17 Tuesday Apr 2012
Posted in Breast, Breast Augmentation, Breast Implants
Dr Gutowski & Dr Epstein of MAE Plastic Surgery are excited to announce the availability of 3D imaging technology to allow patients to see how their breasts would look before and after breast implant enhancement.
A special opportunity to try this new technology is being offered on April 23rd and 24th. Please call 847-205-1680 for a complimentary appointment.
13 Tuesday Mar 2012
Posted in Breast Augmentation, Breast Implants
One of the most common questions patients have when considering breast enlargement is “are drains are going to be used?” Drains are thin rubber tubes that are placed during a procedure and exit through a small hole in the skin. The drain tube connects to a soft plastic container, about the size of an apple, and the container catches any fluid that normally builds up under the skin after surgery. The container can be emptied by a patient at home and the amount of fluid is recorded. After the fluid drainage amount is less than about 25 cc to 30 cc (about one ounce) during a 24 hour period, the drain can be removed in the surgeons office with a gentle pull.
While drains are commonly used in some plastic surgery procedures in an attempt to prevent fluid from building up under the skin at the site of surgery, they do have some disadvantages such as pain, discomfort, leaking, difficulty with normal activity, and possibly infection.
In breast augmentation, there is no evidence that drains offer any benefit or result in a better outcome. There are very few situations where a surgeon may want to place a drain when placing a breast implant:
So if your surgeon is planning on using drains in an uncomplicated breast augmentation, ask if it is really necessary in your case. It is one of those questions that is worth discussing before your procedure.
“In my experience with hundreds of breast augmentations, I’ve only used drains twice, both times in patients with more oozing at the time of surgery than expected. In both cases, the drains were removed the next day. Not using drains routinely allows my patients to have less discomfort and be more active right after their breast procedure.”
Karol A. Gutowski, M.D.
10 Saturday Mar 2012
Posted in Breast Augmentation, Breast Implants, New Technology
The U.S. Food and Drug Administration (FDA) approved a new silicone gel–filled breast implant made by Sientra, offering a third option in breast implant options for women in the United States. As with the other two breast implant products, women who choose to have these new implants should be monitored for any possible problems.
Despite the need for monitoring, the FDA deemed the new Sientra implant and those from Allergan and Mentor as safe. “Data on these and other approved silicone gel–filled breast implants continue to demonstrate a reasonable assurance of safety and effectiveness,” said William Maisel, MD, deputy director for science in the FDA’s Center for Devices and Radiological Health, in a press release.“It’s important to remember that breast implants are not lifetime devices,” said Dr. Maisel. “Women should fully understand risks associated with breast implants before considering augmentation or reconstruction surgery and recognize that long-term monitoring is essential.”
Sientra’s new implants can be used for breast reconstruction for women at any age and to increase a women’s breast size in women aged 22 years and older.
For more information on breast implants go to:
More information on the FDA decision is available on the agency’s Web site.
09 Friday Mar 2012
Posted in Breast Implants
For most women who have breast implants, an infection around the implant is a rare event. However, in some cases, particularly after placing an implant for breast reconstruction, an infection may result. Since the human body has a hard time fighting an infection around an implant, both patients and surgeons face challenges when these unfortunate events happen.
A publication this month by Dr. Gutowski and Dr Washer, an infection specialist, offers advice and guidelines for physicians who are faced with different treatments for breast implant infections.
06 Tuesday Mar 2012
For the many women who are affected by breast cancer, the loss of a breast is a serious concern. Thanks to advances by plastic surgeons, current reconstructive procedures can result in a natural looking breast for most women. But even when the breast is not removed, but only the cancer is excised (as in a lumpectomy), a breast deformity can result, particularly if there is radiation treatment involved.
For actress Suzanne Somers, breast cancer treatment resulted in one breast being a D-cup, and the other breast being a B-cup. Typically, her options to achieve similar sized breasts would have included:
However, a new option is using a patients own fat cells taken from one part of the body and injecting them in to the breast that needs to be larger. While this may be a good option for many patients, it is not for everyone. Furthermore, some surgeons are promoting a “stem cell” breast reconstruction which takes advantage of the normal stem cells found in fat. As in the case of Suzanne Somers, there is little scientific data to support this stem cell procedure and no evidence that the result will be any better than just fat injections alone.
For more details, click here to read the full article, including Dr. Gutowski’s comments, in the Washington Post.
“Despite the recent position statement on stem cell treatments by the American Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery, there are still those who promote stem cell use without educating patients about the lack of proof that stem cell treatments offer any benefit over regular treatments. Although stem cell treatments offer great potential in plastic surgery, the advantages have yet to be proven and risks are not known. To learn more about the current state of stem cell treatments in plastic surgery, click on the link below.”
ASPS & ASAPS Stem Cell Position Statement
Karol A. Gutowski, M.D.
04 Sunday Mar 2012
Posted in Liposuction
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Liposuction is one of the most common plastic surgery procedures and is ideal for removing fat from stubborn to lose areas. For men and women who’ve tried changing their diet and increasing their activity but still can’t achieve their desired shape, liposuction can result in a better appearance of the arms, thighs, waist and other areas. It now appears that the weight lost following liposuction may be maintained with regular exercise.
A new study of women who had liposuction to remove fat from the abdomen showed that compared to women who did not exercise, those who did regular exercise had less fat return around their abdominal organs.
The 4-month exercise program involving aerobic and resistance training three times per a week. Both women who exercised, and those who didn’t, had much less fat in the area treated with liposuction after 4 months. However, those who did not exercise had some increase in fat deposits around their organs in the abdomen. An additional benefit of exercise was that physical capacity also improved only in the exercise group after 6 months of training.
It seems that exercise has a protective effect on metabolism and body composition after liposuction.
“In my practice, liposuction procedures are very common and result in extremely satisfied patients. It is common for patients to return 4 to 6 months later, proud of their continued weight loss. While I don’t attribute it to their liposuction procedure, I suspect it is due to their lifestyle changes that often follow body contouring surgery. For most patients, an exercise program can start 2 to 3 weeks after liposuction so as to help maintain the improved appearance.”
Karol A. Gutowski, M.D.
26 Sunday Feb 2012
Posted in Uncategorized
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As President of the Midwestern Association of Plastic Surgeons, Dr. Gutowski is pleased to announce the Association’s 51st Annual Educational Meeting to be held in Chicago this April.
This two day course is being organized by Dr. Gutowski and the Association’s Program Committee to offer plastic surgeons new and cutting-edge information on topics including:
Dr. Gutowski will also moderate an expert panel on how to help patients in selecting the right implant for breast augmentation.
“Being elected as President of the Midwestern Association of Plastic Surgeons has not only been an honor, but also a wonderful opportunity to serve my fellow plastic surgeons. By working with my fellow association members, we are able to offer an excellent educational program for plastic surgeons. This learning opportunity will result in better results for our patients.”
Karol A. Gutowski, M.D.
25 Wednesday Jan 2012
Posted in Fillers
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Adding to the already available fillers for treating facial wrinkles, Belotero was approved recently by the FDA for correction of moderate-to-severe facial wrinkles and folds.Belotero is an injectable product that combines cohesive polydensified matrix technology with a hyaluronic acid base. It works by drawing water to the treatment area to fill in wrinkles and skin folds offering an improvement for 6 to 9 months.
Areas of treatment include the nasolabial folds, worry and frown line between the eyebrowss, crow’s feet, and lines around the lips and chin. It can also be used to improve lip and cheek fullness. The results are seen right after treatment and may improve for about a week.
Based on an FDA approved study, 97% of patients saw a visible improvement after one Belotero treatment. While no significant complications were seen, as with other fillers, short-term mild to moderate injection-site reaction, including swelling, bruising, and localized nodules were reported.
23 Monday Jan 2012
Posted in Scar Treatment
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Experiencing severe acne as a teenager or young adult can be frustrating and may sometimes affect self-esteem. While most acne sufferers outgrow the skin eruptions, the scars left from long-term inflammation may remain for a lifetime.
Treatment of acne scars ranges from simple excision or injection with a filler to more complex procedures such as skin resurfacing with a laser or dermabrasion. The best treatment option in each case depends on the specific type and severity of the scar. For example, a deep “ice pick” type of scar is not likely to change with laser therapy but can be easily improved by an excision. A classification system of acne scars using a standardized grading scale (Grade 1 to 4) is useful in selecting the proper treatment for each patient.
Laser treatments are becoming more popular thanks to the development of nonablative and “fractional” laser technologies.
When considering treatment for acne scars, lasers may offer one option for significant improvement. A discussion with a Board Certified dermatologist or plastic surgeon can be useful in determining which option in best for you.
16 Monday Jan 2012
Posted in Perspectives
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Ever wonder how the models and celebrities look so good in fashion magazines? Good makeup, ideal lighting and a skilled photographer can highlight a person’s best features while avoiding less favorable areas. However there is one other technique that can result in the most dramatic changes for those wanting to show off their face or bodies. For more details, watch this YouTube video (and for a change, it has nothing to do with plastic surgery).
“Although this video is a spoof of the all too common practice of modifying actual photographs to achieve better results, it should allow us to reflect on how realistic are the images we see everyday in magazines and advertisements. Knowing that many, if not most, of such pictures are modified should help us better accept our own bodies. While plastic surgery is one way of making a change, realistic expectations and comfort with one’s own body – regardless of what the media portrays – is just as important in maintaining high self-esteem and a proper body image.”
Karol A. Gutowski, M.D.
14 Saturday Jan 2012
Posted in Gynecomastia
Tags
Gynecomastia is the abnormal enlargement of one or both breasts in a male. It is actually a common condition that occurs in one-third to two-thirds of boys between the ages of 10 and 16 years old. Fortunately, in most cases, the condition resolves without any treatment and in only about 8% of cases does it continue beyond the teenage years. In those boys who have continued and significant gynecomastia, problems with self-esteem and body image may emerge.
A recent study examined the psychological changes in a group of boys with ongoing gynecomastia and found that all of them had at least one psychiatric diagnosis, most commonly an adjustment disorder (an emotional and behavioral reaction that develops within 3 months of a life stress, and which is stronger or greater than what would be expected for the type of event that occurred). Other findings included anxiety, depression and social phobia. In some cases, the boys went to extreme measures to hide their breasts. The authors of the study reported that:
“Most (of the boys) noted a decrease in self-confidence and, for many, a negative self-image. All of the patients indicated that they restricted activities, including sports, social events with peers, and family outings, because of concern that others would notice or comment on their breasts. As a result, many of the patients had limited contact with peers, particularly in the summer when their breasts were likely to be more apparent under lighter clothing. None of the patients were comfortable with swimming either at school or during the summer, and one patient failed his gym class because he was not willing to swim without a shirt. Another patient stated that he would not return to school because of the teasing he suffered.”
While many boys with gynecomastia are able to tolerate and eventually outgrow it, for some the problem is much more sever and can disrupt normal activities and behaviors. In such cases, pediatricians frequently refer these boys to plastic surgeons for treatment. The procedures available include removing the excess breast tissue, liposuction to reshape the chest and sometimes removal of extra breast skin.
“Gynecomastia is a challenging problem for many boys and their parents. In addition to the obvious breast tissue, some boys experience significant physical pain and discomfort from the hard breast mass that can be seen with gynecomastia. The pain may interfere with sports and other normal activities. Since most insurance plans do not pay for gynecomastia treatment, parents may become stressed if their son doesn’t outgrow this condition. While there aren’t any nonsurgical treatments (pills, injections or therapy) for boys with ongoing gynecomastia, in my experience surgery offers excellent results and a prompt improvements in these boys self-esteem. These are among the happiest patients in my practice.”
Karol A. Gutowski, M.D.
13 Friday Jan 2012
Posted in Trends
Last year’s trends in aesthetic non-surgical and surgical treatments showed that more procedures are being done compared to the previous 2 years, perhaps a sign that the economy is improving. Injectable products such as Botox and facial fillers (Juvederm and Restylane) continue to grow in popularity among younger men and women who are looking for simple steps to improve the early signs of facial aging.
For 2012, patients may expect more combination treatments such as skin resurfacing with a chemical peel or IPL, packaged together with a filler and Botox. Such comprehensive treatments offer a more complete approach to improving facial aging and provide a more natural and harmonious result.
However, not all treatments offer the same results and non-surgical options should not be expected to have the same outcomes as more traditional surgical procedures. For example, an older women with advanced facial aging is not likely to have a significant enhancement with fillers but may have a dramatic improvement with a face and neck lift.
Non-invasive body contouring treatments are also getting more attention and competing with liposuction procedures. While devices such as Zerona and Zeltique may result in some improvements for localized areas of excess fat, they do not seem to give the results that can be delivered by an experienced plastic surgeon using traditional liposuction.
As with all new products and devices, the long-term result may not be as good as the initial promises. For a proper assessment of the latest trends, be sure to discuss your options with a Board Certified plastic surgeon.
12 Thursday Jan 2012
Posted in Breast Augmentation, Breast Implants, Safety
Government health agencies and professional medical organizations around the world have issued recommendations on how to deal with the French made PIP silicone gel breast implants. Now, the largest American organization of aesthetic plastic surgeons has offered guidelines for its surgeon members.
According to the American Society for Aesthetic Plastic Surgery (ASAPS), the French made PIP (Poly Implant Prostheses) implants and Dutch made Rofil implants have a higher rupture rate than other breast implants. Also, since the silicone used was industrial grade, and not medical grade, the possible impurities and potential side effects are not known. For this reason, implant removal should be recommended.
The implants that are affected are the PIP silicone gel (not saline-filled) breast implants used since 2011. They were also sold as the M-implant by the company Rofil Medical in the Netherlands and distributed in Germany by the company Rofil Medro. Affected Rofil implants are designated as IMGHC-TX, MX-IMGHC, and IMGHC-LS. There is strong suspicion that PIP and ROFIL implants that were manufactured before 2001 are also affected and are prone to a higher rupture rate and therefore silicone leakage. These implants were never F.D.A. approved in the United States and so women who had their implants placed in the U.S. should not be affected.
The ASAPS agrees with The International Society of Aesthetic Plastic Surgeons (ISAPS) who strongly supports the recommendation of the French authorities to remove the implants as a precaution, even if no symptoms or hints of rupture or leakage are present.
11 Wednesday Jan 2012
Posted in Botox, Dysport & Xeomin, Migraine Headaches
Migraine headaches can be debilitating for the estimated 35 million Americans who suffer from them. Not only is there a burden on the person affected by them, there are also significant costs to society related to treatment and loss of work. While medications and lifestyle changes make migraine headaches more tolerable for most patients, some have little or no response to treatment.
New studies suggest that some migraine headaches may be caused by compression of nerves further away from the brain than previously thought. In these cases, Botox (which blocks nerve transmissions) has shown to provide a significant, but temporary, relief from such headaches. For patients who find relief from Botox but wish to have a longer lasting or permanent effect, surgical decompression of the nerves may be a good option.
This new approach of using Botox and surgery for migraine headache treatment was developed by Dr. Bahman Guyuron, a plastic surgeon who noticed migraine headache symptom improvements in his patients who had certain facial procedures. After investigating it further, and conducting well designed clinical studies, Dr. Guyuron was able to show that both Botox and surgery are an effective way of treating migraine headaches in selected patients. These techniques are now being offered by other plastic surgeons in conjunction with neurologists who can properly evaluate patients suffering from this debilitating condition.
10 Tuesday Jan 2012
Posted in Breast, Breast Augmentation, Breast Implants
Concerns that the French made PIP (Poly Implant Prothese) silicone gel breast implants have a high rate of breaking or rupturing are being questioned by the latest report from Australia’s Therapeutic Goods Administration (TGA). According to the TGA, the reported PIP rupture rate was approximately 0.4% (37 ruptures in 9054 implants) between 2002 and 2011. This low rate is more consistent with other types of breast implants, all of which should be considered non-permanent medical devices and be replaced at some point. It is possible however, that the PIP implants used in Australia had different production processes or other qualities than those used in Europe where much higher rupture rates are being reported.
TGA National Manager Rohan Hammett stated ”This rate remains well within the expected performance of breast implants based on historical and international trend data”. Mr. Hammett also added that testing in Australia and Britain found that PIP implant silicone gel used in both countries was non-toxic to the tissue around the implant even if the implant ruptured.
This latest information still does not address the concerns that some PIP products used non-medical grade silicone during implant production, perhaps in an effort to offer a less expensive breast implant.
For more information on rupture rates of saline-filled and silicone gel breast implants available in the United States, go to How Long do Breast Implants Last?
09 Monday Jan 2012
Posted in Bariatric Surgery
Bariatric surgery (procedures intended to cause weight loss for those who are morbidly obese) can result in significant improvements in a person’s overall health. A new study from Sweden shows that it can also result in less heart attacks, strokes and death in obese people compared to those who didn’t have surgery. This study adds to the growing evidence that bariatric surgeries such as gastric bypass and gastric banding not only result in significant weight loss, but also have health benefits that are independent of the lost weight.
Bariatric surgery has some risks and therefore is reserved for patients with significant obesity and a high BMI (body mass index). Following the dramatic weight loss, many patients choose to have plastic surgery to remove excess skin once they reach their new weight goal. For more information on body contouring after massive weight loss, go to the before and after pictures of Bariatric Patients.
08 Sunday Jan 2012
Posted in Breast, Breast Augmentation, Breast Implants
Health authorities in Europe offered different recommendations for women with controversial PIP French-made breast implants. The British Health Department recommended that the PIP implants should not be taken out in all women since there was not enough evidence to demonstrate that they can cause health problems. The Czech and Germany authorities went along with the French in recommending PIP implant removal.
Other than a possibly high rate of implant breakage and use of non-medical grade silicone gel inside the implants, there is no evidence that the PIP implants cause a health concern. However, the Germany Institute for Drugs and Medical Devices recommended removal of PIP breast implants as a precautionary measure.
The British recommendation differs from those of other European health agencies and point out that their expert review group did not find a link between PIP implants and cancer, and did not establish if the PIP implants were more likely to break than other breast implants as the information that was available was not complete. ”Reports show that, of the PIP implants that have been tested, there is no risk of dangerous toxins leaking into the body if an implant did rupture,” the British Department of Health said in a statement. ”However, we are not confident that the manufacturer did not change the silicone in the implants, so cannot rule out the possibility that some are toxic.”
Women whose implants were placed in the United States should not be concerned about the potential problems with the PIP silicone gel breast implants as they were never approved for use by the F.D.A in America.
07 Saturday Jan 2012
Posted in Tummy Tuck (Abdominoplasty)
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For anyone considering a tummy tuck (abdominoplasty), a common question is how long will it last. To better understand the answer, it is good to know what is done during a tummy tuck procedure.
Typically, the loose skin in the lower abdomen (bellow the belly button) is removed and the skin from the upper abdomen is pulled down resulting in tighter skin throughout the front of the trunk. During the same time, the loose connective tissue under the skin (rectus fascia) is tightened with sutures resulting in a more “toned” abdomen. For women who developed a rectus diastasis (widening of the abdominal muscles) after pregnancy, the tightening of the rectus fascia will bring the abdominal muscles back to their proper place and improve any bulges that are present.
A study published last month used MRI images to show that 2 years after a tummy tuck, the correction of the rectus diastasis was maintained. So while the improved abdominal tone after a tummy tuck seems to last, care must be taken as significant weight gain or a pregnancy may undo the results.
For more information, click on:
06 Friday Jan 2012
Posted in Face Lift
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With the recent availability of injectable fillers for improving the signs of aging, many women are choosing these non-surgical options instead of face lifts – the “gold standard” for facial rejuvenation. But are these temporary treatments better than traditional surgical options?
A new study found that in women younger than 50 years old, a SMAS face lift had a very high satisfaction rate and tended to provide good long-term results. These findings support the concept of considering younger patients with early or minimal signs of aging for surgical facial rejuvenation (“maintenance face lifts”). It appears that these younger women may be the preferred candidates for a face lift since this age group had consistently positive overall satisfaction with longer lasting results.
05 Thursday Jan 2012
Posted in Breast Augmentation, Breast Implants, Uncategorized
The continued concerns about the PIP silicone gel breast implants continues to grow in Europe and South America. Part of the implant’s popularity was the lower price compared to breast implants by other, more established, manufacturers. For younger women, who may be more price sensitive, the cost of a procedure, which includes the cost of breast implants, may play a big role in their decision to have a breast augmentation. This of course raises the question – is the cost of a procedure related to the quality received?
In this cases, it seems that the lower priced PIP implants were of poor quality due to the non-medical grade silicone gel used, and perhaps the lower quality standards present during the manufacturing process. Fortunately for American women, the F.D.A. identified problems with the PIP silicone gel breast implants and followed the recommendations of its own advisory panel, which included Board Certified plastic surgeons, to not approve these devices in the United States. For a brief time, PIP saline-filled breast implants were used in the U.S. but these implants do not appear to have the problems with non-medical grade silicone being used.
Substandard medical products and procedures being offered at a lower price are not new. Sales of non-approved counterfeit Botox, diluted Botox or fillers, injections of non-medical fillers, use of unapproved laser treatment and performing surgery without proper safety measures all have all been reported over the last few years – sometimes with devastating consequences. In most cases, the patients who suffered the consequences were enticed by low cost aesthetic surgery or cosmetic procedures. While smart shopping and cost comparisons are acceptable in healthcare and plastic surgery, a prospective patient needs to consider that more often than not, cutting corners and seeking bargains is likely to result in more problems (and higher costs) down the road.
“If a product or procedure price seems to good to be true, or is much lower than that offered by Board Certified plastic surgeons, you should ask yourself if you are really going to get what you are paying for and if you are willing to live with the results if things don’t go as planned.”
Karol A. Gutowski, M.D.
For more information on potential problems with “bargain surgery” see the post on Cosmetic Surgery Tourism.
