Silicone Breast Implant Update

Since the wide release of silicone breast implants by the FDA in November of 2006, I have not used a single saline implant. In fact, my surgery center is sending our supply of saline implants back to the manufacturer to make room for silicone implants. On the rare occasion in which we need saline implants, we will have them shipped special order from the implant manufacturer.

For the past fifteen years, 90% of the breast implants used in the United States were saline. During that same time period, over 90% of the breast implants placed in much of the rest of the world were silicone. Most plastic surgeons anticipate that in time, over 90% of the implants used in the U.S. will be silicone.

When patients ask me, “Dr. Ryan, which implants are better, saline or silicone?”, I respond that, like everything else in life, they each have their pros and cons, so I can’t say that one is “better” than the other. I tell my patients that before 1992 (when he FDA put restrictions on the use of silicone implants), over 90% of implants placed were silicone and that I anticipate that we will return to close 90% usage in this country.

When patients ask me, “But aren’t silicone implants dangerous?”, I respond “Of course they’re dangerous! We doctors love doing dangerous things to our patients all the time! And the malpractice lawyers love it even more!” I then explain to the patient, after we both finish laughing, that there is no way that I — or any other doctor — would ever do a procedure or use a device that we feel is dangerous. I then recite the many well-done, peer-reviewed scientific studies that refute that there is any link between silicone breast implants and cancer, autoimmune disorders or any number of other diseases that people have tried to link with silicone breast implants over the years.

In summary, it appears that silicone breast implants are here to stay and that the vast majority of surgeons and patients are welcoming their return.

The Ribbon Lift

As I discussed in my April 4, 2006 post entitled "Jowls", the jowls can be a very stubborn problem. Since that last post, I have been doing a procedure called the Ribbon Lift. Unlike the so-called thread lifts, which many surgeons criticize as yielding disappointing results, the Ribbon Lift appears to be promising, since it is based on time-tested basic surgical principles. Furthermore, because the Ribbon Lift is based on sound surgical principles, the results seem to be long-lasting.

The Ribbon Lift involves placing a dissolvable device (the ribbon) under the skin of the face. An incision is made just below the sideburn and scissors are used to create a tunnel to the the jowls in the lower face. The ribbon, which measures about five inches long by less than a quarter inch wide, is a soft, flexible material with tiny points (like miniature spikes) at one end. It is made up of the same material that dissolvable stitches are made of. The ribbon is slid into the incision and the tiny points are pressed firmly into the jowl tissue. When the end of the ribbon is pulled up near the ear, the tiny spikes pull up on the jowl tissue as well. The jowls are thereby either eliminated -- or at least reduced significantly. A stitch holds the end of the ribbon in place and a series of stitches is used to close the sub-sideburn incision.

The procedure takes about a half hour and is performed with the patient wide awake, under local anesthesia. Some patients opt to take a Valium before the procedure, but this isn't necessary for most patients.

After the procedure, the patient is told to minimize activity for a few days. The ribbon dissolves after several months. For the first week or two, the ribbon can be felt if a finger is run along the cheek, although does not seem to bother the patients.

The Ribbon Lift appears to hold promise for the treatment of jowling and it has become a part of my armamentarium for the treatment of facial aging.

Please go to the "Videos" section of www.drfrankryan.com to a more thorough discussion of the Ribbon Lift.

Why Adrianne Curry Had Plastic Surgery :: Reprint from US Weekly

[REPRINTED FROM US MAGAZINE (www.usmagazine.com), Issue 618, December 18th, 2006]
[By Shirley Halperin]

AMERICA's NEXT TOP MODEL
ADRIANNE CURRRY

WHY I HAD PLASTIC SURGERY
The My Fair Brady and ANTM star shares her diary of the painful -- and funny -- moments of her breast reconstruction and recovery.

THINK ALL MODELS HAVE PERFECT BODIES? Adrianne Curry, 24, a former AMERICA"S NEXT TOP MODEL champ, would beg to differ. Ever since she was in her early teens, the 5-foot-11 newlywed (in May, she married her SURREAL LIFE co-star Christopher Knight, 49, with whom she is currently filming the third season of VH1's MY FAIR BRADY) was hyperconscious of the fact that her breasts were noticeably different in size. After years of feeling badly about her chest, the reality-TV star contacted Beverly Hills plastic surgeon Frank Ryan to correct the imbalance with implants. Curry underwent the procedure on November 14 and shared her experience with US.

["It would be so embarassing when photographers would yell out, 'Your left boob is larger than the other'" Curry tells US.]

THE NIGHT BEFORE

I'm having surgery tomorrow at 7:30 a.m. I've always shown my boobs and acted confident with them, but I wasn't. My left breast is a full B or a small C-cup, and my right breast is a full A-cup. My friends jokingly call me One Hang Low. I used to stuff wads of toilet paper in my bra to fill out the smaller side [see "How She Did Her Asymmetry, below]. Being a model and having something so gravely different, it's like having a hug f--king birthmark on the side of your body and trying to hide it in every shoot. I'd get uncomfortable when Chris grabbed my boobs. One night, he was really drunk and said, "Don't worry, baby, it's like being with two different women." That was the last straw.

I've made it very clear to Dr. Ryan that I don't want to look like a cartoon character. I'm a very skinny girl, and I'd look ridiculous with big boobs.

SURGERY DAY

I was nervous. The anesthesiologist said, "Don't worry, because before we knock you out, we're going to shoot you up with happy venom." I have no recollection of what happened after. Chris told me that as they wheeled me into the operating room, he me the hand sign for "I love you," and I lifted my head halfway, gave him the finger, then passed out.

Dr. Ryan gave me a larger silicone implant on the right and a smaller implant on the left to make both breasts the same size -- a medium C-cup. I was really happy because the implants look and feel very natural. My surgery lasted three-and-a-half hours. The incisions were made through the nipples. He put in two stitches and glued the rest.

When I woke up and I couldn't open one of my eyes, the nurse tried to pry it open for me. I was so uncomfortable. I wanted to ditch everything and just run. When we got to the after-care facility, I was screaming in pain, and they shot me up with morphine. Later, I was perscribed Percocet and Valium, but think because I was addicted to cocaine and heroin as a teenager, they didn't really affect me. The doctor said I was on enough drugs to take out an elephant.

SIX DAYS LATER

Chris had been so helpful. He's pulled down my pants to help me pee and given me sponge baths. it's been very hard because I hate people doing things for me, and I was literally rendered helpless. I don't have any bruises, but my right side is swollen. It's amazing to look down and think, Oh, my God, I don't have deformed deformed boobs anymore.

16 DAYS POST-OP

My nerve endings are starting to heal and tingle, and I'm in even more pain now than I was right after the surgery. It feels better when I wear a compression strap -- which keeps pressure on the implants so they don't get rounded at the top and look fake. Realistically, it'll take a year before I'm 100 percent healed. I just threw out my chicken cutlets because I'm never shoving anything in my bra again.

HOW SHE DID HER ASSEMETRY

Before going under the knife, Curry spent years trying to make her breasts appear equal-sized.

PADDING. At red carpet events, she would wear two bras and stuff her right cup with a "chicken cutlet" gel pad -- or crumpled toilet paper. "I've had toilet paper fall out on the red carpet," she US. "Thank God no one noticed."

POSING. At photo shoots, she would twist her body to show off her bigger breast and throw her right arm in the air to distort the smaller breast. "If you look at my PLAYBOY shots, every single one is cheated," she says.

PUMPING. Curry headed to the gym thinking pectoral-muscle exercises would help balance out the unevenness: "It didn't work."

Sunscreens

It is important to understand some basic principles behind sun exposure and ultraviolet radiation in order to understand what the various sunscreens on the market have to offer.

The sun's ultraviolet rays are measured over a spectrum of different wavelengths. Only some of the ultraviolet rays are harmful, namely those between 290 and 400 nanometers. Some of these rays are called UVB rays (290 to 320 nanometers) and some of these rays are called UVA rays (320 to 400 nanometers). The UVB rays are the rays responsible for a sunburn and they are partly responsible for skin cancers. The UVA rays don't cause a sunburn like the UVB rays, but the UVA rays penetrate deeper to damage the skin, leading to wrinkles, brown spots and other indicators of cellular damage. The UVA rays also cause skin cancers.

Many of my patients proudly say to me, "I wear an SPF 50 sunscreen." When I ask them what the ingredients are, 99% don't know. Unfortunately, SPF only refers to the UVB rays. 100% of the UVA rays could be going right through the sunscreen to damage the skin and cause skin cancers, even though one is wearing an SPF 50. Furthermore, the UVA rays penetrate glass and they are just as strong in the morning and afternoon as they are at noon. Luckily, most sunscreens today offer both UVA and UVB protection, but the amount of protection varies from sunscreen to sunscreen.

The best ingredients, in my opinion, are zinc oxide and titanium dioxide, since these substances block almost all of the harmful UV rays. Zinc oxide and titanium dioxide are known as sunblocks, not sunscreens, since they physically block the UV rays. Most other sunscreen ingredients react chemically with the UV rays, as opposed to physically blocking the rays. Therefore, these are called sunscreens.

A sunscreen that has been touted as one of the best for blocking UVA rays is avobenzone (Parsol 1789). However, it is not commonly known by the public that Parsol 1789 breaks down when it is struck by UV rays. Therefore, although Parsol 1789 is an excellent UVA sunscreen, it must be reapplied frequently throughout the day.

Something people always forget is the amount of reflective UV exposure that people get. Everyone realizes that water and snow reflect, but what about sand, concrete and grass?

Finally, many people think that wearing clothing is a fool-proof sunblock. However, anyone who went swimming as a child wearing a T-shirt to prevent sunburn knows that a wet T-shirt is about an SPF 1 or 2. The same applies to thin, gauzy material. Although these materials are cooler, a tightly woven fabric provides far more UV protection.

Juvederm

The FDA recently approved the filler Juvederm (hyaluronic acid) for use in the United States. Juvederm, which has been available in Canada for several years, is similar to Restylane, which was FDA-approved in the U.S. a few years ago. Restylane is made by Medicis and Juvederm is now made by Allergan, the makers of Botox, after Allergan bought out Inamed Corporation earlier this year.

Juvederm is used for the correction of facial wrinkles and folds and there are three formulations of Juvederm available, Juvederm 24HV, Juvederm 30HV and Juvederm 30. Each formulation is designed to correct different types of facial folds and wrinkles. At this point in time, there is only one Restylane formulation that is FDA-approved. However, other Restylane formulations such as Perlane and Restylane Fine-Lines are expected to be approved by the FDA shortly.

The obvious question: which product is superior? At this point, Restylane certainly has the longest track record of the two and Restylane has become the soft tissue filler of choice in the U.S. However, there is some anecdotal evidence that Juvederm may result in slightly less swelling than Restylane, but this has yet to be demonstrated in controlled studies.

For now, Juvederm is another filler to add to our armamentarium and the choice of three different formulations is a definite plus, at least until Restylane adds their other two formulations to the marketplace.

Lip Lift

Although significant attention has been directed toward lip augmentation, there is one situation in which lip augmentation alone may actually make the lips look worse.

In youth, the distance from the nose to the upper lip is generally fairly short, although the length varies significantly from person to person. With age, this distance increases. As the distance increases, the upper teeth are covered by the upper lip. Furthermore, the "pouty" aspect of the lips where the edges of the lips (the vermilion border) evert, diminishes with time, so that the lips appear flatter. Of course, the overall size of the lips also decreases.

Based on these observations, simply enlarging the lips by injecting a filler (e.g., fat, Restylane, Cosmoplast) addresses only one aspect -- the actual size -- of the aging lip. If a young patient already has a nice pout and has a short distance between the nose and the upper lip, simply increasing the size of the lips is all that is needed. However, if an older patient has a lost that pout and the distance between the nose and the upper lip is too long, just increasing the size of the lips may look strange. In fact, many of the odd-looking lips that one sees these days is the result of a doctor augmenting lips that really needed more than just a filler.

An ideal procedure for many of these patients is the lip lift. The lip lift involves a small incision placed where the nose meets the upper lip skin. The incision extends from one nostril to the other and is hidden quite well in the natural crease where the nostrils meet the face. The incision dips into each nostril, where it is easy to hide the incision. Because of the shadowing effect created by the nose, in the vast majority of cases the scar is virtually imperceptible.

I always perform the lip lift procedure in conjunction with a filler. The combination of a shorter upper lip, a poutier upper lip and fuller lips creates the youthful appearance that patients want. Because the lips are also lifted slightly, the upper teeth become more visible, also contributing to the youthful appearance.

When properly executed, the lip lift is an excellent procedure for many patients.

Mesotherapy Position Statement

The American Society for Aesthetic Plastic Surgery (ASAPS) recently issued a "position paper" on the use of mesotherapy. A position paper by an organization such as the ASAPS presents the organization's official stance on a technique like mesotherapy or a device like a new laser. In this way, a plastic surgeon can better form an objective opinion on a new technique or device without listening to biased individuals like the inventor of the technique or the manufacturer of the device.

The ASAPS often forms ad hoc committees specifically to address new techniques like mesotherapy, where the public is inundated with non-scientific information from the media. Because of this media blitz, plastic surgeons are asked about mesotherapy by their patients. The Aesthetic Society Mesotherapy Committee scours the world literature for any and all information on mesotherapy. Is it safe? Is it effective? What exactly is it? Should plastic surgeons consider doing mesotherapy in their practices? How do they learn how do perform mesotherapy? These are all questions that organizations like the ASAPS want to answer through their ad hoc mesotherapy committee.

Here are the recommendations that the ASAPS made to its members, after an extensive investigation into the use of mesotherapy:

ASAPS does not endorse the injection of phosphatydal choline, deocycholate or any other drugs, vitamins, plant extracts, hormones, etc. into subcutaneous fat as practiced in mesotherapy/Lipodissolve treatments. At present, these therapies lack objective proof of safety and efficacy. They also lack FDA approval.
Members should therefore refrain from adopting these procedures until the results of the ASERF [a plastic surgery research organization] study are available to provide proof of safety and efficacy, or lack thereof. If and when patients ask about these treatments, the scientific reality that currently exists should be explained to them, along with the caution to wait until something definitive is known. Until then, patients should be warned about seeking treatments from people who may not be qualified to administer large numbers of injections that require very precise placement.

[Reprinted from the SPRING 2006 issue of Aesthetic Society News, Volume 10, Number 2.]