Cindy Margolis - Plastic Surgery?

The former "Most Downloaded Woman in the World" Cindy Margolis is making news lately with her July 2008 pictorial in Playboy magazine. The divorced mother of three is now 42 years old and looks fabulous. I do believe she's had a bit of help, though.

When looking at this photo, she appears to be making a rather stern look. Her brow doesn't furrow, however, and this lack of wrinkles is a likely sign of a good Botox job. Her lips may also be modestly enhanced with a filler, like Restylane. I also think she may have had some enhancement of her cheeks, possibly with Sculptra or fat grafting injections. Her skin is flawless, and has been probably helped out by chemical peels and medical strength skin care products. Finally, she appears to have had a breast augmentation. Overall, I think her work is well-done. She does resemble Shannon Tweed a little bit, so I wonder if they share the same plastic surgeon...

I've not seen her Playboy spread since I do not read the magazine. If I did, however, I'd read it for the articles.

Photo credit: prphotos.com

Thanks for reading.
Michigan-based Plastic Surgeon
Anthony Youn, M.D.:

Cindy Margolis - Plastic Surgery?

The former "Most Downloaded Woman in the World" Cindy Margolis is making news lately with her July 2008 pictorial in Playboy magazine. The divorced mother of three is now 42 years old and looks fabulous. I do believe she's had a bit of help, though.

When looking at this photo, she appears to be making a rather stern look. Her brow doesn't furrow, however, and this lack of wrinkles is a likely sign of a good Botox job. Her lips may also be modestly enhanced with a filler, like Restylane. I also think she may have had some enhancement of her cheeks, possibly with Sculptra or fat grafting injections. Her skin is flawless, and has been probably helped out by chemical peels and medical strength skin care products. Finally, she appears to have had a breast augmentation. Overall, I think her work is well-done. She does resemble Shannon Tweed a little bit, so I wonder if they share the same plastic surgeon...

I've not seen her Playboy spread since I do not read the magazine. If I did, however, I'd read it for the articles.

Photo credit: prphotos.com

Thanks for reading.
Michigan-based Plastic Surgeon
Anthony Youn, M.D.:

Is Canada's health system overdue for an "Extreme Makeover"?

I've pointed out here on Plastic Surgery 101 that despite the dysfunction of the American health care system, the alternatives in other western nations have their own problems. In 2007 I posed the question "So You Think You Want Universal Health care?" and featured Dr. Val's review of "Sicko" which glowingly featured other countries' systems.

It was particularly interesting to me to see the "religious conversion" of one Claude Castonguay on this topic. Who is Claude Castonguay? He's the father of Canada's socialized medicine program. After four decades, he finally admitting that the system he laid out for Canada is failing to meet both the medical needs of beneficiaries as well as the budget needs of the individual Canadian provinces. Castonguay now advocates contracting out services to the private sector and American-style co-pays for patients who want to see physicians.

For an interesting overview on this, read the Investor's Business Daily editorial page article "Canadian Health Care We So Envy Lies In Ruins, Its Architect Admits". The Canadian author, David Gratzer, has written extensively on Canada's uneasy relationship with their countries health program.


Rob

Lift Magic

Ever wonder what you may look like with a browlift, or a cheek lift, or a lip augmentation? A new website called Lift Magic allows you to upload your photo and then see what simulated facial plastic surgery would cause you to look like. I have a similar morphing program that I use for my patients, and the results can be pretty realistic is done correctly. It can also be a nice party game...



For Lift Magic, click here.

Thanks for reading.
Michigan-based Plastic Surgeon
Anthony Youn, M.D.:

Lift Magic

Ever wonder what you may look like with a browlift, or a cheek lift, or a lip augmentation? A new website called Lift Magic allows you to upload your photo and then see what simulated facial plastic surgery would cause you to look like. I have a similar morphing program that I use for my patients, and the results can be pretty realistic is done correctly. It can also be a nice party game...



For Lift Magic, click here.

Thanks for reading.
Michigan-based Plastic Surgeon
Anthony Youn, M.D.:

Cynthia Nixon Denies Plastic Surgery Rumors

Cynthia Nixon has denied recent reports that she's had a breast augmentation. According to The Post Chronicle:

U.S. actress and breast cancer survivor Cynthia Nixon is denying a published report that she recently underwent breast augmentation surgery.
Although the New York Post reported that the Sex and the City star had cosmetic surgery at a Manhattan hospital on the quietest day of the week, Nixon told the New York Daily News the story is totally false and she simply went to the hospital for a three-monthly checkup.

If her denial is indeed true, how can someone mistake a monthly checkup with having a breast augmentation???

Photo credit: prphotos.com

Thanks for reading.
Michigan-based Plastic Surgeon
Anthony Youn, M.D.:

Cynthia Nixon Denies Plastic Surgery Rumors

Cynthia Nixon has denied recent reports that she's had a breast augmentation. According to The Post Chronicle:

U.S. actress and breast cancer survivor Cynthia Nixon is denying a published report that she recently underwent breast augmentation surgery.
Although the New York Post reported that the Sex and the City star had cosmetic surgery at a Manhattan hospital on the quietest day of the week, Nixon told the New York Daily News the story is totally false and she simply went to the hospital for a three-monthly checkup.

If her denial is indeed true, how can someone mistake a monthly checkup with having a breast augmentation???

Photo credit: prphotos.com

Thanks for reading.
Michigan-based Plastic Surgeon
Anthony Youn, M.D.:

Dr. A List Will See You Now

There is a great article written by Natasha Singer in the New York Times on the state of plastic surgery in the current economy. The article focuses on how plastic surgery big ticket items, such as facelifts and tummy tucks, have been affected by the recent downturn in the economy. While the demand for less invasive (and less expensive) treatments like Botox and Restylane grows, the amount of actual surgery performed has increased at a snail's pace according to statistics by the American Society of Plastic Surgeons. Part of this may be due to people having less disposable income. This has resulted in declines in the waiting lists for even the most prominent plastic surgeons. Two plastic surgeons featured on TV, Dr. Anthony Griffin and Dr. Linda Li, have undergone decreases in their wait times for consultations to 3 months and 1 month respectively.

I think part of the downturn in business for plastic surgeons is also due to the emergence of non-plastic surgeons performing plastic surgery, often at bargain-basement prices. I do find, however, that some of these fake plastic surgeons funnel patients my way, as their victims often need to find a reputable surgeon to fix their botched surgery...

Click here for the New York Times article.
Click here for my recent post on the Plastic Surgery Recession

Thanks for reading.
Michigan-based Plastic Surgeon
Anthony Youn, M.D.:

Dr. A List Will See You Now

There is a great article written by Natasha Singer in the New York Times on the state of plastic surgery in the current economy. The article focuses on how plastic surgery big ticket items, such as facelifts and tummy tucks, have been affected by the recent downturn in the economy. While the demand for less invasive (and less expensive) treatments like Botox and Restylane grows, the amount of actual surgery performed has increased at a snail's pace according to statistics by the American Society of Plastic Surgeons. Part of this may be due to people having less disposable income. This has resulted in declines in the waiting lists for even the most prominent plastic surgeons. Two plastic surgeons featured on TV, Dr. Anthony Griffin and Dr. Linda Li, have undergone decreases in their wait times for consultations to 3 months and 1 month respectively.

I think part of the downturn in business for plastic surgeons is also due to the emergence of non-plastic surgeons performing plastic surgery, often at bargain-basement prices. I do find, however, that some of these fake plastic surgeons funnel patients my way, as their victims often need to find a reputable surgeon to fix their botched surgery...

Click here for the New York Times article.
Click here for my recent post on the Plastic Surgery Recession

Thanks for reading.
Michigan-based Plastic Surgeon
Anthony Youn, M.D.:

Leg Lengthening Surgery : Urban Legend? Not Really...

There's a fascinating article on Men.Style.Com (Details Magazine) focusing on Leg Lengthening surgery. This is a surgery where the bones of the legs are sawed in half and then gradually allowed to spread apart as new bone grows between the two broken halves. It's called the Ilizarov technique, and has been used for healing fractures for years. It's only recently making news as a technique for making a person taller. The article describes the experiences of several men who have undergone the procedure, some with good, yet others with disastrous results. It's usually performed in other countries such as China and Germany and costs anywhere between $10,000 (cut your legs in half and then chain you to a bed) to $200,000 (they do the same but give you a sandwich too).

Obviously I do not advocate this procedure. Although bone lengthening surgeries are done quite commonly in plastic surgery to treat facial deformities, these are strictly in reconstructive terms. In one syndrome, called hemifacial microsomia, the affected person has one half of their jaw which is underdeveloped. Lengthening can be done of the bone to improve the appearance and function of their jaw. Unfortunately, bone lengthening is a tedious process which can result in a major complication like osteomyelitis (infection of the bone).

In addition, I caution all my patients to be very wary of having a medical procedure performed in another country, since their training and certification processes are different that in the States, and if you were to develop a complication you might be in a big heap of a mess (both medically and financially). If you really want to be taller, learn from Tom Cruise and wear some platform shoes...at least when you're out with your much taller wife.

Thanks for reading.
Michigan-based Plastic Surgeon
Anthony Youn, M.D.:

Leg Lengthening Surgery : Urban Legend? Not Really...

There's a fascinating article on Men.Style.Com (Details Magazine) focusing on Leg Lengthening surgery. This is a surgery where the bones of the legs are sawed in half and then gradually allowed to spread apart as new bone grows between the two broken halves. It's called the Ilizarov technique, and has been used for healing fractures for years. It's only recently making news as a technique for making a person taller. The article describes the experiences of several men who have undergone the procedure, some with good, yet others with disastrous results. It's usually performed in other countries such as China and Germany and costs anywhere between $10,000 (cut your legs in half and then chain you to a bed) to $200,000 (they do the same but give you a sandwich too).

Obviously I do not advocate this procedure. Although bone lengthening surgeries are done quite commonly in plastic surgery to treat facial deformities, these are strictly in reconstructive terms. In one syndrome, called hemifacial microsomia, the affected person has one half of their jaw which is underdeveloped. Lengthening can be done of the bone to improve the appearance and function of their jaw. Unfortunately, bone lengthening is a tedious process which can result in a major complication like osteomyelitis (infection of the bone).

In addition, I caution all my patients to be very wary of having a medical procedure performed in another country, since their training and certification processes are different that in the States, and if you were to develop a complication you might be in a big heap of a mess (both medically and financially). If you really want to be taller, learn from Tom Cruise and wear some platform shoes...at least when you're out with your much taller wife.

Thanks for reading.
Michigan-based Plastic Surgeon
Anthony Youn, M.D.:

Dr. Zenn flamed in Freakonomics plastic surgery Q & A session

Little did Duke University plastic surgeon, Dr. Michael Zenn, know what he was in for in a recent Q&A guest appearance in the Freakonomics Blog column in the New York Times. Out of about 20 questions on a range of subjects he responded to, he made the "mistake" of accurately discussing a single innocuous question about breast implants.

Q: Would you endorse cohesive gel instead of silicone due to the concern over safety issues of silicone? Or do you believe that was all just hoopla? Is it true that breast implants should be redone every 5 to 10 years?

A: Today’s breast implant options are saline or silicone. Saline implants are a silicone shell filled with salt water, silicone implants are a silicone shell filled with cohesive gel. Both implants are equally safe, both have the same safety profile.
The Institute of Medicine found that much of the concerns were hoopla — except for the problems that they both have: rupture, scarring, and infection. Most plastic surgeons and patients will tell you silicone just feels better. Implants are replaced when one of the above problems occurs

Skip down to the comments section and you'd think he was advocating beating your wife as nearly 5 out of every 6 comments are by breast implant "survivors" wailing alternately on his intelligence, character, and ethics. Ah, the wonders of the Internet to organize like-minded partisans into rapid response teams!

Much like the autism vaccine conspiracy theorists, the breast implant siliconistas come off looking out of touch with such reflexive outrage on command, particularly when you recognize the kind of heavy duty microsurgical and reconstructive surgery practice that Dr. Zenn is known for at Duke. He's one of the good guys for Pete's sake!

There's intelligent reasons to object to breast augmentation surgery, but claiming it caused symptom or disease "X,Y,Z...." is a dead horse that's been buried several times over! For a refresher see here and here to recap the comprehensive 2007 landmark review.

Rob

Kristin Davis and Cynthia Nixon - Plastic Surgery??

Much is often made about the alleged plastic surgery procedures of Sarah Jessica Parker and Kim Cattrall. But who would have thought that both Cynthia Nixon and Kristin Davis may have had plastic surgery? According to PageSix:

Apparently, soon after the movie's release, they both paid a visit to Roosevelt Hospital on 10th Avenue for minor surgeries. "Cynthia had a breast augmentation and soon after, Kristin had the varicose veins on her legs removed," said an insider. "They both made sure they did it on the quietest day of the week."

I don't consider having varicose veins removed as a plastic surgery, but it can be construed as cosmetic by some. I haven't had a chance to see the SATC movie, but I think my wife is jonesing to add it to my Netflix queue as soon as it is released.

Photo credit: prphotos.com

Thanks for reading.
Michigan-based Plastic Surgeon
Anthony Youn, M.D.:

Share |

Kristin Davis and Cynthia Nixon - Plastic Surgery??

Much is often made about the alleged plastic surgery procedures of Sarah Jessica Parker and Kim Cattrall. But who would have thought that both Cynthia Nixon and Kristin Davis may have had plastic surgery? According to PageSix:

Apparently, soon after the movie's release, they both paid a visit to Roosevelt Hospital on 10th Avenue for minor surgeries. "Cynthia had a breast augmentation and soon after, Kristin had the varicose veins on her legs removed," said an insider. "They both made sure they did it on the quietest day of the week."

I don't consider having varicose veins removed as a plastic surgery, but it can be construed as cosmetic by some. I haven't had a chance to see the SATC movie, but I think my wife is jonesing to add it to my Netflix queue as soon as it is released.

Photo credit: prphotos.com

Thanks for reading.
Michigan-based Plastic Surgeon
Anthony Youn, M.D.:

Share |

Noninvasive Liposuction in the U.S.???? Not yet...

In plastic surgery news, Medicis, the company which produces Restylane and Perlane, has just announced that it is acquiring Liposonix, a Seattle-based company which specializes in nonsurgical fat removal. Liposonix is a pioneer in focused ultrasound technology as a noninvasive way to reduce fat. It's being used in Europe, but is not available in the U.S. They are hoping that their machine will achieve FDA approval by 2011, if not sooner.

What's the big deal? Well, we are always looking for ways to reduce fat without surgery(or exercise!). External ultrasound has been used in the past, but to my knowledge has never been proven to actually permanently reduce fat. It was a hot topic at one time, but has cooled over the past several years. With technology improving, however, it is possible that the Liposonix machine may produce results superior to the disappointing results of the past. In my office we utilize external ultrasound for cellulite reduction via the Dermosonic technique, but it is not proven to permanently remove fat cells. Yesterday our local Fox affiliate aired a segment on cellulite reduction where I described the cause of cellulite and how cellulite reduction works. Click here for streaming video of it.

Liposonix is a far cry from mesotherapy or Lipodissolve, however, which is by no means non-invasive. I saw a patient recently who had several treatments of Lipodissolve to the fat and loose skin of her tummy. To be honest, the fat did appear to have been significantly reduced. However, she was left with a bunch of leftover loose, hanging skin. She emphasized to me that the treatments were excruciatingly painful and cost several thousand dollars.

I am very interested in the possibilities of fat reduction with Liposonix. No matter what people may falsely advertise however, I know of no proven way to permanently remove fat here in the U.S. except via liposuction.... so far.

For the Medicis press release, click here.

Thanks for reading.
Michigan-based Plastic Surgeon
Anthony Youn, M.D.

Noninvasive Liposuction in the U.S.???? Not yet...

In plastic surgery news, Medicis, the company which produces Restylane and Perlane, has just announced that it is acquiring Liposonix, a Seattle-based company which specializes in nonsurgical fat removal. Liposonix is a pioneer in focused ultrasound technology as a noninvasive way to reduce fat. It's being used in Europe, but is not available in the U.S. They are hoping that their machine will achieve FDA approval by 2011, if not sooner.

What's the big deal? Well, we are always looking for ways to reduce fat without surgery(or exercise!). External ultrasound has been used in the past, but to my knowledge has never been proven to actually permanently reduce fat. It was a hot topic at one time, but has cooled over the past several years. With technology improving, however, it is possible that the Liposonix machine may produce results superior to the disappointing results of the past. In my office we utilize external ultrasound for cellulite reduction via the Dermosonic technique, but it is not proven to permanently remove fat cells. Yesterday our local Fox affiliate aired a segment on cellulite reduction where I described the cause of cellulite and how cellulite reduction works. Click here for streaming video of it.

Liposonix is a far cry from mesotherapy or Lipodissolve, however, which is by no means non-invasive. I saw a patient recently who had several treatments of Lipodissolve to the fat and loose skin of her tummy. To be honest, the fat did appear to have been significantly reduced. However, she was left with a bunch of leftover loose, hanging skin. She emphasized to me that the treatments were excruciatingly painful and cost several thousand dollars.

I am very interested in the possibilities of fat reduction with Liposonix. No matter what people may falsely advertise however, I know of no proven way to permanently remove fat here in the U.S. except via liposuction.... so far.

For the Medicis press release, click here.

Thanks for reading.
Michigan-based Plastic Surgeon
Anthony Youn, M.D.

Celebrity Nose Jobs - Are We Seeing the Same Nose Over and Over Again?

A post from the popular Cityrag blog mentions that celebrities' noses are all looking the same. Not surprising, given that it is rumored that the same Beverly Hills rhinoplasty surgeon has worked on Cameron Diaz, Ashlee Simpson, and Jennifer Aniston. Many plastic surgeons who specialize in rhinoplasty have their own signature "look". This signature look comes from a combination of performing the surgery the same way every time with certain personal aesthetic preferences. For example, some surgeons believe a more pinched nasal tip looks good. Therefore, they will be more likely to place stitches into the cartilage to create this look and not finish the surgery until the pinched look is created.

That's not my style, as I tend to believe the "less surgery is often more" rule for rhinoplasty. I wouldn't want anyone to say, "Look! It's a Dr. Youn nose!"

By the way, I think that the surgeon who has performed the work of the celebrities above has done a nice job.

Photo credit: prphotos.com

Thanks for reading.

Michigan-based Plastic Surgeon
Anthony Youn, M.D.:

Celebrity Nose Jobs - Are We Seeing the Same Nose Over and Over Again?

A post from the popular Cityrag blog mentions that celebrities' noses are all looking the same. Not surprising, given that it is rumored that the same Beverly Hills rhinoplasty surgeon has worked on Cameron Diaz, Ashlee Simpson, and Jennifer Aniston. Many plastic surgeons who specialize in rhinoplasty have their own signature "look". This signature look comes from a combination of performing the surgery the same way every time with certain personal aesthetic preferences. For example, some surgeons believe a more pinched nasal tip looks good. Therefore, they will be more likely to place stitches into the cartilage to create this look and not finish the surgery until the pinched look is created.

That's not my style, as I tend to believe the "less surgery is often more" rule for rhinoplasty. I wouldn't want anyone to say, "Look! It's a Dr. Youn nose!"

By the way, I think that the surgeon who has performed the work of the celebrities above has done a nice job.

Photo credit: prphotos.com

Thanks for reading.

Michigan-based Plastic Surgeon
Anthony Youn, M.D.:

Follow up to a question on breast cancer

I got a question about some of the ideas I was talking about in my last post on how I think about breast cancer. A breast cancer patient wrote me and asked about the difference in how her oncologist explains things

"They quote an 80% recurrence free 10 year survival rate for stage IIA and 75% for stage IIB. I'm stage IIA and my onc says I am probably cured (after surgery, chemo, etc.).

Do you really think all node positive younger women are destined to recur?

Another question: how do you compare positive nodes with lympho vascular invasion? My onc says that there is no data that LVI is as negative an indicator as nodes."

I think it's important to understand that not all breast cancers of stage "x" are created equal, and the biologic "aggressiveness" of a tumor can really skew your personal risks. I talked about 3 of the more important factors (node status, estrogen receptor status, and tumor size), but you've also got histologic characteristics (like tumor grade) and other genetic markers (like HER2/neu) in the mix. Some % of these patients also identified or unidentified inherited genes or mutations which increase their risk substantially for breast and other cancers.

There were two competing worldviews of breast cancer in the classic "Halsted Model" (breast cancer progresses from local->regional->systemic disease) and the "Systemic Model" (breast cancer is already systemic at the time of most diagnosis). I found a nice summary of these ideas on this old newsgroup post for those interested. Personally, I split the difference in my head in that I think that if you're node negative with favorable histology the Halsted model is still true, and that a true absence of residual cancer is possible. If you have nodes involved I'm inclined to believe the Systemic Model in that you have already likely have had some cancer burden establish elsewhere. This is supported by the fact that metastatic breast cancers still show up decades after mastectomy on occasion with no local or regional recurrence of the original cancer preceding it.

Younger breast cancer patients are particularly worrisome in that you have some many decades left of potential exposure for recurrence or new primary breast cancers. It makes absolutely no sense to me to push breast conservation (lumpectomy and radiation) for all but the most favorable invasive cancers in women in their 20's or early 30's. I think maximum risk reduction should be advised for many of these women with bilateral prophylactic mastectomy.

For stage II/III breast cancers (those without systemic mets) the data's a pretty slippery slope where 10 year survival curves run from 70-78% in the more favorable patients to 20-40% depending on grade, size, and # of nodes. This data is laid out nicely at this British Cancer site. Keep in mind that all 3 of those factors are subject to sampling error, and that some of the stage II patients are actually stage III.


There's a great article in the Atlantic magazine "Good News and Bad News About Breast Cancer" from a decade ago which is much more eloquent then I am trying to be reluctant about telling people they're "cured" from breast cancer. It features some of the work by one of my professors, the late Dr. John Spratt from the University of Louisville, who was really visionary in describing tumor's behavior and growth clinically

Breast cancer, unfortunately, is not among this select group (of tumors we can eradicate). As far as we know, a woman found to have invasive breast cancer is always at higher risk of dying prematurely than women without breast cancer. Even thirty years after her diagnosis she is up to sixteen times as likely to die of the disease as a woman in the general population. That is why responsible researchers in this field avoid the word "cure." Even as they report advances, they must acknowledge the reality: Postsurgical chemotherapy and antihormonal therapy do buy time—an important advance. The slowed progress of the disease can give a woman additional years of life and even allow her to die of other, less traumatic, causes. But breast cancer is every bit as incurable as it was in Halsted's day.

Rob

TV Made Me Do It - Have Plastic Surgery

TV Made Me Do It is a national cable series on the Canadian TVTropolis channel. It explores how television influences people to do certain things, like propose marraige, come out of the closet, and yes, have plastic surgery. Their most recent episode, entitled Beautiful, followed a patient of mine as she underwent a tummy tuck. The video clip above is a small snippet from this episode. TV Made Me Do It can be seen every Wednesday at 7:30am and 7 pm.

Thank you to the fine folks at Proper Television for inviting me to participate on the show!

Thanks for reading.
Michigan-based Plastic Surgeon
Anthony Youn, M.D.:

TV Made Me Do It - Have Plastic Surgery

TV Made Me Do It is a national cable series on the Canadian TVTropolis channel. It explores how television influences people to do certain things, like propose marraige, come out of the closet, and yes, have plastic surgery. Their most recent episode, entitled Beautiful, followed a patient of mine as she underwent a tummy tuck. The video clip above is a small snippet from this episode. TV Made Me Do It can be seen every Wednesday at 7:30am and 7 pm.

Thank you to the fine folks at Proper Television for inviting me to participate on the show!

Thanks for reading.
Michigan-based Plastic Surgeon
Anthony Youn, M.D.:

Breast Cancer primer and a new wrinkle in breast cancer treatment

There was a good article for the lay public a week ago in the New York Times "With a Tiny Bit of Cancer, Debate on How to Proceed" about the phenomena and controversy over breast cancer "micrometastasis" to lymph nodes. I do a lot of breast cancer related surgery and have this kind of discussion frequently with patients. I've tried over the years to come up with simple concepts for these women who often feel overwhelmed with ideas and terms that have been poorly explained to them.

If you're trying to keep things simple for patients with invasive breast cancer (meaning it has acquired characteristics on microscopic exam suggesting it has the potential to spread elsewhere), it's important to come up with a simple way to explain what their diagnosis really means. There's 3 things that really affect whether or not you're likely to do well when you're diagnosed with invasive breast cancer.

1. the size of your tumor


2. the presence or absence of cancer in your lymph nodes


3. the presence of Estrogen hormone receptors on the cancer cells

Tumor size and nodal status are proxies for metastatic potential. A larger tumor is more likely to have spread to the lymph nodes at the time of diagnosis. A tumor present in the lymph nodes is in turn more likely to have spread elsewhere and show up again down the road as systemic terminal disease. Breast cancer, like most solid tumors that spread via lymphatic tissue, is conceptually really only "cured" if you remove it surgically before it gets to lymph nodes. This basic fact is essentially unchanged despite steady refinement in radiation (XRT) and chemotherapy (CRT) treatments for 60 years. XRT or CRT do not cure anything, but rather decrease/delay recurrence or palliate symptoms. (I'm simplifying this greatly, but that's the skinny in a nutshell).

Estrogen receptors (ER) are conceptually an "on/off" switch for normal breast tissue cells. A breast cancer cell that still maintains this normal regulatory switch offers a target for hormone manipulation. This "killswitch" provides the basis for medicines like Tamoxifen or Arimidex to show improvements in local recurrence after surgery by blocking these receptors or interrupting estrogen metabolism by essentially "starving" the tumor. We're increasingly seeing how important having this receptor is, particularly in post-menopausal women. It's looking more and more from tumor databases that many older women with ER+ tumors may be able to avoid chemotherapy altogether after surgery, and this observation is currently being tested in prospective trials. A breast cancer that's ER- (missing the receptor) suggests a more "primitive" tumor that's lost some of it's normal regulatory mechanisms and implies a worse prognosis. I found a really nice primer on this for people over at "Cancer Geeks"


BACK TO THE TIMES ON "MICROMETS"
Complicating treatment options now is our increasing ability to detect infinitesimal amounts of cancer cells (micrometastasis) in some lymph nodes that would have been labeled normal just a few years ago. Do we treat this the way we traditionally did positive nodes or are we over treating? We just don't know. It has played a little havoc with interpreting some breast cancer data that was suggesting we were doing better with our treatment.

Why? Well if you suddenly take these micromet positive patients and up the stage of their diagnosis like you would normally with positive nodes, you make both the node - and node + groups look like things are getting better. Nothings really changed except you're removing people who do worse from one group and putting them into a group of node + cancer patients where they will do better then their peers. (I cannot for the life of me think of the name for this statistical phenomena....)

Anyway, read the article (click here) as it's interesting.

Rob

Rob

Who Doesn't Like Fake Breasts??? George Clooney?

According to the Celebrity Smack blog, George Clooney may have dumped his ex-girlfriend because of her fake breasts. According to the report:

George really didn’t want her to get the boob job. She asked George if she could do her recovery at his house and he agreed,” a source told In Touch Weekly.
As for the breakup, Larsen never saw it coming.
“They had a huge fight and he left the house. Sarah read in the media that they’d broken up and freaked out because George hadn’t told her anything. He had to explain himself because she’d found out with the rest of the world.”

Is George really picky when it comes to breast implants? I guess when you're him you're allowed to be picky! Most of us normal joes are usually happy with real OR fake.

Photo credit: prphotos.com

Thanks for reading.

Michigan-based Plastic Surgeon
Anthony Youn, M.D.:

Who Doesn't Like Fake Breasts??? George Clooney?

According to the Celebrity Smack blog, George Clooney may have dumped his ex-girlfriend because of her fake breasts. According to the report:

George really didn’t want her to get the boob job. She asked George if she could do her recovery at his house and he agreed,” a source told In Touch Weekly.
As for the breakup, Larsen never saw it coming.
“They had a huge fight and he left the house. Sarah read in the media that they’d broken up and freaked out because George hadn’t told her anything. He had to explain himself because she’d found out with the rest of the world.”

Is George really picky when it comes to breast implants? I guess when you're him you're allowed to be picky! Most of us normal joes are usually happy with real OR fake.

Photo credit: prphotos.com

Thanks for reading.

Michigan-based Plastic Surgeon
Anthony Youn, M.D.:

Jimmy Buffett - Plastic Surgeon in Margaritaville

Sorry for the lack of updates recently. Normally I try to get a post up at least every other day, but after operating for eight hours yesterday, I rushed home, fed my kids dinner, and zipped off to the local Jimmy Buffett concert with my wife and in-laws. The show, as usual, was a blast.

I'm a big Jimmy Buffett fan, have all his albums, been to probably a dozen of his shows, and know most of his songs by heart. According to his autobiography, A Pirate Looks at Fifty, one of his best friends is actually a plastic surgeon in Boston (not me, unfortunately).

Anyways, has Jimmy had any work done?? I doubt it. As you can see by the photos above he's lost quite a bit of hair over the years and has gained quite a few wrinkles. At least he shaved off that God-awful 70's porn-stache. That's better than any plastic surgery I could give him!

Thanks for a great show, Jimmy!

Photo credit: prphotos.com


Thanks for reading.

Michigan-based Plastic Surgeon
Anthony Youn, M.D.:

Jimmy Buffett - Plastic Surgeon in Margaritaville

Sorry for the lack of updates recently. Normally I try to get a post up at least every other day, but after operating for eight hours yesterday, I rushed home, fed my kids dinner, and zipped off to the local Jimmy Buffett concert with my wife and in-laws. The show, as usual, was a blast.

I'm a big Jimmy Buffett fan, have all his albums, been to probably a dozen of his shows, and know most of his songs by heart. According to his autobiography, A Pirate Looks at Fifty, one of his best friends is actually a plastic surgeon in Boston (not me, unfortunately).

Anyways, has Jimmy had any work done?? I doubt it. As you can see by the photos above he's lost quite a bit of hair over the years and has gained quite a few wrinkles. At least he shaved off that God-awful 70's porn-stache. That's better than any plastic surgery I could give him!

Thanks for a great show, Jimmy!

Photo credit: prphotos.com


Thanks for reading.

Michigan-based Plastic Surgeon
Anthony Youn, M.D.:

Conan the Barbarian's wants his breasts back.

Computer game publisher Funcom had to do some fixing of their popular online mulitplayer game when apparently a recent update of the game's software code left the female characters suddenly "breast deficient".

The MMORPG Age of Conan: Hyborian Adventures features partially nude female character models. Based on the original stories by Robert E. Howard and brought to the big screen in 1982 by Gov. Arnold Schwarzenegger, the game takes place in the fantasy world of Hyboria, which combines fantasy elements with strong sexuality.

This issue has caused controversy all over nerd-dom with hundreds of messages left by players demanding Funcom bring their boobs back. Seen below is a pair of images whose player felt like they'd had a mastectomy.

"Funcom can confirm that some of the female models in the game have had the size of their breasts changed. This is due to an unintended change in data that was introduced in an earlier patch, data which controls the so-called morph values associated with character models and the size of their respective body parts. We are working on a fix for this and your breasts should be back to normal soon. The plastic surgeons of Hyboria apologize for the inconvenience."

Well at least they have a sense of humor about it!

Rob

Botox for Breast Augmentation?

Will its applications never end? Some doctors have found a new use for Botox: Breast Augmentation. According to nbc10.com, some plastic surgeons are injecting Botox into the muscles of the chest in an attempt to straighten a woman's posture and thereby enhance her bust line. Click here for the article.

I've never performed this procedure before, but I bet that the before-and-after photos are not very impressive. I would think that the doctor would need to use huge amounts of Botox to weaken the muscles of the chest, which are quite large. Time will tell on this one...

Thanks for reading.
Michigan-based Plastic Surgeon
Anthony Youn, M.D.:

Botox for Breast Augmentation?

Will its applications never end? Some doctors have found a new use for Botox: Breast Augmentation. According to nbc10.com, some plastic surgeons are injecting Botox into the muscles of the chest in an attempt to straighten a woman's posture and thereby enhance her bust line. Click here for the article.

I've never performed this procedure before, but I bet that the before-and-after photos are not very impressive. I would think that the doctor would need to use huge amounts of Botox to weaken the muscles of the chest, which are quite large. Time will tell on this one...

Thanks for reading.
Michigan-based Plastic Surgeon
Anthony Youn, M.D.:

Beverly Hills Rhinoplasty Blog

I'd like to direct some traffic to the really good Beverly Hills Rhinoplasty Blog. Excellent original and insightful articles without the up front promotion that plagues many Plastic Surgery/Cosmetic Surgery blogs run by surgeons.
I've enjoyed their particular focused writing on rhinoplasty and facial aging!

Rob

Dr. Youn to be a guest on WDVD "It's Your Community"

I've been asked to be a guest on Metro Detroit's 96.3 WDVD for It's Your Community with Vanessa Denha. We'll be talking about the latest controversial trends in plastic surgery, including lunchtime facelifts, mesotherapy, and even buttock implants. It airs tomorrow (Sunday) at 6 am-6:30 am. If you don't live in the area or are still asleep at 6 am, then check out their website for a streaming version of MP3 of the broadcast.

Link: It's Your Community

Thanks to Vanessa Denha for having me on the show.

Thanks for reading.
Michigan-based Plastic Surgeon
Anthony Youn, M.D.:

Dr. Youn to be a guest on WDVD "It's Your Community"

I've been asked to be a guest on Metro Detroit's 96.3 WDVD for It's Your Community with Vanessa Denha. We'll be talking about the latest controversial trends in plastic surgery, including lunchtime facelifts, mesotherapy, and even buttock implants. It airs tomorrow (Sunday) at 6 am-6:30 am. If you don't live in the area or are still asleep at 6 am, then check out their website for a streaming version of MP3 of the broadcast.

Link: It's Your Community

Thanks to Vanessa Denha for having me on the show.

Thanks for reading.
Michigan-based Plastic Surgeon
Anthony Youn, M.D.:

Something else that belongs on bull#%@*.com

I was pleased (snark!) to find out via the mail today that I am now officially one of "America's Top Surgeons" as recognized by the "Consumers' Research Council of America" (CRCA). Ever heard of it? Me neither.

What do you have to do to be recognized? Have a medical licence and a credit card to buy their over-priced cheezy swag plaques and knick-knacks to impress patients with as far as I can tell.

The sad thing is that some meaningless promotional thing like this is just as likely to get someone's attention for my skill as any of my academic awards, real diplomas, or multiple board-certification certificates.

Rob

Brigitte Nielsen to Have Plastic Surgery on TV?

MakeMeHeal.com is reporting that Sylvester Stallone and Flavor Flav ex Brigitte Nielsen is planning to have plastic surgery and have it filmed for German television.

According to Brigitte, she will receive “a complete renewal: facelift, eyelift, fat injections in my face, liposuction, a breast lift and I need new teeth... I know I am the first female celebrity in the world who has allowed herself to be filmed like that in an operating theater. I know I will be breaking a taboo. But I’m sure that it will provoke a new discussion. It’s time things change. I feel 30 and want to look that way again. The secrecy in Hollywood is annoying. You can see that the stars do not age naturally. It’s not right that the fans, the normal women, are lied to.”

Although I found her annoying in The Surreal Life, it's refreshing to hear her talk this way. Hopefully everything goes well with her plastic surgery. By the way, the posted photo is a great example of someone with breast implants that are probably above-the-muscle.

Photo credit: prphotos.com

Thanks for reading.
Michigan-based Plastic Surgeon
Anthony Youn, M.D.:

Brigitte Nielsen to Have Plastic Surgery on TV?

MakeMeHeal.com is reporting that Sylvester Stallone and Flavor Flav ex Brigitte Nielsen is planning to have plastic surgery and have it filmed for German television.

According to Brigitte, she will receive “a complete renewal: facelift, eyelift, fat injections in my face, liposuction, a breast lift and I need new teeth... I know I am the first female celebrity in the world who has allowed herself to be filmed like that in an operating theater. I know I will be breaking a taboo. But I’m sure that it will provoke a new discussion. It’s time things change. I feel 30 and want to look that way again. The secrecy in Hollywood is annoying. You can see that the stars do not age naturally. It’s not right that the fans, the normal women, are lied to.”

Although I found her annoying in The Surreal Life, it's refreshing to hear her talk this way. Hopefully everything goes well with her plastic surgery. By the way, the posted photo is a great example of someone with breast implants that are probably above-the-muscle.

Photo credit: prphotos.com

Thanks for reading.
Michigan-based Plastic Surgeon
Anthony Youn, M.D.:

No Plastic Surgery for Selma Blair

I like Selma Blair. She grew up in the Metro Detroit area (which I now call home) and went to Kalamazoo College for a short time while I was there. She was nice to me, and had a very dry sense of humor. Here is what she told In Style magazine (from In Your Face Blog):

“I wanted to get Botox once to make me feel younger. But I don’t really have [enough wrinkles] to justify it yet. As for going under the knife, I can’t say I wouldn’t, but I haven’t thought too much about it,” she said.
Blair said she isn’t interested in breast implants. “I wore huge prosthetic boobs for a John Waters movie. They were glued on every day by a really handsome guy, but ripping them off every night was definitely outside my realm of comfort. After those bosoms, I didn’t mind being flat-chested anymore!” she said.

Hmm, she must have left out the part explaining how she went to college with a good-looking, cool, future big-time doctor!

Or how she also went to college with me.

Photo credit: prphotos.com

Thanks for reading.

Michigan-based Plastic Surgeon
Anthony Youn, M.D.:

No Plastic Surgery for Selma Blair

I like Selma Blair. She grew up in the Metro Detroit area (which I now call home) and went to Kalamazoo College for a short time while I was there. She was nice to me, and had a very dry sense of humor. Here is what she told In Style magazine (from In Your Face Blog):

“I wanted to get Botox once to make me feel younger. But I don’t really have [enough wrinkles] to justify it yet. As for going under the knife, I can’t say I wouldn’t, but I haven’t thought too much about it,” she said.
Blair said she isn’t interested in breast implants. “I wore huge prosthetic boobs for a John Waters movie. They were glued on every day by a really handsome guy, but ripping them off every night was definitely outside my realm of comfort. After those bosoms, I didn’t mind being flat-chested anymore!” she said.

Hmm, she must have left out the part explaining how she went to college with a good-looking, cool, future big-time doctor!

Or how she also went to college with me.

Photo credit: prphotos.com

Thanks for reading.

Michigan-based Plastic Surgeon
Anthony Youn, M.D.:

www.bull#%@*.com - the wild,wild world of hospital rankings

US News and World Reports' (USNWR) annual hospital ranking, akin to their notorious college rankings, is kind of the king of the block for these types of rankings. Keep in mind though, there are hospitals on some of those lists that patients in some of those cities (and even some doctors who work in those hospitals) won't take their dog to, particularly in some urban teaching hospitals. (And No, I'm not naming names!)

The "leapfrog study" indexed by USNWR for rankings reviewed available data from nearly 1300 hospitals and ranked hospitals largely (as I understand it)on 4 endpoints

1. Having intensive care units staffed by specially trained doctors

2. Having computerized order-entry systems for medications and other orders with error-prevention measures

3. Performing procedures such as cardiac catheterization and caring for certain high-risk neonatal conditions

4. Having practices such as those designed to control hospital-related infections and cut down on medication and treatment errors.

It's hard to argue in theory that these are bad goals, but are these the things that patients need/want and is the information we're using to assess it accurate. A number of high profile institutions are typically included on these list which can make some doctors chuckle.


I saw an interesting editorial in the journal, Contemporary Surgery,a commentary on how confusing or misleading it is to try and figure out which hospitals, programs, or physicians are "the best". A quick review of a number of consumer oriented web sites provide significant inconsistencies -- for example, with colon resections for cancer, one hospital was ranked best by two sites but worst by the other site, and the hospital ranked best on that site was ranked worst on another, in a study reported in the journal, Archives of Surgery. Why is this so? There is no standard way of calculating quality differences, thus different sources (despite good intentions)come up with different results for the same hospitals

"What makes the 2007 Toyota Camry Motor Trend’s Car of the Year? Who decides who should be ranked number 1 in college football? Which tastes better: Coke or Pepsi? More importantly, is your hospital any good, and are you any good?...Ask patients to weigh in on their surgical experience or hospital care and you might be surprised to find out what they want (free parking). Or, what they don’t care about (board certification)."

Sites like Healthgrade, purport to offer patients some objective criteria for making comparisons between hospitals. This site ranks hospitals, surgery centers, and nursing homes based on data generated from Medicare records. Hospital rankings are based on 13 AHRQ (Agency for Healthcare Research and Quality) categories that include: decubitus ulcers, death in low mortality DRGs, postoperative hip fracture, and postoperative PE or DVT among others. The rankings are “calculated” by 100 employees in Golden, CO, using Medicare data that hospitals supply. Repeat: your very own hospital supplies the data!

If you want to get an even more confusing way to look at healthcare, you can also check out a site like Vimo.com which purports to give consumers (err......) patients comparisons for the cost of surgical procedures. As most of those numbers represent "funny money" (ie. neither the feds, hospitals, nor insurers expect to pay these imaginary numbers).

Rob

Sarah Jessica Parker - Rhinoplasty?

Has Sex and the City star Sarah Jessica Parker had a rhinoplasty? This one is not obvious. When comparing these photos, it does appear that the tip of her nose is a bit thinner, which could be the result of a subtle rhinoplasty.

If she did have a rhinoplasty, then her surgeon was very conservative, so as to not change her look too much. The worst thing that could happen to her would be what happened to Jennifer Grey, where the nose was altered so much that she was not recognizable as her old self. This has obviously not happened to Sarah Jessica Parker. I do think she is aging very gracefully, and actually looks better now than she did 15 or 20 years ago. Being married to Ferris Bueller may have its benefits!

In Style.com has a photo progression of SJP from 1984 (photo above) to the present. I don't see a huge difference in the photos with regards to the schnozz, but maybe a more subtle one from 2006-2007? Click here for link.

Photo credit: instyle.com, prphotos.com

Thanks for reading,

Michigan-based Plastic Surgeon
Anthony Youn, M.D.:

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Sarah Jessica Parker - Rhinoplasty?

Has Sex and the City star Sarah Jessica Parker had a rhinoplasty? This one is not obvious. When comparing these photos, it does appear that the tip of her nose is a bit thinner, which could be the result of a subtle rhinoplasty.

If she did have a rhinoplasty, then her surgeon was very conservative, so as to not change her look too much. The worst thing that could happen to her would be what happened to Jennifer Grey, where the nose was altered so much that she was not recognizable as her old self. This has obviously not happened to Sarah Jessica Parker. I do think she is aging very gracefully, and actually looks better now than she did 15 or 20 years ago. Being married to Ferris Bueller may have its benefits!

In Style.com has a photo progression of SJP from 1984 (photo above) to the present. I don't see a huge difference in the photos with regards to the schnozz, but maybe a more subtle one from 2006-2007? Click here for link.

Photo credit: instyle.com, prphotos.com

Thanks for reading,

Michigan-based Plastic Surgeon
Anthony Youn, M.D.:

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Malignant Hyperthermia confirmed in Florida Plastic Surgery death

An autopsy has confirmed that the South Florida teenager, Stephanie Kuleba, who died this Spring after corrective breast surgery (reportedly for significant asymmetry and inverted nipples) suffered from a rare genetic disease that had been speculated to have causes her death. Genetic testing at the University of Pittsburgh shows she possessed the genetic mutation RYR-1 which is responsible for most cases of the malignant hyperthermia (MH) response to certain inhaled anesthetics. However, over 80 genetic defects have now been potentially associated with MH. As these mutations are inheritable, they will vary in rates among the population and some increased clusters of MH mutation carriers have been suggested in states like Wisconsin, Nebraska, West Virginia and Michigan.

The exact incidence of Malignant hyperthermia is unknown, but the rate of occurrence has been estimated to be as frequent as one in 10,000 or as rare as one in 100,000 patients who undergo general anesthesia. (A range that big suggests they have no idea to me) There is no practical screening test to determine if a patient has the rare condition so you rely on family history or consultation questions to identify high risk patients. Again, the incidence is so rare there is no way to prevent these MH events from happening. The signs that develop are usually suble (ie. a tense jaw) before they're not (ie. 104 degree temp and cadiovasular collapse).


Despite her doctors efforts to treat the Ms. Kuleba during the event with the medication Dantrolene, her parents claim her Plastic Surgeon's office was not prepared to care for their daughter once they had figured out that she was suffering from the hidden hereditary condition and have (in the great American tradition) announced their intention to file a lawsuit.

When MH is identified or suspected, time becomes valuable for salvage treatment. As soon as the malignant hyperthermia reaction is recognized, all anesthetic agents are discontinued and the administration of 100% oxygen is recommended. Dantrolene should be administered by continuous rapid IV "push" beginning at a minimum dose of 1 mg/kg, and continuing until symptoms resolve or the maximum cumulative dose of 10 mg/kg has been reached.

Kulebas' family attorney Roberto Stanziale, has said the teenager should have received as many as seven vials of the drug as an initial dose. On medical records Stanziale obtained following her death, one doctor noted she received one vial of the antidote. The other doctor wrote she received two. It's not known at what time the drug was administered or whether there was enough Dantrolene available at Dr. Schuster's Boca Raton clinic, Schuster Plastic Surgery. Both doctors have defended their actions, saying the situation was handled appropriately and that Kuleba received the Dantrolene dose needed once they consulted with the Malignant Hyperthermia Association (MHA) hotline and called an expert at the Mayo Clinic in Minnesota.

This dosing issue and it's timing is going to be a big issue in the lawsuit. You can't really give informed consent for MH as it's so rare so that shouldn't be an issue (although that will likely be claimed by a plaintiff's attorney). According to the brochure for Dantrolene, each vial contains 20 mg of the drug. As it's suggested in her anesthesiologists notes, she received 2 vials initially (40mg) while they called the MHA hotline to confirm treatment (as again it's so rare no one really has a lot of experience with treating it). That 40mg dose is in the ballpark for the recommended range (by weight) for initial treatment for most thin teenagers.

At the end of the day, I'm not sure what's going to be achieved with this lawsuit. It sure seems like reasonable steps were initiated by her doctors after the event to try and save this girls life. There is only so much you can do when unforeseen or extremely rare complications arise and no amount of preparation can prevent some bad outcomes. Contrast the hostile posture of the Kuleba family attorney with this MH tragic event during orthopedic surgery on a 20 year old described by Dr. Henry Rosenberg, President of the Malignant Hyperthermia Association of the United States. The pain of the medical staff and their communion with the deceased's family is moving.

I hope that this event will continue to foster more discussion on oversight for office-based surgery and anesthesia. It's ironic that it's actually been Plastic Surgery that been the most progressive in regulatory oversite in ambulatory surgery. While this case was an anesthesia complication rather then a surgical one, the who's, where's , and how's of who can (or should) be doing surgery is overdue for more scrutiny.


Rob