News & Features

Plastic Surgery News: World Roundup February 2006

The Virtual Nose

Not too long ago, it was anatomically correct dolls that made headlines. Now, an anatomically correct nose, known as The Virtual Nose, has come onto the scene although it’s not making as many headlines….just yet. A Virtual Nose at University of Illinois at Chicago, (U.I.C.) is housed on a gigantic human skull that seems to float in mid-air like a huge hologram. Moreover, the virtual reality model might just be the teaching tool on which your plastic surgeon learns his or her way around a real human nose if you ever have a rhinoplasty, or nose job, in the near future.

Virtual Nose
A nose is a tough nut to crack; the human schnozzle is actually the most complicated part of the body on which rejuvenation surgeons operate. It’s because a nose is a 3-dimensional jigsaw puzzle with alternating and interlocking layers of skin, soft tissue, bone and cartilage. Traditionally, surgeons-in-training have used books and other medical drawings but 2-dimension graphics don’t really put the concepts across. Of course, taking apart noses on dead bodies is a great way to learn but medical cadavers are expensive and in short supply. So most wannabe plastic surgeons stand at the elbow of a more senior colleague and watch as many – often, in the thousands – operations for which they have time.

Now, a better way has come along. Researchers in the School of Biomedical and Health Information Sciences at U.I.C. have labored the last four years to create the Virtual Nose. They did it by digitizing 460 images of structures inside a nose. Some things inside the nose are so obscure, medical modeler and sculptor Andrea Stevenson fashioned and then showed them to surgeons who suggested corrections. The 3-D Nose also drew on CAT scan data from the Visible Human Project at the National Library of Medicine.

To get the 3-D effect, medical students must wear a special pair of glasses. Moreover, if the user has a special wand, he or she can remove skin, bone, tissue and cartilage from the Virtual Nose, twist it around in space to see all sides and then put the pieces back together again.

“Rhinoplasty is extremely delicate and demanding,” says J. Regan Thomas, M.D. professor of Head and Neck Surgery at U.I.C. “Removing one millimeter of bone – that’s the width of a line drawn by a pencil – is easily noticeable on the nose after the procedure. So a very thorough knowledge of nasal anatomy is absolutely necessary.” Necessary because, in the worlds of plastic and cosmetic surgery, rhinoplasty is one of the most requested procedures. And because the human proboscis is so complicated, nose jobs are the plastic surgeries most often requiring a redo.

But the amazing technology does not stop there. “We are working with other virtual reality methods medical students can use to get a sense of what operating on a real nose feels like,” says Mary Rasmussen, the lab’s director. On the medical horizon is technology to wire other hospitals and teaching centers, worldwide, to U.I.C.’s Virtual Nose. Desktop computer users can also access the nose in 3-D. There’s just one thing the Virtual Nose and its surrounding skull can’t do: laugh. Humor, of course, is always a good thing unless it makes milk come out of your nose. Could virtual milk be next?

Stand-Up Liposuction

Being awake during an operation is nothing new, but how about standing up while undergoing surgery?

If you receive liposuction from New York plastic surgeon Leonard Grossman, M.D., you just may find yourself in a situation where you are asked to stand and deliver…..excess fat, that is.
Stand up Liposuction

Dr. Grossman has used this technique with great success for nearly a decade on patients requiring “liposuction of the saddlebag area and the hips,” he says. Those places tend to shift in shape when a patient lies down. And that makes it more difficult for a doctor to determine if the outcome will be what the patient wants.

“The patient benefits because she is in almost complete control of the surgical outcome,” says Dr. Grossman. “If she’s standing, she can tell me if she wants more fat removed for an even slimmer look.”

The surgeon also benefits because he can perform the procedure once with maximum accuracy and lower the chances for post-op, touch-up procedures and a possibly dissatisfied patient.

“The standup procedure is not just for control-freaks or backseat drivers, but anyone interested in getting the most for their money,” says Dr. Grossman. “Getting liposuction redone is time-consuming and costly.” Moreover, the reoperation rate on stand-up liposuction is nearly nil, according to Dr. Grossman.

The tumescent method of liposuction sometimes requires intravenous sedation to more completely relax the patient. In tumescent liposuction, Dr. Grossman infuses the area to be suctioned with a solution containing saline and local anesthetic. That method is known to reduce bruising and swelling later. He asks them not to look at the mirror or down at him while he’s doing the liposuction.

“When I think I’m satisfied, I ask the patient to look in the mirror and we decide if she needs more fat removed at any one spot,” says Dr. Grossman. Nobody has ever fainted on Dr. Grossman, but some patients have been placed on their back if they begin to feel a little woozy. Standup lipo has the same recovery time as traditional liposuction and doesn’t cost any extra. In fact, Dr. Grossman says “the cost for the procedure is the same even though the whole procedure takes ten minutes more than regular liposuction. And, there are actually fewer anesthesia requirements.”

Plastic surgery with a reliable outcome and it won’t cost any extra? Seems too good to be true, but it’s for real. Is this a stand-up guy or what?
--- Nickie Dobison Saucedo

Greece: Counting Dimples…… for ¼ Century!

Counting Dimples
Researchers in academia are always looking for things to study to increase our knowledge of the vast, complicated world in which we live. One scientist even studied why toast almost always falls to the floor, buttered side down. Another analyzed why chickens seem to prefer beautiful humans while yet another duo of physicists in Australia started an experiment back in 1927. Those Aussies wanted to know why a gob of congealed black tar drips through a funnel at a rate of one drop every nine years. (We’re not making any of this up; these are real research projects.) There was even a scientific test of the Five Second Rule which said any object that fell on a kitchen floor was safe to eat if you picked it up within five seconds.

Back in 1980, a professor at Aristotle University in Greece finished counting the dimples on 28,000 Greek boys and girls. Just to cover all the bases, the researchers observed both smiling and straight-faced children. In July, 2005, those scientists wrapped up their analysis of all the data and published their findings in a respected scientific journal. The findings? 13 percent of Greek children bore a dimple, or dimples, in their cheeks. Moreover, boys and girls were almost equally well dimpled. Additionally, the dimples were equally distributed between right and left cheeks. But only about 3.5 percent of the youngsters had dimples in both cheeks.

Sure, it’s edge-of-the-seat stuff but now the plot really thickens. In 1983, that professor and an equally hard working colleague published yet another study revealing that 34 percent of Greek adults had dimples – that’s almost triple the occurrence of dimpling in Greek youngsters. The professors figure natural aging processes create the massive dimpling in adults.

And what does all this have to do with plastic and cosmetic surgery, you ask? Well, if you run an online search for plastic surgery and dimples, at least two hundred pages of willing, eager and ready providers will appear on your screen, some with reasonable prices already fixed for putting dimples into your otherwise unmarked cheek, or cheeks. For instance, one cosmetic surgeon in Bangkok, Thailand, will insert dimples for $500 each. Yet another surgeon from Vietnam offers a talk for other surgeons, “An Easy and Precise Way to Make a Cheek Dimple.”

So, while we are certainly not anywhere as learned as university professors, we propose an alternate explanation: undimpled children, not only Greek kids but all youngsters worldwide, suffer so much envy in their formative years, they go to plastic and cosmetic surgeons just as soon as they are adults and request the marks be surgically installed in their cheeks. Why else would there be three times as many adults – compared to kids – with dimples?

Consequently, it has all resulted in a quiet explosion of dimplectomies worldwide. Its existence is almost as important as learning why toast usually falls to the floor, buttered side down.

Jogging -- Bad For Your Skin!

With a current epidemic of obesity happening everywhere among all age groups in America, more people are taking up some form of exercise in hopes of knocking off some of that unsightly flesh. Already, some 22 million Americans make a habit of jogging for health, exercise and – believe it or not -- fun.

But a Colorado plastic surgeon has made some comparisons of his jogging and non-jogging patients while they were under the knife and urges a word of caution to those who want to take up running.

“Beware of jogging,” warns Denver plastic surgeon John A. Grossman, M.D. “Jogging can be bad for your skin! It can be particularly hard on the skin of both mens’ and womens’ faces. “For your skin’s sake, give up jogging and get a bike!” he says.

Science has already learned how year after year of jogging can be hard on ankles, knees and hips. It’s because the weight of your body is multiplied by a factor of five or six every time a foot strikes the ground. Jogging downhill is especially hard on the body and the underlying collagen as well as tissues of the face, breast, thighs and buttocks.

“I’m not saying forget exercise,” adds Dr. Grossman. “Just take up some form of low-impact workout like a bicycle, an elliptical trainer or swimming. “The hard impact and repetitive up and down motion of jogging on land or on a treadmill tears collagen, the body’s building block that creates healthy, youthful skin,” he says. “Your skin is something like a rubber band -- continuous stretching through bouncing up and down causes it to lose elasticity. Plus, as we age the impact is much more dramatic.”

Because Dr. Grossman has spent so many years working closely with skin during various rejuvenation surgeries, he started noticing that patients who jog had much more saggy skin everywhere on their bodies compared to non-running patients. And, the older the patient, the worse the effect. He matched notes with other plastic surgeons and eventually mentioned his observation to an exercise physiologist who said it makes perfect sense.

“I think that no amount of jogging is good,” Dr. Grossman says. Hollywood funny lady Joan Rivers would agree. She has often said, the first time she sees a jogger smiling, she’ll consider taking it up.

Sea Coral: Plastic Surgery Implants

It’s not like holding a sea shell up to your ear and hearing the ocean but some plastic surgery providers can fit a little piece of the romantic South Seas into your body. While medical science has turned out a remarkable number of products, machines, tools, techniques and other gizmos used in plastic and cosmetic surgery, some surgeons have found it’s hard to improve on nature’s own. So they are using little pieces of carefully crafted coral – yes, as in coral that grows in the ocean – for implants in plastic and cosmetic surgery.

Local anesthetic
“ Coral is highly valued in plastic surgery for its strength and ability to be carved enough to conform to various shapes and sizes,” says Harvey M. Rosen, M.D., D.M.D., chief of plastic surgery at Pennsylvania Hospital in Philadelphia.

Coral is also so porous that tissue, bone and blood vessels eventually grow into and through coral implants so they become part of the patient’s skeleton. The material is additionally resistant to infection because the body embraces the new material as part of itself.

“Many patients are both surprised and relieved to hear about coral implants because without the substance, the surgeon may have to use a bone graft for implantation,” says Dr. Rosen. “And that means another incision and more discomfort.”

Local anesthetic
Usually, the surgeon uses a dental drill to carve a small block of coral into the dimensions required by the patient. One common use, for instance, is implanting coral on aging faces. Because, as we grow older, our faces become more square. Lengthening a face at the chin with a four or five millimeter (one millimeter is the width of a pencil line) block of coral creates a younger face. Coral is also commonly inserted into the middle of the face to create more projection. Many are inserted through incisions inside the mouth, a procedure that leaves no visible scarring.

Of course, if you like to keep your medical procedures private, you can always deny having any implants at all and just claim you had a sudden growth spurt.

Reese Witherspoon: On-Again, Off-Again Wrinkles

Reese Witherspoon
While Reese Witherspoon is getting rave reviews for her performance as June Carter Cash in the Johnny Cash bio-pic, Walk the Line, it’s possible she had Botox Injections in the middle of production. Dead bang giveaway: in some scenes, Reese’s forehead is highly wrinkled. But the next scene shows a totally smooth forehead followed by yet another scene in which the wrinkles have reappeared.

“It looks like Reese had some Botox near her mid-forehead and just above her nose in some scenes,” says Cincinnati plastic surgeon Jon E. Mendelsohn, M.D., F.A.C.S. who reviewed the movie for News. “The Botox was very well done because she could still animate her face.”

Additional rejuvenation work on the Legally Blonde star, according to Dr. Mendelsohn, includes slight lip augmentation. But the skin on her chest, back and shoulders shows some sun damage with hyper pigmentation. “One may also presume she has had a rhinoplasty,” says Dr. Mendelsohn. “Reese has a slight bump on her nose but it appears natural. Otherwise, she is a Natural and stunningly beautiful!”

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