MedWorm: Plastic Surgeons

One year blogiversary

Suture for a Living — Fri, 16 May 2008 13:19:54 +0100

It has been a year since I began this blog. I am amazed to find that I have the same anniversary as T (Notes of an Anesthesioboist). I was sure she had been around for several years. She seems so polished. So congratulations to her and also to Dr Rich, Covert Rationing, whose blog turned 1 yr yesterday! (photo credit)It has been a good year. I was nominated for the "Best New Medical Blog 2007" which was won by Dr Val (deservedly so). I have hosted SurgeXperiences twice (here and here). I was given the honor of hosting Grand Rounds (here). I won a Scrubby Award for this post, but still haven't received the red scrubs (they must be in the mail). I did get this T-shirt for my birthday last year after seeing it on Emergiblog's post.I have made many new friends through this blog. My husband and I took Dr Val to dinner when she came to Little Rock, AR back in October. I was invited by a quilting friend, Kate, who lives in England (the country not the town in Arkansas) to participate in a quilt swap. I am almost done with my little quilt. I have grieved with Dr Smak over Henry, but am gladden by his response to chemotherapy. I have traded e-mails regarding our dogs with another quilter Penny and grieved with her when one of hers died as I did when I lost Girlfriend in September. I would like to meet more of you in person, but until then thanks for the chats in Dr Anonymous' BlogTalkRadio chat room and the connects on Facebook, Pownce, and Twitter. Thank you all for welcoming me into your fold. It's been a very good year! I'm looking forward to another good one. THANK YOU! (Source: Suture for a Living)

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Just when you thought madonna had run out of plastic

Awful Plastic Surgery — Fri, 16 May 2008 10:05:51 +0100

Just when you thought Madonna... [[ This is a content summary only. Visit MyWebsite.com for full links, other content, and more! ]] (Source: Awful Plastic Surgery)

Nose job: knowing when to keep quiet

plasticized.com — Fri, 16 May 2008 04:00:00 +0100

(Source: plasticized.com)

Dermal fillers -- some tips

Suture for a Living — Thu, 15 May 2008 12:13:18 +0100

The Dermatology Journal Club (Elsevier) published a CME-related activity on "Achieving Optimal Outcomes with Dermal Fillers". It is reviewed two articles. The CME exam is available here, but I can't find the on-line publication of the journal. You will need to register to use the site, but it is free. The two articles are listed below under references. If you use dermal fillers, these articles are well worth reading. I reviewed several of the different fillers here. The results can be great as in the photo to the right (credit) when used properly. Tips for both patient and doctor:All dermal fillers have the potential for complications. Appropriate filler and injection-site selection, correct injection technique, and appropriate patient selection will minimize most complications. Temporary side effects associated with all fillers include swelling, redness, itching, bruising, and mild pain. Patients should limit their expressions and normal facial movements for 3 days after injection. The face should also be protected from extreme cold postinjection (ie snowmobiling without facial protection). By 3 months, permanent implants will have assumed their final shape. Touch-ups can provide additional symmetry and correction at this point. Early complications include Persistent erythema (long-lasting redness) is the most frequent early complaint. It is usually due to unintended intradermal injection. If the erythematous area is flat, then intense pulsed light (IPL) can be used to effectively reduce the lesion. Ridges along the injection site and superficial beading are due to superficial intradermal injection and generally appear within 2 weeks. Injected strands (in particular those in the nasolabial folds) can separate unless an attempt is made to minimize motion at the injection site for 3 days. Limiting motion will allow the implanted material to become encapsulated and prevent it from dislocating. Blanching after a particulate injectable indicates that a ridge may form later unless pressure is applied to the area to distribute the implant evenly. Nodules will often appear within the first 4 weeks. They are often due to superficial or improper technique or inappropriate injection location. They tend to be small, isolated, well encapsulated, and respond poorly to intralesional steroids. They may require excision. Late complications include Hypertrophic scarring may occur in patients who are prone, but only if the substance is injected too superficially (intradermally). Late inflammatory reactions include localized redness, swelling, and paresthesias. These can occur years after injection in all but the temporary fillers. Treatment with IPL or intralesional steriods is frequently effective. Granulomas tend to appear 6-24 months after injection. They are true foreign-body reactions. They can occur despite proper injection technique. They are characterized by their late-onset rapid growth, inflammatory appearance, relatively large size, discoloration, and projections into surrounding tissues. They seem to appear simultaneously at all injection sites. They usually respond well to intralesional steroids. (photo credit) Steroid atrophy, depending on the dose, may occur in 5-30% of patients treated for chronic redness, nodules, or granulomas. Recommended intralesional corticosteroids includeTriamcinolone 20-40 mg Betamethasone 5-7 mg Methylprednisonlone 20-40 mg Betamethasone (0.5 mL) in combination with 5-fluorouracil (1.6 mL) and lidocaine (1 mL) Triamcinolone (10 mg/mL) with 5-fluorouracilIntralesional steroid injections can be associated with secondary effects such as skin atrophy, treatment resistance, and risk of recurrence. A few summary points from the second article:Some patients are better candidates for aesthetic volumizing with Sculptra than others, because they are better at making collagen. Ideal locations for Sculptra injection are the nasolabial folds or creases, marionette lines, cheek hollows, zygomatic arches, temporal depressions, and depressed, scarred areas. Some physicians also use Sculptra for lateral eyebrows and dorsal hand areas. Large areas, such as cheek hollows benefit from serial injections of very small volumes (0.1-0.2 mL or less) applied in a cross-hatched pattern. Advanced needle techniques such as fanning and retrograde tunneling using very small volumes work well in these areas. Specialized training and experience are necessary to utilize these techniques. Sculptra should not be used in the body of the lip. This site offers a high probability of having nodules or papules form. Injections into the glabella and forehead are not recommended because of the risk of necrosis (photo credit)with any particulate product in these areas. Nodule or papule development can be prevented by proper injection technique and appropriate identification of areas to be injected. Ice application postinjection may minimize bruising. A massage several times a day postinjection to the area can minimize papule formation. REFERENCESTreatment Options for Dermal Filler Complications; Aesthetic Surg J 2006; 26:356-365; Gottfried Lemperle MD, PhD and David M Duffy MDUse of Sculptra in Esthetic Rejuvenation; Semin Cutan Med Surg 206; 25:127-131; Kenneth R Beer, MD and Marta I Rendon, MD (Source: Suture for a Living)

Michael jackson video

Celebrity Cosmetic Surgery — Thu, 15 May 2008 04:00:00 +0100

This interesting video contains some photos of what appears to be Michael Jackson's actual vitiligo. It is made by an obvious Michael Jackson fan, and has some very eye-opening photos. Check it out if you have eight free minutes (the first 4 minutes are the most interesting). Thanks to AwfulPlasticSurgery.com for the link. (Source: Celebrity Cosmetic Surgery)

Nikki's husband loves her lips

Awful Plastic Surgery — Wed, 14 May 2008 21:56:30 +0100

While she does plenty of... [[ This is a content summary only. Visit MyWebsite.com for full links, other content, and more! ]] (Source: Awful Plastic Surgery)

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Antibiotic tx for seawater injuries

Suture for a Living — Wed, 14 May 2008 11:47:39 +0100

I wanted to share this article (reference below) as many of us may either see these patients as tourists or after they return from vacation. It is nice to have a logical choice for empiric antibiotic therapy. (photo credit)The proposal of the article was "that the analysis of seawater pathogens will act as a guide for rational empiric antibiotic therapy, either as prophylaxis at the time of penetrating injury or as early treatment of a developing infection." To do this, 50 ml samples of seawater were collected from 25 preselected locations along a 12-km segment of the southern portion of the Galveston beach area in Texas. These water samples were taken over four seasons, the fall and winter of 2002 and the spring and summer of 2003. "Despite variations in water temperature and beachgoer population size, the seasonal variations of bacterial species were minimal. Throughout all four studies, the most effective antibiotics against most Gram-positive microorganisms were penicillin, ampicillin, vancomycin, and levofloxacin, whereas the most effective antibiotics against all Gram-negative microorganisms were levofloxacin, lomefloxacin, and cefepime. Because all four studies contained similar trends in both Gram-positive and Gram-negative microorganisms, these authors believe that it is necessary to prescribe initial antibiotics that provide dual coverage of Gram-positive and Gram-negative organisms to patients with seawater-contaminated wounds, regardless of the season. Although the majority of organisms analyzed showed some sensitivity to levofloxacin, this drug has somewhat limited Gram-positive coverage that the addition of penicillin will address more appropriately. Thus, prescribing a combination of penicillin or ampicillin with levofloxacin to patients with seawater-contaminated penetrating wounds at any time throughout the fall, winter, spring, or summer should provide the necessary coverage to promote proper wound healing and functional recovery of the injured site. As is usually practiced, antibiotic therapy should be administered for a period of 5 to 7 days, with further changes being made based on the treating physician's clinical judgment. Using this regimen will also cover the dangerous Vibrio species and aid in preventing the morbidity and mortality associated with such infections."The decision to treat any wound with antibiotic therapy should be based on clinical judgment. Abrasions and superficial injuries may only require debridement and copious irrigation. Lacerations and penetrating wounds that have a clearly visible base and no signs of infection in the wound or surrounding tissues may be irrigated and closed primarily using clinical judgment. However, seawater-contaminated wounds that are penetrating deeper than the dermis and associated with erythema and/or edema in the surrounding tissue will most likely benefit from dual-coverage prophylactic antibiotic therapy pending culture results. REFERENCESEmpiric Antibiotic Therapy for Seawater Injuries: A Four-Seasonal Analysis; Plastic & Reconstructive Surgery. 121(4):1249-1255, April 2008; Jennifer S. Kargel, B.S.; Vanessa M. Dimas, B.S.; Dennis S. Kao, M.D.; John P. Heggers, Ph.D.; Peter Chang, M.D., D.M.D.; Linda G. Phillips, M.D. (Source: Suture for a Living)

Isolaz, a new/old acne treatment

plasticized.com — Wed, 14 May 2008 04:00:00 +0100

(Source: plasticized.com)

Now offering new facial filler prevelle

What's New In Plastic Surgery? — Tue, 13 May 2008 20:12:00 +0100

Dr. Hamori is pleased to now offer a new facial filler, at her Duxbury, MA plastic surgery + skin spa practice. Prevelle is another hyaluronic acid (HA) gel, that is injected just under the skin’s surface to temporarily fill wrinkles for a more youthful appearance. "It is similar to Restylane or Juvederm," according to Dr. Hamori. Prevelle's advantage over other injectables is that it contains Lidocaine, a local anesthetic, which reduces the pain of injection.Dr. Hamori has a wide assortment of injectibles for use in treating wrinkles and folds such as frown lines, forehead lines, periorbital lines (more commonly known as "crow's feet"), smile lines, oral commissures (marionette lines) and vertical lip lines.For a listing of facial fillers and injectibles offered by Dr. Hamori, see her web site at: www.christinehamori.com. (Source: What's New In Plastic Surgery?)

Fascinating video about michael jackson and plastic surgery

Awful Plastic Surgery — Tue, 13 May 2008 11:47:18 +0100

I happened upon this video... [[ This is a content summary only. Visit MyWebsite.com for full links, other content, and more! ]] (Source: Awful Plastic Surgery)

Megan fox - real or fake?

Awful Plastic Surgery — Tue, 13 May 2008 11:39:56 +0100

create a free poll on... [[ This is a content summary only. Visit MyWebsite.com for full links, other content, and more! ]] (Source: Awful Plastic Surgery)

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Grand rounds is up

Suture for a Living — Tue, 13 May 2008 11:39:08 +0100

David E. Williams of the Health Business Blog is this week's host for Grand Rounds. It is a wonderful edition you can read here.Welcome to the latest edition of Grand Rounds at the Health Business Blog. This is my fourth time hosting (fifth if you include the April Fool’s edition).Next week's host will be Dino (Musings of a Dinasaur). (Source: Suture for a Living)

Kim kardashian and anti-cellulite treatments

Celebrity Cosmetic Surgery — Tue, 13 May 2008 04:00:00 +0100

Kim Kardashian was filmed undergoing anti-cellulite treatments on her E! Television reality show. Here is a link to the video on the great Celebrity Smack! blog.The three most common cellulite treatments are Velasmooth (which Kim had), Dermosonic, and Endermologie. All of them employ a deep tissue massage with various other treatments. I am partial to Dermosonic, which I have in my office, although I think they all work. Dermosonic combines external ultrasound treatments with a deep tissue massage using mechanical rollers. Unfortunately, I don't know of ANY permanent cellulite eradicator. Most treatments provide for the "temporary reduction of the appearance of cellulite." This means that the treatments must continue to a certain extent for the results to continue. But feel assured, even a glamorous young Hollywood star like Kim Kardashian has cellulite!Photo credit: prphotos.comThanks for reading.Michigan-based Plastic SurgeonAnthony Youn, M.D.: (Source: Celebrity Cosmetic Surgery)

Guidelines for von willebrand disease

Suture for a Living — Mon, 12 May 2008 12:09:38 +0100

The National Heart, Lung, and Blood Institute (NHLBI) recently issued guidelines for the diagnosis and management of von Willebrand disease. Von Willebrand disease (VWD) is an inherited bleeding disorder that is caused by deficiency or dysfunction of von Willebrand factor (VWF), a plasma protein that mediates the initial adhesion of platelets at sites of vascular injury and also binds and stabilizes blood clotting factor VIII (FVIII) in the circulation. Therefore, defects in VWF can cause bleeding by impairing platelet adhesion or by reducing the concentration of FVIII.VWD is a relatively common cause of bleeding, but the prevalence varies considerably among studies and depends strongly on the case definition that is used. VWD prevalence has been estimated in several countries on the basis of the number of symptomatic patients seen at hemostasis centers, and the valuesrange from roughly 23 to 110 per million population (0.0023 to 0.01 percent)Suggested Questions to Ask Patients in Screening1. Do you have a blood relative who has a bleeding disorder, such as von Willebrand disease or hemophilia?2. Have you ever had prolonged bleeding from trivial wounds, lasting more than 15 minutes or recurring spontaneously during the 7 days after the wound?3. Have you ever had heavy, prolonged, or recurrent bleeding after surgical procedures, such as tonsillectomy?4. Have you ever had bruising, with minimal or no apparent trauma, especially if you could feel a lump under the bruise?5. Have you ever had a spontaneous nosebleed that required more than 10 minutes to stop or needed medical attention?6. Have you ever had heavy, prolonged, or recurrent bleeding after dental extractions that required medical attention?7. Have you ever had blood in your stool, unexplained by a specific anatomic lesion (such as an ulcer in the stomach, or a polyp in the colon), that required medical attention?8. Have you ever had anemia requiring treatment or received blood transfusion?9. For women, have you ever had heavy menses, characterized by the presence of clots greater than an inch in diameter and/or changing a pad or tampon more than hourly, or resulting in anemia or low iron level? If the patient answers yes to one or more of the above: An initial hemostasis laboratory evaluation usually includes a platelet count and complete blood count (CBC), partial thromboplastin time (PTT), prothrombin time (PT), and optionally either a fibrinogen level or a thrombin time (TT). If these are suggestive of VWB, then the initial tests commonly used to detect VWD or low VWF are:VWF:Ag -- an immunoassay that measures theconcentration of VWF protein in plasma. VWF:RCo -- a functional assay of VWF that measuresits ability to interact with normal platelets. FVIII coagulant assay -- a measure of the cofactorfunction of the clotting factor, FVIII, in plasma.There is a very nice section on management. For me, it is probably best to work with the patient's Hematologist as it is very dependent on which type of VWB's the patient has and what type of injury (laceration, etc) or surgery (repair of laceration, breast reduction, etc). I did a breast reduction on a Type I VWB a couple of years ago with suggested DDAVP (Desmopressin: 1-desamino-8-D-arginine vasopressin) therapy preoperatively. The patient hardly bled or bruised. By working together, it worked well for all of us.The guidelines can be read in its entirety here (PDF file). Also, available for CME credit through Medscape: Management of Surgical Patients with VWD: New Research-based Options [CME available through May 5, 2009];released May 5, 2008; Joan Cox Gill, MD; Prasad Mathew, MD (Source: Suture for a Living)

Drug expiration or ?

Truth In Cosmetic Surgery Blog — Mon, 12 May 2008 04:00:00 +0100

RedorbitDrug expiration dates are kinda a gimmick. I don't recommend that you take an expired drug, but I have taken some. Read this article to see why.Best Regards,John Di Saia MD (Source: Truth In Cosmetic Surgery Blog)

Penn jillette on facial fillers and breast implants

plasticized.com — Mon, 12 May 2008 04:00:00 +0100

In his video blog, Penn discusses having filler to his nasolabial creases and how some of the other contestants on Dancing with the Stars had the same. And then he explains how silicone implants should be sold as paperweights. Classic quote: "Any time you don't have a breast implant in your hand, life is not as good as it could be." (Source: plasticized.com)

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Surgexperiences 121 and mother's day!

Suture for a Living — Sun, 11 May 2008 13:24:17 +0100

Necessity is said to be the mother of invention. Mother's Day is then the perfect day for this edition of SurgeXperiences (121). The host The Sterile Eye chose surgical instruments as the theme. What a great edition! You can read it all here. Happy Mother's Day! This picture is of my mom, Cathy (sister), me, Krystal (niece), and Jeanne (sister). (Source: Suture for a Living)

Jenn sterger - when did looking like a stripper become a good thing?

Awful Plastic Surgery — Sun, 11 May 2008 09:45:02 +0100

Jenn Sterger is known as the... [[ This is a content summary only. Visit MyWebsite.com for full links, other content, and more! ]] (Source: Awful Plastic Surgery)

What do cosmetic surgery and lesbians have in common?

Plastic Surgery 101 — Sun, 11 May 2008 04:00:00 +0100

Now that you've been roped in with a salacious post title, the answer is kind of boring and mundane.So what do they have in common? Trademark issues.This type of Lesbian on lesbian action involves the tiny Aegean Sea island of Lesbos, home to the ancient Greek poet, Sappho, who famously praised romantic love between women 2700 years ago and gave us the origin of the term lesbian, has been threatening to sue to protect it's name from being used by Gay rights groups.Similar to other old world cities, and most often involving foodstuff or liquors, these areas do have some legal claims on words derived from the area if they've trademarked them in a concept known as "protected designation of origin".Image Source: Slap Upside the Head Blog.Think of things likechampagne - which can only come from certain areas of FranceBourbon whiskey - which has to come from Kentucky and be distilled a certain wayRoquefort cheese - cheese must be made from milk of a certain breed of sheep, and matured in the natural caves near the town of Roquefort in France, where it is infected with the spores of a certain fungus that grows in local caves (Ick!)Budějovický Budvar beer from the Czech Republic city of Budweis which had brewed a budweiser (literally a "beer from Budweis") style of beer since the 13th century, had a 20 year lawsuit settled with American corporation, Anheuser-Busch Co. over their popular Budweiser brand. This Czech beer, praised by beer aficionados, is now available in the USA as the brand, Czechvar. (Good stuff!)The concept of trademarking surgical procedures has caused a little controversy in recent years. In particular, a number of facelift variations have been given catchy monikers like QuickLift, ThreadLift, S-lift, MACS lifts, E-Z lift, Lifestyle lift, etc.... Some surgeons have even had enough gumption to send cease & desist letters claiming intellectual property violations for surgeons performing these procedures. They were actually asking for royalties to do these operations.The "Lifestyle Lift", a minor variation of the "short scar" facelift procedures has been commercialized by a chain of clinics and is advertised heavily in print and media. There have been an inordinate number of complaints (see here) among patients with these clincs which may represent who is doing the surgery (often not plastic surgeons at these clinics) rather then some inherant flaw in the technique. You can get OK results in very modestly aged faces with these procedures, but I get the impression it's being used on people that need "real" facelifts. A popular variation (and one I like), the MACS lifts, is a little more powerful tool for trying to get by with shorter scars on some of these patients.This practice goes against a long history of our profession disseminating ideas & innovations around the world. Cosmetic surgery is probably one of the only industries where businesses publish and lecture on their trade craft for free! In addition, many of these "new" surgeries have been described many times before if you know where to look. John McGraw, the father of modern reconstructive surgery, has quipped "If you think you've invented some new operation in Plastic Surgery, you probably haven't looked in German surgery journals from the 1920's!"RobDr. Rob Oliver Oliver Plastic Surgery www.oliverplasticsurgery.com (Source: Plastic Surgery 101)

Italy's scariest socialite - michaela romanini

Awful Plastic Surgery — Sat, 10 May 2008 13:49:09 +0100

Michaela Romanini was covered... [[ This is a content summary only. Visit MyWebsite.com for full links, other content, and more! ]] (Source: Awful Plastic Surgery)

John mccain and melanoma

Celebrity Cosmetic Surgery — Sat, 10 May 2008 04:00:00 +0100

The New York Times has recently jumped on John McCain for his history of melanoma. Apparently, he's had a history of four melanomas removed. Melanoma is a dangerous form of skin cancer, and can metastasize to other organs and cause death. It is because of this that physicians recommend you to see your doctor if a mole displays one of the following signs: Assymetry, border irregularity, various colors, size greater than 6 mm, or changes in the mole.I've always wondered why the left side of his face looked bloated and droopy. It appears that this was the area where the melanoma was removed. I once took off a big skin cancer off the side of the face in an older gentleman like him, and to close it up gave him a virtual facelift on one side. Too bad insurance didn't pay for me to lift the other side as well. At least he takes photographs good from one side!Photo and story credit: nytimes.comThanks for reading.Michigan-based Plastic SurgeonAnthony Youn, M.D.: (Source: Celebrity Cosmetic Surgery)

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Stamp out hunger

Suture for a Living — Fri, 09 May 2008 23:13:59 +0100

The National Association of Letter Carriers will be collecting non-perishable food items like canned meats and fish, canned soup, juice, pasta, vegetables, cereal and rice on Saturday, May 10th. You and I can help by placing food donations at the mailbox on May 10th before the letter carrier arrives. The food donations will then be taken to the Post Office. Later it will be delivered to local food banks or pantries. Please make sure the food items do not have expired use dates. They also ask that there be no glass containers.For more information check out these sites:Help Stamp Out HungerNational Association of Letter Carriers Community ServiceGlobe Trotters for Stamp Out Hunger (Source: Suture for a Living)

Abby's quilt

Suture for a Living — Fri, 09 May 2008 12:04:59 +0100

This quilt was made for a little girl. The block pattern is called "Alabama". It is made of blues, purples, deep reds, and white. It measures 40 in X 58 in. It is machine pieced and quilted. The back is fabric I found at a garage sale years ago. The fabric was licensed through the American Greetings Card Company, 1970's --Holly Hobbie. The current Holly Hobbie has been updated (website). You can find more history of Holly here. (Source: Suture for a Living)

Nikki cox - situation critical

Awful Plastic Surgery — Fri, 09 May 2008 11:08:24 +0100

Another reader just sent in... [[ This is a content summary only. Visit MyWebsite.com for full links, other content, and more! ]] (Source: Awful Plastic Surgery)

Clay aiken vs zac efron

Awful Plastic Surgery — Fri, 09 May 2008 10:17:36 +0100

Okay, you're in a bar. Two... [[ This is a content summary only. Visit MyWebsite.com for full links, other content, and more! ]] (Source: Awful Plastic Surgery)

Clay aiken - making an american idol

Awful Plastic Surgery — Fri, 09 May 2008 09:53:26 +0100

I don't think that many would... [[ This is a content summary only. Visit MyWebsite.com for full links, other content, and more! ]] (Source: Awful Plastic Surgery)

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The nikki cox story

Awful Plastic Surgery — Fri, 09 May 2008 08:06:46 +0100

In an effort to heighten her... [[ This is a content summary only. Visit MyWebsite.com for full links, other content, and more! ]] (Source: Awful Plastic Surgery)

Ot - can you spare a few thousand dollars to pay somebody else's mortgage?

Awful Plastic Surgery — Fri, 09 May 2008 05:58:10 +0100

This is totally off topic but... [[ This is a content summary only. Visit MyWebsite.com for full links, other content, and more! ]] (Source: Awful Plastic Surgery)

Play the celebrity plastic surgery concentration game

Celebrity Cosmetic Surgery — Fri, 09 May 2008 04:00:00 +0100

If you are looking for a pleasant diversion, check out iVillage.com for a Celebrity Plastic Surgery Concentation Game 2. In this game you try to match before and after photos of celebrities and their plastic surgery. My time was 87 seconds. Can anyone beat that?Click here for the game.Thanks for reading.Michigan-based Plastic SurgeonAnthony Youn, M.D.: (Source: Celebrity Cosmetic Surgery)

Words to live by

Suture for a Living — Thu, 08 May 2008 15:23:47 +0100

The following was the conclusion of an article I recently read on David Cheever in the Journal of Plastic and Reconstructive Surgery (referenced below). I would like to share it. I think it applies to whatever field you choose to study, not just medicine. "Although we may remember David Cheever as a surgical innovator, his character is more aptly revealed in the following passage from a lecture, delivered before the Harvard Medical School class of 1871, entitled “How to Study Medicine”21:If you seek for wealth you have mistaken your avocation. There must be something more, and something higher. That something is a love of your profession; a passion for science for its own sake; a broad humanity, which covers all the sick with a mantle of charity. Never lose sight of that motive, for if it once takes flight, your profession is reduced to a trade, and there is absolutely nothing left. As long as you can keep alive the sacred flame of this early passion which first called you to embrace the medicalprofession, so long shall you be warmed, sustained, upheld amid disappointment, unjust treatment or reverses." Cheever's Double Operation: The First Le Fort I Osteotomy; Plastic & Reconstructive Surgery. 121(4):1375-1381, April 2008; Halvorson, Eric G. M.D.; Mulliken, John B. M.D. (Source: Suture for a Living)

Is ashlee sporting milk filled boobs or saline?

Awful Plastic Surgery — Thu, 08 May 2008 13:48:26 +0100

The blogsphere is buzzing... [[ This is a content summary only. Visit MyWebsite.com for full links, other content, and more! ]] (Source: Awful Plastic Surgery)

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A promotion patient before her breast augmentation

Truth In Cosmetic Surgery Blog — Thu, 08 May 2008 04:00:00 +0100

I did this case a few months ago. This is a brief clip before her surgery. I recently saw the television spot (for German Television,) and I am not in much of it. Oh, well. Maybe I should call it the promotion that really didn't promote much.LOL.Best Regards,John Di Saia MD (Source: Truth In Cosmetic Surgery Blog)

Six word memior

Suture for a Living — Wed, 07 May 2008 15:22:42 +0100

I was tagged by Midwife with a Knife who was tagged by TBTAM for the six word memior meme. The instructions? Write a 6 word memior and tag 6 others. Leave a comment on the tagged blogs with an invitation to play. MWWAK's --- Catch a baby, watch the floor. TBTAM's --- I want to do it all. Dr Wes' --- Show them kindness, integrity, and love. So here's mine: My life is full of stitches. To me that covers my work (plastic surgery), my hobbies (quilting, sewing, knitting), my jogging (the occasional side-stitch), and my enjoyment of good jokes (keep me in stitches). It somehow doesn't cover my family, friends, dogs. Unless you allow me to call them the threads that hold everything together. Here are some links to others who have played: Seaspray, Whitecoat, Monkey Girl, Scalpel I'll tag: Sterile Eye, Knudsen, Bongi, Scanman, Bruce, and Val. And Dr David because he feels left out and we don't want that (added 5-7-08). (Source: Suture for a Living)

Dermatomes

Suture for a Living — Wed, 07 May 2008 12:07:29 +0100

dermatome /der·ma·tome/ (der´mah-tom) 1. an instrument for cutting thin skin slices for grafting. 2. the area of skin supplied with afferent nerve fibers by a single posterior spinal root. 3. the lateral part of an embryonic somite. It's the first definition that I will be discussing. Padgett invented the first dermatome in 1939. This one was a drum dermatome and was manually operated. It was a surgical instrument for easily removing large flaps of skin of a prescribed depth. This helped move skin grafting to common practice from a miraculous one. Today dermatomes can be operated manually, air-powered, or electrically. Many are named after their inventors. There are what I would consider three main types: Blade dermatomes These provides rapid harvest of large grafts of uniform thickness. These may be air powered, electric, or manually operated. All of these harvest by the same mechanism: a rapidly oscillating side-to-side blade is advanced over the skin with thickness and width settings adjusted by the surgeon. Commonly used dermatomes include the Castroviejo, Reese, Padgett-Hood, Brown, Davol-Simon, and Zimmer (photo credit) When using the air or electric powered dermatomes, the operating surgeon must be familiar with the installation of the blade and how to adjust the setting for graft thickness and must check these before operating the device. There is a correct and an incorrect orientation of the blade, and the two may easily be confused. Insertion of a No. 15 blade scalpel simulates a thickness of 0.015 inches and can be used to check that thickness settings are uniform and correct. After the blade orientation, width guard and depth setting are confirmed, and harvesting may begin. Drum dermatomes Drum dermatomes are less frequently used today but are available for specialized grafting needs. On these instruments, the oscillating blade is manually powered as the drum is rolled over the skin surface. These dermatomes can be used to harvest broad sheets of skin of exacting thickness. They are useful when the donor site is irregular, with a convexity, concavity, or bony prominence (neck, flank, buttock), because the skin to be harvested is first made adherent to the drum with a special glue or adhesive tape. These dermatomes also allow precise irregular patterns to be harvested by varying the pattern of adhesive applied to the skin and drum. Disadvantages include the risk of injury to operating personnel by the swinging blade, the need to use flammable agents such as acetone or ether to cleanse the donor site and remove surface oils to ensure secure adhesion of the skin to the dermatome drum, and greater technical expertise required to safely and effectively operate these devices. Reese and Padgett-Hood (photo credit) are examples of this type. Check out the 5th reference article. Free-hand Knives Called knives and not dermatomes, these still fit the definition. Examples include the Humby knife (photo credit), Weck blade, and Blair knife. The disadvantages include grafts with irregular edges and varying thicknesses. As with the drum dermatomes, greater technical expertise is necessary, and graft quality tends to be operator dependent. Check out this link on "preparing a Humby knife" REFERENCES 1. Hand Knife Versus Powered Dermatome: Current Opinions, Practices, and Evidence; Annals of Plastic Surgery. 57(1):77-79, July 2006; Tehrani, Hamid MBBS, MRCSEd; Lindford, Andrew MBBS, MRCSEd; Logan, Andrew M. FRCS (abstract online) 2. Skin, Grafts; eMedicine Article, Feb 17, 2006; Don Revis Jr MD and Michael Seagle MD 3. Applying Split-Thickness Skin Grafts: A Step-by-Step Clinical Guide and Nursing Implications; Ostomy/Wound Management , Volume 47, Issue 11, November 2001 , Pages: 20 - 26; 4. History of Skin Grafting; Brown University Online Article 5. Grafting of Skin: Advantages of the Padgett Dermatome; Calif West Med. 1942 July; 57(1): 16–18; George Warren Pierce (Source: Suture for a Living)

Mischa barton queen of cellulite

Awful Plastic Surgery — Wed, 07 May 2008 10:20:57 +0100

Mischa Barton has been... [[ This is a content summary only. Visit MyWebsite.com for full links, other content, and more! ]] (Source: Awful Plastic Surgery)

New growth for catherine zeta jones

Awful Plastic Surgery — Wed, 07 May 2008 10:04:08 +0100

Catherine Zeta Jones is the... [[ This is a content summary only. Visit MyWebsite.com for full links, other content, and more! ]] (Source: Awful Plastic Surgery)

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The scary lips of calpernia

Awful Plastic Surgery — Wed, 07 May 2008 08:26:05 +0100

Calpernia is an actress with... [[ This is a content summary only. Visit MyWebsite.com for full links, other content, and more! ]] (Source: Awful Plastic Surgery)

Lifestyl- lift lawsuit dismissed

Celebrity Cosmetic Surgery — Wed, 07 May 2008 04:00:00 +0100

According to a news report from Wired, a Michigan judge has thrown out a lawsuit brought about by the Lifestyl- Lift company against infomercialscams.com. They alleged trademark violation by use of the trademarked name "Lifestyl- Lift." According to the article,Many of the online complaints were from women who said they had a face-lift after seeing Lifestyle's infomercials. One woman claimed she lost hearing in one ear. Another said "every week my face proceeds to return to the way it was before the lift." Another said, "I feel ripped off."The lawsuit was a bid to stifle free speech, according to Public Citizen, which defended the case.I do not perform the Lifestyl- Lift. Note: I am spelling it Lifestyl- Lift so that they don't sue me too.Thanks for reading.Michigan-based Plastic SurgeonAnthony Youn, M.D.: (Source: Celebrity Cosmetic Surgery)

Mccain and melanoma

plasticized.com — Wed, 07 May 2008 04:00:00 +0100

(Source: plasticized.com)

Grand rounds 4:33

Suture for a Living — Tue, 06 May 2008 19:53:10 +0100

I had no theme for this Grand Rounds, but thought I would share some links and photos of Arkansas. This first one is of the Trail of Tears (photo credit). This first post may well bring tears to your eyes --David, Marianas Eye, describes his thoughts while awaiting a diagnosis of cancer in his six-year-old son in his post "On the Other Side of the Diagnosis". A well written post about a very emotional time in his life. Dr Rob, Musings of a Distractible Mind, remembers his own son in "The Cry of a Tiny Baby". His son turned 16 this week. Doctor Shazam is back from a trip to Honduras. "I can’t wait for my next machete wound in Hondura!" Check out the post on the extensor tendon repair done there. Buckeye Surgeon presents a case of Fournier's Gangrene. Read the comments as well. Bruce, Reflections in a Head Mirror, looks at Fear. His posts are always thoughtfully written. Chris, Spinal Cord Injury and Healing, lives in Brooklyn, NY. He sustained an injury to his spinal cord in late January 2008. He talks about his Inspiration. "Many people who know me also know that I have wanted to be a surgeon, or at least some type of physician, since I was a child........ But just after I was injured, although I knew I could complete medical school, I became very scared that surgery might be out of my reach forever." PalMD, Denialism Blog, writes Never say "hopeless". "I can't tell you the number of people who complain to me about having their hope taken away. Exactly what this means, though, isn't always clear." Scalpel has seen some pretty nasty things happen to people over the years, but nothing like this Horror. Landmarks and monuments are featured in some parks, like this one of the Louisiana Purchase State Park or the Crater of Diamonds State Park (Arkansas actually has a diamond mine open to the public -- you get to keep what you find). (photo credit) Here are some folks who received honors or should have this week--Shadowfax states "When finally they were done, I made it a point to express my admiration and gratitude in the most direct way I could -- I went down to the hospital Starbuck's and bought them their favorite drinks (white chocolate mochas). Nurses rock!" I agree.Christine, But Your Don't Look Sick, was recently honored at the NY Lupus Alliance Gala Brunch. Her acceptance speech focused on the " Yes, this has been my battle, my war with lupus… but luckily I have had an army to fight with me. We all have had lupus."MedGadget highlights the National Marrow Donor Program's registration campaign to boost the ranks of committed bone marrow donors by allowing potential donors to register for free during the month of May. Within five Arkansas state parks are cabins, pavilions, bridges, trails, a lodge, and other works that endure as a legacy to the craftsmanship of the Civilian Conservation Corps, part of Franklin D. Roosevelt's New Deal. (photo credit) Sometimes policies/politics leaves behind a grand legacy, sometimes they don't. I'll let you decide about these next posts--Annie, Home of the Brave, writes Nurses Week 2008: "There Were No Nurses". "I wrote this post over a year ago, but the more things change, the more they stay the same. The first week in May - to be more precise, May 6-12 - has been designated - mostly by hospital and nursing employers’ marketing departments - as Nurses Week."Dr Val asks, "Do you know what your state's momscore? " Check out her post to find out what a mom score is.Anybody practicing medicine today needs to be serious about medical guidelines. Dr Rich, Covert Rationing Blog, has a post that should not be missed on the the growing tyranny of medical guidelines.Dr Anonymous asks a simple, yet, controversial question: If someone has used marijuana - even if used for medical reasons - should this prohibit him or her from being considered to be on a transplant list? Hospitals throughout this great nation struggle with this question every day. John, NHS Blog Doc, submits an article regarding a major controversy in the UK. It seems that at present independent midwives work outside the NHS and do not feel bound by conventional medical practice. Consequently they cannot get insurance. So, unbelievably, they work without insurance. This article looks at one such Midwifery practice in Kent. Laurie, A Chronic Dose, begins a series looking at the candidates healthcare plans beginning with John McCain. She attempts to look at the key policies of the candidates that resonate most with her perspective: someone with multiple chronic conditions whose problem isn’t lack of insurance per se, but lack of confidence in my insurance and lack of the comprehensive coverage I used to have. Dr Couz, Tales from the Emergency Room and Beyond, is still plugging away at the incredibly misguided assumption that doctor shortages can be blamed on women. Robert, Health Care Blog Law, writes a post on the new CHCF Report on the social media impact on health care (think blogging about health/medicine). Sam, Canadian Medicine, feels that pathology is in a sorry state up in Canada. His post is about the discovery of a fourth scandal over a short period of time. Pathologists are mostly blaming the system's failure to devote enough resources to pathology and laboratory diagnostics. There are many places for rock climbing (photo credit), hiking, fishing, and boating within Arkansas. Granted we are land-locked so no major sailing for us. Paul, Medicine for the Outdoors, warns ocean swimmers to be careful. From the month of May through September, if you swim in the waters along the U.S. Gulf coast be mindful of sea bathers eruption, a particular form of skin rash caused by tiny jellyfish. Vijay, Scan Man's Notes, writes about an old man who had sustained an injury to his left forearm on the farm a month ago and was being ‘treated’ by a traditional bone setter. Whitecoat allows us to play detective in his post CSI Whitecoat #2 . "What can you tell the detectives based on the appearance of the patient’s hand?"Dr Clairebear writes "I Don't Smoke". She discusses how well (or not) we doctors follow the advice we give to patients. It's not just the smoking advice; it's the cholesterol diet, the exercise, etc.TBTAM shares "I'm Glad She's Not My Patient". Every rose has it's thorns, but ...........Joey MD explains why it is important to be careful with self medication. In the Philippines, antibiotics can still be bought over the counter in some drugstores......... Dr Benabio, The Derm Blog, wants you to know that Botox can get into your head. Literally! Check out his post "Your Brain on Botox". How to Copy with Pain Blog wants you to know that Mindfulness matters when it comes to back pain -- “awareness that emerges through paying attention on purpose, in the present moment and non-judgmentally, to the unfolding of experience moment by moment.” You may find that making small changes in your posture will ease the pain. Doc Gurley wants to help you with your spring cleaning -- spring cleaning your thoughts -- or, how to stop worrying about things you can't control (like the price of gas, the election, whatever). In her post For Goodness Sakes Cosmetics Can Kill You, Nancy (Teen Health 411), writes about the safety of the cosmetics that our teens like to use. Very interesting and not just for teens. Want to reduce your stress level, spend less money at the pump and do your part to help save the planet? Here’s one of the most simple yet effective tips that will accomplish all three. Walter, Highlight Health, may be able to help you. I know that Arkansas' history is short compared to Africa or India's. Still there are the prehistoric Native American Indian burial mounds (Toltec) and farming-based, aboriginal civilization that lived here from 1400 to 1650 A.D. (Hampson Museum). (photo credit) Blogger and type 1 diabetic Kerri Morrone, Six Until Me compiles a second edition of the Diabetes Terms of Endearment, with some of the best jargon bits of the community. What do stereos and health care have in common? Henry Stern, InsureBlog, thinks that we're watching an evolution in how health care is delivered. Louise, Colorado Health Insurance Insider, points out that Smoking Can Be Hazardous to Your Career. The post discusses Whirlpools potential termination of 39 employees for lying about tobacco use. The comments are very interesting, also. Amy over at Diabetes Mine wants to announce The 2nd Annual DiabetesMine Design --- a competition designed to foster innovation in diabetes design and encourage creative new tools that will improve life with diabetes.David, Health Business Blog, reviews a helpful little book that provides advice for board members of not-for-profit health care organization. It is an e-book: Navigating the Boardroom, 40 Maxims… Things You Must Know and Do to Be a Great Director. He provides a link to the book. He'll be hosting next week's Grand Rounds (May 13). Clinical Cases Blog shares with us 5 Tips to Stay Up-to-Date with Medical Literature.Tell a nurse how valued she/he is. Maybe buy them a cup of coffee or something. Thank you for allowing me to present Grand Rounds to you. I hope you will visit each blog that submitted a post. Have a GRAND week!Come visit us here in Arkansas. We'd love to see you. (photo credit) (Source: Suture for a Living)

Ashley massaro spin control

Awful Plastic Surgery — Tue, 06 May 2008 10:12:11 +0100

On the left in the bikini is... [[ This is a content summary only. Visit MyWebsite.com for full links, other content, and more! ]] (Source: Awful Plastic Surgery)

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Holly madison's breasts - contracture

Truth In Cosmetic Surgery Blog — Tue, 06 May 2008 04:00:00 +0100

Drunken Stepfather PostJesus at DrunkenStepfather (my favorite obnoxious NSFW blog) comments on the uneven nipple position of Holly Madison. Most women have some difference in nipple position between breasts, but with implants a larger difference can represent capsular contracture or internal breast scarring. Without knowing whether or not implants are present or where she stood before implant surgery, it is impossible to know what is going on here, but there is enough here to fix. I'd wager that she has implants.Best Regards,John Di Saia MD (Source: Truth In Cosmetic Surgery Blog)

Teacher fired when racy bikini photos of her appear online

Awful Plastic Surgery — Mon, 05 May 2008 07:37:28 +0100

Above is biology teacher... [[ This is a content summary only. Visit MyWebsite.com for full links, other content, and more! ]] (Source: Awful Plastic Surgery)

Christy turlington good genes-or-good-docs on tmz

Truth In Cosmetic Surgery Blog — Mon, 05 May 2008 04:00:00 +0100

TMZ - picsTMZ provides images of a very pretty Christy Turlington with obvious nasal work over the years. She is well preserved but with a bit of a thin nasal dorsum to my tastes at least facially.Best Regards,John Di Saia MD (Source: Truth In Cosmetic Surgery Blog)

Who looks younger? demi or cameron

Awful Plastic Surgery — Sun, 04 May 2008 06:22:22 +0100

Who looks younger, Demi or... [[ This is a content summary only. Visit MyWebsite.com for full links, other content, and more! ]] (Source: Awful Plastic Surgery)

Josie moran

Awful Plastic Surgery — Sun, 04 May 2008 04:45:33 +0100

Model Josie Moran holds a... [[ This is a content summary only. Visit MyWebsite.com for full links, other content, and more! ]] (Source: Awful Plastic Surgery)

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Halle berry - breast augmentation?

Celebrity Cosmetic Surgery — Sun, 04 May 2008 04:00:00 +0100

This photo of Halle Berry has been circulating around the internet and in magazines. Does it show a scar in her armpit from a breast augmentation?It is definitely possible, however I usually place the scar in a wrinkle crease of the armpit which is perpendicular to the possible scar that we see here. It doesn't make much sense for her surgeon to place the scar in this direction because it would only make it more visible. It's possible that she doesn't have breast implants at all, and the scar is from something completely unrelated. No matter what it is from, one thing is certain. She looks fabulous.photo credit: In Case You Didn't KnowThanks for reading.Michigan-based Plastic SurgeonAnthony Youn, M.D.: (Source: Celebrity Cosmetic Surgery)

Revisional cosmetic breast surgery - dr o in print this month

Plastic Surgery 101 — Sun, 04 May 2008 04:00:00 +0100

I like to say that unlike most blogs by plastic surgeons, Plastic Surgery 101 really isn't about me, but today's post is actually about me.I was asked by the editor of Plastic Surgery Products (PSP) magazine, an industry trade journal, to come up with something interesting to write about for his magazine. One of the questions that I'm always thinking about is "What are the things we do that really cause long term problems and how can I avoid that?".Spending time as a fellow working with the world's best re-operative breast surgeon (for my money), Nashville's Dr. Pat Maxwell, really gave me a different kind of respect for some of the complications we can produce with cosmetic and reconstructive breast surgeries. There's a famous quote (attributed to former Houston Oilers coach Bum Phillips) about Alabama football coach Paul "Bear" Bryant, that he could "Take his'n and beat your'n, and then take your'n and beat his'n.". Well Pat could do the same with some of the most unfavorable or difficult to treat scenarios in breast surgery that you can imagine.Anyway, I've kind of gotten an interest in this kind of patient and put some of my understanding and thinking on these issues down for PSP in an article entitled "Solid Strategies in Revisional Breast Surgery" which you can read here.Thanks to editor Jeff Frentzen for the opportunity to contribute, however Jeff, I'm going to demand the cover story next time :)Ok now back to posts definately "not about me".RobDr. Rob Oliver Oliver Plastic Surgery www.oliverplasticsurgery.com (Source: Plastic Surgery 101)

Wow, someone in hollywood has natural breasts

Awful Plastic Surgery — Sat, 03 May 2008 10:01:37 +0100

Wow, someone in Hollywood has... [[ This is a content summary only. Visit MyWebsite.com for full links, other content, and more! ]] (Source: Awful Plastic Surgery)

Jennifer walcott has a stalker

Awful Plastic Surgery — Fri, 02 May 2008 13:17:02 +0100

Model Jennifer Walcott has a... [[ This is a content summary only. Visit MyWebsite.com for full links, other content, and more! ]] (Source: Awful Plastic Surgery)