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“No implantable device on planet has been more thoroughly studied than silicone gel implants.”

If you’ve been following plastic surgery news lately, you know that silicone-gel breast implants are back, big time. When they returned to the market in 2006 after the FDA ban was lifted only 19 percent of breast augmentation procedures used silicone. In 2012, according to new statistics released by the American Society for Aesthetic Plastic Surgery (ASAPS), 72 percent of the 330,631 breast augmentation procedures in the U.S. used silicone implants, while only 28 percent used saline.

Further, one can speculate that the total increase in breast augmentation procedures in 2012 (330,631 compared with 316,848 in 2011), and the comeback of breast augmentation as the number one plastic surgery procedure in the U.S., is because women can choose silicone, which, according to patients and surgeons, feels and looks more natural.

But if you’re considering breast implants, to know that they’re popular is not enough. Breast augmentation is surgery and implants take up permanent residence in your body. You are probably asking, “What was so wrong with silicone-gel implants in the first place that they were taken off the market for years?” In a recent live interview, the Huffington Post got together prominent plastic surgeons to answer these questions:

Why were silicone-gel breast implants taken off the market?

The FDA banned the use of these devices in cosmetic procedures in 1992 after complaints that the devices ruptured. At that time there were concerns that once released in the body, the implant material could lead to health problems, including connective-tissue diseases like rheumatoid arthritis. Plastic surgeons did not believe this to be true, but manufacturers at the time had no long-term data at this point, so they agreed to the ban to collect more information. During the ban, silicone implants continued to be used for breast reconstruction.

Why were they put back on the market?

The efforts of scientific studies made by 2,000 institutions exploring 1,200 data points showed that silicone-gel breast implants were not associated with breast cancer, autoimmune disease or any other systemic diseases.

Even though a scientific advisory committee recommended that the ban be lifted in 2003, the FDA recommended even more studies. It was not until 2006, after three more years of studies, that the FDA decreed these implants “safe and effective.”

Why are silicone-gel breast implants more popular than saline implants?

Water is not compressible. Women want a breast implant that is soft and compressible like silicone. Most women think the silicone implants feel more like a natural breast.

What are the dangers of silicone breast implants?

Silicone-gel breast implants were not banned because things went wrong but because, at the time, there weren’t scientific studies to refute claims that were made. The concern in the early 1990s was that these implants could make you systemically ill, i.e., cause disease. Now we have studies that show that neither silicone nor saline implants cause disease.

However, both these implants can have local complications. The most common local complications associated with both are capsular contracture (hardening), reoperation, implant removal and rupture or implant deflation.

Is there a higher complication rate with silicone than saline?

Studies since 2006 show an equal complication rate between saline and silicone. With saline implants, you can tell immediately if there is deflation. When it ruptures it deflates and the saline is absorbed by the body. With silicone implants, you sometimes need additional tests.

Saline implants are more prone to rippling and can sometimes be seen through the skin, but an advantage is that they can be adjusted by small increments at the time they are implanted.   This is helpful when adjusting volumes to improve asymmetry in breast size.  Saline implants require a much smaller incision, meaning less scarring. The shell of the implant is inserted and then is it filled with saline. Removing it is also easier.

On the other hand, the new silicone-gel breast implants have the virtue of being firm enough that if you cut one of these in half and squeeze it, the silicone protrudes from the open end, but when you release the pressure, it goes right back in. This ability to retain its integrity takes away the concerns, to a large degree, that in the event of rupture, there may be free silicone in the body. Additionally, breast implants create a pocket or capsule once implanted into the body, which prevents it from moving or sliding out, even in case of rupture.

Why do studies show that 20 percent of patients need their silicone gel breast implants removed after 10 years?

This removal rate is not due to implant failure, i.e., a broken implant. Most reoperations are because women want to change their breast size, have breasts that droop, or chose an implant that is too large. In other words, the reoperation rate is due to the way patients and surgeons select and use implants, rather than implant failure. Another consideration is that not every doctor performing breast augmentation is a skilled board-certified plastic surgeon; poor surgery will certainly lead to reoperation.

So, what’s the fuss about?

The fuss about silicone breast implants is because breast augmentation is politically and sociologically loaded and makes great fodder for news stories. For lawyers, it became their new ‘asbestos’ and for feminists breast implants became a symbol for bad values. Though Pamela Anderson is a poster child for breast implants, most patients are young women with underdeveloped breasts who feel inadequate or women with deflated breasts following pregnancy that just want a ‘natural look.’

Most of us have at least one area that’s going to annoy us forever. No matter how many calories you cut and miles you run, you can’t get away from it. There’s a bulge or a spillage of fat that stubbornly clings to your body like a parasite.

It’s no wonder that liposuction is the second most popular cosmetic surgery in the country. It has become integral to a population increasingly more aware of getting healthy and looking that way. According to the American Society for Aesthetic Plastic Surgery (ASAPS), 313,011 men and women had the procedure in 2012.

Although, liposuction literally sucks fat out of the body, don’t confuse it with a weight loss method. It is recommended to actually lose as much weight as possible before undergoing the procedure, so that you are at a stable, ideal weight that you can maintain. Think about liposuction as sculpting instead of just suctioning. It can help you achieve the contours you’re looking for by removing fat from a stubborn area. The beauty of liposuction is that it treats various body areas, from the head down to the ankles – anywhere there is a pocket of fat that cannot be dieted or exercised away; it can be sucked out.

Different types of fat

Fat is not all the same. Some of it grows around your organs and is associated with dangerous conditions like diabetes and heart disease. This type of “visceral fat” cannot be removed by liposuction; you have to eat right and exercise to get rid of it. The good news is that it’s easier to get rid of and through a good diet and workout routine; it goes away twice as quickly as the subcutaneous fat, which sits just underneath the skin.

This is where liposuction comes in. That stubborn fat that takes at least twice as much effort to lose and sits on your hips, calves, thighs and underarms can be suctioned out and the area contoured to look flatter and slimmer. It’s important that you have good skin elasticity so that when the fat is removed, your skin will shrink back and not hang loose. Otherwise, a skin excision or a “lift” might be needed.

Subcutaneous fat might not have the same effects on your health as visceral fat, but some studies recently have shown that liposuction might have some added benefits. Research showed that people who had high triglycerides (which lead to heart disease), had a 43% reduction in triglycerides and an 11% reduction in white blood cells (which causes inflammation). Those with normal levels had no change positively or negatively.

While this means that both types of fat might have an effect on your body and health, it also
means there’s a chance liposuction could have an added bonus.

Demystifying the procedure

It is suggested that you have a healthy BMI of below 30 to undergo this procedure. This is for your safety and to make sure you get the best results and ensure that the weight doesn’t come back. Once you have reached an ideal weight, liposuction can help you achieve your best contours and perhaps even motivate you to get in even better shape. Getting liposuction too early without sufficient weight loss could result in having to go back for more procedures and not getting ideal results.

During the consultation, after a thorough medical history and examination takes place, an assessment will be made and you will find out if you’re a good candidate for liposuction. The amount of operating time, fat removed and incisions required will vary patient to patient, but rest reassured in knowing that this is one of the most common and safest procedures. The incisions are small and some patients have been known to return to work in a few days. Healing from the bruises and swelling might take over a week to three weeks.

Does the fat come back?

Say you get liposuction and you’re 35-50 years old. You want to know what happens if you gain a little weight over the years. There’s no straight answer for this, but some studies have suggested that when you gain back weight, it may seem to travel to other areas in the body. Some patients who have had liposuction from the abdominal area might start gaining weight in the thighs or the arms instead. This doesn’t mean you can’t lose the weight or it will be disproportionate like before, but it may be redistributed differently.  It is best to just not gain weight!

This is another reason why maintaining a healthy diet and exercise routine is important. You want to make sure your insides match what you’re trying to achieve on the outside.

The American Society for Aesthetic Plastic Surgery just released the 2012 Statistics on Cosmetic Surgery!

- There were over 10 million surgical and nonsurgical cosmetic procedures performed in the United States in 2012. Surgical procedures accounted for 17% of the total number of procedures and 61% of the total expenditures, with nonsurgical procedures making up 83% of the total number of procedures and 39% of total expenditures.

- From 2011-2012, there was a 3.1% increase in the total number of cosmetic surgical procedures, with almost 1.7 million surgical procedures performed this past year.

- The most popular surgical procedure in 2012 was breast augmentation. In 2006, 383,886 breast augmentation procedures were performed and of those 81% used saline implants and 19% used silicone. In 2012, 330,631 breast augmentation procedures were performed and of those only 28% used saline implants and 72% used silicone.

- Since 1997, there has been almost a 250% increase in the total number of cosmetic procedures. Surgical procedures increased by more than 80%, and nonsurgical procedures increased by 461%.

- The top five cosmetic surgical procedures in 2012 were: breast augmentation (330,631 procedures); liposuction (313,011 procedures); abdominoplasty (156,508 procedures); blepharoplasty (153,171 procedures); rhinoplasty (143,801 procedures).

- The top five nonsurgical cosmetic procedures in 2012 were: Botulinum Toxin Type A (3,257,913 procedures); hyaluronic acid (1,423,705 procedures); laser hair removal (883,893 procedures); microdermabrasion (498,821 procedures); chemical peel (443,824 procedures).

- Women had more than 9.1 million cosmetic procedures, 90% of the total. The number of cosmetic procedures for women increased over 252% from 1997.

- Men had almost 1 million cosmetic procedures, 10% of the total. The number of cosmetic procedures for men increased over 106% from 1997.

- The top five surgical procedures for men were: liposuction, rhinoplasty, eyelid surgery, breast reduction to treat enlarged male breast, and otoplasty (ear surgery).

- Americans spent almost $11 billion on cosmetic procedures in 2012. Of that total $6.7 billion was spent on surgical procedures; $2 billion was spent on injectables procedures; $1.8 billion was spent on skin rejuvenation procedures; and over $483 million was spent on other nonsurgical procedures, including laser hair removal and laser treatment of leg veins.

- People age 35-50 had the most procedures – over 4 million and 43% of the total. People age 51-64 had 29%; age 19-34 had 19% of procedures; age 65 and over had 8 %; and age 18 and younger had 1%.

- The most common surgical procedure for people age 35-50 was lipoplasty; for people age 51-64 it was blepharoplasty; for people age 19-34 it was breast augmentation; for people age 65 and over it was facelifts. For all four of these age categories the most popular nonsurgical procedure was injections of Botulinum Toxin Type A.

In “I Feel Bad About My Neck,” Nora Ephron gave voice to generations of women who have been silently hiding their necks like turtles in scarves, boas, turtlenecks and chokers. Her blunt advice is to start concealing the neck at age 43. “Our faces are lies and our necks are the truth. You have to cut open a redwood tree to see how old it is, but you wouldn’t if it had a neck.” Sure, she had a point. But there is an equal embarrassment perched right above the neck: the sagging jawline.

When you reach your early 40s, you may notice that the skin between your neck and jaw, which was once a taut right angle, is now simply dropping. This “drop zone” is the subject of many heart-to-heart conversations. We have all watched at least one friend (of a certain age) pulling back the skin in front of her ears with two thumbs to illustrate how much better she would look without the drooping, wavy jawline. She asks, “Tell me the truth, don’t I look better like this?” You answer dishonestly: “Don’t be silly. You look great the way you are.”

The aging jaw and neck are challenging. The neck is comprised of three layers: skin, fat, and muscle. Sagging muscles and bulging fat are located under the thinnest, creepiest skin on the body (except for eyelid skin). To make matters worse, a thin ropey material called platysma tends to split into a V-like formation of two cords that stick out especially when they contract. To see this phenomenon in action (if you’re over 40) look in a mirror, say “eee,” and watch in horror what happens.

Dr. Aston recommends a neck lift for women in their early to mid-40s who are not ready for a facelift.   For some patients, a neck lift will be all that is needed to give an excellent improvement.  The neck lift tightens muscles and the jawbone to restore that all-important right angle.  It is impossible to fix that with Botox, Fillers, lotions, & potions.  Compared with a facelift, incisions are smaller, there is less pulling and recovery time is much shorter. However, a neck lift has traditionally been part of a facelift and many plastic surgeons believe it should remain so. The reasoning is that, anatomically, the muscles of the neck are connected to muscles of the face, so if you try to tighten just the neck muscles, you may do your face a disservice. Using this line of reasoning, even if your big complaint is your neck, you will probably get better results with a facelift. If you’re confused about which procedure is right for you, have a consultation to give you feedback while perusing your very own unique face and neck.

There are three areas that can instantly age a person – their eyes, lips and neck. And while many people focus on facial features when it comes to deciding which surgical or non-surgical cosmetic procedures to consider, Dr. Aston says focusing on the neck is crucial.

The front of the neck is one of the primary features we use to guess a person’s age. It often catches our eye first. Sagging neck skin is the telltale sign of true aging, so restoration of the neck is an important part of facial rejuvenation or facial plastic surgery.

Banding, wrinkling and fullness of the neck are among the things that make one’s neck appear old. Each case must be considered independently to determine which method can result in a younger-looking neck area.

The key is to identify the underlying problem. Is it wrinkles, or is it only deep lines that bother the patient? Maybe it’s just sagging skin, but not wrinkles. Perhaps the problem is both the skin and fat. Or, it could be all three: skin, fat and muscle.

Some muscle cords in the neck can be treated with Botox, excess fat in the neck can be removed with liposuction and loose skin can possibly be tightened using radiofrequency or pulsed light skin tightening. In some cases, all three procedures may be utilized or a plastic surgeon will focus on improving the neck area during facelift surgery.

If you properly correct the sagging neck in facial rejuvenation such as a face lift, that is the key to a youthful face and a happy patient, and is consistent with most patients desired outcome.

As the holiday season fast approaches many of us think about our personal appearance, after all there are many parties and social functions to attend during a four to five week period.

If one has been thinking about a little help from a plastic surgeon, time is running out. However with today’s less invasive refined techniques and significantly faster recovery, the possibilities of what one can have done have expanded. Of course there is individual variability in bruising, swelling and final healing but it is possible to make some generalizations for the most common procedures.

Facelifts today require ten days to two weeks to attend a social function and three weeks to return to full athletic activity. Short incision facelifts look very good in seven to ten days. Today’s facelift procedures are technically sophisticated and highly individualized for the particular patient. Repositioning the underlying foundation rather than just the skin is the key to a refreshed more youthful but not operated look. Most patients in their 40’s and early 50’s do not need volume added in their face but volume repositioning of the sagging tissues. Some individuals may lose facial fat as they get older and benefit from fat grafting or a filler substance very judiciously placed.

A forehead or brow lift to reposition the eyebrows and help remove heaviness off the upper eyelids will take five to seven days before one is ready for the office party. Having one’s eyelids refreshed can take years off your appearance and is about the same recovery time regardless if one is having the upper lids, lower eyelids or both done.

Nasal surgery or Rhinoplasty is a procedure frequently done over the Thanksgiving and winter holidays. A patient can be back at work/school in a week depending on what is done and the individual’s bruising. Patients can also be ready to go in a week after procedures such as liposuction of the neck and jaw line and chin implants, with the help of a turtleneck!

Breast augmentation can be performed today and one is out tomorrow. The incision and swelling will be hidden in one’s party clothes although you may have significant discomfort if you try to dance the night away too soon. Your surgeon will demand that you limit your vigorous physical activities for two to three weeks. A breast reduction has similar limitations but they are usually extended to four or five weeks.

Liposuction of small to moderate amounts of fat from the stomach, love handles, sides the thighs (saddle bags) inner thighs and arms can be performed one day and have you out the next. You will likely be bruised but sore but your party clothes will not give away your secret. Whether you have traditional liposuction, laser lipo or some other marketing label lipo, your course is likely to be similar. The amount of fat removed will determine your post-operative activities.

I want to make the point that all the procedures discussed above are real surgical procedures. Bruising and swelling varies from person to person. Factors such as one’s general health, medications, anatomy and the extent of surgery required to accomplish the desired result influence recovery time. The incidence of infection or excessive bleeding is very low with these procedures but one must know that just as with any other surgery there is a possibility of either.

So what can you do to enhance your appearance if you just don’t need any of the procedures discussed above? Injectables! Injectables are in three categories: (1) a muscle-paralyzing agent, botulism toxin (Botox®,) (2) filler substance such as hyaluronic acid (Juvederm®, Restalyne® and Perlane®), calcium hydroxlapatite (Radiesse®), polymethyl methacrylate (Artefil®) and poly-L-lactic acid (Sculptra®) (3) Fat.

If you only have a few days before your party, Botox®, in my opinion is less risky in terms of having the potential of “looking like you have had something done.” Botox® can reduce frown lines between the eyes and crow’s feet as the sides of the eyes, slightly pick up the corners of the eyebrows or the corners of the mouth and reduce forehead lines. Too much Botox® makes facial expression distorted or non-existent. It takes one to two days to see the beginning effect and it is most effective after seven to ten days. Botox® usually lasts two to four months.

All of the filler substances and fat are a little more risky if you are down to the last five to seven days before your special event. Why? There is the risk of swelling, lumps, and bumps and bruises. Fillers and fat require time to settle down just like the surgical procedures. Fillers and fat can be used in the lower eyelids, Nasolabial folds (fold from corner of nose down to mouth), the labio-mandibular fold (fold from corner of mouth to jaw line), lines around the mouth, in front of the jowls, on the cheekbone area and to enhance the lips.

One must be cautioned against having large volumes of fillers and fat and too frequent injections, as permanent lumps, bumps, cysts, skin discoloration and changes in facial shape are all possible. Just as with surgery, expert judgment and skills are required to administer these materials. My best advice is to always seek out a surgeon certified by the American Board of Plastic Surgery. Happy Holidays!

Sherrell J. Aston MD F.A.C.S

Published in Celeb Life Magazine

http://issuu.com/avenueinsider/docs/ave1012/62

For some patients with tear trough deformity, autologous fat may be the best material to use for lower eyelid augmentation, according to Sherrell J. Aston, M.D.

“In my experience, autologous fat grafting in the lower eyelid has been associated with low morbidity and good to excellent short-term results,” says Dr. Aston, professor of plastic surgery, New York University School of Medicine, and chairman, department of plastic surgery, Manhattan Eye, Ear & Throat Institute. “However, while there is some proof that fat grafts remain viable in the face and can grow, there are no scientific data on survival rates and no way to predict resorption in the individual patient or the longevity of the results.”

PREVIOUS EXPERIENCES Dr. Aston says he first considered using autologous fat for lower-eyelid augmentation several years ago based on good results reported by respected colleagues at various meetings. However, he changed his mind after a patient came to him seeking revision after previous fat grafting.

The woman gave a history of having fat injected into the lower lids five years earlier and receiving additional fat injections subsequently to address lumpiness. When seen by Dr. Aston, she presented with irregularities and discoloration of the lower lids.
Dr. Aston performed surgical correction that proved difficult because the fat had been injected above, within and under the muscle, and the patient developed a lower-lid ectropion, which was temporary and resolved over time with conservative management. He says he co-authored a case report on this patient as a cautionary tale warning against autologous fat grafting to the lower lid until more objective data became available (Spector JA, Draper L, Aston SJ. Aesthetic Plast Surg. 2008;32(3):411-414).

Consequently, Dr. Aston says he began to think instead about using hyaluronic acid as a filler material for tear trough deformity. He changed his mind again when a patient treated by a dermatologist with hyaluronic acid gel presented dissatisfied with her appearance. She had received filler injections into the lower and upper lids that resulted in a Tyndall effect. She was treated with hyaluronidase and improved over time, he says.

Thereafter, Dr. Aston undertook autologous fat grafting into the lower eyelid, and he says he has achieved good results in improving the tear trough deformity and blending the infraorbital rim. “Injecting deep, right onto the periosteum, is the key to minimizing the risk of surface irregularity,” he says.

Persistence of the benefit of the augmentation procedure has been variable as demonstrated by the outcomes in a series of cases. While some patients were maintaining improvement of their appearance with follow-up to 18 months, another patient was beginning to show some loss of the effect at seven months.

TALKING TECHNIQUE For harvesting the fat, Dr. Aston says he uses a harvesting cannula measuring 2.7 mm in diameter that has multiple 1 mm holes at the end. He introduces it through a 2 mm stab incision after first injecting a small amount of lidocaine at the stab site. The most frequently used donor sites are the upper medial thighs and abdomen, he explains.

The aspirated fat is placed on top of a stack of Telfa pads (Kendall) and is then rolled back and forth into a sausage shape using a wooden blade before being drawn into a 1 cc syringe, Dr. Aston says.

For delivering the fat, Dr. Aston uses a 3 cm, 20 gauge injection blunt tip cannula that he says was designed with his input (Sherrell Aston Robust Cannula, Wells Johnson). The instrument features a shallow elongated opening and increased wall thickness.

“This design does not alter the fat stream that emerges from the opening, which is governed by the amount of pressure put on the plunger, but it affords greater tip strength, which is helpful when working in the lower eyelid where the cannula is pushed along the periosteum,” he explains.

The injection cannula is also available in a 19 gauge size that Dr. Aston uses for autologous fat injections elsewhere on the face.

Fat is injected into the lateral orbital rim, the tear trough and along the infraorbital rim when necessary. The entry site for the cannula is created just below the orbital rim using a No. 11 blade to puncture through the orbicularis muscle (see figure 1). Before it is introduced, the cannula is first primed so that fat will be delivered as soon as pressure is placed on the plunger. The cannula is placed under the muscle onto the periosteum, and the fat is injected as the cannula is withdrawn. The area is massaged to smooth the contour and more fat is injected as needed.

Disclosures: Dr. Aston reports no financial interest in the Sherrell Aston Robust Cannula. He is a consultant to Black & Black Surgical.

A near recession in out economy hasn’t phased the anti-aging industry. Last year, statistics show Americans spent $10.1 billion on cosmetic procedures and the age group leading the trend was not the 78-million-strong Baby Boomer generation, but Generation X.

According to a study by the American Society for Aesthetic Plastic Surgery (ASAPS), adults between the ages of 31 and 45 accounted for 43% of all cosmetic procedures in 2010, while baby boomers (ages of 51 and 64), made up just 28%.  The trend can be probably be attributed to more readily available information about products and cosmetic surgery.  Direct to consumer television ads and infomercials, magazine ads, and literature in physician’s offices and spas frequently feature information about new, less-invasive cosmetic procedures.

Besides minimally invasive procedures such as Botox and laser treatments, rhinoplasty, breast augmentation, liposuction, and some facial procedures like eyelid lift are popular among this age group as well.  But, industry statistics show that of the 13.1 million procedures performed last year, 11.6 million of them were non-surgical given that patients may have financial constraints and are not able to take much time off of work.

Many patients consider these procedures for personal maintenance within their budget, although the cumulative cost may be greater than a single more definitive and long lasting surgical procedurs. In addition to “personal maintenance,” experts say there are professional reasons for an increase in use of anti-aging remedies desire to look better for both personal and professional reasons help make them more competitive in the workplace. Who knew Gen X’ers would care so much about their appearance like their Baby Boomer predecessors?

Dr. Sherrell Aston performs breast augmentation, liposuction, blepharoplasty, rhinoplasty as well as many other cosmetic surgical procedures in Manhattan on patients of all ages. He also offers minimally invasive treatments such as Botox, Juvederm, Restylane, Radiesse, and chemical peels.