Ten Plastic Surgery Risks You Need To Know
Miriam Marcus, 10.10.07, 12:01 AM ET

We are one vain bunch. Need proof? Demand for cosmetic plastic surgery continues to increase. Americans spent $11.5 billion for 11 million cosmetic procedures in 2006--a 48% increase over the number performed in 2000, according to the National Clearinghouse of Plastic Surgery Statistics.

While TV shows like ABC's Extreme Makeover and NBC's Bionic Woman paint a rosy picture, plastic and cosmetic surgeries are not without risks.

After all, surgery is surgery.

"The human body makes no distinction when the scalpel hits," warns Dr. Richard D'Amico, president-elect of the American Society for Plastic Surgery (ASPS). "The difference with elective cosmetic surgeries is that patients generally start out being healthy."

Among the more common dangers: numbness, seroma and necrosis.

Proceed With Caution
Temporary numbness or loss of feeling at the site of the incision is fairly common in face-lifts and tummy tucks, though it's rarely permanent.

Numbness after breast surgeries of any type is the most common. Loss of sensation in the nipple in particular occurs anywhere from 10% to 70% of the time, says Dr. Nahai, president of the American Society for Aesthetic Plastic Surgery (ASAPS) depending on the type of procedure. What's worst? Breast reductions, where the nipple and areola are totally removed and reattached as skin grafts.

Seroma is a collection of watery body fluids that occurs most often in tummy tucks. It's common enough that many surgeons take preventative measures by inserting a drain during surgery, notes Dr. D'Amico.

Some tissue death from surgical manipulation, called necrosis, is inevitable after any procedure, though your risks increase dramatically if you're a smoker. That's because smoking affects blood supply to the tissues. By definition, the surgeon is cutting into those tissues, and if the blood supply is already compromised, necrosis is more likely to occur.

After any surgery, there is the possibility of excessive bleeding. Hematoma, a collection of blood, occurs more in men than in women because beard follicles in the face mean there are more capillaries--and therefore an increased blood supply in that area.

Infections are rare in plastic surgery patients, since most are healthy to begin with. When they happen, however, they can spread quickly and must be stopped immediately.

The rarest and most feared of side effects is, of course, death. Toxic levels of anesthetics have been known to cause respiratory failure in some patients. In some rare instances, high levels of topical lidocaine have led to death. In others, imitation Botox, or other imitation fillers not approved by the FDA, have left patients in comas for up to several years, and eventually dead.

Scared? There are several steps you can take to minimize the potential dangers of plastic surgery.

Reduce Your Risk
Choosing the right surgeon is important. Identical twins may undergo the same procedure by two different doctors and have two different results, explains Dr. Darrick E. Antell, a New York-based plastic surgeon who specializes in cosmetic and aesthetic surgery.

Be sure to pick a surgeon who is board certified by the American Board of Plastic Surgery, the only plastic surgery board recognized by the American Medical Association. Ask your doctor which types of medicine they hold certifications in, and check for yourself at the American Board of Medical Specialties Web site.

Any MD can claim to be a surgeon, but you should choose only a board certified plastic surgeon for your procedure.

Also, verify that your doctor of choice has privileges to perform surgery in a hospital. A doctor may choose to perform certain procedures in a private office, but he or she should have credentials from a hospital's "credential committee." Having such credentials, says Dr. Antell, is as important as a doctor's board certification.

If your doctor chooses to perform surgery in a private space, make sure the facility is accredited by the Joint Commission on Accreditation for Healthcare Organizations (JCAHO) or the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF). Accreditation is "the gold standard," according to Dr. Antell--and many of these facilities are better than what you'll find in hospitals. Make sure there are registered nurses and an anesthesiologist on hand in case anything goes wrong.

To Operate Or Not To Operate?
Some elective surgeries are a safer bet than others. Many surgeons, like Dr. D'Amico, would recommend any proven procedure as long as there is an acceptable ratio between risk and benefit. Others, like Dr. Nahai, disapprove of certain procedures per se. He's not in favor of thread lifts, for example (like a face-lift, but less invasive).

"It's not a good operation," he says. In relation to the risk, "the results don't last long enough."

The doctor must be certain the surgery is appropriate for that specific patient, and that the risk to benefit ratio is balanced.

"People need to practice some restraint," insists Dr. Antell. You want to pick the smallest procedure to get the results you want with the least risk. Remember that these are elective surgeries.

"Everyone thinks 'complications won't happen to me,'" he says, "but they can and do happen."

http://www.forbes.com/2007/10/09/health-surgery-risks-forbeslife-cx_mlm_1010health_print.html

Surgical Treatment Of Migraines Reduces Sick Days And Increases Employee Productivity

Science Daily — ARLINGTON HEIGHTS, Ill. With more than 28 million Americans suffering from debilitating migraine headaches each year, employers also suffer through missed days from work and reduced productivity. However, Migraine sufferers who had surgical treatment reduced the amount of time missed from work by 73 percent, according to a study published in the January issue of Plastic and Reconstructive Surgery® (PRS), the official medical journal of the American Society of Plastic Surgeons (ASPS). Additionally, surgical treatment substantially lowered the annual cost of migraine care for patients, the study found.

"The economic impact of migraine headaches on American businesses is staggering due to the loss of employee time and productivity each year," said ASPS member and study author Bahman Guyuron, MD, clinical professor of plastic surgery, Case Western Reserve University, Cleveland. "By identifying the trigger areas for migraines and performing targeted surgical procedures, we significantly reduced or eliminated their migraines and the amount of time missed from work."

Patients in the study were injected with Botox® to help determine which muscles in the forehead, or back of the head, triggered their migraines. Once identified, these muscles were then surgically removed.

Prior to surgery, migraine sufferers missed 4.4 days of work per month, according to the study. After surgery, patients only missed 1.2 days per month and the employee out of pocket expense for annual treatment was reduced from approximately $7,612 to $925.

Plastic surgeons successfully reduced the frequency, intensity or duration of migraines for 92 percent of the patients studied. In fact, the surgical treatment eliminated migraine headaches for 35 percent of the patients studied.

"Before surgery, my patients expressed extreme frustration by not being able to gain control of their lives," said Dr. Guyuron. "They wanted to work or spend time with their family. Through our new surgical discoveries, we are able to help the appropriate patients escape the awful effects of migraines and start living their lives again."

Businesses lose approximately $13 billion per year due to migraines, according to a study published in the April 1999 issue of the Archives of Internal Medicine. In addition, the National Headache Foundation estimates 157 million workdays are lost annually because of the pain and associated symptoms of migraines.

http://www.sciencedaily.com/releases/2005/01/050111154753.htm

For more information about migraines, please visit:

http://www.migrainesolutionsnyc.com/

Review Of Office-Based Plastic Surgery Finds Less Than One Percent Complication Rate

ASPS Journal Says Plastic Surgery Performed in the Office is Safe, Efficient, and Cost Effective

For Immediate Release: August 6, 2003

ARLINGTON HEIGHTS, Ill. – At first thought, the idea of having cosmetic plastic surgery in an office may sound a bit unsettling, but plastic surgery procedures, once only reserved for hospital operating rooms or ambulatory surgery centers, can be performed safely in office-based facilities according to a study in the August issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).

"Some groups have challenged that performing plastic surgery in an office-based facility compromises patient safety," said ASPS President-elect Rod Rohrich, MD, and co-author of the study. "The purpose of this study is to determine whether outcomes were adversely affected by performing plastic surgery in accredited office-based facilities."

The authors reviewed 5,316 consecutive plastic surgery cases completed between 1995 and 2000 – the majority of which were cosmetic plastic surgery procedures including facelift, eyelid surgery, breast augmentation, liposuction, and nose reshaping. Less than one percent of the 5,316 patients experienced complications, the vast majority were due to hematomas (a collection of blood) following facelift surgery.

"There are many advantages to office-based plastic surgery for both patients and plastic surgeons including cost savings and efficiency," said Dr. Rohrich. "But patient safety must take precedence over cost and convenience. The study shows that plastic surgery in the office setting is safe."

According to ASPS statistics, in 2002 fifty percent (3.3 million) cosmetic plastic surgery procedures were performed in an office-based facility.

To help ensure patient safety in office-based facilities, the ASPS requires that all of its members (board-certified plastic surgeons) perform outpatient plastic surgery in an accredited office. Accredited or licensed outpatient surgical facilities must meet at least one of the following criteria:

· Be accredited by a nationally recognized or state-recognized accrediting agency, such as the American Association for Accreditation for Ambulatory Surgery or the Accreditation Association for Ambulatory Health Care.

"The safety profile of office-based facilities must meet and even exceed that of traditional hospital-based or ambulatory care facilities," said Dr. Rohrich. "Patients should also know that surgeons must have privileges at a nearby hospital and be credentialed to perform any procedure being contemplated at an office-based facility."

"After reviewing our experience with office-based plastic surgery over the last six years, we found patients experienced few complications and there were no deaths to report," said Rohrich. "We continue to support the judicious use of accredited outpatient surgical facilities by board-certified plastic surgeons."

The American Society of Plastic Surgeons is the largest organization of board-certified plastic surgeons in the world. With more than 6,000 members, the Society is recognized as a leading authority and information source on cosmetic and reconstructive plastic surgery. ASPS comprises 90 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the Society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada.

Latest South Beach trend -- the perfect 'innie' belly button
June 11th, 2006

Dr. Darrick Antell and his patient are featured in this Associated Press article on the "perfect innie belly button."

The Associated Press

MIAMI · Nips and tucks are always on display in perennially bikini-clad South Beach. And now, nestled between chiseled abs, is the latest plastic surgery has to offer -- the perfect innie belly button.

Thrust into the spotlight by the popularity of low-rise jeans, belly rings and midriff-baring celebrities, the itty bitty belly button is getting a lot of attention from plastic surgeons, who are reporting an increase in the number of umbilicoplasties they're performing.

More than 8,000 were performed between 2002 and 2005, according to the American Society for Aesthetic Plastic Surgery. But doctors say they are performing hundreds more in conjunction with tummy tuck surgery.

The most popular request is turning the ostracized outie to the coveted innie, but vertical belly buttons and hooded ones are also common. It's a fairly simple procedure that lasts between 30 and 90 minutes and costs between $2,000 and $5,000, according to doctors.

Ayana Cannon says she never bared her abs because she had an outie.

"I didn't wear a bikini because I thought it was strange. It is something that I always wanted to change," said the 29-year old medical student from New York.

After having an umbilicoplasty in February, she bought a bikini and flaunted her new abs during a vacation to Greece.

About 95 percent of patients are women, due to changes that often occur during pregnancy, says New York plastic surgeon Dr. Darrick Antell. Pregnancy or weight gain can turn even a natural innie into an outie.

Outies are typically a sign of an umbilical hernia or minor weakness in the area. Under local anesthesia, a surgeon cuts on the perimeter of the belly button and uses sutures to tack it down and close the weakness. Any extra skin is also trimmed off, says Antell, who is also a spokesman for the American Society of Plastic Surgeons.

"I think people just want to feel normal. That's what plastic surgery is about," said Antell, who has seen a definite increase in the past 10 years. "They're embarrassed to go to the beach; they're embarrassed to go to the gym."

Teenagers and Plastic Surgery
May, 2007

Dr. Darrick Antell appeared on The Morning Show with Mike and Juliet to talk about teenagers and plastic surgery. He advocates responsible and mature decision-making when it comes to cosmetic enhancements in young adults.

You may see this media segment at: http://youtube.com/watch?v=o5JcAMBk-jw

Wrinkle Drug's Action Is Found
February 20, 2007

Wall Street Journal
Page D4

A popular injectable antiwrinkle treatment, Restylane, appears to stimulate skin cells to make natural collagen, a basic skin protein, according to a study whose findings suggest Restylane's effects may last longer than expected.

Restylane, sold in the U.S. by Medicis Pharmaceutical Corp., has been thought to smooth wrinkles by physically filling space created through collagen loss and other aging processes. The study by University of Michigan Medical School researchers, in this month's Archives of Dermatology, suggests the product's temporary benefits are also caused by a biological response, which explains why injections seem to have longer-lasting results after repeated treatments.

"The article is an important one because it begins to build a scientific basis for a cosmetic procedure that has historically just been based on the end result," said David J. Leffell, professor of dermatology and surgery at Yale University School of Medicine.

"I wish we could require more of this kind of data prior to product approval," said Amy Newburger, a Scarsdale, N.Y. dermatologist and consultant to the Food and Drug Administration.

The study focuses on skin cells known as fibroblasts. "In the last few years, we've learned that a basic problem in aging skin caused by ultraviolet light is that the fibroblasts that make collagen down deep in the skin have collapsed and flattened on each other," said John J. Voorhees, chairman of the university's dermatology department, which has been studying the causes of aging skin for over 20 years.

In a young person, the fibroblasts that make collagen are normally "stretched," Dr. Voorhees said. The study using Restylane was designed to see if the fibroblasts could be "restretched" and "that is exactly what happened," he said, noting that "the stretching caused the cells to make collagen like they did when they were young."

The initial antiwrinkle benefit of Restylane is caused by its "physical presence," but after three or four weeks, new collagen formation begins, the study showed. Dr. Voorhees said it isn't clear how long the new growth continues because the study was for only 13 weeks. The Restylane injections also inhibited the breakdown of collagen by an enzyme that acts on aging skin.

The study explains why Restylane seems to last longer after the firstfew injections, typically six to 12 months apart, dermatologists said. "To me, this is a validation of what we've seen clinically," said William P. Coleman III, clinical professor of dermatology at Tulane University Health Sciences Center. The cumulative effects of collagen growth "would theoretically apply to all hyaluronic acid fillers," he added. Juvéderm, introduced by Allergan Inc. in January, is a hyaluronic acid that competes against Restylane.

"The manufacturer of the product had nothing to do with the study except to donate material for it," she said. Dr. Voorhees said Restylane was chosen because when the research began, "it was the only hyaluronic acid out there."
By RHONDA L. RUNDLE

Katie Couric Interviews Dr. Antell
December 20, 2006

After First Lady Laura Bush revealed that she had a skin cancer removed from her leg, Katie Couric of the CBS Evening News interviewed Dr. Antell to get more information on this increasingly common sickness.

Here's a segment from Ms. Couric's blog.

Katie: The Skinny On Skin Cancer

Yesterday, I spoke with Dr. Darrick Antell, a leading plastic surgeon who regularly identifies skin cancer. I wanted to know, as a doctor, what he thinks is the most important message for people. He says we all need to do self-exams and ideally, go to a dermatologist or plastic surgeon at least once a year to check for any suspicious growths or changes. Squamous cell carcinoma, the type of cancer Laura Bush has, can often appear as a rough or scaly patch and requires a biopsy, Dr. Antell says.

The rate of skin cancer is actually increasing around the world at a dramatic rate. As we make dramatic advances in fighting all sorts of cancers, why is skin cancer on the rise? Doctors aren't really sure. It could have something to with "binge tanning," according to Dr. Antell. It's the first time I've heard of that term. It refers to a burst of sun exposure, which can substantially increase your risk of skin cancer. The easier it has become to just pick up and travel to a tropical climate, the more prevalent binge tanning has become. Even skiing out in the cold can seriously damage your skin.

That ozone layer isn't nearly as protective as it once was. So, remember to wear that sunscreen. And don't skimp on it! We typically apply half as much as we need, and then, forget to reapply it, Dr. Antell told me.

For the complete blog entry, please visit:
http://www.cbsnews.com/sections/couricandco/main500803.shtml

FDA Approves Silicone Gel-Filled Breast Implants
November 26, 2006

After significant scientific review, the U.S. Food and Drug Administration (FDA) recently approved the marketing of silicone gel-filled breast implants for breast reconstruction in women of all ages and breast augmentation in women ages 22 and older.

In the past decade, a number of independent studies have examined whether silicone gel-filled breast implants are associated with connective tissue disease or cancer. The studies, including a report by the Institute of Medicine, have concluded there is no convincing evidence that breast implants are associated with either of these diseases. However, these issues will be addressed further in post-approval studies conducted by the companies.

It is important to note that breast implants are not lifetime devices, and a woman will likely need additional surgeries on her breast at least once over her lifetime. Rupture of a silicone gel-filled breast implant is most often silent, which may mean that a woman will not know that her implants have ruptured. For this reason regular screening MRI examinations are advised to determine if silent rupture has occurred.
If you are considering breast augmentation, the FDA's recent approval of silicone implants will give you more to think about. Please feel free to schedule a consultation with Dr. Antell to discuss your options, questions, and concerns.

Forehead Lifts and Facelift-Like Procedures to Treat Migraines
November 1, 2006

Over 28 million Americans suffer from debilitating migraines. To treat these terrible headaches, many turn to powerful drugs, such as narcotic painkillers and serotonin receptor agonists called triptans. Others try dietary changes, exercise, and meditation. Now surgeons are being called upon to help in the treatment.

No one knows what exactly cause migraines. Many of the country's top neurologists and surgeons believe that migraines are triggered by muscles that pinch branches of the trigeminal nerve which innervates the face and head. According to recent studies, a procedure in which some of the muscles around this major nerve are released has been successful in about 90% of the cases (35% reported elimination of the pain, 57% experienced significant reduction of headaches).

Dr. Antell, a New York City plastic surgeon who has been in practice for over 20 years, works on the muscles through incisions behind the hairline. He releases the pressure above the eyes, temples, and back of the neck. In some cases Botox is also used to achieve positive results. The out-patient procedure is performed at his fully accredited, office-based surgical facility. In addition to a more youthful appearance through this facelift-like procedure, Dr. Antell helps migraine patients reclaim their lives.

Breast Reduction Surgery and Insurance Companies
October 23, 2006

Women with overly large breasts experience more than dissatisfaction with their body image. Overly large breasts and the weight of excess tissue can cause pain and physical conditions that can adversely affect one's life. Numerous scientific studies have confirmed the necessity for breast reduction, yet some insurance companies place many road-blocks in-front of this medically necessary procedure.

Many insurance companies require patients to exhibit specific signs and symptoms prior to approving breast reduction: back, neck, shoulder, and arm pain; rashes; bra strap grooves; and numbness in the upper torso. The amount of tissue removed to relieve symptoms associated with overly large breast is a hotly contested insurance criteria. Sometimes they require a minimum amount to be removed, irrespective of a woman's height and weight.

When Dr. Antell performs breast reduction surgeries, he tailors his work to each individual case. The amount of tissue removed must be go hand in hand with body weight and bra cup size. Although some women are able to manage the complications from overly large breasts with physical therapy and pain medication, when surgery is the only alternative, it is important for insurance companies to completely understand the gravity of the situation.

Dr. Antell has a staff of medical and patient coordinators to work on behalf of his patients, striving to reach equitable, compassionate resolutions in claims for breast reduction surgeries.

Plastic Surgery Increasingly Popular for Men
October 9, 2006

Dr. Antell served as a consultant for a recent Forbes Magazine article on the increasing popularity of plastic surgery for men.

According to the American Society of Plastic Surgeons and Forbes Magazine, there was a 44% increase in minimally invasive cosmetic surgeries for men between 2000 and 2005. This change speaks to many men's desire to look their best through quick and easy treatments that do not cause much bruising or require lengthy recovery periods.

For many patients, simple procedures, such as Botox, Restylane, and Juvederm suit their needs as well as their busy schedules. Dermabrasion and laser hair removal are also popular with the modern man. According to the ASPS, the number of Botox treatments among men increased 233% from 2000 to 2005, with an estimated 313,519 injections administered.

Cosmetic surgical procedures have also risen in popularity among men. More and more men are seeking nose reshaping, brow lifts, and liposuction. The typical male liposuction patient is someone health conscious. He is careful about his diet, and he exercises regularly. The stubborn areas where fat loss has plateaued can be targeted with liposuction. The lower back, upper flanks, and abdomen are areas commonly treated. Excess fat under the chin can also be removed.

All these procedures are performed on-site, at Dr. Antell's fully accredited out-patient, office-based surgical facility.

Surgeons and medical experts expect tummy tucks and body lifts to show dramatic growth due to the popularity of gastric bypass surgery. Patients can lose hefty amounts of weight following the surgery, leaving them with unattractive, baggy folds of skin.