The ISAPS Biennial Global Survey™ uncovered some interesting trends in aesthetic plastic surgery as well as what countries are climbing the ranks in overall procedure numbers. As always, the U.S. holds the number one spot. A few of the countries in the top ten may be a bit suprising:

1. United States
2. China
3. Brazil
4. India
5. Mexico
6. Japan
7. South Korea
8. Germany
9. Turkey
10. Spain

For more than ten years breast augmentation was believed to be the most desired invasive procedure, however, this is not true. Liposuction takes the top spot with 18.8% of all surgical procedures, followed by breast augmentation with 17%, blepharoplasty (13.5%), rhinoplasty (9.4%) and abdominoplasty or tummy tuck (7.3%).

Non-invasive procedures proved to be more popular than invasive surgery. Botox® and Dysport® came in first with 32.7% of all non-invasive treatments. Hyaluronic acid injections (dermal fillers), such as Juvederm, came in second with 20.1%, followed by laser hair removal (13.1%), fat grafting (5.9%) and IPL treatments (4.4%).

The Survey also established that there are approximately 30,817 board certified (or equivalent) plastic surgeons practicing throughout the world. According to the Survey, 8,536,379 surgical procedures and 8,759,187 non-invasive procedures were performed worldwide in 2009.

Industry Insights, Inc., an independent research firm, produced and analyzed the findings of the ISAPS Biennial Global Survey™. The firm’s study was led by Scott Hackworth, a CPA with 15 years of experience in researching aesthetic plastic surgery trends. Members of different international plastic surgery societies were asked to complete a two-page questionnaire focusing on the number of procedures performed in 2009.

To Your Health & Beauty,

Mark P. Solomon, M.D., F.A.C.S.

A lot of physicians are opting to use fat grafting because it only leaves incisional scars and oftentimes has fewer complications than injecting foreign materials into the body.  While doctors worldwide have been eagerly working towards advancement in the technology, physicians in Japan have recently made the most significant headway.

Kotaro Yoshimura, M.D., Associate Professor of Plastic Surgery at the University of Tokyo, is leading the way in terms of advancement in stem cell technology for the use of aesthetic application. Dr. Yoshimura, along with his team, developed a system called cell-assisted lipotransfer (CAL) that overcomes common problems that arise with traditional fat grafting. Unpredictable results and low fat cell survival rates are just two common issues seen during fat grafting.

During the CAL process, stem cells found in adipose (fat) tissue are combined with lipoinjection. The fat that is removed during liposuction is split in half, and stem cells are removed from one half of the fat and added to the other half of the fat. This creates stem cell-enriched fat tissue that, according to Dr. Yoshimura, regenerates additional tissue after a portion of the original fat dies off. The stem cell density of the fat is crucial to the success of lipoinjection. Up until Dr. Yoshimura’s breakthrough, patients saw an average of 50% loss of voume following lipoinjection.

Dr. Yoshimura and his colleagues have successfully tested the CAL process on more than 450 breast restoration and augmentation patients over the past seven years.

The CAL process is executed in three simple steps: fat tissue is extracted from the donor site, the soft tissue is purified and stem cells are isolated, and then the tissue is injected elsewhere into the body.  Isolating the stem cells is the most difficult step in the CAL process.  Isolation can either be done manually using a cell-processing room or automatically using Tissue Genesis Technology.

Not only will the stem cell-enriched fat work more effectively and reduce complications, it may even have a therapeutic effect. According to Dr. Yoshimura, fat stem cells are similar to bone marrow-derived stem cells and can aid in the healing process following fat grafting.

While these advances sound promising, CAL still needs to undergo further studies to determine its long-term efficacy and safety. CAL is also not recommended to patients with a low BMI as there can be problems when trying to find enough adipose tissue to harvest.

To Your Health & Beauty,

Mark P. Solomon, M.D., F.A.C.S.

During the study, Dr. Carruthers injected a group of 80 men and 80 women with varying doses of Botox®. The women, split into clusters of 20, were injected with 10, 20, 30 or 40 unites of Botox®, while the men were injected with 20, 40, 60 or 80 units. There was a substantial difference in results between the women who received 10 and 20 units, however, the larger dose did not extend the duration of the results.

On the contrary, the men experienced superior and longer lasting outcomes with each increasing dose. Twenty-five percent of the men injected with 60 units and 40% of the men who received 80 units still had visibly smooth foreheads six months from their initial injection date.

Carruthers also found that men could withstand a higher dose of Botox® than women while experiencing a low incidence of side effects.

The higher muscle density and thicker skin in men is the reason why they need a larger dose of Botox® in order to see the same results as women. The study is imperative in helping doctors to administer the correct amount of Botox® to their male patients.

Of the women studied who had acne, 85% were found to have comedonal post-adolescent acne (CPAA), a type of acne characterized by blackheads and non-inflamed. Previously, CPAA has thought to be less frequent in women than inflamed cystic acne. Not only that, an alarming 72.9% percent of the women with CPAA identified themselves as cigarette smokers. The study also found that the more someone smoked, the more severe her adult acne was.

“Recognizing this form of acne is fundamental to providing correct information about the effects of tobacco on the skin,” said one of the study’s authors, Dr. Bruno Capitanio.

If the deadly side effects weren’t enough to persuade you to quit, maybe the fear of wrinkles and acne is. There are multiple different nicotine replacement therapies available, including the patch, gum, and even prescriptions.  For Philadelphia residents who are interested in quitting, Smoke Free Philly is a great resource with advice and even classes available to help you kick the habit.

To Your Health & Beauty,

Mark P. Solomon, M.D., F.A.C.S.

The study, which was published in the Journal of Agriculture and Food Chemistry, reported that two organic compounds that are found in the fruits are responsible for the cancer cell deaths. The compounds, which are known as phenols, are slightly acidic and are possibly associated with traits such as color, aroma or taste.

“It was a differential effect which is what you’re looking for because in current cancer treatment with chemotherapy, the substance kills all cells, so it is really tough on the body,” said AgriLife Research plant breeder Dr. David Byrne. “Here, there is a five-fold difference in the toxic intensity. You can put it at a level where it will kill the cancer cells — the very aggressive ones — and not the normal ones.”

Prior to this study, Dr. Byrn and Dr. Luis Cisneros-Zevallos had originally researched the antioxidant and phytonutrients in plums. The duo had found plums to match or exceed blueberries, which had been previously considered superior to other fruits in those categories.

The research brings a new sense of hope in the never-ending fight against cancer. The World Health Organization reports that breast cancer accounts for 16 percent of female cancer deaths globally and that in 2009 there were over 194,000 new breast cancer cases nationwide.

According to Cisneros Zevallos, the “Rich Lady” peace and the “Black Splendor” plum treated two types of breast cancer cells and normal tissue cells. The extracts from the fruits killed the cancer cells without harming the normal cells.

The researchers found that two phenolic acid components—chlorogenic and neochlorogenic—were responsible for killing the cancerous cells. Though the two compounds are very common is other fruits, peaches and plums have much higher levels.  Laboratory tests also confirmed that the compounds prevented the growth of cancer in animals.

The findings are very attractive in that the use of peach and plum extract to fight cancer could be a safer alternative to chemotherapy in the future. Chemotherapy is currently the most effective, as well as most taxing, treatment available for cancer.  Chemo can weaken the immune system dramatically, which can cause other complications even if the patient overcomes the disease.

Although future research is still needed, these findings are detrimental to ongoing advancement in treatment of cancer.

To Your Health,

Mark P. Solomon, M.D., F.A.C.S.

1. DO: Make sure your doctor is a board-certified plastic surgeon with experience using a variety of lasers. The doctor can make a tailored recommendation based on your skin type.
2. DON’T: Ask your doctor to treat you with only a specific laser. Instead, tell your doctor about the skin issues you would like address, and they can in turn recommend the best laser solution for your skin.
3. DON’T: Undergo a laser treatment if you have a tan, even if it is a spray-on one. Most laser lights are attracted to skin pigments, so the darker your skin is the greater your risk of complications.
4. DO: If someone other than the doctor is administering your laser treatment, such as a physician assistant, make sure they are permitted to do so under your state’s law.
5. DO: Have realistic expectations about the outcome of your treatment. Laser treatments are very beneficial to the skin, however, they cannot cure all skin issues or be used a substitute for surgery.
6. DO: Allow yourself enough downtime following your laser treatment. If you have a big event coming up, such as a wedding, check with your doctor on the best time frame to be treated. Some lasers can cause swelling and redness, while others require you to avoid the sun for a period of time.
7. DO: Inform your doctor if you have used Accutane within a year of laser treatment.  Failure to do so may lead to preventable scarring.
8. DO: Tell your doctor if you have ever had fever blisters or cold sore. Skin resurfacing can instigate a herpes breakout in the treated areas. Use of an antiviral medication prior to your laser treatment can greatly diminish the chance of an outbreak.

If you are considering laser treatment in Philadelphia, the friendly and caring staff at my office is delighted to help you find the best treatment for your skin. We would be glad to address your skin concerns on the phone or in our office during your initial consultation.

To You Health & Beauty,

Mark Solomon, M.D., F.A.C.S.

Companies including DermGenoma, Navigenics, 23andme, and Decode Genetics all have developed genetic tests that can ascertain one’s predisposition for cellulite, obesity, psoriasis, hair loss, and even melanoma. The tests require the subject to swab the inside of their cheek and send the sample to a lab for examination and analysis.

The tests cannot guarantee whether or not someone develops a certain condition, however, they will reveal if the subject has a greater genetic disposition for said condition than the rest of the population. Different environmental factors may increase ones likelihood of developing a condition such as cellulite or melanoma.

DermaGenoma just launched their genetic test for moderate to severe cellulite in time for the summer (and bikini weather). So what can you do if you are found to have a predisposition for cellulite? Certain lifestyle changes can be made to prevent the onset of cellulite, including: quitting/never smoking, exercising regularly, and avoiding birth control pills. Pre-existing cellulite treatments may also be used in advance to prevent the appearance of unsightly dimples.
While genetic testing sounds simple, it is important to have the results reviewed by a qualified physician before seeking preventative treatment. Some medical centers offer patients a comprehensive genetic testing as a part of their health and wellness evaluation. This way, the patients receive proper evaluation and follow up care in conjunction with their testing.

Navigenics, one of the testing companies, offers telephone consultations with trained genetic counselors who can explain recommended lifestyle changes based on an individual’s results. The company also includes a report on medications that would most likely work best with the subject’s body.  This reports prevents patients from playing the trial-and-error game with their medication before finding one that treats their condition.

Navigenics offers tests for melanoma, psoriasis and obesity as well. Patients who are susceptible to melanoma are warned to be extremely careful about sun exposure and educated on self-screening for skin cancer.  If caught early enough, melanomas are completely curable. People who are predisposed to obesity are taught how to maintain a healthy diet.

Another company, 23andme, offers genetic tests for baldness, hair and eye color—as well as hair thickness and height. There’s also a chance tests could be covered by health insurance in the future if the illness being tested for is serious enough.

With such advances made in genetic testing, the ability to determine a predisposition should not be far off. While these tests are certainly exciting, they have not been proven definitively and may not yet be worth the considerable costs.

Though such tests can help us understand an incredible amount about the human body and diseases, we must also take into consideration environmental and lifestyle factors. Processed foods, cigarette smoke, UVA/B exposure, and pollution are all factors in that can increase your risk of different cancers and heart disease. Keep in mind that the next best thing to finding a cure for said diseases is preventing them.

To Your Health & Beauty,

Mark Solomon, M.D., F.A.C.S.

UVA exposure is not completely harmless, however. UVA, a carcinogen that is accountable for squamous cell carcinomas, is known to suppress the immune and contribute to premature aging of the skin. The researchers also note that long-term chronic exposure to UVA may expedite the progression of pre-cancerous cells.

The study’s lead author David Mitchell, professor in M. D. Anderson’s Department of Carcinogenesis, and colleagues tested the effects of UVA and ultraviolet B (UVB) light exposure in melanoma-prone fish that can sporadically develop the cancer without any UV exposure. The fish were exposed to UVA and UVB separately within the first five-to-ten days of life. The exposed fish were then tested for melanoma 14 months later.

“We found that UVB exposure induced melanoma in 43 percent of the 194 treated fish, a much higher rate than the 18.5 percent incidence in the control group that received no UV exposure,” Mitchell said. Of the fish exposed to UVA, only 12.4 percent tested positive for melanoma—less than that of the unexposed control group.

While UVA exposure in early life has been ruled out as a direct cause of melanoma, future research will help us to understand other possible negative effects of UVA exposure. Research may even reveal one day that UVA and UVB work symbiotically in the production of melanoma.   For the time being, however, don’t shortchange yourself on the sunscreen. I recommend a sunscreen that is SPF 45 or higher to prevent sun damage and that is detrimental to your health and beauty.  This should not lull patients into thinking that sunscreen is irrelevant. UV exposure still causes other skin cancer types and causes aging of the skin prematurely. So while avoiding skin cancer is a good thing, looking your best best is just as important!!

To Your Health & Beauty,

Mark Solomon, M.D., F.A.C.S.

With the recession affecting the cosmetic industry, consumers and doctors alike are finding unsafe ways to cut costs when it comes to plastic surgery. Often times, the people performing discount cosmetic procedures are not board-certified plastic surgeons, and even worse, some aren’t even doctors! One cautionary tale is that of the six New Jersey women who were hospitalized after undergoing black market buttock injections.  This women were injected with a mixture of  silicone, petroleum jelly and hardware-grade caulk and suffered from deep tissue and skin infections. The New Jersey women were seeking a more voluptuous backside at a cheap price and in turn risked their lives.

One of the MANY reasons why doctors can discount surgical procedures  is that they are able to cut costs in the anesthesia department as well as facility fees. If you subtract the cost of anesthesia and an operating facility, the overall cost will be significantly reduced while the risks are increased dramatically. The use of local anesthesia with is marketed to consumers as a safer alternative since the patient will not be unconscious for the procedure. However, this is a great myth.  Anesthesia providers not only give medication to help ease anxiety and discomfort during surgery, they monitor breathing and vital signs. The act as your lifeline while the surgeon concentrates on performing surgery. In addition, when doctors perform cosmetic surgery under local anesthesia in the office, they are able to get away with doing so in a regular medical office, which is not regulated in the same manner as an accredited surgical facility or hospital. This can be very dangerous and leave patients more vulnerable to many complications, including but not limited to overdose of local anesthesia, uncontrolled bleeding and an increased risk of  infection.

There are 2-day crash courses available for procedures such as  liposuction or breast augmentation, which is a scary thought. An ophthalmologist, gynecologist, general surgeon or family practitioner can offer breast augmentation without prior experience operating on the human body, while board-certified plastic surgeons are required to have more than six years of surgical training and experience, with at least two years specifically in plastic surgery. This is why it is important for consumers to understand that just because a doctor is performing your procedure; it does not mean it is safe.

According to an article on StyleList.com, a Florida doctor with a suspended medical license left four patients temporarily paralyzed and almost killed when he administered injections using a raw botulinum toxin instead of FDA approved Botox. One patient was temporarily paralyzed and survived after spending months on a ventilator, finally recovering with lingering facial paralysis and three permanently collapsed vertebra. Some doctors are using illegal substances that they sell as legal to uninformed patients. This practice can cause deformity and even death.

1. Verify that the doctor is certified by the American Board of Plastic Surgery by going to ABMS.ORG
2. Make sure your surgeon is a member of the American Society of Plastic Surgeons by going to PlasticSurgery.org. This is the largest organization of board certified plastic surgeons in the world.
3. Plastic surgeons with a focus in cosmetic surgery are members of the American Society of Aesthetic Plastic Surgeons. You can find out if your doctor is a member of this organizatin by going to Surgery.org.
4. Check with your state medical board to see if there are any complaints against the doctor and if their license is valid. But remember that a license to practice medicine does not tell you anything about the physician’s specialty training, although it will tell you that your doctor is a medical doctor and not a dentist (Yes, some dentists perform cosmetic procedures).
5. See what past patients are saying on online review sites like Google and Yelp.
6. If a price seems too low for a procedure, it probably is. The American Society of Plastic Surgeons and RealSelf.com have average national pricing for cosmetic procedures available on their websites. Remember that fees vary from state to state due to many factors, including costs of labor, office space, practice insurance, implants, and facility and anesthesia fees. Some posted fee reflect only the surgeons fee and will be lower than the actual cost.
7. Ask around from colleagues who have had plastic surgery. See who they have gone to and if they were satisfied with their results.
8. Use online resources like RealSelf.com and MakeMeHeal.com to read other patients’ plastic surgery stories. This way, you can cross-reference your consultation(s) with the experiences of patients who have undergone the same procedure.  But be aware that some people like chocolate ice cream while others like vanilla. Your experience may be good for you but different than the one that you read about.
9. Trust your instincts! If something seems fishy, it probably is.