Two and one half years ago, I posted about Jean-Claude Mas and his substandard PIP Breast Implants. Poly Implant Protheses, PIP for short, had their Breast Implants banned in 2010, after it was revealed that industrial grade silicone was being used, rather than the medical grade silicone that has passed safety tests for use in the human body.
PIP’s Jean-Claude Mas Goes To Jail
PIP founder, Jean Claude Mas, loses appeal in French court, and goes to jail. Photo credit: Guillaume Horcajuelo
In 2013, Jean-Claude Mas was convicted of fraud. His sentence included: four years in prison, a75,000 euros ($86,000) fine and that he be banned for life from working in medical services or running a company. This year, a French appeals court upheld the decision.
Plastic Surgeons Blew The Whistle First
Plastic Surgeons were aware there was a problem years before the government took action, because PIP Breast Implants leaked about ten times as often as FDA approved breast implants. In fact, the US FDA refused PIP’s application for Silicone Breast Implant sales in the US.
Unfortunately, the Pre-filled Saline version of PIP Breast Implants was sold here for a short time. They also leaked at much higher rates than those seen with the other FDA approved Saline Breast Implant manufacturers at the time: Allergan and Mentor.
PIP – Cheaper Is Not Better
You have likely heard the expressions, “You get what you pay for,” and that, If something is too good to be true, it is false.” Well both these expressions apply to Plastic Surgery. It is not an area that you want to get the cheapest price.
PIP’s appeal was that they were cheap. While they claimed to be equivalent to other manufacturers, they were not. They cost less, because they were made cheaply. Industrial silicone is not the same grade or cost as medical silicone, and the company substituted industrial grade silicone for medical grade silicone for years without regulators catching on.
Jean-Claude Mas posing at his manufacturing facility. Only a few knew what was really going on with PIP’s breast implant quality control.
Plastic Surgeons complained for years that something was wrong with PIP Breast Implants, but the final straw was when the company supplying the large quantities of industrial grade silicone raised their suspicions also. Even the people selling the industrial grade silicone knew there was nothing good about these Cheap Breast Implants.
PIP Knew The End Was Coming
PIP Breast Implants manufacturing was headquartered in La Seyne-sur-Mer, France. Since they were not FDA approved, they were not subject to FDA rules, like surprise inspections. Incredulously, European inspectors had to give 10-days notice prior to an inspection. During this grace period, PIP would remove drums of industrial silicone from their manufacturing facility and quickly order the medical grade silicone they should have been using all along. After the inspection, the industrial silicone was brought out again and cheap manufacturing resumed.
When it was clear that the end was near, PIP slashed its prices further. Knowing that their inventory was going to be confiscated, they sold in bulk, and they sold quickly. PIP flooded the market with cheap “European Approved” breast implants throughout Europe and South America. In the end, between 300,000 and 400,000 women in 65 countries are believed to have received PIP implants. Europe was a major market, but more than half went to South America. Fortunately, they were not sold in the United States.
Medical Tourism – Buyer Beware
Poly Implant Protheses was founded in 1991 and shut down in 2010. It is thought that the manufacture of the Bogus Breast Implants, those made with industrial grade silicone, began in 2001.
It Is Recommended That All PIP Silicone Breast Implants Be Removed
PIP Silicone Breast Implants were never sold in the US; however, if you took advantage of cheap overseas breast augmentation early this millennium, you need to check if you have PIP Silicone Breast Implants.
Breast Implant Removal Before And After Photos: One option is to have the breast implants removed and not replaced. Another is to replace your PIP breast implants with FDA approved breast implants, the later options will also preserve the size of your breast. Be certain to ask your Board Certified Plastic Surgeon about your options for treatment.
PIP Silicone Breast Implants have a higher risk of leaking than approved models, as well as being implicated in several deaths due to systemic toxicity and several cases of induced breast cancer. If you have these breast implants, the current world-wide recommendation is to have them removed, and if you desire, replaced with approved Medical Grade Silicone Breast Implants.
If you have PIP Silicone Breast Implant’s, find an Experienced Board Certified Plastic Surgeon in your area and get the information about the benefits, and risks, of having them removed. I have removed several. The Ruptured Saline Breast Implants are easy to remove. The saline is absorbed by the body, and all that remains is the solid shell. Ruptured Silicone Breast Implants, especially those filled with the less cohesive gel, are a much bigger problem.
When Breast Implants are ruptured, the gel that fills them can migrate. Most the PIP silicone Breast Implants I have removed were ruptured. The longer the Leaking Breast Implants remain in your body, the less likely it is that all the industrial silicone gel can be removed. Like most problems, the sooner it is addressed the better the outcome. Breast Augmentation Revision is a better option. If you are in the San Francisco Bay Area, call (925) 943-6353 today.
Gynecomastia is normal breast tissue and fat in the male chest, that is often disproportionate. When large enough, it causes a feminization of the chest, and in the case above, puffy nipples. Direct excision of the excess breast tissue creates a more masculine appearance, and less embarrassment at the beach.
More men are having Cosmetic Plastic Surgery. Since starting my practice in 1997, the number of cosmetic procedures performed among men has increased over 325%, according to the American Society for Aesthetic Plastic Surgery (ASAPS). Liposuction remains the number one requested procedure; however Male Breast Reduction, or Gynecomastia Reduction, has the fastest growth rate.
How Common Is Male Breast Reduction Surgery?
In 1997, according to the American Society of Plastic Surgeons (ASPS), around 20,000 men underwent Gynecomastia Reduction. Last year, over 30,000 men did the same, representing a 5 to 7% increase from the previous year’s data. The word is out. You don’t have to live with man boobs anymore.
What Is Gynecomastia?
Gynecomastia is the medical term for enlargement of the male breast. Enlargement can as small as a lump under the areola, to large enough to look like a well endowed female breast, and everything in between.
When Does Gynecomastia Arise And Will it Go Away?
Gynecomastia Reduction: In this case, direct excision of the glandular tissue from under the areola not only smooths the chest’s contour, but also reduces the apparent size of the areolae — the pigmented skin that surrounds the nipple. The darker color is simply a result of the same amount of pigment distributed over the new, significantly smaller, area.
Gynecomastia normally becomes a problem at puberty. It is estimated that two-thirds of men suffer from some degree of breast enlargement during adolescence, and that for half of them, it persists into adulthood. If you are a young man with a new lump in your breasts, it is a good idea to have it checked by your family doctor to be certain the tissue and your hormones are normal. The best early treatment for true Gynecomastia is usually observation, as half the cases with resolve on there own within two years of developing.
What Is Gynecomastia Made Of?
Just like in the female breast, there are two tissue types found in the enlarged male breast: glandular tissue (breast) and adipose (fat). The amount and location of these tissues determines how best to treat the gynecomastia. Glandular tissue is firm, tough and sometimes painful. Adipose is soft, weak and non-tender. Glandular tissue is most often found under the nipple and areola, with a tail extending to the side, while fatty tissue is more peripheral. Both are more likely to be found in the lower pole of the male chest. Too much of either can stretch the skin to the point that extra skin may also need to be removed.
How Is Gynecomastia Treated?
Gynecomastia Reduction: Sometimes the amount of breast tissue on the chest is enough to completely feminize the chest. Liposuction, combined with direct excision of the glandular components, restored the flat chest that this young man is expected to have. Again, the reduction in areolae is due to the skin’s elastic contraction after the breasts are unstuffed.
So how do I treat Gynecomastia? The answer depends on several factors and the best way to find out what can be done in your specific case is to schedule a personal consultation appointment with an experienced, Board Certified Plastic Surgeon in your area.
For adolescents, usually the best treatment is to wait a few years and see if it goes away. On the other hand, all new lumps should be checked by your primary medical doctor to be safe. If the area has persisted for several years, and is not resolving, Gynecomastia Reduction may be the best next step.
For adults, first you must be healthy. Male Breast Reduction is an elective procedure and needs to be held to a higher standard. If treatment is safe, there are the components to breast reduction that need to be evaluated and treated: the amount of gland, the amount of fat and the amount of skin.
Glandular tissue, true breast tissue, responds best to direct surgical excision. It is tough, so the cannulas used for Liposuction often just bounce off it. Fatty tissue, on the other hand, is soft and responds well to Liposuction. Both methods reduce the amount of “stuffing” in the chest, and allow the skin to shrink.
Gynecomastia Reduction: Sometimes the skin enveloping the breasts is redundant. This man has breast enlargement and sagging from his gynecomastia and loose skin. In this case, the breast tissue and the excess skin were removed through an incision that runs along the bottom of each breast. Without this, the skin would sag further over the inframammary fold from the loss of support caused by removing the chest’s stuffing, just like deflating a balloon causes the balloon to fall over.
In most cases, the skin and the areola will shrink proportionately, to reveal the contours of the pectorals major muscles. In cases of extreme gynecomastia, or after large weight loss, the skin may be loose, and direct excision of the excess skin may be necessary. This needs to be determined at an in-person consultation.
Gynecomastia Reduction Consultations
If you are suffering with embarrassing, or painful, male breasts, treatment is available. Call my San Francisco Bay Area office in Walnut Creek, CA at (925) 943-6353 today, and schedule your private, informative consultation appointment. More information is available on line through the links embedded in this article and on my San Francisco Breast web site’s Gynecomastia Page.
The official torch of the Rio Olympics (Click picture for a close-up.)
All eyes are on Rio de Janeiro this week. Most of us are celebrating the spirit of competition during the XXXI Olympiad. But for Plastic Surgeons, despite the amazing achievements of our athletes, it may be remembered more for the passing of a single Brazilian Plastic Surgeon.
The Olympics and Northern California
Northern California in particular has a lot to celebrate. Eighty-Four of the five-hundred-fifty athletes representing the United States have Northern California ties, with seventy-six US olympians coming from the San Francisco Bay Area. An additional thirty-one former Cal (UC Berkeley) or Stanford athletes will compete for other countries.
Passing the Olympic Torch
The prelude to the Olympics is the passing of the Olympic Torch. The flame originates from Greece and is nurtured along on its trek to the current Olympic city. About twelve thousand torchbearers carried the Olympic flame across Brazil between May 3rd and August 5th, 2016.
The Olympic cauldron was lit at the Maracana Stadium on August 5, 2016. One of the torch bearers on this the final day was Brazilian Plastic Surgeon, Ivo Pitanguy. Dr. Pitanguy was as much a national symbol of Brazil’s excellence in Plastic Surgery as he was a hero for his care of many of the victims of the Niterói Circus Fire; 70% of the approximately 3000 in the audience were children. He credits this experience with teaching him that for many, physical appearance was critical to living. The day after helping light the Olympic Torch, his own light extinguished. At the age of 93, he suffered a fatal heart attack at his home in Rio de Janeiro.
At Palácio da Cidade, plastic surgeon Ivo Pitanguy hands over the Olympic torch to Gyleno dos Santos, waiter at Mayor Eduardo Paes’s Office / Photo Credit: Ricardo Cassiano
Dr. Ivo Pitanguy Philanthropist
Dr. Pitanguy was as much philanthropist as celebrity in his home country. He renovated a ward at the public Santa Casa da Misericórdia Hospital in Rio where, for four decades, he offered free treatment. He also founded the Clinica Ivo Pitanguy in Rio de Janeiro, which provides members of underprivileged communities, carriers of congenital or traumatic deformities, with opportunities for psycho-social assistance and physical repair. Since its opening, more than 50 thousand surgical interventions have been performed, as many as 1,800 operations per year, in the three surgical theaters that make up the surgical center at the hospital.
Dr. Ivo Pitanguy Celebrity
There is no doubt that Dr. Pitanguy was famous among Plastic Surgeons, but he was known for his famous friends and life away from the practice of medicine, too. He provided many a column inch for the gossip magazines. Early in my practice, I took a Breast Reduction course from Dr. Pitanguy at an American Society of Plastic and Reconstructive Surgeons meeting (now the American Society of Plastic Surgeons or ASPS). I was privileged to learn from the best.
Shortly after returning back to my San Francisco Bay Area Plastic Surgery practice, I read an article about the near death experience of Rolling Stones Guitarist Ron Wood. From the European Rolling Stone Fan Club’s web site, It’s Only Rock’n’Roll web site:
While Mick and Charlie stayed at their hotel Copacabana in Rio, Ronnie and Keith went to the plastic surgeon Ivo Pitanguy’s house on the island Angra dos Reis. Ronnie with his wife and son went on a boat trip off the island, and during the trip the engine stroke fire, and they had to evacuate the boat in a hurry. Luckily they were followed by paparazzi boats, and the boat from Jornal Do Brasil picked up Ronnie and his family. See photo etc in Aftonbladet.
On An Approachable Pedestal
Ivo Pitanguy – as he still appears on his web site.
While always in demand, my personal experience with Dr. Pitanguy at our professional meetings was that he was always ready to offer advice and share a joke. Although we met only at professional meetings, and the sum of our interactions can be measured in days, he was a great influence on my chosen profession. I thank him, and I am humbled that he so easily shared his time.
At one meeting he tells me, “You American’s are screwing everything up.” I pondered the meaning of his words, and considered the possible target of his criticism. Was it politics, finances, the ASPS? No. He spent the next fifteen minutes expressing his concern that MTV was changing the Brazilian woman’s ideal of the perfect female form. Apparently, his patients were asking for larger and larger breast implants, like the women on MTV.
Beauty ideals are cultural. They change by geography and they change over time. There is a reason that fat grafting to the buttocks is called a Brazilian Butt Lift. It originated in Brazil, and Dr. Pitanguy is credited with its invention. Perhaps, he has turned the tide back on America. Maybe, I should be concerned that he has changed the American woman’s ideal of the perfect female form. I will miss you Ivo. In your lifetime, you have passed thousand of torches and provided an abundance of light for those that will follow in your footsteps.
Prominent Ears can be a cosmetic concern for both the young and old. For the young, ears that stick out can be a source of ridicule and teasing. At older ages, it may prevent enjoying the option of short hairstyles. However, the problem can be addressed at almost any age.
How Young Is Too Young For Otoplasty?
There are two peaks in the age at which people present to have their ears fixed. The first peak is around the time that children go to school, when their parents have the means to intercede. The second, is in the 20’s, when we are financially able to take care of ourselves.
Sometimes Otoplasty sooner is better. For children, early intervention can often reduce teasing and bullying.
The youngest age that cosmetic Otoplasty is performed is age five. By five years of age, the ear is about 85% of its adult size. This makes Ear Pinning predictable. For children, Otoplasty is performed under general anesthesia. This provides the necessary level of cooperation, safety and relaxation.
Does Otoplasty Need To Be Performed Under Anesthesia?
Ear asymmetry is more common than not. Sometimes Otoplasty is needed on only one side.
For adults, Cosmetic Ear Surgery can be performed either under general anesthesia or with local anesthesia. For my patients who do not want to be awake, general anesthesia is the best option. You get some medicine through an IV, and the next thing you know, it’s all done. For patients who are less anxious, local anesthesia provides a lower cost with less fatigue and none of the occasional nausea seen in about 10% of patients.
How Is Otoplasty Performed
Ear Pinning is an outpatient procedure. The majority of the work is accomplished through an incision placed in the crease behind the ear. Thin, strong sutures are used to bend and hold the ear cartilage in its new, folded back position. As with most of plastic surgery, the goal is to achieve just enough reduction, but not too much. The amount of Ear Pinning can be modified by adjusting the placement of the sutures and by scoring the cartilage along the desired path of bending.
What Is The Recovery After Otoplasty?
The Otoplasty scar is hidden in the fold behind the ear, allowing the hair to be worn up, or even shaved off with confidence.
Recovery is variable, but most patients are feeling normal in a few days. A head dressing is required during the first week to protect the repair, especially at night. After the head dressing is removed, the ears will be swollen, but look fairly normal. At night, a head band is worn to prevent inadvertent forward folding of the ears during sleep. Vaseline is usually all that is needed to keep the incision moist and to help it heal.
“Do No Harm” is the doctor’s moto, so safety and predictability are paramount for medicine. This is especially true for elective surgery, including my specialty, Cosmetic Plastic Surgery. There are many benefits to plastic surgery, but there are also risks. Even though the risks are usually small, it is important for surgeons and patients alike to understand the risks before making the decision to proceed.
Breast Implant Associated ALCL
Breast Implant Associated Anaplastic Large Cell Lymphoma (BI-ALCL) is extremely rare, and has only recently been described. Through the efforts of the American Society of Plastic Surgeons (ASPS) and the American Society for Aesthetic Plastic Surgery (ASAPS) a database was and continues to be compiled.
The typical presentation of ALCL is a large seroma (fluid collection) around the breast implant causing obvious enlargement and asymmetry of the breast augmentation.
The presentation of ALCL is fairly obvious. Since the tumor is extremely rare, the presentation is usually unilateral (on one side only). The effected side begins to collect fluid around the breast implant, causing enlargement. A sudden increase in size after breast augmentation is always worth asking your Plastic Surgeon about.
ALCL Not Associated With Breast Implants
ALCL comprises about 1% of all non-Hodgkin lymphoma. Symptoms of ALCL can include fever, backache, painless swelling of lymph nodes, loss of appetite, and tiredness. It is found in skin, in the lymph nodes, or in organs throughout the body. ALCL that appears in the skin is most often called primary cutaneous ALCL, and it typically has a less aggressive disease course than the systemic (throughout the body) types.
First Cases of BI-ALCL
Thirty-Four unique cases were described in the medical literature from between 1997 and mid 2010, and awareness was raised. Like any new disease, once physicians knew what to look for, more cases were identified.
In 2011, the FDA reported approximately 60 cases of ALCL in women with breast implants, out of approximately 5-10 million women who had received breast implants worldwide.
Since that time Plastic Surgeons and the FDA have:
Reviewed medical device reports (MDRs)
Reviewed the medical literature
Exchanged information with other international regulators, scientific experts and plastic surgery societies
Initiated a collaborative effort between the FDA and the American Society of Plastic Surgeons (ASPS) and the Plastic Surgery Foundation (PSF) to collect data through the Patient Registry and Outcomes for Breast Implants and Anaplastic Large Cell Lymphoma (ALCL) Etiology and Epidemiology (PROFILE Registry)
August 25, 2010 through September 10, 2015 the FDA received 258 MDRs, including the original 60 cases reported in 2011, of anaplastic large cell lymphoma in women with breast implants, with reports of three deaths. Although the MDR system is a valuable source of information, it has limitations, including incomplete, inaccurate, untimely, unverified, or biased data. In addition, the incidence or prevalence of an event cannot be determined from this reporting system due to potential under-reporting, duplicate reporting of events, and the lack of information about the total number of breast implants.
ALCL Associated With Breast Implants 2016 Update
Based on the information we currently have, the current estimate is that there have been 100-250 known cases of ALCL in women with breast implants worldwide. According to the World Health Organization, BI-ALCL is not a breast cancer or cancer of the breast tissue; it is a lymphoma, a cancer of immune cells. Women with breast implants may have a very low, but increased risk of developing ALCL adjacent to a breast implant. Textured implants may increase the risk or ALCL.
ASPS and ASAPS recommend educating breast implant patients on the risk of BI-ALCL and the early detection of symptoms. Women with breast implants are encouraged to contact their plastic surgeon if they notice swelling, fluid collections, or unexpected changes in breast shape (Figure 1).
In symptomatic patients suspicious for BI-ALCL, perform an ultrasound and send suspicious peri-prosthetic fluid for CD30 immunohistochemistry, cell block cytology, and culture. Surgical treatment is essential for the management of BI-ALCL. See Figure 2 for treatment algorithm.
Above is the current (2016) treatment algorithm for BI-ALCL. If you experience breast implant enlargement, breast inflammation, breast pain, a breast lump, a breast sore or have fluid around you breast implant, follow up with your plastic surgeon or primary medical doctor ASAP. (Click image for larger view.)
Breast Implant Associated-ALCL is very rare, and if it occurs, is highly treatable in the majority of patients. The FDA, ASPS, and ASAPS recommend that all women, including those with breast implants, follow their normal routine in medical care and follow-up, including mammography when appropriate.
The FDA as well as the Institute of Medicine (IOM) maintain that breast implants do not impair breast health or cause breast cancer, and scientific evidence continues to support that FDA-approved breast implants have a reasonable assurance of safety and effectiveness.
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.
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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.
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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.