ARE SALINE IMPLANTS BACK?

Recently the FDA approved a new line of Implants called “Ideal Implants”. What is different is that these are saline not silicone. These new implants are different from traditional saline implants in that there are 2 lumens within 2 shells that are attached at the back patch of the implant. These implants were developed by Dr. Robert Homan, a board certified plastic surgeon. These supposedly are soft like silicone. He says this will help to eliminate concerns about silent rupture of silicone implants. When a saline implant ruptures or leaks it becomes readily apparent. With silicone implants they recommend an MRI every 2 years but most of my patients never get them and do fine. I do many implant exchanges and I am sure many women who have had silicone implants in for 20 years have implants contained in the capsule that have been ruptured for years. There does not seem to be any adverse effects from this.

Patients with Ideal Implants (502 study patients) had complication rates after 2 years of 42.2% for primary augmentation and 50.5% from revision. Saline rupture rates may be higher than silicone because “water” has no lubrication properties compared to silicone.

It gives women another option but I still prefer the feel of silicone but perhaps the Ideal Implant will feel more natural. The vast majority of women (90%) prefer silicone to saline. Another point will be the cost of the new Ideal Implant.

IMPLANT REMOVAL AND REPLACEMENT WITH LARGE VOLUME FAT GRAFTING

Silicone Implants remain very very popular. For sure one of my more common cosmetic procedures. But now women who have hard, painful implants have a new alternative. Before choices were exchange or removal. I just read a recent article out of Belgium where some plastic surgeons removed the women’s implants and did simultaneous fat grafting.

The volume of fat injected ranged from 300 to 600 cc’s per side. Implants normally are measured in cc’s. I have done autologous fat grafting to the breast to enhance an augmentation. It also is a great option for someone who wants a “more” natural breast, sort of like antibiotic free range chicken. Also when I do fat grafting to the breast or buttock area (Brazilian butt lift) it is important for the patient to understand my limitation is based on the availability of their fat stores.

This means suction your abdomen or flanks or hips and rather than throw the fat away you put into the patients breasts. This is a win-win. So now women with implants have a new option to exchange them.

VIAGRA FOR WOMEN

It took a while but there finally is a Viagra for women. But questions remain as to how effective it actually will be but the FDA after tossing and turning gave the new medication it’s blessing. The new drug is called flibanserin and it always amazes me where these names come from.

 Unlike the male Viagra this medicine works directly on a woman’s brain to increase libido. Originally this drug was developed as an antidepressant and it must be taken DAILY – not just when the mood suits you. The effects were modest but maybe that’s all one wants and can hope for. The cost is yet to be determined but if I were a betting man – it will be pricier than aspirin.

FLUID COLLECTION POST TUMMY TUCK

Abdominoplasty or tummy tucks are a very popular operation.  One of the risks associated with this procedure is development of a collection of fluid called a seroma.  What a group of Plastic Surgeons did was to do a series of ultrasounds at 4,11,18,25 and 32 days.

The lowest incidence of seroma occurred on post op day 4.  The highest rate was on day 11!  The area with the greatest collection was the left iliac fossa.  If a surgeon suspects a seroma then maybe an ultrasound would be beneficial and it may need to be aspirated.

ARTOURA – NEW TISSUE EXPANDER FOR BREAST RECONSTRUCTION

This is a new tissue expander by Mentor.  This new expander is designed to control pocket formation during the first stage of breast reconstruction when the expander is placed.  This new expander has internal structural elements that provide more precise expansion.

This expander will supposedly allow more controlled expansion to create a more natural look. This new expander will limit expansion laterally AND superiorly.  The expander has 2 projections available.  So who knows this may be a step forward in creating a more natural look with breast reconstruction.

GALDERMA – NEW RESTYLANE LYFT

Galderma just introduced and received FDA approval for a competition to Allergans Voluma. Restylane Lyft is for augmentation of the cheek and midface.

This use to be marketed as Perlane-L.  It also can be used to fill deep nasolabial folds.

HEARING LOSS – PREVENTABLE

I am sensitive to people with hearing loss since I have lost a lot of my hearing due to nerve damage by mumps and measles I had as a young boy. But much of it is preventable. There are many jobs that pre-dispose to hearing loss and in an article I read recently which one profession has a high degree of hearing loss?

 I was dumb founded – farmers. The noise from the tractor and farm equiptment plus the sounds of farm animals predispose farmers to significant hearing loss. In our ears we have tiny hair cells that are susceptile to trauma caused by excessive noises.

 As the hair cells are destroyed our hearing activity declines. Think of all the young people today losing their hearing with excessively loud music. This is totally preventable with ear plugs. We only have one set of ears.

FDA – ALERT AND FILLERS

The FDA just released an alert warning for injectable fillers such as collagen or hyaluronic filler like Juvederm and Restylane. The warning stems from the inadvertent injection of these products into blood vessels potentially causing serious side effects. This can lead to visual impairment or even loss of vision or stroke.  It also can lead to tissue necrosis leaving significant scarring.

The FDA warns people to go to qualified Healthcare Professionals who are knowledgeable about the anatomy and are trained in proper injection technique.

HAND REJUVENATION – NEW PLAYER

An area that is sometimes forgotten in our quest for beauty are our hands.  As we age like other parts of our body we lose volume and our hands look thin, shelotonized tendons become prominent.  Now Radiesse has been given FDA approval for hand rejuvenation.

In a randomized controlled study 75% of patients treated with Radiesse at 3 months showed improvement in the appearance of their hands.  I am somewhat surprised more women don’t seek hand rejuvenation because like your face, your hands are there for the world to see.

My preferred method?  Autologous fat grafting.  Great procedure and again using your own tissue. Doesn’t get any better than that!

FAT GRAFTING – HOW TO HARVEST

Researchers at MD Anderson were trying to decide what method was the best to use to get the best fat to re-implant.  Success of a fat graft depends on adypose derived stem cells and the stromal vascular faction.

They found that direct excision of fat from the abdomen or using Coleman’s technique with a centrifugation yielded the most ASC and SUF cells.  Also the abdomen was a better site to harvest from than the flanks or axillae.  I am still not sold totally on centrifugation.