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Sunday, January 15, 2006



Cleveland Jewish News



05-13-2005



The latest trends in involve minimally invasive techniques,

improving safety, and preservation of function.



Rhinoplasty. Modern techniques in rhinoplasty (nose reshaping) reflect the

overall evolution of . Contemporary techniques strive to

preserve individual familial and ethnic characteristics so that the nose

looks refined, natural, beautiful, not artificial. The function of the nose

as an airway is also addressed with adjunctive procedures that correct

internal blockage, so that breathing is improved by surgery.



Facelift. The traditional facelift remains useful and powerful, but less

invasive procedures like the midface lift (elevation of the cheeks and

jowls), endoscopic brow lift (using telescopes through small incisions), or

neck lift may be used instead of, or in addition to, a facelift in

appropriately selected patients. The so-called "one-hour" or internal

suture lifts have not yet gained general acceptance because results seem

temporary. Nonsurgical enhancements can also complement the facelift.

Treatment is tailored to the patient's needs, so that natural, lasting

improvement can be achieved.



Laser resurfacing and nonsurgical techniques. The newest additions are

nonsurgical enhancements, like Botox®, Hylaform®, and Retin-A®. These

modalities can eliminate the need for surgical intervention in some

patients or complement surgery in others. Fillers are injected into

wrinkles to restore thickness to the skin, partially erasing the wrinkles.

Botox® is selectively injected into specific facial muscles to paralyze

them so that they can't form frown lines. Retin-A® is applied topically; it

increases skin cell turnover, thereby reversing sun-damage and diminishing

wrinkles. Laser resurfacing treats fine wrinkles and color irregularities

in the skin. The popularity of these procedures has validated their

usefulness.



Liposuction and tummy tuck. The basic technique for liposuction remains

unchanged: suction fat through limited incisions. The tumescent technique

has been popular for several years; it involves injecting a high volume of

dilute anesthetic solution to minimize pain and blood loss. Because it is

safe and effective, the tumescent technique is considered the standard for

most liposuction cases.



Ultrasonic liposuction uses an internal probe or an external handpiece to

administer sound waves to the fat cells, theoretically to help break them

up and facilitate their removal. This was very popular several years ago.

But further study suggests that it offers little benefit over conventional

liposuction and adds some risks, so it is less commonly used. It remains

useful for certain cases, like gynecomastia (male breast) correction.



Abdominoplasty (tummy tuck) involves removal of excess belly skin and

tightening of the underlying muscle layers to reshape the belly and

waistline. This is one of the most effective and popular

procedures. It is often combined with liposuction.



Breast augmentation. Current trends in breast augmentation include using

minimal (small) incisions, smooth-shelled implants, and placement under the

pectoralis (chest) muscle, to give a more natural, longer-lasting result

than when placed on top of the muscle. The under-the-muscle approach has

been used for years; but an accumulating body of evidence suggests it has

significant advantages long term.



The Food and Drug Administration is currently evaluating the safety of

silicone gel implants, but advisory panels have suggested limited approval.

Currently they can be used for reconstruction when patients are enrolled in

experimental protocols. The evidence that silicone gel causes medical

complications is tenuous, but saline (salt water) filled implants are

versatile and safe.



In medicine, new is often better. However, new can also mean unproven,

untested. When new trends are supported by experimental studies and the

collective experience of national medical societies, they can be taken

seriously. Deciding whether to try a new therapy is like choosing a medical

specialist: The first task is to gather information.



For cosmetic surgery, make sure the physician is certified by the American

Board of Plastic Surgery and is a member of the American Society of Plastic

Surgeons. Qualified physicians may be certified by other specialty boards,

but the patient has a right to know exactly what kind of training the

physician has in cosmetic procedures; a weekend course in liposuction is

not enough.



--Steven A. Goldman, M.D.



Interim chief of



University Hospitals of Cleveland Case School of Medicine



Article copyright the Cleveland Jewish News.