Crows' Feet, Begone!

Plastic surgery researchers are always looking for new and better ways of doing things cosmetic.

For instance, surveys show that many people dislike and avoid needles, although needles on surgical syringes have shrunk to virtually nothing and are even coated with special materials so that a puncture is barely felt.

Some plastic surgery researchers have even developed syringes that blow a blast of numbing frigid air just before the needle touches flesh. (Read more about cosmetic surgery ouchless needles.)

Plus, smaller, less painful needles can be used on all types facial fillers.

Other Botox, Dysport and Xeomin (the newest wrinkle fighter) users also say they don’t like needles anywhere near their eyes.

Plus, if unskilled practitioners inject too much Botox, the wrinkle killer can spread under the skin and make an eyelid droop, cause an eyebrow to sag or result in a partially drooping lip that might make you look like you’re pouting. Too much Botox, Dysport, or Xeomin injected into the crows’ feet in an overdose can result in dry eyes. And, bruising at the injection site is always a concern.

Now in stage II clinical trials, a California company is developing a gel that smooths crows’ feet very much like Botox, but without injections. Instead, the substance – now known only as RT001 — is spread on like night cream or sun block…. by a cosmetic plastic surgeon.

But don’t hold your breath just yet; it may be several years before the next, and final, round of clinical trials of topical Botox are finished.

According to the manufacturer, Revance Therapeutics in Mountain View, California, RT001 has been in 11 clinical trials that treated 550 research subjects.

Researchers found the active ingredient, the muscle-paralyzing botulinum toxin type A, does not cross through the skin. But, when combined with another substance – in this case a coating of something known as peptides – the wrinkle fighter penetrates the skin to stop muscle actions resulting in facial wrinkles.

In the latest RT001 tests, about half of patients and researchers saw a huge improvement (from severe to mild) in crows’ feet after a month. About 89 percent saw a modest improvement. Just to make sure they were on the right track, some researchers painted botulinum toxin right on the skin. But nothing happened.

When RT001 goes onto the market – under a more attractive name, of course – it will only be used by doctors and not available for home use.

Reading Cosmetic Surgery Do's

News reports indicate that plastic surgery in America is increasingly picking up steam, with more people searching the Internet for qualified plastic surgeons, planning their surgeries and actually going under the knife for surgical rejuvenation.

You may know the most common things to do, but we would like to present our thoughts on good ideas not to do when it comes to cosmetic plastic surgery

The Top 10 DON’Ts for finding a good plastic surgeon:

•    Don’t go to a cosmetic surgeon only because you saw him on TV
•    Don’t ask a surgeon to give you Brad Pitt’s nose or Salma Hayek’s eyelids
•    Don’t make the doctor selection strictly on who the cheapest provider is
•    Don’t select a “Jack of All Trades, Master of None”

• Find a specialist who does the procedure – like rhinoplasty — you want three         times weekly

Don’t forget to ask about qualifications and certification of anesthesia providers and the surgery facility.

•    Don’t be hustled into the operating room by an overly-aggressive staff

The red warning flags should go up if anybody OTHER than the surgeon shows up for you initial consultation.

•    Don’t believe that every procedure is a “piece of cake” and that you will be “back to work in no-time”

Too many TV shows lead people to think recovery from cosmetic plastic surgery takes somewhere around 20 minutes. Ask what the usual, expected, customary recovery times are for the procedure you want so you can make appropriate shopping and working plans.

•   Don’t ever go into an operating room to please anyone else or if you are not positive about having surgery. (Read our previous post, “When in Doubt about Cosmetic Surgery….Do Without)

•    Don’t have a cosmetic surgery procedure alone

At a bare minimum, somebody should drive you to and from your surgery, remain with you overnight and back to the surgeon’s office the next morning for a quick check.

•    Don’t have cosmetic surgery without being examined by your internist or family physician

First thing your cosmetic surgeon looks for are signs you are healthy enough for plastic surgery. Good medical ethics – along with the laws of some states – require you to have a physical before any cosmetic surgery.

The excellent plastic surgery blog, Suture for a Living, (by plastic surgeon Ramona Bates, M.D, who, (to quote her, “sutures for a living but sews” quilts for fun) once carried a blog post about a type of flannel garment designed to keep surgical patients warmer.

Many of our own face lift and rhinoplasty patients have mentioned how chilly it was in the operating room. Actually, it’s that way for a several good reasons.

Plastic surgeons work under very hot lights and are wrapped up in surgical gowns that hold in the heat. Excellent medical reasons for a cool – literally – operating room include:

• Retarding the growth of bacteria which grow faster in warmer conditions
• Making sure surgeon and colleagues don’t become groggy

Some surgeons actually work less efficiently if they are hot. In the days before air conditioning, surgeons have been known to drip sweat onto patients.

Patients under anesthesia may not notice if they are cold; however, the high tech monitors used today show the patients’ body temperatures as well as many other readings like:

• Blood pressure
• Carbon dioxide level
• Oxygen level

Thus, even while under anesthesia, the patient is at a safe temperature.

But it can be a different story in the pre-op and post-op recovery areas. While your teeth won’t be rattling, you may find yourself more chilled than you prefer. If so, ask for a blanket or sheet, or if you are really cold, a device known as a Bair Blanket. That’s a couple of light blankets sew into a sleeping bag. The Bair Blanket can be connected to a fan that blows warmer air into the blanket and over waiting or recovering patients.

That’s one of the reasons the surgical suit-gown (pictured below) mentioned by Dr. Bates caught our eye: that gown has a connection to attach the warming fan normally used on a Bair Blanket. Smaller versions warm only the legs or only the chest.

If you don’t want to use a Bair Blanket, you can ask for a light blanket that is first made toasty in special warming ovens.

If you are really sensitive to cold, ask your surgeon before surgery if any transfused fluids can be warmed first. Many O.R.s actually have special ovens to warm intravenous fluids.

Even if you’re not in surgery and see cold steel instruments coming at you, ask the doctor to please warm them first.

All the doctor has to do is lay the instrument in the palm of the hand.

(Look at some before and after nose job pictures)

Surgery Suit

It’s widely known that many surgeons pipe music into the operating room while performing cosmetic plastic surgery.

Given the many surgeon personality types, any one day is likely to find cosmetic surgeons and their staffs rocking, grooving, swaying or chilling to the following types of music:

• Heavy metal
• Jazz
• Classic or hard rock
• Pop
• Hip Hop
• Old favorites

A recent study published in the professional journal, Surgical Endoscopy, found that classical music affected surgeons more positively than hard rock or heavy metal.

We were glad to read that because classical music is the only type of music to which we listen while operating. Over the years, we’ve found that classical music promotes a great mood of tranquility in the operating room. It’s very important for everyone in the modern O.R. to be truly “cool” with their brains and eyes in overdrive.

The Brandenburg Concerto promotes that while Lady Gaga, in our humble opinion, does not although some very fine plastic surgeons listen to Lady Gaga.

Nonetheless, some classical selections can really get you going so one chooses selections carefully. We personally would skip the Mars movement from Holst’s The Planets (because as the God of War, Mars’ theme is some very angry, in-your-face military music.) Along the same lines, the Khachaturian Sabre Dance tends to promote rushed, frantic bodily movements. Not good for face lifts!

Why O.R. tranquility?

The newer style in any modern operating room is a far cry from when a head surgeon brusquely grunted, “Scalpel!” “Clamp!” and “Nurse – brow, wipe!” These days, all heads turn to the task at hand and if anybody notices anything at all amiss, they are told to speak up. Three or four brains at work beat a single mind any day of the week!

Nonetheless, the head surgeon chooses the music. (Imagine our embarrassment if a nose job patient awoke to Frank Sinatra crooning, “I’ve Got You Under My Skin” or “The Way You Look Tonight”!)

We also noticed that the study of best music in surgery varies widely among journals. Coming into print the same month is another “best O.R. music” study, carried in the journal, Surgical Innovation. It found that surgeons work best while listening to hip-hop or reggae.

Given the necessity of rock (as in stone) steady hands, we hope that hip-hop music has nothing to do with actual hopping.

Botox, please!

More teens are Jonesing for cosmetic surgery – and getting it.

According to the American Society of Plastic Surgeons (ASPS), 218,000 people between 13 and 19 received some type of invasive or nonsurgical procedure during 2010, the most recent year for which statistics exist. That’s two percent of all plastic surgery and a five percent increase over teens who had similar procedures during 2009.

High on the teenage cosmetic plastic surgery list are:

• Rhinoplasty (nose reshaping): 35,005 patients
• Ear pinning, (otoplasty):  8,763
• Eyelid surgery, (blepharoplasty): 1,922

Other invasive surgery included breast augmentation (8,525), male breast reduction (13,530) and liposuction (3,205).

The common denominator for all the above point to a teen’s basic desire at that time of life: to fit in with his or her peer group.

Nobody knows cruel teasing like the kid with standout ears, a crooked or overly large nose, and a teen girl with a flat chest or the boy with large, fleshy breasts that violate the masculine ideal of a broad, flat and hard upper torso.

Because the teasing and ridicule sours school and learning, cosmetic surgery — which makes the unhappy normal patient happy again — can be deemed medically and socially necessary.

But it appears to be something else again with minimally invasive procedures like Botox which saw 13,467 teen injections.

It’s hard to image a 13-year-old who has forehead wrinkles, crow’s feet or is badly creased and wrinkled between the eyebrows.

You may also scratch your head over the 66,664 instances of laser hair removal. Lives there a 15-year-old guy anywhere with a hairy back? Or a 14-year-old girl who sports a peach fuzz beard?

Ditto the laser skin resurfacing on 19,466 teen patients. While a few could have acne scars, those facial marks usually don’t show up until the 20s.

Equal puzzling are the 20,991 cases of laser treatment of leg veins. Problem leg veins usually show up after pregnancy.

While 9,091 teens had microdermabrasion, that procedure is usually performed on people to remove age and sun damage. It’s hard to picture a fresh-faced 16-year-old with age spots.

Most puzzling of all: 9,770 injections of soft tissue fillers like Radiesse, Juvederm, Restylane and Sculptra. Those fillers are usually used to fill in the lines and deep facial folds that accompany normal aging.

But maybe that’s the key – many teens are so worried about looking good, they’re going through early aging!

Look at some young nose job before and after pictures.

Liposuction at home? Never!

More than a few areas require lots of training before you can get by reading up on do-it-yourself (D.I.Y). Notable examples include home owners who jump right into repairing plumbing fixtures. Cartoon artists have made a living from D.I.Y. plumbing fumbles for decades.

A few more special areas of knowledge you may not want to take up at home include:

• Nuclear power

Want a nuclear powered home? Better get a Ph.D. in physics first.

• Bomb disposal

No physics knowledge needed for things which go boom! and can blow you up. But, extensive training is required, anyhow. Also high on your never-do-at-home list should be liposuction (or any other surgical procedure.) The largest red warning flag? Anybody who knows what they are doing understands that your den, bedroom or apartment is no place to perform surgery.

The most excellent About.com blogger, Millicent Odunze, M.D.  reports that a three-member ring in Florida were busted for doing plastic surgery on people at home. None had training, a medical license or any concept of the word, “sterilize.”

The trio was busted after a patient looking to stretch her surgery bucks was hospitalized for complications. (Read more about the liposuction case.)

Unfortunately, a mini-craze exists on do-it-yourself  cosmetic surgery procedures.

Fueled by the ability to buy anything  short of nuclear reactors  on the Internet, plastic surgeons are already seeing patients who have freely engaged in D.I.Y. cosmetic surgery, including:

• D.I.Y. Botox shots

The kits contain everything needed for jabbing your wrinkles with Botox.  Keep in mind Botox is a dilute  toxin that paralyzes muscles. When your kit arrives from India or  China, you may find that too much Botox or an injection in the wrong place can have unexpected side effects. Like,  for instance, removing your ability to breathe.

• At-home chemical peel and microdermabrasion kits

These home kits are weakened versions of the real thing you would find in a cosmetic surgeon’s office. Skin peel kits, for instance, range in price from $25 to $250 but are nowhere nearly as effective as what a rejuvenation surgeon offers.

Chemical peel, with 1.1 million procedures done in 2010, is the third leading noninvasive procedure performed, right behind Botox and soft tissue fillers.

(Read more about chemical peel.)

In one of the most bizarre cases known, a Korean woman used cooking oil as a D.I.Y facial filler and suffered disastrous results.

Solution?  Why not leave all doctoring to, well, doctors?

Mike Tindall & Nose

Any broken nose is a royal pain but, in this case, we are referring to the broken nose of Mike Tindall, a rough-and-ready captain of a British Rugby team. Tindall (his nickname in the U.K: “Tinman”) just married Queen Elizabeth’s granddaughter, Zara Phillips.

For those who don’t know, Rugby is basically football with no pads or helmets. Is it any wonder Tindall’s nose is tweaked and bent after being fractured a reported eight times?

Actually, Tindall demonstrates a possible wrinkle with any broken nose, anywhere. A break knocks the nose’s bones and cartilage out of place. Usually, that person has to get medical help within ten to 15 days or the bones will start growing back together in their out-of-whack positions. Like on Tindall’s face.

Actually, Tindall once had a nose job. He told British newspapers a local plastic surgeon put tiny metal stints inside his nose to support the septum, the thin wall of cartilage that separates the nostrils and is a major piece of the architecture of the nose.

Tindall went back to doing what he does best – Rugby – got popped in the face during a game and found the nasal inserts lying at his feet on the Rugby field. No more rhinoplasty for him, he declared. (Read more about Tindall’s Rhinoplasty.)

But the subject arose once more when Royal wedding plans were made with lots of input from his princess bride and the queenly grandmamma. Their message was: get corrective surgery before the wedding. Think of the pictures!

However, the 446 FaceBook fans of the Tindall Nose (yes, his nose has its own FaceBook page!) declared the royals should butt out and leave the damaged nose alone as a proud battle scar.

Having been a Los Angeles rhinoplasty surgeon to an American world champ boxer (who, alas, must go nameless due to medical privacy laws) we noted with sympathy that badly healed broken noses almost always have breathing problems, which include snoring that can rattle window panes.

But why do a delicate, expensive operation that can take months to heal if the patient returns to the Rugby pitch or the boxing ring?

Cosmetic Surgery Costs

While Fox Business is reporting on the top 10 ways to pay for cosmetic surgery, they don’t mention any ways to trim the total costs of plastic surgery. (Read the top 10 ways to pony up for cosmetic surgery.)

If you know the natural up and down business cycles of rejuvenation surgery, you can arrange the procedure you want when cosmetic plastic surgeons will be very glad to hear from you and may consider trimming not only some sagging flesh, but the tab for it as well.

Some insurance-covered procedures produce a better function and a more pleasing appearance, including:

• Nasal procedures inside the nose for people complaining of sinus-like symptoms. (Read more about breathing woe due to internal nasal structures.)

From November through the New Year, most facial surgeons are booked solid for patients requesting:

• Eyelid lifts
• Face lifts or rejuvenation by facial fillers like Restylane
• Wrinkle removal

But the first two months of the New Year see fewer patients. Arrange your surgery then and ask about a discount of 20 percent.

Summer, however, is not a time to seek bargains, with many high school grads, before heading off to college, booking:

• Rhinoplasty
• Other facial procedures like ear pinning, or otoplasty

College grads are also in the mix, wanting an improved appearance before a serious job hunt.

Another excellent – and financially sound – way to spring for cosmetic surgery is to save up and pay by check or cash. Credit card companies charge the surgeon anywhere from three to five percent of the procedure.  Likewise a three to five percent discount from the surgeon is reasonable for full cash payment.

Smart consumers can also ask for surgery on a standby basis, with seven to 14 days notice before surgery.

Plastic surgeons arrange their surgery dates in advance. And the staff in an operating room must be paid, even if a patient cancels the surgery. But if a patient on the standby list can replace the cancellation, the operating room remains busy. A 20 to 25 percent discount for standby surgery has been granted by some surgeons.

A word about shopping for plastic surgery bargains: confine price comparisons to board-certified cosmetic plastic surgeons.

Why?

If a lesser-trained surgeon botches the job, your costs to repair the damage can be two to four times greater than the price of the first surgery!

Before Plastic Surgery

Some time ago, we told how James “Whitey” Bulger, an outlaw on the lam for 16 years, was tracked down in part through involvement with cosmetic surgery. (Read our plastic surgery-on the lam post.)

It actually happens all over the globe, with thugs of various descriptions and nationalities doing their best to avoid justice by changing their looks to defeat wanted posters.

The most recent, a Mexican wanted for bagging $200,000, took the new persona trend way over the top, changing his (her?) gender to female! When Aaron Vera Morales was caught, she (he?) had a female I.D. (Read more about cosmetic plastic surgery and the gender-changing fugitive.)

In Japan, 32-year-old Tatsuya Ichihashi spent two and one-half years on the run after committing a murder. Police later found Ichihashi had eyelid surgery, a nose job and mole removal from a cosmetic surgeon. The fugitive also tried some do-it-yourself plastic surgery on his own face, failing miserably, according to the Daily Mail in London.

Before that, Libyan strongman Moammar Gadhafi’s plastic surgeon from Brazil, Dr. Liacyr Ribeiro, came forward and told all. (Read more about Gadhafi’s cosmetic surgery.)

(By the looks of things, NATO may additionally change Gadhafi’s appearance, but not in a good way.)

Yemeni president Ali Abdullah Saleh seem to also run into a little bomb trouble  (hidden inside his palace) and reported to a military hospital for minor burns and wound treatment. And, yes he, too, had a little facial cosmetic surgery on the side while there.

Italian Prime Minister Silvio Berlusconi, 73, isn’t actually a thug – unless you talk to the parents of his teen “bunga-bunga” girls. But he is in a scrape with the law and he does love rejuvenation surgery, given the mystery of his disappearing and re-appearing hair. Noted the Italian newspaper La Repubica about the state of his not-so-curly locks: “Three versions in five days!”

Berlusconi only admits to a nip ‘n’ tuck under his eyes although his before and after plastic surgery pictures tell a different tale.

Long before those cases, notorious gangster John Dillinger tried to burn his fingertips with acid to avoid identification.

Cosmetic Surgeons Look at Wanted Posters

Humphrey Bogart once made a movie, 1947’s Dark Passage, about an escaped prison convict who had plastic surgery and healed to look so completely different, his own mother would not recognize him.

Since then, criminals on the lam have toyed with the idea of getting cosmetic surgery so they would not look anything like their wanted posters.

Just for the record: unless your face is totally missing and you have had a complete face transplant, cosmetic plastic surgery – even in the best of hands – can only make you look like the best version of yourself. Your mother — and most especially the long arm of the law — will still recognize you at first glance.

(Get a better idea what cosmetic plastic surgery is all about by looking at some actual before and after face lift pictures of ordinary, non-law breaking people.)

Recently collared crook James “Whitey” Bulger spent years on the FBI’s most wanted list while  traveling with a woman, Catherine Greig, now 60, who had cosmetic surgery, including:

• Liposuction
• Eyelids lift
• Rhinoplasty
• Breast augmentation
• Facelift

The FBI noticed that Catherine’s breast implants were first implanted in 1992 and figured that she might have to have them replaced sometime soon.

So the federal sleuths sprang for an ad in the Plastic Surgery News showing Whitey and Catherine’s faces, wondering and if any plastic or cosmetic surgeons or their staff had seen them, asking in a large headline “Have You Treated These Fugitives?”  Next best thing, they figured, to actually staking out the surgeons’ offices.

The feds also took out an ad in dental publications because Catherine had once worked as a dental hygienist. (Always good to having something solid to fall back in case the crime capers don’t work out, huh?)

Ditto, beauty salons, because gal pal Catherine was fond of dying her hair.

Two days ago, a tip fingered the duo, coming from a so-far-unknown Santa Monica, California, neighbor where the wanted couple had been living an ordinary life for years. Well, “ordinary” if you consider a cash stash of $800,000 and an armory of 60 firearms sitting in closets.

Too bad no plastic surgeons, dentists or beauty operators did not come forward. The reward for Whitey and Catherine’s capture had increased to a cool two million bucks.

Nonetheless, kudos to the feds for calling on cosmetic surgeons!