Kamis, 30 April 2009
FDA Approves Botox Competitor Dysport / Reloxin!
BIG news in the plastic surgery field. The FDA approved the drug Dysport (otherwise known as Reloxin) today for the treatment of fine lines in the glabella (between the brows). This is the first bona-fide competitor to Botox, as it is also a Botulinum Toxin Type A.
I've mentioned Reloxin in this blog before, as well as on the Rachael Ray show a couple months ago. Plastic surgeons (and patients) hope that this can act as an economic bailout for the 4 million Americans who pay several hundreds of dollars for each Botox treatment. I think we would all welcome a price war between Allergan (makers of Botox) and Medicis (makers of Dysport).
How does Dysport compare to Botox? Other than the fact that they are both Botulinum Toxin Type A, it's difficult to tell. However, if Dysport is priced competitively with Botox and has similar efficacy, we may see a multi-billion dollar product reaching your plastic surgeons' offices in the next 30-60 days. Stay tuned!
Source: Globe Newswire
Thanks for reading.
Michigan-based Plastic Surgeon
Anthony Youn, M.D.:
Rabu, 29 April 2009
Saline or Silicone Gel? The Results May Surprise You...
A recent survey published in the Aesthetic Surgery Journal shows what the current preferences are for breast augmentation surgery. According to a survey of 1746 board-certified plastic surgeons and members of the ASAPS:
- Sixty percent of surgeons are still using saline implants, and the vast majority of them are using them 75-100% of the time.
- The majority of surgeons (64%) preferred an incision near the breast crease, while 25% preferred an incision around the bottom half of the areola.
- The average implant size reported by 81% of surgeons was 300 to 400 cc (which is approximately a small to a full "C" cup bra).
- Smooth implants, rather than implants with a textured surface, were most often preferred by 92% of respondents because it was the surgeon's preference, less wrinkling, or overall better results for the patient.
- Ninety-six percent of surgeons used round, rather than anatomically-shaped, implants.
- The most common position for implant placement was under the muscle (62% of surgeons).
- The average implant size reported by 81% of surgeons was 300 to 400 cc (which is approximately a small to a full "C" cup bra).
- Smooth implants, rather than implants with a textured surface, were most often preferred by 92% of respondents because it was the surgeon's preference, less wrinkling, or overall better results for the patient.
- Ninety-six percent of surgeons used round, rather than anatomically-shaped, implants.
- The most common position for implant placement was under the muscle (62% of surgeons).
With the exception of the majority use of saline implants, these statistics reflect what I see in my practice. I estimate that I use saline implants only 25% of the time, since most patients seem to prefer gel. I utilize three incisions (underneath the breast, around the areola, and the armpit), with the most common being underneath the breast. My average size implant is probably 350-375cc, and I usually use smooth round implants placed under the muscle. I find that these choices usually minimize any complications and revisions.
To view a breast augmentation I performed on Fox News, click here.
Thanks for reading.
Michigan-based Plastic Surgeon
Anthony Youn, M.D.:
Michigan-based Plastic Surgeon
Anthony Youn, M.D.:
Senin, 27 April 2009
Does Sharon Stone Have Breast Implants?
This photo from The Blemish.com shows what appears to be Sharon Stone's breast implants. She looks like she's lost a lot of weight, revealing the round edges of breast implants that may be positioned below the muscle (hence the space between them). It's possible she may also have a capsular contracture, or excess scar tissue that can accumulate around the implants, causing them to look round and hard. Sometimes the scar tissue can be really thick, other times it can be just a Sliver!
I think her face looks great, though!
Thanks for reading.
Michigan-based Plastic Surgeon
Anthony Youn, M.D.:
Jumat, 24 April 2009
Seven Plastic Surgery Tips to Survive the Recession
With the recession as bad as it is (I'm hearing that some plastic surgery practices are down 80%!), I thought I'd think up some ways my readers can still have their plastic surgery... but on a budget. Here are my Seven Plastic Surgery Tips to Survive the Recession:
7. Try Saline Implants Instead of Silicone Gel - Although not as natural-looking or feeling, saline breast implants are still nice implants, and may have a lower complication rate. They can also save you a cool grand in implant costs.
6. One Cream to Rule Them All - If you could only use one anti-aging cream for your face, it should be Retin-A. Not only does it improve acne, but it also smooths wrinkles, exfoliates, thickens collagen, and clears blemishes. And it costs less than a hundred bucks for a big tube. Do not use if you're pregnant, though.
5. Try Sculptra instead of conventional fillers - Although not FDA-approved for general cosmetic use yet, many surgeons are using Sculptra off-label to fill in hollowness under the eyes and overall gauntness. Unlike traditional fillers which last only 6-12 months, it can last 3-5 years.
4. Opt for Regular Lipo Over Ultrasonic or Laser Lipo - I recently returned my VASER machine since I didn't see a significant improvement over traditional liposuction in my patients, therefore not justifying the higher price tag.
3. Try Chemical Peels Instead of Lasers - A good TCA peel (like the Blue Peel) is comparable to laser treatments, but carries a much smaller pricetag. Whereas a laser can cost $150,000 to purchase, what are the costs for the supplies of a generic TCA peel? A couple bucks.
2. A Little Botox Goes a Long Way - Many patients are saving money on Botox by using a smaller amount and spreading it out over multiple areas. Instead of injecting 20 units in the forehead, they may have 10 units in the forehead and 10 units in the frown lines.
1. Let Your Insurance Pay For It - Do not take this wrong. Health insurance will not pay for your breast augmentation, tummy tuck, or facelift, BUT it might pay for your upper eyelid lift if you can prove the excess skin of your eyelids severely disturbs your vision. It may also pay for your breast reduction, if your breasts are massive and create severe pain.
If anyone has any other suggestions on how to save money and still have plastic surgery, please comment!
Thanks for reading.
Michigan-based Plastic Surgeon
Anthony Youn, M.D.:
Rabu, 22 April 2009
Susan Boyle Gets Her Brows Waxed
Britain's Got Talent and YouTube star Susan Boyle has gotten her bushy eyebrows waxed. They look sooooo much better than before. If you haven't seen her absolutely fantastic performance on YouTube, you can check it out here. She has an amazing voice. I'd buy one of her CDs!
Photo credit: Pacific Coast News
Thanks for reading.
Michigan-based Plastic Surgeon
Anthony Youn, M.D.:
Senin, 20 April 2009
Rupert Everett or Wax Figure?
Wow. What has happened to Rupert Everett's face? I really liked him in My Best Friend's Wedding, but it looks like the British actor is now planning to go for even younger roles! His skin is now smooth and wrinkle free, a possible consequence of Botox and chemical peels. I surmise that he's also undergone a facelift and injections of fillers, possibly Sculptra, to soften his cheeks and deep lines. He now looks like a very young Ray Liotta!
Photo credit: Popwatch
Thanks for reading.
Michigan-based Plastic Surgeon
Anthony Youn, M.D.:
Sabtu, 18 April 2009
Michael Douglas and Plastic Surgery
Michael Douglas continues to look younger than his 64 years. A recent post on Right Celebrity analyzes this.
In my opinion, he's had a good amount of work done. I would count an upper and lower eyelid lift (blepharoplasty) and facelift (maybe more than one) among the surgeries he may have had. Overall he does look pretty natural, especially when compared to some other plasticized male celebrities his age.
One of the keys to avoiding an overly operated, feminized look in male plastic surgery patients is to limit any tightening of the cheek area. Some male celebrities who've had obvious overdone facelifts exhibit a 'sweeping look' to the cheeks, making them look tight and overly pulled in an upward direction. I tend to focus my tightening more on the lower face and neck in men, as this tends to take off the years without making them look like they're in a wind tunnel or a skydiving George H.W. Bush.
Photo credit: prphotos.com
Thanks for reading.
Michigan-based Plastic Surgeon
Anthony Youn, M.D.:
Kamis, 16 April 2009
A Bra That Firms Your Breasts?? I Doubt It!
Anna Chan from MSNBC.com has recently asked me to analyze the claims of the Victoria's Secret Bust Firming Bra. According to the manufacturer, regular wearing for eight hours a day for four weeks results in an 18% increase in the firmness of the breast. Check out the article here to see what MSNBC.com's writer thought about it after wearing the same bra every day for seven weeks! They also include some of my oh-so-insightful opinions ;)
Thanks for reading.
Michigan-based Plastic Surgeon
Anthony Youn, M.D.:
Selasa, 14 April 2009
Quick Links
Here are some links to take up your time:
1. A friend of mine writes an entertaining and humorous blog, Confessions of a PA (Physician's Assistant) student. Check it out if you're interested in the life of a physician's assistant. Click here.
2. A new documentary about plastic surgery, Youth Knows No Pain, will have its world premiere on Tuesday, April 28th at the Walter Reade Theatre in the Lincoln Center in New York City. Filmmaker Mitch McCabe spends two years on the road, visiting doctors, reconstructive surgery experts, and real-American characters who have gone to varying lengths to stay forever young. You may even catch a glimpse of me, although I doubt I made the cut! Click here for tickets.
3. Kim Kardashian has announced that one of the members of the Kardashian family is going to undergo plastic surgery to look "totally different." Click here for details.
Thanks for reading.
Michigan-based Plastic Surgeon
Anthony Youn, M.D.:
Minggu, 12 April 2009
Stevie Nicks: Botox Users "Look Like Satan's Children"
Fleetwood Mac's Stevie Nicks has recently admitted to having used Botox and disliking it:
WWD: You said in a recent interview that you were relieved to still look like you. And you do. Is this the result of good work or no work?
S.N.: You mean like plastic surgery? No.
I had Botox and I hated it. For four long months, I looked like a different person. It almost brought down the whole production of the last tour. It was so bad, I would look into the mirror and burst into tears. Botox is becoming the new face of beauty and it’s unfortunate because it makes everybody look like Satan’s children. Everybody has pointed eyebrows. Everybody looks related. All the Desperate Housewives look like sisters.
If you’re an unattractive girl who’s trying to be beautiful with Botox, forget it. If you are a beautiful girl who’s trying to be beautiful with Botox, you will look like you’re angry all the time. You’d have to tie me down to get me to do it again.
In certain cases when people with arched brows have Botox, it can give them an overarched "Botox Brow." This can easily be treated by injecting a few more units above the eyebrow region. Most patients can also avoid this look by injecting less than the usually recommended 17-20 units in the forehead.
Overall I think Stevie is being a bit too harsh. I don't think that Eva Longoria looks like Marcia Cross's sister!
If you'd like to try using the Botox treatment visualizer (upload a photo of yourself and see what you'd look like with Botox), then click here.
Story credit: In Your Face blog
Photo credit: prphotos.com
Thanks for reading.
Michigan-based Plastic Surgeon
Anthony Youn, M.D.:
Jumat, 10 April 2009
Update on Donda West's Surgeon
It appears that there is one (possible) final postscript to the tragic death of Kanye West's mom, Donda West after having plastic surgery. Her surgeon, Dr. Jan Adams, has just surrendered his medical license for the State of California. He has recently been given a one year jail term for drunk driving.
Sad story all around. Many physicians carry medical licenses in more than one state, so it's possible that he can still practice as a plastic surgeon in another state, like Florida, even though he surrendered his California medical license. Since I have practiced in both California and Michigan, I carry medical licenses in both states.
Unfortunately, I can think of a couple cosmetic surgeons in my area who should maybe have their license revoked too!
Happy Good Friday!
Source
Photo credit: prphotos.com
Thanks for reading.
Michigan-based Plastic Surgeon
Anthony Youn, M.D.:
Kamis, 09 April 2009
Surgical Site Infections
Definitions
Overall, surgical site infections (SSIs) are the leading cause of nosocomial infections, accounting for 38% of these complications. By definition, to be an SSI, an infection must occur within 30 days of the operation. SSIs can be broken down into three general categories. Superficial incisional SSIs involve only the skin or subcutaneous tissue of the incision. Signs and symptoms of this type of infection may include pain, swelling, redness, warmth and tenderness. Deep incisional SSIs demonstrate either purulent drainage from deeper tissue, a deep incisional dehiscence, or an abscess in the depth of the incision. Lastly, organ or deep space SSIs involve infections in manipulated regions other than the skin and subcutaneous tissue that was opened during the procedure. By definition, these infections must contain purulent drainage, positive cultures with fluid aspiration or documentation of the presence of an abscess. If a foreign body such as mesh or titanium was left in the wound an SSI can occur up to one year postoperatively.
Overall, surgical site infections (SSIs) are the leading cause of nosocomial infections, accounting for 38% of these complications. By definition, to be an SSI, an infection must occur within 30 days of the operation. SSIs can be broken down into three general categories. Superficial incisional SSIs involve only the skin or subcutaneous tissue of the incision. Signs and symptoms of this type of infection may include pain, swelling, redness, warmth and tenderness. Deep incisional SSIs demonstrate either purulent drainage from deeper tissue, a deep incisional dehiscence, or an abscess in the depth of the incision. Lastly, organ or deep space SSIs involve infections in manipulated regions other than the skin and subcutaneous tissue that was opened during the procedure. By definition, these infections must contain purulent drainage, positive cultures with fluid aspiration or documentation of the presence of an abscess. If a foreign body such as mesh or titanium was left in the wound an SSI can occur up to one year postoperatively.
Risk Factors
Generally speaking, the overall well being and the severity of any comorbid conditions determine how susceptible a patient is to wound infections. The American Society of Anesthesiology rates patients’ operative risk according to their level of illness and comorbidities, termed the ASA class. There is a close correlation between the severity of the preoperative risk and the risk of wound infection. Furthermore, greater operative time is also associated with an increased risk of developing an SSI. When planning an operation, the surgeon must consider the level of expected contamination. Clean surgical procedures are those that involve only skin and the musculoskeletal soft tissue and carry approximately a 2% chance of developing an SSI (although it must be noted that wound infection rates are probably underreported). Clean-contaminated procedures are those that involve the planned opening of a hollow viscus (e.g., the respiratory, biliary or gastrointestinal tracts) and have a 7-15% risk of becoming infected. Contaminated procedures are those that introduce nonsterile, bacteria-rich contents into the wound for a short period of time (e.g., penetrating abdominal trauma, unplanned enterotomies) and lead to SSIs in 20% of cases. Dirty procedures take place in an infected setting (e.g., bowel resection for an abscess related to Crohn’s disease, removal of infected prosthesis). Approximately 20-40% of these wounds will become infected if closed primarily.
Generally speaking, the overall well being and the severity of any comorbid conditions determine how susceptible a patient is to wound infections. The American Society of Anesthesiology rates patients’ operative risk according to their level of illness and comorbidities, termed the ASA class. There is a close correlation between the severity of the preoperative risk and the risk of wound infection. Furthermore, greater operative time is also associated with an increased risk of developing an SSI. When planning an operation, the surgeon must consider the level of expected contamination. Clean surgical procedures are those that involve only skin and the musculoskeletal soft tissue and carry approximately a 2% chance of developing an SSI (although it must be noted that wound infection rates are probably underreported). Clean-contaminated procedures are those that involve the planned opening of a hollow viscus (e.g., the respiratory, biliary or gastrointestinal tracts) and have a 7-15% risk of becoming infected. Contaminated procedures are those that introduce nonsterile, bacteria-rich contents into the wound for a short period of time (e.g., penetrating abdominal trauma, unplanned enterotomies) and lead to SSIs in 20% of cases. Dirty procedures take place in an infected setting (e.g., bowel resection for an abscess related to Crohn’s disease, removal of infected prosthesis). Approximately 20-40% of these wounds will become infected if closed primarily.
Bacteria and Prophylaxis
Whereas most SSI are caused by skin derived Gram-positive cocci, including Staphylococcus aureus, coagulase-negative staphylococci such as Staphylococcus epidermidis and Enterococcus species, site-specific pathogens, may infect wounds. Consideration for Gram-negative bacilli should be given to any wound that is located near the site of bowel injury or repair, and when either bowel or tracheopharyngeal structures are violated, both enteric aerobic bacteria such as Escherichia coli and anaerobic bacteria such as Bacteroides fragilis may be of concern. Prophylaxis for clean surgery is controversial. It is generally accepted that when bone is violated (e.g., during cranial vault reconstruction) or when a prosthesis is inserted, preoperative antibiotics are indicated. Less convincing data exists for straightforward soft tissue surgery (e.g., scar revisions).
Whereas most SSI are caused by skin derived Gram-positive cocci, including Staphylococcus aureus, coagulase-negative staphylococci such as Staphylococcus epidermidis and Enterococcus species, site-specific pathogens, may infect wounds. Consideration for Gram-negative bacilli should be given to any wound that is located near the site of bowel injury or repair, and when either bowel or tracheopharyngeal structures are violated, both enteric aerobic bacteria such as Escherichia coli and anaerobic bacteria such as Bacteroides fragilis may be of concern. Prophylaxis for clean surgery is controversial. It is generally accepted that when bone is violated (e.g., during cranial vault reconstruction) or when a prosthesis is inserted, preoperative antibiotics are indicated. Less convincing data exists for straightforward soft tissue surgery (e.g., scar revisions).
Patient factors
Anemia (postoperative)
Ascites
Chronic inflammation
Corticosteroid therapy (controversial)
Obesity
Diabetes
Extremes of age
History of irradiation
Hypocholesterolemia
Hypoxemia
Malnutrition
Peripheral vascular disease
Recent operation
Remote infection
Skin carriage of staphylococci
Skin disease in the area of infection (e.g., psoriasis)
Environmental factors
Contaminated medications
Inadequate disinfection/sterilization
Inadequate skin antisepsis
Inadequate tissue oxygenation
Treatment factor
Drains
Emergency procedure
Hypothermia
Inadequate antibiotic prophylaxis
Prolonged preoperative hospitalization
Prolonged operative time When choosing an antibiotic agent, the following factors should be considered:
Contaminated medications
Inadequate disinfection/sterilization
Inadequate skin antisepsis
Inadequate tissue oxygenation
Treatment factor
Drains
Emergency procedure
Hypothermia
Inadequate antibiotic prophylaxis
Prolonged preoperative hospitalization
Prolonged operative time When choosing an antibiotic agent, the following factors should be considered:
- It should have minimal side-effects and be safe for the patient.
- It should have a narrow spectrum of coverage for the expected organisms.
- It should not be overused (making it less likely that bacteria have developed resistance).
- It should cover typical infections that are specific for the institution.
- It can be used for a brief period of time (less than 24 hours).
Long prophylactic courses have been associated with an increased risk of nosocomial infections and multi-drug resistance. For clean and most clean-contaminated cases, a first-generation cephalosporin should be used. If a patient has a documented penicillin allergy, clindamycin is an alternative. Only in the setting of a hospitalized patient in an institution that carries a high rate of methicillin-resistant S. aureus (MRSA), should vancomycin be considered for prophylaxis. It is important to recall that the timing of the antibiotic dose determines its effectiveness. Preoperative prophylaxis should be closed within two hours of incision time. Given too early, the antibiotic can be cleared before the case is started. Some benefit can be gained from intraoperative dosing if antibiotics are not given before the case begins, but no benefit has been shown when the first dose is given after the case ends. This loss of benefit after skin closure is related to the fact that sutured wounds exist in a low blood flow state owing to vasoconstriction, the use of electrocauterization for hemostasis, and the constrictive effects of the suture closure. Therefore, antibiotics will not reach the surgical site. In extremely lengthy cases, redosing intraoperatively is recommended.
Prevention and Treatment
In the weeks to months before a planned operation, much can be done to maximize the immune state and wound healing capabilities of the patient. Smokers should be encouraged to stop at least one month prior to their surgery. Smoking is a known vasoconstrictor that can reduce oxygen delivery to wounded tissue, and its effects have been found to last weeks beyond the point of smoking cessation. The nutritional status of the patient should be taken into consideration as well. Obese patients should be encouraged to lose as much weight as possible while maintaining a healthy, protein-rich diet, and in the malnourished hospitalized patient, even a short 5-7 day course of parenteral or enteral nutrition has been shown to significantly reduce the risk of SSIs. Studies show that having a patient take a preoperative shower with an antiseptic soap (e.g., hexachlorophene) can reduce skin bacterial load. However, shaving the planned surgical site with a razor either the night before surgery or immediately preoperatively should be discouraged due to the transient bacterial infestation that it promotes. Studies report greater than a 3-fold increase in infection rates with shaving versus hair clipping (5.6 vs. 1.7%). Finally, known S. aureus carriers should have their nasal orifices treated with topical 2% mupirocin. Intraoperatively, care should be taken to keep the patient warm and well hydrated. This will improve blood flow to the wound and maximize oxygen delivery. Even 30 minutes of preoperative warming can reduce patient risk for SSI by two-thirds in some cases. Adequate oxygenation is important for cellular function and bacterial destruction via superoxide and peroxide formation. Case length should be kept to a minimum, given the fact that infection rates almost double for each hour an operation lasts. Tissues should be handled gently and electrocautery for hemostasis should be kept to a minimum. During the case, wounds should be kept moist and retractors should be released periodically to restore blood flow. The smallest possible suture diameter should be used to minimize foreign material in the wound (studies show that on average, surgeons use sutures one size larger than needed), and the prudent use of drains should be encouraged. By acting as a conduit for bacterial invasion and preventing epithelial closure of wounds, drains probably cause more SSIs than they prevent and they should be removed as soon as possible. Antibiotic prophylaxis of an indwelling drain is never indicated. High pressure pulse irrigation and topical antiseptic washes have been proven to be of some benefit in the contaminated or dirty wound. Both during the case and postoperatively, blood glucose concentration should be kept under tight control (80-110 mg/dl). And finally, postoperative nutrition should be optimized. Controversy exists on whether it is appropriate to close contaminated wounds primarily. Studies in adults show that this practice can lead to a higher rate of wound failure and a greater cost of care. It is recommended that a delayed primary closure of the incision be used. This involves either placing untied sutures during the case that can later be cinched down, or using adhesive strips for closure when the wound is ready. Until the time when the wound appears to have minimal debris and no apparent progressing erythema, wet-to-dry, twice daily packing should be used (usually for 4-5 days).
In the weeks to months before a planned operation, much can be done to maximize the immune state and wound healing capabilities of the patient. Smokers should be encouraged to stop at least one month prior to their surgery. Smoking is a known vasoconstrictor that can reduce oxygen delivery to wounded tissue, and its effects have been found to last weeks beyond the point of smoking cessation. The nutritional status of the patient should be taken into consideration as well. Obese patients should be encouraged to lose as much weight as possible while maintaining a healthy, protein-rich diet, and in the malnourished hospitalized patient, even a short 5-7 day course of parenteral or enteral nutrition has been shown to significantly reduce the risk of SSIs. Studies show that having a patient take a preoperative shower with an antiseptic soap (e.g., hexachlorophene) can reduce skin bacterial load. However, shaving the planned surgical site with a razor either the night before surgery or immediately preoperatively should be discouraged due to the transient bacterial infestation that it promotes. Studies report greater than a 3-fold increase in infection rates with shaving versus hair clipping (5.6 vs. 1.7%). Finally, known S. aureus carriers should have their nasal orifices treated with topical 2% mupirocin. Intraoperatively, care should be taken to keep the patient warm and well hydrated. This will improve blood flow to the wound and maximize oxygen delivery. Even 30 minutes of preoperative warming can reduce patient risk for SSI by two-thirds in some cases. Adequate oxygenation is important for cellular function and bacterial destruction via superoxide and peroxide formation. Case length should be kept to a minimum, given the fact that infection rates almost double for each hour an operation lasts. Tissues should be handled gently and electrocautery for hemostasis should be kept to a minimum. During the case, wounds should be kept moist and retractors should be released periodically to restore blood flow. The smallest possible suture diameter should be used to minimize foreign material in the wound (studies show that on average, surgeons use sutures one size larger than needed), and the prudent use of drains should be encouraged. By acting as a conduit for bacterial invasion and preventing epithelial closure of wounds, drains probably cause more SSIs than they prevent and they should be removed as soon as possible. Antibiotic prophylaxis of an indwelling drain is never indicated. High pressure pulse irrigation and topical antiseptic washes have been proven to be of some benefit in the contaminated or dirty wound. Both during the case and postoperatively, blood glucose concentration should be kept under tight control (80-110 mg/dl). And finally, postoperative nutrition should be optimized. Controversy exists on whether it is appropriate to close contaminated wounds primarily. Studies in adults show that this practice can lead to a higher rate of wound failure and a greater cost of care. It is recommended that a delayed primary closure of the incision be used. This involves either placing untied sutures during the case that can later be cinched down, or using adhesive strips for closure when the wound is ready. Until the time when the wound appears to have minimal debris and no apparent progressing erythema, wet-to-dry, twice daily packing should be used (usually for 4-5 days).
Pearls and Pitfalls
Antibiotic prophylaxis of clean surgical procedures (e.g., elective operations on skin and soft tissue) is controversial based on a single randomized trial that showed benefit in breast and groin hernia surgery. The controversy persists because the incidence of superficial surgical site infection was so high (4%, versus an expected incidence of about 1%) in the placebo group. Evidence that antibiotic prophylaxis is indicated for soft tissue procedures of other types is lacking entirely, and prophylaxis cannot be recommended. If administered, antibiotic prophylaxis should be given before the skin incision is made, and only as a single dose. Additional doses are not beneficial because surgical hemostasis renders wound edges ischemic by definition until neovascularization occurs, and antibiotics cannot reach the edges of the incision for at least the first 24 hours. Not only is there lack of benefit, prolonged antibiotic prophylaxis actually increases the risk of postoperative infection. Increasingly in the practice of plastic surgery, there is a tendency to leave closed-suction drains in place for prolonged periods in the erroneous belief that the incidence of wound complications is reduced by prolonged drainage. Nothing could be further from the truth. Data indicate that the presence of a drain for more than 24 hours increases the risk of postoperative surgical site infection with MRSA. Closed suction drains must be removed as soon as possible, ideally within 24 hours. Prolonged antibiotic prophylaxis is often administered to “cover” a drain left in place for a prolonged period. This is a prime example of error compounding error, and is a practice that must be abandoned.
Antibiotic prophylaxis of clean surgical procedures (e.g., elective operations on skin and soft tissue) is controversial based on a single randomized trial that showed benefit in breast and groin hernia surgery. The controversy persists because the incidence of superficial surgical site infection was so high (4%, versus an expected incidence of about 1%) in the placebo group. Evidence that antibiotic prophylaxis is indicated for soft tissue procedures of other types is lacking entirely, and prophylaxis cannot be recommended. If administered, antibiotic prophylaxis should be given before the skin incision is made, and only as a single dose. Additional doses are not beneficial because surgical hemostasis renders wound edges ischemic by definition until neovascularization occurs, and antibiotics cannot reach the edges of the incision for at least the first 24 hours. Not only is there lack of benefit, prolonged antibiotic prophylaxis actually increases the risk of postoperative infection. Increasingly in the practice of plastic surgery, there is a tendency to leave closed-suction drains in place for prolonged periods in the erroneous belief that the incidence of wound complications is reduced by prolonged drainage. Nothing could be further from the truth. Data indicate that the presence of a drain for more than 24 hours increases the risk of postoperative surgical site infection with MRSA. Closed suction drains must be removed as soon as possible, ideally within 24 hours. Prolonged antibiotic prophylaxis is often administered to “cover” a drain left in place for a prolonged period. This is a prime example of error compounding error, and is a practice that must be abandoned.
Rabu, 08 April 2009
Ann Coulter - Breast Implants?
Quick post today, since I've been busy with many, many other things...
Here's a link to Make Me Heal.com's post on Ann Coulter and possible breast implants.
For my previous posts on Ann Coulter, click here and here.
p.s. Yes, I assume the Playboy magazine is photoshopped...
Thanks for reading,
Michigan-based Plastic Surgeon
Anthony Youn, M.D.:
Here's a link to Make Me Heal.com's post on Ann Coulter and possible breast implants.
For my previous posts on Ann Coulter, click here and here.
p.s. Yes, I assume the Playboy magazine is photoshopped...
Thanks for reading,
Michigan-based Plastic Surgeon
Anthony Youn, M.D.:
Senin, 06 April 2009
Kylie Minogue Admits to Botox
Aussie singer Kylie Minogue has admitted to using Botox in the past, but states that she's now "a lot more natural." According to the Mirror:
"I'm definitely not one of those people who says, 'You shouldn't do this.' Everyone individually can do what they want. “I also think it doesn't have the stigma that it had when I was growing up. For all time women have wanted to, for the most part, look their best.
It's just that what we have available to us today is - what it is today. I'm preferring to be a lot more natural these days. I've tried Botox, I've tried all... You're damned if you do and damned if you don't."
I've always thought that she displayed a bit of the Botox brow, like her fellow Aussie Nicole Kidman, however her brows have always been a bit over-arched. Botox or not, she does look great at 40!
For a previous post on Kylie Minogue and Botox, click here.
Photo credit: prphotos.com
Thanks for reading.
Michigan-based Plastic Surgeon
Anthony Youn, M.D.:
Sabtu, 04 April 2009
Plastic Surgeon? Cosmetic Surgeon? Phony Doc?
Recently there have been several articles detailing bad events that have occurred at the hands of people who aren't board-certified plastic surgeons. Here are a sampling:
1. A family practice physician who considers himself a specialist in cosmetic surgery and advertises as a plastic surgeon was recently reprimanded by the State Board of Medicine for prescription fraud. He wrote prescriptions for patients and family members, using them to obtain drugs "for his own personal and unauthorized use." Click here for the story.
2. A Bronx mother dies after undergoing silicone injections by a "non-medical, unlicensed person." Click here for story.
3. A Head and Neck surgeon is accused of performing liposuction without a patient's consent. She had planned on having a tummy tuck only, but accuses him of performing a facelift and liposuction too. Click here for story.
The American Board of Plastic Surgery and the American Society of Plastic Surgeons holds its members to strict ethical guidelines which many other "cosmetic"-type societies do not. It's not surprising, then, that most of the crazy plastic surgery-related news comes from physicians who are not certified by the American Board of Plastic Surgery.
Here are two well-written articles by laypeople who focus on the difference between a "Plastic surgeon" and "Cosmetic surgeon."
1. What's the Difference Between a Plastic Surgeon and Cosmetic Surgeon?
2. Cosmetic Surgery Advice-- Consider the Source.
On my website I've written "How to Choose a Plastic Surgeon." Click here for it.
It's not enough for your "cosmetic surgeon" to have just stayed at a Holiday Inn Express last night!
Thanks for reading.
Kamis, 02 April 2009
Lauren Conrad - Plastic Surgery?
The Hills star Heidi Montag has received a lot of press about her plastic surgery. What about her friend / enemy Lauren Conrad? Has she had plastic surgery too?
I doubt it. The most common plastic surgeries in a woman her age are breast augmentation, rhinoplasty, and liposuction. Her breasts don't appear augmented, her nose doesn't show signs of previous surgery, and she's too thin to benefit from liposuction. IMHO she's a natural beauty.
And then there's Heidi...
photo credit: prphotos.com
Thanks for reading,
Michigan-based Plastic Surgeon
Anthony Youn, M.D.:
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