July 31st, 2013 Miguel A. Delgado Jr, MD
San Francisco, CA-Cosmetic plastic surgery procedures for men have increased 106% since 1997, and increased 20% from 2011 to 2012 according to “The American Society for Aesthetic Plastic Surgery” known as (ASAPS). ASAPS was established in 1967 and is one of the two prestigious societies for Board Certified Plastic Surgeons.
ASAPS mailed out 23,000 questionnaires to Board Certified Physicians to come up with the percentages. Men had almost one million procedures done in 2012 which accounts for one tenth of all cosmetic procedures performed. More men of all ages are seeking cosmetic surgery each year as heightened awareness and acceptability of surgical solutions increases.
According to ASAPS, the top five procedures for men for 2012 are:
2. Rhinoplasty (nose reshaping)
3. Blepharoplasty (eyelid surgery)
4. Gynecomastia (male breast reduction)
5. Otoplasty (ear surgery)
Liposuction for men has become increasingly popular as men learn of the benefits of body sculpting on many TV shows and news articles. The three most popular areas are; the neck, the abdomen and the flanks (love handles).
Many surgeons feel it is the treatment of choice for male breast reduction, however, without the inclusion of surgical excision the results are very disappointing for men with true gynecomastia.
Liposuction is an excellent treatment for fat deposits that do not respond well to diet and exercise, but for a man the surgeon has to take great care not to give a feminized look for the man keeping a more square appearance to the back and waistline. Men prefer etching of the abdomen to accentuate the abdominal muscles. Men also want their scars hidden, as do women, and they are usually in the belly button and the underwear line.
Rhinoplasty can be any time after the nose stops growing, usually between 15 and 18 years of age for males.
This is a 30-year-old, San Francisco, CA resident who presented to the San Francisco office at Union Square for evaluation for an external rhinoplasty.
A man’s nose should fit his face, which may mean a stronger dorsum and/or a more projected nasal tip. Women may seek a narrower nose while men may seek a wider nose.
Computer imaging is a great tool for the surgeon to show to the patient what the final result may be.
Blepharoplasty is surgery for the eyes; the eyes are one of the first places to show age and can make a person look tired, angry or old. Eye surgery is different for men than women, with different goals. Men have thicker skin and heavier facial muscles. Heavy upper eyelids can make a man look older. A low brow is attractive for the man, but if it is elevated during surgery, it must be done conservatively to avoid feminization of the male face.
Fat can accumulate in the upper and lower lids with the result of the upper lids looking puffy and hooding the eye and the lower lids can be puffy and saggy with dark circles. Some men may have enough drooping upper eyelid skin that it will interfere with vision and in some cases to such a degree that upper eyelid surgery may be covered with health insurance.
Gynecomastia surgery is up 5% over 2011 according to ASAPS. It appears that not only is the amount of surgery going up, but also
This 29-year-old San Francisco man suffers from adolescent gynecomastia. He underwent glandular excision and suction-assisted lipectomy of the chest, from which I excised 23 grams of glandular tissue from the right and 21 grams from the left side.
the incidence of gynecomastia cases being reported. It is believed that the increase in gynecomastia cases may be due to the use of many prescription drugs and well as many over the counter medications. Supplements and steroids are also linked to the development of male breasts, and as more hormones are introduced to the environment the increase in cases will continue.
Otoplasty, as noted in the previous blog can be done on boys as young as five years old, and is preferable so that teasing and psychological trauma can be avoided. However, as long as a patient is in good health, there is no age limit to having this surgery.
This procedure is popular for men due to the fact that their ears are more noticeable than women’s because they generally wear their hair short.
The American Society of Plastic Surgeons (ASPS) is the other prestigious society for Board Certified Plastic Surgeons. ASPS also reports statistics based on surveys taken from their members. The results are similar to ASAPS, but with a few variations.
ASPS reports that the top 5 procedures of 2012 for men are:
Gathering the statistics is not a perfect science, but the results do give us a trend and in both studies show the acceptance of men seeking a natural but improved appearance in the face and body.
July 15th, 2013 Miguel A. Delgado Jr, MD
Dumbo the Elephant
San Francisco, CA-As cosmetic surgery procedures increase year after year, it’s not surprising to see some strange developments, fads and marketing ploys. There are pet plastic surgeons that do many procedures on animals including facelifts, alter droopy ears and even give them Botox injections. There are braces for dogs called Rin Tin Grin and you may have heard of silicone implants called Neuticles that replace testicles on neutered dogs.
On a more serious note, parents are seeking measures to protect their children from the devastation that bullying can cause for their children and teenagers. There have been multiple stories in international news lately of children being tormented by classmates and cyber stalking leading to teen suicide.
Adolescent boys may be teased for gynecomastia, but for young children, the most notable condition that seems to cause teasing to the point of bullying is protruding ears. Children can be cruel by calling the afflicted child with names like; Dumbo, elephant ears and Mickey Mouse.
This can be (but not always) a hereditary factor and; therefore, many parents want to save their children from going through the torment they may have faced as a child. Ears that protrude can erode self-confidence in a child, and impact their emotional stability and eventually affect behavior. Adults also may experience extreme embarrassment from protruding ears to the point it may affect their everyday life.
The pinna is the outer ear and has a minor function in the aid of hearing. If there is too much cartilage in the pinna, there is a greater chance it will be prominent or protruding.
Normally the ear projects out about 20 degrees to 35 degrees from the side of the head, if the angle is greater than that it can be quite noticeable.
Another cause for protruding ears is when the edge of cartilage at the uppermost part of the ear does not bend down in the right position during development. Lastly, injuries to the ear can cause distortions.
About 30% of babies are born with malformations of the ear. Congenital conditions can be the cause, or it may occur during birth. Many of the deformities will correct themselves, but if they don’t by the time the baby is a week old, surgical intervention may be needed at some point.
For babies who are six months or younger, an ear splint may be used. Ear splinting is a safe and simple procedure where the soft cartilage can be reformed with the use of a splint. However, usually when the baby is six months old the cartilage will become hardened and not able to respond to a splint and cosmetic surgery may be needed for correction.
The technical term for ear surgery is otoplasty. Usually a child’s ears have finished developing by 5 years of age, and surgery should not be done before then. Plastic surgery can craft absent folds and also make the ear flatter against the head.
The three principal forms of otoplasties are:
1. Ear augmentation – this is where the external ear is undersized or doesn’t even exist.
Incision for Ear Pinning
2. Otopexy – is protruding ears that are flattened or pinned back.
3. Ear reduction – Is where the outer ear is too large.
For adults, the surgery often is done under local with IV sedation; general anesthesia is the preferred method for children. For the procedure itself, the plastic surgeon will take the necessary amount of cartilage and skin from an incision in the back of the ear. The scar will be hardly detectable after it heals.
Often otoplasty surgery can be done before the child starts school to avoid probable teasing, but it is important that this is something that the child understands and wants. The other procedure that is sometimes considered for older children (teenagers) is rhinoplasty or nose surgery. In some cases, reconstruction is necessary for breathing issues, and some cosmetic corrections can be done at the same time.
July 1st, 2013 Miguel A. Delgado Jr, MD
San Francisco, CA-When the FDA called a moratorium on silicone breast implants in 1992, the road back to approval for these implants was very slow. The scare that the implants might be causing autoimmune diseases and various other complications made the implants unavailable to all except patients undergoing breast reconstruction surgery or breast augmentation revision surgery. That left women who wanted breast augmentation, saline breast implants as their only choice.
Mentor’s MemoryShape Implant
After many clinical trials, silicone breast implants were deemed safe and returned to market in 2006 for women 22 years of age and older. The approval comes with the understanding that the FDA recommends (not requires) that women have an MRI after three years of implantation and then every two years after that. The MRI is to watch for what is referred to as “a silent leak”. Within just a few years, the popularity of silicone breast implants surpassed saline implants by 80%.
Conducting trials for breast implants is very challenging for manufacturers, surgeons, patients and the surgeon’s staff. Once the excitement of the surgery has worn off, it is difficult to keep patients that are not having any issues to come in for their yearly visits, even with incentives offered by the manufacturer. In many cases, the patient may have moved out of the area, or there may have been staff turnover in the surgeon’s office and compliance starts falling through the cracks, making consistent follow up for 5 to 10 years daunting.
In anticipation of future FDA approval for silicone breast implants, manufacturers continued to develop new types of implants and started to conduct clinical trials. The “gummy bear” which is a colloquial term to describe the firmer anatomical cohesive gel implant, had trials beginning in 2001.
The highly cohesive implant made by Mentor is called “MemoryShape” and has been available for the past 10 years in 70 countries but not in the United States, until now. The “MemoryShape” implant has a tapered “teardrop” shape. It is thinner at the top and gently slopes to a fuller projection at the bottom. The shell has a subtle imprint; “Siltex Texture” designed to keep the implant in place.
The appeal of the anatomical shaped cohesive breast implant for most women is for a more natural look, youthful firmness and due to the high cohesiveness, they are less likely to ripple, rupture or leak throughout the breast tissue. For the downside, many women do not like the firmness or the risk of rotation of a teardrop shaped implant leaving them looking deformed. Also, it is very difficult to insert the implant through an incision around the areola, the recommended approach is the inframammary fold which requires a longer incision. The breast implant cost goes up by approximately $1000. The anatomical shaped implant does not work well with breast revision surgeries or for the woman who desires larger and/or softer implants and for the woman having a breast reduction with a lift and implant, will most likely be happier with the standard gel implants.
Allergan got FDA approval for their “gummy bear” implant, Natrelle 410 in February 2013, and Sientra got approval for their anatomical cohesive gel implant in March 2012. Mentor is the only company that manufactures their implants in the United States, but all implants available in the United States are manufactured with the same strict guidelines.
The anatomical cohesive gel breast implants vary in; their firmness, their shape and dimensions. They all have a textured shell to help the implant from moving out of place or rotating. The different manufacturers made their implants with different degrees of cohesiveness and they vary on how much gel they put into the shell. The more cohesive the gel is and the more they fill the shell, the better it will hold its shape, and is more resistant to shell folds, but will not feel as soft.
Since FDA approval of silicone gel breast implants in 2006, women have many more choices. There is fierce competition amongst breast implant manufacturers. Each manufacturer has its own philosophy for advantages and disadvantages for the different possible aspects of breast implants.
In deciding to have breast augmentation surgery, the patient needs to review all risks and possible complications with her surgeon and understand that implants are not lifetime devices. It is important to be aware of the fact that revision surgery will most likely be necessary at least once in a patient’s lifetime, and maybe more.
Surgeons have their own preferences and experiences with different implants. It is more important to find a Board Certified Plastic Surgeon that you trust, to help you determine what type of implant is best for you. Be sure to request to see many pictures, before and after breast implants.