I recently had the opportunity to attend the annual ASAPS (American Society for Aesthetic Plastic Surgery) meeting in San Francisco. What a well-organized and profitable event it was! Opportunities to renew old friendships and to examine new ideas!! A few of the highlights:
–Textured anatomically shaped silicone breast implants are the newest thing in breast augmentation surgery. Although some physicians have embraced them to the exclusion of the extremely popular smooth round silicone implants, most doctors are taking a much more cautious view of them. Consider their disadvantages:
o Textured anatomic implants are more expensive than smooth implants (~ $1000 more per pair)
o They are firmer
o Breasts that have been augmented with anatomic implants tend to be stiffer and move less well than those augmented with smooth round implants
o The access incision must be longer, resulting in a longer scar
o The recovery is longer, requiring avoidance of exercise for 4-6 weeks versus 2-4 weeks for smooth implants
o There is a greater chance of fluid formation around the implant, months or even years after surgery, requiring replacement
o If a patient wishes more fullness in the upper breast, a round implant is preferable
o Occasionally the anatomic implants will rotate when inside the patient, resulting in a deformed breast and requiring revision surgery
On the other hand, there are advantages such as more precise control of the shape of the breast after surgery and a lower rate of scar tissue contracture. The implants may also be more durable. The verdict is still out, but I believe that round smooth implants are still the gold standard when it comes to breast augmentation.
– There was an emphasis on preventing blood clots in the legs (deep venous thrombosis) that can travel to the lungs (pulmonary embolus) after surgery. The recommendation was made that every patient who undergoes surgery be evaluated for risk factors that predispose them to blood clots and that in high risk cases, a mild blood thinning agent be given for the week after surgery.
This comes as no surprise to me as our office has been doing this for years. Every patient who undergoes surgery has air powered compression stockings place on their calves prior to surgery and every patient ambulates the night of surgery. Certain patients are asked to discontinue oral hormones such as birth control pills or hormonal replacement medication before surgery.
– Liposuction, the most popular procedure in the U.S. in 2013, continues to be refined.
o SAFE ™ Liposuction, a technique developed by Dr. Simeon Wall of Louisiana, continues to produce excellent results. The word “SAFE” does not indicate that it is any safer than other forms of liposuction, but is an acronym standing for “Separation of fat – Aspiration – Fat Equalization.” It does employ traditional injections of local anesthetic before the liposuction, followed by pre-tunneling so as separate the fat with a basket-shaped suction tube known as a cannula. Not only is the area of proposed liposuction treated, but also the adjacent areas. This undermining of the surrounding skin allows for better skin contraction after surgery, an important element in obtaining an excellent result. Traditional fat aspiration (suction) is next performed, followed by a final step in which the basket-shaped cannula is used to equalize the fat in the zone of liposuction so as to avoid high and low areas.
Dr. Wall believes this last step leaves some fat that has been rearranged into a layer of newly formed fat grafts which help rejuvenate and tighten the skin because of the effect of the stem cells that are present in the fat. The results are excellent! More traditional liposuction, whether with laser, ultrasound, or power assisted devices, does not include the separation of fat or the fat equalization.
SAFE ™ Liposuction seems to be particularly useful in cases where there are areas of skin dimpling and irregularity from previous liposuction.
o “Fat – Freezing”, also known as Cryolipolysis, continues to attract attention. It’s a treatment that originated after researchers fully understood what happens when humans get frostbite: fat cells freeze before skin freezes. Cryolipolysis works like frostbite; it freezes fat, leaving the overlying skin intact. A section of your skin is inserted into a freezing device for about an hour, resulting in the disappearance of some fat cells over the next months. Are the results as good as liposuction? The short answer is yes, but to get comparable results, it takes careful treatment planning, a skilled practitioner and multiple treatment cycles. If you’re looking for a single procedure, choose liposuction. If you have the time and the money to undergo multiple treatments, look into “Fat – Freezing.”
For questions, please contact my office.
Comments are always welcome!
George Sanders, M.D.
