By Mike Stokes
As the clock struck midnight to begin the year 2000, much of the world breathed a collective sigh of relief when the calendar turned over four digits as planned without the dreaded Y2K bug wreaking global turmoil on the planet’s computer systems. Nowhere amid the celebratory popping corks, swirling confetti and choruses of “Auld Lang Syne,” however, did anyone imagine just how drastically the political, economic and medical landscapes would change during the tumultuous first 10 years of the new millennium - and plastic surgery was impacted by every shift. Economics, globalism, technology and war each impacted the specialty greatly over the past decade.
Fueled by media coverage and the affordability of new minimally invasive procedures, the specialty experienced unprecedented growth in the number of cosmetic procedures performed as plastic surgery suddenly became both accessible and acceptable to the average American. The cosmetic boom would eventually be offset by an economic bust, however, as the decade came to close with an economic downturn that sparked a renewed interest among many plastic surgeons in returning to the basics of reconstruction and maintaining greater diversity in their practices.
The decade also marked the beginning of a new era of unimaginable advances in reconstructive surgery. Plastic surgery has historically responded in times of war with great innovation, and the specialty has continued this legacy in concert with the ongoing military actions throughout much of the past decade. Horrific craniofacial and extremity wounds sustained by troops in Iraq and Afghanistan - many injuries that would have been fatal if not for life-saving advances in body armor and front-line evacuation techniques - have forced plastic surgeons to push the envelope of medical possibility, with promising breakthroughs in stem cell research, composite tissue allotransplantation, robotics and prosthetics expanding the specialty’s reach throughout surgery.
Not all of the specialty’s advances of the past decade, however, were limited to the O.R., as an increasingly web-savvy public turned to the Internet to research procedures and surgeons prior to their first consultation. Rapid expansion of online social media further redefined how plastic surgery practices could be marketed in the 21st century. ASPS also underwent significant changes in how it used technology to provide education to the public and members, streamline operations and advocate for the specialty by leveraging web technology to provide information on silicone breast implants, cosmetic surgery taxes and patient safety issues. The past decade also saw the implementation of a new governance structure to streamline operations and vastly increase funding available through the Foundation for clinically relevant research that will undoubtedly continue to shape the specialty for decades to come.
There’s no question that the past decade has been a pivotal one for plastic surgery on many fronts. To compile the following Top 10 list of the specialty’s biggest stories from 2000 through 2009, members of the PSN editorial team of the past decade were assembled to look back at a decade’s worth of news stories and rank them based on a combination of impact on the specialty, resonance with the public and media - and how they helped define the decade of plastic surgery.
No. 1
Face transplantation becomes a reality
No. 2
Silicone implants return
No. 3
Plastic surgery and ‘reality’ TV
No. 4
Botox launches minimally invasive trend
No. 5
The next generation of soft-tissue fillers arrives
No. 6
High-profile deaths raise patient-safety awareness
No. 7
Plastic surgery goes to Washington
No. 8
Post-bariatric boom
No. 9
Increase in office-based surgery
No. 10
Medical tourism
Originally published in the January/February 2010 issue of Plastic Surgery News

Continue to follow this blog and details of each of these fascinating stories will be added!

We sincerely appreciate the confidence that you have shown in our practice! We have noted that former patients of ours have referred the majority of our new patients to us. It is especially gratifying to know that our previous patients have been so pleased with our care and services that they have sent their friends and relatives to us as well.

To thank you for the support and confidence that you have shown in us, we would like to offer a gift certificate to you for each new consultation that we see who lists you as their referral source. This gift certificate of $50 may be used towards any service or product offered by our practice including aesthetician services. The certificates are valid for one year and may be used together if desired.

Just think, if you send enough patients, your surgery could potentially pay for itself!

Have you ever considered a filler to improve the appearance of your lips but were afraid of the discomfort? Fear no more - ALL of the fillers we use including Juvederm contain a local anesthetic to make the process pain free! Look your very best with quick, easy and pain-free office procedures!

Watch this interesting video about the latest swimsuit trends and styles for 2010: Swimwear Trends

Botox: Another Shot at Looking Young
By Tamar Nordenberg

If you’ve had a Botox injection, you’ve probably noticed your face restored to a youthful appearance. Botox injections are common, but do you know the Botox injection treatment facts? In this article, we cover the facts about having a Botox injection and will give you the Botox injection treatment facts you need to know before scheduling a Botox injection for you.

A smile has laughingly been referred to as an inexpensive way to improve one’s looks. But now the smile, usually known for exuding cheerfulness, is getting attention, too, for its devilish side effect: Over the years — and together with its displeased conspirator, the frown — a smile can leave behind age-revealing facial lines.

To join the ranks of facelifts and skin resurfacing, enter an unlikely face-saver: botulinum toxin. It can cause botulism, a sometimes-deadly form of food poisoning, but injected into the facial muscles in its diluted, purified form called botox, it can restore the face to a youthful appearance of years gone by.

Botox: A Four-Month Fix
First approved by the Food and Drug Administration in 1990 for treating eye muscle spasms, botox showed its cosmetic potential almost immediately, when patients with their eye on ophthalmologic gains noticed their wrinkles softening. The toxin that could block nerve impulses to temporarily paralyze certain misfiring eye muscles, it turned out, could also be directed to disable those muscles that form “crow’s feet” around the eyes, wrinkle lines on the forehead and frown lines between the eyebrows.

Ten years after it initially hit the market, botox is one of the most popular cosmetic medical procedure in the United States; almost 800,000 Americans got the injections in 2000, according to the American Society of Plastic Surgeons (ASPS).

With California-based Allergan Inc. expecting approval of botox for cosmetic use shortly, the ASPS predicts that the product’s popularity “could increase exponentially.”

Botox can iron out wrinkles earned over years of facial movements, such as smiling and frowning, concentrating and squinting. In addition to the most popular complaints — furrows between the eyebrows, crow’s feet and forehead lines — women in particular get botox injections to correct some imperfections of their lips and necks. Recently, botox has found yet another use: a “chemical brow lift” to restore the arch to falling eyebrows. (Outside the cosmetic sphere, botox is used not only for muscle control, but also to treat migraine headaches and other types of pain and to eliminate excessive sweating, or “hyperhydrosis.”)

Botox Has a Predominately Female Clientele
Most botox users are women (88 percent, according to the ASPS), and most are aged 35 to 50 (59 percent). Says Kevin Poitras, M.D., who treats some 100 people each year with botox injections in his Bethesda, Md., dermatology office, “My patients aren’t satisfied with growing old gracefully. They say ‘I don’t feel old. I don’t think old. Why should I look old?’”

For $300 to $1,000 per treatment — $366 on average, according to the ASPS — botox can restore a refreshed appearance to aging faces that are starting to look anxious, tired or angry. “I knew it was time to do something when people started looking at me and asking ‘Are you mad’?” says 40-year-old Anna Masica, an aesthetician at a Bethesda, Md., spa who turned to botox earlier this year to get rid of bothersome frown lines between her eyes.

“I feel better about myself knowing my forehead doesn’t always look scrunched up,” Masica says. “I feel I look younger, and my makeup doesn’t end up in the creases between my eyes like it used to by the end of the day.”

The Results of Botox Are Temporary
Masica knows her wrinkles will return after four months. Botox is a temporary fix, lasting about that long before the lines gradually reappear, requiring another treatment to keep them at bay. (However, doctors have observed that repeated botox treatments may last progressively longer as the facial muscles atrophy from non-use.)

Although the benefits of botox injections are more fleeting than those from surgical procedures such as facelifts and laser skin resurfacing, botoxing has pluses of its own.

To name one, the injections are doled out in a five-minute to half-hour procedure, depending on the number of areas treated. Patients “come in, have it done, get off the table and go back to work,” Poitras says. “There’s no down time.”

What’s more, the injections with a tiny needle are “pretty close to pain-free,” says Los Angeles plastic surgeon Brian Kinney, M.D. Botox recipient Masica is even less equivocal: “There is no pain involved.”

As a rule, Kinney doesn’t numb his patients while he performs the several injections (three for your basic frown lines, for example). But patients who have a low threshold for pain may opt for a pre-injection numbing agent.

To minimize the chance of complications, patients are asked to do two things: use the facial muscles so the botox is attracted to the right areas — “just make funny faces for half an hour,” clarifies Poitras — and avoid lying down for up to four hours.

Having followed these pointers, the improvements should show themselves within two to five days. There’s no need to worry about being left expressionless, assures Kinney, while acknowledging that post-botox expressions may be less dramatic than before. The side effect might be perfectly acceptable for a poker player, but could be a liability for, say, a hardball negotiator whose ability to intimidate is a highly prized commodity.

Botox Risks
The basic approach for injecting botox is “really straightforward” so risks are “minimal,” according to Kinney, who has five years’ experience offering the wrinkle-reducer. Doctors inject about 25 to 50 units of botox to smooth patients’ skin, ten times fewer than the 3,500 units that could kill.

Still…paralyzing the facial muscles: The thought could unnerve the most enthusiastic youth-seeker. As a beauty school student, the botox basics were enough to scare Masica away for a time. “I knew it was botulism that paralyzed the muscles. That’s a scary thought,” she says. But with her job at a spa came a better understanding of botox and a confidence in the procedure’s safety.

The risks, though rare, include bruising, numbness, swelling, muscle twitching, headache, droopy eyebrow and, most commonly, a droopy eyelid. Poitras explains, “Rarely, if the botox drifts too close to the eye muscles, a person can find it impossible to open their eyelid completely.”

Some people shouldn’t use botox, such as women who are pregnant or breast-feeding and people with certain kinds of medical problems, including, in Kinney’s view, some kinds of musculoskeletal and neurological conditions.

People contemplating the injections should choose their doctor carefully, making sure they are trained and experienced in performing the procedure and are willing to discuss expected results and risks openly.

That said, there is something for patients and doctors alike to smile about: Like its skin-smoothing benefits, botox-related problems are temporary. No need to fear botox-based lawsuits, doctors joke, because by the time the patient gets to an attorney, the side effects have worn off.

Botox as Starter Surgery?
Botox might be a good starter surgery, says Kinney, for those who aren’t ready to go under the knife. “Get started, get to know your surgeon, see if you have a similar approach to staying beautiful.”

With all of botox’s promise for patients whose wrinkles appear when they smile or raise their eyebrows, it’s of no use, however, for sun-damaged skin and gravity-grown jowls. For these concerns or facial creases that have been etched permanently over years, some choose to combine botox with facelift, fat injection, laser or chemical peel or eyelid surgery.

Plans for plastic surgery aside, staying beautiful requires an overall healthy lifestyle, Kinney emphasizes, which includes giving up smoking, eating right, exercising and using sunscreen. It may be true what existentialist author Albert Camus wrote in 1957: “After a certain age every man is responsible for his face” — and in the name of taking charge of your own countenance, dermatologist Poitras exhorts the use of botox along with sunblock. But he frowns on the idea of a life sans smiling to shun those dreaded wrinkles — much too depressing a price to pay for a furrow-free brow.

High-tech tanning devices heighten melanoma risk
Jun 9, 2010
By: Bill Gillette
Cosmetic Surgery Times E-News

Minneapolis — A new study shows that people who use high-speed/high-intensity indoor tanning beds run the highest risk of melanoma, HealthDay News reports.

Researchers at the University of Minnesota surveyed 1,167 subjects diagnosed with invasive cutaneous melanoma from 2004 to 2007, as well as a demographically matched control group of 1,101 subjects. The two groups were asked about their experience with indoor tanning equipment, type of equipment used, age of initiation, length of use, period of use, doses and any tanning-caused burns.

Among the melanoma group, 62.9 percent of subjects had used indoor tanning equipment compared with 51.1 percent in the control group. Among those who had used indoor tanning equipment even for a short time, there was a 74 percent increased risk of melanoma.

Risk odds were highest among those who had used high-pressure (UVA-emitting) tanning devices and high-speed/high-intensity (UVB-enhanced) devices than among those who used sunlamps or conventional tanning equipment.

There was a strong dose-response relationship between melanoma risk measured in total hours, sessions or years spent tanning.

“In a highly exposed population, frequent indoor tanning increased melanoma risk, regardless of age when indoor tanning began. Elevated risks were observed across devices,” the authors conclude.

The best and gold standard treatment for spider veins is laser. Laser vein removal is an easy, fast and effective way to treat superficial veins. The laser uses a focused beam of light and in the treatment of veins, the wavelength of light is targeted to the pigment in the blood. The laser heats up the small vessel and destroys it. The laser beam is focused and does not damage the nearby skin tissue. Over a period of 4-6 weeks, the vein is reabsorbed by the body and disappears.

During your treatment, you may feel a slight tingling sensation as the laser fires. Soon after the procedure, you may feel a slight bump on the skin which will disappear in the next 2-4 hours. The area may also appear slightly redder and occasionally may be bruised. The results of laser treatment for spider veins are not immediate. After laser therapy, the vessels underneath the skin will gradually change from a dark blue to light red color, then eventually disappear in 2-6 weeks. After treatment, there is no down time. The risks associated with laser vein therapy are minimal. You can resume all of your normal activities immediately afterward. Healing can be facilitated by wearing support hose.

Depending on the size and number of veins, 2 to 6 treatments will be needed. Treatments are usually scheduled 4-6 weeks apart. Spider veins are recurrent and thus more treatments will be required in the future.

Advantages of Laser Therapy:
* It has much fewer side effects
* It is less traumatic to the surrounding skin compared to sclerotherapy
* It takes a much shorter time to complete laser treatment
* It is less painful than sclerotherapy
* Recovery is immediate
* Downtime is almost zero
* Laser therapy can even be used on the face

If the answer is no, due to unsightly veins on your legs, we have the solution for you! Dr. Nein now offers laser vein therapy to get rid of those pesky veins that keep you from enjoying summer clothing and activities. Laser vein therapy is easy, fast and effective for the treatment of superficial veins. It can even be used on the face. Downtime is almost zero, recovery is immediate and you are back to your normal activities immediately. Why put it off any longer? Call our office today at (615) 327-0201 to schedule your appointment with Diane and be ready for summer in no time with great looking legs!

Unfortunately, there is no diet or exercise that will get rid of excess skin. The skin has some elasticity and will contract to a certain extent after it has been stretched such as after pregnancy or after weight loss. But after the skin has contracted as much as it can there is no addition exercise or diet that will cause it to contract any further. The only way to get rid of excess skin is to remove it surgically. That is part of what we do when we do tummy tucks, facelifts, thigh and buttock lifts and many of the other procedures we do to trim up people who have loose skin or have undergone large amounts of weight loss.

Pregnancy is a great thing and a wonderful experience for most women and of course there are a number of changes that happen to a woman’s body during pregnancy. Unfortunately, a few of these changes persist even well after the pregnancy is over and the babies aren’t babies anymore. Some things sag, some stretch while others just widen a bit more than those skinny jeans can handle.

So in a mommy makeover, we can do any number of single procedures or combination of procedures to undo some of the less desirable changes associated with pregnancy. These procedures may often include a breast lift to perk up the appearance of the breasts and get rid of the sag that often occurs. This may sometimes be combined with implants to fill out some of the deflation that can occur from pregnancy.

Tummy tucks are also a very popular part of the mommy makeover. Pregnancy not only stretches the skin of the stomach but often can cause permanent stretching of the muscle layer as well. A tummy tuck normally removes the excess, loose skin and tightens up the muscle layer so that a nice flat pre-pregnancy stomach contour is achieved. No more need to wear once piece swimsuits.

The nature of pregnancy is such that many women are left with a little more accumulation of fat on the thighs, buttocks and hips. Unfortunately, some of these fat deposits are resistant to diet and exercise. Specific areas of fat accumulation such as these are very treatable with liposuction. In this procedure, we remove the excessive fat from these areas until a prettier, sexier more feminine contour or shape is obtained.

All of these procedures are normally performed as an outpatient although when a significant combination of procedures is performed it may be advisable to spend one night in the hospital.