The doctor conducted a 30-patient clinical trial for this off-label application of Botox, demonstrating that botulinum toxin type A can address post-operative pain.

Breast reconstruction (using silicone breast implants) typically involves the positioning of a temporary expander implant between layers of the chest muscle, which is filled with water to create a pocket where a permanent implant will reside. Pain can result from muscle contractions and spasms in response to the expansion.

Dr. Gabriel, along with his collaborator Dr. G. Patrick Maxwell, theorized that Botox injections could offer relief by temporarily paralyzing the muscle so that fewer spasms occur, resulting in less pain.

The clinical trial assigned 30 breast cancer patients—who all planned a mastectomy with silicone implant breast reconstruction—into two groups: one group had Botox injected into the chest muscle and the other received injections of saline solution as a placebo.

After surgery, the women who received the Botox injections were reportedly more comfortable than those who received placebo. The doctors measured patient responses three times during and after the procedure, noting that during days 7 to 45 of the recovery period, those that received Botox injections used significantly fewer doses of narcotics and muscle relaxants.

Read more about this study on Medscape

As they lose a significant percentage of their body weight, these patients become prone to nutrient deficiencies.  In this study of 100 bariatric surgery patients (98 gastric bypass and 2 lap band), nearly 18 percent of the subjects showed protein intake levels that were lower than the recommended intake.  Additionally, 39.7 percent showed low iron intake and 11 percent had low intake of vitamin b12.

The Importance of Protein for the Post-Bariatric Patient

Protein intake is important for the post-bariatric patient, for general health reasons as well as surgical reasons.  Protein aids the healing process during recovery from body contouring and its deficiency has been linked to problems such as “decreased wound tensile strength and increased rates of skin and fascial wound breakdown.”

The authors found certain predictors of low protein intake in their subjects. Those with increasing age and those who underwent a greater change in BMI after bariatric surgery were more likely to have a low daily protein intake.  Because food intolerance is relatively common in post-bariatric patients, a higher daily protein allowance may be recommended, the authors suggest.

Read more

• Post Bariatric Body Contouring
• Nutritional Assessment of Bariatric Surgery, Patients Presenting for Plastic Surgery: A Prospective Analysis Naghshineh, Nima; O’Brien Coon, Devin; McTigue, Kathleen; Courcoulas, Anita P.; Fernstrom, Madelyn; Rubin, J. Peter.  Plastic & Reconstructive Surgery. 126(2):602-610, August 2010.

An unfortunate reality is that many patients don’t undergo breast reconstruction because they’re not aware that the procedure has universal health insurance.  Doctors pushed for the new law so that a discussion of breast reconstruction options would be required, thus increasing the number of patients undergoing the surgery.

There seems to be a stark contrast in resources between breast reconstruction patients of different backgrounds.  Evidently, some are making decisions about treatment with a relative lack of information, while others are independently seeking out advanced microsurgical procedures.   According to a recent study in Plastic and Reconstructive Surgery, a growing number of breast cancer patients are using the Internet to find a reconstructive surgeon on their own, and many are choosing advanced microsurgical breast reconstruction procedures.

The most popular cosmetic surgery, according to the data, is liposuction, followed by breast augmentation, eyelid surgery, rhinoplasty and tummy tuck.  Although procedures varied among different countries, the U.S., Brazil, China, Mexico, India and Japan represented the bulk of the top five surgical procedures.  The total estimated number of cosmetic procedures performed by board-certified (or equivalent) plastic surgeons was 17,295,557.

Interestingly, plastic surgeons reported more non-surgical procedures than surgical procedures, with the most common treatment being botulinum toxin injections (Botox or Dysport).

The survey data was released in time for the 20^th Biennial Congress of ISAPS, which is taking place right now in San Francisco.  Read more on isaps.org or prnewswire.com

The authors mailed a survey to 708 doctors who are members of the American Society of Plastic Surgeons, half of them male and the other half female.  They asked several questions about career satisfaction such as:

• Was a career in plastic surgery the right choice?
• Would you choose this career again if you had to do it over again?

Other questions inquired about income, switching specialties and retiring early.  The results are very positive, i.e. it appears that plastic surgery is a generally satisfying career in the United States.  93 percent of respondents said it was the right career choice and 78 percent said they would make the choice again if they had to.  Only a small percentage said they regretted the choice to become a plastic surgeon.

The most interesting outcomes of the survey were 1) the data regarding differences in satisfaction between surgeons who are “intellectually isolated” and those who are actively involved with their colleagues, and 2) the difference in satisfaction between surgeons who are focused primarily on reconstructive surgery and those who “balanced” their focus between reconstructive and cosmetic operations.

The study is published online ahead of print and you can access it through the journal’s website.

Source

Satisfaction with Career Choice among U.S. Plastic Surgeons: Results from a National Survey.   Streu, Rachel; Hawley, Sarah; Gay, Ashley; Salem, Barbara; Abrahamse, Paul; Alderman, Amy K . Plastic & Reconstructive Surgery.

The study in the American Journal of Surgery compared the hospital to the surgery center and showed that total facility time and the time intervals before and after surgery were longer in the hospital setting.

The authors had the opportunity to compare both facilities as their breast operations were relocated — from an ambulatory surgery center to a hospital.  The records of 92 hospital patients and 92 ASC patients were then retrospectively analyzed to compare time intervals and other information.

Time intervals for surgical care were measured and reviewed by the authors and they found that on average, total facility time was 69 minutes shorter in the ambulatory surgery center.  Most significant was the 55-minute difference in the preoperative time period – “the time from the entrance into the holding area to entrance into the operating room.”

Based on the findings, they argue that outpatient surgery is more efficient when performed at a dedicated outpatient center.  Also, if the time saving practices used at the surgery center are incorporated at the hospital, it could increase efficiency in that setting.

Read the study “Outpatient surgery performed in an ambulatory surgery center versus a hospital: comparison of perioperative time intervals” in the American Journal of Surgery (2010) 200, 64 – 67

Although many of us believe that we judge people purely on their personality, character, or competence in the workplace, there may be other biases at work, the report suggests. “Looking good is no longer something we can ignore or dismiss as frivolous or vain,” argues reporter Jessica Bennet.

If society were not biased in favor of attractive people, would these statistics be true?

• “A good-looking man will make some $250,000 more than his least-attractive counterpart, according to economist Daniel Hamermesh.”
• “Fifty-seven percent of hiring managers told Newsweek that qualified but unattractive candidates are likely to have a harder time landing a job.”
• “More than half of those hiring managers advised spending as much time and money on “making sure they look attractive” as on perfecting a résumé.”

More surprising statistics are cited throughout the report, but what’s more interesting are the biological and psychological explanations for the beauty advantage.  Is our bias an appreciation of the Platonic ideal form?  Are we unconsciously surrounding ourselves with attractive people in order to produce healthy offspring?  It’s unlikely that a single answer can satisfy our curiosity on this topic.

For many people in our generation, it comes down to an individual choice: how far will you go in your pursuit of beauty?  In the continuum of choices you can make to change your appearance, it’s not always clear where to draw the line.  Many people are quite satisfied with little more than a stylish wardrobe or haircut, but not every person begins their pursuit with the same beauty advantage.

The last two years have brought many changes in the market for injectable wrinkle fillers.  The most recent developments are announcements by two leading makers, Allergan and Johnson & Johnson, that they will no longer produce their respective collagen products (the human-derived CosmoDerm and CosmoPlast, the bovine Zyderm and Zyplast for Allergan; the porcine Evolence for Johnson & Johnson). For more than two decades, collagen has been the dermal filler of choice for many dermatologists. With skin allergy testing and the relatively short-life of collagen fillers, it’s understandable that newer products are taking over.

As in many markets, demand and money drive the evolution of new products, and dermal fillers are no exception. The popularity of non-animal hyaluronic acid (HA) fillers (known as replacement fillers because they replace lost volume) and PLLA and PMMA fillers (known as stimulatory fillers because they stimulate collagen and fibroblast production) has been strong in the recent past. Perlane, Restylane, Radiesse, Juvéderm, and Sculptra currently dominate the US market. Dermatologists report these hypoallergenic HA, PMMA, and PLLA fillers as being more versatile, longer-lasting, bulkier, and better for deep-volume filling than collagen.

But what about fine and thin line use, such as for foreheads or smokers lines around the mouth? Collagen was usually considered better for those applications. But Restylane Fine Lines is one HA product that makers hope to take over what used to be collagen territory.

Change is definitely underway. Although fillers that indirectly stimulate fibroblast production are holding sway, direct injection of fibroblasts with Human Dermal Fibroblasts (HDFs) may be an upcoming trend. UK dermatologists are currently testing Valveta, a filler derived from the foreskins of male babies that is reputed to repopulate skin with healthy young cells and be long-lasting, if not permanent.

However, a recent study by the American Society of Plastic Surgical Nurses argues that information provided about post-operative events of breast surgery is “fragmented, incomplete, or lacking.”   By analyzing interviews with 48 patients, the authors of this article sought to uncover what patients are missing and report on the informational needs of women who undergo breast reconstruction, breast reduction, and breast augmentation.

They found 2 predominant themes among breast surgery patients: unexpected outcomes and helpful/unhelpful information.  Both themes have some clinical implication for plastic surgeons performing breast surgery – namely, “the need for more comprehensive education to better prepare women undergoing breast surgery and to help create more realistic expectations.”

Most patients in the study reported a positive outcome and high satisfaction with their surgeries, but most of them also experienced an unexpected event. Swelling, numbness, discomfort, sensations in the skin, and a “just plain weird feeling and uncomfortableness” were reported by patients in the study group.  Had these patients received more complete information before surgery, they would have been psychologically prepared for these events, the authors suggest.

Patients in the study also named the most useful information sources that prepared them for breast surgery:

• The surgeon’s before and after photos
• Stories about the experiences of other women
• Online forums

These sources are readily available online, but you should still seek a plastic surgeon who is willing to provide comprehensive information about breast surgery and what to expect during your recovery.

You can read the article “Not What I Expected: Informational Needs of Women Undergoing Breast Surgery” through PubMed.gov or journal, Plastic Surgical Nursing.

You may remember last year’s campaign led by Brooke Shields. This year, the campaign is led by lifestyle designer Kathy Ireland, professional ballroom dancer Chelsie Hightower and style guide Bobbie Thomas. Watch the video to learn more about the campaign and see important product information about Latisse.

“With approximately 1.5 million bottles sold since launching the product a little more than a year ago, LATISSE is giving back by helping the Make-A-Wish Foundation grant the wishes of children. Through the campaign, we will double each individual’s donation, with a maximum donation of $250,000, through October 31,” said Robert Grant, President of Allergan Medical, a division of Allergan, Inc.