Overview of the Recent American Society of Plastic Surgeons' Annual Meeting

I did not attend, but I spoke with colleagues who gave me a capsule summary of the meeting including substance of the presentation and even the mood and spirit of the attendees. Also, I reviewed the Society's website for its synopses of the presented papers and discussions.

My friends reported good attendance although there is concern by plastic surgeons regarding the difficulties of a slow economy. Practices that are primarily elective cosmetic plastic surgery, particularly in some areas of the country, are suffering greatly. And for those practices that are still heavily engaged in reconstructive plastic surgery, which relies on health insurance payments, there is the uncertainty of how the new health care legislation, being bandied about in Congress, will effect practitioners.

Apropos of the concerns of reconstructive plastic surgeons, it is important that the public be reminded that plastic surgery has both reconstructive and cosmetic surgery arms.

There were awards given to patients who underwent reconstructive plastic surgery and "triumphed over adversity". An Iraqi citizen injured in the war there, a breast reconstructive patient, a patient with port-wine stain, as well as a patient with a difficult skin cancer on the nose were identified and their stories told.

The Society's underlying message is that plastic surgery is not exclusively about beautification, celebrities, and high-profile public figures. Every day, plastic surgeons are in the trenches performing necessary repairs wrought by injury, accidents, cancer, and birth deformities.

It is very important that plastic surgeons continue to have training in these areas to help relieve misery and suffering.

There were a variety of subjects discussed that will be of interest to the public.

During the Hot Topics session, there was discussion about Lipodissolve, a fat-melting formula that has been controversial heretofore. Traditionally, this has been suspect with respect to its ability to essentially melt away the fat deposits which have been heretofore handily dealt with by liposuction. The science has been reviewed and there may be, in fact, some strong potential for utilization of this technology. Stay tuned, we need more information. Another important Hot Topics discussion that took place which I will discuss shortly, was the role of fat injections to enhance the breast size as a possible alternative to breast implant placement.

GENES ARE STILL KING – OR QUEEN

How often I have heard patients sit in my consultation room and say, "I'm starting to look like my mother. And I don't like it."

At the meeting, there was a discussion regarding the prediction of the signs of aging in specific facial areas. It was interesting to recognize that the essence of the study was what we have all known intuitively: as your mother (or your father) ages, so will you. If your mother's sags, bags and wrinkles first manifested in the eye area, the advice is "keep an eye open" on your eye area. You have a peek into the future.

However, I am pleased to say that today cosmetic plastic surgeons have more tools in our toolbox than ever. While we can't stop it from ticking, we turn back the clock daily. There is Dysport and Botox Cosmetic to ease the wrinkles caused by muscle contraction, particularly between the eyebrows, forehead and around the eyes. There are the great and reliable fillers: Restylane and Juvederm. And, now Sculptra, longer lasting. To bring back the skin's more youthful appearance, the venerable work-horses: chemical skin peels, lasers, micro-dermabrasion and Retin-A and bleach creams. Yes, your body is programmed to age as your ancestors have but today there is help out there.


LIFTING BREASTS AND FILLING CLEAVAGES WITHOUT SURGERY?

My practice is limited to cosmetic surgery of the face and neck and so when it comes to breasts and body issues, I am an observer and reporter rather than an expert.

But I do understand the chemistry of products that are being used and I, of course, understand the anatomy.

There was a report and discussion about using Botox Cosmetic as a possible breast lifter. The anatomic basis of that would be that if the pectoralis minor chest muscle, one of the "pecs", had its function neutralized by the muscle paralysant, then there would be unopposed lifting of the breast by other muscles in the area. Now, of course, this is not permanent. Muscle paralysants tend to last between four to six months. And this would be an off-label use.

The doctors reporting on this possible new role for Botox Cosmetic - and perhaps the newer Dysport - suggest that the procedure would be ideal for younger women between 30 and 50 with relatively small cup sizes.

There were some naysayers who pointed out that it is unlikely that patients would have satisfaction from a technique that may not be any better than better posture. And, that in fact, the volume of the medication, since the aim is to paralyze a large muscle, could be significant and that would translate into perhaps too high a dollar cost to be practical. There were other medical issues raised including some increased risk since perhaps the drug could spread to muscles participating in breathing.

I consider papers like this to be stimulating and most valuable by furthering thought and research. This technique will not replace surgical breast lifts in the near future until more information has been gained.

FAT INJECTIONS INTO THE BREAST RETURNS AGAIN FOR CONSIDERATION

Fat injections into the breasts as a means of enlarging the breasts is not a new concept. It has been performed in other countries and has its champions. One paper reported a study of 46 women who received fat injections into the breasts after a breast lift. Apparently they demonstrated "improvements in the size and shape of the breasts after one year." It is important to follow patients for many months and ideally many years to see what the effect is since transferred fat has an uncertain fate. It could shrink, it can form some firm nodules and all this would have long-term implications.

Understand that there has always been a concern about whether or not fat transfer might compromise diagnosis of breast cancer. Certainly women would not want to decrease the likelihood that an early breast cancer could be discovered because there was concealment by transplanted fat. Apparently, the authors argued that "It's easier to see breast tissue in breasts that were augmented with fat than implants." Again, I am not an expert and I believe that we need much more time to study the issue. There needs to be more research studies. Achieving a major increase in size would require large volumes of fat. And, typically, the greater the volume of tissue transplanted, the more uncertain the fate of the transplants.

One of the doctors at the meeting commented that the amount of augmentation was an increase of only 212 cc which is 14 tablespoons of liquid. It may not be enough to satisfy most patients.

— Robert Kotler, MD, FACS