News & Features

Plastic Surgery News: World Roundup January 2006

Ribs Used to Create New Ears

It's a situation Shakespeare would have handled by having his actors announce: "...mend me your ears!" A British surgeon is helping some of Saddam Hussein victims whose ears were sliced off as punishment. The award-winning surgeon, Dr. David Gault, learned how to make new ears from Burt Brent, M.D., a California plastic surgeon (and talented bronze sculptor) who is regarded as the father of ear reconstruction. So far, experts figure about 350 people in Basra and another 1000 in Baghdad lost one or both ears as punishment.

To make a new ear, Dr. Gault - who had to choose between art and medicine as a career -- traces an outline of the victim's other ear and makes a template. He then harvests a small amount of rib and cartilage from the person's "floating ribs" - at the bottom of his or her rib cage. Next, the highly artistic surgeon uses a tiny scalpel to carve the framework of an ear and inserts it under the victim's skin where ears are normally seen. Next, he attaches a vacuum device for five days so the skin tightly adheres to the bare bones. That part stays in place for six months to give the framework time to more strongly attach to the patient's skull. In a second operation, the surgeon frees the ear, uses some donor skin from the thighs or buttocks to cover the back of the ear and - presto! - the once disfigured victim has a new, amazingly realistic ear that never attracts a second glance.
An Iraqi whose ear was sliced off as a form
of punishment, recieves reconstruction.

According to Dr. Brent's website, ears made from ribs are also grafted onto people who are missing an ear due to trauma, burns, cancer and, especially, for children born with microtia, an inherited condition that leaves only a fold of skin and tissue where a normal ear is usually seen.

"These reconstructed ears are remarkably sturdy and, despite about 70 reports of major trauma, all healed without incident," writes Dr. Brent on his website. "These traumatic episodes included severe blows from soccer kicks, baseballs, and hockey pucks; abrasive injuries from football tackles and wrestling matches; insect bites and bee stings and even a dog bite." And then, with both ears intact, the person can easily fit into H.L. Menken's definition of a politician: an animal that can sit on a fence and yet keep both ears to the ground.

Study: Patients Should "Talk Back" During Surgery

One of the upsides of using local anesthesia while having plastic or cosmetic procedures is talking back to your doctor. Gregg Morganroth, M.D., a plastic and dermatologic surgeon in Mountain View, California, studied the effects of both general and local anesthesia and found, under locals at least, patients often discuss everything from goals for the surgery to any standard topic of conversation like family, vacations and politics.

Dr. Morganroth did the study because the serious risks and complications to people under a general anesthesia are well known - woes like upset stomach, allergic reactions and worse.
Local anesthetic

Nonetheless, many physicians and patients do not fully appreciate the benefits of using a local anesthesia, so Dr. Morganroth set out to evaluate the benefits of doing a combination of face and neck lifts, chin implants and blepharoplasty (eyelid surgery) procedures, blocking the pain with only a local.

After doing a combination of procedures - which are typically performed under general anesthesia -- on 43 patients, Dr. Morganroth found that patients were extremely satisfied, with most experiencing minimal post-operative pain, and all returning to normal daily activities within four days and to unlimited social activities within 11. Moreover, he found none of the serious side effects often linked with surgery performed using general anesthesia. Those bugbears include nerve injury, allergic reactions, hemorrhage, abnormal heart rhythms, fluid overload, hypotension and the need to be monitored in the hospital overnight after surgery. Accordingly, Dr. Morganroth says using only a local is a safer, more cost-effective approach that allows surgeons to walk their patients step-by-step through a procedure.

"Patients discuss the relative tightness they feel and can see the results during the operation to compare the treated and untreated sides of their faces," Dr. Morganroth says. "Plus, they can sit up afterwards and see the results. They go home happy and excited and that helps make a happy, relaxed patient in the post-op period." Maybe dentists could take the hint and figure out a way for their patients to clearly talk while their mouths are stuffed full with cotton.

Baldness Cured - Thanks to Scalping!

Two plastic surgeons are taking scalps - sorta. But instead of hanging them from lodge poles, the scalps, or more appropriately, scalp flaps, are sewn back onto the shiny heads of bald men, thereby curing the ages old curse of what the politically correct call the "hair-challenged head."

Beverly Hills plastic surgeons, Richard Fleming, M.D. and Toby Mayer, M.D. of the Beverly Hills Institute of Aesthetic and Reconstructive Surgery devised a way to cover shiny pates by using the remaining hair left on the sides of patients' heads. And, the procedure has attracted far flung attraction: According to the Independent, a newspaper in Manchester, England, "scores of Britons have already flown to America to have the operation and are talking of having their lives transformed by thick lustrous hair that makes them look ten to 15 years younger."

Flap Hair Diagram
The treatment, known as the Fleming-Mayer Flap, -- named for its inventors -- is performed in three stages over three weeks. The surgeons first make three long incisions in a long section of hair bearing scalp on the sides of the head and wait a week for an improved blood supply to develop throughout the flap. Later, during the actual operation, the surgeons loosen and twist that flap 90 degrees and attach the loose ends across the top of the bare head. The same procedure is done on the other side of the patient's head. Then, the surgeons bring together and suture the areas on the side of the head where the scalp flaps were taken. Because the blood supply is never cut off, the hair continues to grow just as before - only in a more prominent position. Before the scalp flaps are moved, the original patch of thin skin atop the head is removed and discarded before the banana-shaped flaps are moved over across the crown and sutured down. The stitches in the hairline are removed after six days; after ten days, the stitches in the flaps on the side of the head are removed. The result is permanent, immediate while the hair of the flap maintains the same density and texture as the rest of the hair.

Some patients with tight scalps require tissue expansion to increase the amount of hair-bearing skin. To stretch a scalp, the surgeon places a tissue expander - a medical device much like a deflated balloon - under the scalp. The expander is gradually filled by periodically injecting small amounts of sterile water. After several weeks, the surgeons have more hairy skin to work with, remove the expander and use the additional scalp to cover bald areas.

Consequently, the Bald Headed Men of America - who actually claim to be proud of their chrome domes -- are scratching their shiny pates trying to think up a new motto that will rhyme with the words "scalp flaps." Their current motto? "No plugs, drugs or rugs!"

Israel: Rates of Cosmetic Surgery Zooming

Twenty years ago, Israel had only two licensed surgical clinics performing plastic surgery. Now, with a 120 board certified plastic surgeons on hand nationwide, Israel has one of the highest per capita rates of plastic surgery in the world when you compare surgeons with its small population. Experts say cosmetic surgery has become so popular there because of Israel's warm climate and Mediterranean lifestyle. Thus, many are concerned about beauty and are more open to rejuvenation surgery. Estimates place 15,000 to 20,000 Israelis going under the knife annually to improve their looks. Women patients outnumber men, 25 to one, but more men are showing up at surgeons' offices for body hair removal and ear, nose and eyelid surgery. As in other nations, a few more men are starting to get facelifts and liposuction.

Colombia Models: Big Boobs, No! Small Size, Si!

With its beautiful beaches, weather and women, South America has always been a leader in fashion and trend setting. And so Pamela Anderson and other hefty bosom wannabes take note: the leading trend in the Colombian fashion industry is for models with a smaller bosom. At the annual Medelin Moda fashion fair last August, the models who stalked the catwalks were anything but voluptuous. Many fashion directors insist on smaller breasted models.

Local anesthetic
Using smaller breasted models is understandable because designers always, always want the emphasis to be on the clothing. But the trend is reportedly spreading from the fashion industry to casting directors for television and films and other modeling directors. While Colombia has about 485 plastic surgery clinics, the International Association of Aesthetic Plastic Surgery ranks Colombia 21st on its 2004 worldwide list in the number of corrective procedures. Moreover, surgeons say it may take a while for the smaller-breast trend to work its way down to the street so that many more women choosing breast reductions instead of enlargements.

Contact Lenses Create Baggy Eyelids

Do you wear contacts? If so, you are probably pulling on your eyelids at least once a day to pop the tiny lenses off your eyeball. Jin-gyu Lee, M.D., a plastic surgeon at the Dong Yang Plastic Surgery clinic in Seoul, Korea, wondered if all that pulling and squeezing might make contact lens wearers more prone to droopy eyelids. So he studied five patients, aged 23 to 43 who showed up in his clinic requesting a blepharoplasty, the operation that tightens overly loose eyelids. While the patients' average time for wearing contacts was 6.7 years, Dr. Lee found the subjects eyelids were all A-O.K. - with one exception: a tiny muscle in the eyelid, known as Muller's muscle, had been thinned by being pulled sideways so often and by closing over the contact many thousands of time. To cure the droop? A tiny stitch from the center of the muscle to the side, pulling it tight.

Michael Jackson - a Nasal Cripple?

We asked New Jersey plastic surgeon Valerie J. Ablaza, M.D. (and co-author of the newly published book, "Beauty in Balance") to analyze the changes in Michael Jackson's face over the years. Her findings:

"Michael Jackson has admitted to 'minor surgery to treat a sinus condition and possibly a little other work' on his nose but I would say it's quite obvious that over the years the basic architecture of his nose is dramatically different and not explainable by weight loss or the natural aging process. The bridge of his nose is narrower while the tip is pointier and well defined. The lower part of his nose is also narrower with less flaring of his nostrils. There has clearly been cartilage resected and over-resected in some places while in other places, it appears he may have had bone or cartilage grafts inserted to build up the nasal contour, especially along the nasal bridge.

The current shape and appearance of his chin, including the cleft, appear to have been surgically modified when compared to his younger photos. The hollowness of his cheeks could be the result of changes in weight and natural aging. I have also seen other photos wherein it appears he may have had some cosmetic surgery on his upper and/or lower eyelids or possibly laser treatments or chemical peels to tighten the skin.

Michael Jackson definitely looks like his skin has been bleached or somehow permanently lightened. A variety of methods can bleach skin, including chemical peels, lasers and topical creams which either inhibit or destroy melanocytes, the skin's pigment-containing cells. If any danger exists, it would be at the time of treatment. Plus, depigmenting the skin to such a severe degree causes a person to lose the sun protection usually afforded by the melanocytes. As a result, a person would be more prone to sunburn with unprotected sun exposure. I suppose some of the white coloration of Michael Jackson's skin may possibly be from make-up or facial powder applied daily."

Michael Jackson

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