oh my.

They don’t know what this person was injecting, but being a foreign substance, it 1. got infected and 2. the body didn’t like it so it spit it out. 

There are more and more of these cases popping up: a NY woman injecting free silicone, the Florida injections of super glue, tire sealant, and cement.   I don’t have a lot of patients seeking to enhance their bottoms.  If you want a larger or curvier bottom, the best way in my opinion to get more curve is to 1. take down the surrounding areas like the love handles and outer thighs using liposuction, to help define the buttock area more, and 2. fat graft into the buttock to give more volume.  (This is a surgical procedure, and in my view should be done by a board certified plastic surgeon well versed in liposuction and fat grafting.) 

I cringe when I read these stories.  I get these hotel room, back room injections are cheaper.  But are they?  When you get infections and ER visits and operations to try to fix things… and the likely irreversible scarring and disfigurement which comes with it…. I don’t understand.  In this age of computers and information, please do your homework. 

• Safe surgeon.  Look at their credentials and training.  Research them.
• Safe technique and substance.  Research it.  Free silicone has issues which are well known.  And who would ever think cement and tire sealant are good things to inject?
• Safe place. When doing a large scale injection, you need sterile technique.  Otherwise you can get infections. 

http://abcnews.go.com/GMA/WaterCooler/wireStory/nc-woman-charged-buttocks-injections-bad-15114376

and Botox (the wrinkle eraser for the forehead, lines between your brows, and crows feet around the eyes)

have paired up.  The current program is INSTANT REDEMPTION of $75 if you are a member of Brilliant distinctions.

Rules:

• Do botox and Juvederm between August 15 2011 and November 30 2011
• We have coupons in the office with a special code.  We enter that into our handy dandy computer while you are at check out and…
• WALAH! $75 off.

We just got these coupons in our office today.  So if you have already done botox or juvederm, you are half way there…. come do the other one, and get $75 off.  (If you do the mail in form they need to be done on the same day).  Add this to the $25 you save with botox and $25 for the syringe of Juvederm and it totals $125 off!!!

So at my favorite TIPS Plastic Surgery meeting in San Francisco in June we discussed many of the new things out there.  What I am repeating here is what I learned there. 

• platelet rich plasma.  Good stuff, may help fat survive, BUT you need a large amount of blood to get enough to help.  Likely not feasible.
• stem cells.  Studies showed if you supplement fat with stem cells you can increase survival.   Again a feasiblity issue- you need a lot of fat for a tiny plug of stem cells.  Many women seeking fat transfer don’t have much fat to transfer, much less extra liters of fat to spin down for a small plug of stem cells.

There is still a lot of controversy.  Yoshimura out of Tokyo has looked at stem cells a lot.  He focuses on the face.  He published a study in the Aesthetic Plastic Surgery Journal in 2008 showing adipose stem cell enriched fat showed increased transfer efficacy.  (IN NON DOCTOR TALK= When you move the fat, if you add stem cells to it, more of it lives.)  The ratio of stem cells to fat he used was high.  An issue remains – in order to get that amount of stem cells you need to harvest a lot of fat and distill it down to get the little tiny amount of stem cells.  Again, as I alluded to above, maybe stem cell enriched fat is better for smaller areas, where you are grafting less fat.  For large areas, it can be hard just to get enough fat to transfer, much less get extra liters of fat to spin down for stem cells to enrich the fat.  And many in the plastic surgery field say you don’t need to enrich the fat with stem cells, as fat is a rich source of stem cells in itself.  They argue when you transfer fat, you are transferring stem cells already in the fat.

And there are other basic questions about fat grafting which we don’t fully understand yet.  (This gets into more science-y stuff, so some of you may tune out)

• Do the cells you transfer live?  Or do the cells die and release something the neighboring cells like? 
• When he looked at the cells 4 weeks out, he found a lot of cells are dead, but there were new cells from the progenitor cells.  (It was like you tranferred a mommy cell which gave birth to new baby cells and then the mommy cell died.)
• At 3 months he found no more new fat.  At that point you could see oil cysts. (So things tend to stay stable after 3 months.  Until that point there is more flux with fat cells- some which have died are bdisappearing and the new cells which formed are growing)

From his research he hypothesizes during the first 3 months you see tissue repair, then for the next 9 months you see stabilization, oil absorbtion, or oil cyst formation.  Understanding what happens to the fat when we move it will help us be better at helping it survive in its new location.

All good stuff to help us make fat grafting techniques improve.

CURRENT SPECIAL: $50 off each vial, up to 3 vials.

My patients overall have loved it. The only issue I have heard of is bruising. To help stack the deck in your favor, please read my blogs on how to avoid bruising. Also ice your face on the way into the office.

I have loved the results- I think it is a beautiful, natural change. 

For how it works, follow this link. http://www.sculptraaesthetic.com/consumer/how-does-sculptra-aesthetic-work-video.aspx

1. I have tons of goodies coming up. 

• Did you print out your brilliant distinctions coupon? If you are signed up, you will get rebates which you print out and bring in to me for additional money saved.  This is good for Allergan products: Latisse, Juvederm, Botox.
• Botox special day: September 8.  This may be the last one of this for a while (I am able to offer it with help from the rep).  24 units for $275, 48 for $450. 
• $100 off each syringe of Juvederm.  Til September 15.  This is not a mail in rebate. Read my blog on what to do before doing filler to avoid bruising! (it works!)
• Restylane and Dysport (another brand of botox) day.  September 15.  Use two syringes of Restylane, and get a free area of Dysport (a $325 value!!)  Dysport also has a special going on right now, where you get $50 off each treatment, and another $50 off if you can show you used Botox or Dysport from 3-12 months ago. (These are mail in rebates for the money off, the free area of Dysport is from here.)

2.  Groupon and other “deals of the day” and plastic surgery.

I have not done any of these.  Today I got the Plastic Surgery Practice magazine, and their lead article was about doctor offices and the “deal of the day” sites.  They state “Partnerships between medical practices and third party “deal of the day” organizations such as Groupon, when based on compensation per lead is fee splitting, which is violation of the law in many jurisdictions.”  I do not mean to single out Groupon.  There are many sites: livingsocial, dailydibs, etc.  In the article the people interviewed do feel these laws are antiquated and have not caught up with the internet and e-commerce age. But as of now, deals of the day are in a legal gray area.

Until everything is clearer, I will stick with the good old fashioned specials.  They might not be broadcast widely, but I am more about grass root support anyway.

Please feel free to forward on to a friend.

Nonsurgical procedures are common.  The whole beauty (pun intended) of nonsurgical procedures is there is “no downtime”  and they are secret.  No one knows why “you look refreshed” “relaxed” “young for your age.” But if you get a bruise… uh oh.  There goes the whole anonymity of it all.  There is no downtime, but you need to go to work, drop kids off at school, go to the grocery store.  If you get a bruise…. How many times are people going to believe you bonked your head on the car door (silly me!) or your kid threw a toy which accidentally gave you a bruise (oh no!) on your cheek?

I had a patient whom I did filler on last week who said, “OH MY GOSH!”  as she had the epiphany a woman whom she knows very well who says she was doing “nothing” has for a while been doing fillers.  The culprit? How did my patient figure it out?  Aha!

A bruise.

So.  There is no sure fire way to avoid bruising.  When I take a sharp object (ie a needle) and poke it through your skin (sorry, I know it is graphic), you can bruise.  The face is very vascular (ie has a lot of blood vessels), and certain areas have higher tendencies to bruise than others.  Should we give up? Throw in the towel? No. 

There are things you can do to help.

I wrote on this a while ago.  See original blog:

Two weeks ahead of time:

• Avoid medications which cause bleeding.  See my blogs: aspirin NSAID products, herbal products, and any vitamins or pills in general which are “heart healthy.”
• Some people tend to bruise more.  In general, if you know you are a bruiser, expect you will bruise.
• If you are doing Sculptra, which involves injections over a more broad area, expect some area may bruise.
• The cheek/eye junction and the mouth like the bruise the most.
• Don’t schedule it right before a big event like a wedding, reunion, etc.  Murphy’s law will reign supreme, and we will hit something.



Two days ahead

• Start herbals which decrease bruise and swelling: arnica and bromelain



The day of

• Exercise if you are going to waaay ahead of injection time. (Yes, you Palo Alto girls.  Walk the dish early in the morning or wait until a day out.) You don’t want to be hot, sweaty and have your blood vessels be dilated when you come in.
• Ice on the way driving into the office



After

• Elevate
• Ice
• No bending over, straining, lifting heavy objects (like kids)
• Crank the AC in the car.  Being hot= blood vessels dilated= easier to bruise.
• Do the anti bruising and swelling herbals
• No exercise (this includes anything which raises your blood pressure or makes you hot and sweaty. Yes, this includes things which I cannot discuss here.)
• Sleep with your head elevated

If you have any sign of bruise, do not work out until the bruise is gone.  Once you bruise, it will take a week til it is fully gone.  For most women it is not bad, particularly if you have darker skin.

And pray to the anti-bruising angels. There is always a little luck involved.

“Dr. Lauren Greenberg is the only board certified plastic surgeon I will let work on me now.  Dr. Greenberg takes as much time as you need during consults to ensure that you have all the information you need, and that all questions are answered.  I went in wanting a breast reduction and mini face lift, and instead she told me I needed a lift, not a reduction and could do it with a lollypop incision.  My other surgeon that I was schedule for the procedure said I had to have an anchor incision and take me down to a C, which is smaller than I wanted.    This is a HUGE difference in scarring and size.  It’s easier to take off more breast tissue  later on if I want them smaller than to have to put an implant in to get the size back.  Regarding the request for a mini face lift, she said it wasn’t time and suggested several other options that were non-invasive and much less expensive.  (I am 48 years old).  I said I’d go the Juvederm route first, and she stayed late to administer it without hesitation.  I went back three weeks later for a second round, and the next day coworkers told me how good/rested I looked – vibrant with great skin!  

Dr. Greenberg does not up sell you, gives you all of the downsides of treatments and surgeries and is honest about complications that past patients have had and how to avoid them.  She doesn’t talk down to you, doesn’t use clinical terms that a layman would not understand, and uses analogies to explain how the different options work.

She is very busy, and you need to be patient when making appointments because she is so booked…because she is THAT good.  I have two more procedures scheduled with her and am no longer afraid to have the surgery.  Check out her website – she puts so much time and thought into it to educate her patients and the public.  She described the different incisions for breast reductions/lifts including what she favors and how she does it.   Don’t have fillers or surgeries done until you have the chance to meet her.  You’ve be happy you did.”

NM, San Jose, CA,  juvederm patient

Sculptra sculptra sculptra.  For all of you Bay Area women who are anti surgery 40 somethings, I think this is a great product.  I have patients out 2-3 years after injection, and we like the results.  As you may have noticed, Sculptra is finally doing some advertising to let people know they are out there.  As with all ads, the ad is more likely about name recognition than anything else. But it doesn’t change the fact I think it is a good product and my patients love it.

Sculptra TV ad

And to see a more informational video of a woman who really has received the product, see this:

Sculptra patient video

• Patients can receive $50 off each mL of Restylane or Restylane-L® (minimum purchase of 2 mL in a single treatment required) or
• $65 off each mL of Perlane or Perlane-L® (minimum purchase of 1 mL required) they receive in their treatment, up to a maximum of 6 mL per visit!
• To qualify, patients must receive treatment with a product in the Restylane family between February 1 and March 31, 2011, and mail in their redemption submission postmarked by April 30, 2011.

I have been injecting it in patients for over two years now.  All of my patients have loved it, particularly the subtle slow onset, the longevity, and the naturalness.   If you are doing two or more syringes of Juvederm or Restylane a year, this is likely a better alternative.  (Though Sculptra is not to be used in the lips.)

http://abclocal.go.com/kgo/story?section=news/health&id=7805045

And Sculptra is offering a rebate through March 31, 2011…. $100 off each vial, up to three vials.  !!