I was just asked about the expected lifetime of breast implants. All patients with Mentor MemoryGel breast implants are automatically eligible for the Mentor Lifetime Product Replacement Policy.    Just to show how much implant companies stand by their products -Mentor Corporation is offering a limited time Premier Advantage breast implant warranty  which includes: in addition to lifetime product replacement - 10 years of financial assistance from the date of implant of up to $3,500 in surgical assistance, free contralateral implant rep[lacement and non -cancelable terms.This definitely is a long term commitment from Mentor!     I have told many patients that the products must be made well or the company could not offer this sort of warranty.  This additional warranty is free but this offer is only available for surgeries done between May 1st, 2009 and December 31, 2009.  After that time the optional  warranty coverage will again be $2400 and cost $100.

A recent article in Plastic and Reconstructive Surgery ( the official medical journal of the American Society of Plastic Surgeons) highlights the nutritional problems which can occur after bariatric surgery and can then lead to healing difficulties after plastic surgery.  Not all patients who have undergone bariatric surgery will have nutritional problems but without good care some will and these nutritional problems can lead to  increased complications and poor wound healing.   Patients who have undergone a Lap band procedure usually do not have nutritional problems as this procedure encourages weight loss by a restriction on the size of the stomach.  Patients who have undergone either a Roux-en-Y or Duodenal switch procedure   , if they do not take their vitamins and are not vigilant about their protein intake , may have nutritional deficiencies.  In my practice I like to see labs early on in the consultation process so that any deficiencies can be identified and corrected before the date of surgery.  A lot of patients will benefit from supplementation , both protein and vitamins in the postoperative period, to help with the increased demands on their bodies as they heal.  There are a huge number of protein supplements available and nowadays they even taste good!

  There has been a major advance in breast reconstruction with the use of acellular dermis.  Tissue expansion and implant reconstruction have  produced good results for many patients but there have been problems for some.  Now there is a new advance which can help patients with certain problems and even for some women allow them to have a single stage reconstruction .  This advance is the use of acellular dermis .  This is a product which is derived from human skin -  the cellular elements are removed and left behind is strong matrix which can be used to provide an internal sling.  This acellular dermis is used as an extension of the pectoralismajor muscle allowing  coverage and support of the breast implant.  It can be used with tissue expansion  but it is really exciting that we now have for some women the choice of a single stage reconstruction.  This product has also been helpful in correcting implant position problems as well as it has been used to add an additonal layer of coverage in areas of thin coverage over an implant.

A most interesting article was in last months Plastic and Reconstructive Surgery journal.  I don’t ever remember having taken an article to show my staff but this time  I did.  The article described observations at the annual identical twin conference.,  Twins were photographed and then asked questions about their lifestyle choices.   The twins were then rated as to whom and appeared older -  remember these  were identical twins -  and then the twins that looked older were evaluated.  The results were amazing -  identical twins who looked 10 -20 years older than their twin!!!!  I tell you -  look at these pictures and not only will you never smoke you will never go outside without sunscreen !!!  However a little good news for us -  a few extra pounds helped the twins looked younger -  YES!   OK the bottom line -  sunscreen, don’t smoke and don’t get too skinny!

The media has been all over the recent statistics released from the American Society of Plastic Surgeons showing the number of cosmetic surgical  procedures done in 2008 to be down 9%.  However as always when one looks closely at the statistics this is not the whole story.  Overall cosmetic procedures ( not just surgical procedures) are up 3%! This includes Botox and fillers such as Restylene , Juvederm and Evolence. And Reconstructive procedures are up 3% as well.  Not bad for the worst recession since the great depression! I was very pleased to see that breast reconstruction was reported up by 39% -  this means to me that women are getting offered breast reconstruction and as they should ( there is a Federal law mandating that insurance companies cover reconstruction after cancer treatment) insurance companies are covering the procedures.  There was also an increase in lower body lifts and buttock lifts both of which are procedures often done after patients have lost a lot of weight -  both by diet as well as by bariatric surgery.  The news is not always that bad it matters what you are looking for!

It started out as an ordinary call. “Dr. Downey, can you help a colleague of mine?” But then the inquiry became anything but ordinary. The patient in question had traveled to Mexico for cosmetic surgery. Now back in Los Angeles she was having complications. The patient’s anxiety level was sky high. She had spent all her available cash on the surgery in Mexico and she had a high deductible on her insurance plan. The first plastic surgeon she had seen had proposed another surgery which was way out of her range financially. Fortunately I was able to hold her hand through several weeks of healing and then do a small procedure to minimize the scarring.

Medical tourism is a term which has been coined by the media to describe a rapidly – growing trend of patients traveling to other countries to obtain health care. Cosmetic surgery tourism is a price driven phenomena. Elective cosmetic surgery procedures are not covered by insurance so cost is the major selling point for patients of cosmetic surgery tourism. In my practice I have noticed that the complication rate or at least the patient’s anxiety over a possible complication is directly related to the distance traveled. How easy it is when a patient calls and says “Is this normal?” To have the patient come in and take a look when they live in the LA area. However if they have returned home many miles away things become much more difficult. Patient’s descriptions can be difficult to understand, emailed photos can be blurry and anxiety levels ride high. Even if I am sure that all is okay and what is being described is a normal or expected part of healing, I never feel as if I can calm the patient down and reassure them over the phone ( not to mention I never feel as confident ) as I would in person.

Some patients on seeing my specialty would then respond “Great now I won’t have scars!” I would then have to explain that plastic surgery is a specialty not a technique and that while plastic surgeons do everything they can to minimize scarring we cannot do surgery without causing scars. Cosmetic surgery as real surgery has risks. These risks may increase when procedures are done while traveling. Infections have been the most common complication seen in patients who have undergone cosmetic surgery abroad. Long flights as well as surgery are associated with increased risk of blood clots and pulmonary embolism. Put together it would seem that the risk is even greater. Standards for physician qualifications, hospital or facility accreditation as well as FDA approvals for cosmetic surgery products or devices are well established in the United States. This may not be true in other countries .Although there are many talented and skilled plastic surgeons throughout the world, it is difficult for patients from outside that country to evaluate the qualifications of a given physician or the facility.

Follow-up care is an important part of any surgical procedure. In the United States the fee paid for a cosmetic surgical procedure covers the postoperative office care. If a patient needs to return to the operating room, the plastic surgeon may absorb the cost or there is even insurance specifically designed to cover complications after cosmetic surgery. Patients who have traveled outside the United States and then experience a complication on their return home may, as my patient did, find themselves facing additional costs which can be substantial. In addition it can be difficult for the plastic surgeon in the United States to figure out what procedure had been done without any records. Revisonary surgery is rarely as satisfactory as surgery done without complications the first time.

Cosmetic surgery is elective. If one cannot afford the procedure then it should be put off until one is in a better financial position. If a patient does consider doing plastic surgery in another country to save money, they should understand the additional risks that they may be undertaking. At the very least I would recommend budgeting additional money to cover the possibility of complications. Preferably I would recommend finding a qualified Board Certified Plastic Surgeon close to home, discussing the procedure you are interested in, finding out the cost and then saving money and planning for the surgery. It may take a while but taking unnecessary risks with your health are too dangerous. Safety and quality should not be compromised by cost.

I remember the first time it happened. The teenage girl had come to the Plastic surgery clinic when I was a new plastic surgery resident. She had one breast that had not developed. She was wearing baggy clothes and kept her head down with her hair covering her face. Her mother did all the talking. We discussed a surgical plan and took her to operating room. Afterwards when she came for her postoperative visit the change was nothing short of miraculous. Not the surgical results although that had turned out well but the overall change in her appearance and even attitude. She was wearing clothes that fit, her hair was pulled back and best of all she would not stop talking! She even left her mother outside when she came into the exam room for her postoperative exam. `I was again reminded of this girl when a similar situation happened. Again it was a young girl and her mother. No one could explain why she had failed to develop on one side of her breasts but worse yet, no one had offered any solutions. It had even been suggested that she might have to wait to get anything corrective done until she was an adult. I was able to diagnose her and offer surgery that would give her symmetry throughout her development with a final surgery to be done when she was fully grown. The look of relief and gratitude on both the mother and daughters faces was overwhelming. The day had been long before with problems with obtaining authorizations from insurance companies, scheduling problems, lost dictations and all the other myriad of problems that make up a typical day in a medical office. I had recently received notice from my medical school that a big reunion year was approaching. A questionnaire had been sent out to all of the alums. One of the questions asked was “If you had it to do over again would you choose a career in medicine?” Quite a few had responded that they would not , citing the increasing pressures on physicians with decreasing reimbursements and increasing paperwork as the reasons. If I had been asked that question earlier that day while in the middle of a particularly frustrating fight with an insurance company I might have been tempted to answer “No” . Fortunately most of my time is spend in the actual care of patients and just when you get frustrated enough a patient comes along like that young girl who reminds you of what plastic surgery is all about. Too often especially in Hollywood the perception of plastic surgery is one of a purely cosmetic field. Cosmetic surgery is the improvement on the normal, reconstructive surgery is the restoration to the normal. Plastic Surgery encompasses both, often with the same techniques used to achieve the different goals. It is too easy to get swept along in the business side of keeping a practice going and forget what the real goals of the day are and most importantly why I became a plastic surgeon. I have the privilege of being able to travel with Interplast and offer my skills to help the very poor of the world correcting cleft lips and palates or undoing the damage done by burns. On my last trip to Ecuador in December a burn victim brought us her finest chickens to thank us for what we had done for her. No thanks were necessary. I had received much more from her than she had from me. My husband calls these mission trips my “psychic income”- a term he learned from a business professor in college. Medicine and in my opinion especially plastic surgery, is a wonderful career and fortunately these patient interactions occur often enough to remind me of how lucky I am to have chosen this profession.

Plastic surgery has certainly  received a lot of media attention in the past few years especially with shows such as “Extreme Makeover”.  Despite all of this attention a lot is still not understood about plastic surgery.  First the name -  plastic surgery is derived form the Greek word Plastikos which means to bend or shape.   The substance plastic can be molded or shaped into any shape one desires.    Plastic surgeons mold or shape the body to change the contour or to even remake a part and so the name Plastic Surgery.  A very good example is when the skin and fat of the abdomen is used to recreate a breast after cancer treatment.  This procedure is called a Tram flap.  Extra skin and fat of the abdominal wall can be transferred to the chest area with the blood supply coming from the rectus muscle.  Once the abdominal tissue is up on the chest it can be molded and shaped to match the opposite breast.

Plastic surgery includes both cosmetic and reconstructive procedures.  The definition of a cosmetic procedure is one done to improve on the normal.   A reconstructive procedure is one done to restore the normal form or function.  Although the goal is different the surgical techniques are often the  same.  For example a breast implant can be placed for augmentation of  a breast in a cosmetic operation or a breast implant can be placed to reconstruct a breast after cancer.  The implants are the same, the surgical techniques are similar but the reasons for the operations are very different.

These are exciting times for our practice!  After years of our tiny office in the Larchmont medical building we have finally moved into a new suite just one floor below.  Our new suite (#800)  is much more open and Irma even has her own office!  My good friend Jeff Bradley is of course in charge of decorating and the colors  are great.  Wait until you see the walls painted “melted chocolate”!  Stop by and see our new space.