Alexa Ray Joel - Rhinoplasty

Alexa Ray Joel, daughter of Billy Joel and Christie Brinkley, has admitted to People magazine that she's had a rhinoplasty (nose job). According to the New York Daily News,

"I was thinking about getting this for years," the 24-year-old singer told People magazine. "[It's] always bothered me a little bit. I was self-conscious of pictures taken from the side." She said she underwent rhinoplasty earlier this month.

The only photos I've seen are from the front, not the side. From the front she looks a bit straighter, but otherwise the same. It sounds like she had a bump on her nose that she wanted removed, one of my favorite things to do.

Her father is one of my favorite singers. Piano Man, Scenes from an Italian Restaurant, River of Dreams, Rosalinda's Eyes, Vienna, Say Goodbye to Hollywood, etc. etc. He rocks. Awesome concert performer too. I would give my left leg for a private concert with Billy.

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

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Alexa Ray Joel - Rhinoplasty

Alexa Ray Joel, daughter of Billy Joel and Christie Brinkley, has admitted to People magazine that she's had a rhinoplasty (nose job). According to the New York Daily News,

"I was thinking about getting this for years," the 24-year-old singer told People magazine. "[It's] always bothered me a little bit. I was self-conscious of pictures taken from the side." She said she underwent rhinoplasty earlier this month.

The only photos I've seen are from the front, not the side. From the front she looks a bit straighter, but otherwise the same. It sounds like she had a bump on her nose that she wanted removed, one of my favorite things to do.

Her father is one of my favorite singers. Piano Man, Scenes from an Italian Restaurant, River of Dreams, Rosalinda's Eyes, Vienna, Say Goodbye to Hollywood, etc. etc. He rocks. Awesome concert performer too. I would give my left leg for a private concert with Billy.

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

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Prophylactic Mastectomy - an ounce of prevention is worth 5% of cure

Sometimes things that are so obviously intuitive still have to be validated. After a number of years of controversy, an increasing utilized surgery to prevent breast cancer is now being shown to be quite effective in both risk reduction and cancer-related mortality. The study "A Population-Based Study of Contralateral Prophylactic Mastectomy and Survival Outcomes of Breast Cancer Patients" is published in the Journal of the National Cancer Institute and can be seen here.

Contralateral prophylactic mastectomy, (CPM), a preventive procedure to remove the unaffected breast in patients with disease in one breast, clearly appears to offer a survival benefit to breast cancer patients age 50 and younger, who have early-stage disease and are estrogen receptor (ER) negative. We've known for several decades that CPM reduced the risk of developing breast cancer, but it was always more elusive to show that it actually saved lives at the end of the day. The practice of CPM has expanded significantly, with >150% growth in the number of such surgeries since the late 1990's.

How effective is CPM? Those younger than age 50 with early stage cancer with ER negative disease had a survival benefit of almost 5% at five years.  For a therapeutic intervention for cancer, 5% is really substantial. You can take it to the bank that following these patients out even farther that we will show increased survival benefit with longer follow-up in the population. This is due to the fact that

1. the patient's likelihood of getting a second breast cancer in the non-removed breast increases with time
2. patients with prior breast cancer are among the highest risk group for developing breast cancer

Women older then 50 have a little more complicated decision. In cold, hard actuarial terms you are more likely to die from something else before a new breast cancer would kill you. On the other hand, steadily increasing lifespans of adult Americans has made some of these kind of statistical bets have to be reexamined. I would guess that the reported benefit of CPM gradually increases towards 60 years in future clinical guidelines.

Rob

Lady Gaga - Poker Face or Plastic Surgery Face?

Rumors have been circulating recently that Lady Gaga is considering plastic surgery. A source has been quoted as saying:

"She's desperately unhappy but keeps talking about having thousands of dollars worth of plastic surgery. She really thinks that could fix everything."

This has led to a slew of blogs claiming that Ms. Gaga is planning to go under the plastic surgeon's knife. Not so, says someone in the know:

A spokesperson for the Poker Face star told the news provider he was "categorically denying" the reports, describing them as "ridiculous and untrue".

So, we've established that she is not planning plastic surgery now, but has she had it in the past? A rhinoplasty perhaps? My Magic Eight Ball Says: Signs Point To Yes.

I really like her music. Let's Dance is great, as is Poker Face and that GAGARARARA Bad Romance song. Her videos are really strange though...yet I can't not watch them when they are on.

Thanks for reading.

Michigan-based Plastic Surgeon

Anthony Youn, M.D.:

Lady Gaga - Poker Face or Plastic Surgery Face?

Rumors have been circulating recently that Lady Gaga is considering plastic surgery. A source has been quoted as saying:

"She's desperately unhappy but keeps talking about having thousands of dollars worth of plastic surgery. She really thinks that could fix everything."

This has led to a slew of blogs claiming that Ms. Gaga is planning to go under the plastic surgeon's knife. Not so, says someone in the know:

A spokesperson for the Poker Face star told the news provider he was "categorically denying" the reports, describing them as "ridiculous and untrue".

So, we've established that she is not planning plastic surgery now, but has she had it in the past? A rhinoplasty perhaps? My Magic Eight Ball Says: Signs Point To Yes.

I really like her music. Let's Dance is great, as is Poker Face and that GAGARARARA Bad Romance song. Her videos are really strange though...yet I can't not watch them when they are on.

Thanks for reading.

Michigan-based Plastic Surgeon

Anthony Youn, M.D.:

Study confirms that breast implants do not affect breast cancer survival

A recent Canadian study long term follow-up (see here) confirms prior observations that women with breast implants who go on to develop breast cancer have similar outcomes as women without implants who develop cancer. This is more reassurance to our patients about this theoretical concern with implants (ie. that potential difficulty with mammograms would lead to delayed breast cancer diagnosis and worse outcomes). Along a similar vein, women with implants actually have a much lower (~ 40% lower I think) rate of breast cancer as compared to peer groups in the population.

Rob

ASAPS Annual Meeting 2010

I just returned from the annual meeting for the American Society for Aesthetic Plastic Surgery in Washington, D.C. It was an excellent meeting, attended by a "who's who" in aesthetic plastic surgery. Some interesting topics covered in the first few days:
1. Biofilms as a cause of capsular contracture - the bane of my existence as a breast augmentation surgeon is capsular contracture, or excess scar tissue that can build up around a breast implant. This can make the breast look round, hard, and painful. One potential cause is biofilm, or a coating of bacteria that can cover an implant. Techniques to limit biofilms were addressed, including the interesting Keller Funnel. If there is any way to reduce the amount of capsular contracture, I'm all for it.
2. Acellular Dermal Matrices (ADM) in breast revision surgery - We are now using several different types of radiated skin (from cadavers, pigs, etc.) as a way to prevent breast implants from bottoming out, moving into the armpit, or creating a una-boob (symmastia). My good friend Dr. Brad Bengtson gave two great talks on using these ADM's for preventing capsular contracture.
3. Laser Liposuction - Does laser liposuction really tighten the skin? Depends on who you talk to. There really wasn't a consensus on whether it visibly tightens skin, but there was a consensus on the need for more scientific studies to see if it does.
4. Lipodissolve injections actually work? One study sponsored by ASAPS/ASERF appeared to show a visible decrease in the thickness of fat in people injected with substances typically used for lipodissolve. There were no major adverse events, although the changes were subtle and the treatments did entail dozens of injections over several weeks/months. Another study didn't show any significant changes in their patients. So the jury is still out on that one.
5. I did a small talk on the eMatrix for International Hot Topics in Plastic Surgery. This is one of the newest fractional skin treatments I demo'd on the Rachael Ray Show.

There were more great topics than I can cover in a blog post. The meeting is actually still going on! I left early because I missed my family and have surgery to do tomorrow. It's always nice to sleep in my own bed next to my beautiful wife!

Thanks to everyone on the ASAPS meeting planning team for putting on a great meeting.

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

ASAPS Annual Meeting 2010

I just returned from the annual meeting for the American Society for Aesthetic Plastic Surgery in Washington, D.C. It was an excellent meeting, attended by a "who's who" in aesthetic plastic surgery. Some interesting topics covered in the first few days:
1. Biofilms as a cause of capsular contracture - the bane of my existence as a breast augmentation surgeon is capsular contracture, or excess scar tissue that can build up around a breast implant. This can make the breast look round, hard, and painful. One potential cause is biofilm, or a coating of bacteria that can cover an implant. Techniques to limit biofilms were addressed, including the interesting Keller Funnel. If there is any way to reduce the amount of capsular contracture, I'm all for it.
2. Acellular Dermal Matrices (ADM) in breast revision surgery - We are now using several different types of radiated skin (from cadavers, pigs, etc.) as a way to prevent breast implants from bottoming out, moving into the armpit, or creating a una-boob (symmastia). My good friend Dr. Brad Bengtson gave two great talks on using these ADM's for preventing capsular contracture.
3. Laser Liposuction - Does laser liposuction really tighten the skin? Depends on who you talk to. There really wasn't a consensus on whether it visibly tightens skin, but there was a consensus on the need for more scientific studies to see if it does.
4. Lipodissolve injections actually work? One study sponsored by ASAPS/ASERF appeared to show a visible decrease in the thickness of fat in people injected with substances typically used for lipodissolve. There were no major adverse events, although the changes were subtle and the treatments did entail dozens of injections over several weeks/months. Another study didn't show any significant changes in their patients. So the jury is still out on that one.
5. I did a small talk on the eMatrix for International Hot Topics in Plastic Surgery. This is one of the newest fractional skin treatments I demo'd on the Rachael Ray Show.

There were more great topics than I can cover in a blog post. The meeting is actually still going on! I left early because I missed my family and have surgery to do tomorrow. It's always nice to sleep in my own bed next to my beautiful wife!

Thanks to everyone on the ASAPS meeting planning team for putting on a great meeting.

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

Spanish Plastic Surgeons Perform First Full Face Transplant

Plastic surgeons in Spain have recently performed the first full face transplant on a farmer who had most of his face destroyed by a gunshot wound. The surgery took 22 hours and employed a team of over 30 doctors, nurses, and technicians.

According to an article:

The technique involved removing what was left of the man's face and giving him a replacement "in one piece." By the means of plastic reconstructive surgery and microsurgery of blood vessels.
, the doctors transplanted the entire face apart from the tongue and eyeballs onto the man.
The unnamed farmer now boasts of a brand new face from his hairline down. The only one scar he has runs across his neck, which looks like a wrinkle.
"The operation was carried out by a multidisciplinary team led by Dr Joan Pere Barret, performing the transplant of the entire facial skin and muscles, nose, lips, maxilla, palate, all teeth, cheekbones, and the mandible by means of plastic surgery and micro-neurovascular reconstructive surgery techniques."
Experts took care to ensure that the patient's new face resembled the one he had before the accident and did not have any likeness to that of the anonymous donor.
According to Barret, his new face will be reminiscent of both.

Amazing stuff. It's stories like this that make me proud to be a plastic surgeon. I am humbled by the skill of plastic surgeons like Dr. Barret and all of the surgeons who have contributed to the advancement of our specialty, both reconstructive and cosmetic.

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

Spanish Plastic Surgeons Perform First Full Face Transplant

Plastic surgeons in Spain have recently performed the first full face transplant on a farmer who had most of his face destroyed by a gunshot wound. The surgery took 22 hours and employed a team of over 30 doctors, nurses, and technicians.

According to an article:

The technique involved removing what was left of the man's face and giving him a replacement "in one piece." By the means of plastic reconstructive surgery and microsurgery of blood vessels.
, the doctors transplanted the entire face apart from the tongue and eyeballs onto the man.
The unnamed farmer now boasts of a brand new face from his hairline down. The only one scar he has runs across his neck, which looks like a wrinkle.
"The operation was carried out by a multidisciplinary team led by Dr Joan Pere Barret, performing the transplant of the entire facial skin and muscles, nose, lips, maxilla, palate, all teeth, cheekbones, and the mandible by means of plastic surgery and micro-neurovascular reconstructive surgery techniques."
Experts took care to ensure that the patient's new face resembled the one he had before the accident and did not have any likeness to that of the anonymous donor.
According to Barret, his new face will be reminiscent of both.

Amazing stuff. It's stories like this that make me proud to be a plastic surgeon. I am humbled by the skill of plastic surgeons like Dr. Barret and all of the surgeons who have contributed to the advancement of our specialty, both reconstructive and cosmetic.

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

The King of Kong is a...Plastic Surgeon???

Funny story from amednews: The newest King of Donkey Kong is a plastic surgeon! Dr. Hank Chien, a plastic surgeon from New York, scored over 1 million points in 2.5 hours on Feb 27th. According to the article:

In September 2008, about a year after watching the documentary, Dr. Chien sought out an arcade that carried the game. He said he figured his skills in the operating room could translate to a video game environment, and he believed he could master Donkey Kong...
A clinical study published in the February 2007 Archives of Surgery found a direct correlation between gaming and proficiency in laparoscopic surgery. Researchers said surgeons who played video games at least three hours a week in their past were 27% faster than were nongamers and had 37% fewer errors...
On the fateful morning of Feb. 26, Dr. Chien woke up to find New York City buried in several inches of snow. His office called to say his surgeries had been canceled...
He completed his game in the early hours of Feb. 27. Dr. Chien announced his victory on Facebook and was surprised at the number of people who were still awake and read his message. The flood of e-mails and calls started coming, and his life as an international celebrity in the gaming world began...
Dr. Chien's life once consisted of plastic surgery during the day and Donkey Kong at night. Now his spare time is eaten up with interviews and autographs.

I have heard of surgeons buying video games and writing them off on their taxes. I'd like to poke fun at Dr. Chien for spending so much time playing a video game, but then again, who am I to talk? I spend time writing a blog on celebrity plastic surgery.

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

The King of Kong is a...Plastic Surgeon???

Funny story from amednews: The newest King of Donkey Kong is a plastic surgeon! Dr. Hank Chien, a plastic surgeon from New York, scored over 1 million points in 2.5 hours on Feb 27th. According to the article:

In September 2008, about a year after watching the documentary, Dr. Chien sought out an arcade that carried the game. He said he figured his skills in the operating room could translate to a video game environment, and he believed he could master Donkey Kong...
A clinical study published in the February 2007 Archives of Surgery found a direct correlation between gaming and proficiency in laparoscopic surgery. Researchers said surgeons who played video games at least three hours a week in their past were 27% faster than were nongamers and had 37% fewer errors...
On the fateful morning of Feb. 26, Dr. Chien woke up to find New York City buried in several inches of snow. His office called to say his surgeries had been canceled...
He completed his game in the early hours of Feb. 27. Dr. Chien announced his victory on Facebook and was surprised at the number of people who were still awake and read his message. The flood of e-mails and calls started coming, and his life as an international celebrity in the gaming world began...
Dr. Chien's life once consisted of plastic surgery during the day and Donkey Kong at night. Now his spare time is eaten up with interviews and autographs.

I have heard of surgeons buying video games and writing them off on their taxes. I'd like to poke fun at Dr. Chien for spending so much time playing a video game, but then again, who am I to talk? I spend time writing a blog on celebrity plastic surgery.

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

Did Haylie Duff Have a Breast Augmentation?

The latest issue of Star Magazine (and this photo from Hollywoodtuna.com) shows what appears to be a dramatic size increase in Haylie Duff's breasts. They look like they're about to explode out of her shirt. Has she had a recent breast augmentation or did she stuff two grapefruits into her bra?

I would bet on the breast augmentation. Give her some time and they should settle down nicely, unless she went to Europe and got the 'gummy bear' implants. Then she may be stuck with what she has.

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

Did Haylie Duff Have a Breast Augmentation?

The latest issue of Star Magazine (and this photo from Hollywoodtuna.com) shows what appears to be a dramatic size increase in Haylie Duff's breasts. They look like they're about to explode out of her shirt. Has she had a recent breast augmentation or did she stuff two grapefruits into her bra?

I would bet on the breast augmentation. Give her some time and they should settle down nicely, unless she went to Europe and got the 'gummy bear' implants. Then she may be stuck with what she has.

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

Sharon Osbourne's Breast Implants Destined To Be Ozzy's Paperweights??

In a recent interview on the Today show, Sharon Osbourne stated that she plans to have her breast implants removed this summer and then plans to give them to her husband Ozzy to use as paperweights! According to nydailynews.com:

"They're better on his desk than on my chest," she said. "They're awful!"

Even for a plastic surgeon who does this surgery nearly every day, I find that pretty gross. I once removed breast implants from a patient who asked me if she could take the explanted implants home with her. When I asked her why, she replied that she planned to mail them to her ex-husband!

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

Sharon Osbourne's Breast Implants Destined To Be Ozzy's Paperweights??

In a recent interview on the Today show, Sharon Osbourne stated that she plans to have her breast implants removed this summer and then plans to give them to her husband Ozzy to use as paperweights! According to nydailynews.com:

"They're better on his desk than on my chest," she said. "They're awful!"

Even for a plastic surgeon who does this surgery nearly every day, I find that pretty gross. I once removed breast implants from a patient who asked me if she could take the explanted implants home with her. When I asked her why, she replied that she planned to mail them to her ex-husband!

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

Kate Hudson Had A Breast Augmentation?

There are reports that Kate Hudson has had a conservative breast augmentation. Recent photos show her with larger breasts (likely going from a AA to a nice B). This is in contrast to her previous comments at the 2002 Golden Globes: "I have small breasts, obviously... It's nice to be able to wear a plunging neckline and have it be elegant."

It looks like her surgon did a nice job. The surgery was probably performed at least a month ago since she doesn't appear to have much swelling. This is in stark contrast to Heidi Montag who looks like she could float all the way to Sri Lanka.

I wish she would.

Photo credit: usmagazine.com

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

Kate Hudson Had A Breast Augmentation?

There are reports that Kate Hudson has had a conservative breast augmentation. Recent photos show her with larger breasts (likely going from a AA to a nice B). This is in contrast to her previous comments at the 2002 Golden Globes: "I have small breasts, obviously... It's nice to be able to wear a plunging neckline and have it be elegant."

It looks like her surgon did a nice job. The surgery was probably performed at least a month ago since she doesn't appear to have much swelling. This is in stark contrast to Heidi Montag who looks like she could float all the way to Sri Lanka.

I wish she would.

Photo credit: usmagazine.com

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

Is Heidi Montag Trying To Become a Human Barbie?

How do Heidi Montag and Barbie's measurements compare? Is Heidi trying to become a real life Barbie doll? Check out lemondrop.com to find out.

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

Is Heidi Montag Trying To Become a Human Barbie?

How do Heidi Montag and Barbie's measurements compare? Is Heidi trying to become a real life Barbie doll? Check out lemondrop.com to find out.

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

Slick Deals from Allergan for Botox or Juvederm rebate

One of my favorite shopping websites is Slickdeals (www.slickdeals.net) which is a user driven collection of random shopping deals around the internet. You can find some fantastic bargains on all kinds of things, and the site is updated throughout the day by users reporting sales and promotional items.

In honor of this, I'd like to point out the "slick deal" Allergan is offering on it's products thru July. Allergan is the world's largest breast implant manufacturer, but they also make BOTOX, the dermal filler Juvederm, and the eyelash growing solution Lastisse. Thru July they are offering a $50 rebate coupon on either BOTOX or Juvederm purchases when you try Latisse. Details are available here.

Rob

FDA to mesotherapy - Put up or shut up! (but shut up first)

The FDA last week issued cease and desist orders for a number of clinics offering fat melting "mesotherapy" injections.  The drugs most regularly used in this process are phosphatidylcholine and deoxycholate. Other drugs or products such as vitamins, minerals, and herbal extracts are often mixed into the "gumbo", complicating any assessment of safety or efficacy. Phosphatidylcholine is not approved for injection into your body and has never been evaluated for that use in controlled settings. The new warning shot over the bow went out to six U.S clinics:

• Monarch Medspa in King of Prussia, Pa.
• Spa 35 in Boise, Idaho
• Medical Cosmetic Enhancements in Chevy Chase, Md.
• Innovative Directions in Health in Edina, Minn.
• PURE Med Spa in Boca Raton, Fla.
• All About You Med Spa in Madison, Ind

I would strongly advise people considering using these facilities to think again, as their disregard for patient safety with off label experimentation of these injectable concoctions should signal a general disregard for their patients. As alerts to this FDA warning went out on the ambulance chaser network of websites, expect to see ads shortly recruiting clients for lawsuits.

FYI If you are interested in reading about mesotherapy, I've written several entries about it since 2007 which can be seen here.

Rob

Blog Reader's Experience with Juvederm Ultra

One of our faithful blog readers, Rosina from Middle Ageless, has posted a photo essay on her recent experience with Juvederm Ultra injections into her cheeks and nasolabial folds (groove extending from the side of the nose to the corner of the mouth). You can see her nice improvement here. She has a fairly typical result from a conservative amount of filler injected. I wonder how many vials were used? Most people with fairly prominent nasolabial folds need at least 2 vials to get optimal results.

If you haven't checked out her Middle Ageless blog, make sure to visit. It has a great combination of beauty, plastic surgery, and fashion secrets. You can check it out here.

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

Blog Reader's Experience with Juvederm Ultra

One of our faithful blog readers, Rosina from Middle Ageless, has posted a photo essay on her recent experience with Juvederm Ultra injections into her cheeks and nasolabial folds (groove extending from the side of the nose to the corner of the mouth). You can see her nice improvement here. She has a fairly typical result from a conservative amount of filler injected. I wonder how many vials were used? Most people with fairly prominent nasolabial folds need at least 2 vials to get optimal results.

If you haven't checked out her Middle Ageless blog, make sure to visit. It has a great combination of beauty, plastic surgery, and fashion secrets. You can check it out here.

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

National Television Show Looking For Plastic Surgery Enthusiasts Age 18-28

A national television program has asked me to help them locate anyone age 18-28 who is obsessed with plastic surgery and has multiple procedures at this young age. They produce a docu-style program which explores the double-life that some people lead. According to the producers:

We will treat your story with the utmost sensitivity, compassion, dignity and respect... We want to explore how you cope and how you untangle the web of your double life. With the help of a qualified, highly-credentialed, on-camera therapist, our hope is for you to jump start a dialogue about the issues you confront on a daily basis. Family members or friends may take part in your transformation.

If you are interested in sharing your story and you fit the above description, email me at miplasticsurgeon@yahoo.com and I will forward your info along to the producers.

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

National Television Show Looking For Plastic Surgery Enthusiasts Age 18-28

A national television program has asked me to help them locate anyone age 18-28 who is obsessed with plastic surgery and has multiple procedures at this young age. They produce a docu-style program which explores the double-life that some people lead. According to the producers:

We will treat your story with the utmost sensitivity, compassion, dignity and respect... We want to explore how you cope and how you untangle the web of your double life. With the help of a qualified, highly-credentialed, on-camera therapist, our hope is for you to jump start a dialogue about the issues you confront on a daily basis. Family members or friends may take part in your transformation.

If you are interested in sharing your story and you fit the above description, email me at miplasticsurgeon@yahoo.com and I will forward your info along to the producers.

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

Demi Moore Comes Clean About Plastic Surgery... Kind Of

In an interview with Elle Magazine, Demi Moore has finally confirmed the rumors that she's had plastic surgery. The 47 year old actress stated that she had work done, but only to her body. She also admitted to body image issues, and would not rule out more plastic surgery in the future. According to nydailynews.com:

"I've had something done but it's not my face," says the mother of three... However, Moore did reveal that she wouldn't be opposed to having plastic surgery in the future.
"You know what? Maybe one day I'll go under the knife," she admits. "It just irritates me that people are constantly saying how much I've spent on plastic surgery."

"I had an extreme obsession with my body," she says. "I made it a measure of my own value. I tried to dominate it, which I did, and I changed it multiple times over."

It's nice to hear her finally revealing that her body is not 100% plastic surgery-free. I never believed the audacious rumors that she'd had $3 million worth of plastic surgery, nor did I believe her frequent denials of going under the knife. I wish that the reporter from Elle would have asked her why she felt it necessary to deny having plastic surgery for all those years. Good for you to finally embrace it, Demi! Now admit to having work done on your face and we'll all be happy!

For my previous posts on Demi Moore and her plastic surgery denials, click here.
Photo credit: prphotos.com

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

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Demi Moore Comes Clean About Plastic Surgery... Kind Of

In an interview with Elle Magazine, Demi Moore has finally confirmed the rumors that she's had plastic surgery. The 47 year old actress stated that she had work done, but only to her body. She also admitted to body image issues, and would not rule out more plastic surgery in the future. According to nydailynews.com:

"I've had something done but it's not my face," says the mother of three... However, Moore did reveal that she wouldn't be opposed to having plastic surgery in the future.
"You know what? Maybe one day I'll go under the knife," she admits. "It just irritates me that people are constantly saying how much I've spent on plastic surgery."

"I had an extreme obsession with my body," she says. "I made it a measure of my own value. I tried to dominate it, which I did, and I changed it multiple times over."

It's nice to hear her finally revealing that her body is not 100% plastic surgery-free. I never believed the audacious rumors that she'd had $3 million worth of plastic surgery, nor did I believe her frequent denials of going under the knife. I wish that the reporter from Elle would have asked her why she felt it necessary to deny having plastic surgery for all those years. Good for you to finally embrace it, Demi! Now admit to having work done on your face and we'll all be happy!

For my previous posts on Demi Moore and her plastic surgery denials, click here.
Photo credit: prphotos.com

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

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There's no escape from Magical Thinking on health care apparently

There's a good bit of magical thinking around the idea of preventive care. One of the most disingenuous aspects of this is the push for these measures as "free" as part of the health care reform debate. Nothing of value is free, and in health care the overhead propping up the system makes that even more true.

Now there are both cheap and expensive measures that included in what we call preventive care or cancer screening, but at the end of the day they do not save money (even if they may make us healthier). It's actually counterintuitive that some bad habits or diseases from them (smoking or diabetes) may actually save  money as they die younger and end up costing less over a lifetime. That's not a reason to not support early intervention, but it is something that has to be considered when making your countries health care budget.

The truth that the health care costs as a % of GDP are ignored by the bill passed is really scandalous. Facing those true costs was not something the  left was going to let get in the way of entrenching their goal of federal health care. A story about the effects of the health care reform bill I read (see here) seemed to forget that all costs matter until pointed out over and over by readers in the comments section. I thought this one was spot on,

Colonoscopies and mammograms are absolutely not “preventive” care, they are early detection. Having a mammography will not prevent breast cancer any more than owning an umbrella will prevent rain. It may stave off the full and most dire effects of a diagnosis of cancer by allowing early intervention, but that is far from prevention. You will have to pay for the surgery, the radiation, the medication, all the same. Talk about “magical thinking”.

The politics of  telling people NO is complicated and gets caught up in issue driven advocacy groups. A large study from Denmark touched on this obliquely by studying an area of screening efficacy (or lack thereof) when they found no evidence that screening women for breast cancer has any effect on death rates when applied to their countries women in well organized screening programs. For context, breast cancer is the most common cancer in women worldwide, accounting for around 16 percent of all female cancers and is attributed to almost 519,000 people globally each year.

How do other western countries with modern health care systems screen for breast cancer? In Denmark, women are screened every two years from age 50, while in Britain the policy is for women over 50 to be screened about every 3 years. Evidence now suggests that for every 2,000 women who are screened over 10 years, only one stands to have her life saved by the mammogram program, whereas the chance of getting an unnecessary breast cancer diagnosis is 10 times that.

If you'll remember in 2009, we had a hailstorm of controversy here in America when it was suggested that our current guidelines of starting screening mammograms at 40 was neither cost-effective nor evidence-based for affecting breast cancer mortality. There was a lot of ignorant political grandstanding on this as a woman's issue (step forward congresswoman Debbie Wasserman-Schultz D-FL) and Democrat's were furious that this kind of recommendation was coming out during their poorly-conceived sales job on health care reform. God forbid there be any notion that evidence based medicine might infringe upon you right to insist on your ______ (Mammogram, CT Scan, MRI, back surgery, etc....) without considering considering the cost or efficacy. It was a lie then and it's a lie now.

Rob

Heidi Montag Had Her Back Scooped?

I've been asked by several media outlets what Heidi Montag meant by having her 'back scooped.' While the media outlets are swirling around what type of unusual new plastic surgery this might be, I have a pretty disappointing but accurate definition: liposuction of the back of her hips.

This area, also known as the love handle, can be very effectively liposuctioned, creating a 'scoop' or concave effect. It's one of my favorite areas to liposuction since it can create such a nice contour that most women (and men) really like. Plus, the risk of unevenness in this area is pretty low, especially compared to the abdomen, which can get lumpy very quickly (just ask Tara Reid).

Yes, I scoop backs all the time. Sorry, Heidi, you're not special in this regard.

For a great MSNBC article on "back scooping", click here.

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

Heidi Montag Had Her Back Scooped?

I've been asked by several media outlets what Heidi Montag meant by having her 'back scooped.' While the media outlets are swirling around what type of unusual new plastic surgery this might be, I have a pretty disappointing but accurate definition: liposuction of the back of her hips.

This area, also known as the love handle, can be very effectively liposuctioned, creating a 'scoop' or concave effect. It's one of my favorite areas to liposuction since it can create such a nice contour that most women (and men) really like. Plus, the risk of unevenness in this area is pretty low, especially compared to the abdomen, which can get lumpy very quickly (just ask Tara Reid).

Yes, I scoop backs all the time. Sorry, Heidi, you're not special in this regard.

For a great MSNBC article on "back scooping", click here.

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

Growing Hacks in Cali...Cali - Underqualified cosmetic surgeons plague the Golden State

Nod to LL Cool J in the post title :)

California is an iconic part of the United States that sets many trends. Unfortunately one of these trends is the growth of under or untrained physicians performing cosmetic surgery procedures.

A snapshot of who is performing cosmetic procedures in California, published this month in the journal, Plastic and Reconstructive Surgery, examined 1,876 cosmetic practitioners from San Diego to Los Angeles. Only 495 of them were actually trained in plastic surgery. Primary care physicians with no surgical training to speak of made up the 4th group of liposuction providers following plastic surgeons, dermatologists and otolaryngologists.

Scary, Scary stuff! It seems obvious, but always look for a board certified Plastic Surgeon if you're considering plastic surgery.

Rob

FDA Warns Spas Against Fat-Melting Claims of Lipodissolve

Is Lipodissolve or mesotherapy safe? The FDA has recently issued a warning to six medical spas for making false or misleading statements that their fat melting injections are safe and effective, despite the fact that they've never been appropriately studied or approved by the FDA for this purpose. According to the US News and World Report:

Lipodissolve involves injecting small amounts of soy lecithin and bile salt directly into problem areas on the hips, waist, thighs, and buttocks, which supposedly melts away fat. The injections became wildly popular three years ago with spas opening up around the country and with doctors in every specialty—from pediatricians to dermatologists —taking weekend seminars to learn the procedure before opening fat-dissolving clinics.

Fat melting injections became popular a few years ago, but have since lost a lot of their hype. To date, no wide-scale scientific study has validated its safety or effectiveness, although some smaller case studies have shown some effectiveness with the injection of certain drugs to melt fat. The problem is that the majority of physicians who perform these fat-melting injections have the drugs made in a compounding pharmacy to whatever concoction they believe might work. There is no standardization, like in most other medications we take. In my area (metro Detroit) I don't know of a single reputable plastic surgeon who performs these treatments. Most of the doctors who perform these treatments are what I consider 'fringe' practitioners. I have seen patients who have lost fat from mesotherapy, however, so I do believe there is some validity to these treatments. They just need to be standardized and studied to make sure they are safe, effective, and at least somewhat predictable.

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

FDA Warns Spas Against Fat-Melting Claims of Lipodissolve

Is Lipodissolve or mesotherapy safe? The FDA has recently issued a warning to six medical spas for making false or misleading statements that their fat melting injections are safe and effective, despite the fact that they've never been appropriately studied or approved by the FDA for this purpose. According to the US News and World Report:

Lipodissolve involves injecting small amounts of soy lecithin and bile salt directly into problem areas on the hips, waist, thighs, and buttocks, which supposedly melts away fat. The injections became wildly popular three years ago with spas opening up around the country and with doctors in every specialty—from pediatricians to dermatologists —taking weekend seminars to learn the procedure before opening fat-dissolving clinics.

Fat melting injections became popular a few years ago, but have since lost a lot of their hype. To date, no wide-scale scientific study has validated its safety or effectiveness, although some smaller case studies have shown some effectiveness with the injection of certain drugs to melt fat. The problem is that the majority of physicians who perform these fat-melting injections have the drugs made in a compounding pharmacy to whatever concoction they believe might work. There is no standardization, like in most other medications we take. In my area (metro Detroit) I don't know of a single reputable plastic surgeon who performs these treatments. Most of the doctors who perform these treatments are what I consider 'fringe' practitioners. I have seen patients who have lost fat from mesotherapy, however, so I do believe there is some validity to these treatments. They just need to be standardized and studied to make sure they are safe, effective, and at least somewhat predictable.

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

Heidi Montag Can't Jog?

In a recent interview with Ryan Seacrest, Heidi Montag has admitted that she can't jog due to the size of her breasts, since they are now an "E" or "F" size. She also revealed that her surgery was recorded for possible airing on a future reality show.

To Heidi: So, you can't jog?

Duh! Your implants are huge! Most insurances require 500 grams for a breast reduction to improve back and neck pain. Your implants are 700 cc, almost the biggest size they make. Of course you can't jog!

Why do we still care about her?

Photo credit: huffingtonpost.com

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

Heidi Montag Can't Jog?

In a recent interview with Ryan Seacrest, Heidi Montag has admitted that she can't jog due to the size of her breasts, since they are now an "E" or "F" size. She also revealed that her surgery was recorded for possible airing on a future reality show.

To Heidi: So, you can't jog?

Duh! Your implants are huge! Most insurances require 500 grams for a breast reduction to improve back and neck pain. Your implants are 700 cc, almost the biggest size they make. Of course you can't jog!

Why do we still care about her?

Photo credit: huffingtonpost.com

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

Are your breast implants under warranty?

The New York Times had a story last week (see here) on how expensive orthopedic implants for knees and hips were to replace when they failed. As the cost of the devices themselves (without hospital or physician charges) can run north of $15,000, it can be more then $50K on the price tag when these patients require re-operation for premature failure. Highlighted in the story was the fact that the manufacturers did not expressly provide a warranty for replacement costs of their implants.

Much like these orthopedic devices, patients with breast implants can expect their devices to have to be replaced at some point in their life, either thru device failure or for aesthetic revision issues as their body changes. In contradistinction to the orthopedic companies, both Allergan and Mentor Corp. (whom combined sell 99% of all breast implants in the United States) have offered lifetime replacements on their failed devices for several years now. Allergan in particular has been admirable, as the parent company that makes the implants has been sold twice from it's roots as McGhan medical (later Inamed Corp.). As both Allergan and Johnson & Johnson (owner of Mentor Corp. since 2009) are huge multinationals, it would seem patients with these implants should have a good deal of security of their devices fail for replacement of their implants.

These implant companies do not however cover all other costs associated with the replacement of the devices, but have come up with a fairly generous standard program matched by both Mentor & Allergan

• 10 years of guaranteed financial assistance
• Up to $1200 in out-of-pocket expenses for surgical fees, operating room and anesthesia expenses not covered by insurance
• Silicone filled and saline filled breast implants are both covered
• Lifetime product replacement
• Automatic enrollment at the time of your original surgery

Now as a breast implant is relative expensive to design and test clinically, but inexpensive to manufacture by the unit, it's easy to see how these companies can absorb the cost. I don't know exactly their margin per device, but I think it's $600-700+ per silicone implant they sell.

Rob

A Plastic Surgeon on Michael Jackson, Dr. Conrad Murray, and Regulatory Reform

There is a very interesting article in the Huffington Post written by a board-certified plastic surgeon who shared a surgical suite with the late Michael Jackson's plastic surgeon. In it, he explains his thoughts on why Michael may have died (which appear to be refuted by the autopsy findings) and the responsibility that physicians and the lack of true health care reform share in contributing to his unfortunate death. While you may or may not agree with some of his opinions, it's definitely an interesting read. You can check it out here.

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

A Plastic Surgeon on Michael Jackson, Dr. Conrad Murray, and Regulatory Reform

There is a very interesting article in the Huffington Post written by a board-certified plastic surgeon who shared a surgical suite with the late Michael Jackson's plastic surgeon. In it, he explains his thoughts on why Michael may have died (which appear to be refuted by the autopsy findings) and the responsibility that physicians and the lack of true health care reform share in contributing to his unfortunate death. While you may or may not agree with some of his opinions, it's definitely an interesting read. You can check it out here.

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

Raquel Welch - No Plastic Surgery?

Raquel Welch was recently on the Oprah show making some pretty amazing claims. She denied going under the plastic surgeon's knife and instead attributed her youthful appearance to Yoga, a perfect diet, and three hours of makeup in the morning.

What do you think? I think she's a liar.

My opinion:
Her forehead hardly moves, likely frozen by a good amount of Botox or Dysport. Her brows are nicely elevated, possibly from a browlift. She shows none of the excess skin and puffiness of a 69 year old woman. I believe she's also undergone an upper and lower blepharoplasty. Her cheeks and lips are full, likely from a filler like fat grafting. Her neckline is way too sharp for a person her age who hasn't had a facelift. Finally, her nose looks overly chiseled, likely from at least one reduction rhinoplasty. If her looks are solely due to Yoga, diet, and makeup, then I'm one of Tiger Woods' mistresses.

Photo / story credit: twominutenews.com

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

Share |

Raquel Welch - No Plastic Surgery?

Raquel Welch was recently on the Oprah show making some pretty amazing claims. She denied going under the plastic surgeon's knife and instead attributed her youthful appearance to Yoga, a perfect diet, and three hours of makeup in the morning.

What do you think? I think she's a liar.

My opinion:
Her forehead hardly moves, likely frozen by a good amount of Botox or Dysport. Her brows are nicely elevated, possibly from a browlift. She shows none of the excess skin and puffiness of a 69 year old woman. I believe she's also undergone an upper and lower blepharoplasty. Her cheeks and lips are full, likely from a filler like fat grafting. Her neckline is way too sharp for a person her age who hasn't had a facelift. Finally, her nose looks overly chiseled, likely from at least one reduction rhinoplasty. If her looks are solely due to Yoga, diet, and makeup, then I'm one of Tiger Woods' mistresses.

Photo / story credit: twominutenews.com

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

Share |

Thank you and The End - APRIL FOOLS

I've been writing this blog for nearly four years now, and have had a blast doing it. I truly appreciate the thousands and thousands of readers who have left comments and regularly read my ramblings. Unfortunately, I've been threatened with a lawsuit from Carrot Top who took offense at my opinion on his appearance. For that reason (and others) I've decided to end my blog.

Starting today.

April 1st.

Gotcha :) (Yes, this was an April Fools Joke. You didn't think you'd get rid of me this easily, did you?)

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

Thank you and The End - APRIL FOOLS

I've been writing this blog for nearly four years now, and have had a blast doing it. I truly appreciate the thousands and thousands of readers who have left comments and regularly read my ramblings. Unfortunately, I've been threatened with a lawsuit from Carrot Top who took offense at my opinion on his appearance. For that reason (and others) I've decided to end my blog.

Starting today.

April 1st.

Gotcha :) (Yes, this was an April Fools Joke. You didn't think you'd get rid of me this easily, did you?)

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