“For fifteen years these statistics have been a large part of the Aesthetic Society’s public education mission,” said Jeffrey M. Kenkel, MD, President of the American Society for Aesthetic Plastic Surgery. “Since 1997, the interest in and demand for cosmetic plastic surgery has risen exponentially and our comprehensive statistics continue to show that.”

Cosmetic surgical procedures increased almost 1 percent in the past year, with over 1.6 million procedures in 2011. Surgical procedures accounted for 18% of the total numbers of procedure performed representing 63% of total expenditures.  The top five surgical procedures were:

• Liposuction (325,332)
• Breast augmentation (316,848)
• Abdominoplasty (149,410)
• Eyelid surgery (147,540)
• Breast Lift (127,054)

Cosmetic minimally-invasive procedures performed one of the surveyed physicians decreased almost 2 percent, with over 7.5 million procedures in 2011. Nonsurgical procedures accounted for 82% of the total number of procedures performed representing 37% of total expenditures.  The top five minimally-invasive procedures were:

• Botulinum Toxin Type A (2,619,739 procedures)
• Hyaluronic acid (1,206,186 procedures);
• Laser Hair Removal (919,802 procedures)
• Microdermabrasion (499,427 procedures)
• IPL Laser Treatment (439,161 procedures)

For the first time ever this survey asked the doctors for the total number of non-surgical procedures being performed in their practices by BOTH physicians and their physician assistants and nurse injectors. Below is the TOTAL number of procedures performed in the practices surveyed:

• Botulinum Toxin Type A: 4,030,318
• Hyaluronic Acid:  1,662,480
• Laser Hair Removal: 1,452,880
• Microdermabrasion: 794,357
• IPL Laser Treatment: 726,125

“Growth in demand will likely coninue to grow as  baby boomers and their offspring begin to explore surgical options,” said Dr. Kenkel. “Minimally-invasive procedures such as Botox and soft tissue fillerswork to a point. However, as you age and gravity takes over, surgical procedures that lift the skin and reshape the underlying tissues are necessary in order to show significant improvement.”

Women had almost 8.4 million cosmetic procedures, 91% of the total. The number of cosmetic proceduresfor women increased over 208% from 1997. The top five surgical procedures for women were: breast augmentation, liposuction, tummy tuck, eyelid surgery, and breast lift.

Men had almost 800,000 cosmetic procedures, 9% of the total. The number of cosmetic procedures for men increased over 121% from 1997. The top five surgical procedures for men were: liposuction,rhinoplasty, eyelid surgery, breast reduction to treat enlarged male breast, andfacelift.

Americans spent nearly $10 billion on cosmetic procedures in 2011. Of that total $6.2 billion was spent on surgical procedures; $1.7 billion was spent on injectable procedures; $1.6 billion was spent on skin rejuvenation procedures; and over $360 million was spent on other nonsurgical procedures, includinglaser hair removal and laser treatment of leg veins.

The Aesthetic Society partnered with RealSelf, the most visited online community for learning about and sharing information and results for medical-beauty treatments, to get information on patients’ first-hand experience with procedures.  The RealSelf ‘Worth It Rating’ printed in the statistics report reflects the combined opinions of thousands of RealSelf community members. Each member shares whether an elective surgery or treatment was “worth it” all things considered.

About the ASAPS Cosmetic Surgery National Data Bank

ASAPS, working with an independent research firm, compiled the 15-year national data for procedures performed 1997-2011. A paper-based questionnaire was mailed to 22,700 Board-Certified physicians (8,900 Dermatologists, 8,100 Otolaryngologists, and 5,700 Plastic Surgeons). A second request was mailed to 4,000 Dermatologists and 4,000 Otolaryngologists.  An online version of the questionnaire was also available. A total of 1,107 physicians returned questionnaires, of which 92 were retired or otherwise inactive during 2011. Of the 1,015 active respondents, the sample consisted of 420 Plastic Surgeons, 384 Dermatologists, and 211 Otolaryngologists.

Final figures have been projected to reflect nationwide statistics and are based exclusively on the Board-Certified Plastic Surgeons; Otolaryngologists; and Dermatologists. The findings have been aggregated and extrapolated to the known population of 24,650 active physicians who are Board Certified in these specialties. Though the confidence intervals change by procedure, depending on the grouping’s sample size and the response variance, the overall survey portion of this research has a standard error of +/- 3% at a 95% level of confidence.

It is the cosmetic treatment many women have dreamed of –taking the fat from their hips and thighs and redistributing it to their breasts. But many people question whether this procedure is safe or effective. Breast enhancement using fat grafts (lipoaugmentation) rather than silicone or saline implants employs fat suctioned from the patient’s buttocks, thighs or other fatty areas. This type of breast surgery can be used to increase the size of the breast or to fill in defects or abnormalities in existing breasts, including enhancing the appearance after breast reconstruction and softening the look of existing implants. Lipoaugmentation of the breasts may offer patients permanent breast augmentation with a natural look and feel and the benefit of body contouring through liposuction—without the requirement for incisions or implants.

Sydney Coleman, MD, a plastic surgeon in New York City, is a leader in the field of micro fat grafting to the face, which has become a major part of facial rejuvenation as it is practiced today. The technique has recently been extended to the breast and body where much larger amounts of fat are injected. “Breast shaping and augmentation with fat grafting provides a more natural aesthetic result for aesthetic and reconstructive patients. The placement of the fat grafts allows for dramatic or subtle shaping of the breast in a manner previously not attainable,” said Dr. Coleman. “This type of shaping is extremely difficult or impossible with implants or surgery. The result is a natural appearing reshaped breast in which telltale signs of implants and surgery are absent – the resultant breast is completely fluid and natural appearing.”

However, long-term safety and efficacy data, and the effect of the procedure on breast cancer screening using mammography, is still being evaluated in clinical studies. Concerns about fat grafting for breast enhancement include typically low survival rates of the transferred cells (which are frequently absorbed by the body), development of cysts, calcification and tissue scarring, as well as long-term problems with breast cancer detection due to difficulties distinguishing mammographically between calcifications associated with breast cancer and calcifications associated with fat transfer. This procedure offers mostly a one cup size enlargement and the degree of enlargement will depend on the amount of spare fat that the patient has.

Numerous questions remain about this new technique: How much of the fat survives? Does the procedure have to be repeated? Are the breasts hard and uncomfortable for long periods after the procedure? Perhaps most importantly, what are the cancer implications of this technique?

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The so-called “Vampire Facelift” uses a patient’s own blood as an injectable to smooth wrinkles and rejuvenate the skin. While such treatments have made the news before, it seems that more and more individuals are turning to the procedure at greater rates.

According to the Los Angeles Daily News, the Vampire Facelift – which is also known both as PRP (Platelet Rich Plasma) therapy and Selphyl – involves taking a vial of the patient’s blood, isolating the platelet-rich plasma and injecting it back into the face or other areas of the body.

The non-invasive, FDA-approved procedure may be favored by some over other injectables such as Botox and Restylane because the chance of allergic reaction is minimized due to the fact that the filler is the patient’s own blood. Using blood plasma is also believed to cause tissue regeneration and stimulatecollagen production.

However, some caution that this procedure may not be a good option for everyone.

“One of the problems with your own blood is that some people pass out from having their blood taken,” a New York City-based plastic surgeon told ABC News. “Also, blood tends to cause an itchy after-effect. Sometimes it causes burning or discoloration. You’re injecting blood into a place where blood doesn’t normally reside.”

Like other injectables, the Vampire Facelift doesn’t offer a permanent solution, as results are expected to last 15 months.

Gynecomastia is defined clinically by the presence of a firm, rubbery often painful 0.5 cm mass extending concentrically from the nipple-aerolar complex forming a dome shaped appearance to the aerola. In many cases, there is a fatty component that enlarges the entire breast (lipomastia).

The causes of common gynecomastia remain unclear, although it has generally been attributed to an imbalance of sex hormones estrogen and testosterone. Testosterone controls male traits such as muscle mass and body hair while estrogen controls female traits including the development and growth of breasts. Recent studies have demonstrated pathophysiologic mechanisms to involve either a relative excess of estrogens, a decrease in testosterone or a defect in its receptors. Approximately 4-10% of cases are due to prescribed drugs such as Proscar, Aldactone, digoxin, cimetidine, HIV retrovirals, or illegal drug use such as anabolic steroids, marijuana, heroin, and methadone. Several health conditions can cause gynecomastia by affecting the normal balance of hormones. These include:

• Hypogonadism – any condition that interferes with normal testosterone production, such as klinefelter syndrome or pituitary insufficiency.
• Aging – decreasing levels of testosterone during the normal aging process can cause gynecomastia especially in men who are overweight (body mass index > 25).
• Tumors – testicular, adrenal, or pituitary tumors can produce hormones that alter the male-female hormonal balance.
• Hyperthyroidism – increased levels of the thyroid hormone thyroxine have been linked to gynecomastia.
• Kidney disease – 50% of renal dialysis patients have gynecomastia due to hormonal imbalance.
• Cirrhosis and liver failure – hormonal fluctuations related to liver disease from hepatitis or alcoholism as well as medications administered for cirrhosis are associated with gynecomastia.
• Malnutrition and starvation – levels of testosterone decrease while estrogen levels remain constant resulting in a hormonal imbalance.

In most instances, no etiology is discovered and the exact cause is unknown (25%).

Clinical examination is mandatory to correctly diagnose true gynecomastia from pseudogynecomastia (lipomastia) or male breast cancer. The physical examination should involve assessment for glandular or fat predominance, degree of glandular ptosis (skin excess), nodules or masses, and nipple abnormalities or discharge. The history should include age, duration and onset of breast enlargement, symptoms of pain or tenderness, medications and recreational drug use, and the psychological and social effects.

It cannot be underestimated the torment that men with this condition have endured from the inability to exercise to recreational activities shirtless. No laboratory or imaging studies are necessary unless a pathologic cause is identified.

Generally, no treatment is required for physiologic gynecomastia. However, if gynecomastia is caused by an underlying condition, such as malnutrition, kidney disease, cirrhosis, this must be treated prior to the decision to treat gynecomastia. In adolescents with no apparent etiology, observation every three to six months to see if the conditions improves or resolves spontaneously is recommended.

Gynecomastia usually goes away in less than two years. That being said, if the condition does not improve, or causes pain and/or embarrassment, surgery is required. Although medications have been prescribed and attempted, such as clomiphene, tamoxfen, danazol, and testlactone, these have not been approved by the FDA specifically for the treatment of gynecomastia and have had limited success. In fact, if the breast enlargement has been present for more than two years, the current standard of care is surgery.

Aging can be a progressive
decline in mental and physical ability,
accompanied by an increase in susceptibility
to chronic disease. Humankind has long sought
ways to slow or retard the aging process.
Given the vast number of aging baby boomers
in our society, the relevance of anti-aging
medicine looms ever larger. Are the effects
of aging inevitable? Taken in the broadest
and most positive light, anti-aging medicine
is an extension of preventive health care.Technique:

Anti-aging medicine incorporates the realms
of biochemistry, biology and physiology,
and utilizes elements from the fields of
sports medicine, molecular genetics, nutrition
and mind/body medicine. Hormone levels begin
to decrease by the mid-thirties, and hormone
replacement therapy is a popular, though
controversial anti-aging technique, specifically
human growth hormone (HGH), DHEA, testosterone,
progesterone, estrogen and melatonin. Oxidative
stress reduction is another technique: Natural
metabolic processes as well as environmental
toxins lead to the formation of free radicals,
electrically unstable molecules that damage
DNA and protein; antioxidant formulas are
prescribed to combat free radicals, creating
a healthier balance between free radical
production and antioxidant defense. Other
primary natural tools against aging are
rest, exercise, and stress control techniques.
Plastic surgery is the surgical arm of the
field of anti-aging medicine.

Benefits:

• Anti-oxidant vitamins
  have few negative side effects and have
  shown a wide range of health benefits.
• 10 million American
  women are undergoing estrogen replacement
  therapy—a form of “anti-aging”
  therapy that is widely accepted and substantially
  effective.
• Emphasizes tried and
  true approaches such as good nutrition
  and exercise.
• Metabolic typing is
  also useful—the process of profiling
  an individual’s unique metabolism
  in order to prescribe maximally effective
  supplementation and other treatments. 

Other Considerations:

• Magic elixirs do not
  exist. There is not much science behind
  much so-called anti-aging medicine. There
  has been no dramatic new breakthrough
  in anti-aging medicine. Most drugs and
  approaches have been in clinical practice
  for at least 10 to 30 years.
• The Institute on Aging
  of the National Institute of Health urges
  caution in the use of “anti-aging”
  hormone supplements.
• All substances should
  be taken only under the guidance of a
  physician who is properly grounded in
  traditional medicine.
• Beware of anti-aging
  organizations with specific products to
  sell. “Immunity boosters” and
  “glandulars” may be without
  known therapeutic benefits.
• ok for current scientific
  information in peer-reviewed journals.
  Currently, anti-aging is not a recognized
  medical specialty, so beware of self-designated
  experts or organizations. 

The mammographic changes occurring after fat injection are indistinguishable from abnormalities associated with breast cancer, according to the study by Dr. Cong-Feng Wang of Meitan General Hospital, Beijing. Based on this “mammographic confusion,” the authors conclude that the use of autologous fat injection for breast augmentation should be “prohibited continuously.”

Microcalcifications Cause Confusion on Mammograms after Fat Injection

Dr. Wang and colleagues report on 48 women who underwent autologous fat injection for breast augmentation between 1999 and 2009. In this procedure, small amounts of fat obtained by liposuction from one area of the body (such as the hips or thighs) are injected to shape the breasts.

In the study, mammograms obtained some years after fat injection showed “clustered microcalcifications” in eight of the 48 women – a rate of 16.7 percent. In all eight cases, the microcalcifications were regarded as “highly suspicious” for breast cancer.

The abnormalities prompted surgical biopsy to remove and examine the breast area showing microcalcifications. None of the biopsies revealed breast cancer. Instead, the calcifications appeared to be related to death (necrosis) of the injected fat cells.

There is a long history of debate over the use of injected fat for breast augmentation. In the late 1980s, the ASPS issued a strong statement against the use of this procedure, citing the risk of difficulties in early diagnosis of breast cancer. However, more recent studies have reported that autologous fat injection provides very good results, and that any changes seen on mammograms are easily distinguished from abnormalities related to breast cancer.

In contrast, the new study finds mammographic abnormalities suspicious for breast cancer in 1 out of 6 women undergoing fat injection for breast augmentation. The clustered microcalcifications are indistinguishable from those associated with breast cancer, requiring biopsy to make the correct diagnosis. Because of this issue – and independent of the aesthetic results achieved – Dr. Wang and colleagues strongly believe the use of autologous fat injection for breast augmentation should be discontinued.

However, that recommendation conflicts with a paper published in the March issue of PRS, which concluded that “Radiographic follow-up of breasts treated with fat grafting is not problematic and should not be a hindrance to the procedure.” The conflicting results highlight the need for caution – and for more scientific evidence on the mammographic changes occurring after fat injection.

For many, the words natural, herbal and, the words “natural,” “herbal,” or “alternative medicine” conjure up images of safety and purity. Products that are available over-the-counter without a doctor’s prescription are often believed to be free of any risks. Unfortunately, this perception is inaccurate and may create a false sense of security for consumers who purchase these products-and there are a lot of them. An estimated 60 million people in the United States use herbal remedies and the herbal/dietary supplement market represents a growing multi-billion dollar industry.

Botanics (products made from plant life such as roots, barks, or herbs), as well as vitamin and mineral supplements and conventional over-the-counter medications, are chemically active substances that can have powerful effects on the body. The origins of many modern-day pharmaceutical medications can be traced back to plants. Willow bark, for example, was used over 1,000 years ago to reduce fever and pain. The active ingredient in willow bark, salicin, is a pharmacologic predecessor of a class of drugs called salicylates, one form of which is aspirin. Digitalis, a genus of perennial flowering plants, is a source for cardiac medications such as digoxin.

Like pharmaceutical medications, herbal remedies and dietary supplements often have the potential to cause side effects and interact with other prescription medications. There is a growing number of alarming anecdotal reports from doctors’ offices and medical centers around the country-some of which have been reported to the Food and Drug Administration’s (FDA’s) MedWatch program. Reported adverse events range from insomnia and headache to heart attack and death. Included in a 1993 FDA statement before the Senate Committee on Labor and Human Resources are the herbal ingredients chaparral, comfrey, and ephedra (Ma huang), Vitamins A, B6, niacin, and L-tryptophan (an amino acid), all of which are listed as having possible health hazards. A more recent FDA statement warns consumers against using dietary supplements labeled “plantain” because the product may contain components of the plant Digitalis lanata, which can cause fatal heart reactions.

Lack of FDA regulation

Unlike prescription or over-the-counter medications, dietary supplements are exempt from the FDA’s scrutiny for safety and effectiveness. (For the FDA to be able to remove a supplement from the market, it must prove that it is unsafe and, in most cases, this process occurs only after numerous adverse events are reported.) The Federal Trade Commission (FTC) has issued new guidelines for the advertising of dietary supplements but creative labeling can be misleading.

With the integrity of the product left to the discretion of manufacturers, quality control is highly variable. The amount of active ingredient in each pill or capsule may not be standardized, which means that it may vary from batch to batch delivering unknown dosages; in some cases, tests have shown the specified ingredient to be missing from the product altogether. There are also reports of herbal products being contaminated with substances such as fungicides or lead.

Probably of greatest importance is that manufacturers are not required to understand the way in which herbal and dietary supplements work or what their side effects are before distributing the products in the marketplace. Moreover, the product may contain other active substances-whose mechanisms of action are also unknown. This lack of scientific understanding creates the potential for significant risks, especially to those who are having surgery. Unpredictable interactions may occur with medications and anesthesia, and supplements on their own may interfere with the normal mechanism for blood clotting, causing bleeding that is prolonged or difficult to control.

Medications and plastic surgery

Prior to surgery, plastic surgeons take careful health histories and advise their patients to temporarily discontinue certain prescription and other over -the-counter medications, as well as certain vitamins. Among them are aspirin, nonsteroidal anti-inflammatory medications (eg: ibuprofen), and Vitamin E, which can cause excessive bleeding. Medications categorized as monoamine oxidase (MAO) inhibitors (eg: the antidepressants Nardil or Parnate) are contraindicated because of their interaction with certain narcotics. If given with the frequently-used pain medication Demerol (meperidine), seizures, coma and death may occur; if given with substances such as dopamine or epinephrine, a hypertensive crisis may result.

When patients do not disclose their use of herbal or other dietary supplements along with the other medications they are taking, because they believe these supplements “don’t count,” unexpected drug interactions may occur. For example, St. John’s Wort, an herb used for mood and sleep disorders, has been found to behave like an (MAO) inhibitor. Gingko biloba, which comes from the Chinese maidenhair tree and is commonly used to enhance memory, has anticoagulation effects that are more potent than Vitamin E. Melatonin, used to induce sleep, is believed to compound the effect of the anesthesia being administered, and Echinacea, used to stimulate the immune system, has been reported to cause liver damage and blood pressure abnormalities when used with general anesthesia. Dietary supplements do count!

Some plastic surgeons advocate the use of Arnica (from the flower Arnica montana) and Bromelain (an enzyme found in pineapples) to decrease postoperative bruising and swelling. These supplements may be prescribed for the day of surgery and several days after. However, there is no consensus on the benefits of such treatment, and these supplements should be taken only under the guidance of one’s surgeon.

Patients are advised against self-medicating in general and should disclose to their surgeon any substance they are taking. This includes vitamins, minerals, herbal or other dietary supplements, as well as all prescription and nonprescription medications. In most cases, the potentially harmful substance should be discontinued 1 to 2 weeks before and after surgery to prevent complications.

Dietary supplements should be taken with caution and only after being fully researched. Potential health benefits may not outweigh the risks and a physician’s advice should be obtained before taking most supplements