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

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