According to the latest estimates, up to 400,000 women in at least 65 countries have had Poly Implant Prothese silicone breast implants placed.

Months ago, it was revealed that the PIP silicone implants were made with non-medical-grade silicone. This has resulted in a range of potential problems, including an increased risk of rupture or leakage, inflammation to surrounding breast tissue once the implant tears, and the possibility that the silicone gel could increase the risk of cancer.

Most American women who have breast implants can breathe a collective sigh of relief. PIP silicone breast implants were never approved for use in the United States.

American women that went abroad for breast augmentation surgery and had silicone breast implants placed should research whether PIP implants were used. PIP silicone breast implants were distributed mostly to countries in Western Europe and Latin America.

If you traveled overseas for breast implant surgery, it is in your best interest to contact the surgeon that performed your operation to find out what type of implant was used. If you find that PIP silicone implants were placed, you should seriously consider having your implants replaced.

The French government has recommended that women with PIP silicone implants have them replaced; the government has pledged to cover the costs of revision surgery for French women.

The British and Brazilian governments have advised patients to meet with their surgeons to determine the best course of action.

It is interesting to note that PIP’s saline implants were used here in the United States in the 1990s. However, when the FDA raised its standards for breast implant products, PIP’s application was denied FDA approval. The FDA reported 11 breaches from standard ‘good manufacturing practices’ at PIP manufacturing plant in southern France.

If you have had faulty PIP silicone breast implants placed and would like to have them removed, contact our practice to schedule a personal consultation with Dr. Deuber.

BELOTERO Balance®

BELOTERO Balance® is a dermal filler that contains the popular wrinkle busting ingredient hyaluronic acid. The product is manufactured by Merz Aesthetics and was approved to treat moderate and severe facial wrinkling by the FDA on November 14, 2011. In a study of 118 patients, BELOTERO Balance® was used to treat facial wrinkles on one side of the face, while bovine collagen was used on the other side of the face. According to the results of the study, BELOTERO Balance® resulted in less facial wrinkling, for a longer of a period of time when compared to collagen.

Restylane® Injections for Lip Enhancement

On October 11, 2011, the FDA approved Restylane® Injectable Gel for use in injectable lip augmentation treatments for patients that are 21 years of age or older. Restylane®, made by Medicis, is a hyaluronic acid-based filler that temporarily adds fullness to the lips. It was previously approved for the treatment of nasolabial folds, the vertical facial creases that develop on both sides of the mouth. Plastic surgeons and dermatologists have been safely and successfully using Restylane® off-label in lip augmentation procedures for years. Now that the FDA has officially expanded its uses, patients can feel more comfortable when undergoing treatment.

LIPOSONIX®

The LIPOSONIX® system is designed to reduce the size of the waist and destroy belly fat. The FDA cleared the device for sale in the United States on September 8, 2011. Manufactured by Medicis, the device uses ultrasound technology to contour the body. The system is directed at the area of fat, and then the highly focused ultrasound waves target fat through the skin. In a controlled study using the LIPOSONIX® system, patients experienced, on average, a 1-inch reduction in the size of their waists.

Xeomin®

On July 21, 2011, Merz Aesthetics announced that the FDA approved Xeomin® for the treatment of moderate to severe glabellar lines. The primary active ingredient in Xeomin®, botulinum toxin, temporarily relaxes the muscles that cause frown lines. Xeomin® is similar to products like BOTOX® Cosmetic and Dysport®; what sets Xeomin® apart is that the product does not have to be refrigerated prior to use.

LaViv®

LaViv® was approved by the FDA on June 21, 2011. The injectable treatment utilizes the patient’s own cells, or fibroblasts, which are processed and then re-injected into facial wrinkles. The advantage of the treatment is that patients consider it to be a natural treatment; the downside is that several treatments are needed to achieve desired results.

The risk of developing certain complications after breast reduction surgery, including infection and wound-healing problems, are higher in women that are over the age of 50, according to the results of a recent study.

Researchers at The John Hopkins Medical Institutions conducted a study of 1,192 women that had breast reduction surgery during a 10-year period, from 1999 to 2009. The team evaluated the rates and types of complications that occurred in three age groups: under 40, 40 to 50, and over 50.

The results of the study, which will be published in the journal Plastic and Reconstructive Surgery in December, found that women in the over 50 age group had higher rates of infection. Women in the over 50 age group had an infection rate that was 2.7 times higher than the rate for women in the under 40 age group.

Women in the over 50 age group also had a higher rate of wound-healing problems; wound-healing problems could result in the need for additional surgery to remove areas of dead skin.

The study found that women over the age of 50 experience a higher rate of post-surgical complications. According the Dr. Michele A. Shermak and colleagues, the authors of the study, the increased rate could be associated with age-related hormonal changes.  Hormone levels in women typically begin to decline when women are in their 40s.

It is interesting to note that complication rates were lower in women undergoing hormone replacement therapy and higher in women that may have hormonal deficiency (due to a history of hysterectomy and/or oophorectomy). This suggests that hormonal deficiency, not age, is linked to post-surgical breast reduction complications.

Past studies have identified other risk factors for complications after breast reduction surgery. Cigarette smoking, obesity, and extensive breast reduction are also associated with problems after breast reduction surgery.

Are you thinking about getting liposuction? Check out these commonly asked patient questions to learn more about the procedure.

Does Liposuction Cause Cellulite?

Although liposuction does not cause cellulite, its appearance may become more prominent after liposuction. Additionally, if fat removal is uneven, it could result in a cellulite-looking appearance. The best way to avoid skin dimpling after liposuction is to choose a qualified plastic surgeon to perform your procedure. If you have a genetic predisposition to cellulite, you may want to consider undergoing non-invasive skin tightening treatment after surgery to minimize the appearance of cellulite.

How Much Weight Can I Lose After Liposuction?

Liposuction should not be used as your primary weight loss method. As a matter of fact, you should only undergo liposuction if you are at or near your target weight. That being said, liposuction does remove fat from the body and patients will lose some weight after surgery. On average, patients lose about five pounds after liposuction surgery, though in extreme cases patients can lose as much as 10 pounds of fat.

Will I Have Loose Skin After Liposuction?

When patients lose weight, the skin tends to become a little looser. This is because the skin has stretched and does not contract down to its previous size. Skin elasticity is generally better in patients that are younger and in good shape. If you are affected by loose skin after liposuction, you may want to consider undergoing laser skin tightening therapy or tummy tuck surgery.

If I Don’t Wear a Compression Garment after Surgery, Will it Ruin My Results?

If you do not wear a compression garment, it won’t necessarily “ruin” your aesthetic outcome, but it may result in increased, uneven swelling. It can also help the skin contract. It is important that patients follow their plastic surgeon’s instructions regarding compression garments; the amount of time that you wear the garment is related to your personal surgical plan.

Should I Get Liposuction If I Plan On Getting Pregnant in the Future?

Patients can undergo liposuction to get rid of excess fat in problem areas before they get pregnant. As long as patients exercise routinely and consume a healthy diet, they should be able to keep the extra fat off. In some cases, patients that undergo liposuction surgery before getting pregnant have an easier time losing their pregnancy weight because they have already lost their excess weight and are in good shape prior to getting pregnant.

A study conducted by researchers at Johns Hopkins University School of Medicine found that obese women who undergo breast surgery procedures such as breast reduction and breast reconstruction are more likely to develop complications after surgery.

“Obesity is associated with a nearly twelve-fold increased odds of a post-operative complication after elective breast procedures,” Dr. Catherine Lee Chen, one of the researchers of the study, said in a statement.

The research team reviewed the insurance claims of about 8,000 women that had breast reduction and breast reconstruction over a four-year period from 2002 to 2006. It was determined that about 30 percent of the patients that underwent these elective plastic surgery were obese. The researchers then compared the two groups, including the rates and types of complications that developed in the obese and non-obese groups, and concluded that the obese group developed a significantly higher rate of post-surgical complications.

According to the results of the study, 18 percent of obese women submitted an insurance claim related to a surgical complication, while just 2 percent of women in the non-obese group filed such claims.

Upon accounting for other factors, obese women were 11.8 times more likely to develop some type of complication after breast surgery. The common complications that affect the obese women include inflammation, infection, pain, seroma, or hematoma.

The results of the study are published in the November issue of Plastic and Reconstructive Surgery. Chen and her colleagues at Johns Hopkins University School of Medicine are urging plastic surgeons to account for obesity when determining if a patient is a good candidate for plastic surgery.

The American Society of Plastic Surgeons also released a news advisory stating that obese women face a much higher risk of developing complications after elective breast surgery.

If you are thinking about undergoing a plastic surgery procedure such as breast reduction or breast reconstruction, contact our practice today. Dr. Deuber will review your medical history and determine if surgery is right for you.

Breast augmentation surgery is considered to be an extremely safe procedure, as evidenced by the fact that it has been successfully performed on millions of women here in the United States. The patients that experience the best results typically do some research prior to undergoing treatment; patients that educate themselves about the implant and surgical options that are available typically achieve an improved post-surgical outcome. More importantly, most happy breast augmentation patients have put some serious thought into the plastic surgeon that they choose to perform their procedures. Choosing a skilled surgeon can greatly decrease patients’ chances of developing unwanted aesthetic complications after breast augmentation surgery.

Here are some of the cosmetic problems that can occur as a result of breast enlargement surgery:

Asymmetry: Most women suffer from some amount of asymmetry before undergoing breast enlargement surgery. A good surgeon will make every effort to make the breasts look as symmetrical. However, if your breasts are significantly different in size and shape after surgery, you make require a revision operation to correct the problem.

Bottoming Out: During breast augmentation, a pocket is made for the breast implant. Surgeons must take care to create a pocket that is ideally positioned and will perfectly accommodate the implant. If the pocket is too low or too big, or the inframammary fold has been released too much, the implants will ride low.

Implants Ride Too High: Some patients find that their implants seem too high and do not drop in the months following surgery. This may be the result of a problematic pocket design, insufficient muscle release, or poor healing.

Synmastia: Synmastia is the condition in which the breasts are too close together after surgery, resulting in a uni-boob appearance. This unwanted complication could be caused by the use of implants that are too wide for the patient’s frame, tearing of the muscles, surgical error, and the patient’s anatomy.

Gap Between the Breasts: If the breast implants are placed too laterally, the breasts feel as though they are under the arms and leave a gap where cleavage can be. This condition can be caused by a range of factors, including use of implants that are too narrow for the patients’ frame, too much lateral dissection during surgery, or breast muscles that are pushing the implants to the side.

Double Bubble: The double bubble refers to implants that have dropped below the inframammary fold, while the natural breast tissue remains above the fold. This results in a double breast effect in which the patient appears to have four breasts. This can be corrected with breast implant revision and lift surgery.

Capsular Contracture: Capsular contracture refers to the development of scar tissue around a breast implant. As time goes by, the scar tissue begins to squeeze the implant, distorting its shape and making the breast feel hard to the touch.

Rippling: Breast implant rippling can result when the implant is not filled to ideal capacity. The implant shell begins to ripple, and in severe cases, the rippling can be seen and felt on the breast.

A recent study suggests that liposuction surgery may be good for the heart; according to a study conducted by the American Society of Plastic Surgeons, three months after undergoing the procedure, liposuction patients’ triglyceride levels decreased by an average of 43 percent. This is twice the reduction that is experienced in patients taking cholesterol-lowering medication.

Triglycerides are a type of fat that is found in the blood, and high triglyceride levels are linked to an increased risk of cardiovascular disease.

The researchers also found that patients’ white blood cell counts also went down by an average of 11 percent. High white blood cell count is an indication of inflammation, which is believed to be associated with the development of coronary heart disease, high blood pressure and diabetes.

The Study

The study was presented at the annual ASPS meeting in Denver at the end of the September. According to lead researcher Dr. Eric Swanson, a plastic surgeon based in Kansas, the study included:

• A total of 332 liposuction patients, 270 women and 52 men
• 78 percent of the patients ranged from normal to overweight
• 22 percent of the patients were obese

The patients were required to undergo fasting blood tests prior to surgery, one month after surgery, and three months after surgery. Patients had an average triglyceride level of 151.8 milligrams per deciliter (mg/dL) prior to surgery; it dropped to 112.8 mg/dL three months after surgery.

Dr. Swanson says that the results of his study should prompt additional research into determining which types of body fat are most harmful.

“For years, it has been assumed that visceral fat surrounding the internal organs has greater metabolic importance and is more directly linked to cardiovascular disease and diabetes risk than ‘subcutaneous fat’ that lies under the skin,” Swanson said. “These new findings support recent studies suggesting subcutaneous fat, which can be reduced by liposuction, is just as metabolically important.”

Further studies will be needed to see if the reduced triglyceride levels will last in liposuction patients.

Here in the United States, we have been observing National Breast Cancer Awareness month each October for the past 25 years. In support of the cause, many organizations seek to increase public knowledge of the disease in hopes of lowering breast cancer rates and finding a cure. At the plastic surgery practice of Mark Deuber, MD, we want to make sure that our patients are proactive about their health so that if they do develop breast cancer, it is caught in its earlier stages.

According to the American Cancer Society, about 230,000 women will be diagnosed with breast cancer and about 40,000 women will die from breast cancer in 2011. If all women undergo breast cancer testing such as clinical breast exams and mammograms on a regular basis, breast cancer fatality rates could drop off dramatically.

Breast Self-Exams

At one time, monthly breast self-exams were considered an effective screening tool for breast cancer. In the 2000s, several studies were published, showing that breast self-exams do not decrease breast cancer survival rates, but do increase the risk of undergoing biopsies for benign lumps. In response, most medical organizations revised their recommendation that women perform monthly breast self-exams. Instead, they advise women to be aware of the natural consistency of the breasts and underlying tissue; if patients notice changes in the breasts, they should report them to their doctors.

Clinical Breast Exams

Physicians perform clinical breast exams to check for lumps and other breast problems in women. These clinical breast exams are performed in combination with the pap test, which should be done every one to two years. If your doctor detects changes or abnormalities of your breasts, he or she may order additional tests such as a mammogram or biopsy.

Mammograms

According to the guidelines set forth by the National Cancer Institute, women should undergo mammograms every one to two years after they reach the age of 40. Those that are at an increased risk of developing breast cancer (due to family history of the disease, breast density, or other factors) may need to undergo mammograms at an earlier age or more frequently.

For more information on breast cancer prevention, contact your primary care physician.

An FDA hearing on the safety and effectiveness of silicone breast implants was held this week; although the FDA decided to keep silicone gel implants on the market, agency officials stated that the manufacturers of these products did not sufficiently track thousands of women who received silicone implants. 

As a condition of the FDA’s approval of silicone gel implants in November of 2006, the two manufacturers of these products, Mentor and Allergan, were required to conduct large, 10-year post-market studies on the safety and effectiveness of their silicone implant products.

During this week’s hearing, both companies admitted that they failed to follow up with a significant number of women. Mentor’s study included 40,000 women when it started; within three years, the company was following up with just 21 percent of participants. Allergan was a little more successful in tracking patients; two years after the study started, the company was following up with 60 percent of the 39,300 women enrolled in their study.

Consumer advocate Diana Zuckerman, president of the National Research Center for Women and Families, testified at the FDA hearing, saying that Mentor and Allergan did a poor job of collecting the data that was required of both companies.

“This is one of the most visible, controversial medical devices, and they can’t even get the data right,” Zuckerman said. “Without proper data, we still don’t know how safe or effective they are and whether there are certain patients at risk for extremely negative outcomes.”

Christopher Allman, a spokesperson for Mentor, says that the company encouraged patient participation in the studies.

“At Mentor’s request, letters from FDA were sent to physicians and patients to encourage follow-up and state the importance of follow-up; unfortunately, there was minimal impact with respect to the follow-up rate,” Allman said.

Despite the poor patient follow up, the FDA maintains that silicone gel implants are safe and will remain on the market.

“We felt that way before the meeting, and we continue to feel that way after the presentations and discussions over the past two days,” Dr. William Maisel, chief scientist for the FDA’s Center for Devices, said.

FDA officials said that the agency would work with breast implant manufacturers and consumer groups to improve patient participation in studies.

The JUVÉDERM® filler gel contains hyaluronic acid, a hydrating substance that is naturally found in the body and can add volume to facial wrinkles. Unlike other dermal fillers that contain hyaluronic acid, JUVÉDERM® is made using the specialized HYLACROSS™ technology; this means that the product has a higher concentration of hyaluronic acid so that results last longer in patients. JUVÉDERM® also contains lidocaine, a light anesthetic that helps our patients feel more comfortable during treatment. Contact the practice of Mark Deuber, MD, in Dallas to schedule your JUVÉDERM® appointment.

JUVEDERM® Uses

JUVÉDERM® is FDA approved to treat the wrinkles and deep folds that affect the lower half of the face, including:

• “Smoker’s” lines: These fine, vertical wrinkles run along the upper lip and can affect anyone, not just smokers.
• Marionette lines: These folds resemble parenthesis, and affect the corners of the mouth.
• Smile lines: Like marionette lines, smile lines look like parenthesis, but lie higher on the face, along the sides of the nose.

JUVÉDERM® can be injected into vertical, marionette, and smile lines to reduce or eliminate their appearance for up to one year. Our Dallas JUVÉDERM® patients that have facial wrinkling in the upper half of the face, such as around the eyes or on the forehead, can also undergo BOTOX® injections at our practice.

JUVEDERM® Side Effects and Risks

Non-surgical aesthetic procedures such as JUVÉDERM® injections come with far fewer risks and side effects than plastic surgery procedures. However, soft tissue filler injections can present some problems. The side effects associated with JUVÉDERM® include:

• Redness
• Discoloration
• Pain
• Firmness
• Swelling
• Lumpy appearance
• Itchiness
• Bruising

These side effects typically dissipate within one week. More serious complications that can result from JUVÉDERM® injections include:

• Infection
• Allergic reaction

Dallas JUVÉDERM® Injections

Our Dallas JUVÉDERM® patients have achieved excellent results with use of the product. Contact our practice today to find out if you are a good candidate for treatment.