Do that which cannot be done

It is often said that plastic surgery is art and science, and it is true. So I draw inspiration from artists who innovate as well as scientists with imagination. Picasso once said “I am always doing that which I cannot do, so that I may learn how to do it.” Much of what is now almost routine in plastic surgery must have seemed impossible only a few generations ago; in fact as a recognized specialty it is less than 100 years old. (The term comes from the Greek word plastikos, which means to change form or restore.) How does one rebuild an ear or a breast using only available “spare” parts? That kind of creative challenge is the real joy of plastic surgery.
But surprisingly there are old ideas that seem to reappear in new packaging from time to time. The heavily advertised “brand name” facelifts look a lot like the descriptions of the very first facelifts, yet are heralded as dramatic breakthroughs. And too many plastic surgeons fail to update their skill set or way of thinking, preferring the safe, tried and true methods. There’s nothing wrong with safe and predictable, but we are in a world of rapidly evolving technology, and consumers (our patients) are being bombarded with information overload. Only some of what’s new and innovative is truly worthwhile, but it takes the sort of mind that embraces what seems impossible to learn what is.

"Paint by Numbers" Plastic Surgery?

Lately I have been thinking more about the relationship of art and plastic surgery. What usually sets me off on this train of thought is an article or lecture by some expert who has developed an elaborate mathematical analysis of the approach to a particular operation. While there are circumstances where numbers are important (for example matching the base diameter of a breast implant to the dimensions of the patient) but they can be misleading just as often. Take the example of rhinoplasty (nose reshaping): there are standards that can be referenced for every angle of every part of the nose, so that an “ideal” result can be achieved. So what is wrong with this “cookie cutter” approach?

The answer is that there is no such thing as an ideal set of proportions that works on every face, or every body. Consider for example the actress Penelope Cruz: a mathematical analysis of her nose would likely show that it is too long, the angle from the nose to the lip is too acute, and so forth; but she is widely regarded (and I agree) to be one of the most beautiful women in Hollywood.

There have been some intriguing articles written where people are surveyed as to which celebrities have the best features; who has the nicest nose, the most luscious lips, etc. A computer program is then used to cut and paste all of these favorites into a composite face, which usually ends up looking fairly bizarre. This is why these canons of beautiful proportion have been routinely debunked, but they reappear on a regular basis nonetheless. I call it “paint by numbers” surgery, like the kits that help you reproduce a “masterpiece” by just painting in the designated color onto the numbered spaces. The thing is, they never quite look like the real deal either.

Good Sport: Botox Competitor Dysport Successful

A few basics: Dysport (pronounced to rhyme with “miss sport”) is a product newly approved by the FDA for marketing in the U.S. where it is positioned to challenge Botox, which celebrates 20 years of clinical use. Both products are similar and work the same way. Both are used to relax muscles, either for medical conditions or aesthetic purposes, specifically “dynamic” wrinkles such as the worry lines between the eyebrows.
The arrival of a lower-cost alternative to Botox has already had an effect. Allergan, the maker of Botox, has announced a $50 rebate on cosmetic Botox injections this summer. We just saw our first series of Dysport patients in follow-up this week and all have done well, with results in about 3 days. The above photos are with maximum frowning attempt before (bottom) and 5 days after (top).

More info here.
Oh and the name? Medicis, the manufacturer, had planned to call it “Reloxin” but for practical reasons went with Dysport as it is known in Europe. It comes from its original indication for use, a condition called cervical dystonia (cervix means “neck” if you didn’t know) and its site of manufacture in Portsmouth, England.

A is for Aging, B is for Burning: Summer Skin Care Tips

We are experiencing an event in Seattle as rare as an eclipse: a sunny forecast for the fourth of July. Local tradition has summer officially starting on the 5th, perhaps some sort of punishment from the weather gods for our usually mild climate. One thing for sure is that the sunshine, siren-like, draws us outdoors; like Odysseus tied to the mast, extreme measures would be required to keep us inside.
So some loss of compulsion about wearing sunscreen is understandable, and my point here is not to begrudge anyone their moment in the sun. In fact, if you get some sunshine in the morning or late afternoon, you are actually converting cholesterol into vitamin D, which in turn has some anti-cancer benefits. But if you are frying in the midday, your skin will pay the price.
Just keep one important thing in mind: Your sunscreen’s SPF rating doesn’t tell the whole story, because it only measures protection against burning, which is due to UVB rays. That’s a good thing of course, but it is the UVA rays-the same ones that you get in tanning beds-that actually cause the long-term aging changes in the skin. As yet, there is no universally recognized standard for UVA protection, so you need to look for it specifically. The easiest way is to look for the term “full spectrum” protection, or specific UVA blockers like Mexoryl.
Another simple thing you can do is make sure you include antioxidants in your diet. Since one of the best sources of these is berries and pigmented fruits, take advantage of blueberries and cherries in season. And stay well-hydrated, but please, don’t go for the sugary vitamin-enhanced drinks. Just do like Mom says: play outside for a while, get plenty of rest, and eat your vegetables.