The “Donda West” Law in California
By Dr. R. Jarial | January 20, 2010
As of January 1, 2010, the much publicized “Donda West Law” is in effect in California.
The law, named after rap artist Kanye West’s mother, who died a day after cosmetic surgery in 2007, prohibits doctors from performing elective cosmetic surgery without a physical examination and clearance from a medical professional.
The law requires an “appropriate” physical exam within 30 days before a procedure and “written clearance” from a doctor, nurse practitioner or physician’s assistant before cosmetic surgery is performed.
The law will change little, since reputable cosmetic surgeons have always obtained a patient’s medical history and made sure the patient has had a physical exam before a procedure, says Terry Zimmerman, M.D., F.A.C.S., head of the Greater Sacramento Plastic Surgical Society.
According to UPI, autopsy results showed Donda West died of pre-existing coronary artery disease and “multiple post-operative factors” a day after she had undergone an abdominal tuck, breast surgery and liposuction. The surgeon who operated on West surrendered his medical license in April.
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Aquamid vs. HA / Restylane
By Dr. R. Jarial | January 7, 2010
According to results of a new study, the investigational injectable filler 2.5 percent polyacrylamide hydrogel (Aquamid) is as effective and well-tolerated as hyaluronic acid (HA, Restylane) for the correction of nasolabial folds, reports Medical News Today.
The study, conducted by researchers at the New York University School of Medicine, suggests that polyacrylamide hydrogel was as effective as HA at six months on the widely validated Wrinkle Assessment Scale (WAS), the study’s primary endpoint. Efficacy was maintained at the 12-month follow-up evaluation.
Medical News Today quotes Rhoda Narins, M.D., clinical professor of dermatology at NYU School of Medicine, as saying, “Our results demonstrate that polyacrylamide hydrogel shows strong potential as a permanent soft tissue filler,” adding that because polyacrylamide hydrogel is non-biodegradable and does not migrate, it is expected that efficacy will continue over a longer period than with HA. Dr. Narins and colleagues compared the efficacy and safety of polyacrylamide hydrogel to HA in 315 men and women who presented for bilateral soft tissue augmentation of the nasal labial folds and had a WAS of 3 or 4. The primary efficacy measure was the mean change in WAS scores at six months. The study found that the average WAS improvement at six months in the polyacrylamide hydrogel group was 1.8 points, as compared with 2.0 in the HA group.
Study results also suggest a benefit for polyacrylamide hydrogel beyond its favorable safety and efficacy: Because the filler is non-biodegradable and not resorbed, the patient does not require periodic re-injections. The study’s authors emphasize that while the study results are promising for use of polyacrylamide hydrogel, longer follow-up is needed to establish whether favorable one-year results hold up over a longer period of time.
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The Ax on the Cosmetic Surgery Tax
By Dr. R. Jarial | January 7, 2010
Americans would continue to get cosmetic surgery tax-free if the Senate’s sweeping health care bill becomes law, but a trip to the tanning salon would cost 10% more.
After a lobbying campaign by plastic surgeons, the American Medical Association and the company that makes Botox, Senate Democrats pulled a proposed 5% tax on elective cosmetic surgery from the latest draft of the bill unveiled this weekend.
In its place: A tanning bed tax that would start in July. The last-minute switch was cheered by cosmetic surgeons, but it left Dan Humiston with the Indoor Tanning Association feeling burned.
“We don’t have the war chest … the medical industry has,” said Humiston, who said the tax would be a financial hardship on the nation’s roughly 20,000 tanning salons. “We’re somebody who won’t fight back because we’re too small.”
The battle over the tax, which represents less than 1% of the 10-year, $871 billion cost of the health care legislation underscores the challenges lawmakers face as they look for ways to pay for expanding coverage.
The House proposal calls for a 5.4% income surtax on couples earning more than $1 million and individuals earning more than $500,000 a year. The Senate bill includes a 40% tax on so-called Cadillac health plans that cost more than $8,500 for individuals and $23,000 for families.
Dubbed the “Botax” on Capitol Hill, the levy on elective cosmetic surgery first appeared in the legislation in November. The non-partisan Joint Committee on Taxation estimated the tax would raise $5.8 billion over 10 years.
Interest groups opposed the measure. California-based Allergan, the company that makes Botox, launched a website and a Facebook page to stop the tax. The company spent more than $1 million on lobbying in the first three-quarters of this year — before the tax became an issue — disclosure reports show.
Caroline Van Hove, a company spokeswoman, said the tax was discriminatory toward women and that it did nothing to reduce health care costs. “These are elective procedures that middle-class women are paying for out of their own pockets,” she said.
The American Academy of Cosmetic Surgery engaged its 2,500 members and encouraged them to ask patients to contact Congress, said Steven Hopping, who sits on the academy’s board. “There was an outcry from many, many different sectors,” he said. “Apparently, it was heard.”
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IPRAS 2009 – New Delhi, India
By Dr. R. Jarial | January 7, 2010
Hello Everyone……….
Happy New Year.
In November/December 2009, there was a meeting of the International Confederation of Plastic, Reconstructive, and Aesthetic Surgery in New Delhi, India. I had the fortunate opportunity to attend this meeting. Of particular interest, the topics were varied from cosmetic surgery to complex reconstructive techniques.
There was quite a blend of opinions and techniques from plastic surgeons represented from a variety of countries.
Of particular interest, there was even a section devoted to charity care and volunteer work.
Gratitude goes to all the staff and physicians who devoted their time and resources in order to bring this meeting to light.
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Liposuction and a Bad Outcome
By Dr. R. Jarial | November 4, 2009
An operation that began as a routine cosmetic surgery procedure ended with the patient in a coma. Authorities later learned the doctor was not board certified in plastic surgery, and the facility was not licensed for the procedure.
Sources say 37-year-old Rohie Kah-Oruktoan, mother of three, is now clinically brain dead after undergoing liposuction at Weston MedSpa, an unlicensed medical facility in Weston, Florida. Her surgeon was Dr. Omar Brito, who is reportedly licensed. According to his attorney, Brian Bieber, the woman had been a customer at the facility for almost five years. The operation in question was a minimally invasive procedure.
The exact complications are still unknown. However, sources also quote attorney Michael Freedland, who is representing the patient’s family.
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SCULPTRA – A Long Standing Filler
By Dr. R. Jarial | November 3, 2009
SCULPTRA, a long-lasting filler that has been used since 2004 to plump the cheeks of H.I.V.-positive patients with facial wasting, is finally having its cosmetic debut. In July, the FDA – approved Sculptra Aesthetic — as the cosmetic version is named — for use to improve the appearance of nose-to-lip wrinkles.
But that is not to say Sculptra is a new-to-the-ball debutante. Since 2004, Sculptra has been used off-label not only to tame stubborn skin folds but also to add volume to cheeks and temples withered by time. Now that Sculptra has been approved for some cosmetic uses, plastic surgeons and dermatologists are expecting a surge of interest.
Previously, little prevented a dermatologist or plastic surgeon from recommending Sculptra to a patient gaunt from exercise or distressed by hollow cheeks. In fact, last year, plastic surgeons and other doctors treated nearly 80,000 patients with Sculptra, up from 46,732 in 2005, according to the American Society of Plastic Surgeons.
Sculptra has already won over some doctors and patients. One advantage is its longevity; it can last up to two years once an optimal result is achieved, while alternative fillers including Restylane, Juvéderm and Evolence generally last a year or less. Another advantage is Sculptra’s ability to address broader depressions like sunken cheeks.
That said, the drawbacks of Sculptra include the need for several treatments in some cases to achieve a desired result, the need to massage the treated area for up to a week, and the risk of developing lumps beneath the skin.
Made of a synthetic material called Poly-L-lactic acid, Sculptra is injected deep into the tissue below the skin to spur a patient’s collagen growth gradually. Results — sometimes months in the making — look natural, a benefit touted by Sanofi-Aventis U.S., the company that makes Sculptra.
Often, multiple treatments, spaced four to six weeks apart, are necessary. Some lucky people respond to a single treatment, but two or three is more typical, most doctors interviewed for this article said.
Side effects of Sculptra include tenderness and redness near the injection site. But what has caused the most concern is the occasional occurrence of small bumps that can be felt under the skin. Some bumps are visible. Doctors speculate that they are undispersed Sculptra or a result of not injecting deep enough.
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When There is a Need for a Do-Over in Plastic Surgery
By Dr. R. Jarial | November 3, 2009
No face-lift stops time, so as aging continues, even a satisfied patient may choose to have another one a decade later. But what if your face-lift never pleased you, not because of complications or monstrous scars, but because of aesthetics pure and simple? Perhaps your first surgeon’s technique resulted not only in a tighter jaw line, but also a flat wind-swept cheek and a stretched mouth. Or your nose no longer has an unsightly bump, but now, postsurgery, is asymmetrical.
These days, there’s such a critical mass of plastic surgery patients dissatisfied with their results that many doctors market secondary surgeries, or re-dos. It’s not hard to find surgeons’ Web sites that describe in detail how an asymmetrical nose job or an unsatisfactory face-lift can be righted.
No organization tracks how many procedures are done to correct cosmetic work. (Muddying the situation is the fact that some doctors tweak their own work if it falls short of the patient’s goals and that some complications call for immediate reoperation, like a hematoma, or a collection of pooled blood, beneath a closed incision.)
In this still-shaky economy, cosmetic surgery is down, and revisions for unhappy patients are included in that slump. But doctors who do a lot of revision face-lifts and nose jobs (two common redos) say demand for those operations is still strong.
Reasons vary, depending on the procedure. Rhinoplasty, for instance, is tricky because surgeons can’t control healing or how good the building materials are. Cartilage can be too thick or too flimsy; skin draped over a newly fashioned nose structure might not shrink to the shape the surgeon wants.
Sometimes earnest miscommunication between patient and doctor is at the heart of the matter. “What the patient is seeing in their mind is hard to describe to the doctor,” said Dr. Jack P. Gunter, who devotes 40 percent of his nasal-surgery practice in Dallas to redos. “Patients will say, ‘I just want a little taken off.’ How much is a little?” Other doctors sweet-talk patients into thinking the perfect nose or face-lift is within reach, leading to discontent. “People are marketing things they cannot achieve,” Dr. Gunter said. These days advertising creates unrealistic expectations, said Dr. Grotting, whose practice is in Birmingham, Ala. The idea that a procedure can be quick, simple, painless, “all of these catchphrases are heavily marketed to plastic surgery patients,” he said.
In summary, surgery is not always an exact science. Providing informed consent and taking the time to thoroughly explain a procedure with its potential risks and benefits are always important.
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Breast Implant Options
By Dr. R. Jarial | August 16, 2009
Silicone breast implants were released by the FDA for cosmetic use in 2006. Both types of implants have a silicone shell; the difference is what is inside the implant.
An implant filled with silicone gel is more expensive but feels more natural. A implant filled with saline will naturally feel different compared to a silicone gel implant
Two advantages of saline are 1.) smaller surgical incisions, because the implant goes in empty and then gets filled, and an easy way to tell if something needs to be modified at the time of surgery.
And 2.) If a saline implant ruptures, you know right away because it deflates. The saline will be absorbed by the body. With silicone, you might not even know because the gel holds its shape. The silicone gel will not get absorbed by the body.
In order to detect ruptures, Mentor Corporation and Allergan, manufacturers of FDA-approved implants, recommend that women who opt for silicone gel have an MRI every two years, starting three years after the initial surgery.
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Dysport in Competition with Botox
By Dr. R. Jarial | August 16, 2009
Dysport, the first alternative to Botox, is now available in the United States.
Dysport has been used in Europe for years, but most U.S. residents officially got their first taste of it during the past two weeks, when it became widely available to doctors after being approved by the U.S. Food and Drug Administration.
Approval came after five years of clinical trials across the nation.
Like Botox, Dysport contains the muscle-paralyzing botulinum toxin A, but there are some minor differences. It appears to take effect a day or more sooner than Botox, which works in about four days; appears to last a month or more longer than Botox, which typically wears off in three months; and it might spread slightly into other areas of the face.
Botox is made by Allergan Inc. Dysport is marketed in the United States by Medicis, which also makes Restylane and Perlane, fillers that plump creases and enhance the fullness of the lips.
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Cometic Surgery & A Comeback – Maybe?
By Dr. R. Jarial | August 16, 2009
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