The doctor conducted a 30-patient clinical trial for this off-label application, demonstrating that botulinum toxin type A can address post-operative pain for patients of breast reconstruction.  A temporary tissue expander is often used during breast reconstruction, which is placed between layers of the chest muscle and filled with water to create a pocket for the breast implant. Pain can result from muscle contractions and spasms in response to the gradual tissue expansion.

Dr. Gabriel, along with his collaborator Dr. G. Patrick Maxwell, theorized that Botox injections could offer relief by temporarily paralyzing the muscle so that fewer spasms occur, thereby reducing pain and discomfort.  The doctors designed a clinical trial with 30 breast cancer patients who all planned a mastectomy and subsequent silicone implant breast reconstruction.  They were divided into 2 groups: one received Botox injections in the chest muscle and the other received injections of saline solution as a placebo.

After reconstructive surgery, the women who received the Botox injections were reportedly more comfortable than those who received placebo. The doctors measured patient responses 3 times during and after the procedure, noting that during days 7 to 45 of the recovery period, those that received Botox injections used significantly fewer doses of narcotics and muscle relaxants.

You can find more information about this topic on Medscape.

The Dysport Challenge is a promotional offer designed by Medicis, the manufacturer of the wrinkle-relaxing injectable Dysport, to pit their new botulinum type A product against the long-standing wrinkle reduction king Botox, which is manufactured by Allergan.

After patients have received Dysport injections to reduce forehead creases, frown lines or crow’s feet, the Dysport Challenge asks them to indicate whether they are satisfied with the outcome of their injections by selecting a positive “Love It” response, or if they are dissatisfied and wish to trade Dysport for its competitor Botox by selecting a negative “Leave It” response.

Patients enrolled in the program would receive a total of $150 in rebates on two Dysport treatments if they choose the “Love It” selection, whereas patients who choose the “Leave It” selection and opt for Botox injections during their next wrinkle treatment session would still receive a $75 rebate.

Medicis has previously reported that of all the patients who have registered for the Dysport Challenge thus far, only 2.6% have made a selection to “Leave It” since the program was launched.

Although the majority of Dysport patients have responded positively to the treatment according to Dysport Challenge results, this does not necessarily indicate that most patients preferred Dysport over Botox, only that they are happy with Dysport results.

Similarly, the Dermatology Times reports that expert opinion has not clearly swayed in favor of either Dysport or Botox, largely because physicians are still learning the nuances of administering the new product.

“Most of your problems and disappointments will occur in your first 100 cases because you’re still learning,” says Ontario dermatologist Dr. Kevin Smith.

The newness of Dysport is still a factor for experts in assessing its performance as compared to Botox, and other than obvious differences in the chemistry and ratio of unit measurements between the two products, the only other purported difference is that Dysport may have a tendency to spread or migrate more than Botox after injection.

Some physicians find it likely that injector preference for Botox or Dysport will be determined not by differences in the two products, but differences in the doctors’ loyalties to the product manufacturers and comfort level using one product over another.

Regarding the Botox vs. Dysport debate, Nashville dermatologist Dr. Michael Gold commented that Dysport data shows no difference in migration tendencies as compared to Botox “depending upon whose study you read,” and added, “If you’re experienced enough with Dysport, the spread factor is a nonissue.”

“There’s a major tug-of-war going on between physicians who utilize those toxins,” Dr. Gold said.  “Depending on whose team you’re on, your statements will generally favor that toxin over another.”

An unfortunate reality is that many patients don’t undergo breast reconstruction because they’re not aware about the procedure’s coverage under universal health insurance.  Doctors pushed for the new law so that a discussion of breast reconstruction options would be required, thus increasing the number of patients undergoing the surgery.

There seems to be a stark contrast in resources between breast reconstruction patients of different backgrounds.  Evidently, some are making decisions about treatment with a relative lack of information, while others are independently seeking out advanced microsurgical procedures.

According to a recent study in Plastic and Reconstructive Surgery, a growing number of breast cancer patients are using the Internet to find a reconstructive surgeon on their own, and many are choosing advanced microsurgical breast reconstruction procedures.

In order to address the question, radio show host Steve Scher asked each panel member to respond to several questions related to body image concepts, offering listeners tips to help maintain a healthy self-awareness and recognize if body consciousness becomes unhealthy.

Listen to your body, but don’t let it take over your head

The mind and body are closely related, and it’s healthy to be constantly conscious of your physical well-being and limitations.  But when considerations of body consciousness and self-awareness leave the realm of the physical and become too entrenched in the psychological, they can quickly become preoccupations that cause people to pin their hopes for achieving self-fulfillment and life satisfaction to achieving an ideal physical form.

To differentiate between healthy and unhealthy body consciousness, registered dietician Julie Church offered the following thoughts:

“The root motivation that leads [body consciousness] to be unhealthy is when one is subscribing to the equation that an ideal form is going to give them happiness, success, relationships, love, fulfillment—all those things.  I believe that’s when it leads to the preoccupation and obsession, and that’s when it becomes unhealthy.”

Minor physical flaws should remain minor concerns

According to Seattle plastic surgeon Dr. Jourdan Gottlieb, if you’re seeking cosmetic surgery or taking other health risks because you are preoccupied with a minor physical flaw, it’s a sign of unhealthy body consciousness.

“Consciousness of your body is important all the time, however when it begins to interfere either with a patient’s mental health, physical health, or causes them to take unnecessary risk, it becomes a problem.  When people inappropriately come asking for surgery for fairly minor problems or for problems that have other, safer means of treatment, it’s interfering with their life and their health decisions.”

Dr. Gottlieb also added that patients who seek cosmetic surgery for minor flaws, such as seeking liposuction to remove very small fat deposits that could be addressed by changes to diet and exercise habits are typically not satisfied with their plastic surgery outcomes.

“A patient that comes in with an apparently trivial problem and has a great deal of concern over it is much less likely to have a satisfactory outcome,” said Dr. Gottlieb.

Before seeking surgical body contouring or making significant changes to your diet or exercise program, spend some time considering the help of trained experts, such as registered dieticians, licensed fitness trainers and board certified plastic surgeons to help you make healthy decisions about changing your body and your lifestyle.  The more realistic your physical goals and expectations, the happier you will be with your body.

According to the Florida Board of Medicine, last year the doctor allowed two unlicensed medical assistants to illegally perform liposuction on a patient in an unregistered surgical facility then failed to properly document important details of the procedure, including the amount of anesthesia used and the volume of fat removed.

The board’s investigation stemmed from an unrelated complaint made by the liposuction patient, but its findings resulted not only in the yearlong suspension of the doctor’s license but also in a $50,000 fine and potential three-year probation following the suspension.

“I think he’s in a lot of trouble because he doesn’t have a surgical background,” remarked Dr. Trina Espinola, a St. Petersburg surgeon and Florida medical board member.

Although state medical boards do not currently limit medical practice based on a doctor’s specialty certification, Florida’s community of plastic surgery and dermatology specialists has grown concerned about the rise of untrained professionals, whose patients they end up treating when complications arise.

The Florida Board of Medicine has taken notice of this concern, and in the interest of protecting patient safety is cracking down on inadequately trained physicians like Jean-Baptiste looking to cash-in on the cosmetic surgery industry after pursuing only a few days of training.

“This kind of case underscores how a weekend of coursework doesn’t prepare physicians to perform procedures such as liposuction,” said Chris Nuland, a Jacksonville attorney representing Florida’s plastic surgeons and dermatologists.

Considering that physicians certified by the American Board of Plastic Surgery spend two to three years exclusively learning how to correctly perform plastic surgery procedures, including several hours of liposuction training, it’s no wonder that physicians who do not undergo this level of training are not qualified to perform plastic surgery.

Just as board certified family medicine doctors are specialists in addressing a wide range of physical conditions and illnesses that may afflict both pediatric and adult patients, board certified plastic surgeons are true plastic surgery specialists and are uniquely qualified to perform liposuction.  You don’t visit a plastic surgeon to treat your child’s sore throat, so don’t visit a family medicine doctor for body contouring surgery.

Although Xeomin is approved only for therapeutic use, to treat neuromuscular conditions like cervical dystonia and blepharospasm, there is a good chance it may also be used off-label for cosmetic use, to reduce dynamic wrinkles or expression lines on the forehead and between the eyebrows.

Xeomin has been used in Europe since 2008 and works like other neurotoxin injectables, temporarily paralyzing muscles that cause expression, as well as painful muscular tension and spasticity.  The differences between Xeomin, Botox and Dysport will likely be negligible, however unproven rumors have circulated regarding the advantages and disadvantages of Xeomin as compared to its competitors.

Xeomin will be mildly more convenient than Botox and Dysport, as it is the only botulinum type A product that does not require refrigeration prior to reconstitution, and the product’s lack of complexing proteins will help prevent antibody formation, or resistance to neuromuscular treatment with botulinum type A toxin, in patients being treated for neuromuscular conditions.

On the other hand, it may be riskier to use Xeomin for cosmetic wrinkle reduction, since the product purportedly has a tendency to spread or migrate beyond the injection site, which may result in side effects like droopy eyebrows or a crooked smile.

Xeomin is measured in units comparable to Botox units and will be distributed in 50- and 100-unit vials.  The per-unit cost of Xeomin is expected to be roughly the same as the cost of Botox, and hopes that Xeomin’s launch will lower the price point for cosmetic wrinkle-relaxing injections are likely unfounded.

The most important thing to remember when seeking wrinkle reduction with injectables is that the product formulation has little to do with the outcome of your procedure.  It is the skill of the injector that determines how well your results turn out, so don’t spend too much time worrying about product chemistry.  Instead, trust your face to an experienced Indiana plastic surgeon to ensure you achieve natural, youthful-looking results.

Injectable filler derived from marine algae

Merz recently launched a unique new injectable filler product in Europe called Novabel.

Unlike most of today’s popular fillers like Juvederm and Restylane, which are made of hyaluronic acid, Novabel is made of spherical, flexible structures called Geleons derived from brown marine algae.

It is Novabel’s patented Geleon technology that makes injections smooth, easy to administer and virtually pain-free.  It also makes Novabel ideal for filling facial areas with thin skin, such as the lower eyelids and tear troughs, and less likely to cause as much swelling than other injectable fillers.

Molecularly engineered skin substitute

Award-winning New Zealand research and development company Mesynthes recently announced the release of Endoform Dermal Template, a tissue substitute FDA-approved for wound care and skin reconstruction.

Unlike skin grafts, Endoform Dermal Template is not composed of donor skin but rather of extracellular matrix material, which provides a unique mix of biological macromolecules that actively promote the skin regrowth via cell regeneration and blood vessel formation.

thus, this new hi-tech skin substitute is ideal for reconstructive surgery patients suffering from flesh wounds and tissue damage caused by severe burns and other accidents, and it will likely make skin grafting, the process of transplanting skin tissue, largely unnecessary.

“Fly tape” to replace surgical sutures

Scientists studying caddisfly larvae at the University of Utah recently discovered that the design and properties of the silk spun by these insects acts as a sort of “wet BandAid” and could be mimicked to create a stronger surgical tape.

This fly-inspired surgical tape could be engineered to close incisions similarly to surgical sutures, but it would offer dramatically increased adhesive bond strength.

Surgical tape with increased adhesive bond strength could potentially lower decrease the number of suture failures in patients who have had a facelift, abdominoplasty or other cosmetic surgery procedure.

Indiana plastic surgeon Dr. David Robinson recognizes the importance of staying up-to-date on the latest advances in plastic and reconstructive surgery research and development, as innovation in medical technology is what has allowed Dr. Robinson to offer patients the most effective procedures that achieve the best aesthetic results for nearly a decade.

In February 2010, Atlanta-area mother of four Kenyatta Brown sought breast augmentation from an eye doctor offering deep discounts and nearly bled to death during what is typically considered a routine operation.

A few months later, 22-year-old Mayra Lissette Contreras died after receiving silicone injections for buttock enhancement from a pair of unlicensed practitioners operating out of their San Fernando Valley home.

Brown and Contreras were lured to unqualified practitioners promising low prices for cosmetic enhancement—one, a doctor with inadequate plastic surgery training practicing outside his specialty area of ophthalmology, and the others, back-alley practitioners with no valid medical licensure or training.

Unfortunately, cosmetic medicine is a lucrative, cash-only industry that attracts a number of untrained, unscrupulous practitioners hoping to make a few quick bucks at the expense of unwary consumers.

It is important to research both your medical practitioner and educate yourself about the cosmetic procedure(s) you desire before seeking treatment.

• Verify your doctor’s license is clear and active with the appropriate state medical board
• Verify your doctor’s medical specialty with the American Board of Medical Specialties (ABMS) or the Royal College of Physicians and Surgeons of Canada (RCPSC)
• View before and after photos of your doctor’s past patients
• Speak with your doctor’s past patients about their experiences
• Find a variety of online resources to read about your desired cosmetic treatment(s)
• Learn how much experience your doctor has performing your desired procedure

Dr. David Robinson is a highly experienced, board certified plastic surgeon in Indiana with over a decade of experience performing cosmetic surgery and skin care procedures.

Stories like those of Brown and Contreras serve as cautionary tales reminding prospective patients that if prices for cosmetic treatment sound too good to be true, they probably are.  Remember that making decisions about your health based solely on price can cost you more than money, so let this be your last consideration in choosing a surgeon.

According to study results, performing breast surgery in an ASC rather than a hospital saved 69 minutes on average, and most of the time savings was attributable to decreased preoperative time, or time spent preparing for surgery.

Key time-saving advantages of the ASC include:

• Avoidance of unscheduled surgeries, such as add-on cases and emergency cases common in hospitals
• Better case flow as a result of having a surgeon assigned to a single room in the ASC
• Smaller, more consistent ASC staffing
• Smaller physical ASC facility that makes it easier to move patients and equipment

The study also concluded that while the type of anesthesia used during surgery can also affect recovery time immediately following surgery, this did not significantly affect overall surgical time from the preparation stage to the patient discharge stage.

Hospital vs. ASC study details

In 2005, the study authors’ ASC facility was closed, which forced all outpatient breast surgeries to be performed alternatively in a hospital setting.

Study authors Drs. Terrence Trentman, Jeff Mueller, Richard Gray, Barbara Pockaj and Daniel Simula compared the surgical records of 92 patients who had breast surgery in an ASC facility between January 2004 and December 2005 with the surgical records of 92 patients who had breast surgery in a hospital facility starting January 2006.

All study subjects were female patients of similar age, with similar recovery room times, and each breast surgery procedure was performed by the same two salaried surgeons who did not receive additional bonus pay for productivity.

ASC pre-op vs. post-op

In addition to concluding that ASC facilities offer significant preoperative time-savings, the results of the study also suggest that breast surgery patients spend an almost identical amount of time in an ASC as in a hospital once they reach the operating room.

According to Anteis, the injection pen allows physicians to achieve more precise and consistent results with gel-based dermal filler injections because it electronically controls and regulates the volume of the filler as it is injected, as well as the injection speed as the filler is introduced into the dermis.  As a result, the Anteis Injection System also decreases physician muscle fatigue, making it physically easier to use than standard syringes.

In addition, the device is said to offer physicians improved handling, greater freedom of movement and increased opportunity to focus on ideal product placement rather than injection technique.

Physicians who use the Injection System have also reported improved patient outcomes marked by less pain during treatment, decreased social downtime and fewer and less severe side effects, such as bruising, swelling and redness after treatment.

According to Anteis, the Injection System is effective for all types of cosmetic injectable treatments, including:

• Wrinkle treatments
• Facial volume restoration and augmentation
• Treatment of skin depressions, such as cellulite

Although the Anteis Injection System is a promising innovation in cosmetic dermatology, it has not been appropriately tested or approved by the FDA and is not yet available in the U.S.

Additionally, the injection device was designed to work with Anteis-brand injectable fillers made of hyaluronic acid gel that are also not available in the U.S.  The Injection System has not been tested with other brands of hyaluronic acid fillers, such as Juvederm and Restylane, nor has it been tested with wrinkle-relaxing injectables, such as Botox.

If you’re considering non-surgical facial rejuvenation with injectable fillers, seek a skilled injector with superior injection technique and experience using a wide variety of injectable fillers.