Facial Yoga vs. Botox

This morning, a patient of mine asked me if I had heard of facial yoga as a replacement for Botox.
It turns out that a story about yoga for the face had come out last week in Time magazine.

The story tells of a New York yoga instructor who noticed that a lot of her patients received Botox during their lunch breaks. She came up with several "poses" for the face that would tighten facial muscles and reduce wrinkles- an "all natural" Botox!

The article also talked about how some of these exercises have helped people increase facial muscle tone- especially a few people with facial palsy or motion deficits.

It's a nice article- one thing that they pointed out was that the class was full of laughter and that afterwards, women said that they felt much more relaxed and at ease. Some even notice fewer lines in their face! It sounds like the class is a GREAT way to let off steam and afterwards people feel much more relaxed and at ease. I think that this is the reason they feel and "look" better.

Facial muscle exercises couldn't hurt and may help people relax- but they won't replace Botox any time soon. Botox relaxes muscles and helps prevent the lines in the skin that are caused by these muscles. These yoga exercises STRENGTHEN muscles and could in theory, make these lines more obvious.

My patient agreed that she would try the exercises for fun and as a stress reliever- AND use Botox to help erase the wrinkles she already has.

Great Advice from TMZ.com

A lot has been written about the tragedy with Kanye West's mom- Donda West.
For those who have not heard the story- Mrs. West received outpatient cosmetic surgery last Friday, was found unresponsive the next day and was brought to the hospital, where she was pronounced dead. Dr. Jan Adams has come out and stated that he was the surgeon. An autopsy has been performed and the results are pending.

Since the story broke, TMZ, CNN, ABC, etc have come out with a number of stories about this tragedy and the background of the surgeon. A lot has been talked about and blogged about his qualifications, board certification, etc.

This blog will hopefully clear up some of the confusion...

1. Was the doctor who performed Donda West's surgery board certified in plastic surgery?
No.

2. Can a doctor perform plastic surgery even if he is NOT board certified in plastic surgery?
Unfortunately, yes. In the US, a doctor can perform any surgery that YOU let him/her. It's up to each patient to check the credentials.

3. This doctor was featured on Oprah and had his own show on the Discovery Channel- don't they check for these things?
No. Keep in mind that these shows are only for entertainment- it is up to every patient to do their own homework.

4. What's the big deal about being board certified?
Board Certification by the American Board of Plastic Surgery is a process that takes years to complete. A surgeon must have completed the required years (5-8 yrs!) of training in Plastic Surgery and General Surgery, passed an 8 hr written examination, and then pass an Oral Examination which lasts 3 days. It's a demanding, intensive, and thorough process- the reason why some surgeons aren't able to pass or choose not to go through it.

5. How can I find out if my doctor is board certified?
Don't rely on doctor's websites, TV, etc.
As TMZ pointed out, another aspect of this tragedy is how EASY it is to find out this information. All it takes is a few minutes on the web. Go to the site below, register for free, and enter the name of ANY doctor you want to check. If it does not say that they are board certified in plastic surgery or they are not listed- they aren't.

www.isyourdoctorboardcertified.com

Will Yoga Replace Plastic Surgery?

An interesting story by Natasha Singer in The New York Times today highlighted a new trend in the yoga world. It seems that people are now performing yoga exercises as an alternative to plastic surgery! These classes can be found in many parts of the country such as Manhattan, San Francisco, and Austin, Texas and come under names such as Yo-Tox, the Yoga Facelift, and Revita-Yoga.

These classes are billed as combinations of yoga and facial exercises that will combat frown lines, wrinkles, and sagging. One instructor, Annelise Hagen, states that “each pose, stretch or exercise is designed to relax the muscles and release the patterns people unconsciously etch into their skin.” To sculpt your nose, she recommends alternating breathing out of each nostril (I would take the class just to see how this can be done!). To remove crow’s feet the student must open the eyes wide to smooth the lines. Another yoga exercise called the “downward dog” can add color to the complexion. By teaching her students to consciously relax their facial muscles, they can get a similar effect to using Botox. Gary Sikorski, another instructor certified in yoga facial toning, notes that “Folks are realizing the face has muscles and that there’s a substitute to plastic surgery that costs less and can achieve similar results.”

Can these exercises possibly work?
Will yoga replace Botox and plastic surgery?
Can I learn to alternate breathing out of each nostril?

Very unlikely. While the yoga exercises may relax you and your facial muscles, muscles aren’t the only culprit in facial aging. Here in Miami, it’s plain to see that many of the effects of facial aging are the result of sun, gravity, smoking, and genetics. Juvederm, Radiesse and other dermal fillers are an excellent way to replace facial volume that has been lost due to the thinning of our skin or that has descended because of gravity. Surgical procedures such as a facelift, brow lift, eyelid surgery, etc are still the best way to remove excess or baggy skin and reposition soft tissue to create a more youthful look.

The GOOD news is that these yoga exercises can’t hurt- unlike many of the “alternative” therapy regimens out there (just ask Anna Nicole). In our hectic lives, we all need more opportunities to stretch, relax, and rejuvenate ourselves. Who knows? Maybe I’ll learn how to alternate my breathing out of each nostril after all…

Did Anna Nicole Smith’s HGH Anti-Aging Regimen Contribute to Her Death?

Earlier this week, the medical examiner here in Broward County released the autopsy report of Anna Nicole Smith. The coroner found evidence of repeated needle injections to her left buttock. These injections produced a deep-seated abscess filled with yellow-green pus. The medical examiner noted that it was possible that bacteria from this abscess entered her bloodstream, producing a fever of 105 F, and prompting her to respond with an overdose of medications, ultimately leading to her death.

What were these injections for? The coroner noted that Anna Nicole was receiving a cocktail of anti-aging drugs including human growth hormone (HGH) for “self-treatment for longevity and weight control."

This finding has placed the spotlight directly on HGH. This hormone is produced in the pituitary gland at the base of the brain. It has been used for decades in children whose growth was stunted because they were deficient in this hormone, but over the last 17 years, it has been touted as the pharmaceutical fountain of youth that builds muscle, sheds fat, and restores youth.

The only problem is that these “off-label” uses of HGH have not been systematically and are not approved by the FDA. However, this has not stopped the popularity of this latest wonder drug- just last month, Sylvester Stallone was charged by Australian authorities for illegally importing 48 vials of HGH.

How did HGH get so popular? The current boom in use can be attributed to findings in an article in the New England Journal of Medicine in 1990 which showed that 12 men over the age of 60 who received HGH injections showed increases in lean body mass and bone density. Although the authors and an accompanying editorial did not tout HGH as an age reversal drug, this study became the inspiration for a slew of anti-aging clinics. JAMA noted in 2005 that 20,000 and 30,000 adults used growth hormone as an anti-aging therapy. This therapy can get real expensive, real fast… often more than $1,000 per month. The irony to all this is that the side effects of HGH may actually make your body age faster… researchers have noted that people injecting HGH can develop diabetes, arthritis and hypertension. These are serious diseases which can affect a patient’s quality of life.

Authorities are beginning to crack down on this black market, as well. New York investigators have arrested doctors, pharmacists, and clinic operators involved in HGH clinics. The US Senate is also considering listing HGH as a controlled substance to help prosecute the illegal use and sale of this drug.

As a plastic surgeon, patients continually ask me about the latest anti-aging cocktail regimen. I remind all of my patients that this is not the approved use of drugs like HGH and we simply don’t have the benefit of long term studies that help us understand how these drugs can help, or even hurt, a patient. Would you let someone inject a drug into you when they aren’t sure what effect it will have? It’s really unfortunate someone didn’t explain this to Anna Nicole…

The Olsen Twins: Mary-Kate and Ashley to Receive Plastic Surgery

In the blogosphere today, it was reported that Mary-Kate and Ashley Olsen have looked into getting matching rhinoplasties. Supposedly, Ashley felt that her nose was a little a large and wanted to reduce the size and contour. Her sister loved the idea and wants one too.

Rhinoplasties are the most delicate and demanding procedure in plastic surgery. The difference between a great result and a poor outcome can be just a few millimeters. A good rhinoplasty surgeon is one half structural engineer and one half artist. I find it extremely important to have at least two pre-op consultations with a rhinoplasty patient and do a complete internal, external, and whole face evaluation each time. We then use digital morphing technology to show the patient what is possible and make sure that we are both on the same page. A rhinoplasty patient never has as good an opportunity to get a nice result as the first time!

Is it common for family members to receive plastic surgery at the same time? You bet. At our plastic surgery center here in Miami, we’ve seen all combinations: twins, husband-wife, sister-sister, mother-daughter, father-son, grandmother-mother-daughter, best friends, etc, etc. My patients have told me that it really helps to have someone to go through the surgery and the recovery period. They have also said that the experience brought them a lot closer.

Too Few American Women Receive Breast Reconstruction

A study from the University of Michigan Comprehensive Cancer Center revealed that fewer than 20% of American women who receive breast cancer surgery (mastectomy) undergo breast reconstruction surgery.

The study also noted that 44% of general surgeons DO NOT refer the majority of their breast cancer patients to a plastic surgeon before the patient’s breast cancer surgery.

This second finding may help explain the consistently low number of American women that receive reconstructive breast surgery after their mastectomies. (General surgeons or breast surgeons are the doctors who remove the breast cancer via mastectomies. Plastic surgeons are the doctors that reconstruct a woman’s breast after the cancer surgery. The large majority of women who receive a mastectomy are candidates for breast reconstruction.)

The survey was compiled from the responses of 365 general surgeons in Ann Arbor, Michigan and Los Angeles, California. 44% of these surgeons referred less than a quarter of their patients to a plastic surgeon before the patient’s breast cancer surgery. Only 24 percent of general surgeons referred three-quarters or more of their patients for reconstruction.

The lead author of the study, Amy Alderman, MD, MPH, made an excellent point about the importance of reconstruction in breast cancer management, “We need to help patients through this difficult decision-making process up front, through patient decision aids that include information about reconstruction and multidisciplinary approaches to care, where all surgical options are fully explained."

General surgeons in this study attributed the low rates of breast reconstruction to patients not wanting the procedure:

• 57% of surgeons said it was not important to patients
• 64% thought patients were not interested
• 39% thought patients were concerned that reconstruction takes too long.
• 50% felt patients were concerned about the cost of reconstruction.

These concerns about the cost of a reconstruction are particularly unfortunate. Patients need to be educated that insurance companies are REQUIRED by a 1998 federal law to pay for breast reconstruction and symmetry surgery (surgery on the opposite breast to make the breasts match after a reconstruction).

Interestingly, the study pointed out that the surgeons most likely to refer their patients to a plastic surgeon tended to be female, with a large volume of breast cancer patients. They were also more likely to work in a cancer center rather than a community hospital or teaching hospital. The study authors suggested that surgeons who do not refer as many patients for reconstruction may be more likely to treat patients with limited resources or to practice in settings with limited access to plastic surgeons.

This study highlights a really disappointing trend in American cancer care. As a plastic surgeon, I can tell you that breast reconstruction is one of the most rewarding surgeries we perform. When you embark on a breast reconstruction, you get to know the patient and their family very well. You allay their concerns and also share their sense of victory as they overcome the cancer and look forward to the rest of their life. It’s amazing to think back (not so long ago- just before 1998) when insurance companies would try to refuse to pay for a breast reconstruction because they considered this cosmetic surgery. Is having two eyes, two feet, two hands vanity? Would they choose to go through life with one eye, one hand, or one foot?

Today, there are so many options for breast reconstruction. During my consults, we go over all of these with each woman and let them choose the one that will fit their goals, lifestyle, and preferences in shape, size, feel, look, recovery period, etc. I do hope that more American women are referred for breast reconstruction- getting on board BEFORE their initial breast cancer surgery lets us coordinate with the general surgeon and make sure that the patient gets the best outcome.

Did Salma Hayek Have a High Profile Breast Augmentation?

One of my favorite actresses, Salma Hayek has definitely gotten more busty than a few years ago. This new look is accentuated by the fitted swimsuit in the second picture. Could this be from a high profile breast augmentation? Very possible.

As the most recent statistics have noted, breast augmentation is now the most popular cosmetic surgical procedure for women. All women- celebrities and those not so famous- love the way breast implants can improve their figure, enhance their cleavage, and help them fill out their clothes.

In my practice, we have women of all shapes and sizes requesting breast augmentations. When I sit down with women before their surgery, we spend a great deal of time talking not just about the SIZE of the implant they will select, but about the implant shape and profile height too.

Smaller women like Ms. Hayek (Salma is a petite 5' 1.5") often prefer implants with MODERATE or HIGH profiles. These implants are TALLER and more narrow than low profile implants- allowing a woman to receive a fuller volume implant WITHOUT the implant spilling off their chest and into their armpits.

(Salma Hayek Photo Courtesy of awfulplasticsurgery.com)

Breast Implants Improve Sex & Self-Esteem!

A recent study from the University of Florida noted that women reported better sexuality and improved self-esteem after cosmetic breast augmentation surgery!

The study recruited participants by advertising for volunteers at the offices of local plastic surgeons. 84 women completed questionnaires on self-esteem and sexuality before and after cosmetic breast augmentation surgery.

The study noted that overall; the women did NOT have particularly low self-esteem or poor sexual function prior to surgery. But the women DID NOTE a significant improvement to both aspects of their lives after they got breast implants.

This highlights that body image is an important factor in a woman’s self-esteem. The author of the study, Cynthia Figueroa-Haas, PhD, bristled at the idea that it’s frivolous for women to want to improve their body image through surgery:

"A lot of people consider plastic surgery a procedure that doesn't need to be done. They say women should stay with their bodies and what God gave them and be satisfied. I don't agree," she says. "This procedure does change women's psychosocial issues. There are differences [in life satisfaction] between people with good and poor self-esteem."

After the breast augmentation, women also experienced every aspect of their sexuality more intensely. They noted significant increases in arousal, sexual desire, sexual satisfaction, and lubrication.

These findings are consistent with what patients have told me at our center, as well. Women who receive breast augmentation often do so to improve or correct (for deficiency, asymmetry, etc) one aspect of their body that they may feel self-conscious about. Once their concern has been corrected, they feel more comfortable in their own skin.

It’s really rewarding to see a happy patient after a breast augmentation- they are more confident and tell us that they enjoy ALL aspects of their lives more. They usually leave it at that- we don’t pry for details…

I think that the importance of this study is to show that if there is a SAFE and EFFECTIVE way to fix something you don’t feel comfortable about… you should do it.

Personally, I encountered this 6 years ago when I decided to have LASIK surgery- did I NEED to do it? No. Could I have worn glasses for the rest of my life? Sure. But the glasses and waking up with contacts glued to my eyes bothered me, so after a lot of research I found a great, board-certified ophthalmologist and did it. The surgery was a miracle- everything turned out great and I have never regretted that decision.

Cosmetic surgery can make a great, positive change in your life. The important thing is to do your homework first- make sure that you are a candidate for that procedure and that the doctor you have selected is qualified to perform it. More on this later...

Hispanics lead minority groups in cosmetic surgery!

This week, the American Society for Aesthetic Plastic Surgeons (ASAPS) released their 2006 Plastic Surgery Statistics. This survey highlighted several interesting trends in American plastic surgery.

The study noted that the number of cosmetic procedures in this country is at an all time high at 11.5 million! And that women receive 92% of these procedures. The study also showed that across the nation, Hispanics accounted for 9.7% of these procedures, African-Americans for 6.6%, and Asians at 4.7%.

Although, I think that the exact numbers may vary depending on where you are located, I think that the overall trend is correct. In my Miami plastic surgery practice, we are seeing a growing demand in cosmetic surgery and non-invasive procedures, especially from the Hispanic and the African-American communities.

I think that part of this is cultural- plastic surgery is VERY popular throughout South America and we are blessed to have many Latin Americans live here in South Florida. We also have patients who fly in for their procedures and to enjoy beautiful South Florida while they recover. Lastly- the word is out- cosmetic techniques have proven to be safe and effective! As these procedures have evolved, they have produced better, longer-lasting results with minimal down time. I think that this has opened the doors to busy professionals and other people who in the past would not have considered themselves candidates for cosmetic surgery.

It's important to note that these communities do have very particular needs- every procedure (esp those for skin tone correction and tightening) need to be approached with the individual's skin type, color, and thickness in mind. Educating patients on their options is as important as always- that's why all our staff and all our office literature is multilingual! Thank God I'm from Ecuador. Adios!

62% of Americans Approve of Cosmetic Surgery: An All- Time High!

The American Society of Aesthetic Plastic Surgeons (ASAPS) released its 10th Consumer Attitudes Study. This is a study that takes the pulse of the nation on cosmetic surgery.

In asking 1000 Americans ages 18 and above about their attitudes and perceptions of cosmetic surgery, the survey found a continuation of a ten year trend. 62% of Americans approve of cosmetic surgery! This is an all time high and is an 8% increase from last year.

The study also found that 61% of men and 63% of women approve of cosmetic surgery. Females are 16% more likely to consider plastic surgery than men. This is consistent with the 2006 statistics just released by ASAPS which show that 92% of those who received cosmetic procedures in 2006 were women! In a related survey (see post below) the most common cosmetic surgery for women was breast augmentation- this is the first time this has happened since they started this survey. I think American women are satisfied with the beautiful results we can achieve with aesthetic breast surgery and the safety of these procedures.

As Americans learn more and more about the safety and effectiveness of cosmetic surgery, we can expect the popularity of plastic surgery to continue to grow!

The 2006 Plastic Surgery Statistics Are In!

(Click graph above to enlarge!)

Hello all! 2006 was another great year for aesthetic plastic surgery. The American Society of Aesthetic Plastic Surgeons (ASAPS) has just released their 2006 statistics. The survey noted that in 2006, there were nearly 11.5 million surgical and nonsurgical cosmetic procedures performed in the United States! This was a 1% increase since 2005. Since 1997, surgical procedures have increased 123% and nonsurgical procedures have increased 749%!

These results are a testament to the continued popularity of aesthetic plastic surgery in America. The study also highlighted some very interesting trends. They noted that in 2006, surgical procedures actually decreased by 9 percent. Nonsurgical procedures (such as Botox, dermal fillers, and laser therapy) increased by 3 percent. We have seen this increased demand in noninvasive techniques in our center- their popularity continues to grow because of their proven safety record and their effectiveness. There’s a lot you can do today with just a syringe, a peel, or a laser these days!

Surgical Procedures- Break down by men and women.

The survey noted that women account for 92 percent of these aesthetic procedures.

The Top 5 Plastic Surgery Procedures for Women are:

1. Breast augmentation
2. Liposuction
3. Eyelid Surgery
4. Tummy Tuck
5. Breast Reduction

For the first time since the beginning of this survey- breast augmentation proved more popular than liposuction! This was due in part to the FDA approval of silicone gel breast implants in late 2006 (the use of silicone gel implants increased by 18% from 2005). We have seen this at our center as well. We have A LOT of women requesting silicone gel implants because of their softer feel and natural results.

Men accounted for 8% of all cosmetic surgery.

The Top 5 Plastic Surgery Procedures for Men are:

1. Liposuction
2. Rhinoplasty
3. Eyelid Surgery
4. Breast Reduction for a fatty chest (gynecomastia)
5. Facelift

Top 5 Nonsurgical Procedures are:

1. Botox
2. Hyaluronic Acid (Juvederm, Restylane)
3. Laser Hair Removal
4. Microdermabrasion
5. Laser Skin Resurfacing

Because of the safety and effectiveness of the surgical and nonsurgical techniques, we can expect continued growth through 2007 and beyond! Stay tuned!

Beauty Truth or Myth #1: Can an unknown woman be identified by her breast implants?

VERDICT: TRUE

Earlier this week, I ran across a terrible news story about an unidentified woman found in Tampa who the police were trying to identify by looking up the serial numbers on her breast implants. Is this possible?

Doing a little research, I found out that police have used this technique before in Newport Beach, California and in London, and that this idea has even been a plot element on the TV show, Bones.

I thought about this sad story again today when I was in the OR performing a breast implant revision surgery. Many years ago, my patient had previously received a breast augmentation with saline breast implants and wanted to exchange these for silicone gel breast implants. When I took out the saline implants, I noticed that they had the size "XXX cc" stamped onto them, but no other numbers. The silicone gel implants had the size and the Lot number stamped onto them. (Companies make implants in batches called "lots"- this helps them keep track of the implants and check their manufacturing process) However, there were no serial numbers on the implants themselves.

I called the implant company and asked if it was possible to identify a woman by looking up the serial numbers on the implants. They informed me that their saline and silicone gel implants do not have serial numbers, but they do have Lot numbers stamped on them. The company has records where implants of that Lot were distributed. Investigators can then track down the implants in that lot and account for each implant (whether it is on a shelf or happily in a patient). Therefore, breast implants CAN help identify a person, but the process requires some leg work.

Conclusion: Breast implants can make a wonderful change in a woman's appearance, but they won't replace fingerprints any time soon.

Welcome to Truth in Beauty!

There has never been a more exciting time to learn about aesthetic medicine & plastic surgery! It seems that every day we hear about a new cosmetic cream, skin filler, or injectable that has come on to the market. Just as often, new surgical techniques are profiled on the news or we hear rumors of a celebrity having had cosmetic surgery.

What’s real and what isn’t? This blog will help you sift through all that- my hope is that Truth in Beauty will serve as an open forum to discuss new cosmetic products, surgical techniques, and other plastic surgery topics in the news. Comments and suggestions are always welcome.

Thanks for visiting and stay tuned...

From beautiful South Florida...

Pat Pazmino, MD
MIAMI AESTHETIC SURGERY