Monday, January 31, 2011

Tanning Addiction

Tanning Addiction   (Plastic Surgery in Houston)

Having a skin complexion with a golden hue may give one a look of healthy vigor. Whether you're a Jersey Shore wannabe or a Baywatch fan, it is important to be aware of the possible adverse effects of tanning.  Recent studies have shown that having a “toasted look” by going to tanning salons may predispose someone to a tanning addiction or tanorexia. 
Image from

Fast Facts about Tanning Addiction
  • UV light is the reinforcing stimulus for tanning addiction.
  • UV exposure increases endorphin levels of tanners.
  • A study from Memorial Sloan-Kettering Cancer Center and University of Albany showed that frequent tanners were more likely to report moderate to severe symptoms of anxiety and depression than those college students who tan less frequently or did not tan at all.
  • 30.6% of college students in the study who used tanning facilities were addicted to tanning.
  • 47% of Caucasian women aged 18-19 tan. 
  • All of the heavy users of tanning salons are aware that one could increase their risk for skin cancer from using tanning booths. 
  • Addiction to tanning  increases one's risk for more symptoms of anxiety, depression and use of alcohol & marijuana.

    Effects of Tanning
    • Increased risk for skin cancer (melanoma risk is eight-fold higher than people who never used tanning beds.)
    • Premature skin aging
    • Eye damage (both short term and long term)
    • Tanning addiction

    Emmanuel De La Cruz M.D.


    Mosher et al. Addiction to Indoor Tanning:  Relation to Anxiety, Depression and Substance Abuse.  Archives of Dermatology. 2010; 146(4):412-417

    Organ Transplant Patients at Increased Risk for Skin Cancer

    Organ Transplant Patients with Increased Risk for Skin Cancer

    Organ transplant patients have been found to have an increased risk for skin cancer.  The medication given to patients with organ transplants to prevent organ rejection plays a key role.  Unprotected sun exposure also increases the person’s risk for skin cancer, especially in organ transplant patients.  Clinical studies have shown that 20 years after receiving an organ transplant, patients have a 40% overall increased risk for skin cancer.  This is especially true for patients living in temperate climates, such as Australia.

    Fast Facts about Organ Transplant and Skin Cancer:
    •      Squamous cell carcinoma is more common among organ transplant patients
    •       27% of mortality is due to skin cancer in one study in Australia
    •       40% overall increased risk for skin cancer in organ transplant recipients 20 years after receiving an organ
    •       Skin cancer in organ transplant recipient patients tend to develop 2-4 years after the organ transplant.
    Recommendations to Prevent Skin Cancer
    •         Obtain a full body examination before your organ transplant to inspect for suspected skin lesions
    •         Apply sunscreen daily and wear sun-protective clothing
    •        Avoid direct sun-exposure and tanning beds/devices
    •        Obtain regular dermatologic check-ups with your primary care provider or dermatologist.
    •           Perform regular self-exams.  This can be life-saving, especially since skin cancer treatment is most effective when treated early.
    Having an organ transplant is a life-saving and life-changing procedure, but it is very important to be aware of this risk of skin cancer in these patients.  Whether you have a friend, family or yourself have an organ transplant, being aware of this risk and learning what one can do to reduce the risk of skin cancer are likely to improve one’s quality of life, and even survival of your loved one.

    Emmanuel De La Cruz M.D.
    The Woodlands Plastic Surgeon


    Berg D, Otley CC. Skin cancer in organ transplant recipients: Epidemiology, pathogenesis, and management. Journal of the American Academy of Dermatology 2002; 47: 1-17; quiz 8-20.

    Euvrard S, Kanitakis J, Claudy A. Skin cancers after organ transplantation. The New England Journal of Medicine 2003; 348: 1681-91.

    Ong CS, Keogh AM, Kossard S et al. Skin cancer in Australian heart transplant recipients. Journal of the American Academy of Dermatology 1999; 40: 27-34.

    Sunday, January 30, 2011

    Which Dermal Filler is Best For Me?

    Which Dermal Filler is Best for Me?

    "Which dermal filler is best for me?" is a common question asked by patients who are interested in non-surgical facial rejuvenation. So what are the best dermal fillers? Which give the best and most natural results? Which last the longest? Which one should you choose? These are just some of the questions that one should ask your plastic surgeon.  

    Which dermal filler last the longest?
    • Radiesse has been shown to be the dermal filler that last the longest (typically1 to 2 years).

    Which dermal filler has the most natural looking?
    • These dermal fillers produce a natural look after injection and reduce the fine lines or unwanted creases.
    • After a dermal filler injection, one may be able to feel the filler after the procedure for several weeks.  Although you may not see it, but you may feel the filler with your fingers.  
    • Juvederm is reportedly has the smoothest feel.
    Which dermal filler has the least bruising and least pain?
    • The smoothest material to inject is Juvederm, and thus the least painful
    • Radiesse is somewhat more painful when injected since the material requires a larger needle, and the injection technique is a little bit more traumatic 
    So which dermal filler is the right one for you?
    • If you desire the longest correction possible with an FDA-approved filler, and if you don't mind more bruising with each procedure, then Radiesse may be a better choice since you will have to do the procedure less often.
      • If you are new to fillers, desires less downtime, less bruising and less pain with the procedure, then a hyaluronic acid derivative (Restylane or Juvederm) may be a better choice.
      Are there any other dermal fillers?
      • Sculptra is another dermal filler made of poly-L-lactic acid that is FDA-approved for the use of facial lipodystrophy (facial fat loss) in HIV patients.
      • There are other dermal fillers, such as Cosmoplast & Cosmoderm (collagen dermal fillers), that are no longer available in the US.

      I recommend consulting one of your Woodlands Plastic Surgeons regarding which dermal filler would be best for your individual needs.

      Emmanuel De La Cruz M.D.

      Dermal Fillers (Juvederm | Restylane | Radiesse)

      Dermal Fillers (Juvederm | Restylane | Radiesse) ~ The Woodlands Plastic Surgeon
      Dermal fillers, such as Juvederm, Restylane and Radiesse, have become very popular when it comes to reducing  unwanted wrinkles and creases of the face.  These dermal fillers can be injected into those furrows between the brows, marionette lines, crow's feet and even thinning lips.  The most popular dermal fillers (Juvederm & Restylane) are the ones made from hyaluronic acid, a key component of skin connective tissue.  

      Fast Facts about Dermal Fillers
      • On a more technical level, hyaluronic acid is a glycosaminoglycan that is found in all of the body's tissue, with the highest concentrations located in the extracellular matrix of the skin and the synovial fluid that bathes the joints and cartilage.
      • Since wrinkles and the poor texture of skin are usually a result of reduced levels of hyaluronic acid and collagen in the body secondary to aging,  dermal fillers can act as a ‘filling’ agent to plump up and nourish the skin with the the "deficient acid". 
      • Radiesse is a synthetic dermal filler made of calcium microspheres that stimulates the production of collagen.
      • Juvederm and Restylane are composed of hyaluronic acid gels.
      • These dermal fillers can reduce the appearance of acne scars or uneven skin texture.
      • Occasionally, BOTOX® Cosmetic may be used in conjunction with a dermal filler in areas that are affected by repeated muscle use, such as the forehead. 
      • Dermal fillers would not correct or improve the "sagging" of the face from aging.  
      • The cost of dermal filler injections among medical providers, such as your nurse/dentist/dermatologist/plastic surgeon,  is most likely very similar and comparable.

      Fast Facts about Juvederm and Restylane  
      • Both are dermal fillers made from hyaluronic acid. 
      • Both are approved by the FDA: Juvederm received FDA approval in the summer of 2006, while Restylane has been the filler of choice since 2003.
      • The dermal filler injections are both minimally invasive and require little to no recovery time.

      What are the Difference between Juvederm and Restylane?
      • The swelling effects of Restylane may take two to three days whereas Juvederm may take 24 hours 
      • The results for Juvederm are reported to appear instantly while the results of Restylane may not become apparent until about 1 week after the procedure 
      • Juvederm may last longer (3 to 9 months) whereas Restylane can last 6 months or more
        I recommend asking one of your Houston plastic surgeons about these dermal fillers as an alternative to surgery to reduce those fine wrinkles.

        Other articles related to dermal fillers:
        4) Potential Complications of Dermal Fillers (Restylane/Juvederm)

        Thursday, January 27, 2011

        Do Breast Implants Cause Lymphoma? The Truth Behind the Association of Breast Implants & Lymphoma

        Do Breast Implants Cause Lymphoma? The Truth Behind the Association of Breast Implants & Lymphoma

        The FDA recently announced that  breast implants are associated with lymphoma.  "The FDA believes that women with breast implants may have a very small but increased risk of developing this disease in the scar capsule adjacent to the implant."   However, one should look at this very closely since it is not possible to confirm with absolute certainty that breast implants indeed cause lymphoma based on the available data.  According to the FDA, "currently it is not possible to identify a type of implant (silicone versus saline) or a reason for implant (reconstruction versus aesthetic augmentation) associated with a smaller or greater risk."

        Fast Facts about Breast Implants and Lymphoma:    
        •  Approximately 1 in 500,000 women is diagnosed with Anaplastic Large Cell Lymphoma in the United States each year.
        • Anaplastic Large Cell Lymphoma in the breast is very rare:  ~ 3 in 100 million women per year in the US are diagnosed with lymphoma in the breast.
        • Incidence of ALCL of the breast in the Netherland study is 0.1 to 0.3 per 100,000 women with breast implants per year.
        • Chance of dying from a car accident in the US: 1 in 18,585
        • Chance of getting breast cancer:  1 in 9
        • The FDA identified 34 unique cases of ALCL in women with breast implants throughout the world from January 1997 to May 2010.  Currently, 60 cases were identified worldwide.
        • Of the 34 cases in the original study, 19 patients received implants for breast augmentation. 
        • The total number of patients with breast implants worldwide is estimated to be between 5-10 million.
        • There is a possible association between breast implants and lymphoma.
        • Currently, there is no data that would identify which breast implants (saline versus silicone) are associated with lymphoma.
        • Based on the available data, the incidence of Anaplastic Large Cell Lymphoma is extremely low, even in breast implant patients.
        Treatment of Lymphoproliferative Disorder of the Breast Implant Capsule
        • The treatment would consist of capsulectomy (removal of the capsule) and implant removal.
        • Patients may or may not need chemotherapy or radiation therapy depending on the extent of the lymphoproliferative disorder found.
        • Currently, there is no consensus regarding the treatment regimen for ALCL of the breast since there has been very few cases worldwide.  The prognosis has been excellent based on the study conducted at the University  of Texas M.D. Anderson Cancer Center.

        P.S.  Please take the blog poll at the bottom and on the right column of this page.  Thank you.


        US Food & Drug Administration:  Anaplastic Large Cell Lymphoma (ALCL) in Women with Breast Implants:  Preliminary FDA Findings and Analyses.  January 2011

        Atlanta Breast Symposium. January 2011
        Kim B, et al. Anaplastic Large Cell Lymphoma and Breast Implants: A systematic Review: Plastic & reconstructive Surgery. 2011 June; 127:2141-2153
        Roden et al. Seroma-associated primary anaplastic large-cell lymphoma adjacent to breast implants: an indolent T-cell lymphoproliferative disorder. Mod Pathol. 2008 Apr;21(4):455-63.
        Jong, et al. Anaplastic Large Cell Lymphoma in Women with Breast Implants. JAMA. 2008;300(17):2030-2035
        Miranda RN, Lin L, Talwalkar SS, Manning JT, Medeiros LJ. Anaplastic large cell lymphoma involving the breast: a clinicopathologic study of 6 cases and review of the literature. Arch Pathol Lab Med . 2009 Sep;133(9):1383-90. 

        Article updated on 06/15/2011

        Sunday, January 23, 2011

        The Truth About Botox ~ Woodlands BOTOX | Market Street BOTOX

        Fast Facts About Botox   
        • Botox is a muscle-paralyzing agent that is used for the treatment of dynamic wrinkles, and thus it diminishes unwanted facial expressions. 
        • Dynamic wrinkles are lines and wrinkles that form when we express ourselves, such as forehead wrinkles when you raise your eyebrows or wrinkles next to your eye when you squint
        • Botox is used to treat glabellar furrows (wrinkles between the eyebrows), forehead lines, and crow's feet (wrinkles next to the eyes)

          BOTOX Injection (Photo courtesy of
          • How does Botox work? Wrinkles may be caused when there's tightening of the muscles.  Botox™ is injected into the muscle through the skin without any anesthetic.  The Botox injection keeps the muscle from tightening. When the muscle can't tighten, the wrinkle doesn't show as much.
          • The effects of reducing your wrinkles can last around 4 months for most people. However, with multiple injections over time, several patients report that Botox lasts longer, often 6 months or more.
          • Botox does not treat static wrinkles, such as fine wrinkles around your mouth or the nasolabial fold.  Static wrinkles may be treated with dermal fillers, such as Restylane or Juvederm.
          • Botox may produce a "frozen face" when the provider who has been doing it has poor knowledge of the anatomy of the face
          • Botox can be used to treat migraine headaches.  Ask your plastic surgeon or neurologist if they provide this service.
          • Botox may cause droopy eyelids which may last for several weeks. 
          • The price of a Botox treatment is most likely similar among medical providers, whether it's your nurse/dentist/dermatologist/plastic surgeon.
            I recommend asking one of your Woodlands plastic surgeons if you are interested in receiving Botox treatment to reduce your forehead/crow's feet/glabellar wrinkles.

            Please read other plastic surgery related articles:

            Emmanuel De La Cruz M.D.

            "To create something exceptional, your mindset must be relentlessly focused on the smallest detail."
            ~ Georgio Armani

            Other articles related to BOTOX:

            Sunday, January 16, 2011

            Best Bra after Breast Augmentation

            What is the Best Bra After Breast Augmentation?

            A common question a patient, who recently underwent a breast augmentation, would ask is the type of bra that they should wear after surgery.  Finding the best bra after breast augmentation could be challenging. Wearing a bra the first 6 weeks to 3 months after surgery is important in order to prevent the implant from "bottoming out."  The purpose of the bra is mostly for implant support and comfort.

            "The Girl in M&S Bra" by Ian Hunter (Courtesy of Professor Ian Hunter from Spain)
            A simple post surgical sports bra with the clasp in front would be an ideal bra to wear the first 3 months after surgery.  The usage of underwire bras is controversial, especially immediately after breast augmentation.  There is a particular bra, called Le Mystere No.9, that is specifically designed for women who have breast implants.  The manufacturer of the bra is in partnership with one of the leading breast implant manufacturers.  I recommend asking one of your Houston plastic surgeons his/her post-operative bra protocol before purchasing a "special breast implant bra."

            Emmanuel De La Cruz M.D.

            Wednesday, January 12, 2011

            What is Capsular Contracture (A Common Complication of Breast Augmentation)?

            Capsular Contracture, a Common Complication of Breast Augmentation

            Capsular contracture has been one of the most commonly  reported complications  of breast augmentation.  Capsular contracture is the complication of breast implants when the breast tissue surrounding the implant hardens which may cause a deformity of the breast or even cause some breast pain.  This is one of most significant cause of patient dissatisfaction following this type of cosmetic surgery.
            Severe capsular contracture of the right breast after subglandular breast implant/augmentation.
            Photograph courtesy of Walter Peters, Ph.D., M.D., F.R.C.S.C., University of Toronto (Wikimedia Commons)
            The rate of capsular contracture has been reported to range from 0 to 59 percent.  The variability of the capsular contracture rate could depend on multiple factors:  textured versus smooth breast implants, placement of breast implants underneath or above the pectoral/chest wall muscles, the use of saline or silicone breast implants, and the type of irrigation used during surgery.  
            Textured breast implants have been found to have a lower rate of capsular contracture than smooth implants, whether silicone or saline breast implants were used.  Several studies, however, have conflicting results and thus inconclusive.  Moreover, textured breast implants may cause visible rippling which may cause some patient dissatisfaction.   Some patients, thus, may prefer a smooth shell when using saline breast implants due to the less palpability of the implant.
            Placing the breast implant underneath the muscle may be associated with a lower rate of capsular contracture.  However, the findings in several clinical studies were not universally consistent.
            Previously, silicone breast implants were found to have a higher risk of capsular contracture when compared to saline breast implants.  With the new generation of silicone breast implants, however, the capsular contracture rate was found to be significantly different (lower rate) from the older ones.  A recent study showed that there was no significant difference  between silicone breast implants and saline breast implants with regards to clinically significant capsular contracture.   A recent systematic review of the literature, however, has not elucidated a consensus whether there is a difference in the rate of capsular contracture between saline and silicone breast implants.
            I recommend to discuss with your plastic surgeon  their preference regarding the type of implant and location that he/she uses for breast augmentation.  One of your Houston cosmetic surgeons will guide you during the process of your surgical decision to achieve the best possible outcome.
            Emmanuel De La Cruz M.D.

            Please take the blog poll located on the right column.  Thanks.

            Handel N, Jensen JA, Black Q, Waisman JR, Silverstein MJ. The fate of breast implants: A critical analysis of complications and outcomes. Plastic & Reconstructive Surgery.. 1995;96:1521–1533.

            Schaub T., Ahmad J., & Rohrich, R.  Capsular contracture with breast implants in the cosmetic patient: Saline versus Silicone-A systemic Review of the Literature. Plastic & Reconstructive Surgery. 2010 December;(126)6  2140-2149

            Wednesday, January 5, 2011

            Silicone Gel Breast Implants or Saline Breast Implants? That is The Question.

            Saline Breast Implants or Silicone Gel Breast Implants?  That is the Question.

            There are two types of breast implants: saline filled and silicone gel breast implants.  Recently, the 14-year moratorium banning the use of silicone gel breast implant was lifted  in November 2006.  Several scientific studies showed that there is no scientific link between silicone breast implants and systemic disease.  The clinical trials showed no increased risk of breast cancer, neurological diseases, connective tissue disease, and other illnesses in women with silicone breast implants.

            So what's the difference between silicone gel breast implants and saline breast implants?

            With regards to the appearance of the breasts after breast augmentation with either saline or silicone breast implants, there is no discernible difference, except for the higher chance of visible rippling or wrinkling with saline breast implants. 
            With regards to the "feel," saline implants tend to feel firmer than silicone implants, which means the feel is not as close to that of natural breast tissue. In addition, some patients complain of being able to manually detect the outer edge of the implant and/or the fill valve.
            The advantage of saline breast implants over silicone breast implants is the smaller incision that your plastic surgeon uses to place the breast implant.  The saline breast implant is deflated prior to placement into the breast.  Saline is then injected into the implant once it is inside the breast (above or below the pectoral/chest muscles.)  Silicone breast implants, however, are pre-filled and have a fixed volume.  Thus, a larger incision is made when placing the silicone breast implants.   

            I recommend discussing your breast implant preference with your plastic surgeon.  One of your Houston plastic surgeons should be able to discuss with you the best option regarding breast implant selection that would be appropriate for your body type and concur with your goals.

            Emmanuel De La Cruz MD

            Silicone Gel Breast Implant or Saline Breast Implant?