Archive for February, 2010
Tuesday, February 23rd, 2010
With the winter Olympic games ongoing in Vancouver, it gives one pause to ponder about more than the traditional meaning of this event. Every two years, the Olympics and the media exposure that surrounds it provides athletes, known and unknown, with the rare opportunity to showcase their skills and personality on an international stage. As an audience we are glued at night (and sometimes during the day thanks to Tivo) to watch athletes perform in ways that we only fantasized about in our youth. For some of these athletes, their accomplishments will be a springbroad to fame and riches thereafter.
The ancient Olympics were held in Olympic Greece over a span of nearly 1300 years beginning in the 8th century BC. Revived 1400 years later in 1894, Baron Pierre de Coubertin resumed the games in Athens. To adapt the games to the ‘new’ world, a variety of modern inventions since their rebirth have included the Winter Games for ice and snow sports, the Paralympic Games for physically disabled athletes, and the Youth Olympic Games for teenage athletes. To support all these activities, the games have long shifted away from pure amateurism to complete corporate commercialization. Over half of the Olympic coverage seen in Vancouver on NBC were commercials.
The vast majority of Olympic competitors are under the age of 35. As a result, most athletes have much, if not all, of their youthful appearance. Some have had some form of plastic surgery, however, to look better under all this media exposure. Few have owned up to it however. In this young age group, Botox, injectable fillers, rhinoplasty and ear surgery would be the likely plastic surgery procedures. For obvious reasons, liposuction and other body contouring procedures would be unlikely given their state of physical conditioning.
Olympic gold medalist and four-time Word tennis champion Lindsay Davenport has freely spoken about her experience with Juvederm injectable filler. The years of sun damage from playing tennis led her to seek non-surgical facial rejuvenation. Concerned about her ‘parentheses’ (laugh lines), she had those injected to restore volume and had Botox in her forehead and around her eyes to decrease wrinkles as well. Her experience was so positive that she has been a spokesperson for Juvederm’s educational campaign.
Olympic hurdler Jana Rawlinson from Australia has opted to have her breast implants removed in preparation for the 2012 Olympics in London. Such a cosmetic move may be the first in the world of competitive athletics. She felt they were slowing her hurdling down. Having breast implants, adding just 1% to one’s total weight and causing some minor adjustment in balance, may make the fraction of a second difference between winning and losing. Interestingly, she cited a patriotic duty to do the best that she could for her country over her own vanity for the removal decision.
While most recognize the Olympic symbol of the five interlocking rings, fewer know that there is an accompanying motto as well. The Olympic motto is “Citius, Altius, and Fortius” which in Latin means “Faster, Higher and Stronger”. Given the evolution of the Olympics today, perhaps the motto should include Richer and Better Looking as well.
Dr. Barry Eppley
Saturday, February 20th, 2010
Facelift surgery is one of the top five requested procedures in plastic surgery. Despite its popularity, it remains as the most misunderstood of the known plastic surgery operations. Almost everyone thinks that a facelift is a total makeover of the face, from the scalp down to the neck. In reality, it only treats the lower third of the face, the jowls and the neck. Therefore, it is a much less extensive operation to go through than one thinks, with a smaller than anticipated recovery as well. Facelifts are often combined with other facial procedures as well such as blepharoplasty and browlift.
In this edition of the Doc Chat radio show, Dr. Barry Eppley discusses many aspects of facelift surgery, demystifying the operation and providing insight into what it can and cannot do. In discussion of facelift surgery, Dr. Eppley interviews a husband and wife, both of whom had different facelift operations. The wife underwent a traditional full facelift, the husband underwent a direct necklift. Hear what they have to say about their experiences and the learn from actual patient experiences what facelift surgery is all about!
Dr. Barry Eppley discusses Facelift Surgery
Friday, February 19th, 2010
The recent surprise decision by Senator Evan Bayh to not seek re-election is likely a strong reflection of his desire to flee an unpopular ship as it is with his frustration with the ways of Washington. The recent questionable efforts to ramrod through a monster of major health care reform is certainly one factor that drove him closer to the edge of this decision. Perhaps Bayh knew that as the details of the health care bill began to see the light of day, great public disdain for all those that voted for it was sure to occur.
As a plastic surgeon, I was happy to see that the unsavory ‘Botax’(a 5% tax on all cosmetic procedures, surgery or otherwise) was cut from the final version of the Senate health care reform bill. The ‘Botax’ was eventually eliminated when it was quite rightly pointed out that it was not only a discriminatory tax on women but it was punishing those who sought self-improvement…the equivalent of taxing healthy behavior given the efforts of most patients to take good care of their investment in themselves.
As a replacement for taxing cosmetic surgery, the Senate desperately searched for ways to redistribute more of your money. They turned their focus to… indoor tanning of all things. Known as the ‘Tan Plan’, a 10% federal tax on indoor tanning was quietly included in the revised bill. Optimistically, it is expected to generate close to 3 billion dollars to help pay for the uninsured. Tanning is a more palatable target because it is a debatedly unhealthy behavior that in the very least, doesn’t improve your skin’s condition from the experience.
While I don’t want to be an endorser of any behavior that exposes people to more ultraviolet radiation and thereby increases their risk of developing skin cancer, this new federal tax is just as reprehensible as the Botax and may even be more discriminatory. Though the tanning industry and tanning advocates have put forth their concerns, I have yet to hear anyone mention the very biased nature of this tax. I am most definitely not a tanning expert, but I am certain that the vast majority of the population that patronizes tanning salons are light skinned individuals seeking to darken their natural skin tone. The number of non-Caucasian users of tanning salons must surely be very low, at best just a few percent of the total client base. The Tan Plan is really a racially-biased tax, likely unintentionally but true nonetheless.
What the Botax and the Tax Plan demonstrate is that it is virtually impossible to pick and chose what type of human behavior you want to tax (penalize), and not raise a lot of concerns. If you really want to generate a lot of tax revenue and maybe even change societal health behaviors in the process, there should be a Fat Food Tax. Taxing food purchases with a certain percentage of fat content and the industry that makes them would make these other tax proposals as insignificant as the antioxidants in a soda.
Must we really be deluged with food choices that have such high fat or sugar contents? They taste great and we all love them, but most are a nutritional desert and have led us to be one of the most overweight countries per capita in the world. Obesity and all of the problems that it causes is a far greater health problem that cancer, AIDS and many other medical diseases combined. Such a food tax would, however, cause such a societal clamor that the mere mention of it makes one reach for that bag of Doritos. Taxing personal lifestyle behaviors is risky and will never be a politically popular way to try and fund some levels of health care reform.
Dr. Barry Eppley
Friday, February 12th, 2010
As if Michael Jackson’s stunning death this past summer was not tragic enough, last week his personal physician was formally charged with manslaughter . Dr. Conrad Murray, a cardiologist who was with Jackson at the time of his death, is accused of medical behavior that led to his demise. Murray is claimed to have administered the sedative propofol to help Jackson sleep. Shortly thereafter Jackson was found unresponsive, and was declared dead after arriving at the hospital. These charges against Dr.Murray are sure to be the prelude to another sensational celebrity courtroom drama set to play out later this year.
Until this event occurred, most people had never heard of the drug propofol. Known as the ‘milk of amnesia’ amongst anesthesiologists, this white-colored liquid sedative has undoubtedly performed perfectly during millions of surgical procedures – certainly for many surgical patients who are reading this very column. Propofol is intended to be administered only by an anesthesia professional in a medical setting, because it depresses breathing and heart rate while lowering blood pressure. Propofol is absolutely not an insomnia medication . How then did the ‘milk of amnesia’ come to be in use at a private residence?
It’s my belief that the thing that killed Michael Jackson is the very same thing that led to his facial disfigurement from multiple plastic surgeries. The ‘fame’ monter and the opportunity to rub shoulders with a pop star is capable of making anyone, let alone a physician, cross the line between appropriate behavior and irresponsibility. Dr. Murray will ultimately pay a steep price for his short time as a celebrity’s physician but the deceased is not a guilt-free victim. A lifetime of privilege and asking for the ‘extraordinary’ created a pattern of behavior that ultimately proved fatal. It is one thing to demand the best room in the hotel or to make special accommodations for your private plane at the airport…but pushing the envelope in medical treatments can have different consequences.
Ultimately, the doctor should have used better judgment. The use of propofol at home can not be defended at any level. We are certain to hear in court testimony, however, a fantastic story that will justify his actions. It probably will be as equally convincing as the glove that did not fit O.J.’s hand.
Even in a small, Midwestern practice, our best judgment as physicians is tested. When a friend or family member asks for a Vicodin prescription for a ‘bad back’, or a patient expects us to write off her co-payment, or when a local celebrity asks for pain medication that is waaaaaay more than what is necessary for a simple elective surgery, we’re expected to uphold our professional standards and do the right thing. We’re supposed to say no. Because when you don’t refuse, and when you do write that ‘questionable’ prescription because you feel obligated, you’ve opened the door to further indescretions. And before you know it, you’re saying ‘yes’ more often than not, and over time you allow the patient to dictate the course of treatment. And sooner or later you wind up like Dr. Murray.
Dr. Barry Eppley
Tuesday, February 9th, 2010
One of the first signs of aging is what happens around one’s eyes. We are so expressive with our eyes and forehead that they bear the brunt of much of the early and visible signs of the aging process. How many times has someone said to you…are you tired?…have you been working late?…when in fact you just had eight hours of sleep. The development of extra eyelid skin, lower eye bags, and wrinkles around the eyes can be telling.
This makes the blepharoplasty (eyelid tucks) a vital plastic surgery procedure in making one look more refreshed. Many patients fear, however, that such an eyelid procedure will change their appearance rather than just making it more youthful or rejuvenated. This fear is promoted by just looking at today’s over-operated celebrities who have had too much surgery, or overly aggressive surgery, and look very unnatural. Such changes do make one look different, but not better.
Modern blepharoplasty surgery avoid these problems using a more conservative approach based on a better understanding of how the eyelid and face changes with age. Greater emphasis is placed on not disturbing the eyelid’s complex system of support and removing just the right amount of extra skin. This leads to a more natural looking result that does not alter one’s appearance.Baggy upper and puffy lower lids can now be treated with less tissue disruption and scarring for a safer and more natural long-term result. The goal is to look like yourself…just better!
When considering an upper eyelid procedure, the position of the eyebrow must be considered. A low hanging eyebrow can make it look like there is more skin in the upper eyelid than really exists. A browlift procedure is occasionally done with a blepharoplasty when it is determined that a higher brow is aesthetically beneficial. How do you know if your eyebrow is too low? That would depend on where one’s brow was when they were young. I would submit that most people do not remember where it was in their younger days. You simply have to play with it in the mirror to decide if higher is better.
Browlifts are primarily a procedure for women, they are rarely done in men. When browlifts are done, emphasis should be on more lateral brow elevation and less inner brow elevation. A woman’s eyebrow usually has an upward and outward sweep to it towards one’s temple area. Bringing up the inner part of the eye brow is what creates an unnatural overelevated look.
Today’s in-office ‘needle’ treatments can also provide some around the eye area improvement. Botox (and Dysport), not injectable fillers, is what is used. It is a great treatment for reducing the frowning look between the eyebrows, horizontal forehead lines, and crow’s feet wrinkles at the side of the eyes which can be particularly evident when one smiles. As an early treatment before significant eye aging changes occur or as a complement after blepharoplasty surgery, Botox is a simple and cost-effective non-surgical treatment.
One no longer has to be told that they look tired or are seeing their eyeball slowly disappear in a sea of loose and hanging eyelid skin. Between the three Bs (blepharoplasty, browlift and Botox), a more rested and refreshed you awaits!
Dr. Barry Eppley
Friday, February 5th, 2010
The trail of plastic surgery devotees in Hollywood is growing faster than sequels to the movie Saw. From aging musicians and film makers to young actresses on the rise, Tinseltown is awash with everyone getting nips and tucks. While an occasional tweak or two may be the norm, some ‘ stars’ are becoming more mannequin than human in their quest to turn back the hands of time.
Most recently, Heidi Montag of ‘The Hills’ fame, underwent a second round of extensive plastic surgery procedures. The 23-year-old reality TV star, who had a rhinoplasty and breast augmentation in 2007, confessed to having ten plastic surgery procedures in one day according to People magazine. By her own admission, she admits to being addicted to plastic surgery. In her quest to be “the best of me”, she had liposuction on her neck, waist, hips, and thighs, a buttocks augmentation, revision of a prior breast augmentation, an ear pinning, a “mini” brow lift, chin reduction, Botox in her forehead as well as fat injections in her cheeks and around her mouth.
Ms. Montag represents the ‘extreme’ plastic surgery patient. Low self-esteem, combined with easy access and large amounts of disposable income and an insatiable need for attention, can create this perfect storm with the end result what we now see on the cover of People magazine.
Heidi Montag’s situation is definitely the exception. But real addiction can and does occur outside of reality TV and mainly affects those that suffer from Body Dysmorphic Disorder. (BDD) In this condition, there is a never-ending unhappiness with changes that keeps the person affected with it coming back for more. Most repeat plastic surgery patients, however, are not ill and are motivated by what I call ‘accomplishment feedback’, a normal psychological response that creates a desire for further benefits after a previous positive experience. Every retail business thrives to create that outcome. That is a far cry from a BDD illness or a ‘plastic surgery addiction’. The sheer reality of economics prevents most people from ever crossing the line into either of these behaviors.
Ms. Montag’s plastic surgeon has also been the target of criticism. When should plastic surgeons tell patients no? How much is ‘enough’? While many people are appalled by what Heidi Montag did and felt she did more than she should have been ‘allowed’, the answer is not so straightforward. Should McDonald’s be selling those 80 grams of fat in a burger and fries meal to anyone overweight or should home mortgages or debt consolidation services be tendered to people whose finances knowingly don’t support them?
Elective plastic surgery is medicine mixed with a good dose of business and marketing. While the safety of the patient is the number one limiting factor to the number of procedures that should be performed at a given time, it’s impossible to remove the component of ‘personal responsibility’ from the equation. Defining what is reasonable for someone to want is akin to you telling me what I should like. While beauty may be in the eye of the beholder…what is needed to get there is most certainly in the mind of the beholden.
Dr. Barry Eppley
Monday, February 1st, 2010
Liposuction remains one of the most popular and successful of all cosmetic plastic surgery procedures. Patients considering the procedure have many typical question about it and here are the most common.
How much weight should I lose before having liposuction?
Ideally, liposuction is best used as a ‘spot’ treatment for resistant areas of fat. This would imply that one should be near to what they consider to be their ideal body weight. On a more practical basis, one’s weight should be down to what can be achieved with a reasonable effort.
The ‘weight loss before liposuction’ approach is best for two reasons. First, the amount of liposuction needed will be less…and less surgery of any kind is always better than more. Secondly and most importantly, the losing weight process allows one to have made lifestyle changes before surgery. The effort to do so and the induced lifestyle changes provide for a better chance that the liposuction results will be longer lasting.
What type of liposuction is the best?
There are numerous liposuction devices currently available such as ultrasonic, laser (hot), and water jet (cool)devices. With these methods comes the associated marketing and hype that is associated with the manufacturers as well as endorsements by surgeons. In addition, because some of these devices are new, they are promoted as the latest and the greatest.
What all these liposuction technologies share is that they are used for the first phase of the surgical process…loosening up the fat…which is then suctioned out as the second phase. Whether anyone of these methods is better than another can be debated but no one can conclusively prove that one is better than another. The reason is that the technology is only as effective as the surgeon who is using it.
The current use of Snartlipo (laser-assisted liposuction) has a three or four year history of widespread clinical use. While just a promising tool a few years ago, today’s units have higher powers, temperature monitoring, and multiple wavelengths. The very sensitive nature of fat cells to heat makes this technology very appealing and effective.
Are liposuction results permanent?
One of the common myths is that once fat is removed, it can not come back. As patients often say, ‘I have heard that once fat cells are removed, they can not return.’
This perception is false for two reasons. First, not all fat cells are removed from any area that is suctioned. That is not only impossible but unaesthetically undesireable. There needs to be a certain layer of fat between the skin and the muscles so the skin is not stuck down and tethered. Secondly, stem cells exist in fat which always have the potential to turn into fat cells if properly stimulated. Excess food intake and the need for fat storage is just the stimulus for fat re-accumulation.
The best answer is that the long-term results from liposuction are stable if your weight remains fairly stable. If you gain weight of any significance (greater than five pounds), it has to go somewhere and that will likely be from whence it was originally removed.
How much time should I allow for recovery before going on vacation or a trip?
It is quite common that I see patients who have a trip or vacation planned and want to do some body shaping before they go. The biggest mistake is to not give enough time for a ‘full recovery’. You don’t want to go on a well planned and long thought out trip only to still be sore or limited in what you can do and enjoy. Depending on the number of body areas and amount of liposuction, I would allow for at least six to eight weeks (as a minimum) before leaving. Three months is most ideal.
There are also some patients who want to use a trip to recover and their intent is to go and lay around somewhere. In this case, I would recommend one week before you leave.
Dr. Barry Eppley
Monday, February 1st, 2010
In running across a copy of Nora Ephram’s best selling book by the same title, I could not help but think how many times I have heard this very phrase from patients. While we are long past Thanksgiving, some may still be thinking of turkey in a different light…that of their ‘turkey neck’.
Many people want to improve the appearance of their neck without having to resort to a facelift. Getting rid of a neck wattle would return them to a younger look and be able to wear ties, turtlenecks or jewelry more comfortably. The fear of a facelift is a near universal one. Whether one feels that they are too young or too old for surgery, do not have time for any significant recovery or cannot afford it, many potential patients are drawn to any procedure or method that offers an alternative.
Some fuller necks or neck wattles may benefit from targeted treatment just to the neck. Such neck rejuvenation, known as submentoplasty, only works on the neck removing fat and tightening muscles. No incisions are around the ears are needed unlike traditional facelift surgery.
As we age, definition and smoothness under the chin and along the jaw line is lost. This occurs due to fatty deposits, weakening muscles and the appearance of loose skin. This results in the obliteration of a sharp neck angle, where the neck and chin meet. Often this just becomes a straight line angling obliquely down from the chin to the lower neck.
Neck skin is different from the rest of facial skin. It generally has much more elasticity and can actually contract or shrink upward after being released from the underlying muscle and fat. Given that the neck skin lies on the underside of the chin, many would think that it would fall downward and hang more after being released. But this does not generally occur unless one’s neck skin is paper thin.
The submentoplasty procedure is done through an incision under the chin. First, fat removal in the neck is done with liposuction. This is followed by midline platysmal tightening and wide freeing of the neck skin from the muscle. Whether liposuction alone or the complete submentoplasty procedure is needed will depending on the age of the patient and the quality and amount of loose neck skin that is present.
Younger patients (less than age 35), who generally have more skin elasticity and have a skin wattle because of too much fat underneath the skin, usually just need liposuction only. Middle-aged patients (ages 35 to 55) have fat deposits also but in addition have a loose or split plastysmal neck muscle and skin. This requires the full submentoplasty method of treatment. Older patients (age 55 and over) almost always need extensive neck recontouring and a facelift is needed where loose skin is actually removed.
In my Indianapolis plastic surgery experience, I have found that adequate neck rejuvenation for many patients requires some version of a facelift. But age is a key factor in determining the suitability of a submentoplasty. In patients under age forty-five, about half of them can get good results with a submentoplasty and avoid a facelift. Over the age of forty-five, however, that number drops to less than one in ten. And over the age of fifty-five that numbers drops to essentially zero.
While submentoplasties are a primary treatment for certain neck issues, it can also be used as a secondary tuck-up after a facelift. Some facelifts, particularly with really saggy necks, will often get some rebound relaxation in the submental region which is furtherest from the point of skin pull way back at the ears. A submentoplasty allows further neck refinement when the results of the facelift begin to relax.
Dr. Barry Eppley
Monday, February 1st, 2010
China has long been credited for the term ‘saving face’. In Eastern cultures, in particular, preserving one’s dignity is paramount and an extremely important part of everyday life and business conduct. Chinese politicians are, however, putting a new spin on this age-old phrase.
There is a reported surge of government officials having various forms of plastic surgery of the face. It is credited to the fact that such officials have to appear more regularly in public, including television, and they want to make sure their face appears strong and attractive. An appearance which indicates confidence and leadership. The most common procedures being done are blepharoplasty, injectable treatments like Botox, and facial reshaping.
Despite being a communist country, the Chinese people have turned plastic surgery into a multibillion dollar-a-year industry which is growing briskly. While this may be interesting to you, you may be asking what does any of this have to do with the price of tea in China?
The similarity between the United States and China, like most every other country in the world, is that one’s appearance counts albeit for selecting a mate or getting a job…and getting ahead in that job. The importance of one’s physical appearance for career promotion and advancement is certainly influenced by the type of job one has. Fashion models are expected to be lean attractive and weight appropriate.. Professional athletes are expected to be muscular and fit. Business executives should be well groomed and coiffed.
But even in jobs where one’s appearance doesn’t seem to be essential, it still is. Attractive and well groomed will usually make more money and be promoted more often than those who are not. It is well known that taller businessmen have a better chance to get a job and be promoted than those who are more height challenged. The same applies to weight. Is this fair? Of course not. But as the contemporary saying goes…it is what it is.
In Gordon Patzer’s very insightful book, Looks: Why They Matter More Than You Ever Imagined (2008), this bias in favor of attractiveness is called ‘lookism’. In the book, he discusses and reviews the evidence between physical attractiveness and body type and vocational success. Patzer claims that the influence of looks go way beyond the workplace, including school and home. While looks aren’t exclusively the key to success and status, they are far more important than most people suspect or want to believe.
The recent and ongoing recession of the past few years has seen a dearth of new patient interested in improving their appearance for work purposes (or so they say) and they are often quite upfront about it. They openly admit they fear job competition and displacement from younger, less experienced candidates. Professionals today want to project an image of good health and success, and good looks are one important part of that package.
Wanting to be attractive, or even more so (just ask any model) is universal. Most people, however, want to look and feel better…not morph into another person. Today’s extreme plastic surgery examples are outside of the bell curve and do not represent the norm. Contemporary plastic surgery offers a lot of smaller and more ‘lifestyle-oriented’ procedures that really can help one ‘save face’. From Botox to little ‘nips and tucks’ here and there, much can be done to keep one looking fresh and vibrant…and maybe just a tad more attractive too.
Dr. Barry Eppley