Michael Workman, MD

PLASTIC SURGERY SAFETY
ONE OF THE HOT TOPICS REGARDING PLASTIC SURGERY HAS BEEN SAFETY, ESPECIALLY SINCE THE DEATH OF KENYA WEST'S MOTHER.
A COUPLE OF THOUGHTS COME TO MIND REGARDING THIS IMPORTANT TOPIC .
PLASTIC SURGERY IS VERY SAFE AND IN FACT HAS NEVER BEEN SAFER. STATISTICS SHOW THAT DRIVING YOUR CAR PRESENTS A HIGHER FATALITY RISK THAN ROUTINE PLASTIC SURGERY. MALPRACTICE CLAIMS AND PREMIUMS FOR ANESTHESIOLOGISTS (THE DOCTORS THAT PUT YOU TO SLEEP) CONTINUE TO DECLINE DESPITE INFLATION. NONE THE LESS A SMALL NUMBER OF PEOPLE DO DIE BOTH DRIVING AND FOLLOWING SURGERY. I BELIEVE THE DEATH RATE IS APPROXIMATELY 1 IN 50000.
WHEN ONE LOOKS FURTHER INTO THIS IT TURNS OUT THE RISK INCREASES AS THE SURGERY LENGTH AND COMPLEXITY INCREASES. IN OTHER WORDS VERY EXTENSIVE AND LONG PROCEDURES ARE RISKIER.THE OTHER FACT THAT EFFECTS RISK IS THE AGE AND HEALTH OF THE PERSON UNDERGOING SURGERY. RISK INCREASES AS WE AGE AND IF WE HAVE HEART PROBLEMS .
MY IMPRESSSION IS KENYA'S MOTHER WAS NOT VERY HEALTHY AND IN FACT ANOTHER SURGEON REPORTEDLY HAD REFUSED TO OPERATE ON HER . I HAVE HEARD THAT SHE HAD A VERY LONG SURGERY INVOLVING MULTIPLE PROCEEDURES. THE COMBINATION OF A LONG SURGERY ON SOMEONE WHO IS NOT IN VERY GOOD HEALTH PRESENTS A MUCH GREATER RISK THAN OPERATING ON SOMEONE WHO IS HEALTHY AND UNDEGOES A SHORTER PROCEEDURE.
THE THIRD ISSUE IS THE DOCTOR INVOLVED WAS NOT CERTIFIED BY THE AMERICAN BOARD OF PLASTIC SURGERY. AMERICAN BOARD OF PLASTIC SURGERY CERTIFIED MDs HAVE COMPLETED 7 OR MORE YEARS OF SUPERVISED TRAINING IN THE UNITED STATES UNDER VERY STRINGENT SUPERVISION AND HAVE PASSED WRITTEN AND ORAL EXAMS IN ADDITION TO HAVING PRACTICED 3 YEARS OR MORE HAVING ALL OF THEIR SURGERIES REVIEWED BY THE BOARD FOR 6 MONTHS. WHILE THIS DOES NOT ELIMINATE RISK IT HELPS ENSURE YOUR SURGEON IS WELL TRAINED AND HAS GOOD JUDGEMENT.
WHAT CAN YOU DO TO MINIMIZE YOUR RISK OF PLASTIC SURGERY ?
1 AVOID ANY SURGERY THAT IS ESTIMATED TO TAKE MORE THAN 3-4 HOURS.
2 MAKE SURE THE OPERATING ROOM USES SCD's (devices that prevent blood clots by massaging your legs). WE SEND YOU HOME WITH THEM AFTER LONG SUGERIES.
3. MAKE SURE THE OPERATING ROOM IS NATIONALLY ACCREDITED.
4. IF YOU HAVE ANY HEALTH ISSUES ASK YOUR REGULAR DOCTOR IF HE THINKS YOU ARE A CANDIDATE FOR THE OPERATION.
5. MAKE SURE YOUR PLASTIC SURGEON IS CERTFIED BY THE AMERICAN BOARD OF PLASTIC SURGERY.
6. CHECK IF THE OPERATING ROOM HAS HEATING BLANKETS WHICH ARE USED TO KEEP YOU WARM DURING SURGERY AND FURTHER REDUCE RISK DURING LONGER PROCEEDURES.
6. MAKE SURE YOU HAVE SOMEONE TO HELP YOU AFER SURGERY WHO CAN SUPERISE YOUR MEDICINES AND GIVE NEEDED ASSISTANCE.
HOPEFULLY THIS INFO HAS BEEN HELPFUL. PLASTIC SURGERY LIKE EVERYTHING IN LIFE HAS SOME RISKS. THESE CAN BE RUDUCED TO A VERY LOW LEVEL BY FOLLOWING SOME SIMPLE SAFEGUARDS. WE HAVE SAFELY PERFORMED WELL OVER 10,000 PROCEEDURES AT OUR OPERATING ROOM BY FOLLOWING THESE GUIDELINES AND LOOK FORWARD TO CARING FOR YOU.
MERRY CHRISTMAS AND A VERY HAPPY NEW YEAR!

ARE YOUNG PEOPLE HOOKED ON TANNING?

As a surgeon, I have to keep up on every health care study that gets published. A recent one that caught my eye was conducted by a University of Washington team of researchers on the subject of tanning.

A group of 385 male and female University of Washington students were asked to complete a questionnaire that included questions about their tanning practices. 76 percent of the women in the study admitted to tanning their skin, compared to 59 percent of the men questioned. In fact, 42 percent of the women reported that they use indoor tanning devices and services, compared to only 17 percent of the men in the study.

In my opinion, the most disturbing statistic comes from those with a family history of skin cancer. People who may be genetically inclined to develop skin cancer were found to engage in tanning far more than subjects without that family trait. What would drive someone to tan themselves when they know they stand a stronger than average chance of contracting skin cancer?

My theory, which is also looked at in the study, is that this behavior has become an addiction to these people. Over-focusing on one’s personal appearance is one of the easiest addictions to develop and since there is no outside stimulus involved (such as an alcoholic drink, or drug), it’s one of the hardest to personally identify and shake off. The study shows that 41 percent of students who tan do so to de-stress and escape their problems and pressures. These are factors and motivators that are found in any addictive behavior.

If you have a family history of skin cancer and still desire to tan, please think twice about it and speak with your physician. Use a high quality bronzer instead. One carefree season in the sun could cost you in years of pain and disease.

The study, which looked at tanning behavior among undergraduate college students, was conducted by a University of Washington research team and appeared in the March issue of the Journal of the American Academy of Dermatology. Researchers asked 385 male and female University of Washington students to complete a multiple-choice questionnaire that included questions about their personal tanning practices and those of their family and friends.

Of the students who participated in the study, 76 percent of females reported purposely tanning their skin, while 59 percent of male participants reported the same. In addition, 42 percent of the female students reported using indoor tanning devices, as compared with only 17 percent of the male participants.

The study notes that while a known family history of skin cancer is a risk factor for developing future skin cancers, participants who reported a family history of skin cancer were significantly more likely to engage in tanning than those students without a known family history of skin cancer. Of the students with a positive family history of skin cancer, 77 percent purposely tanned their skin outdoors and 45 percent used indoor tanning devices. This result, say the researchers, implies that even a personal experience with skin cancer may fail to alter tanning behavior among young people.

PUBLIC APPROVAL OF COSMETIC SURGERY AT AN ALL-TIME HIGH

The American Society for Aesthetic Plastic Surgery has just released some very interesting statistics, based on a survey conducted with 1,000 people over 18 years old.
62 percent were in favor of cosmetic surgery, which represents an 8 percent increase from last year. This is the highest rating since the survey began ten years ago.
There was only a 2 percent approval difference between men and women, while females were 16 percent more likely to consider cosmetic surgery for themselves.
People above 65 years old were 11 percent more likely to approve of cosmetic surgery than they were only a year ago.
People between 18 and 24 years old were more likely to approve of cosmetic surgery than any other age group.
Overall there was a 1 percent increase in the number of cosmetic procedures performed. Women had more than 10 million surgical and non-surgical procedures while men had just under 1 million.
Why the constant increase in public approval? Is it the proliferation of “Extreme Makeover” shows on television? Personally, I think it’s because procedures are getting safer and more predictable with each passing day and the Internet has given everyone an easy way to research the procedure of their choice. In the future, a trip to your local plastic surgeon may be seen as common as your bi-annual dental visit. With baby boomers getting older and wanting to look younger, I expect approval ratings will continue to increase.

DO ATTRACTIVE PEOPLE MAKE MORE MONEY?

This idea has certainly been pounded into our subconscious from TV, film, radio and magazines. Is this notion an unpleasant comment on our shallow, narcissistic society, or some ad agency’s greedy agenda? Research from the University of Texas seems to support that the idea that “looks equals money” may be true.

The Journal of Labor Economics published the study, which states that physically appealing people earn five percent more than average looking people. Along with that, average-looking people earn nine percent more than plainer looking people. More to the point, those plainer looking souls receive fewer promotions that prettier people.

This idea is not so far-fetched. I’ve seen many people whose lives change dramatically for the better after a cosmetic procedure. You simply cannot put a price tag on inner confidence. Confidence makes anyone look more attractive and if that person elects to change their appearance, whether it’s with liposuction, breast surgery or a facelift, that confidence often increases.

The researchers involved found about 20 percent of the participants’ confidence levels were based on how attractive they felt to others. It’s a fact that confident people do better in life. Confidence is infectious and people instinctively want to be around confident, energetic people.

So maybe the idea that attractive people make more money isn’t as mean as it sounds. Perhaps for some people that burst of confidence has to begin from the outside and work it’s way in. Once that confidence finds it’s center inside you, it can radiate out and touch others.

RESEARCH STUDY ON SELF-ESTEEM AND BREAST AUGMENTATION

Something I’ve seen through thousands of breast augmentation patients is now being supported by a new study conducted by a University of Florida researcher. As reported in Science Daily, the study describes overall increases in women’s self-esteem and confidence, both in their sexuality and overall interactions with the world in general.
The study was comprised of 84 women between the ages of 21 and 57 years old. They were interviewed before and after their breast augmentations. The study’s author, Cynthia Figueroa-Haas, a clinical assistant professor at the University of Florida College of Nursing, used what is known as the Rosenberg Self-Esteem Scale and the Female Sexual Function Index to gauge the patients’ responses.
She found that the average self-esteem score rose from 20.7 to 24.9 (on the Rosenberg scale of 30). She also found the average female sexual-function score increased from 27.2 to 31.4 on the 36-point FSF index. These women are feeling more confident, attractive and are able to more fully enjoy their bodies with their partners. There was also a small number of participants showed no change in their levels of self-esteem or sexuality after surgery.
This study will prompt further investigations into the area of self-image through cosmetic surgery. It seems odd to me that there are still health-care providers who frown upon the benefits of elective procedures. I believe you cannot underestimate the impression one gets when they look at themselves in the mirror. That impression follows you around all day long. I have heard countless “thank you”s from women who not only feel better about themselves with their new look, but also tell me about how the world treats them better. Is it simply because they fit in more closely to modern media’s view of what is attractive? Sure, that plays a small part, however I firmly believe that when you feel great about yourself, that feeling translates to others and they start thinking you’re wonderful as well. All without words, just confidence and renewed, outgoing enthusiasm.

A BREAST REDUCTION ALTERNATIVE FOR AFRICAN-AMERICAN WOMEN
Many African-American women have decided against breast reduction surgery because their darker skin is more prone to adverse scarring. A report that recently appeared in Plastic and Reconstructive Surgery suggests that liposuction breast reduction could give these women what they desire with a “scarless” result.
Seventeen women who had lipo breast reduction were studied for six months after their procedures. They all experienced substantial relief from neck, shoulder and back pain, as well as improved postures.
What is more interesting is the increase in self-esteem each woman experienced. Their quality of life improved, as well as their health. No scarring was apparent, just a happier and freer frame of mind. A happier frame of mind leads to better decisions in your life.
The only caveat to mention is that lipo breast reduction is not a good solution for sagging breasts. Also, the breasts cannot be reduced as much as through traditional breast reduction. That said, it is a wonderful solution for many women who struggle with back strain and an uncomfortable self-image.

SILICONE GEL IMPLANT UPDATE

It is interesting to me how we are seeing an almost weekly increase in the percentage of patients that are opting to go with silicone gel implants rather than saline. I think over the past month approximately 80% of women have chosen silicone gel implants rather than saline. Most have either talked to friends or have done extensive internet research and feel that the softness and more natural appearance justifies the greater expense, longer scar, and the decreased ability to achieve symmetry. If one looks at European data, 90% of women within the first several years given the option, changed to silicones. I think it is not surprising that we are seeing that.

Regarding the gummy bear implants, we continue to get questions on this and have not heard any new information coming from the FDA regarding their approval. At this point, it is anyone’s guess whether or not they will be approved and secondly, it is hard to predict when the FDA will approve them. The gummy bear implant is what we call a form-stable implant, which means that you can cut it in half and it will not change its form. The silicone is much more cohesive than any of the current silicone gel implants out. One of the downsides, however, is they are more difficult to work with because there is less margin for error after the implant has been chosen if it does not conform to the breast pocket. That is why there are many, many more shapes and sizes to choose from when using a form-stable implant. All this notwithstanding, the clinical trials have been very promising regarding the form-stable or gummy bear implants, and we are hopeful they will be approved as I think they offer another choice for women to choose from regarding breast augmentation.



Michael Workman, M.D.
MW/kp