Discussing the do-over

The New York Times' Thursday Styles had another great piece about plastic surgery, this time discussing the challenge of revisional, or secondary, surgery.

These types of surgeries can give any plastic surgeon pause, to be sure, and this article proffers some choice quotes from some of the luminaries of the American plastic surgical world.

Magic with muffins

Illustration from MSNBC.com

This photo was just too good not to share... It accompanies an article on the MSNBC website discussing the conjunction of so many women's dreams and the miracles of modern day science: moving the fat from your hips to give you a bigger bust.

It's a great idea, and not a new one, as the piece discusses. Plastic surgeons have been doing this sort of thing - fat grafting - for decades. Unfortunately, not all of the transferred fat stays where you put it; fat cells are fairly finicky creatures, and reports of 50% volume loss over time aren't unusual. Plus, there is the added risk of confounding cancer detection when fat cells (which often calcify) are moved to the breast (where calcifications are warning signs on mammograms).

The twists that the article reveals are two: MRIs these days are better at sussing out true malignancies from benign calcifications; and you can apparently keep transplanted fat cells happier with giant suction cups on your breast.

Anyone remember seeing ads for the Brava device in the back pages of Glamour or Cosmo? It was basically two giant suction cups, one for each breast, that promised to increase your size by a cup or two. The catch? Other than two giant suction cups - you had to wear the vacuum assisted bra all the time.

So despite decent results, the Brava device never took off - women just couldn't commit to the bulk of the machine. Reenter Dr. Khouri, the inventor of Brava, who has found a new application for the unloved device. A recently published small study of his reveals that using Brava gives patients longer lasting, more predictable breast augmentation with fat grafting.

Dr. Khouri's disclosures and all, you still have to examine these results with an eyebrow raised. I'll be curious to see how the patients do in other plastic surgeons' hands, and whether or not women will be ready to commit to giant suction cups on their breasts this time around.

The verdict is in...

... well, sort of. As you know, Botox finally got some competition earlier this year in the form of Dysport. Same drug, essentially, but with a couple tweaks to give it some sort of market advantage over the industry standard (can you really be the industry standard, if you're the only game in town?).

Dr. Weintraub and I were intrigued by Dysport, as were many of our patients. Who wouldn't be - with promises of quicker onset, longer duration of action, and cheaper? Although we've seen the scientific studies and heard the testimonials, we've been trying to reserve our professional judgment until we used it ourselves.

This is purely anecdoctal "evidence", but I will share with you the reactions of two patients with you, which have been pretty representative of our overall experience.

One woman in her mid-thirties, who was a "botulinum toxin virgin", tried Dysport to correct her glabellar folds and a few crinkles beside her eyes. She reported back to us, saying that the medication seemed to kick in that very night. The morning after the injection, she called the Duet office, absolutely ecstatic over the results: "I look like I have the face of an 18-year old again!"

The other story is perhaps a little more telling. This woman in her early forties is a long-time patient of ours who got Botox regularly. She was willing to try Dysport, and she too was thrilled with the outcome. Being very familiar with the action of Botox, she liked how Dysport seemed to work slightly faster but was really enthralled by how this injection was equally effective, but had a "softer look and feel."

And the verdict? It's still a little early to tell whether or not the longevity claims will pan out, and by no means is this a scientifically unassailable conclusion, but our patients seem to really like using Dysport and having the choice between products. I'll keep you posted.

Scientists say...

This article in Thursday's New York Times Style section got me thinking for a while.

The section's Skin Deep column always runs pieces that I find interesting - both professionally and personally.

This latest column discusses the trend of skin care companies pushing over-the-counter creams, lotions, and potions that work with the body's day and night cycles. That is fascinating enough - what woman doesn't have a random assortment of bottles and jars, some for daytime, some for nighttime, some for work, some for going out, some for really special occasions?

But the part that caught my curiosity was the discussion of what being a "cosmeceutical" really means. Companies want us to believe that there are hard data and stern scientists behind their claims of "47% improvement in radiance in just 7 days" when we buy their products; but if there were any real, objective proof, they would require regulation by the FDA, which is clearly something they're not interested in getting mixed up in for their drugstore brands.

It makes sense, right? How effective can these over-the-counter promotions be at "reducing the appearance of fine lines and wrinkles" or "tightening loose skin without surgery"? Otherwise the FDA would be regulating whatever "special active ingredient" as the latest, greatest drug...

Should seem obvious to a medical school-educated person with loads of practical experience in dealing with the FDA's fine print and convolutions. I guess it was just the hopeful consumer in me that was lulled into suspending disbelief by the pretty pictures and fancy words of cosmeceutical ads. Yeah, I bought it. A lot of it. But, now, both eyes are open - I'm on to you companies now.

Can it be? A plastic surgery app for your iPhone?

For all you iPhone addicts out there...
http://www.reuters.com/article/pressRelease/idUS103166+14-Oct-2009+PRN20091014

I'll have to rely on you hip folks out there to let me know how it is. Unfortunately, I am personally still in the dark ages of cell phones, with my old-fashioned flip phone without a text or data plan (the horrors!).

Settled in

It's been a week since the big move for Duet to Palo Alto. Dr. Weintraub and I have settled in fine. This office complex is actually quite familiar to us; it's the same site as the Stanford Chief Residents' Cosmetic Clinic.


Our signs will be going up soon, but in the meantime our patients seem to be finding us in our new location okay.