For centuries, attempts have been made to map the human brain. Now the roads are a lot clearer.
Trying to figure out what the different bumps on the brain do is not easy. Scientists have been classifying different areas of the brain for centuries. Maps have been based on function, anatomy, cell types, the amount of insulation around cells, neural connections, and more recently, metabolic activity during specific tasks. A few examples are shown above.
It’s All About Making Connectomes
A connectome (pronounced con-nec’-tome) is the complete description of the structural connectivity of an organism’s nervous system. In other words, it’s a map. Much headway has been made in the last decade in refining the brain’s connectome. It turns out, that our soft, squishy, three pound brains have wiring similar the Internet.
Here is the Opte Project’s 2005 map of the Internet. Each line ends on a specific IP address. This map of the Internet has been compared to complex connections exhibited by neurons in the human brain.(Click on the map for more detail.)
A connectome of the “IP addresses” of the brain. (Click on picture to zoom in.)
The picture above is from the NIH Blueprint for Neuroscience Research Website. The sphere’s represent regions of interest (ROI). These ROIs seem to serve specific functions or show increased levels of activity during specific activities.
But What Have We Learned About The Brain Lately?
This week in Nature, an article with the uncomfortable sounding title, A Multi-Modal Parcellation of Human Cerebral Cortex, increased the number of recognized, distinct areas in the human cortex from 83 to 180. This is bad news for medical students learning neuroanatomy, but is good news for brain researchers.
The study is based on brain scans of 1200 young adults. These 180 areas were consistently found within the population. When new subjects were scanned, software could detect all 180 areas correctly 96.6% of the time, and automatically identify individuals with atypical patterns for manual review. This provides researchers and practitioners alike, a new and easily reproducible method of examining the brain.
Fingerprinting Your Brain
High definition brain scans are more than just maps. They may eventually lead to the ability to “fingerprint” our brain. This would allow scientists to see the differences in each of our brains, and further help correlate the anatomy and function of brain areas. High definition brain scans will be able to map the changes that occur in our brains as we age, identifying the milestones of normal healthy development. Moreover, much like an x-ray can detect a fractured bone, the scans will also detect the early signs of brain illness and exactly where the brain is broken.
Plaques and recognition are nice, but it’s the thanks from my individual patients that makes Plastic Surgery great.
The Best of Walnut Creek 2016
I am humbled to receive the 2016 Best of Walnut Creek award for Cosmetic Plastic Surgery. While it is gratifying to receive such an award, especially since only one winner is selected per category for each town, the greatest satisfaction I receive as a San Francisco Bay Area Board Certified Plastic Surgeon is the thanks I get from my patients.
Walnut Creek, CA – A nice blend of open space and civilization. The Lesher Center, shown above, is celebrating 25 years as a regional art destination.
It is a privilege to serve in this community, a privilege I have to fight to maintain on a daily basis. The profession of Medicine has undergone tremendous change in the two decades of my practice. Some changes have been helpful, but many add additional burdens and expense, which takes away from the time I have to take care of my patients. Being a solo practitioner in private practice is not favored by the current medical establishment, but for me, it is still the best and most personal way to deliver excellent care.
Walnut Creek, CA – Nestled up to the western slope of Mt. Diablo. The hills still have their early spring green.
I thank the Walnut Creek Awards Program for the acknowledgement, but it’s the appreciation I receive from my patients on a daily basis that keeps me motivated, and dedicated, to providing the best possible Cosmetic Plastic Surgery in the San Francisco Bay Area. A copy of the award programs press release is included below:
FOR IMMEDIATE RELEASE
Joseph A. Mele, III, MD, FACS Receives 2016 Best of Walnut Creek Award
Walnut Creek Award Program Honors the Achievement
WALNUT CREEK July 9, 2016 — Joseph A. Mele, III, MD, FACS has been selected for the 2016 Best of Walnut Creek Award in the Cosmetic Plastic Surgery category by the Walnut Creek Award Program.
Each year, the Walnut Creek Award Program identifies companies that we believe have achieved exceptional marketing success in their local community and business category. These are local companies that enhance the positive image of small business through service to their customers and our community. These exceptional companies help make the Walnut Creek area a great place to live, work and play.
Various sources of information were gathered and analyzed to choose the winners in each category. The 2016 Walnut Creek Award Program focuses on quality, not quantity. Winners are determined based on the information gathered both internally by the Walnut Creek Award Program and data provided by third parties.
About Walnut Creek Award Program
The Walnut Creek Award Program is an annual awards program honoring the achievements and accomplishments of local businesses throughout the Walnut Creek area. Recognition is given to those companies that have shown the ability to use their best practices and implemented programs to generate competitive advantages and long-term value.
The Walnut Creek Award Program was established to recognize the best of local businesses in our community. Our organization works exclusively with local business owners, trade groups, professional associations and other business advertising and marketing groups. Our mission is to recognize the small business community’s contributions to the U.S. economy.
SOURCE: Walnut Creek Award Program
Cosmetic Plastic Surgery
If you are looking for a Cosmetic Plastic Surgeon in the San Francisco Bay Area, give me a call at (925) 943-6353. My office is located in the East Bay community of Walnut Creek, California. More information about the Cosmetic Plastic Surgery procedures I offer is available on DrMele.com.
This week’s San Francisco Plastic Surgery post is a PSA for preventing typical summer injuries, because prevention is the best medicine. Plastic Surgery, and Cosmetic Surgery in particular, is often about fixing stuff.
Plastic Surgery Problems We Are Born With
Some plastic surgery problems we are born with. Disproportionate Fat, Small Breasts or Prominent Ears cannot be prevented. They are simply genetics. Other plastic surgery problems we earn, or at least aggravate. This article lists some simple steps you can take to prevent common plastic surgery problems, and some fun Bay Area recreation options to help burn those extra calories. While some seem to age faster than others, many normal summertime activities further accelerate the aging process. Some tips to slow down a few of the problems we earn are listed below.
Plastic Surgery Problems We Earn
Other problems we earn, and summer is the best time to prevent them. I am not taking about using the latest Ophidiological Oil, but simple mundane practices that can make a huge difference over a lifetime. You’ve heard them before, but they bear repeating.
Many of the Cosmetic Plastic Surgeries I perform are to repair the ravages of time. While Plastic Surgeons can smooth over some of the more prominent changes, we cannot turn back the clock, but here are a few summertime recommendations that will slow it down: Sun Protection, Hydration, Diet, Exercise, No Smoking and No Burning.
Limiting your skin’s exposure to the sun helps prevent wrinkles, discoloration and skin cancer. Liberal and repeated application of sunscreen is a must, and not just if you have fair skin. Apply sunscreen before exposing your skin to the sun, and keep applying it every hour or two. Reapply after swimming or excessive sweating. Shade and sun protective clothing are also good, but these work better with sunscreen.
I have included a picture from my post entitled How is SPF Calculated? below. The right side of his face was protected by the cab of his truck. The left side was next to the window. The results are as clear as they are dramatic.
This long haul trucker, famously featured in the New England Journal of Medicine, has unilateral dermatoheliosis, which means one sided sun damage to his skin. With the sun shining through the driver’s side window over the years, the left side of his face has received more sun exposure than the right side.
Hydrated skin is happy skin. It not only looks better, but it resists sun damage better. Although our outsides are dry, our bodies are mostly water. The summer heat, especially if you are keeping active, increases the pace of water loss through evaporation and increased respiration. Hydration is also good for maintaining weight, because thirst is often confused with hunger. Since most food has water in it, this reflex makes evolutionary sense. However, if you don’t need more calories, plain water is a better option.
Diet And Exercise
Diet and Exercise go hand in hand. They are two sides of the same equation. The difference between the energy that goes in (food) and the energy that goes out (exercise) is apportioned as fat. If you consume more than you burn, you gain weight. The more optimistic corollary is that if you burn more energy than you consume, you lose weight. It’s that simple and difficult at the same time.
According to the latest CDC Smoking Fact Feet, 16.8% of adults (18 years older) smoked in 2014, down from 20.9% in 2005. The numbers are lowest in the Western US with 13.1% of adults smoking, with California and Utah leading the way. If you are considering joining the non-smoking, there is no better time than now. Every cigarette is time off your life.
The most recent CDC data about smoking among US adults is from 2014, and we are moving in the right direction.
Cigarette smoke has direct and immediate effects on the circulation of the skin. For operations like Facelift, Tummy Tucks and Breast Reductions, complication rates for wound healing are increased 600% in smokers. Most Board Certified Plastic Surgeons will not consider these operations without smoking cessation of at least four weeks before and after surgery. Additionally, quitting smoking will do more for you than even the most perfect cosmetic result.
Summertime is fire season and the season for burns. Not just sunburns, as discussed above, but all types of thermal burns. Barbecues and fire pits are common sources of trouble. Open flames should always be treated with care, especially if children are in the area. As is the theme of this posting, prevention is the best medicine. Establishing a safe Barbecue Zone, where activity is limited to cooking is a good start. Once the cooking is over, the grill remains hot, especially if cooking over coals. After the fire is out, the distinction between hot and cold may not be immediately obvious. For fire pits and grills, establish a clear zone around them, and be certain the area remains clear until they have cooled.
If a burn occurs, clean, cold water should be applied immediately to quickly cool the area and prevent deeper injury. Prompt, appropriate medical care should be obtained, especially for deeper or larger burns.
Summer in the San Francisco Bay Area is a great time of year. There are not too many places on the planet where you can travel a few minutes and experience a change the temperature of forty degrees, but this is a normal summer in San Francisco. The cold coastal currents which make surfing less enjoyable also cool and dehumidify the air. The result is the ability to enjoy the outdoors of your choosing within minutes. It is also the source of the quote, “The coldest winter I ever saw was the summer I spent in San Francisco.” While attributed to Mark Twain (Samuel Clemens), it is most likely an adaptation of James Quin’s remarks about Paris. See the Anchor Brewing Blog or the Quote Investigator for more details about this.
Many of the larger Bay Area Parks appear on this map of the currently under construction Bay Area Ridge Trail (click on map above to visit the Bay Area Ridge Trail website and a larger version of this map)
The abundance of National, State and Local Parks is another Bay Area attraction. The Bay Area Ridge Trail is an ambitious 550+ mile long project, which when completed will link 75 of the Greater San Francisco Bay Area’s parks and open spaces. As of 2016, 365 miles are completed. The Bay Area is also the future home of the San Francisco Bay Trail, which runs around the San Francisco Bay Shoreline. As of 2016, 350 miles of the planned 500 mile long route are completed. So have a good breakfast, put on some sunscreen, bring along some water, go outside and get some exercise. It all right here, with a low price tag and great rewards.
From the North Bay’s foggy coastal Muir Woods (National Park) to the toasty hiking trails surrounding the East Bay’s Black Diamond Mines (East Bay Park) at the foot of Mt. Diablo (State Park) is only 30 miles.
To Fix Or Not To Fix?
When prevention is not enough, there are plastic surgery options. I am a Board Certified Plastic Surgeon, so I am very aware of the latest cosmetic plastic surgery options. However, whether to fix these problems is a separate debate and a personal decision. Most patients struggle, at least a little, with the decision to voluntarily under go surgery. A careful weighing of the risks and benefits is an important part of the decision making process. The benefits of Cosmetic Surgery are also personal, and depend primarily on two issues: the magnitude of deviation from “normal,” and the amount of emotional discomfort the variation causes. Plastic Surgery can provide safe and effective treatment for the right patient and under the right circumstances, and your results will last longer when maintenance and prevention are incorporated.
My office is in East Bay community of Walnut Creek, where it can reach into the 100s in the summer months, while just over the hills in Oakland it will be in the 60s. If you are looking for a Cosmetic Plastic Surgery Consultation, and a little heat, give me a call (925) 943-6353.
When is a Mini Tummy Tuck enough? It’s a question I answer every day. Cosmetic Plastic Surgery options for Abdominal Rejuvenation range from Liposuction to Tummy Tuck, with the Mini Tummy Tuck covering some of the middle ground. Unlike Liposuction alone, the Mini Abdominoplasty can tighten the skin and muscle wall of the lower abdomen. But a Mini Tummy Tuck doesn’t do everything a Tummy Tuck can, and it’s important to know the benefits, as well as the limitations, before proceeding.
Mini Tummy Tuck Video (Mini Abdominoplasty)
The Mini Abdominoplasty is discussed below. This video segment is taken from a recent Body Beautiful episode, which originally aired on the San Francisco Bay Area’s News Station, KRON 4. The following Mini Tummy Tuck Video answers many of the frequently asked questions about Mini Abdominoplasty and reviews the results that can be achieved. Indications for a Mini Tummy Tuck vs. Full Tummy Tuck or Liposuction are reviewed. The information provided is accurate, but cannot be considered medical advice. An in-person consultation with a Board Certified Plastic Surgeon is always recommended prior to choosing a treatment plan.
YouTube videos sometimes get stuck in Apple’s latest Safari Browser (9.1.1). This video may hang at 1:04. Click on the red time bar to fast forward to 1:05 and it should play to the end. Alternatively, you could use another browser.
Mini Abdominoplasty Before and After Pictures
Mini Tummy Tuck Before and After Pictures are included in the video above. The indications and results are illustrated and explained. Additional before and after photos are also available on my main website. For more information about determining what Liposuction, Mini Tummy Tucks and Tummy Tucks can do, see my Liposuction or Tummy Tuck Article.
What Is A Foopa?
Foopa comes from the acronym F.U.P.A., which is short for Fat Upper Pubic Area. Originally, this was meant to identify a disproportionate collection of fat above the privates and below the belt line; however, its meaning has expanded to include all lower belly fat, especially the fat that sticks out above a C-section scar. Foopas cause the fullness seen in “Mom Jeans.” Larger foopas can simulate the appearance of early pregnancy.
Can A Mini Abdominoplasty Fix A Foopa?
Small foopas, both above and below the belt-line, can often be fixed with a Mini Abdominoplasty. Larger foopas are associated with larger amounts of abdominal laxity, and often require a Full Tummy Tuck for the best results.
Mini Tummy Tuck Quick Check
Here is an easy way to check if a Mini Tummy Tuck is enough. Cover the area below the belly button and look at the belly. If the area above the belly button looks good, a Mini Tummy Tuck will often be enough to obtain a good result. If there is loose skin above the belly button, or if the abdomen bulges above the belly button, a Full Tummy Tuck will give a superior result. If the area below the belly button is full, but the skin is tight, Liposuction may be the easiest fix.
Liposuction, Mini Tummy Tuck or Tummy Tuck?
The decision between Liposuction, Mini Tummy Tuck or Tummy Tuck is not always easy. When in doubt, consult a professional. A Board Certified Plastic Surgeon can sort it out and review your options in less time than it takes to read this article. If you would like to schedule a private, in-person Mini Tummy Tuck consultation call (925) 943-6353 today. A personalized approach is taken with each patient.
Big Arms are a big deal. I’m not talking about the “big guns” produced by lifting weights. I’m talking about loosing weight, getting in shape and still having big arms due to loose, flabby skin. This is a common problem for anyone who has lost a significant amount of weight. Some people are born with large arms and loose skin, but many of my Arm Lift patients have lost weight through diet and exercise or after bariatric surgery. For them, the larger the weight loss, the bigger the problem.
Arm Lift (Brachioplasty)
Brachioplasty literally means arm changing. The ideal candidate is healthy, with a large amount of loose, redundant upper arm skin. Sometimes called Bat Wings, this skin excess is not amenable to exercise, and further weight loss only exacerbates the problem. There is no skin shrinking ray, so the options are often either an Arm Lift or to live with it.
Arm Lift Video (Brachioplasty)
Below is a recent Body Beautiful segment dedicated to Arm Reduction surgery from the San Francisco Bay Area’s News Station, KRON 4. This Brachioplasty Video answers many of the frequently asked questions about Arm Lifts and reviews the results that some of my patients have received. The information provided is accurate, but cannot be considered medical advice. An in-person consultation with a Board Certified Plastic Surgeon is always recommend prior to choosing a treatment plan.
Arm Lift Before and After Pictures
The above Arm Lift Video includes many Brachioplasty Before and After Pictures. From arm to arm there are differences in appearance, so the Arm Lift is adapted to your unique needs. There is no substitution for an in-person evaluation, but additional Arm Lift Information is available here on the San Francisco Plastic Surgery Blog and on my main web site’s Arm Lift Page.
Arm Lift Consultations
If you want to know more about your options for Arm Reduction, call (925) 943-6353 today and schedule your personalized Arm Lift Consultation. A focused physical examination and medical history are how we start. If you are a candidate, the risks, benefits, procedure, alternatives, limitations and recovery of the Arm Lift are reviewed in detail, so that you can make an informed decision.
Large breasts can be debilitating. The constant heaviness pulls the shoulders down and strains the neck and back muscles, making physical activity difficult. For women who are suffering from chronic neck, back, shoulder and breast pain, Breast Reduction Surgery may be the answer.
Symptoms Of Macromastia
Doctors have a different word for everything, even large breasts. The terms Macromastia and Gigantomastia are used to describe breasts that are disproportionately large and which can cause the following symptoms:
Neck pain – usually the lower neck
Back pain – usually the upper back, but can be lower too
Shoulder pain – from spasms in the muscles needed to support the breasts
Breast pain – aching pain within the breasts themselves
Shoulder rutting – indentations of the shoulders from the bra straps digging in
Recurrent rashes – fungal or bacterial infections in the folds under the breasts
The Cure For Macromastia
Non-surgical interventions, like custom bras, physical therapy and weight loss, are usually the first treatments tried. In fact, many insurance companies require these before even considering authorizing a Reduction Mammoplasty. For women who truly have Gigantomastia, however, non-surgical interventions are rarely effective.
The most effective treatment remains Breast Reduction. By removing a significant amount of weight and by firming up the breasts by tightening the skin, most patients feel relief within minutes of waking up after surgery. When done for the right reasons, the results are dramatic. Multiple Reduction Mammoplasty Before and After Pictures are narrated in the following Breast Reduction Video segment.
Breast Reduction Video (Reduction Mammoplasty)
Below is a recent Body Beautiful segment dedicated to Breast Reduction surgery from the San Francisco Bay Area’s News Station, KRON 4.
Breast Reduction For Men
Usually, Male Breast Reduction involves removing a small amount of breast tissue, Gynecomastia, from beneath the nipple/areola region. Unlike female Breast Reduction, Gynecomastia Reduction rarely requires a reduction in breast skin. An example of male breast reduction with skin reduction is included in this week’s Breast Reduction Video.
Breast Reduction Consultations
The decision to have Breast Reduction is a personal one. More information about the procedure is available through the links in this San Francisco Plastic Surgery Blog post. The best information, however, is only available through an In-person Consultation with a Board Certified Plastic Surgeon.
If you are in the San Francisco Bay Area and would like to schedule a consultation call (925) 943-6353 today.
The Breast Lift (Mastopexy) is one of the most frequently performed Breast Enhancement procedures. It is part of every Breast Reduction and is performed with Breast Augmentation as high as 40% of the time. There are many Breast Lifts to choose from, and I discuss the Breast Lift Basics in this segment from the San Francisco Bay Area’s News Station KRON 4‘s Body Beautiful.
Breast Lift Video (Mastopexy)
Mastopexy literally means “breast fixing”. Unlike Breast Augmentation, it does not change the size of the breast, but the shape. In this segment from Body Beautiful, I discuss the three basic Breast Lifts and review what they can and cannot do. The Breast Lift Video is illustrated with several Breast Lift Before and After Pictures including an example of combining a Breast Lift with Breast Augmentation for a Dramatic Breast Enhancement.
How Does A Breast Lift Work?
Imagine you have a favorite pillow that has gone flat. To restore the pillow’s original firmness, you have two options: You can add more stuffing or make the cover smaller. Adding more stuffing is like Breast Augmentation. During Breast Augmentation the Breast Implant is the additional stuffing that provides volume and some support to the breasts.
A Breast Lift is more like tailoring the breast skin to match the current size. If you are happy with the size of your breasts, but disappointed with the shape, you breasts have deflated or your breasts sag without a bra, a Mastopexy may be the best option. The amount of sagging and the nipple’s location on the breast mound will determine the amount of tailoring necessary and thus the type of breast lift needed.
Breast Lift with Breast Augmentation
A Breast Implant is not usually used during a breast lift; however, it can be added when both sagging and size are issues. The Breast Implant can be used in two ways. The most common way is for Breast Augmentation, where the entire breast is enlarged proportionately. The second way is to balance the upper and lower halves of the breasts. Often, when there is sagging, the lower half of the breast is larger, while the upper pole remains flat. A low profile implant can be used to provide fullness to the upper breast. This can balance the overall shape of the breast without overly enlarging it.
Breast Lift Consultations
To find out what type of Breast Lift is right for you, see a Board Certified Plastic Surgeon. A personalized consultation and a few measurements are all that they need to provide you with your best options. To schedule an appointment in my San Francisco Bay Area Plastic Surgery office located in the East Bay city of Walnut Creek, California, call (925) 943-6353, today.
Dr. Mele and Body Beautiful host Janelle Marie in the KRON 4 Bay Area News studio.
Since my first Body Beautiful appearance in 2007, the goal has remained the same: to explain what Cosmetic Plastic Surgery can and cannot do. The show began in the old KRON 4 Van Ness studios as a live broadcast, giving San Francisco Bay Area plastic surgery curious viewers the ability to call in and have their questions answered on the air.
Body Beautiful – Still Going Strong
The KRON 4 line up has changed through the decade, and so has the Body Beautiful broadcast time. Originally, part of the Medical Mondays lineup, we followed the morning news. As the daytime line up changed, we moved to Wednesday mornings and on occasion, the show was taped and rebroadcast on Saturday mornings.
Dr. Mele discusses Breast Lifts (Mastopexy), Breast Reductions (Reduction Mammoplasty), Arm Lifts (Brachioplasty) and Mini Tummy Tucks (Mini Abdominoplasty) LIVE next Wednesday, June 8, 2016, at noon on the Bay Area's News Station, KRON 4’s Body Beautiful.
This Wednesday Body Beautiful is LIVE
This week’s show is special. We will again be broadcasting LIVE, on Wednesday, June 8, 2016, at noon. It’s a new time, a new show, and it’s from the new KRON 4 studios, but the goal of demystifying Cosmetic Plastic Surgery remains the same. This week’s topics on Body Beautiful are all about Body Shaping:
As usual, the segments from the show will be posted here on the San Francisco Plastic Surgery Blog. Currently, there are 128 Plastic Surgery Videos on the blog, so if you are looking for Cosmetic Plastic Surgery information, you are in the right place. Use the links under Categories to explore the procedures you are interested in learning more about. This blog, as well as my other plastic surgery web sites, are constantly being updated, as new information and options become available. And don’t forget to watch our next live show this Wednesday at noon on KRON 4.
Cosmetic Plastic Surgery Consultations
The Internet is a great place to get information, but there is no filter on it. There is no substitution for an in-person consultation with an experienced and Board Certified Plastic Surgeon. To schedule your personalized and informative, private plastic surgery consultation, call (925) 943-6353, today.
Many suffer from Migraines. Thanks to Allergan, we know that Botox can help, but there may be something safer and cheaper the can help, too.
A lot of my San Francisco Bay Area Plastic Surgery patients suffer from Migraine Headaches, so I looked into the incidence of Migraines and found that according to the Migraine Research Foundation, it is the third most prevalent and the eight most disabling illness in the world. In the U.S., 18% of women, 6% of men and 10% of children suffer from migraines, and I have found this to be true within my own patient population.
Migraines Run In Families
About 80% of Migraine sufferers have a positive family history. It runs in my family. I had a few myself, but I seem to have outgrown them. Thankfully, mine were few and far between, and they seemed to be associated with sleep deprivation. So diet, exercise and regular sleep were enough to keep them to a minimum, but others are not so lucky. Every 10 seconds, someone in the U.S. goes to the emergency room complaining of head pain. While most sufferers experience attacks once or twice a month, more than 4 million people have chronic daily migraine, with at least 15 migraine days per month.
Sleep and Migraines
My observation of an association between Migraines and sleep is not unique. One of the most commonly cited triggering agents happens to be changes in sleep habits. Insufficient sleep, greater than normal sleep, disturbed sleep or alterations to daily bedtime or waking all have been strongly correlated with initiating migraine attacks. Recent research suggests that some migraineurs might be deficient in melatonin production.
A nap can cure a Migraine, but sleep may also be preventative.
According to a well referenced online article by Dr. Mathew Long, Melatonin (a derivative of serotonin) is manufactured in the pineal gland at night, and it functions to regulate the sleep-wake cycle. Furthermore, it has been implicated in migraine pathophysiology due to its anti-inflammatory effects, ability to scavenge free-radicals, inhibition of dopamine and stimulation of nitric oxide synthase. Melatonin also has a role in membrane stabilization. With sleep-related factors featuring so prominently in migraineur’s lives, it makes sense that we examine the relationship between poor sleep hygiene, melatonin synthesis and the tendency to migraine. Research has linked low levels of melatonin in plasma and urine and altered peak time in melatonin levels to a variety of headache types, including migraines.
Sleep and Melatonin
Melatonin has been available as a supplement in the United States since the 1990s and is often used to aid sleep and attenuate jet lag. A study in published in Neurology in 2004 showed promising results in migraine prevention when 3 mg of melatonin was taken 1 hour prior to bedtime. This was confirmed 10 years later when Melatonin was compared head-to-head-to-head with amitriptyline and placebo.
As reported on Medscape, results from a multi-center, randomized, double-blind, placebo-controlled trial showed that 3 mg of melatonin was more effective than placebo and had efficacy similar to that of 25 mg of amitriptyline. Furthermore, it was better tolerated than amitriptyline, with lower rates of daytime sleepiness and no weight gain.
To test the efficacy and tolerability of melatonin and amitriptyline vs placebo for migraine prevention, the investigators recruited 178 men and women who met International Headache Society diagnostic criteria for migraine with and without aura and who had 2 to 8 migraine attacks per month. All patients underwent a 4-week baseline phase during which each participant kept a diary of migraine frequency.Participants were then randomly assigned to receive 3 mg melatonin (n = 60), 25 mg amitriptyline (n = 59), or placebo (n = 59) for 3 months. Medication was taken between 10 and 11 pm daily.
The study’s primary outcome was a reduction in the number of headache days per month. Secondary endpoints included migraine intensity and duration and analgesic use. Tolerability was also measured in all 3 study groups. The mean reduction in headache frequency was 2.7 in the melatonin group, 2.18 in the amitriptyline group, and 1.18 in the placebo group.
Proportion of responders (patients with a higher than 50% improvement in headache frequency, number of migraine headache days) comparing baseline vs last month of treatment.
Although migraine frequency did not differ between the 2 active treatment groups, the proportion of responders was greatest in the melatonin group: 54% vs 39.1% for amitriptyline and 20.4% for placebo. Melatonin was also “very tolerable” and had significantly fewer adverse effects compared with amitriptyline. Daytime sleepiness was the most frequent symptom in all 3 groups but was most pronounced in the amitriptyline group (n = 24). Although patients gained weight in both the amitriptyline (n = 3) and placebo (n = 1) groups, melatonin was associated with weight loss.
Timing of administration and formulation is also important. Ideally, melatonin should be taken between 10 pm and 11 pm to mimic the physiologic peak. In addition, a fast-acting rather than a slow-release formula should be used.
Overall, said Dr. Peres, the study’s findings are promising and warrant further research.
If you suffer from Migraines, Melatonin, a relatively inexpensive and safe over-the-counter supplement may help. I am not recommending you base your treatment on the blog post of a San Francisco Bay Area Plastic Surgeon. You should see a real headache doctor and have the appropriate testing and examinations performed prior to initiating treatment. However, when you see your doctor, if they do not bring up Melatonin, be certain to ask.
Breast feeding is good for babies nutritionally and emotionally. Above is Naomi Jael, from Germany. She caused a viral sensation this week with this snap of her breast feeding her 10-month-old son at a wedding reception, though comments centered more around her public display than the virtues of breast feeding. A more supportive and more comical imitation can be found here.
A common question I get from women considering Breast Augmentation is, “Will Breast Implants interfere with Breastfeeding?” For women who are trying to reclaim their breasts after finishing having children, this is not an issue. However, if you want Breast Augmentation, and want to have children afterward, here are a few things you should know.
Is Silicone Safe For Babies?
Did you know that silicone drops are used to treat infant colic? An article from 1988, Mylicon drops in the treatment of infant colic, dosed 51 colicky infants with 0.3 ml of simethicone with each feeding. Symptoms of colic improved or resolved in 38 infants (78%) after one day and in 44 (86%) after seven days. Simethicone is an anti-foaming agent that relives bloating, and it is still available without a prescription, over-the-counter at your local pharmacy.
Safe enough to use at every feeding and up to 12 times per day. Active ingredient: Simethicone 20 mg in each 0.3ml dose.
Simethicone is a mixture of polydimethylsiloxane (PDMS) and hydrated silica gel. If you have ever taken Gas-X, you have ingested PDMS. What you may not have known is that PDMS is the same type of silicone found inside breast implants. So it is safe for adults, too. So if silicone is in breast milk it’s safe, but can it get out of a breast implant and into the breast milk?
Can Silicone Get Out of Breast Implants And Into Breast Milk?
PDMS is a silicone polymer which can be cross linked to increase its viscosity. This allows it to remain soft, yet resist flow. It is used inside breast implants, and is surrounded by a soft, solid, tear-resistant shell to further isolate it. Current breast implants are made with shells that do not allow the gel to bleed through them, though this was not always the case.
Modern Silicone Gel Breast Implants are filled with highly cohesive gel that does not flow like the oil found in earlier generations of breast implants manufactured before 1994. Implants made before 1985 have very runny filling and a high rate of rupturing.
Older breast implants, manufactured prior to 1994, did allow a small amount of gel to seep through them without a hole in the shell. It is like Helium seeping out of a balloon; however, rather than leaking out over night, it takes years for measurable amounts of silicone to be detected outside the these older breast implants. New breast implants are made with low-gel-bleed shells, which contains the internal gel, and prevents the gel from seeping through the wall. New breast implants also have high-cohesive gel centers, which do not flow like water. In the most recent long term follow-up studies, there have be no cases of the gel migration, which was seen in the older breast implants. So it is unlikely that silicone can get out of the breast implant, never mind into the breast milk.
Is Silicone Found In Breast Milk?
In 1991, before the more impervious breast implant shells were manufactured, a study measuring the amount of silicone found in the breast milk of lactating women with breast implants was published. The scientific sounding title is, “Determination of low levels of silicones in human breast milk by the aqueous silanol functionality test.”
Silicon compounds are widespread in the environment, making measurement of elemental Si in biological systems difficult. The assay was quite laborious and required 10 days to complete and measures PDMS, not elemental Si. The amount of PDMS in the milk of women with implants was not statistically different from that in water blanks or control human milk samples. The milk from women with polydimethylsiloxane breast implants contained 3.62 ppm (parts per million); control milk contained 3.40 ppm; and water contained 2.25 ppm. Moreover, this was in the older breast implants that had gel bleed, and still the levels were not statistically elevated.
Proper Breast Implant Placement Can Help Too
Surgical considerations for decreasing the risk of breast implants interfering with breastfeeding include scar and implant placement. Incisions made around the areola, may cut some of the ducts going to the nipple. I have had many patients with periareolar incisions maintain the ability to breastfeed, because most of the milk gland is between the nipple and the armpit, away from this periareolar incision; however, for patients wanting to breastfeed, I recommend using the inframammary fold (IMF) incision.
The most frequently used Breast Augmentation incisions are the periareaolar incisions and the inframammary incisions as shown above.
Placing the Breast Implant behind the pectoralis muscle can help, too. This provided an additional barrier between the breast implant and the breast gland, and also takes some of the compression off the milk gland. More pressure may trick the breast into thinking it has made enough milk, and turn off production early. Larger implants may also be more likely to decrease the amount of milk produced for the same reason.
Nipple Sensation is Helpful For Breastfeeding
Nipple stimulation is another stimulus for lactation. If you lose nipple sensation after breast augmentation, this may cause a reduction in milk production as it interferes with the normal milk let-down reflex that nipple stimulation causes. Fortunately, decreased nipple sensation is not common after Breast Augmentation.
Normal Breast Are Better For Breastfeeding
What I mean is that if you have normal breasts before Breast Augmentation, you are more likely to be able to breastfeed after Breast Implants are placed. If your breasts did not develop, you are more likely to have problems breastfeeding with or without breast implants. Other risk factors for not being able to breastfeed are: breasts that are spaced far apart, breasts which are tubular in shape or breasts that are significantly asymmetrical. If any of the above describe your pre-implant breasts, it’s possible you don’t have enough of the glandular tissue you’d need to make milk, and one study found that women with these conditions are 25 percent more likely to be unable to breastfeed and 19 percent more likely to need to supplement.
Can I Breastfeed If I Have Breast Implants?
Yes. The current recommendation for women with Breast Implants is to breastfeed. Breast Augmentation is not a contraindication to breastfeeding. While some women will make a smaller quantity of milk, there is no change in the quality of the milk produced.
Breast Augmentation Consultation
If you are currently trying to get pregnant, of plan to have a child in the next year, now is not the time for Breast Augmentation. If you are considering pregnancy somewhere in the future, or if you are done having children then now is a good time to find out what to expect. For a private, personalized Breast Augmentation Consultation call (925) 943-6353 and schedule an appointment. More information is available here on the San Francisco Plastic Surgery Blog, and my other websites, but there is no substitute for an in-person consultation, tailored to your body and your needs.