After outpatient surgery with anesthesia, older drivers are safer than younger drivers, says a new study released by the American Society of Anesthesiologists.

A study of 198 patients tested driving ability with a simulator, before and after outpatient surgery under sedation. Researchers checked for driving violations, swerving and other indicators of poor driving ability.

Swerving and weaving differed little between the two groups, suggesting that the effects of anesthesia had worn off by the time patients were discharged.

The authors also checked how each group, younger and older, managed post-operative pain, and if that affected their driving ability. “We found the amount of pain did not play much importance in the final analysis, but the speed driven did,” said Dr. Asokumar Buvanendran, the lead investigator. “Older patients drove slower and had corresponding better weaving scores because they were able to correct deviations more quickly” he adds.

The researchers suggest that older patients could be more aware of the effects of anesthesia, so they drive more cautiously after outpatient surgery.

According to Buvanendran, as more people undergo ambulatory surgical procedures with short-acting anesthetics, patients are likely to drive before the typical 24-hour waiting period ends. That’s why they decided to perform this research.

Their study was presented at the ASA’s Anesthesiology 2011 meeting in Chicago. The findings have not yet been published in a peer reviewed journal.

While plastic surgeons in the past had largely used Restylane for its previous FDA approved treatment of lines and wrinkles, this new approval opens up the doors for Restylane lip augmentation. Previously, though it was not FDA approved, plastic surgeons could use the injectable for Restylane lip augmentation, as an off-label treatment.

This announcement comes after the release of findings from a recent study of Restylane lip augmentation treatments. In the study conducted by 12 doctors, it was found that Restylane was “well tolerated and highly effective for lip augmentation for up to six months.”

When measured on several points, researchers found Restylane lip augmentation to be effective and long lasting. The effects of the treatment are said to least up to six months for many patients. Those patients who participated in the study were so pleased with the results of their Restylane lip augmentation, in fact, that 80% of them chose to undergo another treatment after six months.

Restylane is an injectable gel comprised of hyaluronic acid, a key hydrating component of your skin. When injected beneath the surface of your skin at the site of a wrinkle, Restylane provides immediate correction. During a treatment for thin lips, your plastic surgeon will inject a specific amount of the product into your upper and sometimes lower lip. This form of Restylane lip augmentation will provide immediate volume to your lips, creating a larger kissable area.

If you struggle with thin lips, we encourage you to learn more about Restylane lip augmentation in Bellevue. Please join the mailing list of plastic surgeon Dr. Leff to find out about specials on Restylane and other non-surgical treatments.

Reuters reports that facial bone surgery is becoming more common, especially in East Asia, for men and women who have square faces and want a more rounded or more feminine look.

“More and more people who are on the forefront of facial plastic surgery are realizing that structural issues are critical,” said Dr. Jeffrey Spiegel, chief of facial plastic and reconstructive surgery at the Boston University School of Medicine. “Changing bone — which is the underlying surface on which the skin is resting — is what allows you to really create good attractive changes.” Dr. Spiegel said he does two to four of these facial procedures each week.

A recent study published in the Archives of Facial Plastic Surgery found that men who got the procedure in Nanjing, China, were generally satisfied with their appearance and didn’t have any complications a few months after surgery.

The study looked at 19 men who had the surgery, which included having part of their jaw bone sawed off, but the researchers said that most often it is women who want the face-rounding procedure.

Dr. Ross Clevens, a cosmetic surgeon in Florida who was not involved in the research, agreed with the assessment and said he doesn’t treat many male patients who want a more “feminine” face shape.

“What we more commonly see is men who want a more square, more angular … more masculine jaw line,” he said. That procedure involves putting silicone implants along the angle of the jaw and sometimes in the chin as well, according to Dr. Clevens.

Dr. Spiegel believes facial bone surgery will become more common in the United States. “More and more people are realizing that these changes that they may have thought are not attainable actually are,” he said. He added that the jaw area is “probably the most significant way that we determine gender and attractiveness” in the face.

The researchers reviewed insurance claims of 2,403 obese patients and 5,597 normal weight patients who had breast procedures, including breast lifts, breast reductions and breast augmentations, between 2002 and 2006.

Just over 18 percent of the obese group had at least one complication within 30 days of surgery, compared to only 2.2 percent of non-obese patients.

It also found that obese patients were 22 times more likely to have inflammation; 13 times more likely to develop infection; and 11 times more likely to experience pain.

Breast reduction was the most common procedure for patients in the study, accounting for 80.7% of surgeries in the obese group and 63.8% in the non-obese group. Next was breast reconstruction, followed by breast augmentation and breast lift.

Individual breast procedures all had higher complication rates for obese patients, and complications were most common with breast augmentation among obese patients, with half of obese patients experiencing complications.

Complication rates for each breast surgery are as follows:

• Breast augmentation – 50.5% among obese and 4.4% among non-obese
• Breast lift – 24.1% among obese and 11.4% among non-obese
• Breast lift with augmentation – 38.9% among obese and 5.6% among non-obese
• Breast reconstruction – 29.4% among obese and 1.8% among non-obese
• Breast reduction – 14.6% among obese and 1.7% among non-obese

Preparing for Breast Surgery

Based on their findings, the researchers recommended that patients should be informed about the risk of obesity prior to breast surgery procedures.

Other ways surgeons may have patients prepare for breast surgery include getting a baseline mammogram before surgery; not smoking in advance of the surgery; and avoiding certain anti-inflammatory drugs that could increase bleeding.

There was a statistically significant difference in the ratings of the scars by both plastic surgeons and lay people between the treatment and the control group, with the treatment group getting better ratings for scar appearance.

Plastic surgeon Dr. Geoffrey C. Gurtner and his colleagues developed the bandage so that it isolates the wound from the movement of the skin around it. One reason scars form is that skin movement around the incision pulls at the new skin tissue that is growing as the wound heals, causing the scar tissue to thicken and spread out.

The incision is covered by the bandage, which is held on by adhesive strips that run parallel to the wound. Gurtner said that they transfer the stress of movement away from where the skin is growing back together.

According to Gurtner, “In none of the cases was the treated scar worse than the control scar, which I think is different than some of the biologic agents we’ve seen over the last few years.”

The bandage could be used for more than just scars from plastic surgery. For example, Gurtner reported there is interest in it from orthopedic surgeons who perform knee replacements.

Scar Reduction Options

There are a variety of ways to reduce scarring after plastic surgery. Topical treatments, such as gels, tapes or external compression, can help in wound closure and healing, and injectable treatments can be used to fill depressed or concave scars.

Surface treatments, including dermabrasion, laser resurfacing, chemical peels and skin bleaching agents, can reduce uneven pigmentation and soften surface irregularities.

Dysport for Crow’s Feet: How Does It Fare?

The study, which was conducted at the University of California and published in the Archives of Facial Plastic Surgery, used 90 adults, mostly women, to compare their preference for Dysport or similar injectable Botox. Each patient was injected with 10 units of Botox on one side of their face at their crow’s feet, while the other side was injected with 30 units of Dysport for crow’s feet. None of the participants had ever undergone facial surgery, nor had they used a botulinum-based injectable in the previous six months.

One month after they had been treated, the patients were asked to compare their appearance with their facial muscles contracted to photos taken before being treated. According to the study, two-thirds of the patients said they preferred the wrinkle protection provided by Dysport for crow’s feet. With their faces relaxed, the patients generally noted no difference between the treatments.

How Does Dysport for Crow’s Feet Compare to Botox?

While for treating crow’s feet, Dysport may have garnered more patient preference, the authors of the study are quick to note that other injection sites on the face were not tested. For example, botulinum injectables are often used to treat forehead wrinkles, lines around the mouth and sometimes those signs of aging on the neck. Additionally, Dysport and Botox are not interchangeable and contain different formulations of botulinum, which should be considered when contemplating treatment.

When you visit your plastic surgeon for non-surgical wrinkle treatments, be sure to share your aesthetic goals so your plastic surgeon can suggest the best treatment for your needs.

After conducting an in-depth study of silicone implant safety, the FDA has confirmed that silicone gel implants “have a reasonable assurance of safety and effectiveness when used as labeled.” For consumers, this means silicone gel implant augmentations performed by a board certified plastic surgeon, and maintained as instructed, should present no extreme health issues for the patient.

The FDA’s silicone implant safety study also debunked a rumor that silicone breast implants share an association with “connective tissue disease, breast cancer, or reproductive problems.” Based on current data, the FDA said there is no detected connection.

Long-Term Silicone Implant Safety Tips

Women who are considering silicone breast implants should note that though breast implants are long-lasting, no such implant will last a lifetime. Over the course of her life, a woman who has gotten breast implants will likely need to have them replaced.

Patients will need to monitor their silicone gel implants over time and note any signs of complication to their surgeon. Some women may experience a hardening of tissue around the breast, called capsular contracture, or may have a revision or removal surgery.

Silicone implant safety monitoring also extends to visiting your doctor for screenings. Periodic MRIs can detect a “silent rupture” of the implant, which the patient may not be aware of. As an added precaution for women both with and without silicone gel implants, it is important to continue regular mammograms, as directed by your doctor.

Silicone gel implants are used not only for breast augmentation, but often as a part of breast lift surgeries, as well.

British surgeons have successfully used a fat grafting procedure  for breast reconstruction, according to U.S.-based biotech company Cytori Therapeutics, which created the procedure.

Cytori, which calls its procedure RESTORE, said that clinical outcomes reported at the Association of Breast Surgery Conference in Manchester, England, last month suggest that it is a viable breast reconstruction option.

The report from the surgeons was the result of an independent study of 23 patients who received the company’s adipose-derived regenerative cell-enhanced fat grafting to correct breast-contour defects after cancer treatment or benign conditions, such as implant complications. The patients were treated between September 2008 and November 2010, and 82 percent (19 patients) reported good to excellent results, with a mean satisfaction score of 5.1 (1 being worst, 6 being best). The study findings also showed a low complication rate.

Cytori focuses on using stem cells from fat to help the body rebuild itself. For breast reconstruction, liposuction is done to harvest fat cells from the abdomen, and then the fat is injected into the company’s Celution System where a centrifuge separates the fat cells from the stem and regenerative cells and prepares the cells for injection. Finally, a surgeon injects the cells into the breast.

While Cytori is reporting promising results, it should be noted that last month a joint task force of the American Society for Aesthetic Plastic Surgery (ASAPS) and the American Society of Plastic Surgeons (ASPS) released a position statement on the use of stem cells in aesthetic surgery that concluded that while there is tremendous potential for the future use of stem cells in aesthetic surgical procedures, the scientific evidence and other data are very limited in terms of assessing the safety or efficacy of stem cell therapies in aesthetic medicine.

Still, her transformation has piqued interest in chin surgery.

Also referred to as genioplasty or chin augmentation, chin surgery balances a person’s face by adding projection to the chin. During the surgery, a specially shaped implant — typically made of silicone rubber — is inserted in front of the jawbone.

A neck lift can also improve the look of the neck and chin area by removing or tightening fat, muscle and skin.

Non-surgical options, such as injectables, can also be used to improve the look of the chin. For instance, a concave chin could be corrected with hyaluronic acid fillers by temporarily building out the chin.

The Washington Post asked an oral and cosmetic facial surgeon’s opinion on Palin’s look, and he believes she did undergo “some procedure on her chin … It also appears as if she has had liposuction under her jaw.”

Palin said that she wouldn’t consider plastic surgery unless she got in an accident or got disfigured, but she is happy with her new look. She told US Weekly, “I am absolutely thrilled with the results. I look older, more mature, and don’t have as much of a chubby little baby face!”

According to the American Society of Plastic Surgeons (ASPS), the top five surgical procedures for men in 2010 were nose surgery, eyelid surgery, liposuction, breast reduction and hair transplantation. For men, the surgical procedures may have special considerations that women don’t have.

Dr. Bruce Genter, a plastic surgeon who has had many male patients over the past two decades, pointed out some of these special considerations:

• Because men don’t wear makeup, their incisions are harder to hide.
• They usually have less hair — or no hair at all — to camouflage scars.
• For facelifts, sideburns have to be kept in place.
• Because men sometimes go shirtless, liposuction incisions on the body have to be small.

Men are also seeking minimally-invasive procedures as well. Former clothing model Sean Jones said that running kept his body in shape but affected his face. “If you lose weight, it goes from your face, too,” he said. “And I started having those little wrinkles.”

When his modeling agency told him to “freshen up” he got Botox injections to smooth wrinkles and a filler to plump up his cheeks and under-eye area. Botox was the top non-surgical procedure for men in 2010, according to ASPS.

Despite the increase in men undergoing plastic surgery, surgeons have observed that men tend to keep their procedures to themselves. Jones’s surgeon, Dr. Marlene Mash, said, “We have people whose spouses don’t even know they’re having anything done.”