Diabetes and Coronary Artery Surgery

Stents - those little mesh structures inserted in the arteries to keep the flow of blood uninhibited - have been a major innovation in re-establishing blood flow to a damaged heart muscle.  It's simple – just an overnight stay – no more cracking the chest to have open heart surgery.  

A recent study of over 1900 patients with diabetes found that patients who received open heart operations versus stents, however, were 30% less likely to die or suffer a heart attack or stroke within 5 years.  This is significant. It will certainly change choices patients make, as have so many new findings that come across my desk. Even after more than 30 years as a cosmetic surgeon in Florida, I am continually surprised by how much we learn and how much it stands to improve patient outcomes..

The total number of surgical cosmetic procedures...

...performed in 2011 showed women having 1,493,615 total which was 91.2% of all procedures while men had 144,909 total surgical procedures which was 8.8% of the total numbers. As a Fort Myers plastic surgeon, I find these stats instructive.

Cosmetic procedures by age groups – male/female:

18 and under 34,663

19-34 456,400

35-50 665,381

51-64 382,378

65+ 99,701

Top 5 cosmetic procedures:

Breast augmentation 316,848

Liposuction 283,669

Tummy tuck 142,657

Blepharoplasty 124,635

Breast lift 122,054

Top 5 cosmetic procedures for men:

Liposuction 41,663

Rhinoplasty 24,553

Blepharoplasty 22,905

Gynecomastia 17,645

Facelift 10,400

Some year to year comparisons:

1997 2011

Tummy tuck 34,002 149,410

Breast augmentation 101,176 316,848

Breast lift 19,882 127,054

Liposuction 176,863 305,332

Facelift 99,196 116,086

Browlift 55,090 28,200

Interesting stuff, eh?

COSMETIC SURGERY AND THE RECESSION

Apparently cosmetic surgery did not suffer as much as the economy.

There was a downturn in 2008 at the height of the recession. From 2009-2010 people spent 3.8% less on food, 2% less on housing, but spent 1.3 more on breast augmentation, 5.1% more on liposuction, 8.1% more on eyelid surgery and get this 24.4% more on buttock lifts.

What is really of interest, nearly 1/3 of cosmetic surgery patients’ had incomes of less than $30,000 per year and about 70% made less than $60,000 per year.

I think it's evidence that plastic surgery and cosmetic surgery have become mainstream. You don't have to be in the 1% to not want to look like the 99%.

NEW PLASTIC SURGERY APP.

A company in France, Kaeira EURL, has released their latest version of Plastic Surgery Simulator. Version 1.1 is now available for i Phone, i Pad, and i Pad touch.

The app allows people to stretch or shrink body parts to see what they “might” look like.

I only hope prospective patients don’t use this as a motivation to have plastic surgery. To me it’s more of a toy than anything else.

As a Fort Myers Plastic Surgeon, I can guarantee I will not be using Plastic Surgery Simulator.

COSMETIC SURGERY-WHO DOMINATES?

The answer to this is pretty easy. WE DO! How can we not, with the likes of Beverly Hills and Miami Beach?

It may also be true that plastic surgery's popularity is related to the standard of living. Countries with large populations of poor are not going to see much elective cosmetic surgery. Or so it seems to me as a Fort Myers Florida Plastic Surgeon.

What is interesting is that there are new names on the list of top 10 countries for cosmetic surgery? The list was compiled by the International Society of Aesthetic Plastic Surgery. The list, in decreasing order, is U.S., Brazil, China, Japan, India, Mexico, Italy, South Korea, France and, at # 10, is Colombia.

Liposplasty again remains the number 1 surgical procedure, followed by Breast Aug, then Blepharoplasty or eyelid lift. The total number of board certified plastic surgeons is 33,000 world wide.

IMPLANTS ARE SAFE

A lot of concerned was expressed recently when the French government announced it would pay to have all Gel implants in French women removed.

Concerned patients should know that only implants manufactured by PIP (Poly Implant Prosthesis) were to be removed. Apparently, from what research I have done, the gel used in PIP implants was INDUSTRIAL grade NOT MEDICAL grade.

As a Fort Myers plastic surgeon, I only use MENTOR implants, which are medical grade silicone.

I guess it’s like buying steak-you can have choice or top-of-the-line prime. I’m sure there are many European women with PIP implants. PIP used industrial grade silicone because it simply was CHEAPER.

Years and years ago, I took care of several patients who had “industrial” grade silicone actually injected into their breasts. No implants. Just industrial grade material placed into syringes and then injected into their breasts. The results were terrible. These women developed severe inflammations and multiple nodules. Mammograms became more difficult to perform. Many of these women required simple mastectomies and reconstruction.

The company, PIP, went bankrupt in 2010 and shut its doors. Their president/founder is M. Jean-Claude Mas. He is 72 and in poor health. As always this will be played out in the courtroom…many years later. Till then, rest assured, unless you received a PIP implant, most likely in Europe, all is well.

HAND SANITIZER :GOOD OR BAD?

It seems, no matter where we go – a squirt here, a squirt there – we bath our hands in “hand sanitizer”. Several years ago they were non-existent, and now they’re everywhere – gyms, restaurants, stores. You name it, they have it.

There are some risks, however

1. They cut down on the exposure of our immune system. Our immune system pours out antibodies (like antibiotics) in response to contact to germs; no germs – no exercise.

2. They are NO replacement for the time-honored use of good ole' soap and water.

3. They have high concentrations of alcohol which removes skin oils from our skin.

4. They can give you a false sense of security.

I can tell you, after three decades as a practicing Fort Myers Plastic Surgeon, your best protection is a vigorous hand washing with soap and water.

FAT NO MORE

If there is one thing 70%, 80% or 90% of Americans have done, it’s gone on a diet.

Americans are obsessed with weight loss-dieting. The real problem is that there are way too many good tasting, tempting foods. Why couldn’t cauliflower be a chocolate Sunday and brussel sprouts a banana cream pie. It just never really made sense to me.

Well, our never-ending frustration may soon be over.

Researchers of MD Anderson Hospital in Hourton have found a drug that kills a type of fat cell by destroying its blood supply. This new potential miracle drug is called ADIPOTIPE!

The initial studies were done in Monkeys now they are waiting to do some early human trials. These studies will help identify side effects as well as proper dose.

Sit tight-help may be on the way. But then again they would need to get FDA approval. Unfortunately that could take a Lifetime. Oh well, it’s still encouraging.

I care about weight and dieting because they influence how you look as well as how you feel. That is a combination that is essential in my Fort Myers Florida Plastic Surgeon's practice.

PROPHYLACTIC MASTECTOMY

Many surgeons are concerned with the increasing trend among women to request removal of their other “normal” breast after undergoing a mastectomy.

Many women voice concerns about developing cancer in the “other” normal breast. Why is this?

There are several reasons. One – fear of recurrence. Two – new technology such as MRI can pick up miniscule lesions not seen on normal mammograms. Third – many women are getting genetic testing to see if they carry BRCA-1 and BRCA-2, genes associated with an increased cancer risk.

Even after a “double mastectomy” the risk of breast cancer is reduced by 90% - NOT 100%. Tumors can still grow back in scar tissue or under the arm where extra breast tissue may be located.

Careful planning with your surgeon trumps decision making out of fear. Dr. Brueck offers general guidance on his Fort Myers Plastic surgeon web site. You are invited to visit.

LIPITOR

Today marks a milestone in the drug industry. The top-selling drug Lipitor will now be pushed aside by new generics as Pfizer’s patents run out.

Lipitor has been a mega blockbuster. Last year, Pfizer sold over $10 billion of the drugs to millions of patients all over the world to lower their cholesterol.

The sales of Lipitor in dollars over the years were 100 billion.

As new generics come on line the price of Lipitor will of necessity come down. Generics are rapidly taking over the drug industry. It was estimated about 8 out of 10 prescriptions today are generic.

This is good news for all those patients now taking Lipitor.

The status of drugs, new and old, is something I monitor closely, as it relates to my Fort Myers plastic surgery practice.

ANOTHER SECRET TO DIETING

We often hear of new ways to diet and one thing many people stress is portion control.

Now we can add a new wrinkle to that. A new study published in Consumer Research says the size of the portion we eat may be influenced by the colors of the dinner ware and table cloth.

When the contrast between the plate and the table cloth was high, i.e. white plate on a black table cloth, the individuals served themselves portions that were 10% larger.

Just some “food” for thought with the holiday’s upon us.

If you have any questions about weight control, dieting, health or plastic surgery, visit my Fort Myers plastic surgeon web site. You may find them answered on my FAQ pages.

Thank you.

Sparing the nipple is okay.

This is another message from blogger Dr. Robert Brueck MD, who practices plastic surgery in Fort Myers.

Plastic surgeons were always concerned that sparing the nipple during mastectomy may cause a greater recurrence following breast cancer surgery.

A recent article in Plastic and Reconstructive Surgery reports that 20 years of research shows there is NO greater incidence of breast cancer in nipple sparing mastectomies.

This technique however is not right for all women. Women with more advanced cancer or large pendulous breasts may require a standard mastectomy.

HI-TECH FACIAL- FACING TOMORROW

This is a another in Dr. Robert J. Brueck's series of newsworthy blogs about cosmetic surgery and related subjects. Dr. Brueck is a Fort Myers FL plastic surgeon

In this new age everything is hi-tech – hi-tech phones – hi-tech T.V.’s – hi-tech cars – now it’s time for hi-tech facials.

The three new hi-tech facials are:

Oxygen facial: This involves a blast of oxygen on your face. This oxygen heals bacteria and the “blast of fresh air” drives a serum placed on your face into the underlying skin creating softer, more moist skin.

Ultrasound facial: The ultrasound is used with water to first cleanse the skin. Once done a moisturizing cream/serum is then placed on the skin and is driven into the deeper layers with the ultrasound head.

Microcurrent facial: A small electric current is applied to your face with 2 electrodes. This will stretch and relax your facial muscles. Usually you do weekly treatments for 8-10 weeks and then a maintenance of once every 2-4 weeks.

So, there you have the latest in hi-tech facials. The face of a brave new world.

IT’S ALL IN THE NAME

Dr. Brueck MD, Board Certified Plastic Surgeon in Fort Myers, blogs about thing s major and minor. This message is on the minor side. Or is it? You be the judge.

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Sometimes you can tell what something is all about by the name.

Now comes, "Le Goo!"

What is Le Goo? Maybe a new hair mousse? A new gummy bear type candy?

No – Le Goo is a gel that surgeons can use to stop bleeding without clamps or elastic loops.

What will come next? I’m sure there is a copyright on the name so we won’t see a new Le Goo candy.

PAINT BALL PLAYERS BEWARE

Another blog message from Fort Myers plastic surgeon, Dr. Robert Brueck MD FACS.

Life is always filled with risks.

Now we learn that breast implants and paint ball don’t mix. A woman playing paint ball in the United Kingdom was hit in the chest with a paint ball and her “implant exploded”.

If it was saline and it ruptured, it would deflate almost immediately, so the person would know it. However, a silicone rupture would be harder to detect because the “capsule” would contain the silicone in the ruptured implant.

Now, if you have implants and you want to go paintballing, you have to sign a special release AND have extra padding.

Hope the air conditioning is working that day!

Botox Sales are Rising

Dr. Brueck sends items of news and interest from his Fort Myers Plastic Surgery practice.

Botox sales in the second quarter of 2011 were up a solid 16% for the quarter, the dollar volume was $418 million. I think sales of Botox/fillers are up because in a weak economy they are more affordable. Also younger patients are now coming in, in their 20’s 30’s to start Botox.

FORECLOSED ON? STRESSED OUT?

Dr. Brueck MD blogs here on matters of health. He is a Board Certified plastic surgeon in Fort Myers, Florida.

I have always felt that “stress” is truly America’s silent killer. Yes there’s asymptomatic high blood pressure or the silent building up of plaque in our arteries but stress, in my opinion, trumps them all.

I recently read an article in the Wall Street Journal (8/31/11) discussing the effects of the rash of home foreclosures on our health. I found it interesting, but really no surprise.

The research was conducted by Janet Carrie of Princeton and Edel Tekin of George State. They studied the health of patients’ in several states hit hardest by the foreclosure crisis – Arizona, Florida, New Jersey and California. They could have thrown in Nevada for good measure.

Through their collaborative efforts they found that an increase of 100 foreclosures resulted in a 7.2% rise in emergency visits and hospitalization for hypertension and an 8.1% increase in hospitalizations for diabetes in the 20-49 year old age group.

They also found visits to the doctor for “anxiety” increased by 12%. There were other negative side effects as well. Again, the results are not surprising.

Botox - Move Over - Here comes competition

Welcome to the latest edition of Dr. Brueck's blog on plastic surgery. As a board certified Fort Myers cosmetic surgeon, Dr. Brueck reports here regularly.

The FDA recently approved a new “miracle” wrinkle remover and its name is Xeomin.

Don’t ask me how to pronounce it. But more competition is better than less. The price competition will be great both for Doctor and more importantly the patient.

Botox got FDA approval in 2002 and has grown to a $1.3 billion industry. Dysport was approved in 2009 and in that short period of time it has garnered maybe 20+% of the market.

The new Xeomin will be made by Merz -Restylene form - and be available in the spring. A big question remains: how long will Xeomin last relative to Botox and Dysport?

The success of Xeomin will depend on price and longevity. It has the potential to be a huge winner.

Stay tuned. More to come. Sign up for RSS feed of Dr. Brueck's blog to stay up with plastic surgery news.

Dr. Brueck recognized as Top Doctor 2011

American Registry reports that Castle Connolly Medical Ltd. a peer-based rating organization in the medical field, has recognized Dr. Robert J. Brueck MD, Fort Myers Plastic Surgeon as a Top Doctor in Plastic Surgery for 2011.

Dr. Brueck commented, "It is always an honor to be recognized for accomplishments in the field, especially when it comes from peer-review. The end, however, the singular focus of my practice is to provide excellence in surgical procedure and care for my patients. They always come first."

This continues Dr. Brueck's recognitions by Castle Connolly in 2003 through 2008.

PLASTIC SURGERY DEATHS- Dr. Brueck speaks out

From time to time, Dr. Robert J Brueck MD, a Fort Myers Florida-based plastic surgeon posts messages that he feels are important or interesting on the subject of cosmetic surgery. Thank you for your attention.

Florida has some of the country’s toughest laws concerning outpatient plastic surgery.

In spite of the restrictive laws, 32 people lost their lives in pursuit of beauty. Why is this?

There is no simple answer. There were four South Florida mothers who lost their lives while under going liposuction for love handles and bra rolls.

The number of cosmetic surgeries has mushroomed to over 13 million nationally. The number of physician offices licensed to do cosmetic surgery increased from 285 in 2004 to over 400 now. The increase in cosmetic cases would explain the increase in deaths. I also think the number of surgeons performing cosmetic procedures is exploding and many of them are not even plastic surgeons.

When I came to town 32 years ago there were only four plastic surgeons listed in the yellow pages of the phone book. Go check it out now. It truly has become a buyer-beware market.

We have primary care doctors doing facelifts and other cosmetic surgery procedures in our community. This is wrong and I believe if it’s not illegal, it should be.

I tell all my patients that safety is number one. Patient safety is never compromised. I know I have had patients leave me for another doctor over the years because I’ve insisted they get a physical exam by their internist or obtain certain lab work or perhaps cardiac clearance. That’s me – that’s my practice – that’s what I believe in.

Another concern is the length of sedation for some cosmetic surgery procedures. I constantly hear of patients undergoing cosmetic procedures and being sedated for six, seven or more hours. This directly adds to the risks.

The longer someone is sedated the higher the complication rate. I try to limit my operating room time to less than four hours TOTAL!

Bottom line, make sure your surgeon is board certified in plastic surgery, has a state licensed/certified OR and emphasizes patient safety.