The Cosmetic Surgery Blog

Although there are those who would love nothing more than to be rid of areas of body fat forever, and they are most likely aware of liposuction, there is another procedure being bandied about as a new technology. It's called Lipodissolve, or injection lipolysis, and it is billed as a "non-surgical alternative" to liposuction. It basically melts the fat. And, while there are many cosmetic surgeons out there who use the Lipodissolve technology, it is still under scrutiny. In fact, it's not even FDA-approved.

What It Is

There's the rub; there is no standard formula for Lipodissolve, so the ingredients vary. This is probably one of the main issues with the treatment. However, most of the chemical cocktails may include one of two different compounds, or may include both: phosphatidylcholine (PPC) and/or deoxycholate.

• Phosphatidylcholine - a compound extracted from the soy bean.
  
• Deoxycholate - a derivative of bile. Bile is what breaks down fat in our intestines.
  

Other ingredients include multivitamins, enzymes, alpha lipid acid, and plant extracts. Some cosmetic surgeons also include hormones, antibiotics or non-steroidal anti-inflammatory medications to their treatment.

Having said this, there are a number of reputable cosmetic surgeons who use a standard chemical mix whose risks are very small.

What It's For

Lipodissolve, like liposuction, can be used on many parts of the body. Arms, trunk, legs, chin, and other areas are good targets for Lipodissolve. And, because it is done through injections, you don't have to worry about incisions and having a cannula inserted into your body to suck out the fat. Many people would prefer not to go through this kind of healing process, even though the results are scientifically proven.

By injecting you in areas where there are fatty deposits you wish removed, you not only don't have to worry about anesthetic, but the fat is dissolved rather than sucked out. Treatments are done four to six weeks apart, and there is usually no down-time after the procedure. That is, if all goes well.

What Can Happen

There is currently a lawsuit in Illinois, brought forth by a woman who was seriously injured after her Lipodissolve procedure. She had the procedure at a medical spa called Pure Med Spa, which is one of the new cosmetic surgery chains popping up around the country. According to the woman and her lawsuit, she allegedly has rotting flesh on her legs for nearly five months. This is because the concentration of phosphatidycholine/deoxycholate was most likely too high. As one cosmetic surgeon put it, "it's like battery acid. It'll eat through anything." Predictably, Pure Med Spa claims they've done thousands of these procedures, and that their staff is highly trained. (So is the staff at McDonald's, especially the teenagers at the fry counter.)

There are other cases of calcium deposits forming beneath the skin and allergic reactions to the injection. If you are allergic to soy, there is no reason why you should even consider Lipodissolve. In fact, stop reading now.

However, there is potential for Lipodissolve to become one of the main procedures performed in this country. Liposuction is already one of the most popular procedures here, and Lipodissolve has been used in Europe since the '80s. And maybe the risks are truly minimal, as the makers and different cosmetic surgeons claim. But before you decide that Lipodissolve is right for you, you need to grill your cosmetic surgeon with questions about it. If they are a good one, they will answer all of your questions, and be able to point to their success with this procedure.

If you would like more information about Lipodissolve, please contact an experienced cosmetic surgeon in your area.

An article first appeared in the April 2007 issue of Plastic and Reconstructive Surgery, the scholarly journal of the American Society of Plastic Surgeons (ASPS), that discusses a side-effect that may, or may not, be welcome to those who have liposuction. Titled "Spontaneous Breast Enlargement following Liposuction of the Abdominal Wall: Does a Link Exist?," the article shows that a small percentage of women have seen an increase in their breast size.

The study looked into a small group of women who received tumescent liposuction of the abdominal wall and/or flanks, as well as those who had undergone abdominoplasty. Those who had undergone previous breast or abdominal surgeries, or had or were currently breast feeding were excluded from the study. This left 48 or 84 patients who had tumescent liposuction procedures, and 53 of 104 abdominoplasty patients.

Results

Of the liposuction patients, 23 of the 48 (48 percent) reported a postoperative increase in size of their breasts. Objective confirmation was reported in 19 (40 percent) of those patients. Eleven (21 percent) of the abdominoplasty patients believed they had an increase in their breast size. This was objectively confirmed in six (11 percent) of the patients.

Because the percentages of women who were able to show that their breasts increased by at least one cup size was large enough, the ASPS believes that patients undergoing liposuction or abdominoplasty should be warned that this is a potential side-effect/risk.

Possible Reasons

The reasons for spontaneous breast enlargement are as much a mystery as to those who this phenomenon affects. Gerald Imber, a cosmetic surgeon in New York, wasn't even sure it was occurring to some of his patients, but upon discovering its reality, stated that it "could be due to a shift in the relationship between estrogen and progesterone" or even "the trauma of surgery" caused it.

Carolyn Chang, a cosmetic surgeon in San Francisco believes that the result is simply one of rearrangement. "It could be the result of weight gain in people after the fat cells have been removed from their abdomens," however it is not predictable.

Whatever the reasons, there are probably as many women hoping for this kind of side-effect as there are those who don't want it. One of the things a narrower or tighter abdomen tends to give women is that their breast size appears larger. And if the women who have undergone liposuction or abdominoplasty still want breast augmentation, this is something they can discuss with their cosmetic surgeon.

If you are interested in liposuction or abdominoplasty, or have questions about their side-effects (both wanted and unwanted), please contact an experienced cosmetic surgeon in your area.

After the high-profile death of musician Kanye West's mother, Donda West, as a result of underlying health problems following cosmetic surgery, a number of new laws are on the docket in California. The reasoning is that with these rules, patients will be safer and further protected from dangers involved with their cosmetic surgery. Because many cosmetic surgeries are done in a clinical rather than a hospital setting, many believe that cosmetic surgeons do not face the same rigorous reviews that other surgeons must face yearly. And there is concern that attempts to further cosmetic surgery clinic surveillance is failing, especially in the wake of the fast growth of this industry. Also, budget cuts in California forced the Medical Board to disband its team that uncovered unlicensed doctors about five years ago.

Regulatory bills in California put forth include:

• Requiring outpatient surgery centers to be inspected at least one time every three years
  
• Mandating that patients undergo a physical exam before being allowed to get cosmetic surgery
  
• Banning ads or photos that create expectations that are not realistic
  

Other places have also tightened laws in the field of cosmetic surgery. These include certifying doctors as plastic surgeons by the Royal College of Physicians and Surgeons of Canada in British Columbia if they want to practice cosmetic surgery. Florida tightened oversight of "non-hospital surgeries" after the deaths of at least twelve people in 1998. Florida still reports problems with patients who are too sick being operated on by doctors. This, of course, was prior to the very public death of a graduating high school student who died as a result of an allergic reaction to the anesthesia given during her breast augmentation.

If you are interested in finding out if you are a good candidate for cosmetic surgery, please contact an experienced cosmetic surgeon in your area.

Not that there is anything wrong with personal choice, but some may not know when to say, I've had enough. Take Sheyla Hershey for example. As a 28-year-old Brazilian model, she's done what few have done before: made it into the Brazilian version of the Guinness Book of World Records. How, we hear you ask, how has she done it?

She has the world's largest breast implants.

After a reported eight surgeries, this wife and mother has had the equivalent of two quarts of silicone put into each breast to give Hershey the astounding size of 34FFF breasts. Say what you will, but the girl had a dream and made it real. Hershey says, "It's good when you can make your dream come true." She also told Fox News' Houston station, "I want to look better each day, every day."

Many people decide on cosmetic surgery to give them the confidence they may not have felt before. Imagine how confident Hershey must feel these days as she's walking down the street, content to know she's in a record book for her breast size; that the media story was picked up on and written about; that she's a model; that people are looking - nay, staring - at her. And, oh, yeah, a wife and mother. Yet, there must be a shred of doubt about the size of her breasts because Hershey isn't satisfied. She has said that she'd like her breasts even larger.

The state of Texas, who stereotypically enjoys the role of having the biggest of everything in the country, puts a limit on the amount of silicone that can be put into each breast. Perhaps this is a legitimate law. Or, perhaps they just made it up to keep this woman from another surgery. Whatever the reason, there are concerns she may be addicted to cosmetic surgery (there was an episode of Bones that covered this), or she may have a form of body dysmorphic disorder (like Michael Jackson).

While breast augmentation is one of the most popular cosmetic surgeries performed, the results women are looking for are, 99% of the time, not the results that belong in a circus sideshow. And there are few cosmetic surgeons who would argue that Hershey might want to rethink what she's doing to her body. As concerns over the risks of actually getting breast augmentation have hit the front pages, the risks of having breasts that are too large is not mentioned as much as it probably should be. Breathing problems and back pain are just a couple of the results of breasts that are too large. What some women and their doctors might call a medical condition, Hershey strives for.

Yet, once again, this is her choice. However, it has been mentioned that perhaps when Hershey goes in for her ninth surgery, maybe she should have a psychological evaluation as well.

If you are interested in how breast augmentation might enhance your features and are not looking for your fifteen minutes of fame through your breast size, please contact an experienced cosmetic surgeon in your area.

Why does Philip Roth's The Breast come to mind...?

By now you've probably heard about the death of Stephanie Kubela, the Boca Raton high school student who died last Saturday during breast augmentation surgery. There are many topics that fall into the issue of teens and cosmetic surgery, such as are they too young, why are they changing physical aspects of themselves at such a young age, and (as we've blogged about before), what surgeries are they interested in? Another topic that we've touched on is the risk factor involved with cosmetic surgery. Stephanie Kubela isn't the first, and probably not the last to fall into that tiny percentage of people who have severe complications during their procedures.

Malignant Hyperthermia

What killed Stephanie was not the surgery itself, but the reaction she had to the anesthesia. Malignant hyperthermia is a condition caused by something in the anesthesia that reacts negatively with the body. The heart rate and temperatures climb at a precipitous rate, and then the body shuts down. The only way to avoid serious damage during an episode of MH is to get treatment at the onset of symptoms. Clearly this was missed in Stephanie's case.

What Now?

Unfortunately, there is not one easy answer to this question. Cosmetic surgeons are extremely careful about how they perform procedures. They care about the well being of their patients, and Stephanie's surgeon was no different. However, we live in a society that seems to want to correct every little imperfection they see in the mirror. The numbers of people going in for procedures bear at least some of this out. The fact that young people do it is, again, an issue with no easy answers. What is important to understand in this case is that it is more about how this teenager, who was on her way to becoming a freshman at the University of Florida next year, died getting a cosmetic procedure. It has more to do with how she reacted to the anesthesia, something that can happen to anyone during surgery. It's one of the risks we must face if we want to change the physical with the help of expert surgeons.

If you are interested in cosmetic surgery, please contact an experienced cosmetic surgeon who can explain the risks to you.

Luiz Carlos Ribeiro pleaded guilty in the death of 24-year-old Fabiola DePaula in Middlesex Superior Court in Cambridge, Massachusetts on Tuesday, and was sentenced to three years in prison. DePaula went to Ribeiro for a nose job on July 27^th, and returned for liposuction three days later. An autopsy showed DePaula died of complications, namely pulmonary fat emboli (fat in the lungs).

Ribeiro is accused of conducting underground cosmetic surgery out of the home of Ana Celia Pena Sielemann. He allegedly performed Botox injections, rhinoplasty, and liposuction for years in Framingham where there is a large Brazilian immigrant community. Cosmetic surgery is popular among the women here. However, Ribeiro did not have a license to practice medicine in this country. He also allegedly performed DePaula's procedure on a massage table in unsanitary conditions. There was no qualified professional there to monitor DePaula's vital signs.

Ribeiro's ex-wife, Ana Maria Miranda Ribeiro, admitted she acted as a nurse during Depaula's liposuction and pleaded guilty to manslaughter in September. She was deported after serving a one year sentence. Sielemann, the homeowner, was charged as an accessory. She allegedly recruited the women Ribeiro performed cosmetic surgery on. She was deported before she could be brought to trial.

Ribeiro has already served 20 months in prison since his arrest. He may be eligible for release in January 2009, and will likely be deported when he is released.

A Cautionary Tale

Fabiola DePaula went to a dingy Massachusetts basement to get a procedure she thought would improve her looks and her life. This decision killed her.

It would be nice to know that Ribeiro is the only basement cosmetic surgeon in the country, and that his imprisonment has solved this problem. However, where there's one, there are several more who practice without a license, or who believe they can perform difficult procedures without proper training. Liposuction is a little more sophisticated than simply sticking a vacuum into someone and sucking out their fat.

There are always risks with surgery. However, with an experienced cosmetic surgeon who knows what they're doing and cares about your welfare, the risks are low. If you are interested in finding out more about liposuction, please contact a licensed cosmetic surgeon. They will knowledgably answer any questions you have about this, or any other procedure.

After the death of Donda West, hip-hop star Kanye West's mother, fingers pointed toward her cosmetic surgery procedures. In November, 2007, Ms. West had an abdominoplasty and breast reduction surgery. She dies shortly after due to complications related to her surgery.

Due to Kanye West's popularity, the death of his mother took on the appearance of a media frenzy. It also brought to light cosmetic surgeons and their practices. However, her autopsy shows that she likely died of heart disease, which added to the risk factor for elective cosmetic surgery. Her death is still ruled inconclusive by the coroner.

The Donda West Law

Donda West's family didn't stop looking into the cosmetic surgery angle after her funeral. Her niece, Yolanda Anderson, contacted Assemblywoman Wilmer Amina Carter (D-Rialto) to see what could be done. As a result of this contact, the two women have crafted a bill that will require cosmetic surgery patients to receive medical clearance from a licensed physician before their surgery.

Donda West reportedly did not listen to medical advice given to her by one cosmetic surgeon before she found another in the Beverly Hills area who was willing to perform the surgery on her. West's pre-existing medical condition gave one cosmetic surgeon pause, but another was willing to either ignore, or not look into, this condition.

The Reason

Assemblywoman Carter believes that this legislation is important because so many more young people are considering cosmetic surgery. She wants to make sure that people are aware of the risks. This bill will go before a committee in March.

The reason this law is even being considered is due to the fact that not every person who goes into a cosmetic surgeon's office will necessarily let them know of pre-existing conditions, family history, and more. However, there is also a small proportion of cosmetic surgeons who either do not check their prospective patient's history close enough, or simply decide to perform the procedure anyway. Thus, we read about Donda West's death.

While a vast majority of cosmetic surgeons will discuss your prior health and inherent risks associated with procedures, you should think about this yourself. Weigh the risks, research the procedure, and consider your health before consulting a plastic surgeon. Even though more people are getting cosmetic surgery, and most of these people are healthy, the fact that deaths still occur due to complications cannot be overlooked.

However, if you are considering cosmetic surgery, please contact an experienced cosmetic surgeon who will discuss your health and the risks involved.