Indiana Plastic Surgery Blog

Ptosis (pronounced “toe-sis”) is a condition characterized by breast droop and loose, stretched skin on the breasts.  The skin on a woman’s breasts is primarily responsible for maintaining their position.  When the skin becomes stretched or loose or less elastic, the breasts will droop.

What causes breast ptosis?

Breast ptosis is caused by a combination of factors including large breast size, aging, and gravity.  Large breasts may be gradually pulled down by gravity and the skin becomes thinner and less elastic with age.

A recent study sheds light on the lifestyle factors that contribute to breast ptosis.  Plastic surgeons at the University of Kentucky found that age, significant weight loss, higher BMI, larger bra cup size, number of pregnancies, and smoking were found to be significant risk factors for breast ptosis, while “breast-feeding, weight gain during pregnancy, and lack of participation in regular upper body exercise were not found to be significant risk factors.”

Evaluating Breast Ptosis

Plastic surgeons often measure breast ptosis using the Regnault classification, which is as follows in simplified form:

1. Pseudoptosis – the nipple falls above the fold, but the breast is hypoplastic and hangs below the breast crease.

2. Glandular Ptosis – the nipple is above the fold, but the breast hangs below the crease.

3. Minor Ptosis – the nipple is level with the breast crease.

4. Moderate Ptosis – the nipple is below the breast crease, but above the lower breast contour.

5. Severe Ptosis: the nipple is below the breast crease and below the lower breast contour.

Correcting Breast Ptosis

Using the classification system above, a surgeon can recommend the right procedure to correct breast ptosis.  Surgery to correct minor ptosis may be quite different from the procedure to correct a severe case of ptosis.  The usual procedure of choice is breast lift surgery / mastopexy.

A new study published in Plastic and Reconstructive Surgery analyzes the factors that motivate women to undergo breast augmentation, rhinoplasty, liposuction, and abdominoplasty.

According to survey analysis, specific factors –both physical and psychological –can predict an interest in cosmetic procedures.   1862 women in northern Norway responded to a questionnaire regarding their interest in cosmetic surgery.  All participants were under the age of 35.

Women interested in rhinoplasty, breast augmentation, and liposuction were motivated by “complex psychological factors.”   Researchers found correlations with lifestyle factors such as divorce, history of teasing, education, self-image, body dysmorphic disorder, and the so-called Big-Five personality traits.

Questions about abdominoplasty (the tummy tuck) presented some unique findings.  Most participants who were interested in the procedure were interested in it exclusively. Having children and the “desire to repair the bodily changes occurring after childbirth” was a consistent predictor of interest for a tummy tuck.

Read the abstract of this study online on Plastic and Reconstructive Surgery

First quarter earnings for Allergan, maker of Botox, are way up. Second quarter forecasts, according to the Wall Street Journal, are way ahead of expectations.

Given the statistics just released by the ASPS, their success shouldn’t be all that surprising. According to the society, minimally invasive procedures have increased an incredible 99 percent since 2000.  Topping the list are wrinkle fillers and botulinum toxin injections, two treatments in which plastic surgeons will likely reach for an Allergan product.

Image courtesy of the ASPS

For Allergan, being on the cutting-edge of aesthetic medicine also doesn’t hurt. New products like Juvederm Ultra XC and Latisse are getting plenty of attention right now, which should only increase consumer demand for these cosmetic procedures.

A recent study of 581 breast cancer patients has revealed inequalities correlated with race and health insurance coverage.

According to the research, black women have to wait longer for breast cancer treatment and diagnosis, regardless of their health insurance coverage.  White women with no insurance coverage also waited significantly longer.

The findings come from George Washington University Cancer Institute.  Patients were treated at 7 hospitals and clinics between 1997 and 2009.

Highlights

• To get a definitive diagnosis, insured black patients and uninsured white patients had to wait over twice as long as insured white patients.
• Contrary to the researcher’s expectations, insurance coverage did not even the field between racial groups. Having health insurance coverage did not mean a quicker diagnosis in black women.
• After diagnosis, black patients had to wait twice as long as white patients to begin breast cancer treatment.

Read more about this study on womenshealth.gov
Information on breast reconstruction in Indiana

This story from CNN documents the increasing number of cosmetic procedures being performed in Iraq. As violence in the region subsides, Iraqi women have begun to seek cosmetic enhancement with greater frequency.

“It does seem that cosmetic surgery is on the rise” says reporter Mahammed Jamjoom, who stands by while rhinoplasty is performed on 26-year old Noor Aziz.

Read “Buying Beauty in Baghdad” and see more videos on CNN.com

FDA warnings were issued to several med-spas last week (including one here in Indiana) regarding claims made about the safety and effectiveness of lipodissolve.

With an injection of certain chemicals (phosphatidylcholine, deoxycholate, and others) lipodissolve is said to remove areas of persistent fat.  The procedure, which is also known as injection lipolysis, lacks scientific evidence supporting its use as a fat removal treatment.

The medispas involved were apparently claiming that Lipodissolve was “superior to other fat removal procedures, including liposuction” and making misleading claims about the safety record and effectiveness of lipodissolve.

Given the lack of supporting evidence for lipodissolve and the side effects reported by consumers, officials in the FDA felt it was necessary to crack down on these misleading claims and warn consumers about them.  The medical spas are being instructed to “correct these violations and prevent similar violations in the future.”

You can find more information on the FDA website

As you age, the underlying bone structure of your face may begin to change and negatively affect your outward appearance. According to studies published in Plastic and Reconstructive Surgery Journal, the facial bones of your chin and jaw may actually recede as you get older, affecting the proportions of your face.

For these studies, a group of 60 men and 60 women were analyzed with CT scans. The authors noticed that older individuals actually showed changes in bone structure, especially in the chin and jaw area.

Other areas of concern include the middle of the face, in the cheekbones and eye-sockets.

The authors, Dr. Howard Langstein and Dr. Robert Shaw Jr., suggest that during future cosmetic surgeries, a patient’s skeletal structures may require more attention. Aside from traditional facelift surgeries that reduce sagging tissues in the middle and lower part of the face, surgeons may need to focus more on chin implants and procedures that augment your bone structure.

Restoring facial volume has already become commonplace in facial plastic surgery. Non-surgical procedures such as Juvederm and Restylane are used to temporarily augment multiple areas of the face, while facial implants provide long-term solution for inadequate chin or cheek projection.

The FDA just expanded clearance for Botox, approving the drug to be used as a treatment for spasticity in muscles of the elbow, wrist and fingers. Such conditions occur frequently after a stroke, injury or debilitating disease.

They specified that Botox treatment should not be considered a substitute for physical therapy or the “usual standard of care rehabilitation regimens.”

It seems that treatment applications for Botox are continually expanding. While Botox is best known for cosmetic usage — typically the treatment of forehead wrinkles or “frown lines” –there are several therapeutic treatments now being offered by physicians today. Excessive sweating, cervical dystonia and muscle spasm are just a few of those alternative treatments.

• Botox in Munster, Indiana
• More information from the FDA

Earlobe repair is a common procedure performed by facial plastic surgeons and several other physicians. The procedure is necessary because mishaps frequently occur with earrings, leading to an unsightly tear on the earlobe.

If you have experienced such a mishap, Dr. Robinson may be able to repair your earlobe quickly and easily. However, before and after earlobe repair, there are steps you should take to prevent these accidents.

How to Prevent Earlobe Tears/Earlobe Trauma

(via Dr. Joe Niamtu’s “11 Pearls for Earlobe Repair”)

• Avoid wearing heavy earrings for long periods of time
• Remove earrings during certain situations: using the telephone, at the hair salon, at a rock concert, etc.
• Be aware that small children and babies may be attracted to earrings
• Remove your earrings before removing upper clothing, like sweaters
• Do not allow children to wear small loop or dangling earrings

The NPR morning edition broadcast this morning discussed how aging muscles contribute to weight gain, a message that magnifies the importance of exercise for the aging person.

When you get older, you lose muscle mass, meaning your body weight can stay the same but the percentage of muscle in your body decreases. Muscle repair also becomes slower. Because muscle plays such a critical role in burning calories, your weight, health and body shape can all be affected by this change.

Listen to the program online to learn more