Prophylactic Mastectomy - an ounce of prevention is worth 5% of cure

Sometimes things that are so obviously intuitive still have to be validated. After a number of years of controversy, an increasing utilized surgery to prevent breast cancer is now being shown to be quite effective in both risk reduction and cancer-related mortality. The study "A Population-Based Study of Contralateral Prophylactic Mastectomy and Survival Outcomes of Breast Cancer Patients" is published in the Journal of the National Cancer Institute and can be seen here.

Contralateral prophylactic mastectomy, (CPM), a preventive procedure to remove the unaffected breast in patients with disease in one breast, clearly appears to offer a survival benefit to breast cancer patients age 50 and younger, who have early-stage disease and are estrogen receptor (ER) negative. We've known for several decades that CPM reduced the risk of developing breast cancer, but it was always more elusive to show that it actually saved lives at the end of the day. The practice of CPM has expanded significantly, with >150% growth in the number of such surgeries since the late 1990's.

How effective is CPM? Those younger than age 50 with early stage cancer with ER negative disease had a survival benefit of almost 5% at five years.  For a therapeutic intervention for cancer, 5% is really substantial. You can take it to the bank that following these patients out even farther that we will show increased survival benefit with longer follow-up in the population. This is due to the fact that

1. the patient's likelihood of getting a second breast cancer in the non-removed breast increases with time
2. patients with prior breast cancer are among the highest risk group for developing breast cancer

Women older then 50 have a little more complicated decision. In cold, hard actuarial terms you are more likely to die from something else before a new breast cancer would kill you. On the other hand, steadily increasing lifespans of adult Americans has made some of these kind of statistical bets have to be reexamined. I would guess that the reported benefit of CPM gradually increases towards 60 years in future clinical guidelines.

Rob

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Study confirms that breast implants do not affect breast cancer survival

A recent Canadian study long term follow-up (see here) confirms prior observations that women with breast implants who go on to develop breast cancer have similar outcomes as women without implants who develop cancer. This is more reassurance to our patients about this theoretical concern with implants (ie. that potential difficulty with mammograms would lead to delayed breast cancer diagnosis and worse outcomes). Along a similar vein, women with implants actually have a much lower (~ 40% lower I think) rate of breast cancer as compared to peer groups in the population.

Rob

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From Chest to a Desk

On Wednesday night, my friend Ashley and I went to the filming of America’s Got Talent with judges Howie Mendal, Peirs Morgan and Sharon Osbourne. While the show itself was really funny and entertaining, it seemed all of the reporters and press at the filming wanted to know about was what Osbourne was going to be doing with her 34DD breast implants.

Osbourne recently revealed to the Today Show on NBC that she plans on having the removed and is apparently even giving them to her rock star husband Ozzy to use as paper weights.

Here are some tips about how to go about removing silicone or saline breast implants:

Carefully make an educated decision to remove your implants based on your health, self-esteem, economic situation and advice from your medical professionals.

Consider the option of an implant exchange: a procedure to replace older implants of the same size or to a smaller size.

Ensure that you are economically secure to afford the cost of surgery.

Prepare yourself mentally for the change in your external self after you have the surgery.

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Old-In Young-Out

It has always been a challenge to keep up with the constantly changing dos and don'ts of life. Who can forget when eating anything non-fat was all the rage, giving all of America a false sense of how to stay slim regardless of portion size. Did we really think eating the ENTIRE one pound bag of twizzlers was going to be good for our waistline? So America gets fat and what's the solution...low-carb! Overnight being within 10 feet of a piece of bread would up you a size.

It has been the same with exercise over the years. I remember a time when fitness experts everywhere promoted cardio until you were literally blue in the face. Then all of a sudden if you weren't lifting weights to build muscle mass you didn't stand a chance of losing weight. First it was heavy weights and now it's light weights at high repetition. How is one supposed to keep up? Which changes are based on scientific breakthroughs and which to avoid moderation (something Americans seem to do at all costs)

As presented in a great article in the New York Times Styles section yesterday, the latest society 180 is that celebrities should be 'less tucked' than the current crop of Hollywood actresses. Casting directors have grown frustrated with actresses auditioning for the part of a middle aged woman when they look 30. The same goes for the young sector when someone with Heidi Montag's breast size shows up to play a character in a period piece. Breast implants didn't even exist before the 20th century! One casting director is replacing the old fashioned head shot with required bathing suit shots, regardless of what the role calls for the actress to wear. This helps avoid any surprises in the bust area after casting is complete. Movie producers want their movies to be an escape from life for a few hours, however they also want their actors to be believable in the roles they play.

I sympathize with the women of Hollywood...well most of them anyway. For years they have been told to stay looking young or they would be washed up before their 35th birthday. Women didn't want to wait 20 years for their next role as somebody's mother so they fought back with needles and scalpels. Some of the results we've seen have been better than others, but for the first time there are lots and lots of leading roles going to women over the age of 40. A generation ago this was unheard of. Of course just like with anything else, moderation has become a problem (remember that bag of Twizzlers?). The people of Hollywood have had a hard time stopping after the right amount of "tucks" and plastic surgery restrictions are now being placed by casting agents. Women who have had work done are being sent away without roles they would've otherwise been given, and often times are not told the reason why. The word is now getting out and it will be interesting to see how Hollywood reacts. I mean, is Meryl Streep really going to stop getting Botox? Not a chance.

My theory is that we will start to see fluctuations in age on and off the big screen just like we do with weight. Actors and actresses temporarily gain and lose weight for roles all the time. Renee Zellweger didn't exactly decide to keep the weight on when she was done playing Bridget Jones. She must of gone straight to the gym after the wrap party because she was back to a size 2 in no time. I think we will see the same pattern in the Botox department. Actresses will time their injections to be worn off by the time shooting begins. If you want Susan Sarandon to look like a Grandma then so be it, but you better believe she will be at her plastic surgeon's office the second her last line is delivered. As always, Hollywood will conform to get the role, but being skinny and young will always be required outside the editing room. Hopefully one day societal standards will be more attainable, but I won't be giving up my gym membership in the hopes of this happening anytime soon.

Until we can sit down and eat a handful of chips, request a "Full B" at a breast augmentation consult, and not use the whole vial of Botox at one visit, we will be faced with rule changes without warning. I guess it will keep us on our toes...doesn't that at least burn calories?

*To read the New York Times article I am talking about click on the title of my blog. Feel free to comment with your opinions on the subject!

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This is what I wore to study today.

This is me showcasing my hair, and oh shit! It's pink again!

This is the song I've been listening to on repeat for the past several days.

This is me saying bye because I have an exam in seven hours. Bye!

Top and blazer are thrifted. Tights are from a halloween costume shop called Malabar located in Toronto.

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LXNY Segment Boobs vs. No Boobs

LXNY produced a GREAT segment yesterday about the dilemma to get breast augmentation or not. This is always such a hot topic no matter what is going on in the media. As it would have it people like Kate Hudson and Heidi Montag gave these ladies PLENTY to discuss. In addition to experts from magazines like In Touch, was our own Teneia Wooten. Ms. Wooten is a recent patient of Dr. Walden who underwent breast augmentation. Teneia is such a excellent example of the kind of women that make up the majority of patients that undergo breast augmentation. I think with Hollywood stars like Heidi Montag and Pamela Anderson splashed all over the tabloids, we as a society associate breast augmentation with those type of results. To be honest woman like Teneia who have a natural and beautiful result are more the norm.

Many issues are discussed such as breast size, body dysmorphic disorder, and other self confidence issues. We all thought Teneia's answers were spot on! She also brings up a good point that breast augmentation is a big decision and a major surgery. It is incredibly important to always do your research and make sure you go to a board certified plastic surgeon when thinking of going under the knife. Especially when these days we have easy access the Internet which can be such a great research tool!

See below for the entire segment on LXNY! Enjoy!!

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Photoshop is now a Faux Pas

It seems the latest trend in the Hollywood hills is to forget Photoshop and start releasing photos for print campaigns that show the celebrities in their natural state.

Check out the latest ladies willing to dare their bare.

Britney Spears un-airbrushed for Candies

Jessica Simpson without makeup on the cover of Marie Claire

Kim Kardashian nude and showing off her curves for Harper’s Bazaar

Sarah Palin and her crow’s feet on the cover of Newsweek

While all of these leading ladies look great, I can’t help but push front my opinion of Palin getting a couple cc’s of Botox to those crow's feet!

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Christmas Morning

It feels like Christmas morning! I have been waiting for this moment all my blogging life and it has come at last. Kate Hudson FINALLY got breast implants. She has been famously flat-chested forever, going on record in the past about loving her small breasts. I always commended her for loving what the man upstairs gave her, but couldn't help but think she would look even better with a little help from the silicone gods. From the looks of this picture, taken from the current issue of US Weekly, Kate has had a change of heart. The change is subtle, but leaves little question as to what's been done.

If you look at the "before" picture above you can see that she has almost no breast tissue. It is what we call the "A- cup" in the plastic surgery world. These are people that even with the help of a pushup bra cannot create cleavage because there is nothing to push together. The "after" picture shows Kate in the range of a B cup that is not likely to be the result of push-up technology knowing what her natural anatomy is. The top she has on appears to have no padding and little support. She most likely has a silicone gel breast implant around 250cc which is one of the smallest on the market. If a subtle, natural look was what she was going for than she has achieved just that!

Now don't misunderstand. I am a firm believer that the best results in plastic surgery are the natural looking ones. From working in the business though I do know that the biggest regret after a breast augmentation is not having gone "a little bit bigger". Most women who undergo this procedure are so worried about looking too big and fake that they gravitate toward smaller implants and then have what we call "buyers remorse". I think she looks much improved but can't help but feel like she should have gone with a slightly larger implant for optimal results. Of course it really doesn't matter what I think. As long as Kate is happy with her results and achieved her desired outcome than the surgery was a success. This goes for anyone undergoing surgery. If Kate ever does want to "upgrade" the operating room door is always open. Congrats Kate! Can't wait to see you filling out those gowns next awards season...

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Slick Deals from Allergan for Botox or Juvederm rebate

One of my favorite shopping websites is Slickdeals (www.slickdeals.net) which is a user driven collection of random shopping deals around the internet. You can find some fantastic bargains on all kinds of things, and the site is updated throughout the day by users reporting sales and promotional items.

In honor of this, I'd like to point out the "slick deal" Allergan is offering on it's products thru July. Allergan is the world's largest breast implant manufacturer, but they also make BOTOX, the dermal filler Juvederm, and the eyelash growing solution Lastisse. Thru July they are offering a $50 rebate coupon on either BOTOX or Juvederm purchases when you try Latisse. Details are available here.

Rob

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Real Housewife Admits She Gets Plastic Surgery

There are 2 new Real Housewives of New York joining the cast of Manhattan’s Upper East Side elite: Jennifer Gilbert and Sonja Morgan, according to a press release from Bravo TV.

Rumor has it Morgan will replace Bethenny Frankel which would literally devastate me, her and frienemy Jill Zarin make that show! Bethenny hope you and Jill make up and become friends again soon!

While Gilbert looks pleasant, but Morgan reportedly claims to be the “straw that stirs the drink,” and has three interests: sex, shopping and plastic surgery.

Watch this promotional video from Bravotv.com that has a clip of Morgan presumably receiving Botox® injections in the Platysma Bands of her neck.

Botox® is a simple procedure that is done in office, and I personally have used this product and it exceeded my expectations, I could not be more thrilled with my results. With this product, you too can be a Real Housewife of New York City, or, in mine and Morgan’s case, a sassy, sophisticated, sexy single lady of the City!

Interested in getting Botox® or Dysort™(the competitive product to Botox®) injections, give me a call at 212-288-9009 and I will tell you all about it!

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FDA to mesotherapy - Put up or shut up! (but shut up first)

The FDA last week issued cease and desist orders for a number of clinics offering fat melting "mesotherapy" injections.  The drugs most regularly used in this process are phosphatidylcholine and deoxycholate. Other drugs or products such as vitamins, minerals, and herbal extracts are often mixed into the "gumbo", complicating any assessment of safety or efficacy. Phosphatidylcholine is not approved for injection into your body and has never been evaluated for that use in controlled settings. The new warning shot over the bow went out to six U.S clinics:

• Monarch Medspa in King of Prussia, Pa.
• Spa 35 in Boise, Idaho
• Medical Cosmetic Enhancements in Chevy Chase, Md.
• Innovative Directions in Health in Edina, Minn.
• PURE Med Spa in Boca Raton, Fla.
• All About You Med Spa in Madison, Ind

I would strongly advise people considering using these facilities to think again, as their disregard for patient safety with off label experimentation of these injectable concoctions should signal a general disregard for their patients. As alerts to this FDA warning went out on the ambulance chaser network of websites, expect to see ads shortly recruiting clients for lawsuits.

FYI If you are interested in reading about mesotherapy, I've written several entries about it since 2007 which can be seen here.

Rob

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Today I've felt a sense of clarity for several reasons:

i) I have realized my Macbook has in fact not shattered internally, the battery just won't charge. I have in fact wasted several (many) hours mourning what I thought was gone forever but as I type this I emit a sigh of relief. Forget my lecture notes and research essays - do you know how many photos of neon hair I have on this thing? Enough to make people with naturally coloured locks genuinely frightened. But no, I'm actually very grateful it isn't trivial, or else I would be stuck on a wonky 1997 Windows PC (can you say D:) for the remainder of the summer. Let's just say things would not be a slice of cherry fucking cheese cake.

ii) I was in New York City for the first 6 days of April and I've decided I'm going to try and move there after I finish school if everything falls into place. I know the typical claim with New York is that it's pleasant to visit and lingering for too long will result in this perpetual overwhelmingly claustrophobia and intense craving to distance yourself away from it's habitual hectic activity. Yet I feel nostalgic whenever anyone mentions it, like I'm missing a limb and they only place I can get it back and use it is when I'm in the city. I mean, when our bus drove over the bridge and that panoramic landscape came into view, the plethora of lights consuming every inch of my vision, I felt my heart float and my eyes water. And I don't care how cheesy I sound! I remember watching a documentary on the philosopher/poet/NYC tourist guide Speed Levitch a year or so ago and being mesmerized by his relationship with the city. After it concluded I recall thinking "my hopes for the extravagance this city has to offer will always be unsurpassable". This is why as I sat in my bus seat on the way down I anticipated disappointment by the inevitable mediocrity of what I was about to experience. I mean, what we're fond of differs with each individual. It's all subjective. So naturally I thought Speed's adoration with this cornucopia of edifices and busy bee individuals on an island was based on his own subjective ideals, completely contradicting my own. Yet over the near week I spent there I discovered the city was all it was built up to be (a result of my own subjective ideals or general objective claims I've still yet to determine). Thus I find myself missing the island more each day. Guys, I would sit on a crammed bus with stale air for 11 hours one way like I did a few weeks ago just so I can see it again for a mere 24 hours. The anticipation for a next visit is killing me. Like it's literally gnawing at me.

....did I rant there? I think I ranted there. I almost forgot about this clip from the Speed Levitch documentary (entitled "The Cruise") I was gonna post back there before I ran off on a WTFHOLYSHIT tangent. Here he talks about his relationship with the city.

Ugh, embedding is disabled. Whatever guys CLICK HERE it's worth it, trust. Here's a quick quote from the beginning though if you suck and don't want to watch:

"New York City is a living organism; It evolves, it devolves, it fluctuates as a living organism. So my relationship with New York City is as vitriolic as the relationship with myself and with any other human being which means that it changes every millisecond, that it's in constant fluctuation."

Moreover, since my mac is back, here's an outfit I wore today. It was so hot out though :c. I need to realize spring is here and I can no longer layer so much D: Whatever I'll pretend like pit stains and profusely sweating is IN.

I started working around the bottom because it made me feel like a mermaid. Thought it would work best if I left out prints and just worked with pastels. And pink. Also I'm not going to lie I've been inclined to never take off this skirt because of the influence the cute little asian girl from two posts ago has had on me (the skirts are slightly similar. You know what that means? never taking it off, ever)

Everything is thrifted except for the pink skirt over top of the blue dress and under the apron, which is from H&M. Oh wait, the white lace blazer is from Courage My Love vintage in Kensington Market. :3

I seriously meant for this post to take only ten minutes, and alas it's taken me FORTY. Now I must get back to watching Annie Hall and drinking hot chocolate and pretending to sort through photographs for a project.

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Officially Grown Up

Who can forget the catchy Pussycat Dolls song "When I Grow Up" that had every tween around the country singing about wanting "to be famous and have boobies". Well looking at recent photos of Pussycat Dolls lead singer, and Dancing with the Stars contestant, Nicole Scherzinger, it is pretty obvious that she can now check both of those off her list of desired accomplishments in life. She has been famous for quite some time, but up until recently has been small busted. She has never shied away from wearing body revealing outfits and her new cleavage is impossible to miss in her DWTS wardrobe.

Perez Hilton put this 'before and after' comparison on his blog which is a great display of her "grown up" new look. Her breasts are significantly larger these days and I think she looks fantastic! She has such a beautiful figure, and worked the small chested look really well, but the more voluptuous version of her no doubt has men drooling on their remote controls every Monday and Tuesday night. Pamela who?

I applaud her for choosing an implant size that gives her some nice cleavage without looking out of proportion with the rest of her body. Too often women want "to get their moneys worth" so much so that they end up with breasts that are too large for their frame. Not only does this set them up for more complications down the road, but it doesn't look good or at all natural. We all know boobs are a man's best friend but even they want to be able to see other parts of a woman's body. I think Nicole's breasts really add to her figure without taking it over.

Keep rocking those costumes and dance moves Nicole and you will likely be the recipient of a mirror ball trophy at the end of the season. I think your next song should be about what you want to be in middle age, "left alone and lifted"?

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Anxious Amy

I was over at Makemeheal.com yesterday and I saw a new post on songstress Amy Winehouse that caught my eye. Most people know by now that the pop star underwent Breast Augmentation last fall. It was recently reported on People.com that the singer recently checked into the hospital due to "chest pains". Many of Amy's family members have spoken to the press stating that she feels the "pains" are from the breast implants. One of Amy's friends was quoted as saying:

"Amy was in agony and became convinced it was something to do with her boobs. She thought she would leave it for a while but the pain go worse. She went into the clinic on Thursday and they kept her under observation. She is waiting for a decision on whether the implants have to come out or not."

While it is highly unlikely that any type of cardiac condition can be traced to her implants, it is a good thing she is being checked out by medical professionals. Based on her past behavioral issues, there is speculation that these health concerns originate from other sources. Either way we hope Amy feels better soon and continues on her road to staying healthy!

It's a good opportunity to remind all of us that Breast-Augmentation is a REAL surgery and not something that is to be taken lightly. It is always important to follow your board certified surgeons instructions to the letter before AND after your surgery. By doing your part you can expect a beautiful result inside and out! :)

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There's no escape from Magical Thinking on health care apparently

There's a good bit of magical thinking around the idea of preventive care. One of the most disingenuous aspects of this is the push for these measures as "free" as part of the health care reform debate. Nothing of value is free, and in health care the overhead propping up the system makes that even more true.

Now there are both cheap and expensive measures that included in what we call preventive care or cancer screening, but at the end of the day they do not save money (even if they may make us healthier). It's actually counterintuitive that some bad habits or diseases from them (smoking or diabetes) may actually save  money as they die younger and end up costing less over a lifetime. That's not a reason to not support early intervention, but it is something that has to be considered when making your countries health care budget.

The truth that the health care costs as a % of GDP are ignored by the bill passed is really scandalous. Facing those true costs was not something the  left was going to let get in the way of entrenching their goal of federal health care. A story about the effects of the health care reform bill I read (see here) seemed to forget that all costs matter until pointed out over and over by readers in the comments section. I thought this one was spot on,

Colonoscopies and mammograms are absolutely not “preventive” care, they are early detection. Having a mammography will not prevent breast cancer any more than owning an umbrella will prevent rain. It may stave off the full and most dire effects of a diagnosis of cancer by allowing early intervention, but that is far from prevention. You will have to pay for the surgery, the radiation, the medication, all the same. Talk about “magical thinking”.

The politics of  telling people NO is complicated and gets caught up in issue driven advocacy groups. A large study from Denmark touched on this obliquely by studying an area of screening efficacy (or lack thereof) when they found no evidence that screening women for breast cancer has any effect on death rates when applied to their countries women in well organized screening programs. For context, breast cancer is the most common cancer in women worldwide, accounting for around 16 percent of all female cancers and is attributed to almost 519,000 people globally each year.

How do other western countries with modern health care systems screen for breast cancer? In Denmark, women are screened every two years from age 50, while in Britain the policy is for women over 50 to be screened about every 3 years. Evidence now suggests that for every 2,000 women who are screened over 10 years, only one stands to have her life saved by the mammogram program, whereas the chance of getting an unnecessary breast cancer diagnosis is 10 times that.

If you'll remember in 2009, we had a hailstorm of controversy here in America when it was suggested that our current guidelines of starting screening mammograms at 40 was neither cost-effective nor evidence-based for affecting breast cancer mortality. There was a lot of ignorant political grandstanding on this as a woman's issue (step forward congresswoman Debbie Wasserman-Schultz D-FL) and Democrat's were furious that this kind of recommendation was coming out during their poorly-conceived sales job on health care reform. God forbid there be any notion that evidence based medicine might infringe upon you right to insist on your ______ (Mammogram, CT Scan, MRI, back surgery, etc....) without considering considering the cost or efficacy. It was a lie then and it's a lie now.

Rob

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Growing Hacks in Cali...Cali - Underqualified cosmetic surgeons plague the Golden State

Nod to LL Cool J in the post title :)

California is an iconic part of the United States that sets many trends. Unfortunately one of these trends is the growth of under or untrained physicians performing cosmetic surgery procedures.

A snapshot of who is performing cosmetic procedures in California, published this month in the journal, Plastic and Reconstructive Surgery, examined 1,876 cosmetic practitioners from San Diego to Los Angeles. Only 495 of them were actually trained in plastic surgery. Primary care physicians with no surgical training to speak of made up the 4th group of liposuction providers following plastic surgeons, dermatologists and otolaryngologists.

Scary, Scary stuff! It seems obvious, but always look for a board certified Plastic Surgeon if you're considering plastic surgery.

Rob

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FDA Cracking Down on Unproven Lipodissolve (Mesotherapy) Treatments

Thank goodness! The U.S. Food and Drug Administration today issued warning letters to six U.S. based medical spas and a company in Brazil for making false or misleading statements on their Web sites about drugs they claim will eliminate fat in a procedure called “lipodissolve,” or for otherwise misbranding lipodissolve products.  These companies involved have made claims that the drugs they use for their lipodissolve procedures are safe and effective; however, these products have not been evaluated or approved by the FDA for this use. Check out the Associated Press report that has my commentary on the topic featured on USA Today.

Lipodissolve is a procedure involving a series of drug injections intended to dissolve and permanently remove small pockets of fat from various parts of the body. It also is known as mesotherapy, lipozap, lipotherapy, or injection lipolysis. The most commonly injected drugs are phosphatidylcholine (a component of cell membranes in humans and other organisms) and sodium deoxycholate (actually bile salts), usually in various combinations with one another.
In some cases, other ingredients, including drugs or components of other products such as vitamins, minerals, enzymes, antibiotics, and herbal extracts are added to the mixture.  Injectors usually get these cocktails formulated at compounding pharmacies, which adds to the lack of standardization in the mixtures from practitioner to practitioner.  The FDA is not aware of any credible scientific evidence that supports the effectiveness of any of these substances for fat elimination, and their safety when used alone or in combination is unknown.

The FDA press release states that it is requesting a written response from the U.S. companies within 15 business days of receipt of the warning letters stating how they will correct these violations and prevent similar violations in the future. Each U.S. company has been informed in its warning letter that failure to promptly correct the violations may result in legal action.  Each of the companies involved has been cited for a variety of regulatory violations, including making unsupported claims that the products have an outstanding safety record and are superior to other more permanent fat loss procedures, including liposuction.

 The FDA and other doctors have received reports of adverse effects in persons who have had the procedure using these drugs, including permanent scarring, skin deformity, and deep painful knots under the skin in areas where the lipodissolve products have been injected. I have seen contour abnormalities and firmness of the tissues in people who have undergone these procedures, or just no change at all in regard to their weight or contour. I do not perform these lipodissolve procedure, but see patients who may have tried it elsewhere after spending thousands of dollars with little to no result, and then seek the more clinically proven procedure of liposuction.

The warning letters were issued to the following U.S. companies: Monarch Medspa, King of Prussia, Pa; Spa 35, Boise, Idaho; Medical Cosmetic Enhancements, Chevy Chase, Md.; Innovative Directions in Health, Edina, Minn.; PURE Med Spa, Boca Raton, Fl.; and All About You Med Spa, Madison, Ind. The Brazilian company receiving a warning letter markets lipodissolve products on two Web sites: zipmed.net and mesoone.com.  The procedures may also be offered by persons without sufficient medical training, thereby putting patients at risk of harm.
 

Patients seeking fat dissolving treatments should be educated about the lack of clinical data supporting these treatments and cautioned to wait until there is reliable information to guide their decision.  I am glad to see the FDA cracking down on sham procedures and unqualified practitioners rendering aesthetic medical treatments. It's a step in the right direction if you ask me.

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Have MERCY!!

Can you believe that is little DJ Tanner??? I must admit I haven't thought about Candace Cameron Bure in years. I have seen her pop up here and there in those Lifetime movies, but other than that she has been out of the public eye. I was over at Perezhilton.com checking out the most recent gossip and at the bottom of the first page was pictures of Candace announcing it was recently her Birthday.

I noticed as I was looking through the pictures that she is a part of a new show on ABC Family called "Make It or Break It". I have never seen the show itself, but it seems to have a large following and is growing in popularity. The first episode of the new season airs on Monday, June 28th at 10/9c.

Candace has aged beautifully, let's face it she is still a very young woman even though it seems like she has been on TV for years. She has a very lean athletic frame and beautiful skin. Again, the years have been good to her. Although I don't believe she has had any plastic surgery to date, the TV star might benefit from some botox and fillers in the future to keep her youthful glow. I always like to see child stars who keep their head on straight and grow up to be successful and happy adults.

Congrats Candace!

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Bring it on down to Plasticville

For those of you who haven’t met Dr. Walden, one thing you might not know about her is how funny her one-liners can be. She often is livening up our office (not that it needs it, we’re obviously continuously entertained) with jokes and funny clips for us all to watch about Plastic Surgery, celebrities and pop culture.

One of my favorites that she found was when Justin Timberlake was on Saturday Night Live doing a skit on Plasticville.

Click the link below to see Justin cover Lady Gaga, Kelly Clarkson (my two favorite singers ever) and the Black Eyed Peas.

Maybe I can convince Dr. Walden to change our slogan to “Bring it on down to Plasticville”… do you think she’d go for it?

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Makeover Idol

American Idol is known almost as much for its contestant makeovers as it is turning virtual unknowns into overnight celebrities. Who can forget Clay Aiken first walking on stage as a nerdy kid from North Carolina only to end the season with millions of "Claymates" loving his edgier, revamped look. How about Carrie Underwood? Yes she was cute during her idol days, but not even close to the league she's in today with her size two figure and glam look. Not only have we grown accustom to watching the contestants style evolve throughout the season, but these makeovers are as anticipated and talked about as the finalists vocal progression . It wasn't until Kara joined the show though that have we seen such a transformation in one of the judges appearance. Simon hasn't changed a bit, Ryan may have gotten a new suit, and sure Randy had the big weight loss, but Kara has become noticeably more beautiful and confident since joining the show last season.

I'm sure part of it is that she no longer has to deal with the awkwardness of having Paula around. Those two together were a cat-fight waiting to happen! Paula's departure has allowed Kara to come in to her own as a judge and not only does she look great, but she seems to be having a lot more fun. She has clearly put a great deal of effort into her appearance this season and it shows. Her hair, makeup, wardrobe, and "anti-aging" regimen would get a "yeah dawg" from Randy any day of the week. When comparing recent pictures to older ones it seems as though she has had rhinoplasty and mostly likely Botox and filler. She appears to have had filler injected in multiple areas of her face, including her cheeks, which have more volume and definition than in the past. She looks great! All of her procedures have been done in a very natural fashion, enhancing her beauty how plastic surgery should.

Kara spent so many years behind the scenes writing songs and now that she is in the spotlight she has risen to to the makeover occasion Carrie Underwood style. American Idol has proven to produce more than new and improved contestants. Maybe next season Ellen will get hair extensions.

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Are your breast implants under warranty?

The New York Times had a story last week (see here) on how expensive orthopedic implants for knees and hips were to replace when they failed. As the cost of the devices themselves (without hospital or physician charges) can run north of $15,000, it can be more then $50K on the price tag when these patients require re-operation for premature failure. Highlighted in the story was the fact that the manufacturers did not expressly provide a warranty for replacement costs of their implants.

Much like these orthopedic devices, patients with breast implants can expect their devices to have to be replaced at some point in their life, either thru device failure or for aesthetic revision issues as their body changes. In contradistinction to the orthopedic companies, both Allergan and Mentor Corp. (whom combined sell 99% of all breast implants in the United States) have offered lifetime replacements on their failed devices for several years now. Allergan in particular has been admirable, as the parent company that makes the implants has been sold twice from it's roots as McGhan medical (later Inamed Corp.). As both Allergan and Johnson & Johnson (owner of Mentor Corp. since 2009) are huge multinationals, it would seem patients with these implants should have a good deal of security of their devices fail for replacement of their implants.

These implant companies do not however cover all other costs associated with the replacement of the devices, but have come up with a fairly generous standard program matched by both Mentor & Allergan

• 10 years of guaranteed financial assistance
• Up to $1200 in out-of-pocket expenses for surgical fees, operating room and anesthesia expenses not covered by insurance
• Silicone filled and saline filled breast implants are both covered
• Lifetime product replacement
• Automatic enrollment at the time of your original surgery

Now as a breast implant is relative expensive to design and test clinically, but inexpensive to manufacture by the unit, it's easy to see how these companies can absorb the cost. I don't know exactly their margin per device, but I think it's $600-700+ per silicone implant they sell.

Rob

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I Promise its Plastic

This weekend I had the opportunity to attend Promises, Promises, the musical comedy. Let me first gush about how great the show was. I have seen a substantial number of shows, and am not always impressed with the performances. However, this one surely made my top 3. It was witty, interesting, creative, and every detail of the musical numbers, stage props and acting were incredibly engaging.

Having been a Kristin Chenoweth fan from her golden Galinda days in Wicked, I was curious to see how her dancing, voice and aging appearance could stand the tests of time as I had not seen her in person since this past February in Mercedes-Benz Fashion Week Heart Truth Red Dress Collection 2010 where she brought energy and simply grace and beauty to the runway in the Tent.

When I met her outside of the stage door, surprisingly not amongst a bunch of screaming teeny-boppers but a vast array of fans within the 25 to 50 age category, she was nice enough to stop and chat with me for a moment about the book I was asking her to personalize.

She told me that writing her book, A Little Bit Wicked, was one of the hardest things shes ever done, and I responded with “ Well it was very well written, I loved it…” and I did, so I highly recommend you read it, especially if you have big dreams, Chenoweth is inspiring and motivational in her recounts of making it in the Big Apple.

But while I was I’ll admit a little bit star struck (I don’t care what any New Yorker says, no matter how many famous people you run into in your everyday life, sometimes you’re still shocked to meet the select few exceptionally talented people you so heavily admire), I couldn’t help but notice how youthful she looked.

Her cheekbones were so prominent, presumably by fillers as I would not guess any surgeries. Additionally, her skin was simply perfection and her forehead was ageless, suggesting skin resurfacing treatments and Botox injections. In the past, a lot of bloggers suspected breast augmentation and although many people claim she just wears great bras, her nighty scene was a little revealing and I don’t think it was Victoria’s Secret that Chenoweth has been keeping these last couple of years.

All in all, she was as beautiful as always and I personally hope the Tony’s give her a nod this year because her performance was as flawless as her face.

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Comme des Garcons Fall/Winter 2008 (this is the Comme Comme line, right? correct me if I'm wrong). Fast forward to 3:53 until 4:15.

So I felt like literally translating this outfit because I realized I had just about all the piece she was wearing. Well, cheaper versions of the pieces anyway. I better run though I have a lot of errands to run before hopping on a bus to New York tomorrow morning. I'll try and blog those days, but nevertheless I'll have pictures for when I arrive home. Later days!

Blue button up from mom's closet. Skirt and shoes are thrifted. Pants and socks from H&M. The white thing on my skirt is a piece of string.

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