Aldo B Guerra MD, FACS

Scottsdale, AZ - Researchers have found that the chemotherapy drug - fluorouracil - may help reduce the appearance of sun-damaged and aging skin while reducing the number of pre-cancerous skin patches (Source: medicalnewstoday.com).

Dr Dana L. Sachs, Associate Professor in the Department of Dermatology at the University of Michigan, Ann Arbor, led the research team for the study published in the 6 June issue of Archives of Dermatology. According to the study, fluorouracil, which is used in chemotherapy treatment of cancers of the colon, head and neck, pancreas and other organs, stops the body being able to make thymine, a building block of DNA.

For this study, Sachs and colleagues asked 21 healthy volunteers with sun-damaged skin and lesions to apply 5 per cent fluorouracil cream to the face twice a day for two weeks and regularly examined their skin for molecular and clinical changes during this time and also for another 22 weeks afterwards.The clinical evaluation noted overall improvements in aging-relating damage, including a reduction in wrinkling, dark spots and skin tone.

Scottsdale - A new study in the Annals of Plastic Surgery demonstrates patients who have implantable local anesthesia pumps use less narcotics after breast reconstruction with deep inferior epigastric perforator flaps. The study evaluated narcotic use after deep inferior epigastric perforator flap breast reconstruction when a local anesthetic catheter was used.

The analysis was performed comparing 40 consecutive control patients (receiving no catheters) to 40 consecutive study patients who had received a pain pump catheter. The catheter was left in the abdomen for 3 days. All narcotic doses (oral and intravenous) were converted to intravenous morphine equivalents.

Initial average 24-hour morphine requirement for the control group was 42 mg compared with 33 mg for the study group, a difference that was statistically significant. The total hospitalization morphine requirement for the control group was 71 mg compared with 55 mg (average) for the catheter patients, also statistically significant. The conclusion of the study is that use of an implantable local anesthetic catheter placed in the abdomen can decrease narcotic use in the postoperative period after breast reconstruction with deep inferior epigastric perforator flaps.

I have use catheters like the ones studied here and have been impressed with the rapid recovery experienced by patients after tummy tuck and body lift surgery. This includes less narcotic use and a speedier recovery, including earlier walking after surgery and complete rehabilitation after these types of abdominal procedures, which are, similar to the deep inferior epigastric perforator flaps.

Scottsdale, AZ -  A group of  doctors is testing a new kind of obesity surgery performed without incisions on the abdomen.The procedure uses a tube similar in size to a garden hose to snap staples into the stomach. While experimental, the scar-free procedure is promising and creates a narrow passage that slows food as it moves from the upper stomach into the lower stomach. This helps patients feel full more quickly and eat less (SOURCE: AssociatedPress.com).

The new method is part of a medical movement to perform surgery using natural body openings such as the nose, mouth and vagina instead of making incisions via the skin. The researchers hope to reduce risks of infection and post-procedure pain, while creating a speedier recovery. They claim that without scars, there are cosmetic advantages. So far about 300 patients have been included in this new study, which recently ended enrollment. The preliminary results good weight loss and minimal complications. Manufacturer of the device plans to seek federal approval if the research continues to go as planned.

The researchers argue that gastric bypass whether done through a large incision or several tiny ones, is far more invasive and increases chances for malnutrition because it repositions how the stomach attaches to the intestines tract to restrict calorie absorption. That is definitely an advantage of this new endoscopic procedure that I agree with the researches. I am not sure, however, about the cosmetic benefits.

In my plastic surgery practice, which involves a large number of major weight loss patients, the cosmetic procedures to remove excess skin that develops in various regions of the body, require fairly extensive incisions. For most patients, the amount of excess skin that is removed, the tightness that develops and the improved contour obtained makes it worthwhile to have these incisions. However, there are  certainly no “scar-free” types of procedures for major weight loss body contouring . I am afraid that these types of procedures might create another level of HIGH expectations for which most plastic surgeons performing plastic surgery for weight loss will not be able to achieve.

ARIZONA - A report from London, U.K., outlines a new food product invented by scientists that can make you feel twice as full.  If this holds true, such a breakthrough could offer hope to millions of dieters. The project was engineered by experts at the Institute of Food Research in Norwich, United Kingdom.

The researchers found a certain mixture of olive oil, water and a food stabilizer, already used in the baking industry, kept people full for up to 12 hours after eating. It is the first time a mixture with these effects has been developed, but don’t get too excited yet folks, they estimate that it will take 5 to 10 years to reach the shelves (SOURCE: Mailonline.com).

“This formulation could be used as an ingredient in new foods to make them more filling, which in turn could help reduce over-consumption of calories,” said Dr Martin Wickham from Institute of Food Research.  ‘This is the first time that we have seen such a dramatic effect from a model meal.”

The mix was developed by Dr Wickham and Richard Faulks at the Institute of Food Research and its effects tested by scientists at Nottingham University. The 3 year project found that emulsions of olive oil and water can be altered to affect how they react in the acid environment of the stomach.

Dr Wickham said: “If we can retain material in our stomachs for longer we tend to feel fuller. It is important to control obesity and keep weight down, and this is a more acceptable way of doing it than restricting your food intake on a diet. You would feel fuller so you don’t want to eat, rather than starving yourself.”

Scottsdale, AZ - A new study in the May issue of the Archives of Facial Plastic Surgery rated the long-term performance of a  popular type of face lift produce which utilizes barbed sutures, known as “thread-lift”.  The study concluded that only short-lived improvement in appearance is delivered, but no long-term benefit is seen, and the researchers  recommend that the technique no longer be used given its risks, poor results and discomfort for patients. (Source: Reuters Health)

The study examined a total of 33 patients using the thread-lift. Some of the patients had other aesthetic procedures. A control group of patients having facial plastic surgery without thread lift was used.  Four surgeons were blinded to the details of surgery (didn’t know which procedure patients had received) and rated the aesthetic improvement for each patient using a scale from 0 (no improvement) to 3 (considerable improvement). A month after the procedure, improvements were seen  in all the patients.  The average long-term follow-up time averaged 21 months and the thread-lift only group scored lowest on aesthetic improvement, with average scores ranging from 0.2 to 0.5. Patients with thread lifts plus other procedures, scores from 0.5 to 1.4. Patients with traditional procedures, scored the highest, ranging from 1.5 to 2.3.

“Thread-lifts don’t produce lasting results, ” said Dr. Rima F. Abraham of Albany Medical College, New York,  in her report.

The researchers concluded the thread-lift techniques do not work because the sutures do not change the shift in facial volumes that occurs with aging.  They felt that results seen a month after thread-lifting were likely due to swelling and inflammation. Complications with thread-lifts seen in the study included visible knots and dimpling of the skin. Three patients had to have a thread removed. The investigators conclude that thread-lifts carry a high risk of complications, while extensive scarring may make it difficult to remove the threads, which is problematic because studies have found up to 20% of patients need a repeat surgery (Source: Archives of Facial Plastic Surgery).

Whenever I see reports like this it makes me feel good that I didn’t fall for these “new quick fix” procedures. Even though it might be a tempting way to attract patients to the practice, I believe in the “tried and true” plastic surgery procedures. That is why patients will not find these “fly by night” procedures in my practice. I had a patient ask about thread-lift just a few months ago, and I wish this information had been available then. The results of this study, demonstrate that there are no long-term benefits from thread-lifts, something that I suspected all along. There sure are risks, however.

According to the article the thread-lift has been recalled by the FDA, but similar techniques are still available. These are probably just another “fad” that will soon also be unmasked.

Scottsdale, AZ - Diabesity is the term used to describes the obesity-diabetes epidemic that has seized America is endorsed by the American Diabetes Association. Recently, the ADA has also endorsed a more aggressive approach to the treatment of type 2 diabetes. This includes going beyond the typical lifestyle recommendations such as dietary changes and increasing physical activity, and to recommend gastric bypass surgery (Source: Scienceline.com).

In this surgical procedure, surgeons staple the stomach to make it into a small pouch and rearrange the intestine so the middle portion of the intestines is connected to the stomach. Patients begin to loose weight as the food bypasses large portions of the intestine and the calories are not absorbed. The small stomach also prevents patients from eating large amounts of food. As a side effect, many patients suffering from diabetes note that the disease disappears - even before the pounds are lost!

This suggests there is some other underlying mechanism that leads to the resolution of diabetes type 2 in these patients. If this mechanism can be found it may help to understand why people get type 2 diabetes and even to the creation of new medications that can help control diabetes better. Recent experimental data suggests that bypass surgery in diabetic animals can also cure the animal form of type 2 diabetes. It is certainly exciting to see if this new cutting edge research can pay off with new discoveries for the treatment of diabetes in the future.

Phoenix, AZ - Facebook, the popular social networking website has decided to allow breast cancer survivor, Sharon Adams, to place photographs of her mastectomy scars. Initially,  the website banned the photographs, but later apologized and allowed her to post the photos (Source:theoriginalgreenwichdiva.com).

“It was like the breath had been sucked out of me.  I had this really horrible feeling inside,” said Adams, after being diagnosed with breast cancer in January. but once those feelings subsided, the mother of four decided to bring awareness to the horrible disease.

She was diagnosed at the age of 45, has 4 children, and said “All I want to do is raise awareness of breast cancer”. She placed pictures on Facebook, along with details of her fight against breast cancer and encouragement for other women to go and get regular check-ups. Less than one month after the diagnosis, doctors removed her right breast.  “I don’t miss my breast.  I wanted to live,” she said.

Breast cancer can affect 1 in 9 American women. I admire this lady for being so courageous and sharing such a personal part of her life. I think it is important to realize just how disfiguring mastectomy surgery can be, yet at the same time, to realize that this is a life-saving and important operation for breast cancer patients. I encourage women to check their breasts regularly and not to be embarrassed about doing this critically important activity throughout their lives.

Arizona - Simona Halep, she is  young, beautiful and talented on the tennis court. She certainly is seen as a rising star in the tennis ranks, however, there might be one imperfection with her tennis game. And now, Simona is now planning to have a breast reduction to improve her game. I commend her for making the decision and hope that she is able to achieve more success on the tennis court after her surgery.

“This fall I’ll have a breast reduction operation. The breasts make me uncomfortable when I play.  It’s the weight that troubles me - my ability to react quickly, ” said, Ms. Halep. The 17 year old Romanian wears a 34-DD and reportedly has booked herself for surgery at a private clinic this fall (Source: The Sun).

Breast reduction is one of the most gratifying operations performed in plastic surgery. Many patients can suffer from back and neck pain and may also be troubled by difficulties with exercise because of the heavy weight of the breasts. It has been reported that she may loose some fans, but I believe she may gain even more fans if she indeed is able to perform better on the tennis court….