Liposuction revision
Posted in: Blog | January 17, 2012 | No Comments »
I was recently on “The Doctors” TV show where I performed a revision surgery on a patient who had liposuction previously and was left with significant asymmetries. In the last few months, I’ve taken care of many patients who needed their previous surgery fixed. The severity of their problems ranged from subtle contour irregularities to noticeable asymmetries including shelves or chunks of fat left behind. Some of the worst cases I’ve had to fix involved previous mesotherapy – where injections marketed as “fat dissolving” actually resulted in numerous rocks of scar tissue in the fat. These revision cases are usually extremely challenging to fix. There is often a lot of scar tissue present in the areas of previous surgery so blending the asymmetries takes a lot of surgical planning and skill.
When it comes to body sculpting, as with any surgery, it is important to go to an experienced and trained plastic surgeon. Liposuction and body sculpting requires technical skill and an artistic eye to create an ideal silhouette. Good communication between patient and surgeon are essential. As with any surgical procedures, there are always potential risks involved. When it comes to liposuction or any fat removal procedure, there is always a chance of asymmetries, lumps, dents, or un-evenness. However an experienced and trained surgeon can minimize the chances of any of these complications from occurring.
For patients who have had less than desirable results, it is often emotionally challenging for them to undergo a second revision surgery. Many of my patients told me that they had lost hope that there was any chance of fixing their surgery and because of their previous bad experience; they were hesitant to have a second procedure
For the patients who come to me with previous liposuction complications, I always make sure to help them set realistic expectations for what revision surgery can do for them. Sections of fat left behind can be removed and blended into the surrounding areas to create a smoother contour and asymmetries can usually be corrected. Dents and areas where too much fat was taken can be lifted and fat grafted. However, for areas where there is a lot of scar tissue or deep dents, I caution patients that the scar or dents often re-form.
In general, it’s always best to have surgery performed correctly the first time. I always encourage patients to do their research and make sure they have all their questions and concerns answered before proceeding with surgery.
Dr. Cat Begovic
Liposuction Before and After
Liposuction Before and AFter
Dr. Cat in Fitness RX magazine and on the Doctors TV show
Posted in: Blog | January 12, 2012 | No Comments »
In Fitness RX magazine this month, I talk about skin health. I review the basics on skin aging and discuss vitamins and oral supplements that can help improve the appearance of the skin. I’ve attached the full article below for those of you who are interested in reading!
- Skin health, Fitness RX
Also, this Friday Jan 13, I perform complex revision liposuction surgery on “The Doctors”TV show on ABC. In my segment a patient had previously had
liposuction several years ago but was left with significant asymmetries. She had a large shelf of fat left behind on her stomach that was visible even with clothes on. She also had several areas where there were chunks of fat on her stomach and also a ridge of fat along her back. Her previous doctors had told her there was nothing that could be done! Watch her transformation revision surgery! We will post it soon on our website on the MEDIA page.
Dr. Cat Begovic M.D.
———————-
Anti-wrinkle Pills?
Nutritional supplements for skin health
An article published in September’s New Scientist magazine discussed a potential anti-wrinkle pill. Independent researchers contacted by the magazine remain skeptical about the pill until there is scientific research to support these claims. When it comes to anti-aging and anti-wrinkle ingredients, consumers are bombarded with marketing and fancy packaging without really knowing if a product works. In all fairness, proving an ingredient or product works is difficult because with test groups there are many factors, such as diet, genetics, environment and weight, that affect aging and create alterations in the data. There is much more data in the scientific literature on topical ingredients— I reviewed and published these findings a few years ago.1 However, when it comes to oral supplements, specifically for anti-wrinkling, there is limited scientific data. Although many studies do not focus specifically on skin wrinkles, there is evidence that nutritional supplements do improve skin health and have beneficial actions on the skin.2,3 Here I will discuss some of the commonly used anti-aging supplements for the skin, the theory behind their action, and some research found in the scientific literature.
Biology of Wrinkling and Skin Aging
It’s first important to understand how skin ages. There are two main processes that contribute to aging: genetics and the environment. Environmental exposure to ultraviolet (UV) radiation, smoking, wind and chemicals cause roughness, fine lines, sagging, irregular pigmentation and decreased skin elasticity.1,4 The primary mechanism by which UV and other factors damage skin cells is by creating reactive oxygen species that damage nucleic acids, lipids and proteins, including collagen.5 When collagen is damaged, the structural integrity of the skin is compromised, which causes wrinkle formation. Damage to nucleic acids contributes to the formation of skin cancers.
Nutrition and Skin Health
Good nutrition is essential to the skin. Deficiencies in certain vitamins are evidence that nutrients are critical to skin health. Vitamin A deficiency causes dry skin, dry hair, and delayed wound healing. Vitamin B deficiency causes hyper-pigmentation and discoloration of the skin. Vitamin C deficiency causes scurvy, resulting in skin blisters, bleeding gums, and delayed wound healing. It is well known that what you put into your body reflects on the outside as well.
Antioxidants
Antioxidants are believed to fight aging and wrinkles, since antioxidants neutralize the reactive oxygen species that damage the skin. The skin protects itself with naturally occurring antioxidants, such as vitamins A, C and E, squalene, and coenzyme Q-10. Therefore, most anti-wrinkle supplements contain these vitamins. Antioxidants are found in many botanical supplements as well, including grape seed, red wine resveratrol and fruit-based supplements. Selenium— which is found in nuts, chicken, eggs, fish— and beta-carotene— which is found in orange and red fruits and green leafy vegetables— are two other commonly used antioxidants. Although antioxidants are commonly accepted as anti-aging molecules, there are unfortunately few studies that specifically show that antioxidant supplementation decreases wrinkle formation.6 This doesn’t mean that they don’t work; there is just limited clinical data to prove this.
Several studies have shown that oral vitamin C or vitamin E supplementation does cause increases in skin vitamin C and vitamin E content.7,8 In several experiments on human skin cells grown in a laboratory, vitamin C, vitamin E and beta-carotene were all found to protect cells from UVB-induced oxidative damage— the primary mechanism of wrinkle formation.9,10 However, most of the studies on these antioxidants are focused on their anti-skin cancer properties or whether they protect against sunburn, rather than their anti-wrinkle properties. Many of these studies do show that these antioxidants help prevent skin cancer and also increased resistance to sunburn. However, there are also a few studies that show no statistically significant improvement.
Omega-3
Omega-3 fatty acids, which are most commonly derived from fish oil, are believed to be involved in skin health and collagen regulation. Again, there are little to no studies that specifically look at omega-3 supplementation and wrinkle improvement. Most studies look at omega-3 as a skin cancer protective agent or skin inflammation modulator. Omega-3 has been used in patients with psoriasis and eczema because of its anti-inflammatory effects. One study also showed an inverse relationship between omega-3 fatty acids and skin tumor markers in skin biopsied from human subjects, suggesting that it helps in skin cancer prevention.11 Numerous animal studies have demonstrated that omega-3 supplementation also helps sunburn prevention and UV-induced erythema.
Green Tea
There have been many studies on the photoprotective effects of green tea extract and polyphenols on human skin cells in culture.12,13 The chemical components of green tea act as antioxidants. However, there are only a few clinical studies performed on human test groups investigating the anti-aging properties of green tea. One long-term study, where subjects were given green tea supplements for two years, showed a significant improvement in overall skin solar damage after six months and improvement in skin erythema and telangectasias after 12 months.14 Similar results have been found in numerous animal studies.
Soy Isoflavones
There have been some convincing clinical studies on soy isoflavone supplementation to improve the appearance of skin. One double-blind, placebo-controlled study on women who were given supplementation of soy isoflavone showed some improvement of fine wrinkles and cheek skin elasticity.15 Another study, which evaluated skin biopsies of post-menopausal women after soy isoflavones supplementation for six months, showed an increase in epidermal thickness and an increase in collagen in the dermis.16 Animal studies and studies on human cells in culture also show photoprotective effects.
Conclusions
Although there is limited data specifically investigating nutritional supplements on skin aging and wrinkle prevention, there is a large body of evidence showing that many nutrients are beneficial for the skin and overall health. Living a healthy lifestyle is critical to having good, healthy skin. Also, avoiding smoking and sun exposure are two of the most important things one can do to prevent premature aging and skin damage. I always tell my patients to eat foods rich in antioxidants, drink lots of water, and exercise. Taking care of your body on the inside is essential to looking young from the inside out.
Dr. Catherine Begovic is a Harvard-educated, UCLA-trained female plastic surgeon in Beverly Hills, California who completed not one, but two surgical training programs. She is the featured surgeon and medical host for Beauty TV and has published or presented over 40 articles in scientific journals and meetings on topics ranging from molecular biology, cancer, anti-aging, skin care, fat stem cells, to vaginal cosmetic surgery. For more information on Dr. Begovic, visit www.makeyouperfect.com.
References:
1. Huang, CK and Miller T. The Truth about Over-the-Counter Topical Anti-Aging Products: A Comprehensive Review. Aesthetic Surg J 2007;27:402-412.
2. Boelsma E, Hendriks HJF, Roza L. Nutritional skin care: health effects of micronutrients and fatty acids. Am J Clin Nutr 2001;73:853-64.
3. Piccardi N, and Manissier P. Nutrition and nutritional supplementation. Impact on skin health and beauty. Dermato-Endocrinology 2009;1(5):271-4.
4. Gendler EC. Analysis and treatment of the aging face. Dermatol Clin 1997;5:561-567.
5. Harman D. Free radicals in aging. Mol Cell Biochem 1998;84:55-61.
6. Tebbe B. Relevance of oral supplementation with antioxidants for prevention and treatment of skin disorders. Skin Pharmacol Appl Skin Physiol 2001;14(5):296-302.
7. McArdle F, Rhodes LE, Parsiew R, et al., UVR-induced oxidative stress in human skin in vivo: effects of oral vitamin C supplementation. Free Radic Biol Med 2002;33(10):1355-62.
8 Ekanayake-Mudiyanselage S, Draemer K, Thiele JJ. Oral supplementation with all-Rac- and RRR-alpha-tocopherol increases vitamin E in human sebum after a latency period of 14-22 days. Ann N Y Acad Sci 2004;1031:184-94.
9. Jin GH, Liu Y, Jin SZ et al., UVB induced oxidative stress in human keratinocytes and protective effect of antioxidant agents. Radiat Environ Biophys 2007;46(1):61-8.
10. Offord EA, Gautier JC, Avanti O et al. Photoprotective potential of lycopene, beta-carotene, vitamin E, vitamin C, and carnosic acid in UVA-irradiated human skin fibroblasts. Free Radic Biol Med 2002;32(12):1293-303.
11. van der Pols JC, Xu C, Boyle GM. Serum omega-3 and omega-6 fatty acids and cutaneous p53 expression in an Australian population. Cancer Epidemiol Biomarkers Prev 2011;20(3):530-6.
12. Silvergerg JI, Jadgeo J, Patel M. Green tea extract protects human skin fibroblasts from reactive oxygen species induced necrosis. J Drugs Dermatol 2011;10(10):1096-101.
13. Elbling L, Herbacek I, Weiss RM, et al., Hydrogen peroxide mediates EGCG-induced antioxidant protection in human keratinocytes. Free Radic Biol Med 2010; 15;49(9):1444-52.
14. Janjua R, Munoz C, Gorell E, et al. A two-year, double-blind, randomized placebo-controlled trial of oral green tea polyphenols on the long-term clinical and histologic appearance of photoaging skin. Dermatol Surg 2009;25(7):1057-65.15. Izumi T, Saito M, Obata A et al. Oral intake of soy isoflavone aglycone improves the aged skin of adult women. J Nutr Sci Vitaminol (Tokoyo) 2007;53(1):57-62.
16. Accorsi-Neto A, Haidar M, Simoes R et al., Effects of isoflavones on the skin of postmenopausal women. Clinics (Sao Paulo) 2009;64(6):505-10.
Plastic Surgery Before or After the Baby?
Posted in: Blog | January 5, 2012 | No Comments »
I saw a patient in my office last week who is planning on having a baby soon but wanted to have cosmetic surgery. She wanted to know if it was better to have surgery before or after her baby.
In general, with any cosmetic procedure, especially when it comes to body contouring, it is best that your weight is stable before proceeding with surgery. Therefore I tell patients who want to get liposuction or an abdominoplasty that they should wait several months after having their baby. There is no harm to the baby or the patient to having these surgeries before pregnancy, however, because of weight fluctuations and body changes that occur with pregnancy, they may need a second procedure later.
The same thing holds for breast surgery, especially if you are thinking of having a breast lift or reduction. Because the breasts expand and then deflate after pregnancy, you may need to have your lift revised after pregnancy depending on how your body changes. For breast implants, the shape may hold through pregnancy, but it really depends on your anatomy. I know many women who happened to get pregnant just after they had implant surgery and in most cases they retained a nice shape. Of course, you should expect that your breasts will expand greatly with pregnancy on top of the increase from the implants.
For other procedures of the face like rhinoplasty, eyelid, or brow lifts, the anatomy varies less with pregnancy so it wouldn’t be a problem to have the surgery before pregnancy.
Dr. Catherine Begovic M.D.
Beware of Illegal Silicone Injections – They Can be Deadly
Posted in: Blog | October 29, 2011 | No Comments »
This week a 30 year old woman was rushed into the hospital short of breath and coughing blood and almost died after being injected in her buttocks and other areas with liquid silicone at a house party. The silicone was not medical silicone found in implants, but instead liquid silicone similar to the type that one could purchase in hardware stores. A 22 year old woman who showed up at UCLA Medical Center from similar injections performed in Mexico died despite the physicians’ best efforts. There are many other cases of similar deaths and complications from these procedures which are illegal.
Liquid silicone can be absorbed into the blood stream and travel to the lungs and brain causing “silicone embolism syndrome” which can be fatal. Death when it travels to the lungs is 20% and when it travels to the brain is almost 100%.
The American Society of Plastic Surgeons cautions against these illicit procedures which may be on the rise because of patients’ inability to afford licensed plastic surgeons. Patient’s are advised to do their homework and make sure their physicians have the proper training and credentials.
I recommend that patients who wish to to have volume added to their face, buttocks, or other areas see a trained plastic surgeon for a consultation. Your surgeon will be able to discuss with you different options that are the standard of care for achieving your desired shape. When patients ask me about uncommon alternatives or cheaper options in foreign countries, I always remind them that for elective cosmetic surgery, safety and health come first. The rules and regulations here in the United States are to protect patients and are based on established standards of care. Doing something outside these standards is never work risking your health or your life.
Dr. Catherine Begovic M.D.
Vaginal Cosmetic Surgery – Labiaplasty
Posted in: Blog | October 20, 2011 | No Comments »
Last week I saw a few of my patients who recently had labiaplasty. They really felt so much better after having had their surgery and were thankful their OB-Gyn had made the suggestion they have the procedure done. A “labiaplasty” involves trimming some of the excessive labia that shows or hangs. Although it is considered to be vaginal cosmetic surgery, I would argue that in many cases the procedure is more than that – it really improves women’s quality of life. Now, every woman’s anatomy is variable but in general, most women do not like having their labia minora protrude and hang. This can become more noticeable after pregnancy. Sometimes, women are born with significant asymmetry between labia – one is much larger than the other. Most of my patients cannot wear leggings, workout clothes, or even have pain when wearing jeans. They complain of discomfort during common activities like exercising or riding a bike. In many cases, the main complaint is women feeling self-conscious during intimacy.
I know it sounds like a painful surgery, but my patients are usually pleasantly surprised at how quickly they recover. I recently authored a book chapter in the“International Textbook on Aesthetic Surgery” on “Female Vaginal Cosmetic Surgery” which describes in detail the steps of different techniques. In general, the excess labia is carefully trimmed and shaped. The surgery takes about 2 hours. The suture line is hidden along the inner edge of the labia. All sutures are dissolvable so they don’t need to be removed after surgery. Most of the swelling goes down in just a few weeks and patients can return to normal activities within a month or so. For more details please go to the Procedure Section of my website http://www.makeyouperfect.com/procedures/labiaplasty/
Dr. Catherine Begovic M.D.
Recent study suggests that NSAIDS raise the risk of miscarriage
Posted in: Blog | September 9, 2011 | No Comments »
The September American Medical Association newsletter reports a study from Canada that compared 4,705 women who miscarried in the first 20 wks of pregnancy to 47,050 controls who had normal pregnancies. All women were aged 15-45. The study found that in the miscarriage group, twice as many women had taken NSAIDS during their pregnancy. NSAIDS stands for non-steroidal anti-inflammatorys and include ibuprofen, Advil, Motrin, and Alieve (naproxen), Diclofenac, Vioxx (rofecoxib) to name a few.
However, the actual percent of patients in both groups who took NSAIDS was low. Only 7.5% of patients in the miscarriage group had taken NSAIDS and 2.6% of the women in the normal group had taken the medications. Therefore there are likely to be other factors that contributed to the miscarriage.
Many of my friends and colleagues are in the process of getting pregnant so I felt that it was important to share this information. Although there is limited data on the connection between NSAIDS and miscarriages, this study suggests that women avoid NSAIDS if possible to avoid a potential problem. NSAIDS already carry warnings against their use late in pregnancy but the recent Canadian study suggests that there could be dangers in taking them early on in the pregnancy as well.
Dr. Catherine Begovic M.D.
Recent studies show – live longer with just 15 minutes of exercise a day
Posted in: Blog | August 18, 2011 | No Comments »
The American Medical Association newsletter reported this week that just 15 minutes of exercise daily helps increase life expectancy.
This was based on a study in the medical journal Lancet who evaluated 400,000 people and found that 15 minutes of exercise a day increases life expectancy three years. A study from the National Health Research Institute in Taiwan that evalulated 416,000 adults also found that those who exercised 15 min a day cut their risk of death by 14% compared with those who did not exercise.
Of course, fuller and longer workouts are more beneficial. The Taiwan study also found that each 15 min of exercise reduced the risk of death by an additional 4% – those who exercised the most vigorously had a death reduction as high as 40% compared to those who don’t exercise. So for those of you are who committed work out enthusiasts – your time and efforts pay off.
What do these studies tell us? Even you are very busy, it is worth it still to get some gym time in every day. Everyone has at least 15 min to do some exercise so there’s no excuse! Exercise more and live longer!
Dr. Cat Begovic M.D.
FitnessRX for Women magazine article
Posted in: Blog | July 13, 2011 | 1 Comment »
I had the pleasure of writing an article in FitnessRX for Women magazine. It is on stands now.
The article is entitled “Liposuction: A temporary fix?” In it, I give my critique on a recent article in Obesity magazine online that claimed that fat moves from the thighs to the abdomen after liposuction, and that fat comes back after liposuction. It addresses many issues concerning diet and exercise and what liposuction can and cannot accomplish.
For those of you who have read my blogs on liposuction – you will know the answers to these questions. For those of you who don’t and are curious – I recommend you get the magazine and read the article!
Dr. Cat Begovic M.D.
FDA releases updated safety data on silicone breast implants
Posted in: Blog | July 7, 2011 | No Comments »
On Wednesday 6/22/11, the Food and Drug Administration announced that early findings from an analysis of safety issues and adverse events associated with silicone-gel breast implants revealed no new concerns. Therefore, the agency said it will allow the devices to remain on the market.
The Los Angeles Times (6/23, Mai-duc) stated that the FDA said the analysis conducted on more than 80,000 women over 10 years by implant
manufacturers “indicates that they have a ‘reasonable assurance of safety and effectiveness’ when used properly. … ‘What we can say is the current data doesn’t indicate that silicone gel-filled breast implants are linked to breast cancer, connective tissue disease or infertility,’”
However, women considering breast augmentation with silicone breasts implants should discuss the risks, benefits, and alternatives with their plastic surgeon. It is important for women to understand that 20 percent to 40 percent of patients who have implants for cosmetic reasons will need another operation to modify or remove them within eight to 10 years. I always encourage women to do their research and have all their questions answered before proceeding with any cosmetic surgery procedure.
Dr. Cat Begovic M.D.
Common liposuction questions – from my patients
Posted in: Blog | April 14, 2011 | No Comments »
With summer coming up – I’ve been performing A LOT of liposuction procedures the last few months! I’ve had the same few questions come up multiple times from my patients. Here is a quick Q & A of the most common questions.
Q. If I gain weight after liposuction will I need it again?
A. Your body genetically has a certain number of fat cells deposited in particular areas. Some people are just born with more fat cells in their abdomen, flanks, inner thighs and no matter what they do, they just can’t lose the fat there. Liposuction removes the total number of fat cells that has preferentially deposited in these areas. If you gain weight, each fat cell in the body gets bigger, but because you have fewer fat cells in liposuctioned areas, you should proportionately gain less in the liposuctioned areas. It is always a possibility that if you gain a lot of weight, you may need liposuction again.
Q. Can liposuction help me loose weight?
A. Liposuction is not a treatment for obesity or a substitute for diet and exercise. It is for re-shaping the body to treat areas that have a dis-proportionate amount of fat. Liposuction is ideally designed for pockets of fat in isolated areas that do not respond to diet and exercise. Also, the law limits the total amount of liposuction that can be removed at one time to 5L of liposuction for safety reasons. I always tell my patients to start with diet and exercise and to maintain a stable weight before undergoing liposuction. However, having liposuction often motivates patients who look better in their leggings or workout clothes, to begin a healthier lifestyle, and many people lose even more weight after their procedure.
Q. Is liposuction is dangerous?
A. Any surgical procedure has risks of anesthesia, risks of getting a blood clot, and a number of other complications. Many of the serious complications from liposuction in the past involved cardiac reactions to the local anesthesia injected in the body before the procedure. Also, procedures involving large volumes of liposuction (> 5L) resulted in fluid shifts that caused cardiac and respiratory problems. These occurrences are now quite rare. A safe, well-trained surgeon will carefully calculate and keep track of the amount of local anesthesia used as well as the amount of liposuction removed. A partnership and good communication with the anesthesiologist will help to ensure the safest conditions possible.
Q. I’m fit and everyone tells me I’m in shape and don’t need anything done, but I hate the pocket of fat that bulges – am I still able to have liposuction?
A. I would say that the ideal candidate for liposuction is someone who is of healthy height and weight with small pockets of fat that they just can’t lose despite diet and exercise. As long as there are a few centimeters of fat present in an area, it can be removed. Many of my patients are very fit bikini models who don’t like the extra fat bulge or shape of their inner or outer thigh, or feel that they have a “muffin top” making their waistline bigger than desired. Liposuction is ideal for this type of re-shaping. I had an extremely small amount of fat removed from my knees and inner thighs over 10 years ago when I was modeling – so I can really relate to wanting removal of these small fat pockets. On the other hand, I have turned away patients who just didn’t have enough fat to be removed. In general, if you’re unsure, it’s best to see a plastic surgeon in consultation to evaluate your particular anatomy and decide if you are a candidate for liposuction.
Q. I’ve seen some bad liposuction – what happened there?
A. I know exactly what you are talking about – I can spot bad liposuction a mile away. There is always the possibility of asymmetry, skin dents, wrinkling, or folding. However, an experienced liposuction surgeon should be able to avoid most of these things from happening. Most of the really bad liposuction results often come from over suctioning the fat causing the skin to stick unnaturally to the underlying structures. I always tell patients that I have to leave a small cushion of fat under the skin to keep this from happening. I do the majority of the fat removal through surgery, and they do the rest with diet and exercise.
Q. Why do I have to wear compression garments?
A. The liposuction cannulas make tiny tracks as they remove fat. I tell patients to imagine a sponge with small holes. The compression garments help squeeze all the fluid and tissues down to allow for a smooth flat thin contour. They are sometimes cumbersome to wear, but worth it to have the best possible outcome. One of my celebrity liposuction patients who had to do several red carpet events soon after her surgery found some compression garments that give a nice smooth contour under clothing. I now use these often for my patients so the garments are less obvious under clothing.
I hope this helped answer most of your questions! Please remember that liposuction as well as any plastic surgery procedure should always be performed with a good understanding between patient and doctor of realistic expectations, and with an emphasis on safety.
Dr. Catherine Begovic M.D.