jani lane: November 2009

Monday, November 23, 2009

The "New Botox"

Today I am excited to welcome the first post by Michelle Boone, ARNP-BC. Michelle is a Nurse Practitioner, and one of the most experienced and skilled injectors of Botox, Dysport, Juvederm and Restylane in Central Florida. She is also widely recognized as an expert in the use of lasers in aesthetic surgery, and is often asked to speak at national meetings on the topic. We are very happy to have Michelle on the Aesthetic Enhancements Plastic Surgery team and hope you enjoy her contributions to the blog.

THE NEW “BOTOX” ?

You’ve probably heard about Dysport, the new botulinum toxin for use in reducing facial wrinkles, a la Botox… and you are trying to decide whether to try it. The advertising says it is better and lasts longer, so maybe….

Both Botox and Dysport are made from fermented bacteria and both have the final result of reducing muscle movement- and so, both are very effective at reducing the movement that causes facial wrinkles.

Let’s start with some basic anatomy and see how both products work.

In order for a muscle to produce movement, a nerve must send a message from the brain that ultimately causes muscle stimulation and movement. Botox and Dysport temporarily de-activate the nerve, preventing the movement that produces the wrinkle in question (hence the term neurotoxin). Over the ensuing months, the nerve slowly regenerates, and the muscle starts moving again. For most people, this process takes somewhere between 3-4months.

Chemo denervation with Botox or Dysport (chemical deactivation of the nerve) helps to soften facial wrinkles and sometimes eliminate them—if they are not too deep. If injections are repeated at routine intervals—before the muscle returns to full strength—then sometimes the person can begin to use smaller amts or have a little longer effect. But not all will see this benefit. When either product is stopped, no matter how long it has been used, the muscle will return to normal function, and most often the wrinkle will return in short order. So both Botox and Dysport do their job very well, but to maintain the benefit, regular re-dosing is necessary.

Now let’s quickly talk about the bad stuff….for one, the possibility of eyelid drooping. Muscles don’t work by themselves. When you mess with one, another responds. That is why it so important to know who your injector is, and choose only the most experienced and skilled injector. With seemingly every spa and medical practice offering these procedures, poor outcomes are occurring and even making the evening news. The bottom line is that experience, and the skill obtained through it matters more than the letters after the name, whether it is a nurse or a doctor.

So, back to the droop. This can happen because the injector does not understand why the precise placement of those injections matters so much and a muscle that wasn’t treated reacted to one that was. Or it can happen because of spreading.

Spreading may be a significant difference between Botox and the new product, Dysport. Both products come to us in a powder form and have to be diluted with sterile saline. (sterile salt water) This solution spreads a little with each injection. This might be great, for example, in the forehead where the area is bigger. We may get to have fewer pokes and get good coverage, but--- here is where knowledge and experience come in---around the eyes and scowl lines of the brows, adjustments may need to be made in placing those injections to prevent that ‘spread effect’ to muscles we don’t want treated.

Another difference between the two products, Botox and Dysport, is in the way they are made. We speak in “units” when talking about how much you will need. How strong and big the muscle to be treated is determines the amount or number of units you will need. These “units” are totally different in the two products. For example, you may need 15 units of Botox but 37 units of Dysport to obtain the same result in the same area. No, you don’t have to pay more than double for the same result. For most offices, the prices of both are based on a unit charge and the unit charge is usually comparable. The biggest difference that can sometimes occur is the time it takes to stop that muscle from moving. Botox can begin to work in 3days, but for many people it can be a week. Dysport has been known to kick in within a day or two. So, if you have a big event and you didn’t think far enough ahead to get your Botox, Dysport may be a better choice.

So what are the real differences to you, the consumer? Probably not much. Because Dysport is new and the company is trying to launch it, there have been price reductions, making it less expensive to try. Does it work faster? Sometimes. Does it last longer? Not significantly. But it is a reasonable, safe, and effective alternative that costs a bit less than Botox.

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[Comic Spolier] Grandes cambios en "The Transformers"

Al parecer los nuevos hibridos se vienen con todo luego de sucedido los aconteciminetos en "All Hail Megatron". Esto publicó la editorial a cargo de la serie. Con grandes cambios, idas y vueltas la historia en el primer número se centra en los Autobots varados en la Tierra luego de la huida de Megatron y los Decepticons.

Si quieren saber más acerca de que sucede con dos grandes del bando Autobot pueden y si son muy valientes como para leer la nota, presionen aqui (The Transformers #1 Sells Out) o sino pueden contenerse y esperar un poco mas ya que el primer número de esta serie estará a la venta.

Transformers Animated: imagenes de Ratchet y Arcee en modo cybertroniano

Asi es, para aquellos que los estaban esperando, Hasbro sacó a la venta los modelos de Ratchet y Arcee en modo cybertroniano, pero lamentablemente este producto se venderá exclusivaente en las jugueterias Toy R us, lo cual quiere decir que no serán distribuidos al resto de América y que aquellos que los quieran realmente tendran que aflojar el bolsillo, bien vayamos a las imagenes de las figuras.

Ratchet

Cabe destacar que uno de los cambios que trae esta figura es que no viene con sus imanes como se ve en la serie, sino que trae como una especie de dos estabilizadores.

Hay que dar credito tambien al modo alterno ya que en si es muy bueno, sobre todo los detalles.

Arcee

Esta figura es muy buena, y a pesar de que no soy fan de arcee, me agrada mucho su modo robot y sus espadas ya que le da una caracteristica muy elegante.

Su modo alterno me hace acordar mucho al de Hot Rod de G1. Igual me agrada mucho la idea del auto deportivo con los alerones ya que el diseño de la moto en versiones anteriores no convencia mucho ya que Arcee se caracterizo por ser un auto con caracteristicas feeninas.

Friday, November 20, 2009

Cool scene style hairstyles

Cool scene style hairstyles

Scene culture and scene hairstyles seem to have become more favorite as compared to emo hairstyles, which are generally not considered as cool hairstyles. Many youngsters who were even afraid to experiment with emo hairstyles, have now started thinking about cool scene style hairstyles. Scene hairstyles are getting more and more recognition by different people. In fact, many teenagers are thinking of getting a complete new-look by pulling off cool scene style hairstyles that can become an excellent means of keeping one step ahead in the race of hair fashion.

Cool Scene Style Haircuts and Hairstyles are regarded as few of the most fashion-forward hairstyles in the world of hair fashion, which were erst upon looked down as grotesque and bad hairstyles. Although it can not yet be generalized that all the scene style hairstyles are cool and stylish but there are couple of great new ideas for really cool scene style hairstyles. One thing is destined that scene hairstyles are no more treated as crazy or wild hairstyles unlike emo hairstyles.

Cool scene style hairstyles

Thursday, November 19, 2009

My recent experience at the other end of the needle....

I can now officially associate myself with Jenny McCarthy (and Vanessa Williams, Linda Evangelista, Joe Biden, John Kerry, and the many others who have had Botox).

With the addition of Michelle Boone, ARNP to our Orlando Aesthetic Surgery Practice, and with her assessment that it was "time", I finally consented to having a treatment with a botulinum type A toxin for my slowly deepening frown lines.

Because I was curious, and because she is so enthusiastic about it, we decided to use Dysport, the new Botox competitor from Medicis. Truth be told, other than a few minor details (more important to the practitioner than to the patient), the experience is identical to that with Botox for the patient (me), the results identical, the longevity of the outcome the same, and the cost lower. But the company doesn't have the marketing budget that Botox's manufacturer does, so not as many people have heard of it yet.

The whole treatment took but a few minutes and was minimally painful.
I had a great experience, mostly because Michelle is amazingly skilled- as a surgeon, I think I was guilty of underestimating the amount of skill it takes to reliably achieve the beautiful, natural result I now enjoy. I'm so happy to have her on my team- stop by and see us soon!

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Senate Bill Calls for Tax on Aesthetic Procedures

The recently revealed Senate Health Care Reform bill contains a 5% tax on all medical procedures not medically necessary. Really??

This type of tax has been tried in New Jersey, with poor results, and the tax was eventually repealed after projected revenues from the tax fell 72% short of projections. This is not surprising, as any tax professional would say that the best taxes have a broad base and a low margin- not the case here... If that's not enough, it really amounts to double taxation, as these procedures are not deductible in the first place.

Given that the vast majority of aesthetic patients are women, I'm concerned the tax is sexist, and is definitely unfair. Proponents of the tax may say that they intend the tax to target wealthy women, but the fact is that the vast majority of my patients are working women who save their money and/or finance the procedure (the same way we all finance other things that are important to us) because it was something important to them.

Taxing medical procedures, whether the government thinks they are necessary or not, would also compromise the integrity of the Doctor/Patient relationship and the health care system in general- it's a slippery slope from there...

I think this is a really bad idea.

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Update on Mammograms....

After reading everything I could find, and talking to lots of friends- radiologists, cancer surgeons, and women who feel their lives were saved because they had a mammogram (most of whom are in their 40's), I have come to the conclusion that, while the folks doing this recently reported research seem to have their hearts in the right place (I'll explain below), I think the drastic scaling back they recommend is probably not something I could endorse to my own patients...

First of all, here's why I think they were on the right track... What most people don't understand (this has become very clear in the aftermath of this report) is that mammograms are not entirely benign. They subject the breast (an organ already prone to the development of cancer) to a fair dose of radiation (and we know that radiation can CAUSE cancer). Further, the younger you are, the more mammograms you will have under the older recommendations (annual after 40), and the lower the likelihood that the mammogram will actually find something concerning.

On the other hand, I think that the number of women who have been saved by early detection cannot be denied... And if you have ever lost anyone you love to breast cancer, you probably couldn't disagree more strongly with anyone than you do with these researchers...

After considering this, my thinking is that the best thing for most women is probably somewhere in between the old recommendations and the newer ones..

Perhaps women should continue to have their first mammogram at 40, and then depending on the findings of that initial mammogram, future mammograms could be scheduled at annual (for higher risk patients) or every two years for patients at low risk, in order to minimize their radiation exposure.

I think that we do need to eventually come up with a better test... a safer test, and a more accurate test that is also affordable.

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Wednesday, November 18, 2009

Transformers Animated episodio 35 en descarga directa

Un poco fuera de tiempo pero aqui esta, el episodio número 35 de la tercera temporda de Transformers Animated titulado "Los cinco servos de la perdicion", una vez mas se agradece el trabajo a los chicos del blog de mdverde por este aporte, ahora a disfrutar.

Link de descarga: Los cinco servos de la perdicion

Tuesday, November 17, 2009

Screening Mammogram Recommendations to Change Again??

The United States Preventative Services Task Force has announced that after a thorough review of the available science and national experience with screening mammography, they recommend we reduce the number of screening mammograms we refer our patients for...

The recommendations had been that all women have an annual mammogram after age 40, and after age 35 if the patient had a significant family history of breast cancer. I had known, from conversations with friends who are radiologists, that not all in the radiology community agreed this was such a good thing, as evidently a screening mammogram involves a not insignificant dose of radiation to the breast tissue. Of course, all radiation can (over time) increase the risk of developing cancer, and so the risk of developing cancer as a result of the tool used to diagnose it early is highest in younger women. In other words, the younger you are, the less likely you are to actually have a cancer, and the greater the risk of the radiation the mammogram represents. Hence their other recommendation- that women without s significant family history of breast cancer and without a history of radiation to the chest wall not begin having mammograms until age 50. They further recommended that they only have them once every two years, in order to reduce this radiation exposure.

So are these sound recommendations??? What should an appropriately concerned person do? Breast cancer certainly is scary, and it takes too many mothers, sisters, grandmothers, wives, and daughters....

My initial reaction, having reconstructed many breast after mastectomy, and losing many friends to breast cancer over the years, was that they were making a big mistake... and possibly were making a big mistake in order to save money (the cost of annual screenings for all of America's women is not negligible)...

Bu after reading the reports and studying the numbers, I think I'm leaning towards agreeing with them. There can be no doubt that radiation can cause cancer, and that mammograms expose the breast tissue to a pretty good dose of radiation. There is also no doubt that the risk of this radiation causing a cancer is going to be highest in younger patients, and that the risk of breast cancer is lowest in these younger patients. So- younger patients (i.e., those in their 40's) who are not at otherwise elevated risk, are the ones with the least to gain from annual mammograms, and with the most at risk if we expose them to all that radiation.

Having said all of that, however, I'm asking myself the question that always represents the bottom line to me... What would I want my wife, sisters, and mother doing??

I believe in reducing the radiation exposure over a woman's lifetime; but don't think we should completely abandon mammograms in the 40s... Maybe the best thing to do is to have one at age 45, and then not again until 50 if the one at 40 was unremarkable...

Again, if there is any reason the patient is at higher risk, all bets are off and mammograms should start early and occur annually.

For my elective surgery patients, I would sat that because breast enhancement surgery does produce scar tissue within the breast, we should still obtain a baseline mammogram before surgery if you are over 40, and over 35 if you have a family history of breast cancer.

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Sunday, November 15, 2009

Should we care when Jessica Simpson gains weight?

Reading the headlines this morning with my coffee and biscotti, I saw that Ashlee Simpson said in a recent interview that the media should stop calling her sister fat. I think what she meant is that she doesn't think it's appropriate for us all to be so critical of her sister's appearance. And I agree.

As a plastic surgeon, I obviously spend a great deal of time talking with women who are unhappy with their appearance... Part of my job is to help them differentiate between a healthy motivation for reasonable, safe, and attractive change, and unreasonable requests for change that is either not in their best interests, or which is unlikely to achieve their goals. Thankfully most of my patients are very well adjusted and have healthy and reasonable expectations of what can be achieved through plastic surgery.

I believe very strongly, and indeed became a plastic surgeon because I think we all have a right to be happy with what we see in the mirror. I do not, however, believe that we should all want the same things- and I definitely don't think that any of us (no matter how famous) should be subjected to public criticism and insult when we don't look our best. Each of us must define our sense of what makes us feel attractive and healthy for ourselves. It's possible Ms. Simpson prefers the lifestyle which led to her evident weight gain... It's also possible that she is experiencing personal turmoil and that this is complicating her life enough to cause the outward change. The truth is that all of us have our ups and downs emotionally speaking, and if Ms. Simpson has had a difficult time getting motivated to exercise lately, well that should be allowed to be her personal battle.

Why are we so interested? I think a big part of it is the severe contrast between her Dukes of Howard appearance, when she represented nearly everyone's feminine physical ideal, and the photos of her at the now infamous chili cookoff wearing mom jeans. Some of it must also be the unhealthy interest we as a society seem to take in watching previously fortunate young people handle problems poorly. See Britney Spears, Lindsey Lohan, Paris Hilton, Chris Brown, etc...

The fact that Jessica's income is dependent on people wanting to see her looking her best is, I'm sure, not lost on her. I'm sure she understands that her health may suffer through weight gain. I'm sure she's doing her best to get her head on straight and find happiness and contentment. And I'm sure it must be a lot harder with all of us watching and criticizing her at every turn.

So I'm with Ashlee.. and I'm rooting for Jessica- not just because I (like every other red-blooded American male) thought she looked great in Dukes, but because I have four sisters, and a daughter, and I am a plastic surgeon... And I think young women should be allowed to develop a sense of health and well-being that is their own, and not imposed upon them. We should be concerned about what this all says about our culture- and be paying a bit more attention to how we raise healthy, well-adjusted girls who love themselves.

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Saturday, November 14, 2009

Choosing a Plastic Surgeon, Part 2

In a previous entry, I described how common it is for patients who contact my Orlando plastic surgery center to make the mistake of thinking that:

Anyone offering a plastic surgery procedure MUST be appropriately trained and certified to perform that procedure; this is, unfortunately, not the case.
All plastic surgery training is equal, and so shopping for the best price is the best way to choose a surgeon

In that previous entry, I explained how not all people offering plastic surgery are Board Certified Plastic Surgeons, and in fact, many are not even plastic surgeons! There are now many doctors in other specialties offering to perform plastic surgery procedures without the benefit of the years of training a plastic surgeon receives, convincing their patients that a few weeks of training is sufficient for them to learn what we learn in YEARS.

I explained the potentially dangerous error of choosing based on price.

Finally, I explained how to properly choose not only a surgeon, but also the importance of choosing the facility in which the procedure will be performed and also the anesthesia provider.

For today's entry, we'll assume a healthy understanding of these issues. Having done your homework, and ascertained that the surgeons you are considering are all plastic surgeons Board Certified by The American Board of Plastic Surgery, the facilities in which they operate are all certified by the AAAASF or JCAHO, and the anesthesia providers are all well-qualified, how do you make the final decision?

Here are my recommendations:

Consider the relative quality of the surgeon's medical school educations. While it is true that most medical educations will cover the basics, there is a reason that some institutions grow international reputations and perpetually fight for the best students. A medical school education among these "Best and Brightest" students and educators could reasonably be expected to produce (and historically has produced) America's finest doctors and surgeons. Ranking lists of medical schools take these things into consideration and are a useful resource. The most respected list, from US News and World Report, can be found here: http://grad-schools.usnews.rankingsandreviews.com/best-graduate-schools/top-medical-schools/research-rankings
Find out where the surgeon completed his/her Plastic Surgery Residency. This is the critical and years long process of going from a medical student to a qualified plastic surgeon, where we learn to do plastic surgery by gradually taking on more responsibility under the watchful eyes of other, already trained and experienced surgeons. Just like medical schools, not all training programs are equal in the breadth, intensity and quality of training offered. Generally speaking, those programs associated with the best medical schools also provide the best training, as they will be able to attract and retain the best, most experienced and reputable professors of plastic surgery- and the quality of our training will depend on the quality of those training us. For example, I completed my own Plastic Surgery training at Washington University in St. Louis, one of the top 5 medical schools in the United States- and it also happens to be the birthplace of American Plastic Surgery.
It bears repeating that you should be absolutely sure that the surgeon you are considering is Board Certified by The American Board of Plastic Surgery. This is easily done at the Board's site: https://www.abplsurg.org/ModDefault.aspx?section=PubFind It's also good to know the surgeon is a member of The American Society of Plastic Surgeons, which means they've completed plastic surgery training, become board certified, and maintain their education through regular attendance at conferences and meetings. The American Society for Aesthetic Plastic Surgery is another important society, and a surgeon's membership in this prestigious society means that on top of everything above, their practice is heavily focused on aesthetic/cosmetic surgery.
Know that surgeons who claim to be "Board Eligible" in plastic surgery are NOT board certified. This may be because they simply have not taken the examinations- but this is doubtfully the true explanation, as The American Board of Plastic Surgery specifically prohibits claiming ANY status with The Board until and unless you have passed all examinations. Much more likely is that they were unable to pass the examinations (or simply never took them), but realize they may lose patients if they don't find a way to fool them into thinking they have status with The Board. Are you starting so understand that not all doctors have integrity?
Spend some time thinking about the interactions you have had with the surgeon and his/her staff. You should realize that having a plastic surgery procedure is NOT a singular interaction, like buying a new handbag, in which once the bag is purchased (or the surgery completed) the interaction can be considered to be complete. Rather, you are choosing to enter into a very important relationship with your surgeon, the critical portions of which should be expected to last at least a few months beyond the date of your surgery, as you recover and heal. This very important relationship should therefore be approached with the same care you would give any other... think about whether you think the surgeon will be responsive to your needs and concerns, whether your personalities will allow healthy interaction, the approachability of his/her staff, etc... Remember- you don't only want to have achieved a great outcome when all is said and done... you want to have had an uplifting and positive experience you can look back on and smile! You can have this in the best practices.
Finally, never forget that what you are really looking for is the very best outcome you can achieve. Sometimes when I'm asked by friends and family how to sort through all the claims some surgeons make of being the best choice because they (the surgeon in question) were voted "the best" by some magazine, or because the surgeon simply says they are "the best", I am reminded of the first Clinton presidential campaign, in which the slogan "It's the economy, stupid" helped Mr. Clinton win the White House. Once you've done the homework outlined above, it's all about the OUTCOME... Ask to see photos of the surgeon's previous work- and ask yourself if you would be pleased if you looked like the photos they show you. Think about how many good photos they show you. Do most of the outcomes just look funny, with only a few that you think are attractive and natural, or are all of their results pleasing and attractive, even if every one may not be what you specifically want? If the surgeon can't show you at least a few outcomes you find attractive and pleasing, you should look elsewhere. Be sure to ask directly whether the photos you are being shown are the surgeon's own work (believe it or not, some actually do try to attract patients by showing them the work of others!) Don't be fooled by the hyperbole- just as Cuba Gooding says in Jerry Maguire- think Show me the {Outcomes}!
I also always recommend communicating with a few of the surgeon's prior patients who have had the same procedure they are recommending for you. You can ask the surgeon's staff for a list of patients who may have agreed to be called, or find testimonials online at one of the many plastic surgery websites now available. My favorite, because it is objective, free (surgeons cannot pay to be listed higher, so more credibility exists), and allows you to get a feel for the surgeon's manner and personality, is RealSelf: www.RealSelf.com

I know it seems like a huge amount of work, but after you've read this (as well as my prior post) a few times, you'll have a great understanding of the best way to proceed, and it will feel very comfortable and natural to you. Use the resources I've outlined, and use your gut- there are many great surgeons out there- with these guidelines you should be able to attain the outcome and experience you desire.

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Friday, November 13, 2009

La nueva serie de Transformers ya tiene nombre

Nota: Este es un Fan Art que encontre por ahi, lo cual les aviso que no es una imagen logotipo para la nueva serie.

Luego de una larga espera, despues de la convencion de inversionistas, Hasbro ha anunciado que lanzara para el año 2010 una nueva saga de Transformers. Como ya la noticia estaba corriendo por algunas paginas hace unos dias, Hasbro confirmo que el rumor es cierto. El nuevo nombre para esta serie sera "Hunt For The Decepticons", lo que en castellano seria traducido como "Caza de los Deepticons". Por el momento esta es la informacion que ha dado a conocer la empresa, ahora solo tenemos que esperar a fin de año a ver que es lo que sucede si deciden llevarla a cabo o solo guardarla en el armario, pero por el momento podemos estar tranquilos de que tendremos mas Transformers para disfrutar el proximo año.

New & Exciting Goings on in Our Orlando Plastic Surgery Practice and Surgery Center!

We're very excited to have Michelle Boone, ARNP (Advanced Registered Nurse Practitioner) join us!

Michelle has many years of experience in women's health care and indeed, is recognized by patients and providers alike as one of Florida's experts in Botox, filler treatments, sclerotherapy for veins, and laser applications in aesthetic medicine and surgery. She is often asked to speak and teach by Allergan, the manufacturer of Botox, Juvederm, and Latisse, and at national laser meetings.

To welcome her to our Orlando Plastic Surgery practice and introduce her to our patients, we are offering several specials that we hope you'll enjoy: (all through the New Year)

Botox for only $7 per unit. If you've been wanting to try Botox, now may be your best chance!

All fillers 30% off, including Restylane and Juvederm.

Receive a complimentary mini-facial with any filler treatment.

Mixto Laser Resurfacing for only $500. This represents a tremendous savings over our usual price, and the Mixto laser remains the state-of-the-art for resurfacing of the skin to improve wrinkles, brown spots, acne scarring and sun damage. Get beautiful new skin with a single treatment that allows you to be back in makeup in 4-5 days!

We know that all of our patients will love having Michelle in the practice, as she will really round out our offerings and complete the full service aesthetic wellness center concept we want to be able to offer.

Please join us in welcoming her, and maybe even stop in for some Botox!

Also, keep in mind, as the Holidays approach, that we do offer Aesthetic Enhancments Plastic Surgery gift cards!

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