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The Texas Society of Plastic Surgeons recently ran an ad campaign that, as surprising as it may sound, had a lot of truth in it. The ad? "Unfortunately Some People Are Pickier About Shoes Than About Who Does Their Plastic Surgery." This honestly scares me, not just as a plastic surgeon, but also as a consumer, a parent, and a grandparent. There is so much information out there that is misleading at best, and medically irresponsible at worst. The "lunch hour nip / tuck" has become commonplace. As the Texas Society points out in their ad, there are many doctors doing plastic surgery today, but not all of them are plastic surgeons. Some doctors take brief courses to learn cosmetic surgery and then begin to advertise their remarkable promises. As a board certified plastic surgeon, I see the aftermath of under-prepared surgeons taking on more than they're trained to do.

Poor healing
Infection
Muscle paralysis
Filler leaving clearly visible ridges under the facial skin

I'm often called on to try to un-do the damage that has been done and then do the right procedure to achieve the results the patient wanted initially. Becoming a board certified plastic surgeon takes years of intense study. It's simply not reasonable to have a surgical procedure done by someone who hasn't studied, trained and been certified to do the surgery.

This is surgery, not a manicure. It's important to consider what it is you want to accomplish and the best and safest way to do that. Do your own due diligence. Check with more than one plastic surgeon. As boring as it may sound - and it's actually worse than it sounds - but read the surgeons CV. This listing of training, education, accomplishments, publications, etc., will let you know how serious your surgeon is about becoming the best possible plastic surgeon. There is no safe way to stop learning for a surgeon. The procedure that was cutting edge a few years ago has long since become antiquated by the newest standards of excellence. When it comes to your health, your safety, your body, your life - you're only cheating yourself to settle for anything less than an excellent plastic surgeon. Be picky! Don't short change yourself and in the haste to save a few dollars, lose something that can never be replaced.

A recent article published in the Journal of Dermatologic Surgery indicated that in a direct comparison study of Radiesse vs Restylane, patients preferred Radiesse by a margin of 2 to 1. The study also shows that Radiesse required 30% less volume than Restylane for the same amount of correction. Both products were shown to be safe, effective treatments with similar adverse side effects. According to the study, Radiesse lasts longer, takes less to achieve the same results, and provided higher patient satisfaction.

In our practice we use both Restylane and Radiesse and after reading the study results, I began to wonder "Why?" I've been here long enough to know that when an article like this hits the media, our patients who are extremely knowledgeable will start calling wanting to know why we would use Restylane at all if Radiesse is so much better. The fact is, I wanted to know too, so I prevailed on our fillers/injectables professional, Lisa Bowers, RN, to educate all of us on these particular fillers and help to separate the fact, fiction and whatever fluff there might be in this discussion.

My first question to Lisa was "Which filler do YOU like, and why?"

"As an injector, I see application for both Radiesse and Restylane (Hyaluronic Acid-HA filler) in our practice." Both fillers can be used in some of the same areas, ie: the nasolabial folds (those 'smile' lines that develop on the sides of the mouth angling up to the nose) as well as most of the lined areas around the mouth. The exception would be the "rhytids", the lines, especially in smokers, that develop vertically above the top lip which are best treated with Restylane to fill the lips in combination with Botox to stop the muscle action that tends to cause those stern looking lines that seemingly serve no purpose other than to move lipstick from our lips up toward our nostrils. Radiesse however, would be preferred to enhance flat cheeks or to build up the areas around the eyes. Lisa explained, "A comprehensive consultation with the patient is what finally determines which product is used. The factors include not only the areas to be treated, but also their age and related skin condition. There simply is no one answer that's right for every patient that walks through our door."

The products seem to have few differences so far, but the study indicates that Radiesse lasts significantly longer than Restylane. Is that something we're seeing in our practice? According to Lisa, our practice is proving that to be the case. "Radiesse is lasting about 12 months which is substantially longer than our Restylane patients are experiencing. We still use both products because different sites are better suited to one product over the other. I see us continuing to offer both for quite some time."

Now that we're starting to see that both products are useful tools in the lifelong trial to stay vibrant, I want to know more. For instance, at what age should patients begin considering fillers? "Fillers are not the first step in a comprehensive skin care program. Skin care should start much earlier. Our practice philosophy is that we cultivate life long relationships with our patients. What's appropriate at 70, is not appropriate at 25, but patients at both ends of the age spectrum should be concerned about their skin's health and appearance." Lisa should know. After many years being Dr. Byrd's operating room nurse, she became his practice nurse at his adult cosmetic office a few years ago. Usually it's sometime during the 30s when we all begin to notice perhaps a few gray hairs, and maybe a line that is looking more and more like a wrinkle. Maybe the skin begins to look a little less vibrant on some days. This is when it's time to begin medical grade skin care and begin a search to find a physician/surgeon whom you can trust. This time is when the risks are lowest for the patient. The wrong cleanser will do a lot less damage than choosing the wrong surgeon for a facelift.

Developing a long-term, comprehensive skin care routine during your 30s and 40s will stand you in good stead for the long term. It's at this time when fillers begin to become options for some patients. By the time we're in our 50s, the aging process can begin to show in earnest. For patients with a solid history of skin care, fillers may stave off the need for surgery a bit longer. Of course, heredity plays a role in this as well and that has to be taken into consideration. Without a foundation of good skin and health care, you may find yourself fighting a tougher battle than was necessary. Fillers can be a supplement to that skin care and in the right hands can counteract some of the toll aging, gravity and aggravation have on our skin.

So what are the facts regarding the Radiesse vs Restylane controversy? Much of what the article says is true, and we're seeing some of that in our own practice, but that's not as devastating to Restylane fans as it might sound. Yes, it is true that Radiesse lasts longer and requires less volume in some cases. What is also true is that Restylane can be used in circumstances where Radiesse isn't appropriate. We'll continue to use both fillers as part of a long-term comprehensive approach to skin care. Radiesse, Restylane, Botox, Artefill, Sculptra along with medical grade skin care products and surgical solutions are all a part of the package our practice offers our life-long patients. Our care doesn't begin or end with surgery. Surgery is an important part of what we do, and in some cases it's what brought a patient through our door initially, but it's what happens after that which is most important to us. Cultivating a trusting, caring relationship is our goal with each patient. We will continue to evaluate new products as they become available and make thoughtful decisions on which ones are best for our patients. Separating the fact, fiction and fluff is part of what we do to protect and educate our patients and ourselves.

This is from a guest blogger, my adult/cosmetic Practice Manager, Marta Traugott. I hope to have other guest bloggers who will discuss topics important to them, and if you have a question you want answered or a topic you want information about, please feel free to contact my office through this website.

We all know and most have experienced first hand the pain that can be caused by teasing and bullying during childhood. All it takes is for something, anything about a person to be different, and the teasing will commence. It may start slowly, and it may even seem like gentle, friendly kidding, and we might even laugh along at first, but it rarely stays gentle or friendly. The pain can be brutal and the damage devastating. It's bad enough when it happens to you, but when our child becomes a target, that's nearly unbearable.

Most cases of protruding ears are caused by excess cartilage behind the ear or lack of normal anatomy. Many patients have a combination of deformities, which not only call for the removal of excess cartilage, but the use of special sutures to hold the remaining cartilage in place. Otoplasty surgery is used to correct ear deformities and because of the teasing children endure, most plastic surgeons recommend that the Otoplasty surgery be done before the child enters primary school. By the time the child reaches 5 or 6 years of age, the majority of the normal ear growth has stopped making Otoplasty the most effective correction option at this age.

Protruding ears are a very common problem and can be hereditary. If you were teased as a child because your ears were too big, or stuck out too far from your head, at least according to the current standard of beauty, it's very likely that your child may face the same battle.
The EarWell System allows ear deformities to be corrected without Otoplasty surgery IF the condition is caught in the first 7 - 10 days after birth. Most new parents are so delighted over the birth of their beautiful child, they're simply busy reveling in the new perfect addition to their family. That's the way it should be! We're hoping to make pediatricians, expectant parents and even OB-Gyn doctors aware of this 7 - 10 day window that would help this child to avoid a 2 hour surgery, 3 - 6 weeks of recovery and a lifetime of painful, heartbreaking teasing.

The video is now available on our Facebook, and Twitter pages and on:

http://www.wfaa.com/news/health/Perfect-Ears-86970057.html

Please call my office for more information at 214-821-9662

The EarWell System is a revolutionary new procedure that non-surgically corrects the most prevalent birth anomaly - misshapen or deformed ears. In 6 - 8 weeks, your pediatrician can reshape and correct nearly all ear defects in newborns without anesthesia, incision or pain. The correction needs to be started in the first 7 - 10 days after the baby is born, so please pass this information along to your friends and family members who are pregnant now so they'll know what to do if their child should happen to have an ear deformity.

The video is now available on our Facebook, and Twitter pages and on:

http://www.wfaa.com/news/health/Perfect-Ears-86970057.html

Please call my office for more information at 214-821-9662

When patients comes in for their consultation, they're often surprised when they are advised that they will be required to have a group of pre-op medical tests done prior to their cosmetic surgery. In our office that's not where the patient's pre-op evaluations begins or ends, but it is a critical portion of preparing patients for cosmetic surgery.

As of January 1st of this year, the "Donda West Law" went into effect in California. The law was inspired and named after rap artist Kanye West's mother who in 2007 died a day after having cosmetic surgery. The law requires that patients having elective surgery undergo a physical examination and obtain clearance from a medical professional before surgery. The particulars of the law set out that an appropriate physical exam be done 30 days prior to a procedure and that written clearance be obtained from a doctor, nurse practitioner or physician assistant.

What impact does this have on most cosmetic surgery patients? Not much. Most reputable, board certified plastic surgeons already have protocol in place to obtain patients' medical history, as well as requiring them to have bloodwork and/or a physical exam prior to being cleared for surgery. In our office the standards are thorough and comprehensive:

1 Patients complete a two page medical history form listing any chronic illness, previous injuries or surgeries, etc. This is where the pre-op medical evaluation begins - with the patient's own outline of their medical history and current health. If a patient smokes, it can complicate surgery and significantly hinder the healing process and it's this pre-op step that alerts the staff to that complicating factor

2 All patients have the following medical tests done:

Hematocrit
Hepatitis C
HIV
Potassium
MRSA Nasal Swab (test for staph infection)

3 Depending on the age of the patient and the procedure the patient is having done, they may also be required to have the following tests done as well:

EKG
Mammogram
Letter of clearance from a primary care doctor or specialist

4 The day of surgery, all female patients are given a pregnancy test, and yes, occasionally the patients are surprised with the results!

Nearly all of the plastic surgeons I know do a similar screening of their surgery patients. The type of tests done may vary from practice to practice, but the aim is always the same - protect the patient.

According to United Press International, the autopsy results indicated that Donda West died due to a combination of several factors including pre-existing coronary artery disease and "multiple post-operative factors" after an abdominoplasty, breast reduction, and liposuction surgery. Would pre-operative tests made a difference? That's open to speculation, but what is clear is that there is absolutely no chance of catching underlying pre-existing conditions if no pre-op tests and evaluations are done.

A few years ago a female patient came into my office for a consultation. She had gone to our website, set up the consultation and came in alone. None of this is too unusual except that this patient was only 17. As other parents of teenage girls will attest, rarely does a teenage girl do anything by herself, and ordinarily "the more, the merrier" approach applies. This young woman was anything but merry or ordinary, but she had a tremendous impact on my entire staff.

Early during the consultation she mentioned she was here to see about breast augmentation, which isn't completely unheard of for a 17 year old, but again, usually in a breast augmentation consultation for a teenager, there's more than one teenager in the room, and usually a parent as well. This solitary young woman listened intently as we discussed the procedure in general terms. After the first part of the consultation, I left the exam room so the patient could change out of street clothes into a robe for a physical exam.

As I returned to the room for the exam and initially saw her breasts, I began to understand a bit more about her situation. She explained she didn't want to be "big", but asked if there wasn't there something we could do? I asked her if she knew the term "tuberous breasts", but she didn't. This wasn't just a teenager with body image issues; she had tuberous breasts. I explained to her that she had a medical condition in which during the early growth of the breast, the tissue is restricted leading to unusually small, drooping and uneven breasts. In most cases, tissues inside the breast push against the areola causing it to bulge and enlarge. If not diagnosed properly and a surgeon tries to correct the problem by placing an implant in the tubular breast, the breast sags even more dramatically leaving the patient completely devastated. While an implant is used to correct the size and shape of tuberous breasts, it is not a traditional breast augmentation procedure. The procedure done is part augmentation, part mastopexy (breast lift) and part reduction which when done by an experienced, board certified plastic surgeon, results in a much more normal looking breast.

The tuberous breast condition is a congenital abnormality that presents with breasts that have very little breast tissue, and whatever tissue there is, is unusually dense. Because of the abnormal breast tissue, breast-feeding is often compromised. The areola is large and puffy looking, and the chest wall is very narrow but there's a wide gap between the breasts. There's no known specific cause for this condition that affects about 1% of the population, including a few males. The unusual shape the breasts take can result in unflattering terms like "torpedo t*ts" or "Snoopy breasts" which can be especially damaging as the condition appears in adolescence.

While explaining the tuberous breast condition to this young woman, her entire demeanor changed. She was clearly relieved to find out that there actually was something wrong. I asked her if she had told her parents about coming to see me, and she had not. She had done all the research and consultation scheduling on her own. I explained that her condition was absolutely treatable, but to do so she would need her parents' consent. The next day she and her Mother came in to see me. Mom cried. Daughter cried. Although the daughter had told her Mother that she thought there was something wrong with her breasts, her Mom understandably perhaps, thought she would out grow it. Knowing the struggles, insecurities and embarrassment her daughter had suffered without her support was now breaking the mother's heart, and she was just beginning the process of dealing with some guilt because she didn't listen to her daughter. "I just didn't know. I never saw her breasts, and I assumed she was just being impatient because her friends all developed before she did."

We doctors are privy to some pretty personal stuff in our patients' lives. Working through this medical issue, first with the daughter and then with the mother gave my entire staff a peek into their family. While the mother felt like she had failed the daughter, she did the best thing she could do at that point. That night when they returned home after the second consultation, they sat down and shared the story with "Dad". Three weeks later when the patient came in for surgery, much of her extended family came with her for support. By this time the tears had dried. The family had done a great deal of research on tuberous breasts and had some insightful questions for me when I came to give them the report after surgery. The mood was definitely one of support and love.

The patient made a quick, routine recovery and is a much more confident and comfortable 20-something college graduate now. Her courage and strength touched all of us, as did her family's resilience and tenacity. Tuberous breasts had impacted this young woman's life, but she had the courage to not let it negatively impact her future.