Tuesday, December 28, 2004

Preventing Complications in Aesthetic Surgery

One of the most interesting comments I heard at the 9th International Congress of the Oriental Society of Aesthetic Plastic Surgery in Bangkok came from Dr. Thomas Biggs, Editor-in-Chief of the Aesthetic Plastic Surgery Journal. He said that many of the surgical complications occur during the first week following an international congress in plastic surgery. There was an uproar of laughter from the audience following that comment, because there was indeed a grain of truth in that comment by Dr. Biggs.

Many of the presentations in any international conference deal with new techniques in surgery. Sometimes there is too much emphasis on the techniques, and not much attention is given to the indications for the technique and proper patient selection. Sometimes an overeager presentor may skip or overlook certain details. Sometimes generalizations are made, which may not be necessarily true.

The unwary surgeon in the audience who will then apply the new technique may then be faced with complications he/she is not prepared to deal with. There is a learning curve with any new surgical technique. It is encumbent on the surgeon to practice good surgical judgement. Oftentimes, one of the most reassuring experiences in any meeting is the confirmation of the validity and effectivity of old, tried and tested techniques.

Please feel free to email Dr. Lasa if you have any questions.

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Thursday, December 23, 2004

New Technique for Breast Lift

In one of my earlier blogs, I wrote about the Aptos facelift innovation by the Russian plastic surgeon, Dr. Marlen Sulamanidze. At the 9th International Congress of the Oriental Society of Aesthetic Plastic Surgery, Dr. Sulamanidze demonstrated the breast lift using the Aptos technique.

During the live surgery demonstration at the Siriraj Hospital in Bangkok, Dr. Sulamanidze showed us how sagging breasts can be lifted using the Aptos suture suspension technique. Four Aptos 2-0 polypropylene sutures are placed 2 cm deep in the breast tissue and are threaded around the clavicle bone in order to mechanically lift sagging breasts.

The advantage of this technique is that it avoids the vertical or T-shaped scars below the nipple-areola complex in conventional breast lift or mastopexy operations. This is a major benefit for patients who are afraid of getting scars around their breasts.

More about the Aptos Thread Lift

Please feel free to email Dr. Lasa if you have any questions.

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Friday, December 17, 2004

Cosmetic Surgery Conference in Thailand

I recently attended the 9th International Congress of the Oriental Society of Aesthetic Plastic Surgery held from December 6 to 10, in Bangkok, Thailand. This congress was attended mainly by plastic surgeons from the different countries in Asia: Philippines, South Korea, China, Taiwan, Indonesia, Singapore and of course, Thailand. There were formal presentations or lectures during the first 3 days at the Shangri-la Hotel ballrooms, followed by live surgery demonstrations at the Siriraj Hospital the next two days.

The two main guest speakers from the U.S.A. were Dr. Thomas Biggs and Dr. Mutaz Habal, who both gave excellent plenary lectures.

The trend that I noted throughout the conference was the emphasis on surgical procedures that could get the maximum cosmetic results with the minimum of risks. This I will expound on later, after I finish catching up with the pile of work that has accumulated in my absence.

Please feel free to email Dr. Lasa if you have any questions.

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Thursday, December 02, 2004

When to undergo cosmetic surgery?

When is the right time to undergo cosmetic surgery?

Many magazine articles nowadays encourage young patients to undergo cosmetic surgery at an earlier age. It used to be the case that patients started having facial rejuvenation surgery at the age of 4o years. However I now see patients who have such surgery in their mid-twenties and thirties. These articles claim that cosmetic surgery done at a younger age will have longer lasting results, and that major surgery at a later age will be prevented if little "nips and tucks" are done while the patient is younger.

There are many factors to consider in the timing of cosmetic surgery. Physical indications are the most obvious. However the presence of wrinkled sagging skin by itself is not sufficient for one to have cosmetic surgery. Emotional factors are important to consider. If the person is not bothered by the wrinkles and the eyebags, I see no reason to encourage them to have cosmetic surgery. I respect the decision of people to grow old gracefully. I do not have any business telling them that they should have rejuvenation surgery.

The support of one's spouse or family is also an important consideration. The results of cosmetic surgery may be "perfect," but if the spouse or family does not support the patient in his/her decision to undergo the surgery, the patient will not feel fully satisfied.

It is thus important to have a lengthy pre-operative consultation in order to determine whether or not a patient will benefit from cosmetic surgery. If a patient's expectations are unrealistic, I discourage the patient from proceeding with cosmetic surgery. For example, wives,who undergo cosmetic surgery so that their philandering husbands will leave their mistresses, will feel unsatisfied even if the surgical results are "perfect" if their husbands continue on with their philandering.

Please feel free to email Dr. Lasa if you have any questions.

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Friday, November 26, 2004

Breast Augmentation Gift Vouchers

Breast augmentation is one of the cosmetic surgery procedures that patients continue to request during the holiday months. After the operation, there is minimal downtime because patients can immediately move around in public since there is no visible bruising or swelling. The areas which may have postoperative bruising or swelling are easily hidden by the patient’s clothing, unlike in facial cosmetic surgeries like rhinoplasty (noselift), eyelid surgery and facelifts where the black and blue discoloration is there for everyone to see.

The demand for breast augmentation has even prompted some private clinics to start offering cosmetic surgery gift vouchers. The Reuters news agency released an article on November 4, 2004 which was entitled “Bigger breasts under the X-mas tree?”. This article features the sale of cosmetic surgery gift vouchers by Transform, one of Britain’s biggest commercial cosmetic surgery groups. The value of the vouchers range from 50 to 1,000 pounds and are mostly used for non-surgical procedures such as Botox and skin peels.

According to a spokeswoman for Transform, hundreds of vouchers have been sold and “most patients had already expressed an interest in plastic surgery before receiving a voucher… and were not offended by the gift”.

However, the concept of gift vouchers for cosmetic surgery has its detractors. There is concern that cosmetic surgery is being trivialized as an ordinary commodity like shoes and clothing, and that this may lead to complacency in patient care.

Some words of caution are in order for those who are thinking about giving cosmetic surgery gift vouchers. One of the most important prerequisites that a plastic surgeon must do is to determine whether a patient's expectations are realistic. Even the best results from cosmetic surgery will not guarantee satisfaction if expectations are not met, such as expecting that a philandering husband will leave his mistress and move back home.

There is also the possibility that gift vouchers for cosmetic surgery may be given to those who really do not feel the need for any kind of facial or body make-over. This kind of "gift" may even be insulting to those who don't want cosmetic surgery. Having cosmetic surgery is a personal choice and must not be dictated by others such as one's spouse or parents.

Please feel free to email Dr. Lasa if you have any questions.

Cosmetic Plastic Surgery Philippines
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Wednesday, November 17, 2004

Cosmetic Surgery for Traveling Patients

It is the middle of November already and it is that time of the year when many Filipinos working abroad start coming home to the Philippines for the holidays. It has been my experience that many of our Filipino balikbayans decide to have cosmetic surgery with only a few days remaining in their vacation.

Last week my brother referred a friend who wanted blepharoplasty immediately because she was scheduled to leave for abroad the next day! I requested my brother to tell his friend to defer her plans for the surgery.

My advice for those who are contemplating cosmetic surgery in the Philippines as part of their vacation, is to allot from one to weeks recovery period after the operation. This much time is needed for the swelling to subside and for the bruising to disappear. The first 3 days after the operation are especially critical, since many of the complications after surgery occur within this time period.

Stitches will also be taken out during this time period of 1 to 2 weeks postop. Plastic surgeons usually do not use absorbable sutures for skin closure as these incite more inflammatory reaction and more scarring. Instead we use nonabsorbable sutures made of nylon or similar nonreactive material which will need to be taken out early to avoid ugly scars. Patients who undergo blepharoplasty usually have the stitches taken out after 3 days. For other facial plastic surgery procedures, stitches are taken out 5 to 7 days postop. For stitches in the chest and extremities, stitch removal may be delayed up to 2 weeks postop to ensure that the wound is closed.

For those contemplating on having cosmetic surgery during their vacation, my advice is to first review all the activities you intend to undertake, such as reunions, parties, shopping, sightseeing, etc. and prioritize your time allocation. Schedule the surgery for the time period when you have accomplished all your social obligations. Most patients would not want to be seen by others in the immediate postoperative period, especially after facial cosmetic surgery with its accompanying swelling and bruising.

Please feel free to email Dr. Lasa if you have any questions.

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and having affordable cosmetic plastic surgery in the Philippines

Wednesday, November 10, 2004

On Cosmetic Surgery Travel/Vacation Packages

I have spent this morning surfing the internet regarding cosmetic surgery travel packages being offered in various countries like Thailand and South Africa.

I believe that the time is ripe for the Philippines to be a major destination for medical tourism. We have many qualified and well-trained doctors who have acquired their postgraduate or fellowship training from well-known institutions in the U.S.A. and have been mentored by leading plastic surgeons.

In my practice, an increasing number of my patients are based abroad. Many of them are immigrants to the United States who come back to the Philippines for a vacation to visit their relatives here. An increasing number of patients are overseas contract workers based in Europe (notably from Italy and Switzerland), the Middle East, Japan, and HongKong. They decided to include cosmetic surgery as part of their vacation because of their trust in our surgical expertise, combined with the fact that costs here are remarkably lower compared to other countries like the U.S. , U.K., Singapore, Australia, and South Africa.

The affordable cost of cosmetic plastic surgery in the Philippines has also attracted an increasing number of patients of other nationalities. They come to the Philippines to avail of the excellent medical and surgical services that we can offer them. They have also pleasantly discovered the warm hospitality of the Filipinos and the beauty of this tropical paradise of 7,100 islands.

Please feel free to email Dr. Lasa if you have any questions.

Cosmetic Plastic Surgery Philippines
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and having affordable cosmetic plastic surgery in the Philippines

Friday, November 05, 2004

Aptos Workshop

Dr. Marlen Sulamanidze, Russian plastic surgeon who invented the Aptos Thread, conducted a workshop at the Cardinal Santos Medical Center from 2 to 6 pm on November 4, 2004. He demonstrated Aptos Lift techniques using his patented Aptos threads, wires, springs and needles.

I must admit that when the Aptos Lift was first introduced in the Philippines, I was skeptical of the claims that it could alleviate the problem of sagging skin. I had heard from some of my colleagues that the first few patients who had it done had results that were not so convincing. I surmised that probably it could be just a matter of technique, or it could be one of those new marketing gimmicks we often see in the beauty industry. So I welcomed the visit of Dr. Sulamanidze to Manila since it would give me the opportunity to observe the technique as performed by the inventor himself.

The first patient was a middle aged lady on whom Dr. Sulamanidze demonstrated the use of the Aptos threads for lifting sagging skin of the cheek area and the use of Aptos springs to remove so-called "marionette smiles" which are but vertical wrinkles beginning at the corners of the mouth up to the jaw line. Dr. Sulamanidze patiently showed us his preoperative markings on the face, injected anesthesia into the target areas, and explained how deep the threads should be placed. At the end of the procedure, there was indeed a remarkable lifting of the cheek skin and the disappearance of the marionette smiles.

The second patient was likewise a middle aged lady with sagging cheek skin, neck skin, and fairly deep nasolabial folds. Dr. Sulamanidze this time showed a different technique of lifting the cheek skin with non-barbed polypropylene sutures attached to specially designed Aptos needles, which are either curved or straight needles pointed on both ends with the suture attached to the needle at its middle portion. The threads are applied around triangular areas of subdermal tissue and anchored onto periosteum below the lateral canthal area of the eyelid. Again, there was a remarkable lifting of the cheek and neck skin. The nasolabial folds were treated by cutting the skin attachments using the Aptos wire which was threaded around the folds.

I asked Dr. Sulamanidze how long the lifting effect of his Aptos threads would stay. He replied that he has been doing the Aptos Lift since 1998, and results varied from as short as a few months to as long as 5 years. The short-lived results were due to faulty technique or to poor patient compliance in the immediate period after application of the Aptos threads. But Dr. Sulamanidze remarked that these cases could be corrected immediately by reapplication of the Aptos threads.

At the end of the workshop, I was thankful that I now have an alternative procedure to offer to my patients which is nonsurgical but which can lift and support sagging tissues.

More about the Aptos Thread Lift

Please feel free to email Dr. Lasa if you have any questions.

Cosmetic Plastic Surgery Philippines
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and having cosmetic plastic surgery in the Philippines

Thursday, November 04, 2004

Aptos Facelift

The Philippine Association of Plastic and Reconstructive Surgeons held a seminar on November 3, 2004, featuring the Aptos technology for facial contouring. This nonsurgical approach to facial lifting utilizes the use of patented Aptos threads, wires, springs and needles.

The guest speaker was none other than Dr. Marlen Sulamanidze, the Russian scientist, inventor and plastic surgeon who obtained world wide patents on his Aptos threads, also known as Russian threads. These threads are polypropylene threads with fine cogs or barbs cut into the thread; the barbs anchor onto facial tissue as the surgeon lifts the sagging skin in order to obtain a rejuvenated new look. The threads can be applied to brow, forehead, neck, jaw line and cheek lifting.

Dr. Sulamanidze claims that the threads can support the tissues in their new position for years. However the longest follow-up pictures he showed were only 4 months post-application of Aptos threads, although he claims in his brochure that he has been using it since 1998. My initial impression is that the Aptos thread will have its best application for a select group of patients with thin sagging skin. Just looking at the before-and-after pictures, it seems to me that patients with ample facial fat do not seem to have as good results compared to patients with thin skin.

However, when one compares the Aptos thread to the traditional face-lift with all its risks, trauma, suffering, prolonged downtime and high cost, I think it is a technology which will have greater acceptance and application in the coming years.

More about the Aptos Thread Lift

Please feel free to email Dr. Lasa if you have any questions.

Cosmetic Plastic Surgery Philippines
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Monday, November 01, 2004

Aptos Lift: An Alternative to the Face and Neck Lift

Barbed Sutures, Ultrasonic Body Contouring, Wrinkle Fillers Give Patients More Innovative, Non-Surgical Options (October 14, 2004) — Patients without time for a facelift or intimidated by surgery now have more minimally invasive options that produce effective results. Barbed sutures, ultrasonic body contouring and soft tissue fillers, three emerging trends in the plastic surgery industry, offer patients faster results without the downtime of surgery. > full story from http://www.sciencedaily.com

In the Philippines, cosmetic surgeons are just beginning to use barbed sutures as an alternative to facelift surgery. The attraction this offers to patients is that it does not involve extensive surgery with its attendant risks, hospitalization, nor long periods of recovery from the swelling and bruising that invariably accompanies facelift surgery. The Philippine Association of Plastic and Reconstructive Surgeons has taken the lead in informing all practicing plastic surgeons and residents about this new technique. There will be a seminar at the Cardinal Santos Medical Center in Greenhills, San Juan, Philippines about the use of barbed sutures, more commonly known as "Aptos threads," on Wednesday, November 3, 2004.

More about the Aptos Thread Lift

Please feel free to email Dr. Lasa if you have any questions.

Cosmetic Plastic Surgery Philippines
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and having affordable cosmetic plastic surgery in the Philippines

The Cosmetic Surgery in the Philippines

Cosmetic surgery is very affordable in the Philippines and there is an increasing number of Filipinos each year who decide to undergo various cosmetic surgery procedures. The greater acceptance and growth of cosmetic surgery among the general public has encouraged more doctors to enter this field. In the Philippines however, any licensed medical doctor can perform any kind of cosmetic surgery without legal impediment. Any doctor can label himself or herself as a "cosmetic surgeon".

Patients considering cosmetic surgery should know that choosing the right surgeon is the single most important decision they will make. Be sure to have all the facts you need in order to make an informed judgement. The training and experience of your cosmetic surgeon is the most important factor in the success of your surgery.

More on The Cosmetic Surgery Scene in the Philippines

Please feel free to email Dr. Lasa if you have any questions.

Cosmetic Plastic Surgery Philippines
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and having affordable cosmetic plastic surgery in the Philippines