Renaissance Plastic Surgery | Dr. Joseph Fata

Plastic surgery in teens has again come to the forefront, this time due largely to a recent report by the NBC "Today Show" and USA Today. Probably the most significant issue is a report by the American Society of Plastic Surgeons (ASPS) that described a 180% increase in plastic surgery in teenagers from 2003 to 2008.

The core issue is: when is it appropriate for a teen to have plastic surgery? It has long been standard practice for plastic surgeons to agree to perform plastic surgery on teens with an abnormally enlarged nose (Rhinoplasty) or prominent and protruding ears (Otoplasty). The goal was to help these kids not stand out and to move beyond being an object of ridicule, and by and large these goals were accomplished.

More controversial is performing liposuction and breast augmentation in teenagers. Are we helping their self esteem or are we starting them on a path of a preoccupation with their appearance in which the solution is always plastic surgery.

There is no clear answer. However, most would agree that the average teenager can take care of small areas of unwanted fat with a sensible diet and exercise. Liposuction was never meant to be a weight loss tool or treatment of obesity. So it would seem that the indications may sometimes be very reasonable but would be few and far between.

Breast augmentation is more complex because it involves placement of a permanent implant. Teenagers are not adults and should not be expected to fully understand all of the implications of having an implant. Although the overwhelming majority of women who have had breast augmentation are happy that they did, they are making this decision with an adult thought process. As a result, the American Society of Plastic Surgeons (ASPS) and the FDA have restricted the use of saline breast implants to women at least 18 years of age and silicone gel implants to women at least 22 years old. Exceptions are made for birth deformities and severe asymmetry.

This topic raises more question than answers, but it seems that it would be fair to say that plastic surgeons, patients and families should proceed very cautiously when considering plastic surgery on a teenager.

Botox, an injectable treatment for wrinkles caused by excess muscle activity, has had a monopoly and virtual stranglehold on the market of non-invasive wrinkle treatment since it was first approved by the FDA. The American Society of Plastic Surgeons (ASPS) estimates that 2.4 million Botox injections were performed in 2008 alone.The only competition thus far had been from injectable fillers, such as Juvederm and Restylane, which work by injecting a soft substance beneath the wrinkle to fill it out. This monopoly has allowed Allergan, the company behind Botox, to increase the cost of Botox to physician providers by greater than 40%over the past 5-7 years.

Now at last we have an alternative. The FDA recently approved the product Dysport for the cosmetic treatment of wrinkles between the eyebrows, the same approval that has been given to Botox. Both products are also effective in other areas of muscle hyperactivity, such as the forehead and crows feet around the eyes. Thus far it appears that Dysport will be priced at a competitive advantage over Botox and information released thus far suggests that the effects may last longer (about 4 months) compared to the 3 months expected of Botox.

Both Botox and Dysport work the same way in that they selectively impair contraction of muscle fibers. As a result, the wrinkles that are caused by repetitive, excessive muscle contraction naturally soften and it some cases disappear.

Some patients might initially shy away from a new product because it does not have the same track record of success. However, Dysport has been used in the United Kingdom under a different brand name since 1991 with over 2 million patients treated. The safety and success are considered to be on par with Botox.

The release of Dysport is good news for the consumer. The presence of a viable competitor should stimulate both companies to maintain the highest standards and prevent the costs from continuing to spiral upwards. It is probably not a coincidence that Allergan is offering patients a $50 rebate for a single Botox treatment for the first time. Fortunately Dysport is offering a $75discount. As the weak economy has shifted some patients away from cosmetic surgery and towards less invasive treatments, this new alternative could not have come at a better time.

Despite struggles in the economy, breast augmentation has continued to be the most popular cosmetic surgery procedure among women, and it is a procedure that comes with choices. Today I will address one of those choices: placement of the incision and subsequent scar.

The appearance and location of the scar is important, but the most important factor that determines how good you will look is the precise development of the surgical space, or "pocket", that will contain the breast implant. It is only logical that any incision that gives better access to this "pocket", especially the lower part of the breast where the final shape is so important, would be preferred.

The incisions in the breast fold (infra-mammary) and along the boarder of the nipple (peri-areolar) provide the easiest and most direct approach to the implant "pocket", and in my opinion are the best options for a breast augmentation that will give consistently excellent results. An excellent result is possible with any technique, but the key is getting a result that is not only outstanding but consistent and repeatable. The breast fold incision has the added advantages of being able to place the scar in a crease that is hidden even without clothes, and it is the only incision that can be used with most silicone gel implants. It is rare to have to redo a breast augmentation because the scar is not acceptable.

There are other options for scar placement in breast augmentation: through the armpit (trans-axillary) or through the navel (trans-umbilical augmentation, or TUBA). However, both approaches create scars that, while they are off the breast, they may be noticeable. Also, the surgical creation of the implant "pocket" is performed down a long tunnel, and in the case of the armpit approach, it is possible for the breast implant to slide back up this tunnel. Neither approach will accommodate a silicone gel implant, and operating in a tunnel makes a simple and straightforward procedure more challenging. I certainly believe that a skillful surgeon can get an excellent result with either of these techniques, but no matter who you are, the harder the surgery is to perform, the more likely it is for a surgeon to get a less than desirable result.

Every plastic surgeon believes that his or her approach is the best, but with this information you will be better able to make the choice that is right for you.