Apparently we are supposed to care that reality TV star Heidi Montag has had a lot of plastic surgery, to the point that she has had to deny accusations of “plastic surgery addiction.” Liposuction, breast implants (maybe she thought that’s what the title of her TV show “The Hills” refers to), chin reduction, fat injections to her cheeks, revision rhinoplasty (updating her previous one), and more, all told some 10 hours worth. Even Nightline is weighing in on the subject, along with a People magazine cover story. And let’s not forget the news about Tiger Woods in treatment for sex addiction. Where does obsession end and true addiction begin?
I don’t know (and don’t particularly care) about Tiger Woods’ sex life, but the question of plastic surgery addiction is worth exploring. In a medical sense, there are strictly defined criteria for addiction; it involves compulsive, persistent dependence on a drug (substance abuse) or behavior (process addiction.) There are known to be genetic factors with drug dependency, and true addictions are associated with actual structural changes in the brain. Another consistent feature is withdrawal symptoms, which can be severe and even life-threatening with some drugs. These physical manifestations are one reason why addictions can be so hard to treat.
But the behavioral addictions – gambling, shopping, sex, maybe even plastic surgery – have more obscure origins. It appears likely that there is a large area of overlap between obsessive but controllable activities and what are commonly considered to be addictions. There is a known diagnosis in the plastic surgery world called Body Dysmorphic Disorder, or BDD, characterized by anxiety stemming from perceived defects in appearance. Plastic surgeons are well-tuned to recognize BDD because many of those with it become serial plastic surgery patients and are never satisfied. What else could explain the bizarre extents to which people like Jocelyn Wildenstein have gone? Counseling rather than surgery is the best treatment for these cases.
So does a marathon makeover surgery on an already attractive 23 year old represent a step on the road to addiction? Despite her announced plans to do more, Heidi Montag’s motives may be a simple case of an attempt to remain in the spotlight as the allotted 15 minutes of fame elapse. I can hardly wait for the next round of updates on the new and even larger implants.
Monday, January 25, 2010
Thursday, January 21, 2010
Is Viagra the next cellulite treatment?
Every year or so the next great cure for cellulite appears. First it was creams, then Endermologie, then mesotherapy, then lasers with Endermologie-like roller massage, every permutation that biomedical engineers could think of to beat cottage cheese thighs into submission. Thermage has a cellulite tip, which works well but not for everyone. (http://www.baxterplasticsurgery.com/thermage.html) So a definitive treatment remains elusive.
It’s not for lack of trying. Since estimates of the number of women affected are in the 80-90 percent range, it is an enormous problem and women the world over are clamoring for a solution. But before I introduce the latest idea, we should look at why cellulite is such an intractable problem. To begin with, no one can say definitively what it is. That isn’t to say that we don’t see differences between the skin and fat in women with cellulite and men, or unaffected women; we just don’t know what causes those changes. The skin is thinner, and fat compartments tend to bulge into the skin, causing the characteristic upholstery-like dimples. Poor circulation seems to be an issue, and approaches to cellulite treatments often target this with methods to increase blood flow (back to roller massage.)
So someone (actually four doctors from Croatia) noted that Viagra is also a vasodilator, and proposed a theory in the journal Medical Hypotheses last summer. To be fair, note that the journal is for hypotheses, not proven theories or clinical trials, but it is provocative nonetheless. Sildenafil, the generic name for Viagra, was found to not only increase circulation in the skin (which may or may not be helpful), but it also activated enzymes that help break down fat cells in tissue culture. There’s actually some serious science behind this class of drugs and it may very well turn out to be helpful for cellulite. If so, I can hardly wait to see the marketing campaign.
It’s not for lack of trying. Since estimates of the number of women affected are in the 80-90 percent range, it is an enormous problem and women the world over are clamoring for a solution. But before I introduce the latest idea, we should look at why cellulite is such an intractable problem. To begin with, no one can say definitively what it is. That isn’t to say that we don’t see differences between the skin and fat in women with cellulite and men, or unaffected women; we just don’t know what causes those changes. The skin is thinner, and fat compartments tend to bulge into the skin, causing the characteristic upholstery-like dimples. Poor circulation seems to be an issue, and approaches to cellulite treatments often target this with methods to increase blood flow (back to roller massage.)
So someone (actually four doctors from Croatia) noted that Viagra is also a vasodilator, and proposed a theory in the journal Medical Hypotheses last summer. To be fair, note that the journal is for hypotheses, not proven theories or clinical trials, but it is provocative nonetheless. Sildenafil, the generic name for Viagra, was found to not only increase circulation in the skin (which may or may not be helpful), but it also activated enzymes that help break down fat cells in tissue culture. There’s actually some serious science behind this class of drugs and it may very well turn out to be helpful for cellulite. If so, I can hardly wait to see the marketing campaign.
Monday, January 11, 2010
Post-operative breast implant massage: Does it help?
A frequent question we get about breast augmentation is whether or not post-op massage is recommended or potentially beneficial. One popular website, BreastImplants411.com, has created a checklist including a question about implant massage; patients considering breast augmentation are supposed to ask specifically about it. And plastic surgeons seem to be split on the question, with some strenuously advising it and others cast as non-believers. With such contradictory views, what is an informed person supposed to make of it?
The main idea behind it originated in an era when capsular contracture, a hardening of the scar capsule around the implant, was much more common. Plastic surgeons were trying anything that might make a difference, and cases of contracture were sometimes treated with a fairly brutal procedure called a “closed capsulotomy” which consisted of squeezing the breast hard enough to make the scar capsule rupture. Although patients might run out of the clinic in tears, the breast would be softer (for a while.) So the thinking was that perhaps squeezing the breasts on a regular basis, especially during the healing period, could prevent the scar from contracting in the first place.
In retrospect, it was a fairly naive notion, but there wasn’t much else to offer because the causes of capsular contracture were so poorly understood at that time. So it became entrenched as a routine practice and no one bothered to do a clinical study to see whether it did any good. In fact, to this day no such study has been published. Evidence now points to bacterial biofilms, invisible contaminants caused by miniscule numbers of otherwise harmless germs, that cause a reaction in the scar that encloses the implant. Better surgical techniques and better implants than the ones used 25 years ago appear to be the important variables.
So at this point we still have no objective evidence that post-op implant massage makes any difference in capsular contracture. There are certainly cases where swelling tends to push implants up and massage can be helpful in getting them to settle, but that is only sometimes the case. So the question shouldn’t be “Do you recommend massage?” but if so, “Why?”
The main idea behind it originated in an era when capsular contracture, a hardening of the scar capsule around the implant, was much more common. Plastic surgeons were trying anything that might make a difference, and cases of contracture were sometimes treated with a fairly brutal procedure called a “closed capsulotomy” which consisted of squeezing the breast hard enough to make the scar capsule rupture. Although patients might run out of the clinic in tears, the breast would be softer (for a while.) So the thinking was that perhaps squeezing the breasts on a regular basis, especially during the healing period, could prevent the scar from contracting in the first place.
In retrospect, it was a fairly naive notion, but there wasn’t much else to offer because the causes of capsular contracture were so poorly understood at that time. So it became entrenched as a routine practice and no one bothered to do a clinical study to see whether it did any good. In fact, to this day no such study has been published. Evidence now points to bacterial biofilms, invisible contaminants caused by miniscule numbers of otherwise harmless germs, that cause a reaction in the scar that encloses the implant. Better surgical techniques and better implants than the ones used 25 years ago appear to be the important variables.
So at this point we still have no objective evidence that post-op implant massage makes any difference in capsular contracture. There are certainly cases where swelling tends to push implants up and massage can be helpful in getting them to settle, but that is only sometimes the case. So the question shouldn’t be “Do you recommend massage?” but if so, “Why?”
Monday, January 4, 2010
the guy's guide to plastic surgery
Plastic surgery is generally considered to be the domain of women, especially with breast implants having become the most popular surgery. All in all, only 15% of patients are men, but that is still quite a lot in terms of absolute numbers. For the record, the most popular procedure for men continues to be liposuction.
One problem I think is that too many of us labor under false notions about plastic surgery. Husbands and boyfriends accompanying their partners for consultation often say something like “I don’t know why she is doing this, I love her just the way she is.” So the first lesson is that she isn’t doing it for you, she has her own personal reasons that don’t really depend on relationships. In fact, having cosmetic surgery in order to improve a relationship is almost always a bad idea.
Another misconception is body contouring surgery vs. diet and exercise. It isn’t an either/or situation, however; there are things that exercise does that cosmetic surgery doesn’t, and vice-versa. Classic examples are doing sit-ups with the expectation that they will tighten abdominal skin, and the idea that specific exercises can affect body fat distribution. Spot-contouring of fat with exercise just doesn’t happen. On the other hand, liposuction isn’t done for weight loss, it is all about reshaping. So thigh exercises may not burn off thigh fat, and crunching the abs won’t result in a 6-pack if the body is genetically programmed to carry extra fat there.
Our typical lipo patient is someone who isn’t overweight but has areas resistant to change. A woman might be a size 4 on the upper half of the body but a different size in the thighs. We see men who are in great shape but have “love handles” or excess abdominal fat. So do continue to hit the gym, and see your plastic surgeon for what you can’t accomplish with exercise and a healthy diet.
One problem I think is that too many of us labor under false notions about plastic surgery. Husbands and boyfriends accompanying their partners for consultation often say something like “I don’t know why she is doing this, I love her just the way she is.” So the first lesson is that she isn’t doing it for you, she has her own personal reasons that don’t really depend on relationships. In fact, having cosmetic surgery in order to improve a relationship is almost always a bad idea.
Another misconception is body contouring surgery vs. diet and exercise. It isn’t an either/or situation, however; there are things that exercise does that cosmetic surgery doesn’t, and vice-versa. Classic examples are doing sit-ups with the expectation that they will tighten abdominal skin, and the idea that specific exercises can affect body fat distribution. Spot-contouring of fat with exercise just doesn’t happen. On the other hand, liposuction isn’t done for weight loss, it is all about reshaping. So thigh exercises may not burn off thigh fat, and crunching the abs won’t result in a 6-pack if the body is genetically programmed to carry extra fat there.
Our typical lipo patient is someone who isn’t overweight but has areas resistant to change. A woman might be a size 4 on the upper half of the body but a different size in the thighs. We see men who are in great shape but have “love handles” or excess abdominal fat. So do continue to hit the gym, and see your plastic surgeon for what you can’t accomplish with exercise and a healthy diet.
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