NEW RX FOR KELOIDS

Keloids have been and continue to be one of the most vexing problems we face as plastic surgeons.

Now a potential new Rx is on the horizon and it is called Celotres.

The study involved excision of the keloid followed by an injection of Celotres into the epidermal/dermal junction. The recurrence rate was 19% versus the predicted rate of recurrence of over 50%.

I'll post again as we learn more.

BOTOX VS. DYSPORT

As a practicing Fort Myers plastic surgeon, I watch with interest the competitive fight between various "injectables".

The battle goes on. The clash of the titans. And more players are coming on line all the time.

A recent article in the Aesthetic Journal did a comparison study between Botox and Dysport. The study showed there was no statistically difference between the two. Dysports lower price, however, gives it a big cost advantage.

ANTIBIOTICS AND BREAST AUGMENTATION

News from Dr. Robert J. Brueck MD , plastic surgeon in Fort Myers, FL

For years, we used to prescribe pre-operative antibiotics for breast augmentation patients. We would then continue the antibiotics for several days post-op. The question is, is it really necessary?

A recent study seemed to answer that question.

A study of 605 patients over 4 years revealed there was NO difference in over all complications, infection or capsular contraction in patients who received 3 days of postoperative antibiotics versus those who received none.

MASSAGE – GETTING YOUR MONEY’S WORTH

After a hard day's work or a long mentally draining day, (the kind of demanding day a plastic surgeon goes through, LOL), there is nothing like a good, firm, relaxing massage.

A new research study has revealed there is more to a massage than meets the eye. It seems a massage can affect our genes that lead to healing of our muscles.

Scientists took eleven volunteers and placed them on a stationary bike and had them ride until they were totally exhausted. They then massaged one of each volunteers thighs for 10 minutes.

The results? The thigh that was massaged found that the genes associated with inflammatory/soreness were three times less active. The massage also increased, by 30%, the gene that creates mitochondria which increase energy/healing.

So maybe the next time your get a massage, the $50 or $60 you "lay out" maybe money well spent.

SUPER BOWL FOODS

The recent Super Bowl was exciting. It sure had a big audience – in fact, the biggest.

One of the corporate sponsors was Marriott and they did a survey of “fans” to determine their favorite foods for Super Bowl – good information to have to prepare for next year.

Number one was chips/dips (61%), pizza (55%), nachos (41%), subs/sandwiches (38%), BBQ (37%), fried finger foods (35%) – all the way down to vegetables (28%). As a Fort Myers plastic surgeon who deals with weight control patients, I have to ask, "Do you think this may help explain our 'obesity' syndrome? "

But I questioned this survey's validity – where are the wings? I always thought they were popular. Oh well – guess we will have to wait until next year.

IS THERE SUCH A THING AS “GOOD FAT”

I guess if you are trying to lose 20 lbs or so the answer would be a resounding “NO”!

Now, scientists have identified a baby fat called “brown fat”. It was thought that brown fat went away as we got older, but now we know adults have persistent brown fat that is active.

Interestingly the heavier a person is, the LESS brown fat they have. Brown fat gets it’s color from the iron contained in it.

As a Fort Myers plastic surgeon who deals with weight loss patients, I'm always for looking for ways to burn off more "bad" fat.

A study recently showed in mice that excess white fat can be turned into brown fat which is more metabolically active than white fat, ie. it burns more calories.

Cold also increases brown fat activity. Will we see a rush to go “ice fishing?”

So the quest is on to increase the amounts of brown fat in our bodies.

It is thought if we could increase the amount of brown fat in our bodies, to say 3 ounces, only 3 ounces, we could lose an extra 500 calories a day for 52 lbs. a year! Now that’s weight loss!

NEW TECHNIQUE FOR BREAST RECONSTRUCTION

As a Fort Myers plastic surgeon, I find breast reconstruction to be very popular among women who have undergone a mastectomy.

One of the most common forms of breast reconstruction is to put a tissue expander at the site of the mastectomy – expand it over several months – then replace it with a permanent prosthesis. This process can take several months.

A company called Air Expanders has developed an expander that patients, with the help of a remote control can expand the area in a much shorter period of time – instead of months maybe only a couple of weeks.

No more needles – and the patient can decide just how big they want to be. The studies with this new device are being done at New York Presbyterian hospital. The doctor conducting the study is Dr. Jeffrey Ackerman.

LUMPECTOMY FOR BREAST CANCER

Today, many women will bypass a mastectomy for a lumpectomy followed by chemotherapy and/or radiation.

A recent article in the Journal of the American Medical Association revealed that one in four (25%) of patients undergoing this therapy will undergo a second operation.

This creates a significant degree of anxiety along with many questions about the patients future – how deformed will it be? Did it spread?

There is a sincere sense of anxiety and stress associated with this. I also think a patients personality and sense of body image may come into play when making a decision on what therapy is best for her.

BRAZILIAN BLOWOUT

I have never heard of it. As a Fort Myers plastic surgeon, I do hear about Brazilian buttock lifts, with the Olympics coming to Brazil.

But Brazilian Blowout is a product manufactured to straighten hair.

The problem is it contains a toxic substance called formaldehyde. Going forward the company agreed to have their products tested for toxic substances.

I guess Facebook is a big fan of Brazilian Blowout. The product's Facebook page has 28,000 fans! Wow!

NEW INDICATION FOR BOTOX

Today's question from Fort Myers plastic surgeon, Dr. Robert Brueck MD: What will they think of next?

I guess the only limitations of finding uses for Botox is your own imagination.

Now they are injecting Botox in a patients stomach. These injections are NOT in the patients skin on the outside, but are actually injected with a needle to the mucosa or lining of the stomach.

I was watching a doctors' show – it seems there are as many as there are 7-11 stores – and a gastroenterologist was injecting Botox into a patients stomach.

The idea is that by injecting Botox into someone’s stomach it slows down the emptying of the stomach – hence – the patient feels “full” and does not eat as much.

At last, a new weight loss program (?).

The GI doctor (gastroenterologist) who spoke about this has had her stomach injected and has lost 7 pounds over several weeks. Who knows a “Botox” cocktail may be just around the corner.

NEW WAYS TO RESEARCH PLASTIC SURGERY

The way patients get information on plastic surgery is undergoing evolution.

Years ago, it was word of mouth or a referral from your family doctor. Then advertising hit the airwaves and now we have the internet.

A recent survey by the American Academy of Facial Plastic Surgeons shows a whopping 42% of prospective patients get their information from social media sites such as Facebook.

It is amazing to me, as a Fort Myers Plastic Surgeon, how popular and powerful the social media are becoming. Some of my patients spend 1-2 hours a day on social media sites.

I guess the concern I would express – don’t rely of this ALONE to make your decision on who to go to for your cosmetic surgery.

That said, if Facebook is one of your favorite places to research, you'll find me at http://www.facebook.com/DrBrueckMDFortMyersplasticsurgeon. You can "like" me there and receive my informative, and occasionally amusing message on your newsfeed.

BREAST SALVAGE AFTER RECONSTRUCTION

From time to time, as a Fort Myers plastic surgeon, I am exposed to journal articles and reports that may be a little technical for the average reader. But I like to include them here because they may be of interest to some people.

One of the most dreaded complications after breast reconstruction is to develop an infection. A recent study was reported in the Plastic Surgery Journal. It chronicled one surgeons experience.

Once an infection is established, ie: fever, swelling, erythemia or redness, then one must act right away. Usually broad spectrum antibiotics are started. The patient is then taken to the operation room and the infected prosthesis is removed, cultures taken and the pocket is debrided and irrigated with normal saline and antibacterial solution.

If the pocket, in the opinion of the surgeon, was not overly infected, a new prosthesis was placed along with a suction drain. The drain was removed when the output was less than 30 cc’s within 24 hours.

If in the surgeon's opinion, the infection was judged too severe, the prosthesis was NOT replaced.

In the surgeons surveys gathered over several years (2002-2008), 60 patients were identified. Of these, 17 patients (28%) did NOT have the prosthesis replaced. A total of 33 patients had a successful salvage procedure. The success rate was about 77%.

Also of interest was the fact that the average time between the actual reconstruction and the infection / implant exposure was about 14 months.

Another thank you note.

As I have stated before, as a plastic surgeon in Fort Myers, this kind of satisfaction is my major reason for being a plastic surgeon.

"Dear Dr. Brueck, Chi & Debbie,

I would like to Thank You all very much for taking such good care of me during surgery and office visits. Everyone is so helpful. Having a tummy tuck and lipo suction has changed my life. Still can not believe that my stomach is gone. What I really liked is your honesty. A patient coming in for a consult thinking that they want one thing done and you are honest to tell them that it is not really what you need. That you just don't do what the patient wants for the money. You let me know what is best for me. I was impressed with they way that I can ask any question and feel comfortable. Looking forward to the next procedure.

Thank you all so very much" -KJ

GYNECOMASTIA ON THE RISE

You might ask “what is gynecomastia?” Simply put it is male breast tissue.

It is on the rise and can be a very difficult surgical challenge. I happen to enjoy that challenge, because the solution is so gratifying to a patient..

The amount of excess breast tissue can be significant where the person may be a “C” cup. This is a constant source of embarrassment and low self esteem.

Living here in Florida, these men are afraid to bare their chests because of their excessive breast tissue. This tissue can be firm, gritty, regular breast tissue or merely excess fatty tissue. In most cases it is a combination of both.

Often times body builders who take steroids will exhibit varying degrees of gynecomastia. It also is common among men who are obese. Treatment consists of surgery, ie. via liposuction or direct excision.

These are procedures I perform right here as a Fort Myers plastic surgeon.

WHEN SHOULD I HAVE A FACELIFT?

The question has been bantered about for all the ages. I hear it all the time among my patients.

There really is no set answer, but a recent study was reported in the Plastic Surgery Journal this month. The study included 89 women who underwent facelifts. There were three groups, under 50 years of age, between 50 and 60, and over 60!

The results revealed that younger patients, ie: under 50, with minimal signs of aging consistently had a more positive satisfaction rating following their surgery.

In my practice as a Fort Myers Florida plastic surgeon, I’m seeing more younger patients who want to get a jump start to looking younger and maintaining their youth.

PIP UPDATE

The PIP controversy continues. You may recall that these were the toxic breast implants in France that have been recalled and are being replaced.

It was learned the that Italian plastic surgeons association is suing the manufacturer of PIP implants. That’s a win for attorney’s. I believe PIP declared bankruptcy.

They are also suing a German company TUV Rhenland, which apparently certified the implants with the industrial grade silicone.

(I guess if we were talking about cleaning products industrial grade would be ok.)

There also is a German company that sold their PIP implants under the name T; BREEZE. Where did that come from?

Fortunately, only 728 of these were sold and none in the United States.

NEW PRESCRIPTION FOR CYSTIC FIBROSIS

I remember as a young medical student in Chicago how devastating a diagnosis of cystic fibrosis was.

Still today, as a veteran Fort Myers plastic surgeon, it breaks my heart to think about these youngsters.They would usually never live long enough to get their drivers license.

There are over 30,000 patients with cystic fibrosis in American today.

Vertex Pharmaceutical just got FDA approval for a new pill called Kalydeco. It is used to treat a small segment of cystic fibrosis patients.

The cost for one year - $294,000.

The reason? Because the company spent millions to develop it and the number of people using it will be miniscule.

A more expensive drug is Soliris. It is used to treat a certain blood disorder and it’s cost? $409,500 per year.

It seems shameful that these drugs cost so much. But, if there is not enough income to pay for the research, there would be no research.

And the good news is that every breakthrough usually opens the door for another breakthrough.

BREAST SHAPE AFTER MASTOPEXY OR BREAST REDUCTION

Breast shape is important to many women after breast augmentation, breast lift or breast reduction.

For many women who desire an augmentation, it is an increase in size, and size matters more than shape. However, many young and middle aged women want their breasts to be “perky” after a lift or reduction.

This has been, in my experience as a Fort Myers plastic surgeon, a futile goal.

When we do ANY breast reshaping we are not changing the patients old skin for new skin. The skin is still 30, 40 or 50 years old; thinner; less elastic; with stretch marks. Hence, when we re-shape it, yes, it is better than before, but it is not perky.

I recently read an article entitled “A retrospective photometric study of 82 Published Reprints of Mastopexy and Breast Reduction” The author was Dr. Eric Swanson from Kansas.

The results after this extensive study showed that our existing mastopexy/reduction techniques do NOT significantly alter breast projection or fullness in the upper pole, just what many women want.

I guess what we need to take away from this study is that expectations on the part of the patient and reality many times are two different animals. This is sometimes difficult to convey to patients.

SHOULD COSMETIC SURGERY ADS BE BANNED?

Here we go again: Another timely and provocative blog
from Fort Myers plastic surgeon, Dr. Robert Brueck MD

Apparently the British are getting ready to ban or recommend a ban on advertising by cosmetic surgeons. This is the recommendation by the British Society of Aesthetic Plastic Surgeons. They are proposing a 6 point plan.

Ban all ads for cosmetic surgery.
Re-establish an implant register
Re-clarify dermal fillers as medicine (this would restrict who could inject ie. must be a doctor)
Register all aesthetic surgeons
Mandate a safety audit
Revalidation or recertification

This has been prompted in part by the recent PIP implant controversy. For years physicians in our country were not allowed to advertise. Your advertisement was your reputation. If it was good, patients would come and if not well you know the rest of the story. Maybe, for the sake of patient safety we need to long for the old days.

Perhaps they have a point. But with $1.07 billion spent on cosmetic surgery in the US in 2010, there certainly appears to be a hunger for knowledge about plastic surgery procedures in this country.

NEW CANCER DRUG FOR BASAL CELL CARCINOMA

This is another in Dr. Robert Brueck's blog posting as a Fort Myers plastic surgeon dealing with skin and cosmetic surgery issues.

The most frequent type of cancer in the common form of skin cancer is called basal cell carcinoma. This cancer is so common and it frequently increases with age.

It usually grows locally and is treated with surgery the majority of the time.

A new drug called Erivedge will be available to treat more advanced forms of basal cell in patients’ who are not candidates for surgery or radiation. It is also indicated in treating metastatic basal cell – that is a rare breed.

In 32 years I can recall maybe 1 or 2 cases. This is the first ever FDA drug approved for metastatic basal cell carcinoma.