Search for the Best Hyaluronic Acid Filler

The October issue of the official medical journal of the American Society of Plastic Surgeons (ASPS) reports a new and validated method for providing standard cohesivity ratings for hyaluronic acid dermal fillers.

The search for the best hyaluronic filler comes after the surge of interest in the use of dermal fillers to enhance shallow contours, soften facial creases and wrinkles and improve the appearance of recessed scars.

Dermal fillers can be very helpful in those with early signs of aging, or as a value-added part of facial rejuvenation surgery. These fillers are often injected in medspas or a surgeon's office and are predictable, with relatively minimal risks and side effects.

In 2014, ASPS data revealed that around 2.3 million dermal filler injections were done. Statistics from the Cosmetic Surgery National Data Bank and other market research show that dermal filler market in the United States is valued at a whooping $1 billion.

Hyaluronic acid dermal fillers are natural, gel-based products which are highly compatible with the body, making them the most commonly used dermal filler in the industry. Plastic surgeons are now looking for evidences that will aid them in selecting the product that will give the best result for their patients.

Though there is a wide range of available products, there still exists a lack of scientific data to support the rheologic or the flow-related properties of the available dermal fillers in the market.

Dr. Hema Sundaram, a dermatologist in Rockville, MD, Samuel Gavard Molliard, a scientist in Geneva, Switzerland, and colleagues used the ratings of cohesivity and other biophysical properties to identify the dermal filler that is suited to each procedure being done.

The biophysical characteristics of hyaluronic acid gel fillers reflect individual manufacturing processes. They confer rheologic properties that provide scientific rationale with Evidence Level II clinical correlation for selection of appropriate fillers for specific clinical applications.

Cohesivity measures the capacity of a material to "stick together" and not dissociate. It is a key property that maintains gel integrity, contributes to tissue support with natural contours, and diminishes surface irregularities.

Researchers point out that products with higher cohesivity scores are not always the best. The ranking system aims to ‘provide a scientific rationale for the intuitive selection of different products for specific clinical objectives.’

According to Dr. Sundaram and colleagues, fillers with higher cohesivity may be better used for more superficial placement, or placement in mobile areas such as around the mouth or eyes while products with lower cohesivity may be effective for use as ‘deep volumizers’.

The researchers developed a standard test for comparing the cohesivity of hyaluronic acid dermal fillers. Samples of each filler gel were dyed, then squeezed into water and stirred using automated technology.

A panel of plastic surgeon and dermatologist specialists experienced in using HA fillers then rated each sample’s cohesivity on an original five-point scale, known as the Gavard-Sundaram scale.

Cohesivity scores of the FDA-approved fillers varied across the full range of the scale: from ‘fully dispersed’ to ‘fully cohesive’. Cohesivity was rated high for one product, medium to high for three, low to medium for one, and low for one.

Aside from the data on cohesivity, researchers believe that comparative data on other rheologic properties (such as elasticity and viscosity) can make dermal filler procedures more sophisticated and successful.

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Results of the study "Cohesivity of Hyaluronic Acid Fillers: Development and Clinical Implications of a Novel Assay, Pilot Validation with a Five-Point Grading Scale, and Evaluation of Six U.S. Food and Drug Administration–Approved Fillers" may be read on: http://journals.lww.com/plasreconsurg/Fulltext/2015/10000/Cohesivity_of_Hyaluronic_Acid_Fillers__.11.aspx

Domino Effect of Weight Loss Aesthetic Surgeries

New data released by the American Society of Plastic Surgeons (ASPS) revealed that US weight loss surgeries have spurred the number other procedures such as tummy tucks, breast lifts and upper arm lifts over the last four years.

In 2013, 179,000 Americans underwent weight loss surgery, averaging nearly 500 procedures every day. Reports from the American Society of Metabolic and Bariatric Surgery reveal that it's the most since 2009 and the third highest number on record. From then on, there has also been an across the board increase of plastic surgeries related to weight loss.

ASPS President Scot Glasberg, MD thinks that there is a correlation between the two types of procedures and this trend is expected to continue. According to him, post-massive weight loss patients are the number one growth area that he has seen in his practice, and he is also sure that's the case in many doctor's offices across the country.

"You can't attribute that to anything other than the fact that there are more massive weight loss patients out there looking to take care of the problems that they now have after their weight loss surgery. On the one hand they are thrilled to have lost so much weight, but they are trading one dilemma for another."

"Going forward, we'd like to be a part of the process from the outset, when patients are first starting to consider weight loss surgery. A lot of times patients think weight loss surgery is the answer to their issues, when in reality it may only be one step in the process."

Those who experience massive weight loss are often left with excessive amounts of sagging skin, particularly in the thighs, under the arms, around the abdomen and in the breasts. The excess skin can not only be unsightly and uncomfortable, in many cases it can be painful. with these, previously obese patients opt to have a plastic surgery to remove inelastic excess skin and tissue after substantial weight loss and to reshape or recontour their bodies.

In 2014, nearly 45,000 patients who experienced massive weight loss also opted to undergo plastic surgery to reshape their bodies. While those numbers represent the biggest single-year increase in nearly a half decade, it's still only a fraction of patients who may benefit from it.

Henry Ford Hospital researchers report that aesthetic procedures following bariatric surgeries may contribute to improving their long-term results. The researchers recorded patients' Body Mass Index both before the bariatric surgery and 2.5 years after the procedure. Out of the patients who had a contouring surgery, the average decrease in BMI was 18.24 at 2.5 years. This is in comparison to statistically significant decrease in BMI of only 12.45 at 2.5 years for those who did not have further surgery.

Dr. Jason Lichten, MD, of Lancaster, Ohio says that "If plastic surgeons can get involved with patients earlier, we can not only give them a more realistic idea of what to expect from a physical standpoint, but we can help them devise a plan for any follow up procedures after their weight loss.

Read more:

http://www.plasticsurgery.org/news/2015/massive-weight-loss-fuels-surge-in-plastic-surgery.html

Plastic Surgeries for Men... Again

Recent trends in cosmetic surgery reveal that more and more men are requesting for aesthetic surgery. This may be attributed to men wanting to feel good and not wanting their female counterparts to look better than they do after the latter has gone to some rejuvenation procedures.

Nowadays, more men are looking forward to having a more balanced nose, a rejuvenated face and a trimmer waistline. There are those working dads in their late 40s who thinks to themselves that he used to look so goon in college. In a Business Insider, it was mentioned that these "athletic dads" tend to avail of jawline recontouring, liposuction, and a small eyelift.

According to American Society of Plastic Surgeons member Dr. Jay Lucas, MD, some of the most common procedures are eyelid rejuvenation, neck lifts, rhinoplasty, chin augmentation, and male breast reduction.

Eyelid Rejuvenation

Signs of aging are often shown in the eyes. Fortunately, surgery to restore the upper eyelids to a fresh and vibrant appearance with correction of any eyelid droop can be a good remedy. The lower lids can be rejuvenated by removing excess fat and repositioning this tissue over the cheek to eliminate the tear trough. This can be important not only in social situations, but also in how a person is viewed in the workplace.

Neck Lifts

Neck lifts help men get rid of the hanging skin and excess fat around his neck which obscures his jaw line and shows his signs of aging. This procedure helps men restore their youthful look to create a strong jaw line and a crisp chin-neck junction. Neck lifts are done as an out-patient procedure with minimal pain and a recovery of around two weeks.

Rhinoplasty and Chin Augmentation

These procedures suggest proportionality in the face of the patient and requires a great understanding of the patient's facial appearance. If the nose seems big, maybe the lower face is out of place, such as a small lower jaw or chin. To create a harmonious facial appearance, rhinoplasty along with chin augmentation is performed.

Liposuction

This is not a weight loss technique, rather it is a contouring tool which reshapes the abdominal area to create a sleeker frame. Male patients are however encouraged to go on a healthy diet and exercise before availing of this procedure as an adjunct to improve appearance.

In our culture, looking good and youthful is prized, men included. The advent of the advent of latest technology and availability of several plastic surgery procedures drive men to look and feel good themselves. Med Spa owners may capitalize on this trend to open their clinics not only to the women, but the men clientèle as well.

Read more on: http://www.plasticsurgery.org/news/plastic-surgery-blog/most-commonly-requested-plastic-surgery-for-men.html

Breast Fat Grafting Comes Of Age

The search for the ideal breast implant material has spanned everything from soy oil to paraffin. 

The current generation of silicone implants are one of the most studied medical implants in the world.  Despite the favorable safety profile, a sizeable percentage of women interested in augmentation surgery have sat on the sidelines.  There most cited concern is having something they consider unnatural in their body. 

At the recent American of Society Plastic Surgeons meeting in New Orleans,  fat grafting to the breast seems to have come of age.  Plastic surgeons have been using fat grafting to the breast for patients undergoing reconstructive breast surgery for several years now.  The original hesitations of using fat grafts for breast augmentation purposes have to do with the number of procedures necessary and the ability to read subsequent mammograms.  Both these issues are slowly being resolved.

Who is a candidate?

Most patients would prefer to have this procedure in one surgical procedure with one recovery.  Ideally, a perfect patient would want to increase their breast size from 1 to 1 1/2 cup sizes larger.  They would need to have a sufficient fat volume to be liposuctioned to provide enough material to graft.  People that are very athletic often would not have enough donor fat to be used. 

Who is not an ideal candidate?

Traditional augmentation is still best utilized for the very slim patient who wants to increase her breast size 1 1/2 to 2 cup sizes or more.  A breast implant would allow more shaping options to the breast particularly giving a patient more fullness in the superior portions of the breast.

There are still are remaining issues of the effectiveness of mammograms in patients that have had fat grafting to the breast.  Newer imaging technologies, or CT/MRI, may help resolve these issues.

Cosmetic Breast Surgery By Age & Clinic Type Infographic

US cosmetic breast procedures by age and clinic type in 2011.

In looking at this infographic, I'm somewhat surprised that 34% of the procedures are on women over 55. I would have thought that number would be somewhere in the 20% range and the 30-39 year range much higher than 12%.

Top 5 Cosmetic Surgery Treatments In 2011

According to the American Society of Plastic Surgeons cosmetic surgical procedures increased 2 percent, with nearly 1.6 million procedures in 2011. The top five surgical procedures were:

• Breast augmentation (307,000 procedures, up 4 percent) 
• Nose reshaping (244,000 procedures, down 3 percent)
• Liposuction (205,000 procedures, up 1 percent)
• Eyelid surgery (196,000 procedures, down 6 percent)
• Facelift (119,000 procedures, up 5 percent)

Top 5 Medical Spa Treatments In 2011

The top nonsurgical treatments in 2011?

1. Botox: 5.7 million treatments (up 5% from 2010)
2. Filler Injections (Juvederm, Restylane, Perlane, etc) 1.9 million treatments (up 5% from 2010)
3. Laser Hair Removal: 1.1 million (up 15% from 2010)
4. Chemical Peels: 1.1 million (down 3% from 2010)
5. Microderm: 900,000 (up 9% from 2010)

Source: American Society of Plastic Surgeons

Interview With Brazilian Plastic Surgeon Alan Landecker, MD

Visiting Brazil with plastic surgeon Dr. Alan Landecker in his Sao Paulo clinic.

Physician: Alan Landecker, MD
Location: Sao Paulo, Brazil
Website: www.landecker.com.br

That's interesting: In 2005, Alan Landecker, M.D. specialized in primary and secondary rhinoplasty at the University of Texas Southwestern at Dallas, Texas, USA, under Jack P. Gunter, M.D. and Rod J. Rohrich, M.D. For a period of 2 years, he was part of the Adjunct Faculty at the world-renowned Dallas Rhinoplasty Symposium and participated actively in the production of the second edition of the Dallas Rhinoplasty: Nasal Surgery by the Masters book. This book is currently the world´s best-seller in rhinoplasty.

Brazil has some of the busiest plastic surgeons anywhere in the world and it's not uncommon to find those who have been trained in the US.

When did you decide to specialize in plastic surgery?

The attraction began during medical school, when I rotated in the Plastic Surgery Department. The precision, difficulty, and level of detail of the operations enchanted me. However, I believe that an important personality trait (visual attraction to beautiful things) contributed significantly.

Can you tell us more about your clinic and how your staff operates it?

The clinic offers last generation plastic surgery and cosmetic procedures that can be surgical or non-surgical to all age groups. Some of the latter include laser, skin treatments, and postoperative physiotherapy. The clinic is located in one of the most sophisticated areas in São Paulo and is run by professional managers. Most remarkable 'inside' the clinic is the contemporary architecture and interior design, offering patients a unique experience.

The clinic offers IPL for hair removal, dark circles around the eyes, and some vascular lesions. We also have diode laser machines for rejuvenation and hair removal. Our newest machine is a radiofrequency device that is combined with electromagnetic energy. This kind of machine is very popular because splendid body contour is a priority for both men and women in Brazil. So far all of them have worked well for us.

How are you finding staff?

We've had some real issues with staff and due to past problems, we currently hire using only professional headhunters. Although more costly, this increases the chances of getting it right the first time! All staff have top class working conditions and receive a fixed salary plus bonuses depending on how well they perform. The secret is keeping them motivated!

How do you market your clinic?

In terms of marketing, the best is always to do a good job. In other words, the most solid marketing consists of word-of-mouth referrals. Complementary strategies should include a good website with SEO, use of social media, internal programs, and good exposure in the press. If all these are well structured, precise, and especially ethical, good results are inevitable.

What treatments or services are most profitable for you?

Plastic surgical procedures are the most profitable, followed by Botulinum toxin (Botox) and dermal fillers. We are currently developing a high-end aesthetic center to give patients a more complete type of treatment.

What have you learned about practicing cosmetic medicine? What stories can you tell?

The most common situations involve patients who bring tons of photographs of their noses into the consultation. They flog themselves trying to find minute imperfections which are normally invisible to most of us.

On the 'most unusual' side, one patient actually brought the head of a clothing store mannequin to the office, wanting a nose just like that one. As a result, we took the head into the operating room and used it as reference during the rhinoplasty. (Fortunately, the patient was extremely satisfied with the final outcome!)

What advice would you give to other physicians?

Based on my experience, it is very important to get the best training possible and preferably in something that no other surgeon performs. That will necessarily include tremendous dedication and inevitable sacrifices but you just can't succeed if you only do what everyone else does and you don't have a reputation for being the best at something specific.

Physicians must always be ethical and honest, keeping in mind that the most important outcome is patient satisfaction. In other words, never make decisions based on financial factors instead of doing what is best for the patient.

About: Alan Landecker, M.D. is a member of the Brazilian Society of Plastic Surgery and the the prestigious International Society of Aesthetic Plastic Surgery (ISAPS).

Dr. Landecker obtained his medical degree and general surgery training at the University of São Paulo Medical School, Brazil. He was then trained in plastic surgery at the Pontifical Catholic University of Rio de Janeiro and the Ivo Pitanguy Clinic, where he worked directly with Professor Ivo Pitanguy for 3 years.

After passing the ECFMG/USMLE examinations, Alan Landecker, M.D., spent a total of 2 years refining his plastic surgical training in the USA. During this period, he participated in clinical rotations, Research Fellowships, and Clinical Fellowships with some of the country's best surgeons at the Universities of Miami, Alabama at Birmingham (UAB), Pittsburgh, New York (NYU) and Texas Southwestern.

This interview is part of a series of interviews of physicians running medical spas, laser clinics and cosmetic surgery centers. If you'd like to be interviewed, just contact us.