New Laser Technology Demonstrated in Liposuction Workshop

The Philippine Association of Plastic, Reconstructive and Aesthetic Surgeons (PAPRAS) conducted a workshop on liposuction last November 18, 2006. A series of lectures were given on various topics: history and development of liposuction, current liposuction techniques, new technologies, particularly the new Erchonia laser, and autologous fat injection into the facial muscles for facial rejuvenation. The program also included an actual live liposuction demonstration on a female patient regarding, with particular focus on surgical planning, preoperative use of the new Erchonia laser on the target areas for liposuction, and surgical techniques.

Of particular interest to the participants was the aforementioned Erchonia laser. It is a laser with low-level (or cold) output with no thermal effect which will destroy tissues. It is purported to actually emulsify fat tissues. When used just prior to liposuction, it supposedly makes the removal of fatty tissues during liposuction significantly easier and quicker. Clinical trials showed that patients have less pain immediately following surgery. More fat can be removed per minute using the Erchonia laser, which means shorter time for doing the liposuction. No complications such as burning of tissues, seromas or other side effects were reported in the clinical trial.

PAPRAS is the only association of plastic surgeons that is formally recognized by the Philippine College of Surgeons. It is dedicated to upholding the highest standards of surgical excellence in the field of reconstructive and cosmetic plastic surgery in the Philippines. Thus, it regularly conducts workshops on various areas of interest in the field of plastic surgery in order to promote continuing surgical education among its members.

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Prevention and Management of Complications in Aesthetic Surgery

An interesting topic that Dr. Foad Nahai presented at the 13th ASEAN Congress of Plastic Surgery was about the Prevention and Management of Complications in Aesthetic Surgery. With a touch of humor, he stated, "If a plastic surgeon claims he hasn't had any complications, he is either not telling the whole truth or he hasn't had that many operations." A humorous statement but I would say I would agree with him. Dr. Nahai, who is highly esteemed among plastic surgeons as the author of many books on plastic surgery, humbly and candidly shared some of the complications he encountered in his own private practice and generously shared valuable information about how to lower the risks of complications and how to manage complications. I'm sure many of the younger and less experienced plastic surgeons found his talk especially interesting.

Plastic surgeons who have practiced for a long time and who have had years of experience know that although serious complications are rare, there are complications that they have to be ready to manage. This is precisely why it is of primary importance that patients choose their plastic surgeons carefully. Although many doctors choose to do cosmetic surgery without the specialized training that plastic surgeons have, they may only be familiar with the uncomplicated surgery case and may lack the experience to handle complications well.

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The Cutting Edge in Aesthetic Plastic Surgery

The keynote lecture in the 13th ASEAN Congress of Plastic Surgery was given by world renowned plastic surgeon, Dr. Foad Nahai, who I had the opportunity to observe when I was training in 1990 with Dr. John Lewis, founder and first president of the American Society of Aesthetic Plastic Surgery. Dr. Nahai was with the Emory University Hospital in Atlanta, Georgia then.

Dr. Nahai's lecture was interesting because, contrary to popular opinion that the cutting edge in aesthetic surgery means that it is the newest and the best, he stated that the "cutting edge" could be a fad or an unproven technique, therapy or procedure and therefore, not necessarily the best. Some of the newer techniques that he mentioned were now under review were radiofrequency skin tightening, barbed sutures, and nonsurgical liposuction alternatives. He gave a quote that goes something like this: "Not everything that is new is good, but everything that is good was once new." And so, this highly esteemed plastic surgeon cautioned the participants to the Congress and said, "Don't be the first to jump on the bandwagon of something new. Not the last either." With a touch of humor, he warned us "Don't fall off the cutting edge".

Dr. Nahai noted that the world wide interest in cosmetic surgery has never been greater. This is due to the exposure from media. According to him, media coverage may be considered good because it increases awareness and intrest but in a way, it can also be bad because it can lead to unrealistic expectations. Sometimes, media tends to minimize the risks of plastic surgery.

Some statistics that he cited: In the U.S., $12.4 Billion was spent on cosmetic surgery, with a growing trend towards non-surgical options with less downtime. With all the opportunities and challenges the plastic surgeon faces today, Dr. Nahai encouraged the plastic surgeons in attendance to "Continue to hold ourselves to the highest standards, always put the patient's interests first, enforce standards and weed out "bad eggs", educate the media and the public and to continue to be a real plastic surgeon and not just a cosmetic surgeon."





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Plastic Surgeons From Around the World

The 13 ASEAN Congress of Plastic Surgery featured scientific sessions, with some of the world's leading plastic surgeons providing expert presentation panels and discussion groups in almost every field of plastic, reconstructive and cosmetic surgery. Among the plastic surgeons who spoke at the 13th ASEAN Congress of Plastic Surgery were the following:

From the United States of America, Dr. Foad Nahai lectured on a variety of topics, including the Personal Approach to Total Facial Rejuvenation, Augmentation Mammoplasty, Prevention and Management of Complications in Aesthetic Surgery and The Cutting Edge in Aesthetic Plastic Surgery. Other speakers from the United States were Dr. Mutaz Habal, who spoke on the Controversies with Treatment of Crooked Heads, Dr. Reid Hansen, on Breast Reconstruction with Latissimus Dorsi Flap, Dr. Gregory Evans, on Mastopexy techniques and Dr. Kenneth Salyer, on Lessons Learned in 36 Years of Craniofacial Surgery. From Australia, Dr. David J. David, spoke on the Past, Present & Future of Craniofacial Surgery.

On the topic of Body Sculpturing, Dr. Yeap Choong Lieng presented Liposelection, The Revolutionary Technique, Dr. Gwendy Aniko spoke about Water-Jet Assisted Liposuction, and Dr. Benjamin Ascher discussed Lipolysis by External Ultrasounds. Speakers for the topic of Rhinoplasty were Dr. Florencio Lucero from the Philippines, and Dr. Montri Kitmanee and Dr. Yu-Ray Chen.

These are just some of the many topics which were presented. I and the other Congress participants greatly benefitted from the sessions during this congress as the presentors generously shared their experiences and techniques with their collegues.

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Plastic Surgery Around the World

The invited speakers to the 13th ASEAN Congress of Plastic Surgery were plastic surgeons from Thailand, United States of America, Taiwan R.O.C., Singapore, Indonesia, Australia, Austria, Japan, Korea, the Philippines, Switzerland, Israel and Italy. As the various topics were discussed by these surgeons, it was interesting to note the differences and commonalities in the practice of plastic surgery in the different countries. For example, since 1992, plastic surgeons from the United States have only been able to use silicone gel implants under certain conditions such as for the purposes of reconstruction after mastectomy. In contrast, silicone gel implants, which many of the American surgeons prefer over the saline implants they are allowed to use, are widely used in Asian countries such as the Philippines. Thus, patients who prefer the silicone gel implants often have to travel to countries where these are used to have their surgery.

Another example of differences would be the type of rhinoplasty (nose) surgery which is commonly done in the different countries. While nose surgery in the United States is predominantly for reduction, in the Philippines as well as other Asian countries, augmentation rhinoplasty or the nose lift would be the more common procedure. Thus, when deciding to have these procedures done, it is important to consider the experience the plastic surgeon has. Asian doctors usually have more experience in augmentation, and if considering having reduction rhinoplasty done in an Asian country, a plastic surgeon who has had training in countries like the United States is the preferred option.

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The 13th ASEAN Congress of Plastic Surgery

The 13th ASEAN Congress of Plastic Surgery was held at the Sheraton Chaing Mai Hotel, Chiang Mai, Thailand last October 16 - 18, 2006. The theme of the conference was "The Cutting Edge in Plastic Surgery and Charm of the North". In attendance were plastic and reconstructive surgeons from around the world, most of us from the Asian nations. Among the topics discussed were Breast Reduction, Breast Reconstruction, the Personal Approach to Total Facial Rejuvenation, Body Sculpturing, Rhinoplasty & Blepharoplasty. There are many new developments in the field of plastic surgery and there are always many things plastic surgeons can learn from one another during these international conferences. Indeed, it is important for doctors to always keep abreast of these techniques and developments and one way of doing this is by regularly attending these conferences.

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Available Breast Implants in the Philippines

How would you feel if you traveled to a foreign country to have breast augmentation and the specific breast implant you prefer is not available there? The purpose of this article is to inform prospective patients about the kinds of breast implants that are available in Metro Manila, Philippines.

There are various kinds of breast implants. In general, the most commonly used are filled with either silicone or a saline (salt water) solution. The soft outer shell is either smooth or textured. There are various sizes available, as well as shapes and profiles.

In the Philippines, the patient has a choice of the following brands: McGhan, CUI, Mentor or Eurosilicone. In general, round smooth surfaced or textured surfaced implants are readily available and the patient does not have to make a special orders.

If the patient desires anatomically shaped implants, please be advised that these are not in stock by distributors of all the major brands of implants. A special order has to be placed, and it takes from 2 to 3 weeks before the anatomical implants can be delivered.

The following is a list of the specific implants that are readily available:

McGHAN IMPLANTS:

McGhan Style 40: Intrashiel TM Barrier Shell, smooth surfaced, silicone gel filled, round implants with "standard" projection. Available volumes: 180 cc, 200 cc, 220 cc, 240 cc, 260 cc, 280 cc, 300 cc, 320 cc, 340 cc, and 360 cc.

(Intrashiel TM Barrier Shell is a unique design for significantly reducing silicone diffusion.)

McGhan Style 45: Intrashiel TM Barrier Shell smooth surfaced, silicone gel filled, round implants with "full" projection. Available volumes: 160 cc, 200 cc, 240 cc, 280 cc, 320 cc, 360 cc, and 400 cc.

McGhan Style 110: Biocell TM textured, silicone gel filled, round implants with "moderate" projection. Available volumes: 180 cc, 210 cc, 240 cc, 270 cc, and 300 cc.

(Biocell TM Texture is designed to reduce the chance of capsular contracture and to promote tissue adherence which may help maintain positioning.)

McGhan Style 120: Biocell TM textured, silicone gel filled, round implants with "full" projection.
Available volumes: 180 cc, 220 cc, 260 cc, 300 cc, 340 cc, and 400 cc.

McGhan Style 68: Matrix of Saline Filled implants, round, moderate profile.
Available volumes: 240-270 cc, 270-300 cc, 300-330 cc, and 330-360 cc.

McGhan Style 68 HP: Matrix of Saline Filled implants, round, high profile.
Available volumes: 320-340 cc, 350-380 cc, 400-430 cc.

McGhan Style 410 and Style 410 Soft Touch TM implants are anatomical shaped implants incorporating these different technologies: BioDimensional TM cohesive gel-filled, Biocell TM Textured, Intrashiel TM Barrier Shell. These implants are not available in Manila and a special order has to be placed with McGhan. There is a minimum 2-week waiting period between ordering and delivery of the implants. A deposit of 50% is required upon placing the order.

CUI IMPLANTS

CUI SLD: CUI DRIE TM smooth, silicone gel filled, round implants, low profile
Available volumes: 170 cc, 200 cc, 230 cc, 260 cc, 290 cc, 320 cc, 350 cc, 380 cc, 410 cc.

(DRIE TM refers to Diffusion Rate Inhibiting Envelope barrier shell technology to reduce silicone diffusion.)

CUI SHD: CUI DRIE TM smooth, silicone gel filled, round implants, high profile
Available volumes: 190 cc, 230 cc, 260 cc, 300 cc, 340 cc, 380 cc, 410 cc.

CUI MLP: CUI Round MicroCell TM textured, silicone-gel filled, round implants, low profile
Available volumes: 170 cc, 200 cc, 230 cc, 260 cc, 290 cc, 320 cc.

(MicroCell TM is textured surface technology designed to minimize capsular contracture by disturbing the linearization of fibrotic collagen while encouraging mild tissue adherence for a favorable tissue to implant interface.)

CUI MHP: CUI Round MicroCell TM textured, silicone-gel filled, round implants, high profile
Available volumes: 190 cc, 230 cc, 260 cc, 300 cc, 340 cc, 380 cc, 410 cc.

MENTOR IMPLANTS

Mentor Cohesive I Siltex Textured Round Moderate Profile implants
Available volume: 225 cc

(Cohesive I TM is the standard cohesive level gel used in Mentor implants. It is the softest gel in Mentor's line-up.)

Mentor Cohesive I Siltex Textured Round Moderate Plus Profile implants
Available volume: 225 cc

Mentor Cohesive I Siltex Textured Round High Profile implants
None available - special order needed

Mentor Cohesive I Smooth Round Moderate Profile implants
Available volumes: 200 cc, 225 cc, 250 cc, 275 cc, 300 cc, 350 cc

Mentor Cohesive I Smooth Round Moderate Plus Profile implants
Available volumes: 200 cc, 225 cc, 250 cc, 275 cc, 300 cc, 350 cc

Mentor Cohesive I Smooth Round High Profile implants
Available volumes: 200 cc, 225 cc, 250 cc, 275 cc, 300 cc, 350 cc

Mentor Cohesive II TM implants are made of a slightly firmer gel, resulting in a firmer feeling implant. This gel is used in textured Round, Moderate, Moderate Plus, High Profile and Becker implants. These implants have to be specially ordered from Mentor with a 1-2 week waiting period for delivery.

Mentor Cohesive III TM is the most cohesive gel, used in Contour Profile anatomically-shaped implants. These implants are not readily available and have to be specially ordered from Mentor with a 1-2 week waiting period for delivery.

EUROSILICONE IMPLANTS

E.S. 26 - Smooth Surface Paragel Low Profile implants
Available volumes: 220 cc, 240 cc, 260 cc, 280 cc, 325 cc, 375 cc

E.S. 28 - Smooth Surface Paragel High Profile implants
Available volumes: 120 cc, 140 cc, 160 cc, 180 cc, 200 cc, 220 cc, 240 cc, 260 cc, 280 cc, 300 cc, 325 cc, 350 cc, 375 cc, 400 cc, 450 cc, 500 cc, 600 cc

E.S. 46 - Smooth Surface Standard Gel, Low Profile implants
Available volume: 240 cc

E.S. 48 - Smooth Surface Standard Gel, High Profile implants
Available volumes: 160 cc, 180 cc, 200 cc, 220 cc, 350 cc, 375 cc, 400 cc

E.S. 56 - Smooth Surface, Inflatable Saline Implants
Available volumes: 160 cc, 200 cc, 220 cc, 375 cc

E.S. 81 - Textured Surface, Paragel, High Profile Implants
Available volumes: 180 cc, 200 cc, 220 cc, 240 cc, 260 cc, 280 cc, 300 cc, 325 cc, 350 cc, 375 cc.

E.S. 102, 102N - Anatomic cohesive gel implants
These are not readily available and have to be specially ordered. It takes 3 weeks for delivery of these implants.

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The Dangers of Silicone oil injections for Non-surgical Breast Augmentation and Noselifts

Have you ever held a bag of marbles in your hand? Believe it or not, this was how my patient's breasts felt like. She had multiple lumps all over her breasts, the result of multiple injections of silicone oil given one year ago. She felt insecure about her small breasts and she wanted them to be enlarged. Someone told her of a method that was fast and cheap. Nobody told her she was going to end up this way.

I have seen a number of patients who have been victimized by glib-talking people extolling the virtues of silicone oil injections. The primary attraction is the cost: "only" P40,000 for breast enlargement, which is less than half of the average cost for breast augmentation with medical-grade silicone gel implants. For those desiring a noselift, the cost is from P7,000 to P14,000. Victims are often "fast-talked" into undergoing the procedure; they are not given the time to consult with their doctor.

Noselifts and breast augmentations are two of the most commonly requested cosmetic surgeries, but there are many who find the expense quite prohibitive. Thus the lure of low-cost injections is hard to resist. When the complications arise, these victims end up spending more.

Those whose noses are injected with silicone oil end up with noses looking like the noses of lions - as the silicone oil spreads through the tissues with time, the bridge of the nose flattens out and becomes wider. The skin is often reddish, a result of chronic inflammation of the tissues.

The people who perform silicone oil injections are hard to catch. They do not have any permanent offices. They go from one beauty parlor to another; they transfer from house to house, going wherever there is someone gullible enough to fall for their sales pitch.

I hope that with articles like this, people will become aware of the dangers of silicone oil injections so that they can avoid its consequences.

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Medical Tourism in the Philippines

Philippine officials formally launched a Medical Tourism campaign last January to promote the country as "islands of wellness." Health Secretary Francisco Duque III said the program, participated in by government agencies, private clinics and hospitals, aimed to make the Philippines the "new hub of wellness and medical care in Asia".

The components of the program include medical, surgical and dental care, traditional and alternative health care, health and wellness, long-term tourism and the establishment of international retirement and medical zones.

Medical tourism, which combines both health care and travel and leisure, is a multi-billion dollar industry and the Philippines is aiming to compete directly with other Asian countries such as Thailand, India and Malaysia. The program aims to target medical tourists from the United States, Europe, Australia, South Korea, Japan and Pacific island states, especially the large Filipino expatriate and immigrant community.

"We believe that the Philippines can tap into the remaining huge market potential." Duque said. "I think we still have very many worthy qualities as health care providers, and our medical and surgical capabilities are quite comparable, if not superior," he said.

Duque also mentioned that price advantage available to medical tourists for medical and surgical procedures in the Philippines, which are 30 to 50 percent cheaper than elsewhere. A coronary bypass costing about $50 000 in the United States is only about $25 000 in the country, with comparable clinical expertise and facilities, as well as complication and success rates, he said.

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Asian-Americans Criticize Eyelid Surgery Craze

Eyelid surgery the fastest-growing type of plastic surgery in the Asian community in the U.S. But unlike their countrymen in Asia, where blepharoplasty is one of the most popular cosmetic procedures, young Asian-American women considering the surgery are more likely to think twice about having it done.

Here's an article that shows how some young Asian-American women are opposed to the eyelid surgery so many of their countrymen are undergoing, seeing it as an offensive alteration of ethnic identity.

The double eyelid surgery has become more popular as more and more women are exposed to Western culture, fashion, and beauty standards promoted by media. But it is important to remember that to be beautiful doesn't mean that you have to look like the Caucasian models in the beauty magazines that are so popular among women. In fact, the challenge for the plastic surgeon who does double eyelid surgery for Koreans, Japanese, Vietnamese, Chinese and other Asians is not to make a Western eye but to make a more flattering Asian eye.

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Continuing Education for Plastic Surgeons: An Essential

When I went to Chicago last year to attend the annual conference of the American Society of Plastic Surgeons, I had the privilege to attend the INAMED Academy, an educational course provided to board-certified and board-eligible plastic surgeons, and plastic surgery residents by INAMED Aesthetics, (formerly McGhan® Medical Corporation). The stated mission of INAMED Academy is “to educate through a unique forum that reinforces product knowledge, encourages practice innovation and allows for the exchange of new ideas”.

INAMED has been in the business of manufacturing and marketing of breast implants, tissue expanders, and dermal filler products for the past 25 years. The company has pioneered innovations such as the patented INTRASHIEL® Barrier Shell, the BIOCELL® Textured Shell and unique silicone-fill technology. INAMED is well known for its unique BioDIMENSIONAL® Planning System, which provides guidance for patients and their plastic surgeons in finding the right implant for individual breast characteristics and personal goals. In 1999 INAMED acquired the Collagen Aesthetics Corporation and it emerged as the leader in injectable dermal-filler products. The company's Zyderm® and Zyplast® injectable collagen product line has been used in more than 1.5 million procedures and has become the standard of care for the past 20 years.

The course program consisted of a whole day of lectures and updates on different topics. In the morning, lectures were given regarding advanced approaches in Facial Contouring. Among the topics discussed were: “Optimizing Facial Aesthetic Outcomes”, “Combination Therapy: Expanding Role of Dermal Fillers within Surgery”, and case study reviews by a panel. The panel discussed treatment approaches and options, facial contouring, technique “pearls”, and minimizing and avoiding complications. There was also a live injection demonstration of advanced techniques.

This was then followed by talks regarding practice enhancement and “Marketing Tools for Success”. Specific topics discussed were: “Marketing Basics/External Marketing/Managing Your Marketing”, “Practice Enhancement Programs”, and “Running a Practice: Case Example”.

The afternoon lectures centered on breast implants. Among the topics discussed were the following: “FDA Update”, “Rationale for Form Stable versus Non-Form Stable Breast Implants”, and “Personal Experience Using the Style 410”. This was then followed by an Interactive Panel which discussed breast surgery complications, management of breast asymmetry, and expander-assisted breast reconstruction.

The course faculty was composed of distinguished plastic surgeons, namely, Scott Spear, G. Patrick Maxwell, Mark Jewell, Steven Teitelbaum, Per Heden, and several others.

Continuing education is very important for medical professionals and it is essential for plastic surgeons to avail of opportunites like the INAMED Academy to keep up to date with the many developments in plastic and cosmetic surgery products and techniques. It is in this way we can provide our patients with the best options and techniques available.

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Plastic Surgeon or Cosmetic Surgeon: What's the Difference?

With the increasing popularity of cosmetic or aesthetic surgery, patients often encounter different terms such as "plastic surgeon", "aesthetic plastic surgeon", "cosmetic plastic surgeon", "plastic and reconstructive surgeon", "cosmetic surgeon" or "aesthetic surgeon". Is there any difference whether a patient chooses a plastic surgeon or a cosmetic surgeon to perform the procedure they are interested in? The answer is YES, there is a difference.

Patients considering plastic surgery should know that in the Philippines, it is legal for physicians who are NOT PLASTIC SURGEONS to perform cosmetic surgery. Once doctors get their medical degrees, they may practice any specialty, even if they have not completed advanced training in the field they have chosen. And so, a doctor who performs cosmetic plastic surgery is not necessarily trained as a plastic surgeon.

Many documentaries have been made and many horror stories have been told about plastic surgery that went terribly wrong , but in most cases these procedures were done by unskilled and unqualified physicians.

Plastic surgery - like any surgery - carries risks and must be treated seriously. To ensure the best results for the surgery you are considering, choose an authentic plastic surgeon with the training and experience that is essential for the success of your surgery. Choosing the right surgeon is the single most important decision a patient considering plastic surgery will make.

Plastic Surgeons

The primary difference between a plastic surgeon and a cosmetic surgeon is the training that they have undergone.

To become a plastic surgeon and use the title of "Plastic Surgeon" in his clinical practice, a doctor must be fully licensed to practice medicine and must undergo at least five to six years of a formal residency training program in Plastic & Reconstructive Surgery that is accredited by the Philippine Board of Plastic Surgery, in a hospital or medical center that is accredited by the Philippine College of Surgeons to provide such training. This includes three to five years of general surgery residency and two to three years of plastic surgery residency. Doctors who have completed residency training in plastic and reconstructive surgery are the only doctors who can rightfully claim to be plastic surgeons.

A fully trained plastic surgeon can therefore use any or all of the following titles: Plastic Surgeon, Plastic & Reconstructive Surgeon, Aesthetic Plastic Surgeon, Cosmetic Plastic Surgeon, Facial Plastic Surgeon, Aesthetic Surgeon, and Cosmetic Surgeon.

Cosmetic Surgeons

On the other hand, cosmetic or aesthetic surgeons are doctors who perform cosmetic surgery procedures, regardless of the training they have received. Thus, the use of the titles "Cosmetic Surgeon" or "Aesthetic Surgeon" may mean many different things. The patient must inquire into the training of the doctor because these doctors have varying credentials, such as residency training in general surgery, ENT, OB-Gyne, dermatology, or the doctor may not even have formal surgical training.

In the Philippine setting, it is usually a doctor who practices cosmetic surgery and who has not undergone an accredited formal residency training in plastic and reconstructive surgery, who uses the title of "Cosmetic Surgeon" or "Aesthetic Surgeon". From an ethical point of view, such doctor should not use a title containing the word "Plastic" because only those with accredited training recognized by the Philippine College of Surgeons are entitled to do so.

Doctors who call themselves "Cosmetic Plastic Surgeons" or "Aesthetic Plastic Surgeons", but have not undergone residency training in plastic and reconstructive surgery, are misleading the general public and engaging in unethical medical practice.

Choosing a Cosmetic or Plastic Surgeon

The extensive training that a plastic surgeon undergoes gives him a definite advantage over a cosmetic surgeon who has not had this specialized training.

Mere familiarity with the anatomy of a certain body region does not automatically give a doctor the skill to perform cosmetic surgery in that area. The principles of plastic surgery require years of training and experience to be mastered.

General surgeons have more training in doing intestinal resections, appendectomies, cholecystectomies, mastectomies,thyroidectomies and hemorrhoidectomies than in doing cosmetic surgery. Dermatologists have more training in the medical treatment of skin disorders and often do not have training in the surgical treatment of skin lesions. Ear, nose and throat specialists and obstetrician-gynecologists have more training in their fileds of specialty than in doing breast augmentations, facial surgery and liposuction.

A doctor who practices cosmetic surgery must not only know how to do a procedure, but he must also know what to do in case wound healing does not proceed normally or when other complications arise. The specialty of plastic and reconstructive surgery has a major focus on the treatment of difficult wounds and chronic non-healing ulcers. Surgery is not an exact science and the body may react in unpredictable ways. A plastic surgeon is trained to respond to unexpected outcomes.

In addition to possessing an array of technical skills to use when dealing with complications, a plastic surgeon develops a sense of form, an aesthetic judgment, and an ability to visualize the end result. His training and years of experience make a definite difference in the quality of work and success of the surgery.

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Mentor Implants Now Available in the Philippines

Patients considering breast augmentation now have a wider array of breast implants to choose from with the entry of Mentor Corporation into the Philippine market. Mentor is one of only two companies in the world to receive US Food and Drug Administration approval for saline implants. It is also one of only two companies allowed to sell silicone gel products in the U.S. under an Adjunct Study.

Mentor has been making breast implants for the past 30 years. It is recognized for its rigorous quality control process and offers a lifetime replacement policy on all its gel and saline implants.

Mentor offers 3 kinds of cohesive gels in its implants: Cohesive I, Cohesive II and Cohesive III.

Cohesive I is the standard cohesive level gel used; it is the softest gel and is used in Round Moderate, Moderate Plus, High Profile and Becker implants.

Cohesive II is a slightly firmer gel, for those who want a firmer feeling implant. This is used in Round Moderate Profile implants.

Cohesive III is Mentor's most cohesive gel. It provides retention of shape with more firmness than Cohesive II, for optimal cosmetic results. This gel is used in Mentor's Contour Profile implant.

It is best to sit down with your plastic surgeon in order to determine the breast implant that is best suited to your needs.

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Dimples, Anyone?

Cheek dimples have long been considered an attractive feature in the face.

The surgical procedure used to create dimples is, in itself, a fairly simple one and is commonly done on an outpatient basis. The procedure involves simulating the natural way a dimple is formed, by forming a connection between the skin and the cheek muscle, such that when the muscle contracts, it pulls the skin inwards to form a dimple.

So how exactly is a dimple created?

A punch biopsy instrument is placed against the buccal mucosa (inner cheek) and circular motions are made to cut through the mucosa, submucosal fat, and cheek muscle. A circular core composed of these tissues is removed, leaving the skin intact, which will create a shallow cylindrical-shaped defect under the skin.

This 'defect' then is closed by placing an absorbable suture through the cheek muscle on one side of the defect, then through the dermis layer of the skin and finally through the cheek muscle on the othe side of the defect. A surgical knot is tied, which in turn will result in dimpling of the skin even without smiling.

The skin will, however, flatten out in a week or two when the suture is absorbed. The internal scarring which takes place will connect the muscle to the skin, creating a dimple when one smiles.

The surgery can be performed on any kind of cheek, be it chubby or not. It would be easier if the cheeks are not too chubby. If someone wants dimples that are very prominent, a bigger punch biopsy will be used to be able to remove a bigger core of soft tissue.

Usually performed under local anaesthetic, the surgery takes about 30 minutes, and normal activities can be resumed straight after the procedure. You walk in without a dimple and leave with your desired facial indents.

There is usually minimal swelling after, and the after care steps are just as simple and uncomplicated as the procedure. The after care usually involves regular mouth rinsing with Betadine oral antiseptic solution or Bactidol (chlorhexidine) solution, and antibiotic intake.

Read more of these articles:
How to Select a Qualified Plastic Surgeon
The Cosmetic Surgery Scene in the Philippines

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

Cosmetic Plastic Surgery Philippines
Information about procedures, prices, selecting a qualified surgeon
and having affordable cosmetic plastic surgery in the Philippines

How to Look Good this Summer Without Really Trying

Summer vacations in an archipelago like the Philippines are often spent on the beach, frolicking in the water, enjoying the sun and surf, or idling the time away on the sand just watching other people have fun. To many people, the coming of summer means a return to the gym or health club in order to whip one's body back to shape, shedding excess pounds, burning the fat away, in order to look as good as possible in skimpy bikinis or swimming trunks.

For many who do not have the time nor the motivation to spend hours working out in the gym, cosmetic surgery offers a quick solution to the problem of how to look good in swimwear without having to exercise. The popularity of cosmetic surgery coupled with its increasing affordability has made cosmetic surgery a viable option for many who desire an attractive body shape.

What better way is there to get curvy or flat contours other than liposuction? In 2005, it is estimated that more than 270,000 people underwent liposuction in the U.S.A. alone, making it the most popular cosmetic surgery procedure. Such big numbers indicate a desire of a large number of people to have an attractive figure. For men, this generally means having a flat abdomen coupled with straight flanks on both sides. Women on the other hand undergo liposuction to get thinner waistlines and to remove localized fatty bulges that are most difficult to get rid of even with rigorous exercise. Areas where fat deposits are the hips, thighs, abdomen, and buttocks, as well as on arms, knees, calves, upper torso, neck and under the chin.

Liposuction is a safe procedure when done by a well-qualified plastic surgeon. Patients with young, healthy elastic skin who have localized areas of fat are the best candidates for liposuction. This procedure can be done on an outpatient basis, if the fat to be removed totals 5 liters or less. (For amounts greater than 5 liters, it is recommended that patients stay a night or two in the hospital). After liposuction is performed, patients are advised to wear compression garments for 2 weeks, in order to prevent accumulation of blood (hematoma) or serum (seroma), and to enable the skin to adhere to underlying tissues.

There may be some swelling and bruising after liposuction, but these usually subside within 6 to 8 weeks. Patients are advised to restrict their activities for the first two weeks following surgery. Sports activities are resumed gradually on the third postoperative week. Direct sun exposure of liposuctioned areas should be avoided until all bruising has disappeared, usually within 2 to 4 weeks. This schedule for gradual resumption of normal routine should be kept in mind by those who would like to be active on the beach by the time summer starts.

The second most popular cosmetic surgery procedure is breast augmentation. Current norms of beauty regard women with full shapely breasts and thin waists as more attractive than those with breasts of lesser dimensions. It is no secret that women with bigger breasts will get more admiring looks from men compared to those with flatter chests. Do you still wonder why "Baywatch" is the most watched television show all over the world?

Following breast surgery, patients may have minimal to moderate pain which is controlled by painkiller medications. Antibiotics are also prescribed to prevent infection. Patients are advised bed rest and limited activities for the first few days after surgery. Sutures are removed in 5 to 7 days. After one week, massage of recommended to keep the breasts supple. There may be numbness around the treated area but this is usually temporary. There may be swelling and discoloration, but these disappear in a few days. Scars from the incisions are initially pinkish in color but this will gradually fade with time. Patients who wish to undergo breast augmentation should schedule their surgery around a month before summer starts in order to allow time for recovery and resumption of normal activity.

Read more of these articles:
How to Select a Qualified Plastic Surgeon
The Cosmetic Surgery Scene in the Philippines

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

Cosmetic Plastic Surgery Philippines
Information about procedures, prices, selecting a qualified surgeon
and having affordable cosmetic plastic surgery in the Philippines

Guidelines for Cosmetic Surgery Tourism

A growing number of medical tourists are availing of cosmetic surgery when they go on vacation to the Philippines. Many of them are "balikbayan" Filipino immigrants or overseas workers visiting relatives and friends. They often regard cosmetic surgery as a last-minute item on their shopping list, something which can be done during the last few days of their vacation. If a patient is seriously considering cosmetic surgery, the vacation should be planned such that enough time is allotted for the following: pre-operative consultation (1 day), pre-operative laboratory work-up (1 day), actual surgery date (1 day) and time for post-operative recovery (1 to 2 weeks). The American Society of Plastic Surgeons (ASPS) has issued an advisory that before flying, a patient should wait for five to seven days after body procedures such as liposuction and breast augmentation, and seven to 10 days after cosmetic procedures of the face including facelifts, eyelid surgery, nose jobs, and laser treatments.

If a patient has limited vacation time, having the pre-operative laboratory work up (blood tests, electrocardiogram, and chest x-ray) done prior to their vacation will facilitate scheduling of the surgery. A patient with medical insurance coverage may be entitled to a laboratory work up as part of their annual physical examination package.

Patients with risk factors such as diabetes or cardiovascular disease will also need to consult their primary care doctor, HMO physician, cardiologist, or internist, and must secure a written clearance that they are physically fit to undergo the contemplated cosmetic surgery procedure.

Once all these necessary pre-operative precautions are undertaken, the next step is to choose a qualified plastic surgeon. Patients will be taking unnecessary risks if they choose unqualified doctors to do their cosmetic surgery. Patients should also make sure that their operation will be performed in a facility that is well-equipped.
In recent years, it has been noted by the international media that the high cost of cosmetic surgery in the U.S.A., Europe and Australia has resulted in the price-driven phenomenon known as cosmetic surgery tourism. Since medical insurance does not cover the cost of cosmetic surgery and patients have to pay out-of-pocket, price has become a major factor in promoting cosmetic surgery tourism. Thus patients from First World countries have chosen the alternative of flying to countries where cosmetic surgery is more affordable.

The growth of cosmetic surgery tourism is a sign of international recognition of the capabilities of plastic surgeons who have chosen to live and work in "Second or Third World" countries.

A cursory Internet search will show entire cosmetic surgery "vacation packages" that cost less than single cosmetic surgery procedures done in the U.S.A. Many companies are offering cosmetic surgery vacation packages which generally include hospital, hotel or resort accommodations together with the cosmetic surgery. However, it must be pointed out that vacation-related activities should be avoided after surgery. Patients should avoid sun exposure, walking tours, bus tours, alcohol-intake, smoking or exposure to second-hand smoke, exercise, and water activities (swimming, snorkeling, scuba diving, water skiing, jet-skiing, parasailing, etc.). To help ensure optimal results and to limit risks and complications, patients should not treat cosmetic surgery lightly and must observe all the necessary precautions during both pre-operative and post-operative periods.

Read more of these articles:
How to Select a Qualified Plastic Surgeon
The Cosmetic Surgery Scene in the Philippines

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

Cosmetic Plastic Surgery Philippines
Information about procedures, prices, selecting a qualified surgeon
and having affordable cosmetic plastic surgery in the Philippines