Aesthetics

Cosmetic Surgeon, Plastic Surgeon, and Credentials

Saturday, March 21st, 2015

A woman was found dead, lying on a massage table with bloody gauze on her buttocks inside a business that performs eyelash extensions in Dallas on February 19th. It appears that this woman had paid about $520 to have something injected into her buttocks as a buttock enlargement procedure. Exactly who injected exactly what is not clear at this point, but arrest warrants have been issued for Denise Ross, who goes by the name of Wee Wee, and her transgender companion Jimmy Joe Clarke, who goes by the name Alicia, for practicing medicine without a license (both are pictured above). This is such a tragic story, and unfortunately it's not all too uncommon. News reports keep popping up about people who have silicone injected directly into their buttocks or breasts, the procedure being performed by someone who may be in the area only for the weekend. Complications occur, and the injector has long-since vanished.

It is precisely because of tragedies like this that credentialing is so important. One type of credentialing is word of mouth. A friend or colleague went to this place or that place, had something done, was happy with the result, and she tells you about it or posts a positive review online. That type of credentialing can be very helpful and may (or may not) come from a trustworthy source. In medicine, another type of credentialing comes through certification by a Board recognized by the American Board of Medical Specialties (ABMS). This is an entity composed of 24 medical specialty Boards. The American Board of Plastic Surgery is one of the twenty-four. Doctors who are Board Certified by one of the 24 ABMS member Boards and who participate in the Maintenance of Certification program are part of a demanding process that repeatedly assesses and enhances their professionalism, judgement, medical knowledge, and clinical techniques.   ABMS and its member Boards establish lifelong learning standards that ensure physicians keep abreast of the latest practices and treatments.  Before becoming Board Certified by the American Board of Plastic Surgery, a candidate must have completed a plastic surgery training program at an accredited institution.  A list of those institutions reads like a Who's Who, including essentially every major university medical center you have ever heard of.  A surgeon cannot become Board Certified by the American Board of Plastic Surgery without completing training at one of these 100+ member institutions.

From time to time I'll Google some key words, like 'breast augmentation Fort Worth', just to see what pops up.  Occasionally I run across something unexpected, like a website of a surgeon that is new to the area, or at least new to me.  So, I'll look at the website and try to find out a bit about the doctor.  Who is he/she?  What type of practice is it?  Where did the doctor do his/her training?  What types of certification does he/she (I'll just use 'he' or 'his' from this point forward) have?  Sometimes the information is easy to find on the site.  Sometimes it's almost impossible.  As consumers we all want to know as much as possible about the products and services we buy.  With something as important, even 'intimate', as surgery, we have a right to know what qualifications a person who may be operating on us has.  One thing I've found as I've looked at these various websites is that a doctor who trained in plastic surgery will display that training proudly on the first page of the website and on his biography page.  It's not hidden in the website somewhere; you don't have to dig through pages of the site to find it.  A surgeon who is certified by the American Board of Plastic Surgery displays that information on page one.   On the other hand, another thing I see a lot on websites relates to doctors who say they are 'Cosmetic Surgeons'.  Frequently those sites look great.  Lots of animation on the site, lots of color, lots of pictures, even some nice testimonials.  All of this sounds and looks just great, and often these are very good doctors and surgeons.  Something that bothers me about many sites like this, however, is that it's often hard to find out the details.  What is the doctor's background, and where did he do his training? It may be surprising to learn that often these doctors originally did their training in something like family practice or radiology, then decided to start doing cosmetic surgery. In situations like that, it might be worth knowing how exactly the doctor got into doing particular procedures, for instance, liposuction or breast augmentation. Did he attend a weekend course and start doing it? On many of these types of websites that information just is not displayed. The websites look great, but the depth of content regarding training is lacking. And that, at least to me, raises questions.

I am not comparing these doctors to the unknown, non-physicians who inject unknown substances into people, similar to the situation mentioned at the beginning of this blog. To be a licensed physician in Texas, a doctor has to have undergone verified training and passed specific examinations. On the other hand a random person injecting unknown substances into buttocks in a nail salon...well let's just say his or her training is more suspect. What it really comes down to is this: credentialing matters. Word of mouth and positive online reviews are helpful. Board certification in Plastic Surgery or Cosmetic Surgery is, at least in my opinion, essential.

Fat Grafting of the Breasts

Tuesday, January 27th, 2015

While it may sound crazy, fat grafting of the breasts is the real deal. Suctioning out unwanted fat from one area of the body and adding it to specific areas in a breast helps create a more refined, sculpted look. Initially used for breast cancer reconstruction, techniques continue to evolve and the technique is now being used more and more in cosmetic breast surgery as well.

Fat grafting of the breasts is not new. In 1895, a German physician named Vincenz Czerny described breast reconstruction of a 41 year-old singer. She was concerned about how she would appear on stage after having to have a breast removed. She had a large lipoma (fatty tumor) in her lower back, so this was taken and placed in the mastectomy defect. In 1919 another German doctor, Erich Lexer, published "Free Transplantations", a 2 volume text about grafting. In this text he described some clinical applications of fat graft breast augmentation and reconstruction. Melvyn Bircoll, a Los Angeles surgeon, published his experience with breast augmentation using liposuctioned fat in 1987. Emmanuel Delay in Lyons, France began using fat grafting for breast reconstruction in 2000. Gino Rigotti, in Verona, Italy, presented a large series at a 2007 European aesthetic plastic surgery meeting. Over the last 10 to 15 years fat grafting has been championed in the United States by Sydney Coleman in New York, Daniel Del Vecchio in Boston, Roger Khouri in Miami, and Kamran Khoobehi in New Orleans.

Methods for obtaining the fat, processing it, and placing the fat into the breasts are changing all the time, allowing for ever-improving shapes and contours with enhanced safety and predictability. One of the early concerns about fat grafting was that it may make mammograms more difficult to interpret. Clinically this has not been found to be the case. Del Vecchio and others have published their experiences, with a very low incidence of oil cysts and calcifications seen after fat grafting. Peter Rubin in Pittsburgh also reported a study showing that mammograms of women who have undergone breast reduction surgery are actually more difficult to interpret than mammograms of women who underwent fat grafting.

Many women come to the office with a desire to have more shapely breasts. An area that almost all want to have addressed is the flattened area at the top of the breasts, where the chest transitions to the breast. Breast implants help fill that area and may be all that's needed. Sometimes, however, adding a little fat to the upper breast may create an even more subtle transition and more filling in that area. Fat may also be added in other areas as well, depending on the specific findings and desires. A woman who is thinking about breast augmentation who also happens to have fullness in her thighs or abdomen may be an ideal candidate for fat grafting of her breasts. Using slightly modified liposuction techniques, the fat is removed from the areas where contour improvement is desired. The fat is collected and cleansed of oils and blood cells. The cleaned fat is then injected into the desired areas of the breasts.

The surgery may take two or three hours to accomplish. Recovery is similar to that of a typical liposuction operation. For a few days there is some soreness at the sites from which the fat was taken, and the breasts feel fairly tight. Swelling begins to subside after five or six days but the final shape of the breasts and the suctioned areas won't be seen for a few months.

Fat grafting of the breasts is an exciting, evolving technique. Women now ask about it frequently when they visit the office. If you have been thinking about changing the shape and appearance of your breasts, fat grafting is something you should at least know about. Call the office and come learn about this intriguing procedure!

24 Hour Saline Breast Enlargement

Wednesday, September 10th, 2014

It seems to be all the rage in New York these days. Saline injected directly into the breast tissue. Wow!

So, why on earth would a woman have something like that done? There are a few reasons. Some women who are considering breast augmentation want to have a good idea of what they'll look like with breast implants. Rather than trying on implants in their bras, they can have a doctor inject saline into their breasts. Seeing what 350 cc's of saline in the breast looks like may provide some indication of the look a 350 cc implant may create. Some women have no desire to actually get breast implants, they just want to have larger breasts for about 24 hours. The injections can certainly provide an amazing look for parties, weddings, and red carpet type events. The effect, however, only lasts about 18 to 24 hours. In New York City these procedures go for $2500 to $3500. That's quite a bit to pay for a 24 hour pick-me-up.

I understand the thoughts behind saline injection into the breasts. On some level it makes sense. On the other hand, in our office we use the Vectra XT three dimensional imaging system to help women understand about how they may look with specific breast implants. Rather than do multiple needle sticks (some of which invariably will pass through milk ducts, potentially introducing contaminants into the breast tissue), the Vectra system lets the computer do the work to help show potential results. A study published just last month found that this system has about a 90% accuracy rate. Saline that is injected directly into the breast will not give a reliable representation of what a breast implant will do. Saline that is injected into the breast is placed in the breast tissue itself; an implant is placed behind all of the breast tissue and in most cases partly behind the pectoral muscle. Saline injected into the breast tissue will expand the skin and breast tissue in all directions. An implant placed behind the tissue pushes the tissue forward. The look really is different.

There may be some risks to the saline injections. As mentioned above, they may push contaminants into the otherwise sterile breast tissue. This could lead to infection, even if the procedure is done as sterilely as possible. Also, if you've ever been given a shot, you know that some bruising may occur. Injecting saline deeply into breast tissue requires fairly large needles to pass through a lot of tissue, including some blood vessels. That's likely to create some bruising and soreness. Finally, if the procedure were to be done multiple times to the same woman, it's possible that her skin would stretch and become droopy. That's not likely to happen with one or two injections, but it's conceivable that it would happen after multiple procedures.

I have not yet had a woman come into my office asking for saline breast injections. If she wanted to do it for some special event and understood the effect would only last about 18-24 hours, I would probably consider it. On the other hand, if her thought is that she'd like to see how she would look with that volume implant, I would have her try three-dimensional imaging with the Vectra system. I think it's likely that the Vectra system will provide a more accurate representation of the potential outcome, and do it with no real risk.

Come by and see the Vectra XT three dimensional imaging system. We use it with almost every patient we see in the office. It's cool, it's powerful, and it makes the consultation process so much more meaningful.

New Fort Worth Aesthetician

Thursday, August 14th, 2014

We are proud to announce that Katie O'Keefe has joined the practice!  We interviewed dozens of applicants, waiting patiently to find the person we think can provide outstanding results for her clients while maintaining the practice standards of customer service, client education, and desire for continued improvement.  Katie is all that and more!  From every-day skin care programs to chemical peels, dermaplaning, and microderm, Katie would love to personalize a treatment regimen to help your skin achieve optimal health and appearance.  She went to TCU, is an avid hockey fan, and loves animals.  Come visit with Katie and see why we're so excited she's here!

 

Microneedling

Tuesday, July 8th, 2014

We are excited to introduce microneedling (also known as collagen induction therapy, or CIT) to the practice!  This evolving technique uses an electronic device to create controlled channels or microwounds into the skin.  These micro-passages stimulate the normal wound healing cascade by releasing growth factors, leading to the production of new collagen, elastin, and microscopic blood vessels (capillaries).  The micro-channels may also be used to aid delivery of cosmeceuticals, growth factors, and bioactive peptides into the dermis.  Microneedling has many uses, including improving scars (acne scars, surgical scars), reducing stretch marks, improving fine lines, and helping create more even skin pigmentation.  Unlike laser treatments and deep chemical peels, microneedling causes minimal injury to the skin.  This makes microneedling a versatile technique, being able to treat areas that lasers cannot like the neck, chest, and hands.  Collagen induction therapy is an area of growing interest in cosmetic plastic surgery. Come visit and learn more about microneedling!

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