Die vierte Naht im MACS-Lift

February 16, 2012 under Dr. Kai O. Kaye, Facelift, Lifting Facial, Neck Lift, MACS-Lift, Plastic Cosmetic-Surgeon, Plastic Surgery News, Scientific Publications and Lectures

Modifikation zur Verbesserung des ästhetischen Outcomes und Ausweitung der Indikation des Facelifts mit kurzer Narbe

Ein Schwachpunkt der klassischen MACS-Lift-Technik ist der relativ geringe Liftingeffekt im medialen und submandibulären Halsbereich, welcher zu suboptimalen ästhetischen Ergebnissen führt – insbesondere in Fällen ausgeprägten zervikalen Hautüberschusses und/oder harter Platysmabänder. Um diese Limitierung zu überwinden, beschreiben wir eine Modifikation der Originaltechnik, welche den Verjüngungseffekt im Halsbereich maximiert und die erwiesenen Vorteile der kurzen und kaum sichtbaren Narben beibehält. Die Modifikation der Technik durch Einführung einer vierten SMAS-Naht zur lateralen Platysmaplikation über eine 3–4 cm nach kaudal erweiterte Dissektion unterhalb der Mandibula führt zu einem stärker akzentuierten submandibulären Winkel und einer besser definierten Kieferlinie. In Kombination mit einer extensiven submandibulären Liposuktion/Lipektomie und – je nach Fall – der geschlossen Platysmamyotomie wird submandibulär ein konkaver Raum geschaffen, welcher die Einschlagung großer Mengen zervikalen Hautüberschusses ermöglicht und damit in den meisten Fällen eine zusätzliche anteriore oder posteriore Zervikoplastik obsolet macht („konvex wird konkav“).

Journal für Ästhetische Chirurgie, Online First™, 10 February 2012

A modified technique to overcome limitations and widen the indication for a short-scar lift

The main drawback of the classic MACS-lift is the poor lifting effect in the medial neck and submandibular area, which results in a suboptimal aesthetic outcome in cases of severe excesses of neck skin, as well as poor outcome in cases of severe platysmal banding. To overcome these limitations, we describe a modification of the original technique, which maximizes the rejuvenation effect on the neck while keeping the proven advantage of short and less visible scars. Modifying the technique by introducing a 4th SMAS suture to perform lateral platysma plication through a caudally extended dissection 3–4 cm below the mandibular arch/jaw line creates a more accentuated submandibular angle resulting in a sharper, more defined jaw line. Combined with extensive submandibular liposuction/lipectomy and in some cases closed platysma myotomy, this technique creates a concave submandibular space which enables redraping of a large volume of midneck skin, often eliminating the need for additional posterior or anterior cervicoplasty (“convex becomes concave”).

Journal für Ästhetische Chirurgie, Online First™, 10 February 2012

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French Breast Implant Boss Arrested

February 12, 2012 under Breast Enlargement, Breast Augmentation, Breast Lift, Breast Reconstruction, Breast Reduction, Plastic Cosmetic-Surgeon, Plastic Surgery News

From Reuters Health Information
French Breast Implant Boss Arrested

By Jean-François Rosnoblet

MARSEILLE, France (Reuters) Jan 26 – Jean-Claude Mas, the Frenchman who has sparked a global health scare by selling substandard breast implants, was arrested on Thursday and could be charged with manslaughter, the public prosecutor in the city of Marseille said.

In the first arrests since the two-year-old scandal grabbed headlines worldwide in December, Mas and a second executive at his now defunct company Poly Implant Prothese (PIP) were seized at their homes in southern France shortly after dawn.

If charged with involuntary manslaughter and causing injury, both could face longer prison terms than those they already risk in a parallel fraud case due to come to court around October.

French authorities have been criticized for being slow to react to a case that has sown fear among tens of thousands of women who carry PIP implants. French inspectors ordered them off the market in March 2010, due to concerns over their quality.

But only last month did officials in Paris recommend their surgical removal, drawing attention to the problem for patients worldwide whose implants were made by this company, which was at one time the third biggest global supplier.

Lawyers for women in France who have filed complaints over PIP implants welcomed the arrests and said there must be no escaping justice for the 72-year-old Mas, who has been quoted as deriding those suing him as being motivated only by money.

“This is a comfort for the victims,” said Laurent Gaudon, whose clients are pursuing PIP and surgeons who used its implants for fraud. “It’s the feeling that justice is advancing and they have not been forgotten. It’s the assurance that the guilty are at last going to be held accountable.”

Philippe Courtois, who represents 1,300 people with PIP implants, said Mas should not be freed pending any court case. “A degree of provisionary detention is desirable,” he said.

Mas and PIP’s former chief executive Claude Couty were still being questioned at home at midday, as police searched their premises. They were due to be moved to police custody in the Mediterranean port city of Marseille later, under the orders of prosecutor Jacques Dallest.

SUBSTANDARD SILICONE

PIP enjoyed years of success with international sales, but behind the scenes employees, and Mas himself, have admitted to hiding from certification agencies the fact they were using cheap, industrial silicone, not approved for medical use.

Health authorities in France and elsewhere have stressed that PIP’s products carry no proven link to cancer, but surgeons report that they have abnormally high rupture rates. Responses to the problem have varied among different foreign authorities.

Thursday’s arrests follow an investigation opened in Marseille, close to PIP’s former premises, on Dec. 8 after the death from cancer in 2010 of a woman with PIP implants.

Mas and Couty can be held for up to 48 hours while a judge decides whether to charge them with involuntary manslaughter and causing injury and, if so, whether to continue their detention or to free them on bail conditions.

A trial date could be years away, given the extent of inquiry required, but the graver manslaughter case could make it harder for Mas to avoid appearing in court later this year on other charges of fraud and deception.

That latter case targets half a dozen former PIP executives and could also carry prison terms for them of several years. It has dragged on as investigators have had to quiz up to 2,700 women who have filed complaints over PIP implants.

Mas, who sold some 300,000 implants around the world, has acknowledged that he used unapproved silicone but dismissed fears that it constituted a health risk.

Earlier in January, leaks from a police document showed Mas admitting to lying about the quality of PIP’s implants and describing the women filing complaints against him as just seeking money. The comments sparked public anger against him.

PIP closed down in March 2010 after regulators discovered it was using a non-approved silicone gel, and pulled its implants off the market.

In December 2011, the French government advised women with PIP implants to have them removed, and said it would even pay for the operations in France, sparking alarm around the world.

Governments in several other countries such as Britain and Brazil have asked women to visit their doctors for checks.

France has called for tighter European Union regulations on medical devices in wake of the PIP health scare, saying suppliers should be made to carry the same sort of authorization as suppliers of prescription medicine.

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History of Breast Implants

February 12, 2012 under Breast Enlargement, Breast Augmentation, Breast Lift, Breast Reconstruction, Breast Reduction

Background

The number of women in the United States who have breast implants is unknown, but current estimates derived from national surveys range up to more than 6 million. This represents more than 5% of the adult female population. The American Society of Plastic Surgeons (ASPS) collects information annually on plastic surgery procedures performed by its members. In 2008, approximately 307,000 women received breast implants for cosmetic breast augmentation and 111,000 for reconstruction of congenital or postmastectomy deformities.[1] These data do not include those procedures (mostly cosmetic) performed by non plastic surgeons such as otolaryngologists, general surgeons, gynecologists, and others.

Following adverse publicity in the early 1990s, interest in the procedure fell significantly, especially for gel-filled devices, but it seems to have recovered incrementally. According to the ASPS, in 2008, 53% of total breast implants were filled with saline; 47% were filled with silicone.[1, 2]

Prior to 1963, various plastic foam materials were used; for breast augmentation, however, it became apparent that the air cells would collapse and, combined with tissue ingrowth, shrink and harden the device. These materials were wrapped in plastic film to minimize this effect to no avail. Amazingly, some of these implants were so well tolerated that they have stayed in place to this day.

The modern silicone breast implant has been available since 1963 and has gone through an evolution of change and improvement. Several types of devices, with many variations, shapes and styles within each class, are now available or under testing for US Food and Drug Administration (FDA) approval. Basic to all implants is a silicone rubber (elastomer) shell, which can be single or double, smooth or textured, barrier-coated, or covered with polyurethane foam. The foam-covered devices have not been available in the United States since 1990 but are still marketed in Europe.

The contents are either factory-filled with silicone gel of various consistencies or inflated at surgery with normal saline. One brand that was manufactured overseas was prefilled with saline at the factory. It was briefly marketed in the United States but was later withdrawn when the FDA denied approval.

The double-lumen devices consist of concentric balloons that contain silicone in one chamber and saline in the other. The only one still in use is the Becker, which has an outer layer of gel and an inner balloon that is valved to permit postoperative gradual inflation with saline. This is termed a “permanent tissue expander,” since it permits gradual and temporary overinflation to create the pocket and then can be left in as a permanent implant after the size is adjusted appropriately. At this writing, the Becker devices are not generally available in the United States until current FDA mandated studies are evaluated.[3] For more information on expandable implants, see eMedicine article Uses of the Postoperatively Adjustable Implant in Aesthetic Breast Surgery.

In 1990, the FDA placed a moratorium on gel-filled implant use for cosmetic augmentation. They remained available for reconstruction and replacement, but mandated extensive record keeping, follow-up, and IRB approval were required for use. In 2006, after extensive study and analysis, the FDA deemed the device safe for all augmentation and reconstructive purposes, but they continue to require tracking of patients.

Saline Implants

Saline filled implants are available as empty silicone balloonlike devices to be filled with normal saline at the time of surgery. This permits subtle size adjustments to compensate for asymmetry between the breasts. They are less popular than silicone implants, as they often may have a less natural feel. If the patient has very little breast tissue or only a skin covering after mastectomy, unsightly wrinkles and folds of the device may be visible on the breast. This is more common when the surface is textured.

Silicone Gel Implants

Three generations of basic design of this device have been created, with many variations within each type.

First generation

The first models to be marketed had envelopes of thick, smooth-walled silicone elastomer made in 2 sections, filled with a viscous silicone gel material (dimethylsiloxane) and glued together. They were available in only three sizes: small, medium, and large. In the first few years, surgeons believed that the device required attachment to the tissues to prevent migration. Scar ingrowth for fixation was accomplished by patches of material (eg, Dacron mesh or perforated silicone) attached to the back of the device or by an outer covering of polyurethane foam. The Dacron and silicone patches were subsequently found to be unnecessary; they actually detracted from the quality of the result. Some patches or tabs created a stress point that led to tears of the envelope. Fixation patches were eliminated in the early 1970s.

Second generation

Manufacturers varied the gel consistency and shell thickness in an attempt to improve performance. Beginning in the mid-1970s, the shells were made thinner and the gel less viscous (ie, more “responsive”), primarily in an ill-conceived attempt to control hardening from scar shrinkage (capsular contracture.) This trend reversed in the early 1980s when it was recognized as not effective in reducing contracture and as resulting in a more fragile device. Most were broken 10 years later.

Third generation

New formulations of the shell and gel contents became available that were stronger and had a second barrier coat of diphenyl silicone. This coating almost totally eliminated so-called “gel bleed” or diffusion of small amounts of the silicone oil through the implant shell. The gel content also was made more viscous and cohesive.

In 1989, textured-surface shells that many surgeons hoped would minimize the incidence of unwanted firmness from capsular contracture became available. Recent studies are somewhat confusing regarding whether this was effective. The textured implants had the disadvantage of a higher rupture rate than the more traditional smooth shells and often produced visible wrinkles in the breast in women with very little overlying tissue to mask the ripples. Because of these shortcomings and lack of solid evidence that these devices were softer, they have become much less popular in recent years.

Polyurethane-covered implants

In the late 1960s, a variation of the device was developed containing a polyurethane sponge coating over an otherwise standard gel-filled implant. Although the coating originally was planned as a fixation layer, many surgeons came to believe that the foam cover resulted in a decreased incidence (or at least a delayed onset) of capsular contracture. These implants also evolved in shape and design, culminating in the early 1980s with the Meme and Optimam styles. In April 1991, the manufacturer voluntarily withdrew the foam-covered implants from the market.[4]

One style, the MemeME, had a unique construction. It had no true shell, but a skin of sorts was formed in situ by spraying the surface with silicone containing extra catalyst prior to curing. This increased the crosslinking of the surface to create a shell-like membrane. The polyurethane foam was then shaped and sealed over the surface. Implants of this particular type were known to occasionally extrude some of their gel contents through the foam when squeezed. This is a possible explanation for reports of blood being found within the substance of the gel in apparently intact implants. The MemeME model was marketed from 1983-1988.

Other filler materials

While silicone remains the only available shell material, new filler substances were in use in Europe and South America and, at one time, were under development or in experimental trial in the United States. Various hydrogels and a pure form of triglycerides were the 2 main formulations. The major advantage of the triglyceride formulation (Trilucent) was that it had a Z number (measure of radiolucency) similar to that of fat, thus resulting in little or no compromise of mammography. Another fill substance, polyvinyl pyrrolidone in saline, was briefly available, under the trade name Misty Gold. None of these products is currently available in the United States. At this time, only silicone gel or saline-filled models are available for use in the United States.

Recent developments

In late 2006, a new formulation of silicone gel filler called MemoryGel (Mentor Corp, Santa Barbara, Calif) gained FDA approval.[5] This gel implant is thicker and more cohesive so as to minimize gel spread in the case of rupture and to resist scar shrinkage that would deform its contour. When cut, the gel retains its shape and doesn’t run. This device has a doughy feel to it.

Currently available devices in the United States are saline- or silicone-filled implants with either textured or smooth surfaces. They come in round or tear drop shapes with a choice of 3 different projections. Only 2 companies, Mentor Corporation and Allergen (a successor to McGhan and Inamed), have FDA approval to market these devices in the United States.

The implants produced currently are much improved devices compared to earlier units. The shell is still made of an outer layer of a mix of dimethyl siloxane and amorphous silica with an inner barrier coat of diphenyl siloxane to minimize silicone gel bleed. The shells, on testing for breakage, exceed the American Society for Testing and Materials (ASTM) requirements by more than 300%. The gel is more cohesive, varying from a standard 60% crosslinking to 80% for the more cohesive type nicknamed “gummy bear” (because of is consistency similar to the candy).

As evidenced by sales figures prior to the moratorium, and now following their release for cosmetic purposes, approximately 80-85% of surgeons and patients prefer the quality of results obtained by gel implants, making them the implants of choice. In 1997, sales figures for Europe, where usage was unrestricted, show a distribution of 70% for gel, 15% for saline, and 15% for alternate fills such as triglycerides (then still available) and hydrogels for cosmetic use.

Safety

Silicone is probably the most studied implantable material available today. After over 35 well-conducted studies from many countries, it seems certain that this material does not cause disease. The results of more than 7 long-term follow-up studies show that women with implants have a reduced incidence of breast cancer than is otherwise expected in the general population. No hard evidence reveals that a broken implant is harmful. Almost all of the problems that can occur with breast implants, such as infection, hardening, extrusion, and malposition are related to the surgical procedure or the patient’s own biology, not the device.

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Medical devices: European Commission asks for further scientific study and draws first lessons from the recent fraud on breast implants

February 7, 2012 under Breast Enlargement, Breast Augmentation, Plastic Surgery Trends, Scientific Publications and Lectures

Brussels, 2 February 2012 – Following today’s publication of the Scientific Committee on Emerging and Newly Identified Health Risks (SCENIHR) on the safety of silicone products manufactured by the Poly Implant Prothèse (PIP) Company, the European Commission requested to conduct further in-depth study on the potential health impact of faulty breast implants.

The Commission will also discuss with the Member States how surveillance of the medical devices can already be reinforced immediately within the existing legislative framework. In parallel a “stress test” of the legislation on medical devices is under way in order to identify how best the questions raised by this issue can be addressed in the revision of this framework already foreseen for 2012..

Health and Consumers Commissioner, John Dalli said: “In the current situation, patients’ health remains the priority. The opinion published today sums up the current scientific knowledge on this case”. To add : “Furthermore, the Commission will discuss with the Member States a series of immediate measures to strengthen the existing surveillance and safety controls on medical devices already on the market. The capacity to detect and minimize the risk of fraud must be increased”. To conclude : “We had already been working on a revision of the Medical Devices Directive, envisaged for adoption  this spring.  We will now also take into account the lessons learnt from this case and take them on board in redrafting our legislation, in particular with regard to market surveillance, vigilance and functioning of notified bodies.”

Scientists concluded that data available today was insufficient to lead to firm conclusions regarding the health risk for women with PIP silicone breast implants.

The SCENIHR report (requested by the Commission in early January) stresses that, based on the limited data currently available, there is some concern regarding the possibility of inflammation induced by ruptured PIP silicone implants. The report concludes that each case needs to be assessed individually, so the advice remains that women who are worried should contact their surgeon.

Scientists also recommend that further work be undertaken as a priority to establish with greater certainty any health risks associated with PIP silicone breast implants, in order to ensure that potential risks are properly established, quantified and managed.

With regard to the question of whether the breast implants manufactured by PIP are more prone to failure than those of other manufacturers, SCENIHR said that PIP implants have been found to vary considerably in composition and as a result are likely to vary substantially in performance characteristics.

SCENIHR concluded on the basis of available data, that many PIP implants were manufactured from non-medical grade silicone. This type of silicone may contain some components that can weaken the implant shell and diffuse into the body tissues.

Next steps
First, the European Commission will ask the Scientific Committee to pursue a more in-depth investigation based on data from investigations by Member States.

Second, the Commission will discuss with the Member States how surveillance of the medical devices can be reinforced immediately within the existing legislative framework. These issues could include further recourse to unannounced inspections, enhanced controls of notified bodies and additional sample testing on products already on the market.

Third, the Commission is also conducting a stress test in order to identify how best the questions raised by this issue can be addressed in the upcoming revision of the legislation on medical devices which was already underway. The Commission still envisages adopting a proposal on the revision of the Medical Devices legislation in the course of this semester.

National health authorities in the Health Security Committee convene by audio conference today to discuss the follow up to the Opinion.

Background
Breast implants fall under the European legislation on medical devices1. This legislation requires that, before placing such devices on the market, the manufacturers must carry out an assessment to ensure that their devices fulfil the relevant legal requirements, and in particular that their devices will not compromise patient safety. For high risk devices, such as breast implants, a third party conformity assessment body, so-called notified body, is involved in the conformity assessment procedure.

In the present case, an investigation triggered by an unusually high short-term breast implant rupture rate has shown that a manufacturer (Poly Implant Prothèse Company) fraudulently made use of industrial silicone instead of the approved medical grade silicone. The product was withdrawn from the EU market in 2010.

On the basis of available data, it is estimated that around 400 000 PIP silicone breast implants were sold worldwide. These implants were available in nearly all European Union Member States – in particular they were widely used in the United-Kingdom, France, Spain and Germany, where respectively around 40.000, 30.000, 10.000 and 7.500 women were implanted with PIP silicone breast implants.

Work of the SCENIHR
SCENIHR is an independent advisory body established by the Commission. Its members are chosen on the basis of scientific excellence and they advise the Commission on issues associated with new and emerging health risks.

The current rapid opinion drew on top international scientists’ expertise in fields of plastic surgery, polymer science, senology and medical epidemiology.

To see the full scientific opinion on the safety of PIP breast implants, see
http://ec.europa.eu/health/scientific_committees/emerging/index_en.htm

Link to Medical Devices Directive:
http://ec.europa.eu/health/medical-devices/regulatory-framework/index_en.htm

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Scientific Publications and Lectures

October 28, 2011 under Dr. Kai O. Kaye, Scientific Publications and Lectures

Dr. Kaye is a fully registered Plastic Surgery Consultant in Germany, Spain and the UK. He has lectured at national and international conventions and has published several articles in the field of plastic and aesthetic surgery.
He is a full member of various prestigeous international scientific societies (DGPRÄC, EBOPRAS, IPRAS).

Annual Meeting of the German Society for Aesthetic Surgery DGÄC
The 4th suture in MACS Lift. A Modification to Overcome Limitations
and to Widen the Indication of a Short Scar Lift.
Düsseldorf, Gemany
Dr. KAI O. KAYE
Oct. 2011

World Congress of Plastic Surgeons of Lebanese Descent
The 4th suture in MACS Lift. A Modification to Overcome Limitations
and to Widen the Indication of a Short Scar Lift.
Dr. KAI O. KAYE, Dr. DANIEL SATTLER (ES, DE)
Oct. 2010

3rd Congress of EASAPS
European Association of Societies of Aesthetic Plastic Surgery, Aachen, Germany
“The 4th suture in MACS-Lift – a modification to overcome limitations and to widen the indication of a short scar lift”
Kaye KO
June 2010

IMCAS – International Master Course on Ageing Skin, Paris, France
„The MACS-Facelift enhanced – overcoming limitations with additional minimal invasive procedures“
Kaye KO, Taylor L, Sattler D
January 2010

19. Symposium für ästhetische, plastisch-rekonstruktive Gesichtschirurgie, Kampen, Sylt
„The MACS-Facelift enhanced – complementary side procedures in aesthetic facial surgery“
Sattler D, Taylor L, Kaye KO
May 2009

American Society for Plastic Surgery – International comittee for Quality Assurance in Medical Technologies & Devices in Plastic Surgery Transatlantic Innovations, Paris, Frankreich
„The MACS-Facelift enhanced – complementary procedures and overcoming difficulties“
Kaye KO, Sattler D, Taylor L
April 2009

European Congress for antiaging and aesthetic medicine; Düsseldorf
„The MACS-Facelift enhanced – complementary procedures in aesthetic facial surgery“
Kaye KO, Sattler D, Taylor L,
September 2008

Annual meeting of the German Society for Plastic, Reconstructive and Aesthetic Surgery (DGPRÄC)
„Postoperative changes of the breast form following breast reduction after Lejour’s Technique –2 year results of 100 cases”
Kaye KO, Tanzella U, Ueberreiter K
2005

Technical University of Munich TUM: Doctoral Thesis /PhD
„The effects of Implantation of a Silicone-sheet on the neovascularization in a prefabricated skin flap- Experimental study in the rabbit model”
Kaye KO
2003

Annual meeting of the German Society for Plastic, Reconstructive and Aesthetic Surgery(DGPRÄC)
„The use of injectable polyacrylamid (AQUAMID) for soft tissue augmentation of the face –1- year results of a multi-center study”
Kaye KO, Tanzella U, Ueberreiter K
2002

Annual Meeting of the German Workgroup for Microsurgery (DAM)
„The effects of Implantation of a Silicone-sheet on the neovascularization in a prefabricated skin flap- Experimental study in the rabbit model”
Kaye KO, Miele N
2001

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The Reference for Medical Tourism on Costa del Sol

October 14, 2011 under Dr. Kai O. Kaye, Facial Feminisation, Plastic Cosmetic-Surgeon

Ocean Clinic is about to become the most important center for Plastic, aesthetic, and reconstructive surgery on Costa del Sol.  Dr. Kai O. Kaye, director of Ocean Clinic, is ready to announce the completion of the extension of its surgical-medical unit, making it the most comprehensive, secure and complete clinic of it’s kind in Marbella.

 

Ocean Clinic goes beyond other aesthetic clinics and is preparing itself to become one of the most important plastic surgery centers on Costa del Sol. By the end of this year, the extension of its installations will be ready, allowing Ocean Clinic to have at its disposal the most complete, sate-of-the-art surgical installations in Marbella.

As pointed out by Dr. Kaye, “during the last three years, we have grown enormously as a company. This fact has permitted us to consider this extension with the aim of offering our clients a service of an even higher quality.
The new operating suite will allow Dr. Kaye and his team to offer a completely private, independent and exclusive service, placing the standards of quality and security in excellence above all. The extension of Ocean Clinic will permit a comprehensive treatment of a demanding international clientele, who are cared for by Dr. Kaye and his carefully chosen nursing team in luxurious surroundings.

All Ocean Clinic’s medical personnel are highly qualified. They have been selected for their outstanding medical qualifications after having demonstrated a verified experience in the field of aesthetic, plastic, and reconstructive medicine. All speak foreign languages. And, for the clients of Arab origin, Ocean Clinic has at its disposal an Arab coordinator who offers confidence and specialized service in order to assure that the Arab clients feel secure and understood Additionally, along with the extension of Ocean Clinic, the Unit for Maxillofacial Surgery and Facial Feminization will be of increasing importance, expected by Dr. Kaye to become one of THE references in Europe as a whole. “Ocean Clinic will provide together with Facial Team Europe a Maxillofacial surgery service which I feel will be very welcome. Together with other surgeons of recognized prestige and verified experience chosen by me personally, we will offer the best service in this specialty on Costa del Sol”.

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Does Liposuction offer more than a cosmetic benefit?

October 14, 2011 under Abdominoplasty, Liposuction

September 30, 2011 (Denver, Colorado) — Patients who receive liposuction or liposuction with abdominoplasty might emerge from those procedures with metabolic profiles less attuned to cardiovascular disease and other complications, a recent study of 322 individuals who presented with a range of body mass indices has found.

According to Eric Swanson, MD, a plastic surgeon in Leawood, Kansas, decreases in circulating triglyceride levels and leukocyte counts in both men and women after fat-reduction surgery have a beneficial impact on the reduction of systemic inflammatory status, and might illuminate the role of subcutaneous fat relative to visceral fat in disease mechanisms and type 2 diabetes.

cosmetic-plastic-surgery-cosmetic-plastic-surgery-cosmetic-plastic-surgery-

 

Dr. Swanson presented data from his prospective study here at Plastic Surgery 2011: American Society of Plastic Surgeons Annual Meeting.

“Patients with normal triglyceride levels experienced no significant change after liposuction,” he told Medscape Medical News. “However, patients with levels of greater than 150 mg/dL demonstrated a 43% reduction. In fact, 62% of these patients whose levels were at risk before liposuction had normal levels after liposuction.”

Triglyceride levels above 150 mg/dL have been associated with an elevated risk for metabolic syndrome, type 2 diabetes, stroke, coronary artery disease, and peripheral vascular disease.

“We do know that the drop in triglyceride levels we found in these patients actually exceeded what can be accomplished medically,” Dr. Swanson explained, “so it may be that there is a therapeutic benefit.”

Dr. Swanson and colleagues reviewed data from 270 women and 52 men who scheduled fat-reduction procedures over a 2-year period; 22% were considered obese. In the study, 229 underwent superwet ultrasonic liposuction alone and 89 underwent liposuction combined with abdominoplasty. Among the women, 65% underwent lower-body procedures; among the men, 85% underwent trunk fat procedures. Fasting blood tests were performed preoperatively, and at 1 and 3 months postoperatively.

Among the patients undergoing liposuction alone, mean triglyceride levels decreased 26% (P < .05). Of this group, 37% presented with elevated triglyceride levels prior to surgery; that proportion dropped to 18% after the procedure (P < .001).

Patients who underwent liposuction with abdominoplasty experienced reductions that were less dramatic.

Dr. Swanson asserted that this evidence throws light on discussions concerning the metabolic role of fat under the skin, in comparison to the fat that surrounds internal organs.

“A 2004 study published in the New England Journal of Medicine found no difference in lipid levels after liposuction [N Engl J Med. 2004;350:2549-2557]. But that study was limited by the fact that there were only 15 patients — all obese females and all treated in the abdomen only,” he said.

“My study found that there is a substantial reduction in triglyceride levels, probably because not all patients were obese. Thus, the fat reduction relative to total body fat was proportionately greater. For decades, the medical community has viewed visceral fat as more harmful than subcutaneous fat. Many studies have challenged this traditional concept. My study suggests that subcutaneous fat is just as important metabolically as visceral fat.”

The findings suggest a need for additional research to quantify the true contribution of subcutaneous fat to various disease etiologies, he said.

Al Aly, MD, professor of surgery at the University of California in Irvine, who was not involved in the research, agreed that the question carries a fair amount of clinical significance.

“Visceral fat has function. You can’t just go in there willy nilly and cut out visceral fat,” he explained. “We need to leave that alone. I don’t think that with this scientific paper we can say noncentral (subcutaneous) fat is more important. All you can say is that it may have a role. We don’t know the effect of each on cardiovascular health; we need to look at that a little more carefully because we’ve ignored subcutaneous fat. I think that’s a very important point made by this paper. Some of the assumptions that we’ve made could be wrong, or need to be altered.”

Dr. Swanson also observed a significant decrease in mean white blood cell count 3 months after liposuction only (11%; 7030 to 6250 cells/μL; P < .001) and after liposuction with abdominoplasty (12%; 7220 to 6330 cells/μL; P < .001). Previous investigations have found that individuals with higher mean leukocyte counts (8800 cells/μL) have a significantly greater risk for coronary heart disease than those with levels closer to 5600 cells/μL.

No significant changes were recorded in total cholesterol, low-density-lipoprotein cholesterol, or high-density-lipoprotein cholesterol.

“We know…that lower triglyceride levels and lower white counts tend to be associated with fewer health risks,” Dr. Swanson concluded. “However, nobody has actually followed a group of patients after liposuction of a period of years to see if they encounter fewer medical problems. This is the logical next step.”

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“We make people happy because we go beyond beauty itself”

September 23, 2011 under Botox, Dr. Kai O. Kaye, Plastic Cosmetic-Surgeon, Plastic Surgery FAQ


 The motto of the clinic is “beyond beauty itself”. What is the significance of this phrase?
I chose this motto because it is a common phrase in Plastic and Cosmetic surgery. What it means is that, beyond beauty itself there is a concept, an aesthetic vision. That besides being a surgeon with good hands, one must be a good psychologist for the patient,  and know what one has to do. I think that everyone who works in this sector should have a great appreciation of the aesthetic. At Ocean Clinic we are noted for our appreciation of the aesthetic, for maintaining beauty and going beyond beauty itself, with cosmetic surgery treatments, body care etc. We want to fulfil the positive effects of this new aspect in your life by adding assurance, quality and peace of mind in all our treatments.

 In what measure are the ‘artist’s’ or surgeon’s hands an influence?
They are very important. There are many different ways to deal with cosmetic problems and one should find the best way in each case. I think the first consultation is the most important one for the patient, when they speak with the surgeon who is going to attend them. Here at Ocean Clinic the treatment is personalized, patients do not speak to a ‘salesperson’, or with an intermediary between them and the doctor. Here they speak directly to the person who is going to operate on them. The ‘house of surgery’ has different columns that sustain it, one is Plastic Surgery. That means, performing operations for the sake of beauty, without the presence of an illness that has damaged some part of the body. The other is Aesthetic Surgery, when you reconstruct something that has been damaged by cancer, an accident etc. Both specialities have something in common; we make people happy every day. The important thing in this work is to listen, so there are no misunderstandings. There usually are complications, but not too many. In the majority of cases, problems occur because of misunderstandings between, what the patient wants, and what they get after surgery. We don’t have these problems at Ocean Clinic, for the importance we place on listening and understanding our patients. Besides, the surgeon should also be honest and know how to say no to certain things. Patients have come here asking me for certain things, that I knew were not appropriate, that they wouldn’t be happy with, and I decided not to treat them. Honesty should be another of the columns that support this house.

 When did the clinic begin operating in Marbella?
I’ve been in Marbella four and a half years, but I started the Ocean Clinic two years ago.

 What services do you offer your clients?
My main speciality is Reconstructive Surgery and within Cosmetic Surgery, I specialise in the facial area. Besides this we collaborate closely with other doctors of Maxillofaciall Surgery from the Agave Clinic in Marbella. This allows us to treat facial bone problems as well. The collaboration with Agave Clinic Marbella, includes sex reassignment surgery as well. As a clinic we offer a wide range of services; lifting, blefaroplasty, rhinoplasty, otoplasty, breast augmentation / reduction, breast reconstruction, liposuction, tummy tuck, scar correction, deep peeling, botox, filler and cosmetic dentistry.

 Where do you perform the surgical interventions?
There are two routes. If they are small operations performed under sedation or local anaesthetic, we carry them out here in our clinic. More important operations, requiring a general anaesthetic and hospitalization are performed at the USP Hospital.

 Botox and Fillings are very popular, minimally invasive  cosmetic treatments. What advantages do they have with respect to  other treatments?
There are two groups. On one hand there’s  Botox and on the other hand Fillings. Fillings are different substances that are injected under the skin to give volume or correct wrinkles. Also there are two kinds of wrinkle. Wrinkles begin life as a dynamic wrinkle, that is, they only appear through muscular action, this is where Botox works. Some years later, the wrinkle becomes static, that means the deepest layer of the skin has broken a little. It has opened, and we see a wrinkle, which is also visible when the muscle is relaxed. In this case we have to work with (tissue) fillers. Also in the case of Botox, one has to bear in mind that it is the only preventive technique that exists in Cosmetic Surgery. That is to say, if you are treated with Botox, you’ll have fewer static wrinkles. At Ocean Clinic we advise both treatments, but always with moderation.

 dr-kaye-oceanclinic-surgeonDo you think Marbella has become a benchmark clinic worldwide, in cosmetic surgery?
Worldwide no, but in Europe, yes it is. The number of tourist that come to Marbella for Plastic or Cosmetic Surgery has grown over the last couple of years. The only problem is that Spain will never be able to compete with the  prices offered in Asia or Brazil, where the cost of living is much lower, hence the low cost of operations. The strong points here are; the hospitals and clinics are very good, there’s five star cuisine, there’s a beach, sea… In fact a lot enticements for the ‘cosmetic’ tourist, that make a visit to Marbella of greater value.

 Has the number of Ocean Clinic’s male patients  increased over the last years?
Yes, everyday more men decide to have surgery. For example, according to Ocean Clinic 2009 records, 25% of the patients we treated were male. The principal treatments performed on male patients are rhinoplasty and liposculpture.

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Hacemos felices a la gente porque vamos más allá de la belleza

September 23, 2011 under Botox, Dr. Kai O. Kaye, Plastic Cosmetic-Surgeon, Plastic Surgery FAQ

Domingo, 07 de Noviembre de 2010 13:43

Ocean Clinic abrió sus puertas en Marbella hace dos años. De la mano del doctor Kai O. Kaye, la clínica se ha convertido en un referente tanto en tratamientos plásticos como estéticos, realizando sus procedimientos quirúrgicos en el prestigioso hospital privado USP de Marbella.

El lema de Ocean Clinic es “más allá de la belleza”. ¿Qué significado encierra esta frase?
Elegí este lema porque es una frase común en Cirugía Plástica y Estética. Lo que quiere decir es que hay muchas cosas que van más allá de la belleza, hay un concepto, una visión estética, porque además de ser un buen cirujano con las manos debes ser un buen psicólogo para ver dentro del paciente y saber lo que quieres hacer. Creo que todo el mundo que trabaja en este sector debe tener un gran gusto estético. En Ocean Clinic nos destacamos, por este gusto estético, por mantener la belleza e ir más allá con tratamientos de cirugía, estética, cuidados corporales, etc. Queremos hacer realidad los efectos positivos de ese nuevo aspecto en su vida añadiendo seguridad, calidad y paz de espíritu en todos nuestros tratamientos.

 ¿En qué medida influyen las manos del ‘artista’, el cirujano?
Son muy importantes. Hay muchas formas diferentes de tratar los problemas de estética y cada uno debe encontrar el que mejor va con él. Creo que la primera consulta es lo más importante para el paciente, cuando hablan con el cirujano que les va a tratar. Aquí en Ocean Clinic el trato es personalizado, los pacientes no hablan con un ‘vendedor’, con una persona intermediaria entre ellos y el médico, aquí hablan directamente con la persona que les va a intervenir. La casa de la cirugía tiene diferentes columnas que la sujetan, una es la Cirugía Plástica, es decir intervenciones que se practican por la belleza, sin que detrás exista una enfermedad que haya deteriorado alguna parte del cuerpo. Otra es la Cirugía Estética, cuando reconstruyes algo que se había estropeado a raíz de un cáncer, un accidente, etc. Tanto una especialidad como otra tienen algo en común: hacemos felices a personas todos los días. Lo importante de este trabajo es escuchar, para que no haya malos entendidos. Generalmente complicaciones hay, pero son muy pocas. En la mayoría de los casos, los problemas vienen porque hay malos entendidos entre lo que el paciente busca y lo que finalmente obtiene tras pasar por el quirófano. En Ocean Clinic, estos problemas no los tenemos por la importancia que otorgamos a escuchar y entender a nuestros pacientes. Además, el cirujano también debe ser honesto y saber decir que no a ciertas cosas. Hay pacientes que han venido pidiéndome determinadas cosas y yo sabía que no eran adecuadas, que no les harían felices, y he decidido no tratarlos. La honestidad debe ser otra de las columnas que sujetan esta casa.

¿Cuándo comenzó la actividad de la clínica en Marbella?
Yo llevo en Marbella cuatro años y medio, pero puse en marcha Ocean Clinic hace dos.

 ¿Qué servicios ofrecen a sus clientes?
Mi mayor especialidad es la Cirugía Reconstructiva y dentro de la Cirugía Estética estoy especializado en el área facial. Además, colaboramos estrechamente con otros doctores de Cirugía Maxilofacial de Agave Clinic Marbella y en este campo podemos tratar también los problemas de los huesos de la cara. En la colaboración con Agave Clinic Marbella se incluyen también las operaciones de cambio de sexo. Como clínica ofrecemos una amplia gama de servicios: lifting, blefoplastia, rinoplastica, otoplastia, aumento/reducción de pecho, reconstrucción de pecho, liposucción, tummy tuck, corrección de cicatrices, deep peeling, botox, filler y estética dental.

 ¿Dónde realizan los procedimientos quirúrgicos?
Hay dos caminos. Si son operaciones pequeñas que se hacen con sedación y anestesia local las realizamos aquí en nuestra clínica. Las operaciones más importantes, que conllevan anestesia general e ingreso hospitalario se realizan en el Hospital USP.

 

 El Botox y los Rellenos son recurso cosméticos mínimamente invasivos con gran popularidad. ¿Qué ventajas tienen respecto a otros tratamientos?
Hay dos grupos. Por un lado está el Botox y por otro los Rellenos. Los Rellenos son diferentes productos que se inyectan de forma superficial, por debajo de la piel para dar volumen o corregir arrugas. También hay dos tipos de arrugas, las arrugas empiezan su vida como una arruga dinámica que sólo se producen por la acción del músculo, aquí sí funciona el Botox. Unos años más adelante la arruga se convierte en estática, es decir la capa más profunda de la piel se ha roto un poco, se ha abierto y se ve una arruga que también es visible cuando el músculo está relajado, en este caso hay que trabajar con Rellenos. En el caso del Botox además, hay que tener en cuenta que es la única técnica preventiva que existe en Cirugía Estética, es decir, si te tratas con Botox tendrás menos arrugas estáticas. Desde Ocean Clinic aconsejamos ambos tratamientos, pero siempre con moderación.

dr-kaye-oceanclinic-surgeon ¿Crees que Marbella se está convirtiendo en un centro de referencia mundial a nivel de estética?
Mundial no, pero en Europa sí que es una referencia. En los últimos años ha crecido mucho el número de turistas que llegan a Marbella para realizar tratamientos de Cirugía Plástica o Estética. El único problema es que España, nunca va a poder competir con los precios que se ofrecen en Asia o Brasil, donde el nivel de vida es más bajo y por tanto las operaciones también. Los puntos fuertes que existen aquí es que los hospitales y las clínicas de Marbella son muy buenos, también hay una gastronomía de cinco estrellas, hay playa, mar… Muchos alicientes para que el turista ‘estético’ de doble valor a su visita a Marbella.

 ¿Ha aumentado en los últimos años el número de pacientes masculinos en Ocean Clinic?
Sí. Cada día son más los hombres que se deciden a pasar por el quirófano. Por ejemplo, según los datos de 2009 en Ocean Clinic el 25% de los pacientes que tratamos fueron hombres. Los principales tratamientos a los que se someten los pacientes masculinos son rinoplastia y lipoescultura.

 

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Plastic surgery questions answered by Dr. Kaye

August 25, 2011 under Dr. Kai O. Kaye, Plastic Surgery FAQ

Dr. Kai O. Kaye, Director and Head Surgeon of Ocean Clinic, is answering the most important questions regarding Plastic and Aesthetic Surgery.
If you have questions on plastic surgery treatments or other aesthetic surgery procedures, please mail to:
info@oceanclinic.net or use our contact form.

All answers to your questions regarding Plastic surgery issues must be considered as guide lines only as the plastic surgeon did not have the benefit of a personal consultation to assess your individual case.

The most current, day-to-day Plastic surgery questions answered by a specialist. Here some oft the most current Questions & Answers about plastic and aesthetic surgery, answered by Dr. Kai O. Kaye from Ocean Clinic Plastic and Aesthetic Surgery Center, Marbella.

I have very fair skin, but scar very easily which leaves red marks.

These red marks and scars are exactly what I want to get rid of, so that is why I am concerned about any surgical procedure that potentially could leave further scarring.

What do you think would be the best option for me? Can you tell me more about the possible side effects of scarring after a surgical peel or laser resurfacing?

Before any peeling treatment, the skin of each patient needs to be assessed in physical examination, because some skin types are not suitable for deep peeling procedures. The fact that you simply have a fair skin type does not mean automatically that you can’ t have a deep peel, but in some cases the application procedure and the concentration of the peel must be adapted to your skin.
Any kind of deep peeling procedure has a potential risk of scaring if the peeling reaches deep dermal structures, so it is paramount that the treating doctor evaluates your skin to minimize that risk. Taking this in account, a peeling can provide a safe alternative to surgical rejuvenation procedures.

I am well over sixty but reasonably fit, I go to the gym three times a week and keep myself very busy. I had children quite late in life and it has left me with unwanted skin and stretch marks around the waist, would I be a good candidate for a tummy tuck or any other plastic surgery procedure to shape my body, or am I too old?

If you are physically fit, and you have no chronic diseases which forbid you having general nesthesia, a tummy tuck procedure can be safely performed at your age. In the initial consultation, a thorough physical exam and a health questionnaire help us to determine if you are able to undergo surgery, furthermore a exhaustive blood analysis is performed to determine any possible health issues. Aesthetic surgery is very often performed on older patients, and under the conditions named above they have no more risk and an equivalent aesthetic result as younger patients.

Just recently I heard about how Botox can be used for preventing over-productive sweat glands. How long does it last and does it have different reactions to men and women? Also, how long does it really stay in your system, even after the treatment has worn off?

The treatment of Hyperhydrosis (excessive sweating) with Botox is an effective and non invasive alternative to surgical interventions, which leave scars and have associated risks. The treatment can be performed under the arms (Axilla) and in the palms of the hand, educing the excessive sweating almost immediately for a period of 6-7 months.
Afterwards the Botox is processed and disintegrated; therefore it does not persist as a toxin in your system. International studies with yearlong follow-up did not show evidence of long term complications, in some selective cases the Botox just loses effectiveness due to antibodies produced by some patients.

I have been researching Plastic Surgery procedures looking for an easier way to get rid of some fat on my thighs and came across something called ultrasonic liposuction. It is noted as one of the latest ways to remove unwanted fat with a faster recovery time and a lot less ruising. Do you conduct this form of treatment at your clinic?

We use ultrasonic liposuction in patients with extreme fibrotic (hard) fat, which is often the case after a long history of loosing and gaining fat in a certain area; the body produces in those patients more connective fibres to fill out existing voids. Additionally patients who already had liposuction tend to have much more fibrotic subcutaneous fat, for those cases it can be useful as well. Generally, bruising depends more on your individual tendency than on the extraction technique, which can be Ultrasound assisted, Vibration assisted or even Laser assisted. I work with all systems and do get good results with either of those techniques, due to this fact I personally contribute a short recovery time and little bruising more to a efficient technique of injection with a solution containing adrenaline and to the fact that I work with very fine canulas (2-3mm, which allows me to limit the destruction of blood vessels and subsequent hematoma (bruising). This takes a little more time, but results are much smoother and recovery is faster.

There are a lot of different clinics because Plastic surgery is becoming more and more popular, so it can be very difficult to choose a surgeon.
I understand that some Cosmetic Surgery Centers are actually not clinics run by a head surgeon who is reputated for his individual work, but more like managed companies which are hiring different surgeons, and here the decision to hire one can be based more on salary requirements compared to individual skills and personal experience of the Plastic surgeon who will actually perform my procedure. How can I be assured that the surgeon I choose is not only leaglly qualified and licensed to perform the surgery but also that he or she has enough experience in the special treatment I am looking for?

The increasing demand for cosmetic procedures opens the market as well for companies more interested of making big, fast money without offering on the other hand forcefully the best surgeons or sometimes even at minimum qualified ones. The problem in many big cosmetic surgery companies or clinics is that you often don’t even meet the surgeon for your first consultation, in fact this very important first meeting is often enough performed by a senior nurse or a so-called patient coordinator.
This pratice is not Advisable for me personally. The surgeon actually performing the rocedure often comes in only a couple of days per month, you meet him just before, and you can’t really assess if you trust him or not. Qualification and personal experience maybe an issue , and meeting your surgeon just before your actual procedure does not give enough time to assess him personally or to check his experience and qualification level with former patients or regulating bodies.

Are there any particular organizations that I can check with the legal qualifications of the surgeon of my choice?

Any patient should check the surgeon’s Legal qualifications to perform the kind of Procedure they would like to have, in most countries this can be checked with the regulating body or authority. For example, any surgeon who is qualified and registered with the UK Board of specialists can be checked at www.gmc-uk.org.
I personally decided founding my own, Plastic surgeon led clinic , a concept to stand apart from this concept, to provide extraordinary patient care out of one hand, therefore I personally attend all my patients at the first consulation, I operate all of my patients myself and I check on them personally during the postoperative period.

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