I recently found a little straight-forward article by a husband and wife plastic surgery team out in Columbus Ohio who summed it all up very nicely. Drs. Christine and Michael Sullivan of The Sullivan Centre are certified plastic surgeons and this is what they wrote:

The SmartLipo TriPlex is the 5th generation of SmartLipo and is exclusively offered in Northern California by Dr. Andrew Kaczynski at Advanced Concepts in Plastic Surgery.

SmartLipo is a brand name for a laser assisted liposuction technology developed and manufactured by Cynosure in Europe. SmartLipo TriPlex is the lastest, 5th generation of the SmartLipo brand. After more than six years of Cynosure trying to sell me the SmartLipo technology, after consideration of all the data, I have determined that the SmartLipo TriPlex is indeed a better mousetrap. I am now the only certified plastic surgeon in Northern California to offer this better and safer SmartLipo TriPlex liposuction technology. Liposculpture with the SmartLipo Triplex has proven to be even more effective, with better results than I had even hoped for! If you are researching SmartLipo or liposuction techniques, make sure you ask any doctor you speak to which generation of SmartLipo they are offering and if their laser lipo technology has a temperature monitor auto shut-off.

I have been performing liposuction since it was invented by Dr. Illouz in the 1980s. During all those years, different Liposuction methods emerged, such as Tumescence, Superficial, Power-assisted, Ultrasonic (VASER) and Laser Liposuction. Initially Laser Liposuction was experimental and not very practical. As the machines got better so did the results. However, it was still time-consuming, potentially dangerous because of burns due to lack of temperature control, and results were not noticeably different from previous, and I believed, safeer methods.

The ideal liposuction treatment would involve the smallest incisions, remove large amounts of fat, have minimal bruising, rapid healing, and would shrink the skin in the areas where fat is removed. It would also be safe and consistent . For years, the method closest to this standard was Ultrasonic Liposuction, or the VASER. At the time, there were many different Laser Liposuction systems such as and they all claimed to be the best. However, they were still time-consuming and had the risk of burning due to the lack of control over the lasers energy. That is, until Cynosure came out with SmartLipo TriPlex.

The current generation of Smart Lipo is the fifth generation of Cynosure’s technology. It provides three different laser wavelengths(1064, 1320 and 1440). This does make the system more complex, but much more effective: One wavelength decreases bruising, one increases fat melting, and one increases skin tightening. The biggest change as far as results are concerned, is the fact that there is significant additional skin shrinkage compared to previous systems. This is especially important in problem areas like arms, neck, inner-thighs, and abdomen.

SmartLipo now also leads to less trauma and faster healing. Equally important is the fact that this system has a temperature guide. In the past, the surgeon had to either feel the skin, or use a temperature gun to check the outside temperature. This new system has an internal temperature control which is an important safeguard to prevent excessive heating and the possibility of thermal damage.

The Smart Lipo Triplex machine is the next big thing in body contouring in terms of fat removal, skin tightening, and safety.

Part of the Bridalplasty’s concept includes the bride first showing her results to the groom at the “unveiling” during the actual wedding ceremony.

“Viewers will witness his emotional and possibly shocked reaction as they stand at the altar and he lifts her veil to see her for the first time following her extreme plastic surgery,” says E!, according to the Hollywood Reporter.

This, of course just takes the whole idea of the groom not seeing the bride in her wedding dress until the ceremony to a whole new level. A nose job, breast augmentation, lip augmentation and some liposuction and he may not even recognize her! That shouldn’t make an intimidating moment any more difficult, should it? Unfortunately, this is what the network and potentially, the audience,  is after. They are selling the shock of emotional vulnerability.

This concept trivializes plastic surgery, important life decisions, and it makes a mockery of the institution of marriage. It is beyond sad how far entertainment corporations, audiences and participants are willing to go in search of money and the cheap emotional thrills.

Surgery, whether it is cosmetic or otherwise is a serious life and death issue, (although I have personally never lost a patient during cosmetic surgery in 28+ years). Surgery is not entertainment and marriage is not trivial. The very concept of the TV show Bridalplasty trivializes both and knocks our culture down a few more notches in the ranks of civilized societies.

Plastic surgery tourism is helping to spread superbugs around the world.

The recent reports of a new superbug from Southeast Asia are very disturbing. This is something that scientists have been dreading for a very long time — a bacteria that is resistant to virtually everything. How does this happen? Like the United States, India is a country that uses and abuses antibiotics by overprescribing them. Eventually the germs mutate and become resistant to these antibiotics, especially if you combine this with overpopulation, poor hygiene and substandard living conditions. This is a perfect breeding ground for a superbug. Why is this a concern for us? Superbugs have already been found in three states eventually going to head our way since we live in a very small world. However in the world of plastic surgery there is another reason to be concerned.

There is a growing trend for medical tourism and outsourcing of surgery to Third World countries. The countries themselves are even promoting this. They tout that their doctors are American trained and provide just as good surgical care and treatment as in the United States for a fraction of the cost. People are going to India and other countries for heart surgeries and orthopedic surgeries because of the decreased cost. They are even going to countries like India, Thailand, Korea, and Mexico for plastic surgery for the same reasons

However even though a doctor may be American trained that is no guarantee of anything. There are a lot of American trained doctors in the United States who are are sub par, so that alone is not a guarantee of anything. The biggest factor in the safety of the patient is not so much the doctor as his environment. American hospitals are cesspools of germs and bacteria and everyone going into them is at risk for wound infections, catheter infections, and other infections with some very ugly microorganisms. But for all their faults American hospitals are obsessed with quality control and improving the situation. In the Third World cleanliness is not next to godliness. It is next to impossible. Because of cost constraints and loose, or lack of regulation, this is a serious problem.

In addition, as much as I’m disappointed with the legal system in the United States, it does back as a system of checks and balances for extremely bad situations. In the Third World it does not exist. So if a doctor loses several patients or has a horrible infection record, no one really cares. As a matter of fact, there was a terrible scandal in India not too long ago. The leading provider of kidneys and transplant surgeon was a con man who didn’t even finish medical school and was getting his kidneys by forcing laborers at gunpoint to undergo surgery to remove one kidney. So those patients who flew in for a cheap kidney transplant have to live with the reality of where their kidney likely came from.

So what happens if you have a horrible medical situation occur 7000 miles from home? Well, you either make it or you don’t. If it were me, I would place my bets with the resources of specialists and the advanced diagnostics available here in the United States. Even if a patient survives after being infected with a superbug, there are associated complications like scarring. Is it worth your life or your health to save a few bucks? The world is becoming smaller, but the United States, despite all the debate about our healthcare system, still is the most advanced. When it comes to medical safety, there really is no place like home.

Kim Kardashian says she has only used Botox

Kim Kardashian, of Keeping Up with the Kardashians, admitted to using Botox, in an interview with ABC News show Nightline. However, she says she has not had a nose job or breast augmentation.

“Trust me honey, if I take this bra off you will tell me I need to get them done. I’m totally not against plastic surgery. … I’ve tried Botox before. That’s the only thing that I’ve done.”

Just the way she says that, I tend to believe her and while a great breast augmentation will look very natural, natural, can look natural as well!

However, Kim Kardashian’s sister, Courtney Kardashian says that she has had breast augmentation and seems to be very proud of it!

“I have had breast implants, but it’s so funny ’cause it’s not a secret, I could care less. It’s so funny because the ‘before’ picture that they [In Touch magazine] showed was after I had my boob job, so I’m like, they should have written ‘before Mason’ and ‘after Mason.’ Like my boobs have like tripled since breastfeeding.”

They go on to say that none of the Kardashians have had nose jobs and from looking at pictures on the Internet, even the “before and after” pictures that argue that she has, I tend to believe they haven’t. So much of what you see in those pictures can be explained by lighting and make-up. Kim Kardashian says that she actually did want to get her nose done but decided against it.

“But what’s funny is about my nose, it’s my biggest insecurity. I always want to get my nose done. … I went to a doctor, I had them take the pictures, he showed me what it would look like and it just didn’t– It– I wouldn’t look the same.”

I agree with Kim Kardashian here, if that is her natural nose, she does not need anything done to perfect it. If anything, there is more risk in changing it and it not looking as nice or as individual as it does naturally. Perfection doesn’t have to be generic, people all look different for a reason, plastic surgery is not about trying to make every face look perfectly the same, it is about enhancing what you do have or fixing issues that bother you. In Kim’s case, I would keep that nose, it looks great on her.

CHER at the 2010 Video Music Awards "VMA's"

Cher presented Lady Gaga with the Video Music Award for Video of the Year Award last night at the 2010 MTV Video Music Awards. When Cher first walked out wearing a similar or the same outfit she wore for her 1980′s video, “If I Could Turn Back Time,” you could almost hear a collective, “wow,” as the entire country watching realized she is now in her 60′s! Indeed, Cher is 64 years old and looks, even on my high definition T.V., like she’s in her early 40′s. Is plastic surgery the secret? Actually, no… as in, “no, it isn’t a secret.” Cher takes care of herself, but she also has been very open about her use of plastic surgery to maintain her looks.  Make Me Heal reports, “Cher has had a breast augmentation, rhinoplasty (nose job), blepharoplasty (eyelid surgery), and possibly many others including enhancing the appearance of her teeth, liposuction, and a facelift. Although speculation revolved around Cher getting cheek implants, a tummy tuck, and a rib removed, she has completely denied the truth in those rumors. However, Cher openly admits she has become “the plastic surgery poster girl”.

The great thing about Cher is that she doesn’t expect anyone to not realize how old she is, she’s been a celebrity since the mid 1960s! Instead, she’s realistic about her age and the fact that time and gravity tend to be harsh on us all. But this is where great plastic surgery can work. Of course, when we look at Cher we think, “wow, she must have had a lot of work done.” But we don’t think, “YIKES!” like we do with some of the really bad celebrity plastic surgery we are all familiar with. To me, She looks great. She looks like she’s had very talented plastic surgeons and beyond that, she also obviously listened to their recommendations. I’m sure a lot of those scary celebrity plastic surgery cases are more a result of the celebrity insisting on procedures than doctors may have recommended against. At 64, Cher is an example of plastic surgery as an art.

What did/do you think of Cher’s plastic surgery and her overall look? Please weigh in below!

Sheyla Hershey's largest Breast implants in the world

According to her official Website, Sheyla Hershey’s breast implants made her a size M (whatever that is), and she was awarded the Brazilian equivalent of the Guinness Book of World’s Records for largest breast implants after her most recent breast augmentation.

In the United States, plastic surgeons are only allowed to place implants up to 800 cc and for her to achieve this size, I’m guessing she was fitted with 4 implants of perhaps 800 cc each? Sheyla Hershey was originally from Brazil and flew back home where the laws are less strict so she could have this breast augmentation done. Since she is only 5’2 she would appear quite lopsided, as the attached picture illustrates.

I’ve blogged before where I discussed Heidi Montag’s breast implants,  about all the reasons why you don’t want to select breast implants that are too big for your body. In the case of Sheyla Hershey, it is even more an indication of likely mental illness than a misdirected attempt at having an attractive figure. Breasts this size are dangerous, painful and will have to eventually be removed 100% of the time, leaving the patient permanently disfigured.

NineMSN reported on the story:

“We’ve already taken her to surgery twice,” said the surgeon in charge of the breast removal, Dr Ron Bucek.

“We needed to open the area up to allow it to drain because we can’t leave an infection in a contained zone.”

According to reporting by the Herald Sun in Australia, many attempts were made to save her from having to remove four implants, TWO in each breast!

“But after the operation, Hershey became seriously ill and has since been closely monitored by a cosmetic surgeon, Dr. Ron Bucek, and an infectious disease expert, Dr. Shazia Gill.

Before yesterday’s surgery to remove the implants, Bucek performed two other operations to help drain the infected areas, and a special vacuum had been suctioning the infection from Hershey’s body 24 hours a day for months.

“It’s the only thing that has saved my life, to be honest,” Hershey said of the device, though she added that it was “annoying” and “heavy.”

My Fox Houston gave the most detailed report:

“None of the bacteria have cultured out. We had to start her on a third antibiotic, because it wasn’t resolving as rapidly as we wanted to see, so she’s on three antibiotics, and she was on an anti-fungal medication during this time as well,” says Dr. Gill.

Because of the severity of the infections, doctors have been closely monitoring Hershey twice a week.

“I look at white blood cell count, I look at electrolytes and inflammation and right now her drug level. She’s on one antibiotic if her levels get too high she can damage her hearing as well as kidneys, she is on very strong antibiotics,” explains Dr. Gill.

Even with all of this medical intervention, Hershey’s body hasn’t been able to ward off the infection. It has been progressively getting worse.

“What’s happening, the skin is opening because the implants, the two on each side, are beginning to open that area up”, says Dr. Bucek. Hershey’s doctors are confident that she will restore her health by removing all four implants.

Dr. Gill showed Sheyla’s CT scan to FOX 26 to demonstrate how the two implants are stacked up on each side. She says there is a lot of inflammation and thickening of the skin.”

It amazes me that there are doctors ANYWHERE in the world who would butcher an obviously disturbed young woman. Now she’s had to undergo what is essentially a double mastectomy at age 28 because along with the removal of all 4 implants, she also lost most of her breast tissue and her skin is going to be in terrible shape. I can’t imagine any number of surgeries that will allow her to have normal, attractive looking breasts now.

On the TresSugar blog, “Gigglesugar” asked in her poll:

A refined Chelsea Clinton

A lot has been written lately about Chelsea Clinton and her recent wedding. The dresses, the schedule, the expense, the choreography of the wedding dance. All the little details our celebrity obsessed public thrives on and the media is happy to dish out 24 hours a day. There’s also been commentary about possible plastic surgery. Indeed if you look at photos of her growing up you can see that there are some changes. Most noticeably she seems to have had a chin implant and a correction of her somewhat gummy smile, probably with Botox.

So what’s the big deal? The media are always obsessed with celebrity plastic surgery. Mostly they discuss which celebrity is getting what plastic surgery and whether it is good, bad or ugly. In some cases, when it is good plastic surgery or you can’t quite tell whether the celebrity has had a nip/tuck or not and what they might be doing to maintain or enhance their appearance.

But for the vast number of people in the United States that have plastic surgery it’s not about beautiful people getting more beautiful or going to extreme lengths with plastic surgery in a desperate attempt to get that next big roll. It’s more often about people who just have a few details about their body or face that they’d like to change in an effort to be a little more confident about their physical appearance. One way to look at it is that we sort of work from the impression that there is a bell curve of appearance. We all want to be inside the bell curve ideally as far to the right of the top as possible, but most of us understand that that position is occupied by a few actors, actresses, supermodels and genetically blessed people. For the rest of us were content to be within two standard deviations of normal, whatever that is. The fact is that our brains are programmed to recognize attractiveness and symmetry as part of our genetic programming to search for a healthy mate. There is a correlation between attractiveness, health and lack of genetic diseases. So therefore we are programmed to recognize beauty and attractiveness, and instinctively know what falls within the bell curve. At the same time, we tend to assess our own placement on that bell curve and we often have little things that we consider changing in order to move ourselves just a little bit more toward the right. Now this can be complicated by various psychological issues of self-doubt or self worth but for most of us, we see ourselves fairly realistically and can make rational decisions about what plastic surgery might offer us.

Ah, the awkward teen years

Chelsea Clinton, as a teen, had a few challenges with her features and tended to look a bit awkward. Many teens experience an awkward phase as their features mature on the way to adulthood. As she has grown up and matured her looks  improved but she still had a receding chin and a rather “gummy” smile. With the plastic surgery that was performed, she successfully moved herself a standard deviation in the right direction of the bell curve. Her features look much more proportional and most would agree that she looked very pretty in her wedding photos.

So what does this have to do with the big picture? One of my staff members recently told me that before she started working for me she thought that plastic surgery was about bringing in a photo of your favorite movie star and having the surgeon make you look like that. That is absolutely not what plastic surgery is about. Plastic surgery is about restoring or improving balance, symmetry and aesthetic beauty. Like Chelsea Clinton, it is about fixing just a few of those little things that tend to make a positive difference. It’s about optimizing the attractive features that you have and balancing the rest. That is good plastic surgery. It worked for Chelsea Clinton!

Mazel tov!

The beaming bride, Chelsea Clinton on her wedding day.

Hollywood Plastic Surgeon, Dr. Frank Ryan

Hollywood plastic surgeon to the stars, Dr. Frank Ryan, died this last week in a single car accident that was apparently the result of texting while driving. A while ago I had commented on some of his surgeries on Heidi Montag. He was a good surgeon involved with a, to put it mildly, unstable patient in Heidi Montag. And I think that even he, in the end, had told her no more, especially with respect to her breast augmentation. He was a board certified plastic surgeon, a UCLA graduate like me and did good work. There are too many surgeons out there who don’t do good work. There are the many pretenders, the  faux plastic surgeons, these are the get-rich-quick surgeons who are entering the profession in droves because there is no reimbursement in conventional medicine. Dr. Ryan was one of the doctors inside plastic surgery doing his best work for his patients.

This is not necessarily a eulogy to Dr. Ryan but more of a commentary on the tragedy of his death. All of our lives are becoming much more complicated. Because of the nature of business today, plastic surgeons are spending a great deal of time on their websites their blogs their Facebook or Twitter and who knows what else will be coming down the road. If the news reports are true, Dr. Ryan’s death was caused by his tweeting while driving on a fairly dangerous road. Once we become addicted to our electronic media they are a constant part of our lives. Multitasking is also something that many of us feel obligated to do because there just isn’t enough time in the day. This combination of factors, keeping up with his twitter, multitasking and being distracted seems to have led to his untimely death. There are several things that we can take away from this tragedy first and most obvious texting while driving kills. There was a ubiquitous sign poster in the 1960s that said speed kills. This was obviously referring to the drug not velocity. Nowadays texting kills. A friend of mine was almost killed recently when he narrowly averted a head-on collision because a girl in the opposite lane was texting while driving 65 miles per hour on a two-lane highway, didn’t have a clue, and then lost control of her car. She hit the side of his car, spun out and ended up in the hospital, lucky to be alive. She said, “I wasn’t texting, I was reading a text,” which, of course, is texting. Don’t text and drive, it’s just that simple.

The other thing that this incident does is it gives us pause for reflection about how complicated our lives have become. Are we spending more time with our computers, laptops and iPhone’s then we are with the people we love. Are we tweeting, facebooking and texting more than talking and sitting with these people? The pace of life seems to accelerate every year just a little bit. Like the lobster in the stew pot, we don’t even know we are being boiled until it’s too late. This may be a good time to reevaluate all our relationships with our machines, how dangerous they are at times and how much of our lives they consume. Life is short and you never know when your number is going to come up, take time while you still have a chance to enjoy it. The second to last of Frank Ryan’s tweets was, “After 25 years of driving by, I finally hiked to the top of the giant sand dune on the pch west of Malibu. Much harder than it looks!  Whew!”

Dr. Frank Ryan's last tweet: "Border collie jill surveying the view from atop the sand dune."

Then he posted a picture of his dog at the top of the sand dune while driving away. It is a sad irony that it would be the high-tech sharing of a moment he stole away from his hectic schedule to enjoy actually living, that would end his life.

This corresponds with what I’ve been doing for the last several years. However now there is a published study that shows that Singulair works. This doesn’t make it work any better but it does further legitimize the off-label use.

As mentioned before, many different things can cause contracture after breast implants. Factors like bacterial contamination and hematoma. These can prolong the inflammatory response. A colleague and friend of mine, Dr.Schlesinger, discovered that a drug called Accolate, which is an anti-inflammatory asthma drug, worked in improving capsular contracture and published this. However it was discovered later on that Accolate had a very small incidents of extremely severe complications including hepatitis liver failure and death. This led to the abandonment of the use of Accolate despite the fact that it worked very well. Cingular is a similar type of drug. It is what is called a leukotriene inhibitor. These are factors that are thought to be responsible for capsular contracture.

This particular study on women with breast implants confirms what I have personally noted over the last several years. Cingular can help reverse capsular contracture when it is caught early and just starting. It can also help prevent recurrence. However, if someone comes in with established capsular contracture or extremely firm contracture it has little effect. The repair of very firm contracture is still a surgical procedure

Capsular contracture still continues to be an annoying and expensive problem in plastic surgery. By using techniques like the no touch Keller Funnel while placing breast implants during breast augmentation, see my previous blog about the Keller Funnel, IV antibiotics and antibiotic irrigation weekendreduce the incidence of contracture. However it is good to know that Singulair has been shown to be effective. In my own practice I combine it with cold laser to make it even more effective and see about 4 out of 5 people respond to the combination.