Dr Gold's Plastic Surgery Blog

Xeomin the new Botox

Dr Mark Gold — Tue, 17 Jan 2012 05:04:58 +0000

Xeomin is a new paralytic agent produced by Merz Aesthetics. It is presently being introduced in the USA. It is FDA approved for skin wrinkle improvement in the glabellar and peri-orbital areas. I have not used the product as of yet and therefore can not really comment on its use. From the product insert and speaking with the companies representatives, Xeomin appears to be just as effective as Botox and will give the same 3-4 month period of muscle paralysis. As with all new products one must be cautious and conservative in its use.

PIP Breast Implants

Dr Mark Gold — Tue, 27 Dec 2011 03:37:43 +0000

It appears that PIP manufactured and released in Europe defective silicone gel breast implants. These implants were not used in the USA. Patients in Europe are being asked to have those implants replaced. PIP saline filled breast implants were used in the USA and have not been know to have caused any problems. The saline filled implants were not recalled and do not need to be replaced.

FDA States that Silicone Gel Breast implants are Safe

Dr Mark Gold — Thu, 23 Jun 2011 04:41:46 +0000

Even after allowing Silicone gel breast implants back onto to market in 2006, the FDA June 22, 2011 have stated again the silicone gel breast implants are relativity safe. The FDA once again reviewed long term studies presented by Mentor and Allergan corporation, demonstrating the relative safety of silicone gel breast implants. The complications noted were:
1. Implant rupture
2. implant infection
3. Capsular contracture (implant scar contracture)

The FDA announcement is not new but a reaffirmation of older studies.

Fat grafting of the Breast and MicroCalcifications.

Dr Mark Gold — Thu, 31 Mar 2011 19:12:36 +0000

Fat Grafting is the new hot topic in Plastic Surgery. There are monthly courses being offered to teach Plastic Surgeons the technique and eager equipment suppliers waiting to sell new gadgets. And with any new procedure there are the details that need to be worked out.

One of those details is what happens to the breast when injected fat grafts do not survive (die). We know for sure that we can see at least two things. The first is the formation of fat oil collections. We assume that the fat oil will eventually be absorbed by the body but no one has documented the long term effect yet.
The second detail is the formation of Microcalcifications in the breast. Microcalcifications are essentially dead fat cells that have calcified. The problem is that microcalcifications are also seen in breast cancer. Early on most medical malpractice carriers were concerned about the possibility of confusing breast cancer calcifications and fat grafting calcifications. Several papers have been presented by Radiologists stating that they can tell the difference between dead fat and cancer. And then there are other articles that state that you can not tell the difference. Unfortunately the dust has not settled on this issue.

Fat Grafting the breast is a evolving technique. I believe it has promise but at this stage it comes with significant and hard to calculate risks.

Face & Hand Transplantation

Dr Mark Gold — Sat, 26 Mar 2011 00:27:13 +0000

There has been several reports of successful Hand and Face transplants in the news lately. I want to add my two cents to the conversation. First I think everyone should know that Plastic Surgeons have been attempting to Transplant tissue for reconstruction for almost two centuries. This of course does not recognize the two christian saints Cosmos & Damien who in the 13th century transplanted the leg from a dead Moor to another man.
What has made transplantation possible today? Unfortunately like most advances in medicine it has had more to do with luck , than with brain power. Our bodies have a powerful immune system that recognizes self. Our immune systems fight invasions of our bodies by virus, bacteria, fungus, parasites and transplanted tissue from other individuals. Physicians discovered that if you suppressed the immune system globally the body would allow transplanted tissue to grow and live in our bodies. Unfortunately global immune suppression would also allow infection to kill us.
What made transplantation of tissues possible was selective suppression of the immune system. Suppression of cell mediated immunity. The part of the immune system that attacked transplanted tissues. This was done with a new drug called Cyclosporin A. where did cyclosporin A come from ? A intense research project? No, it was discovered by accident. Sandoz drug company asks its employees to send back dirt to the companies lab in Switzerland when the employees go on vacation. One employee went to Norway to visit a fjord and sent back a test tube of dirt. A fungus was grown and it produced cyclosporine A. It was first thought that cyclosporine A would be a great new antibiotic but that did not work out. It was found that it did block the immune system’s cell mediated immunity. The first long term successful organ transplants became possible.

What the public generally does not understand is what is considered a success. If a transplant survives five years, that is considered a success in the medical world. Okay how long do transplants survive? generally speaking 85% of Transplants survive five years. 25% make it to ten years and less than 5% make it to 15 years of survival. The longer a patient is on immune supression the greater likely hood that they will get a cancer that may also kill them.

It is a hard bargain. If you are dying and I gave you a chance to live for five more years. I think almost everyone of us would take the five more years and if you are lucky maybe ten years. Who knows there could be a new break through in the future. The question comes would you take that bargain for a new face or a hand?
A Hard Choice I hope none of us have to deal with. Dr Gold

Blogs and Settings

Dr Mark Gold — Thu, 24 Feb 2011 03:31:49 +0000

Well I still do not believe that I have this Blog thing worked out. At the moment I have yet to get the comment section working. I do apologize and will keep working at. Dr Gold

Fat Grafting: To the Face & Breast

Dr Mark Gold — Wed, 23 Feb 2011 17:12:24 +0000

Taking fat from one part of the body and moving it to another part of the body has been done in medicine for over a 100 years. The problem has been predictability of the result. Some times most of the graft took, some times a little took and some times none of the graft took. Take and the associated risk of infection, made the use of Fat grafting a technique of last choice. Over the last ten years several Plastic Surgeons have been working hard to Refine the technique.

As I attended the Baker Gordon Cosmetic Meeting in Miami 2 weeks ago, I saw some incredible results. Unfortunately both good and bad ones.

The good results for the face showed fuller and more youthful faces when used with a face lift. The bad results involved two issues. The first being that the graft took well on one side but poorly on the other (uneven result). The second issue was that if the patient gain weight, the fat graft grew much faster than the normal facial fat. The result was bulges of fat, that required treatment (liposuction) to correct.

Fat is also being used for breast augmentation. The results were once again impressive. The augmentation appears to be limited to a one to 1 1/2 breast cup increase. The results were generally a bigger version of the original breast. One factor that breast implants produce is significant upper pole fulness and this was missing from fat grafted breasts. Though upper pole fulness is generally only seen naturally in a young women’s breasts, it is a common request in women seeking breast augmentation.

The cost to perform Fat grafting to the breast is going to be significantly greater than a tradition implant augmentation. The length of time to perform a implant augmentation is about one hour. Fat Grafting to the breast involves harvesting the fat from one part of the body (liposuction), preparing the fat for transfer and finally injecting it into the breast. This process could take four to five hours of surgery.

Once again the percentage of graft take (survival) is considered about 50%, but ultimately it is not reliably predictable.

The bottom line is that I plan to use fat grafting in a limited fashion. For the face, only patients 60 years and older (less chance for weight gain issues). For the breast, I plan to use it only to correct contour deformities and palpability of the implant issues. I still believe that if you want an augmentation, a breast implant is still the best choice.

Baker & Gordon Meeting: The Scarless Breast Lift

Dr Mark Gold — Wed, 16 Feb 2011 05:44:23 +0000

Just returned from Miami Beach, FL. I attended the 45th annual Baker & Gordon Cosmetic Surgery Meeting. This meeting is a great resource for learning about the best techniques and latests trends. Over the next several posts I will try to describe what I thought was interesting and what I may offer in my practice.

For this Post I wanted to describe a new “scarless Breast Lift” technique. To start I want to say that I am skeptical of new techniques and especially ones that involve the use of barbed suture. This procedure involves the placement of two barbed sutures into the breast and anchoring them to a third large suture in the upper chest wall. The purpose of these sutures is to suspend the breast in a higher and therefore more youthful position. Generally a lift involving some cutting would normally be required to accomplish this effect. Once again the photos were impressive and for relatively small lifts there appears to be a possible use for this technique.

Unfortunately, I have concerns about placing a large braided artificial permanent suture into the breast. The breast has numerous ducts and these ducts may have bacteria that could contaminate a braided suture. Causing a localized infection. I personally try to avoid using braided suture and especially in any area were there is any possibility of contamination.

I generally prefer to wait on using a technique that does not have at least a five year history of use. Especially if I have concerns. If it is still popular after five years then I know that its downsides are out weighed by the upside benefit.

My next post will be on Fat Grafting of the Face & Breast.

FDA Medical Device Safety Communication: Reports of Anaplastic Large Cell Lymphoma (ALCL) in Women with Breast Implants

Dr Mark Gold — Thu, 27 Jan 2011 06:45:33 +0000

On January 26, 2011 The FDA made an announcement that over a 13 year period there were 34 confirmed case of Anaplastic Large Cell Lymphoma (ALCL) in women with breast implants reported in the world. These cancers were found in the capsules (the scar that forms around a breast implant) of women who had chronic seromas (fluid collection), capsular contracture or masses surrounding the breast implants.

The FDA believes that women with breast implants may have an increased risk of developing ALCL, but also the FDA believes any potential risk is extremely low. Due to the rarity of ALCL (ALCL is diagnosed in the breast in 3 in 100 million women per year in the USA), the small number of reports and the incomplete and limited data from these reports, more information is needed to fully understand the possible link between implants and ALCL.

If you have breast implants what should you do? If your implants are soft and your breasts are pain free, you do not need to do any thing. If your breasts are painful, hard or you feel any masses, I would recommend seeing your Plastic Surgeon for an evaluation. not every patient with capsular contracture, pain or asymmetry has ALCL, the majority 99.9% do not. Remember that on average only 3 women in the world have been diagnosed with ALCL associated with breast implants per year. Unfortunately the risk of developing breast cancer (not ALCL) is one in twelve women and breast cancer has no association with breast implants.

Radiesse- What it is, What it does & How long it lasts!

Dr Mark Gold — Tue, 11 Jan 2011 05:23:27 +0000

Radiesse is a FDA approved soft tissue filler that has been used for more than ten years. It is a gel-matrix made of fine calcium microspheres. Once injected below a wrinkle, the body begins to form collagen over the microspheres. The increased soft tissue volume effect lasts approximately 18 months.

It is white in appearance and therefore it must be placed below the skin. It is generally not used below thin skin or the lips. It is frequently used for improvement of deep nasolabial folds and to enhance the cheek.

It is generally injected mixed with lidocaine (a local anesthetic) and it is an office procedure.

There are few side effects (swelling, bruising, occasional palpability, under or over correction). Most patients have been very happy with the results and long lasting effects.
Dr Gold