Friday, November 18, 2011

Breast Lift with Breast Augmentation

Although many women who wanted to have their breasts enlarged prefer larger breasts with minimal scarring, some women want a combination of both a breast lift (mastopexy) and breast augmentation.  For the woman seeking a breast augmentation, often the surgical decision process is more complex.  Your plastic surgeon will evaluate you whether a breast lift  may be necessary or not.  If one would need a mastopexy, the degree of ptosis (sagging of the breasts) will determine what kind of breast lift procedure would be necessary.   The kind of mastopexy procedure would affect the degree and extent of scarring one would have.  
Another question one should ask would be "when should the breast lift be performed?" Should it be performed before or after you undergo breast augmentation?   These are questions that one should ask your plastic surgeon before you undergo your breast surgery.
Red Brassiere (Courtesy of Wikimedia Commons)

Fast Facts about Breast Lift with Breast Augmentation
  • The complication rate of primary breast augmentation (1st time one is having breast augmentation) is approximately 1.7% over a three-year period (Scott Spear's study).
  • The complication rate of a revision or re-do breast augmentation is ~ 21.6%.
  • The complication rate of a simultaneous primary breast augmentation with mastopexy (1st time of having breast implant surgery with a breast lift performed at the same time) is approximately 17.4% over a three-year period (Scott Spear's study).
  • The complication rate of a revision breast augmentation with a breast lift is ~ 23.3%.
  • Simultaneous breast augmentation/mastopexy (breast augmentation & breast lift done at the same time) has an early revision rate (need to revise the surgery) of approximately 8% in one study. 

Potential Complications of a Breast Lift
  • Wound separation/dehiscence
  • Partial or total nipple loss
  • Need for further surgery (Revision)
  • Undesirable/unattractive scarring
  • Inadequate ptosis correction (correction of sagging of the breasts) and recurrent ptosis
  • Breast asymmetry and malposition of the nipple
  • Loss of nipple sensibility
  • Infection

Even though a simultaneous breast augmentation/breast lift procedure is an elective operation, this procedure carries a risk that is higher than a simple breast augmentation.  Moreover, the risk and type of complications may vary based on the type of mastopexy technique used and performed concurrently with the breast augmentation.  Being aware and informed about these potential complications are critical before undergoing this kind of procedure.  Your plastic surgeon will determine if you are a good candidate for a simultaneous breast augmentation/mastopexy since not everyone is a candidate to have these procedures done at the same time.

    Emmanuel De La Cruz M.D.
    Houston Plastic Surgeon

    Atlanta Breast Symposium 2011
    Rancati, et al. Simultaneous augmentation and periareolar mastopexy: selecting the correct implant. Aesthetic Plast Surg. 2010 Feb;34(1):33-9;
    Spear et al. Augmentation/Mastopexy: A 3-Year Review of a Single Surgeon’s Practice.  Plast. Reconstr. Surg. 118 (Suppl.): 136S, 2006
    Spear, Scott. Augmentation/Mastopexy: Surgeon Beware. Plast. Reconstr. Surg. 118 (Suppl.): 136S, 2006

    Date updated: 2/10/2011

    Thursday, November 10, 2011

    Potential Complications of Dermal Fillers, such as Restylane & Juvederm

    Dermal Filler Complications (Restylane/Juvederm)        

    There are several facial filler materials that have been approved by the Food and Drug Administration for use in the United States that have been employed by physicians for the past several years.  These dermal fillers are very effective and popular cosmetic treatments for today's anti-aging and facial rejuvenation for aesthetic patients.  One of the dermal fillers include hyaluronic acid, which is a ubiquitous carbohydrate polymer normally found as a major component of skin where it is involved in tissue repair.  Hyaluronic acid injections temporarily smooth wrinkles by adding volume under the skin, with effects typically lasting for six months.  Although they seem to be simple procedures, dermal filler complications may potentially occur.
    Woman Getting a Botox Injection: Photo Courtesy of Ambro /
           These complications may include intraarterial embolization of hyaluronic acid (Juvederm & Restylane) which can have disastrous consequences.  The dermal filler may be injected accidentally into tiny vessels if not performed properly by a trained medical professional.  Intraarterial embolization of hyaluronic acid may lead to superficial to deep necrosis of the skin (premature death of cells and living tissues.)  This will then lead to ulceration and severe deformity of the face.  Embolization of dermal fillers may also lead to blindness, which is a rare complication.

    How common is the facial necrosis complication from a dermal filler injection?
    This complication is rare.  The incidence of facial necrosis of the skin from a dermal filler injection (Zyderm/Zyplast collagen injection) was reported to be 9 in 10,000 cases.  Facial skin necrosis may occur secondary to either intraarterial embolization or external compression of the small vessels of the skin by the dermal filler. 
    Necrosis of the tip of the nose from dermal filler injection into the nasolabial fold
    Complication from a dermal filler injection into the nasolabial fold

    How can one treat intra-arterial injection of hyaluronic acid? Progression of the skin necrosis can be further prevented by injection of hyaluronidase (Amphadase) into the area of previous injection site.  Thus, ask your provider if they have hyaluronidase in their office just in case a complication may arise.

    How can one recognize this complication?  One of the first few symptoms of intraarterial embolization of a dermal filler would be sharp pain and erythema (redness).  The area of skin involved may vary from the local injection site to areas specifically supplied by the arterial vessel involved.  This can be further recognized clinically by a bluish discoloration of the face that may eventually progress to necrosis and/or ulceration of the face.

    How can one avoid these potential dermal filler complications?
    It is very important for the medical provider performing these dermal filler injections to have a solid knowledge of the anatomy of the face to avoid injecting the dermal filler into the tiny vessels where embolization may occur.  Moreover, the dermal filler should be injected into the correct plane and not deep enough to penetrate into the vessel.  The level of injection is dependent on what one is trying to accomplish whether to improve a tear trough deformity or reduce perioral rhytids (wrinkle lines).

    Once this complication occurs, can my provider fix the problem?  
    Once necrosis/ulceration of the face occurs, injection of hyaluronidase into the previous injection site may prevent its progression.  Once the necrosis has demarcated, your plastic surgeon may need to perform a plastic surgery procedure, such as debridement of dead tissue and possibly a reconstructive facial procedure.  Whether you need a plastic surgery procedure or not is dependent on the severity and location of the ulceration/skin necrosis of the face.

    Other Potential Complications of Dermal Fillers

    • Bruising -for patients with no history of heart attack, stroke or blood clot, it is recommended to discontinue taking aspirin and other medications that can cause bleeding (NSAIDs such as ibuprofen; gingko biloba; ginseng; garlic; fish oils; and Vitamin E.)
    • Nodule formation (lumps) of the skin - incidence varies, depending on the dermal filler used.
    • Allergic reaction - rare, especially with hyaluronic acid dermal fillers.

    I recommend that one should ask one of your Houston plastic surgeons for these potential complications from injectible dermal fillers, such as Restylane and Juvederm, prior to undergoing such procedures.   One should also ask their plastic surgeon that if such complications arise, what can be done to minimize and correct the adverse outcome that can potentially happen.  Being able to recognize, prevent and treat these potential complications are essential, even for a minor procedure such as a dermal filler injection.

    I recommend reading about Botox for dynamic wrinkles.

    Other Recommended articles:

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

    The Aesthetic Meeting 2010 by the American Society for Aesthetic Plastic Surgery 
    Bailey S., Cohen J., and Jeffrey Kenkel. Etiology, Prevention, and Treatment of Dermal Filler Complications. Aesthetic Surgery Journal January 14, 2011 vol. 31 no. 1 110-121
    Glaich, et al. Injection necrosis of the glabella: protocol for prevention and treatment after use of dermal fillers. Dermatol Surg. 2006 Feb;32(2):276-81.
    Grunebaum, et al.  The risk of alar necrosis associated with dermal filler injection. Dermatol Surg. 2006 Feb;32(2):276-81.
    Hanke, C. W., Higley, H. R., Jolivette, D. M. et al. Abscess formation and local necrosis after treatment with Zyderm or Zyplast collagen implant. J Am Acad Dermatol. 25: 319, 1991.
    Inoue, et al.  Arterial embolization and skin necrosis of the nasal ala following injection of dermal fillers.  Plast Reconstr Surg. 2008 Mar;121(3):127e-128e. 
     Lemperle, et al. Avoiding and Treating Dermal Filler Complications. Plast Reconstr Surg. 2006 Sep;118(3 Suppl):92S-107S.  
    Other articles related to dermal fillers:

    Date article updated:  4/21/2011

    Monday, November 7, 2011

    BOTOX Injection for the Wrinkles Around Your Eyes (Crow’s Feet)

    BOTOX Injection for the Wrinkles Around Your Eyes (Crow’s Feet)
    Fast Facts about Botox Treatment and Crow's Feet

    • Wrinkles around your eyes that are present in motion only are ideal for treatment with BOTOX.
    • If your Crow's feet (wrinkles around your eyes) are present at rest, they may not eliminated with a BOTOX injection.   
    • If your Crow’s feet wrinkles extend toward your cheekbone, and if this increases with smiling, a BOTOX treatment may cause an incongruous appearance.  This can create a “Mickey Mouse” appearance in which one may have a flat area around the eyes that is surrounded by extended lines around the mouth.
    Hooding of the Side of the Brows (Lateral Brows)

    Hooding of the Lateral Brows

    •  If you have hooding of lateral brows which is usually from the loss of tone and descension of the lateral brow, the wrinkle under the hood will likely remain after a BOTOX injection treatment. 
    • Other plastic surgery procedures, such as endoscopic brow lift or Laser resurfacing may be needed, and BOTOX may likely not remove this particular rhytid (wrinkle).
    I recommend asking one of your Woodlands plastic surgeons if you are a good candidate for BOTOX treatment for your Crow's feet.  Being an informed patient is critical prior to undergoing any treatment, even a minor procedure such as BOTOX.

    Emmanuel De La Cruz M.D.

    P.S.  Feel free to read more about BOTOX.  

    Other articles related to BOTOX
    1) The Truth About Botox
    3) BOTOX treatment for your Glabellar Frowns (Wrinkles in Between your Brows)

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