A recent study published in Psychiatry Research provides the most recent update on the prevalence of BDD, examining the population demographics that are most affected and the tendency of those affected to seek cosmetic surgery.  2,510 German people were analyzed in the research study, and 45 of them were showed symptoms of BDD.  Symptoms (or inclusion criteria) included the following:

• Preoccupation with an imagined defect in appearance
• Concern is markedly excessive
• Causes clinically significant distress / impairment in function

Of those 45 people experiencing the above symptoms, 7 of them had undergone cosmetic surgery.

As a general rule, cosmetic surgeons do not operate on patients who have this disorder — for many reasons, including the high chance for the patient to be dissatisfied with the results.  However, patients do not always report symptoms of BDD to their cosmetic surgeon.  They may be embarrassed about it or they may be unaware that such behavior (preoccupation with a perceived appearance defect) is abnormal.  Subjects in the study showed an intense, frequent preoccupation and dislike of body parts such as the ears, nose, stomach, hips, buttocks, skin and breasts.

The disorder poses a significant threat to one’s health.  Aside from being a general hindrance, BDD is linked to increased thoughts about suicide and suicide attempts.  Therefore, as authors of the study suggest, awareness of body dysmorphic disorder should continue to increase and careful screening by healthcare providers should be initiated to help people suffering from it.  A disorder like BDD also reinforces the need for cosmetic surgery patients to be completely open and honest about their reasons for seeking surgery and their medical history.

You can access this study, “Updates on the prevalence of body dysmorphic disorder: A population-based survey” through Elsevier Journals or Science Direct.

Measuring Breast Ptosis

A common way to measure breast ptosis is the Regnault classification, which is as follows in simplified form:

1. Pseudoptosis – the nipple falls above the fold, but the breast is hypoplastic and hangs below the breast crease.

2. Glandular Ptosis – the nipple is above the fold, but the breast hangs below the crease.

3. Minor Ptosis – the nipple is level with the breast crease.

4. Moderate Ptosis – the nipple is below the breast crease, but above the lower breast contour.

5. Severe Ptosis: the nipple is below the breast crease and below the lower breast contour.

Causes of Breast Ptosis

In general, the cause of breast droop is a combination of factors including breast size, aging, and gravity.  Large breasts are gradually pulled downward by gravity.  As your skin becomes thinner and less elastic with age, it stretches and becomes less able to maintain a youthful breast position.

A recent study sheds light on the lifestyle factors that contribute to breast ptosis.  Plastic surgeons at the University of Kentucky found that age, significant weight loss, higher BMI, larger bra cup size, number of pregnancies, and smoking were found to be significant risk factors for breast ptosis, while “breast-feeding, weight gain during pregnancy, and lack of participation in regular upper body exercise were not found to be significant risk factors.”

Correcting Breast Ptosis

Using the classification system above, a surgeon can recommend the right procedure to correct breast ptosis.  Surgery to correct minor ptosis may be quite different from the procedure to correct a severe case of ptosis.  The usual procedure of choice is breast lift surgery / mastopexy.

“There are subtle things that we can do to make a change in the profile, in the definition of the nose, without changing their ethnicity, without intrinsically changing their appearance,” said Charles M. Boyd M.D.

For the cosmetic surgeon, managing the patient’s expectations is important.  Likewise for the rhinoplasty patient, communicating desires and aesthetic goals is critical.  Each surgeon-patient relationship will go through this process in a different way.  One emerging trend facilitating this communication process is the use of 3-dimensional imaging to visually approximate the results that can be achieved.

“I use computer imaging and this is very helpful in pinpointing what patients are trying to achieve, and it enables them to see what’s in my mind as well,” said Steven B. Hopping M.D.

When it comes down to operating, there are also anatomical considerations for the ethnic patient.  View the article on modernmedicine.com to read how these surgeons approach rhinoplasty in patients of Asian, African American, and Middle Eastern descent.

Plastic surgeons in Lithuania recently studied the success rate of different suture types used in Otoplasty.  A 3-year study was conducted with 100 patients.  They were divided into these groups based on the suture materials chosen:

• PDS
• Monocryl
• Mersilene

Patients (48 men and 52 women) had a median age of 20 years.  After analyzing the data for each group, the doctors found that 3 patients in the PDS group and 3 patients in the Monocryl group had unsatisfactory aesthetic outcomes requiring revision surgery.  Patients in the Mersilene suture group had the lowest rate of recurrence.

Read more about this study online on PubMed: “Comparison of otoplasty outcomes using different types of suture materials”

Both rhinoplasty and revision rhinoplasty are complex procedures, worthy of extensive clinical research. Perhaps that is why members of the American Society for Aesthetic Plastic Surgery held a discussion on the topic during their annual meeting last weekend.

A panel of surgeons held two discussions that covered aspects of rhinoplasty such as:

• Correcting a short or crooked nose
• Using grafts or sutures to shape the nasal tip
• Alternative treatment methods
• Treating nasal, nostril and alar base deformities
• Correction of unsatisfying rhinoplasty results

Read more about the discussion on www.surgery.org

The Academy chose a different approach this year, polling random physicians as well as its own members for the survey. The results show numbers higher than ever seen before.

Highlights

• AACS members have seen an 8% increase in cosmetic procedures despite the economic recession.
• Procedures that increased markedly over the last 5 years include the tummy tuck, blepharoplasty, nose surgery, chemical peels and wrinkle fillers.

AACS President and cosmetic surgeon Dr. Mark Berman comments, “As the economy recovers slowly but surely, we are seeing patients come back and feel better about doing some things for themselves that maybe they’d been putting off for a while.

Read more at www.cosmeticsurgery.org

An ideal substance, according to the authors, would have these characteristics:

• Readily available in large quantities
• Resists infection
• Resists absorption
• Completely integrated into host tissues
• Causes little patient morbidity

Analysis of long-term rhinoplasty results with these grafts revealed that patients experienced a low complication rate. Moreover, 94.2 percent of the 357 patients said they were satisfied with the results.

Other common options for rhinoplasty include cartilage from the septum or the ear.  In recent years, non-surgical options such as Radiesse have grown in popularity as some patients choose to forgo a surgical operation.

More information

• Article on ScienceDaily.com
• Article in Archives of Facial Plastic Surgery
• Rhinoplasty in Cincinnati, Ohio
• Revision rhinoplasty with Dr. Mandell-Brown
  

Do….

• Investigate the procedure of interest.

Though your cosmetic surgeon should be a trustworthy, knowledgeable authority, you still need to seek out more than one resource for information. Research will help you protect yourself and help you decide if cosmetic surgery is truly in line with your personal values.

• Ask your surgeon about board certification.

Find out what board has certified your surgeon and what standards must be met to receive that certification.

• Find out if your surgeon has a prevention plan for DVT.

Deep vein thrombosis is a possible complication. Your plastic surgeon should take steps to minimize the risk and be prepared to see early signs of its occurrence.

• Ask about your surgeon’s experience with the procedure and if he or she has hospital privileges.

A good surgeon will have absolutely no qualms about sharing his or her experience and credentials.

• Inquire about the certification and safety of the facility.

If the surgery is done in an outpatient clinic, ask about accreditation of the facility. As Tulsa cosmetic surgeon Dr. Angelo Cuzalina recommends, go “to a clinic that’s been accredited by a group such as the Joint Commission or the Accreditation Association for Ambulatory Health Care.”

Don’t…….

• Seek out unapproved medical procedures.

According to sources for CNN, Argentine beauty queen Solange Magnano requested silicone injections for a buttock augmentation, a procedure that is not approved here in the U.S. or in Argentina.  In most cases, you should assume that such procedures are restricted for a good reason.

• Take the process lightly.

When you walk into a cosmetic surgeon’s office, it may not “feel” like a hospital, but it’s definitely not a spa. Real surgeries are performed in your surgeon’s outpatient suite, with real risks.

We know some women who would much prefer a breast augmentation or mommy-makeover to the usual electronics and clothes that get exchanged each year.

“There are a large number of people who really want cosmetic surgery, and they just need that little nudge or incentive to get it done” says Dr. Mark Berman, President-Elect of the AACS.

However, Berman also offers some crucial advice for those of you considering this type of extraordinary gift: Make sure you’ve discussed the idea with the recipient so it doesn’t come as a total surprise.

A consumer survey conducted by the American Academy of Cosmetic Surgery revealed that nearly 50 percent of consumers would forego an expensive vacation or even a luxury car to pay for cosmetic surgery.

I’d say those are pretty good odds that your gift will be a satisfying one.