This is a belated summary of the big ideas and new procedures in the field of plastic surgery that were important in 2009.  2010 is in and who knows what it will bring in terms of plastic surgery innovation advances and controversy.  Everywhere you look there are best of lists: movies and music books television you name it.  I thought I would take a little time to go over my best in plastic surgery of 2009 list.  These are the ideas that have come to the forefront in my practice and from what I have seen at meetings and in the medical literature.  It’s a very subjective list.  But what list isn’t when it comes to best of ?

#1. The BoTax.  The “BoTax” as it was referred to by the media was almost a part of the healthcare bill the Democrats hope to pass this year.  Basically it was going to be a 5% tax on all cosmetic surgeries: Botox, fillers and plastic surgery procedures   The  fact it was defeated is huge for the plastic surgery industry and patients.  It was wrong on so many levels.  It was the entry into the luxury/sin tax model regardless of the fact that most people using cosmetic services make less than $90,000 per year.  Privacy concerns would have been a huge issue and it would have been a logistical nightmare.  Doctors as tax collectors?  It also would have opened the door to other specific luxury taxes.  Why not Harley-Davidsons, golf clubs, massages, facials, etc.?  The possibilities are endless.  In addition the one place this actually was tried was in New Jersey and the plan just plain didn’t work and brought in nowhere near the projected income.  The only thing it really accomplished was increasing the numbers of surgeries performed in the state next door, New York.  I was very happy to see cooler heads prevail and the BoTax dropped from the healthcare legislation.

#2.  Fat is back.  Fat grafting has been around for over 20 years but was always treated as the poor stepchild of liposuction.  Because, in the beginning the results were variable so it was concluded that fat grafting was not scientifically consistent.  Over the years since there have been many more studies successfully supporting the science.  In addition, now there have been several reports that show that what is being transferred are actual stem cells in addition to the fat.  In fact, the stem cells may be the main source of what remains six months to a year later.  There is now more attention being paid since stem cells are the current darlings of scientific research.  There are even efforts being made to purify the stem cells out of the fat to increase survival of the fat cells.  In addition breast augmentation by fat grafting has become an accepted procedure and several investigators showed impressive results.  It’s not going to replace silicone breast augmentation nor is it for everyone.  This is because it is time consuming more expensive and may even require several procedures to get the final result.  Nevertheless there are a number of people who are candidates and would benefit from this procedure which would basically be permanent as opposed implants which have a limited longevity.  I have used fat grafting in Sacramento both for covering small defects and for breast augmentation at Advanced Concepts in Plastic Surgery with wonderful results.

#3. Vaser Hi Def liposuction.  I’ve been doing liposuction in Sacramento for over 20 years, Vaser liposuction for five and Vaser Hi Def liposuction for 1 ½ years.  There is a very confusing array of new technology, six different laser light machines a brand-new water jets Liposuction system and most recently radiofrequency.  However after reading the information and same salinity systems in action as well as speaking to my colleagues in the field of plastic surgery I’ve come several conclusions.

First of all, for multiple area liposuction skin shrinkage and maintaining viability of fat cells transferred Vaser Hi Def liposuction is the most advanced solution.

Second, laser liposuction works for small areas but is too time-consuming for larger areas.  It’s still unclear which wavelengths of light works the best despite all the claims.  There appears to be a lot at heat damage from the laser.  This does not allow viable cells for transfer.

Third, waterjet liposuction seems promising but it’s still really too new to say much about.

#4.  Thermage has had major technological advancements that have changed the game.  The new Thermage is not the same as the old Thermage.  Thermage has been around for years.  It is now in its third generation.  The first generation was effective but quite painful and needed considerable sedation.  Second generation was uncomfortable but manageable with a little sedation.  The new generation is not painful due to vibration of the tip which confuses the nerves in the skin and also has a cooling apparatus.  I’ve had this tested on myself and it is comfortable.  It is an ideal skin tightening: noninvasive, no downtime, procedure.  With the new changes it is now very patient and doctor friendly.  I recommend Thermage in Sacramento at Advanced Concepts in Plastic Surgery for my patients who need a little skin tightening but are not requiring the more dramatic results that can be a result of a tummy tuck, a face lift, arm lift or thigh lift.

#5. The Mini Lift, they’re back with a vengeance.  To paraphrase Shakespeare, ‘a rose as a rose is a rose.’  Mini face lifts have been around forever.  Actually, it can be argued that the mini face lift have been around since the beginning of the last century.  When I was at UCLA as a medical student, the chief made a lot of Hollywood happy by doing mini lifts every few years because they were small surgeries with minimal downtime.  Now there is a   huge move: for mini lifts, cheek lift, S lift or any other letter.  There have been some changes recently such as using deep purse string sutures that considerably improved the result.  Do they work?  For the most part they do.  However if all you have is a hammer everything in the world is a nail.  In other words, one must be prudent in determining whether a mini lift will work based on advice from a knowledgeable plastic surgeon who can offer other solutions if a mini lift will not achieve the desired results such as a regular face lift. Do I perform mini lifts on my patients in Sacramento?  Yes, I have been performing mini face lifts in Sacramento for about the last 25 years.  Now there are some newer features to a mini lift such as vertical vectors, barbed deep sutures and Vaser liposuction   Would they work for everyone?  No, that’s where the judgment comes in.

#6.  Acellular Dermis.  Acellular dermis is a manufactured product, most commonly made of porcine skin which has been treated to remove any chance of reacting with the immune system  This is then placed underneath the skin in breast augmentation revisions for cases of wrinkling or rippling.  It is also used for breast reconstruction to prevent those same problems.  Patients with thin-skin and implant problems have always been difficult because there was so little to work with.  With the acellular dermis there is now a solution that can solve these problems.  It also seems to prevent capsular contracture recurrence after breast augmentation surgery.  The times I have used acellular dermis on my plastic surgery patients in Sacramento in the last year I have been quite pleased with the results.

So there it is.  Some new ideas, some old ideas, and some ideas that have simply come back with a new angle.  It was a very interesting year with the common denominator being progress for plastic surgery patients, better plastic surgery results and safer and easier surgeries.