Filler with "Less Feel"

Juvederm Ultra XC®  has just been released!
The newest rendition of a the popular Hyaluronic Acid Gel filler, Juvederm, now has local anesthetic mixed within it.
While some of us were hand mixing Lidocaine, a liquid local anesthetic, into the gel just before application, this new product allows anyone who hadn't thought of doing so to administer comfortably, this very safe and predictable sub-dermal filler.
To the surgeon, or injector (always ask, before you go, who actually does the injections), this eliminates the step of hand mixing the material.
To the patient it means very quick, relieving, comfort as the local anesthetic starts to kick in moments after the first 'pin prick'. When the application is over, the patient walks out comfortable and without the awkward numbness, and inarticulate period associated with the "oral block". This is primarily helpful when using the fillers in and around the lips.


Juvederm Ultra and Ultra Plus XC® are not the only, or the first, fillers with local anesthetic built in. We have been using Prevelle Silk ® for a few years now. Prevelle has been very popular with my patients who need to go back to work the same day of their injections, or out to dinner with friends. They didn't want to put up with the few hours of recovery from the oral block, but didn't want to sweat out the procedure with no form of  relief. There are a few other characteristics which make Prevelle preferable for the immediate- need filler. The company's tag line is "Today for Tonight". I like to reach for it when we have a "Plumper Emergency"


However, I am happy to have Juvederm in this new format, since I can expect predictably long results with this filler as compared to most of the other hyaluronic products available.


-drB

Bo-Tax Defeated!

   In case there are some of you who were not aware of the political craziness that went on just before the holidays, let me summarize.
   Under the guise of fixing America's heath care "crisis" the government added, at the last minute, a tax on Cosmetic Surgery, in an effort to fund all the costly, poorly planned changes they proposed for the health system. See Below:

Surprise Addition to Healthcare Bill is Arbitrary, Difficult to Administer

For Immediate Release: November 19, 2009

Arlington Heights, IL and New York, NY - Late yesterday, democratic leaders in the Senate unveiled their proposal for overhauling the health care system, which included a new 5% tax on elective cosmetic procedures. Senate Democrats argue that the tax, which was a surprise addition to the sweeping 2,074-page bill, will generate $5.8 billion over the next 10 years to be put towards the bill's estimated $849 billion price tag. However, the American Society of Plastic Surgeons (ASPS) and the American Society for Aesthetic Plastic Surgery (ASAPS) oppose this tax as discriminatory, arbitrary and ineffective.

  Well, it turns out that this idea was unconstitutional, or at least unfair since Cosmetic Surgery patients, as it turns out, are neither rich, nor evenly distributed in terms of gender, or nationality. A tax would have discriminated against middle income females.

A letter to our local paper's editor follows:

Letter of the Day: An ugly prospect 
Editor, Daily News:
   As you are aware, as part of the national health-care reform solution there is a proposed tax on aesthetic surgery procedures.
   I truly hope that I am not alone in vehemently objecting to such a preposterous concept. I can only imagine that the idea to tax aesthetic procedures was born in some brainstorming session and was immediately, though incorrectly, thought of as a form of luxury tax.
   In this desperate economic climate nobody dared to analyze the idea any further.
   If one took the time to do so they would realize that this tax would penalize women (90 percent of aesthetic patients) and the middle class (90 percent have an income under $90,000 a year).
   This tax is not based on the logic of penalizing an activity which costs the country money, such as smoking. Instead it is a penalty on a random spending habit — an intrusion on a private use of discretionary funds.
   This tax furthermore imposes a new role upon the medical caregiver — that of tax collector. This is a role which will only hurt the patient-doctor relationship.
   The goal to improve the U.S. health-care delivery system is a respectable aspiration. However, let’s not let this goal turn into a one-man or a one-administration crusade.
   To use fear tactics, loosely controlled statistics and popular sound bites is marketing propaganda, which should not be allowed in the election process, let alone in critical policymaking.

— Andrea Basile, M.D., Naples, board-certified plastic surgeon

Naples Daily News Letter to Editor

Fortunately reason won out this time and the tax was removed from the health care reform proposal-at least for now....

The Bo-Tax Defeated!

WRITTEN BY MYCOSMETICPROCEDURES | 19 DECEMBER 2009
POSTED IN ARTICLES

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The "Bo-Tax" has been officially defeated and removed from Senate bill on Health Care Reform. Senate Majority Leader Harry Reid, amidst organized pressure from the medical community, lobbyists and various women's groups, decided to remove the proposed 5% tax on elective cosmetic procedures. While the proposed Bo-Tax was estimated to raise $3.7 billion over the course of 10 years, it was argued that the tax discriminated against middle-class women.

I'll keep you posted about any flip-flopping on this in the future...

-drB

Adios Miami...

More from Miami-the Yummy Mummy Tummy!

   Today we had the pleasure of listening and watching two Brazilian Plastic Surgeons on the topic of LipoAbdominoplasty, or Tummy Tuck. These two well-known surgeons were very thorough in their explanations on how they decrease risks, and improve their results. Excellent results indeed! Judging by the photographs presented, it appears that in Brazil the women are very demanding of their figures. Let me explain.

   The preoperative pix of these surgeons’ patients were on average in fantastic shape. These were not women who had let themselves go, or who had lost massive amounts of weight. These were well cared-for, in-shape bodies; women who demanded to feel good about the bodies they carried around the beaches of Rio. It was a pleasure to see them find a way to polish up, in the hands of these experts, small amounts of fat, and segments of loose skin.

   When I visited Brazil, for fellowship in Cosmetic Surgery, I observed first-hand what an active, sporting culture it was. I remember finishing up at the clinic, during the week, at about 8pm, and after returning to my apartment, cleaning up, and changing I’d head out about 9:30, to dinner, since my American stomach couldn’t hold out much longer. Not only would I still be the first one to arrive at any of the restaurants I’d choose, but on the way I would see leagues of soccer teams along the beach, groups of volleyballers practicing, marshall artists, and runners; All ages; Sweating, Laughing; Keeping their bodies in shape; The same bodies I’d see on the beach during the day. Mind you- I’m not talking about a “south beach” location- just a beach- and it was always filled with women and men wearing very little, to cover bodies of all dimensions, from grandmothers to little tots, and even expectant mothers. They were all confident and comfortable with themselves. They weren’t all model perfect- far from it- but they all showed effort- and from this effort came the attitude. They were beautiful because they wanted to be and because they worked at it. It is no wonder that in South America Aesthetic Surgery is ubiquitous, so accepted, and so much part of the culture.

   We are gaining more of this physical and aesthetic awareness in the States. We go through phases; In my opinion, we are poised for a resurgence of interest in being physically fit. It cannot come too soon- considering we are the most obese country in the world. We are also realizing that looking good and feeling good about it is not an impulse of which to be ashamed. Rather, we are beginning to embrace in America that taking care of ourselves is not selfish, but just.

More on this issue some other time.

-drB

Welcome to MIAMI- Beauty in Paradise

Day 2 Baker Gordon Surgery Conference:
Today we covered many topics. More live surgery. More videos.
More experts getting up and telling us how it is, to be then contradicted by the next speaker.
Some of the interesting topics covered include:
   Issue: Capsular contracture
   What is it: Hardening of scar tissue around a breast implant causing tightness, and distortion of shape.
   Points made: Do not yet know why it happens. Do not have way to avoid it. Not related to implant fill type, implant texture, or implant position relative to the chest muscle.
  
   Issue: Fat grafting
   What is it: Collecting fat from one part of the body and placing it another, in order to make that recipient site fuller.
   Points made: Increasing in popularity. Used in face, buttocks and now, breast. Don't yet know best way to harvest the fat, best donor site, fat preparation, or injection technique--we need some scientific research on this issue. We need to know these things to get the best "take" of the transposed fat. There may even be some positive skin quality effects from this transferred fat. In the meantime we can use lessons learned, and the artistic sensibility we have developed, from the injection-sculpting the use of nonpermanent fillers to the face.

   Issue: Fat graft breast augmentation
   What is it: Transfer of patients own fat from elsewhere on body to the breasts in order to make them bigger.
   Points made: Controversial, limited in effectiveness, legally tenuous, not yet ready for prime-time.

   Issue: Sub-Fascial Breast Augmentation
   What is it: Placement of a breast implant above the chest muscle, but below the thin, tough layer of muscle fascia covering the muscle.
   Points Made: Demonstrated by Dr. Ruth Graf of Brazil. Benefits of technique not obvious. Technique tedious.

Reception at the Vizcaya Museum and Gardens tonight. Maybe I'll find Dr Graf and ask her more about her technique. It wont be in Portuguese however, since when I did an Aesthetic Surgery Fellowship in Rio De Janeiro with Dr.  Ivo Pitanguy I was unable to learn any permanent Portuguese at all! Tough language!
-drB

Minimally Invasive Surgery -"The Non-Cutting Edge"

   Day 1 of the 44th Annual Baker Gordon Aesthetic Surgery Symposium!
   The theme this year is "Agility in Minimally Invasive Plastic Surgery Techniques".
   That which distinguishes this particular conference from most of the other surgery conferences is that it presents live, simultaneously broadcasted surgery to an auditorium, from where we can interact with the surgeon and operating room through two way audio. Though technically marvelous forty years ago---today--- still pretty cool! Most other conference formats involve 5 to 10 minute keynote/powerpoint presentations which are great to reveal research data, or show long-term results. But nothing beats watching one of these "luminaries" in the academic plastic surgery world deal with real life variables, in real time, all the while answering our questions, and colleagues' challenges. Oh, while staying out of the camera's way... Awesome.
   The day started at 8am with Dr. James Stuzin performing an isolated Neck Lift. This procedure highlighted an issue which I have long argued- namely that the neck can and often should be treated in isolation from the rest of the face. Many younger patients present with a full, blunted neck angle which stems from a hereditary propensity to have a thick inelegant neck, or from weight fluctuations early in life. Sometimes simple liposuction is the solution. Sometimes we need to tighten the neck muscles- much like you might lace up a corset to help define the midriff. Yet other times we need to tailor the neck from multiple directions at once. Either way, we needn't do anything to the face when the neck is misbehaving all by itself. Lately, I have seen some older patients who had their face and neck addressed many years ago. Either because their face has withstood the passing years better than their neck, or because perhaps the neck hadn't been treated thoroughly enough at that time, they present with isolated neck issues- usually loose skin and draping, and unkempt neck muscles creating vertical bands spanning from their chin to the collar bone. In these patients, as well, there may be no reason at all to fift their faces again if the neck is out of proportion all by itself. Sure, sometimes its just easier to do both procedures at once.       My father once told me - "Doing what is easy is rarely the right choice". 
   Treat what needs it. Do as little as possible to make the face beautiful and the soul happy. Dr Stuzin showed excellent results, technical efficiency, and an aesthetic sensibility. Bravo.
   The middle part of the day dealt with (appropriately) the Mid-Face Lift. Presentations, surgical videos, and live surgery by three different surgeons showed us their three different approaches to the mid-face. They each had different philosophies on treating the mid-face, different sets of indications and goals, and different techniques. The bottom line here is that the Mid-face Lift has very specific benefits, significant limitations, and more downtime than average. It should not be used on just anyone- certainly it should not be a standard part of every Facelift. Amen to that.
   At the end of the day we were shown some live non-invasive procedures (needles instead of blades) with neurotoxins (BOTOX and Dysport), and Injectable Fillers (Restylane, Juvederm, Radiesse). Didn't discover anything new here. The point was made that we practitioners of aesthetic medicine more often than not use neurotoxins and fillers in "off-label"ways, considering that the FDA's approval of these agents is very specific and limited. Perhaps we should mention this more clearly to our patients. Then again the FDA is often behind the curve of actual practices.
   I thought a nice analogy for this branch of non-surgical aesthetics is to compare our techniques and choice of products, to the palette of an artist, and their use of light, and choice of brush stroke to obtain a pleasing result both to the artist and the patron.
   All in all an exciting first day.
-drB

Miami Plastic Surgery Conference!

Hello from Miami! I am attending the 44th annual Baker-Gordon Aesthetic Surgery Symposium. The theme this year is "Minimally Invasive Techniques". That means better results with less downtime! Stay tuned for updates and summaries of this wonderful conference ...
-drB