adding pretreatment with a product like the Obagi® Skin Care system reduces the risk of having pigmentary abnormalities (white, dark or spotty) after the procedure. It also improves collagen deposition that augments the tightening effect. You actually look better at a year than at one month.

New IPL (Intense Pulsed Light) machines are laser-like, putting out a spectrum of light waves rather than only one, and have almost eliminated reactions, such as blistering, prolonged redness, or down time when treating red or brown spots. It also has the ability to treat actinic keratoses (premalignant sunspots) and severe acne when coupled with a chemical that makes the abnormal cell more susceptible to destruction by light energy.
Many more minimally invasive products and machines have been introduced, but have not proven significantly effective to warrant continued use. One of the most dramatic is the “string lift.” These were barbed sutures placed with a simple needle and intended to accomplish a brow, neck or facelift. However, none were effective for longer than about three months. Therefore, few are used now. Many other machines and procedures have met similar fates, as they do not produce results comparable to other less or equally invasive methods.

In summary, we now have multiple methods to modify and rejuvenate the face and body. These methods are so broad they can meet almost anyone’s needs for down time, effectiveness, permanence and cost. To find out more, visit us on the Web at or call 828-526-3783 or toll free at 877-526-3784 for a complimentary consultation.

Non-Invasive Plastic Surgery

Innovations in Beauty

Non-invasive Plastic Surgery

Plastic Surgery has kept up with the demands of a busy lifestyle. Though the specialty name still implies surgery, fully half of what we do requires no cutting. This is due to the development of many ways to help you feel and look better with no down time, the so-called non or minimally invasive procedures. We can now markedly improve the appearance of sun-damaged skin, hide wrinkles and remove fat without any cutting.

We have learned a significant amount about how the skin ages. This has helped us formulate protocols to either truly rejuvenate the skin or hide the effects of aging better. Cosmetics simply hide the problems, and, in many cases, worsen them. Skin health restoration, however, is a process, not a product. Healthy skin is smooth, firm, evenly pigmented, & hydrated with a slightly acid pH and protective lipid layer. To restore Sun damaged skin we need to:

  • Remove the thickened outer dead cell layer using products containing Alpha Hydroxy Acids, &/or use Microdermabrasion, Dermaplaning &/or Micro-Peels by an aesthetician.
  • Restore the normal pH and protective layer with topical Vitamin-C and/or balancing toner.
  • Correct the Pigment by removing spots & making the rest of the skin a uniform color using Hydroquinone (or Kojic acid, Arbutin &, to some extent, topical Vitamin-C) occasionally supplemented with Micro-Peels or IPL light treatments.
  • Rebuild tissue & blood vessels & heal injured cells using Retin-A® and, to some extent, Kinerase®.

We need to protect our skin from any further sun damage. It is the long wave UVA rays that cause the most severe cellular damage leading to aging and skin cancer development. Not only are these present all the time and at all latitudes, they penetrate clothing and glass causing damage even when we think we are out of the sun. Because of this, we need to apply a UVA as well as UVB sunblock every day that lasts all day. Presently SPF indicates only the effectiveness of UVB blockage and protection from sunburn. Wearing a sunscreen with high SPF without UVA blockers only increases the length of time you stay in the sun, and, thus, the amount of exposure to the harmful UVA rays causing more cellular damage. We recommend you apply a sunblock containing CLEAR Zinc Oxide of at least 5% every day. Our office carries nothing but zinc oxide sun blocks from 6.8 – 18%.

The Obagi Nu-Derm® prescriptive system incorporates all of the above. The Theraderm® and Epionce® systems also utilize these principles. These and the other adjuncts are available in our spa. At the spa portion of the office, we have incorporated many of the products used in these systems in our facials to make them effective in aiding rejuvenation, rather than just a relaxing interlude, which they remain.

You can now enhance your eyelashes using an old medication in a new way. Many people using bimatoprost, a glaucoma drug noticed that their eyelashes were becoming longer, thicker and darker. The manufacturer reformulated the drug, and it is now available as Latisse® to enhance your lashes. It is safe and you see exceptional results in eight to sixteen weeks.

A new laser can melt fat without slowing you down. Zerona is a new low level laser that has been proven and accepted by the FDA to reduce fat and contour the body without surgery, pain or any down time (other than the brief times under the machine). We are using it with dietary modification to jump start weight loss and reduce the need for some surgical body modification.

All these modalities are completely non-invasive. They are available at the Medi-Spa part of the office.