More non-caucasians are having nasal surgery to look more caucasian.

http://www.news-medical.net/news/20130706/Embodying-racism-Race-rhinoplasty-and-self-esteem-in-Venezuela.aspx

It makes sense that the more we take pictures of ourselves and post them to social media, the more we care about our looks.

http://www.news-medical.net/news/20140311/Study-Rise-of-selfies-have-huge-impact-on-facial-plastic-surgery-industry.aspx

A woman writes about her benefits of a breast lift. Most of the time, diet and exercise will not correct droopy breasts. Sometimes an augmentation is enough but with significant ptosis (droopiness) a breast lift may be required.

http://www.huffingtonpost.com/elisabeth-dale/cosmetic-breast-lift-surg_b_4770817.html

18 years of age is the youngest that I will perform a breast augmentation. For some teens like Kaley Cuoco, it was the best thing they had ever done.

http://www.nydailynews.com/entertainment/gossip/kaley-cuoco-reveals-breast-implants-age-18-best-decision-made-article-1.1745456

This is an interesting article on an investigational injectable drug to reduce fat under the chin.

http://www.medicalnewstoday.com/releases/276078.php

Ultrasound Fast Alternative to MRI for Breast Implant Status

Pam Harrison

April 01, 2014LAS VEGAS — High-resolution ultrasound done in a physician’s office is a fast, convenient, and friendly alternative to MRI for ascertaining the status of breast implants, a pilot study suggests.

Researchers found a “higher than expected” rotation rate in 2 types of shaped cohesive gel implants and detected 2 ruptures that were later confirmed on MRI.

Dr. William Adams Jr.

“Clinically, our rotation rate is only about 2%. It was surprising that we were definitely able to show with ultrasound that the rotation rate was much higher,” said William Adams Jr., MD, clinical associate professor of plastic surgery at the University of Texas South Western Medical Center in Dallas.

“This means that a fair number of rotations are going unnoticed by patients. We haven’t had this type of information about shaped implants before, so it’s something we can add to our discussion with patients when they are considering these types of surgeries,” he told Medscape Medical News.

The study results were presented here at the American Institute of Ultrasound in Medicine (AIUM) 2014 Annual Convention in Las Vegas, Nevada.

MRI Screening

Currently, the US Food and Drug Administration (FDA) recommends that breast implant recipients undergo MRI screening 3 years after implantation and every other year thereafter to determine whether an implant has ruptured. However, even in the best studies, there is at least a 15% false-positive rate, Dr. Adams noted.

This means that a woman might be rescheduled for breast implantation surgery only to have the surgeon discover the implant was intact.

In addition, “MRIs aren’t much fun for the patient; they’re loud, the patient has to lie still for a long time, and they are very expensive,” said Dr. Adams.

Because of this, very few women ever go for an MRI, especially when their implants seem to be fine, he said.

In fact, rotation is not an issue with round breast implants; orientation is an issue only for implants that resemble the natural shape of the breast, where rotation could result in a misshapen breast. Rotational status cannot be determined with MRI.

The researchers evaluated 74 patients with bilateral shaped cohesive gel implants using ultrasound. Of the implants in this cohort, 48 were Allergan 410 and 100 were Mentor CPG.

Both types of implants have a textured outer shell and untextured fiducial markers on their surface at the lower pole, which allow the surgeon to feel and assess implant orientation during surgery, the researchers report. It was previously assumed that textured implants become anchored to the surrounding tissue and do not rotate.

The fiducial markers were imaged using a Terason 2000+ ultrasound system with a TouchView linear array probes.

The ultrasound examination itself is painless and nonthreatening, much like the fetal–maternal ultrasound screening many women are familiar with, Dr. Adams noted.

Marker orientation relative to the nipple was determined by using a clock-hand position, where 6 was directly downward and 3 directly to the right. Any orientation between 5 and 7 o’clock was considered to be “unrotated.”

On ultrasound examination, which took place 6 months to 7 years after implantation, 25% of the Mentor CPG implants and 21% of the Allergan 410 implants had rotated from their original position.

Patients need a better solution than MRI; unquestionably, that technology is high-resolution ultrasound. Dr. Brad Bengtson

“The vast majority of these rotations will ‘self-reverse’ and the implant will reorient itself over time, so it’s somewhat of a dynamic process,” said Dr. Adams.

“Still, my personal opinion is that ultrasound will eventually replace MRI. It just has to have FDA ‘blessing’ before surgeons can openly recommend it,” he explained.

The percentage of women who follow the FDA recommendation and go for MRI screening is not known, said Brad Bengtson, MD, from the Bengtson Center for Aesthetics and Plastic Surgery in Grand Rapids, Michigan. However, he told Medscape Medical News that he would be “shocked” if it were over 3%.

Dr. Bengtson and his colleagues published the first landmark evaluation of high-resolution ultrasound for the detection of breast implant shell failure (Aesthet Surg J. 2012;32:157-174). They concluded that the ultrasound approach is equivalent to MRI in terms of visualization of implant rupture, but that its relative accessibility, affordability, and real-time visualization represent “significant potential advantages” over MRI for this indication.

“Since our original research began in 2012, we have imaged more than 500 patients and detected more than 80 patients with implant shell failure. And in every patient with a rupture who has gone to surgery, shell failure has been confirmed, with no false-positives to date,” Dr. Bengtson reported. “Patients need a better solution than MRI to follow their breast implants over time; unquestionably, that technology is high-resolution ultrasound.”

Dr. Adams and Dr. Bengtson have disclosed no relevant financial relationships, although both have served as investigators in the development of the 2 shaped breast implant clinical trials.

American Institute of Ultrasound in Medicine (AIUM) 2014 Annual Convention. Abstract 1836503. Presented April 1, 2014.

GRAY MATTER

By RICHARD A. FRIEDMAN

March 21, 2014

FEELING down? Smile. Cheer up. Put on a happy face. No doubt you’ve dismissed these bromides from friends and loved ones because everyone knows that you can’t feel better just by aping a happy look.

Or perhaps you can. New research suggests that it is possible to treat depression by paralyzing key facial muscles with Botox, which prevents patients from frowning and having unhappy-looking faces.

In a study forthcoming in the Journal of Psychiatric Research, Eric Finzi, a cosmetic dermatologist, and Norman Rosenthal, a professor of psychiatry at Georgetown Medical School, randomly assigned a group of 74 patients with major depression to receive either Botox or saline injections in the forehead muscles whose contraction makes it possible to frown. Six weeks after the injection, 52 percent of the subjects who got Botox showed relief from depression, compared with only 15 percent of those who received the saline placebo.

(You might think that patients would easily be able to tell whether they got the placebo or Botox. Actually, it wasn’t so obvious: Only about half of the subjects getting Botox guessed correctly. More important, knowing which treatment was received had no significant effect on treatment response.)

OLIMPIA ZAGNOLI

Other studies over the past several years have found similar effects of Botox on mood. Michael Lewis at Cardiff University reported that nondepressed patients at a cosmetic dermatology clinic receiving Botox injection above the eyes frowned less and felt better than those who did not receive this injection. And M. Axel Wollmer at the University of Basel found that Botox injection was superior to a placebo in a group of depressed patients.

Is paralyzing the muscles involved in frowning truly enough to make depressed patients feel better? The notion that your expression can exert a powerful influence on your mood turns our sense of psychological causality on its head. After all, we smile because we feel happy, and cry because we feel sad, not the other way around, right?

Not necessarily. The idea that facial expressions may feed information back to our brain and influence our feelings goes back to a theory of emotion first proposed by Charles Darwin. In “The Expression of the Emotions in Man and Animals,” Darwin posited that the control of facial expression causes a like effect on subjective emotions. William James took the idea further and proposed that emotions were the result, not the cause, of various bodily sensations, suggesting that “we feel sorry because we cry, angry because we strike, afraid because we tremble, and not that we cry, strike, or tremble, because we are sorry, angry, or fearful, as the case may be.”

We are used to thinking of the brain, not the body, as the prime mover of our emotional states. Consider the field of so-called psychosomatic medicine, which emphasizes a mischievous flow of information from brain to body: hence, the psychosomatic stomachache, headache and the like. You can literally worry yourself sick.

The Botox studies, by contrast, suggest a circuit between the brain and the muscles of facial expression in which the brain monitors the emotional valence of the face and responds by generating the appropriate feeling. (Obviously, information flows in both directions, as you can think yourself into practically any emotional state and then have the face to match it.)

There are other treatments for depression that appear to use facial feedback in a similar way. Light therapy stimulates the retina and excites the optic nerve, which sends signals directly to the brain and effectively treats seasonal depression. And direct electrical stimulation of the brain’s vagal nerve has antidepressant effects.

Botox for depression is part of a long tradition of “outside-in” somatic therapies — many of dubious efficacy — that manipulate the body with the aim of altering the brain and mind, for instance by using cold wet sheet packs to treat severe agitation or acupuncture for anxiety.

In a broad sense, these Botox studies underscore one of the biggest challenges in treating people with depression. They might think that the reason they are depressed is that they have little interest in the world or their friends — a mistaken notion that is the result, not the cause, of their depression. They insist that only once they feel better will it make sense for them to rejoin the world, socialize and start smiling. Their therapists would be well advised to challenge their inverted sense of causality and insist that they will start feeling better after they re-engage with the world.

Whether Botox will prove to be an effective and useful antidepressant is as yet unclear. If it does prove effective, however, it will raise the intriguing epidemiological question of whether in administering Botox to vast numbers of people for cosmetic reasons, we might have serendipitously treated or prevented depression in a large number of them.

Richard A. Friedman is a professor of clinical psychiatry at Weill Cornell Medical College.

Laugh Off Flu Season with This Vitamin

Getting plenty of this vitamin may strengthen your immune system and make venturing out of your house a little less scary this flu season. We’re talking about the sunshine vitamin — good old D.

In a study done during flu season, people who had higher blood levels of vitamin D were half as likely to get hit with the bug — or any other viral infection of the respiratory tract, for that matter.

“D” Is for Defense
Not only were the D lovers in the study less likely to get sick compared with people who had lower D levels, but the high-D group also tended to be out of commission for fewer days when they did get hit. Of course, washing your hands frequently and living a healthy lifestyle are still the cornerstones of flu avoidance. But it’s nice to know that a D supplement could act as positive reinforcement. Researchers aren’t totally sure why D helps, but it could be that this immune system vitamin’s inflammation-suppressing powers help reduce the severity of infections.

Another good defense against flu? Getting vaccinated.

Americans like big butts: The numbers cannot lie.

Last year, cosmetic surgeons across the country performed nearly 10,000 buttock augmentations, up from the approximately 8,500 done in 2012, according to new stats from the American Society of Plastic Surgeons.

Let’s put this into context: The numbers for the Brazilian butt lift, as it’s nicknamed, still aren’t anywhere near the popularity of the most common plastic surgery procedures; nearly 30 times as many breast augmentations were done in that same time period, for just one example. But the new statistics do show a 16 percent increase in butt augmentations from 2012, perhaps a side effect of a nation’s ongoing quest to keep up with Kim Kardashian.

“It’s just amazing, the numbers,” said Dr. Douglas Taranow, a board-certified plastic surgeon in New York City’s Upper East Side. “It’s with J. Lo, and Beyonce, and everyone else having a great derriere. … I think people see that and they want to mirror image it.”

“It’s with J. Lo, and Beyonce, and everyone else having a great derriere. … I think people see that and they want to mirror image it.”

Taranow says he started getting requests for Brazilian butt lifts about three and a half years ago; now, it’s the second most popular procedure he does. It’s still not quite as popular among his patients as liposuction, but it surpassed breast augmentations last year. He says he’s lately been doing as many as four or five Brazilian butt lifts in a week, and while it’s mostly women, he’s had two male patients in the past six months.

“Plastic surgery used to be a reduction specialty; so, when we did nose jobs, we reduced the nose. But now, as we are more sensitive to ethnicity and different body types, we sometimes augment the nose. Well, same thing with the buttocks,” said Dr. Robert X. Murphy, Jr., president of ASPS and a plastic surgeon in Bethlehem, Pa.

Cosmetic surgery as an industry continues to grow, according to the report: 15.1 million procedures were done last year, which is up 3 percent since 2012. Those figures took a slight dip in 2009, but have been inching up every year since. And the most interesting findings in this year’s report are all about the booty: 30 percent of cosmetic surgeons ASPS surveyed in 2013 said they were doing butt augmentations, compared to 19 percent in 2012. This is the first year the plastic surgery association has included the procedure in its annual statistics.

The particular procedure is “buttock augmentation with fat grafting,” which means surgeons liposuction fat from somewhere the patient’s got plenty of it — usually the tummy, thighs or hips — and inject it into the tush. This kind of procedure is being used more in many different kinds of cosmetic surgery, including breast augmentation and some reconstructive surgeries.

“Fat is one of the great resources we have in this country,” Murphy said. “As a tissue, it’s been underappreciated.” But he says surgeons prefer it because the fat tissue is pliable, giving the physician more control than they have when working with synthetic materials, and patients like the “twofer” benefit of losing fat in an area they didn’t want it. But patients also gravitate toward fat grafting for cosmetic surgery because the idea sounds so much more natural. It’s still you, after all. Just … rearranged.

“You hear all these horror stories about people getting these butt injections that are like, things from Home Depot.”

“It’s like, you’re taking it from one area, and you’re putting it where you need it,” said Marissa, a patient of Dr. Taranow’s. She’s a 39-year-old mother of three who lives in the Bronx and just had a Brazilian butt lift done two weeks ago. (She didn’t want to give her last name.) “And it’s your own fat; it’s not like you’re getting some foreign subject in your body. You hear all these horror stories about people getting these butt injections that are like, things from Home Depot.”

She’s talking about the horrific case of the fake doctor arrested in 2011 for injecting a woman’s buttocks with a combination of cement, Fix-A-Flat, mineral oil and superglue. But there was also the 28-year-old mother of two who died last summer after receiving a round of injections meant to enhance her derriere, or the British touristwho died in 2011 after getting silicone injections into her buttocks in Philadelphia. The procedure’s increasing popularity means that there are a lot of quacks out there wanting to make a quick buck, and so it’s especially important that patients make sure that they’re in the hands of a board-certified surgeon, Murphy says.The website for the plastic surgery association has a “find a surgeon” tool patients can use as one way to ensure that their surgeon is properly trained.

Murphy says he’s seen so many terrible, sometimes irreversible, complications happen to people who’ve gone to non-professionals. It may be cosmetic, but, he reminds, “Plastic surgery is still real surgery.”

First published February 26th 2014, 12:02 am

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