By Jeanie Lerche Davis
Reviewed By Michael Smith
The wizards of beauty are working their magic, whipping up longer-lasting wrinkle fillers, fine-tuning Botox and liposuction treatments -- even debuting silicone butt implants. That's right, butt implants.
"The public seems to want this," James Wells, MD, president of the American Society of Plastic Surgeons, tells WebMD. He is on the clinical faculty of the University of California at Irvine and a private practice plastic surgeon in Long Beach.
Butt Implants. It's a cultural phenomenon that's moving northward. "Buttock implants are very popular in South America, where Brazilian women want to have very round, curvaceous buttocks," Wells tells WebMD. "Breasts are big here, but in Brazil, it's buttocks."
The implants have a more "solid" covering than breast implants because they must sustain weight, he says. "There's been an increasing interest from the public, so surgeons want to know more about them."
Breasts Deliver Drugs. Who knew? Silicone breast implants, because they are covered by permeable membranes, can be drug carriers -- in fact, they can act as timed-release drug carriers. Researchers are looking to include a drug in the implant that can reduce the scar that occurs around the implanted breast. "There's an early suggestion that the drug might help," Wells says.
Believe in Botox. Male or female, almost everyone wants a younger-looking face. "There are job retention issues," says Wells. "We see men in their 40s and 50s knowing they need to compete with others in their 20s, 30s. You and I both hear stories of people with equal talents, but the person who looks better gets the nod. Appearance is a big issue."
"Botox has probably been the greatest product in the last 20 years," says Seth A. Yellin, MD, chief of facial plastic surgery at Emory Healthcare. "It has an incredible safety profile -- still in my opinion the single thing I would take on a desert island to make people look better."
First used to treat crow's feet and eyebrow creases, Botox is making inroads all over the face of America. One popular use: Injecting Botox to soften lines around the mouth -- "the ones that make you look angry, even when you're not. [But] it takes an experienced plastic surgeon to get it right," he says.
Aesthetic surgeons are perfecting their technique, sharing secrets. If not done right, there's "risk of losing oral function -- you don't want to do that," Yellin adds.
Better Than Collagen. A product called Restylane (or Perlane) -- very popular around the world as a filler for both wrinkles and lines -- acts much like collagen, yet is longer-lasting. However, it is not yet FDA-approved, says Wells.
"We're interested in facilitating its introduction into the American market," he tells WebMD. "It seems to be easier to use than collagen and has longer staying power. Most tissue fillers, even the person's own fat, have an uncertain lifespan. The information we have on [Restylane] looks very exciting. We can't wait to get it through the FDA and use it in this country."
Restylane is made of hyaluronic acid, a naturally occurring molecule in the skin -- one that draws water to itself and allows the skin to remain hydrated, explains Yellin. Though created in the laboratory, the injectable form is longer lasting than any other wrinkle fillers -- perhaps lasting up to one year. There also are virtually no allergic reactions to Restylane.
"The FDA should be approving it in the second quarter of next year," he tells WebMD.
Combo Package. Whereas Botox can smooth the wrinkled lines in your face, it often takes fillers to completely get rid of them. "If you have a well-formed crease, Botox will soften it, but it won't make the well-formed crease disappear," says Yellin. "Fillers complement Botox. Laser resurfacing can also complement Botox."
Other wrinkle fillers are in the works, he says. One company is working on a product made from human foreskin. Yellin is developing one made from the placenta, which is normally discarded after delivery.
His theory: Cells extracted from the placenta can be injected into the skin, where they might stimulate cells to grow their own collagen. Normally, human collagen -- when injected -- does not live long because it does not have a blood supply. "This will have its own blood supply, so it will live," he tells WebMD. It's only in the laboratory phase, though, so don't get too excited.
Speedy Healers. After a face-lift, fibrin glues and tissue sealants help seal wounds quicker, control bleeding and bruising, and reduce swelling -- which hasten healing, Wells tells WebMD.
Fibrin glue is another product that mimics nature: "Your body makes a tissue glue in response to an injury," Wells explains. "When you fall down and scrape your knee, the weeping that creates the scab is fibrin glue. When you have a facelift -- or wherever we introduce injury -- the body's process is to leak this material out."
"I use fibrin glue as a routine part of facial aesthetic procedures, have been doing so for over a year," says Yellin. The product can be squirted into an area or sprayed -- like spray paint, he says. "It's supposed to seal up any little capillaries, reduce bruising. But it won't reduce significant bruises."
Souped-Up Liposuction. New, high-powered suction devices are especially good for the fibrous areas of the male breast, the flank, the love-handle area -- or for people who are having their second procedure. Because the device has more power, there is less bruising, says Wells. The machine also allows the surgeon to shape or contour the area more easily.
Liposuction devices that are ultrasound-guided are a bit riskier and less effective, "because they don't go around curves and bends very easily," Wells adds. "Also, heat [from the device] can cause some injury to tissue."
Three-dimensional imaging is a new technology that's enhancing all plastic surgery procedures, says Wells. "It increases the depth perception of everything we do. Anytime we can use technology to get a sense of thickness or depth, it allows us to make better judgments."
The Peels. These treatments for sun-damaged skin are practically old news, they're so popular. Microdermabrasian involves removing the superficial layers in a nonsurgical way to let the undamaged layers come up. These skin layers look healthier; it's the difference between a younger person and an older person -- the thickness of the skin, the turnover rate of the cells, and they're better hydrated. It's a series and process of treatments rather than one.
Chemical peels accomplish the same thing, but are a bit more "aggressive" treatment, says Wells.
Just Say No. Not that peels, fillers, and endless suctioning are always the answer, he adds.
Today's plastic surgeons are taking a more holistic approach to patient care, he tells WebMD. "We can approach a patient's problems as a surgical exercise, or take a broader perspective regarding the patient's overall health -- dietary habits, smoking, heart disease. Physicians have to think of themselves as physicians first and plastic surgeons second."
"The plastic surgeon has a responsibility to apply judgment, to tell a patient when it's not a good idea to have surgery, to suggest alternatives if their unhealthy lifestyle puts them at risk," he tells WebMD.
Published Nov. 5, 2002.
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