The Tragedy of the Instant Noselift.

The Tragedy of the Instant Noselift.

Cosmetic surgery of the nose is the most common operation done by Plastic surgeons here in the Philippines. In fact it is considered their bread and butter procedure. Yet a lot more patients desire to improve the appearance of their nose, too many for even all the Plastic surgeons to accommodate. The demand for noselift surgery has tremendously increased in the last 20 years and is still increasing, but the number of properly trained Plastic Surgeons who should do the operation has not increased accordingly. This situation has led to the proliferation of fake plastic surgeons (they like to be called cosmetic surgeons); doctors of other specialties trained to be experts in their respective fields but were enticed to perform plastic surgery (for monetary reasons obviously); and lastly unscrupulous people who are not even physicians but daring enough to offer the public the “instant noselift”. It is not surprising then that complications from Noselift procedures is the most common problem faced by Plastic surgeons today.

What is the “Instant Noselift?


The instant noselift is increasing the height of the nose by injecting something underneath the skin of the bridge of the nose. The material is usually a foreign body, silicone liquid, molten wax, “synthetic fat” or practically anything that can pass thru the needle. Since there is no surgery needed there is no healing time required, thus the term “instant”. The amount of material injected into the nose determines the degree of augmentation making it a very easy procedure to perform. The cost is usually cheaper than when surgery is done, making this option very attractive to patients who have a limited budget and at the same time are scared of being put under the knife.


What are the disadvantages of noselifting by injection?

When medical grade silicon liquid was made available for injection in the 70’s, it was mainly used as a filler material to efface or improve the fine wrinkle lines of the face, especially around the eyes. A few enterprising individuals started to inject this material into the nasal bridge producing an instant lift. After a period of time surgeons noticed that the liquid silicon would migrate downwards on the more dependent portions of the face, causing hideous deformities. Because of this, the USFDA banned the use of silicon liquid for injections and was withdrawn from the market. When silicon for injection was no longer available quack doctors resorted to different types of substitute materials they can inject into tissues. All of these materials produced what we call “Foreign body reaction” when inside tissues. This results in the production of hard, deforming scar tissue, which is difficult to remove without injuring the adjacent normal skin. The skin of the nose, underlying tissues and the mucosal lining of the nostrils become thick and hard not only producing an ugly deformity but often times producing difficulty in breathing.


When molten candle wax was used, patients found out that the resulting improvement was temporary since the wax softened and got deformed when exposed to the heat of the sun. When prospective patients learn of this from friends they erroneously expect the same complication with surgical rhinoplasty. They often ask us if they can stay under the sun for long periods of time.

A more serious issue that most of the materials used for injections have not been ascertained in their long term safety with regard to production of cancer in the tissues where they are injected. The injected nose might look good and normal for the first 3 or 5 years but what happens in the next 20 or 30 years is unknown.


The Big Problem

What bothers plastic surgeons is that the deformity produced by injections in the nose is not only very difficult to correct but often times impossible to remedy. One of the most depressing experience in the clinics is when a distraught patient seeks help for these problems and the only thing we can offer is to tell them that they have to learn how to live with the deformity. If an inexperience surgeon attempts to remove the foreign body aggressively or incorrectly, the blood supply of the nose might be compromised resulting in a worse looking nose. This would be an example where the cure is worse than the disease!

If surgery correction were still possible, usually the treatment would involve several operations before an acceptable outcome is achieved. Patients who opt for Injection Rhinoplasty in order to save money end up spending much much more than when they could have the right surgery with the right surgeon.


What to do to avoid this dilemma.


Time and time again, I have emphasized the importance of choosing the right doctor to do the job. Rhinoplasty or noselift is still a surgical procedure and should be done by a well-trained surgeon. Well trained in the sense that they can’t only do the surgery well but could take care of all complications as well.

Avoid making decisions for the procedure based on a friend’s wonderful experience. Most complications manifest several months and even years after the procedure is done.

If unfortunately you had the injections, then observe your nose and have regular follow up visits to your plastic surgeon and follow his advice.

Anesthesia in Plastic Cosmetic Surgery

Anesthesia in Plastic Cosmetic Surgery

One of the most frequently misunderstood aspects of cosmetic surgery is not about the surgery itself but about anesthesia during the operation. This is because, almost always, the question that patients ask is whether the surgery or recovery is painful or not. It is the type of anesthesia used that determines whether the patient will have a pleasant or horrible experience. Very few patients realize that in cosmetic plastic surgery, the choice of anesthesia is also very critical. Most of the morbidity/ mortality or accidents in cosmetic surgery are related to anesthesia. This means the right anesthesia technique was not applied.

A good example is when a patient for liposuction has low tolerance for pain yet the doctor would still perform the procedure under local anesthesia with or without light sedation. Since the doctor thinks that the operation is minor, he would do it in an office setting without the help of an anesthesiologist. For sure the patient would be squirming about when the lipo is done. The tendency of the doctor is to do a lesser liposuction or increase the local anesthetic or increase the sedative. These have led to fatal accidents due to overdose of medication. As the patient complains of increasing pain, more local anesthesia is given resulting in an overdose and the doctor didn’t have the right equipment and training to deal with the overdose.

The other situation may occur where a patient who needs eyebag surgery, which can be done under local anesthesia, is put to sleep under general anesthesia without the proper preparation or support equipment. Patients may vomit and aspirate the vomitus into the lungs and die. If the patient can tolerate the operation comfortably, a local anesthetic technique should suffice to avoid the possible complications of putting the patient to sleep.

So should it be local or general anesthesia? This issue is more confusing because a lot of people think that general anesthesia is more dangerous than local anesthesia. This is not always true. As a matter of fact in my practice I find general anesthesia much safer in certain instances. For example, patients who have an operation for more than 3 hours, or patients who have unstable blood pressure or patients who have to be turned from side to side are better off and safer when put to sleep.

It is very important to understand that complications in anesthesia can occur whether in local or general anesthesia technique. Accidents are usually the result of incompetent practitioners or practitioners who give anesthesia without the proper equipment available. The operating room should have all the equipment and medications available to handle all emergencies. A well trained, Board Certified anesthesiologist will make sure that the patient is well prepared for the type of anesthesia to be given as well as the surgery that is going to be done. He makes sure that the patient is not allergic to drugs he is going to use and that the patient has complied with all pre- operative instructions given. Most important of these is that the patient did not eat or drink anything 6 hours prior to the anesthesia in cases where patients are put to sleep. He also double checks the laboratory results are normal and the heart and lungs of the patient are healthy enough for the operation and for an uneventful recovery.

During the operation, a good anesthesiologist monitors his patients like a hawk, he is aware of problems before they happen. If accidents do happen, he is well trained and equipped to handle them. He works in perfect harmony with the surgeon making sure the conduct of the operation is as safe as possible. He does not hesitate to tell the surgeon not to proceed with the operation if he senses something awry with the patient.
A good anesthesiologist is also someone who makes sure the patient has a pleasant recovery. He makes sure that he is always available for consult even when the patient is sent home right after surgery. Together with the surgeon, he should always be there to address the patients and relatives concerns about recovery.

Patients should always remember that a Board certified Plastic surgeon would allow only a Board certified anesthesiologist to handle his cases. So your selection or choice of your surgeon practically determines your choice of anesthesiologist.

When considering any cosmetic surgery, think like a doctor, Safety first before anything else.

by James Joaquino, MD

Ancillary Procedures in Plastic Surgery : Hair Removal with the MultiLight System

Ancillary Procedures in Plastic Surgery : Hair Removal with the MultiLight System

Removal of unwanted body hair is of major importance to many women and to increasing numbers of men. Tremendous sums of money and much time and energy are spent in pursuit of the smooth, hairless look. Although there are diseases or conditions where there is an increase hair growth, most unwanted hair is a cosmetic rather than a medical problem.

Treatment options for hair removal

Shaving: This is the most common method of hair removal and possibly the most convenient. Shaving is not, however, a long term hair removal treatment because it does not impair hair growth.

Depilatory Cream: This method is extremely tedious and time-consuming since the cream must remain applied until the hair is fully dissolved, and hair can return as quickly as within a week. Many people find the cream to have an unpleasant odor, and the process to be very messy.

Waxing: A popular method as it is intended to last anywhere from two to four weeks. Some people find this method painful, and it can cause skin irritations and pimples.

Electrolysis: By passing an electric current through the fair follicle, this technique damages some follicle beds and slows hair regrowth. However, it can be painful, time-consuming and expensive, as each follicle must be treated individually. Multiple treatments over a period of months to years are usually necessary, and scarring and skin irritations often result.

Lasers: New and improved laser systems are being used for hair removal with varying effectiveness and results. Since the laser’s single wavelength requires a certain amount of contrast between skin color, hair color and absorption ratios, several devices are less effective for treating lighter colored hair and darker skin tones.

MultiLight Hair Removal System: Is ESC’s proprietary intense pulse light technology that allows physicians to customize treatment parameters to allow for successful, longer lasting removal of unwanted hair from all parts of the body on a wide range of skin types, ranging from light to dark complexions, while protecting the overlying skin from burns and their resulting scars.


FREQUENTLY ASKED QUESTIONS


1. What is actually meant by Hair Removal ?
The term “permanent hair removal” is probably misleading since it would imply 100 % hair removal that would never grow again. The truth is there is a minimal number of hair follicles that may remain after the complete course of treatment. Hence the proper term should be “ permanent hair reduction” and anyone who claims they can remove ALL the hair permanently probably don’t know what they are saying.

2. How is MultiLightTM different from conventional lasers?
The MultiLightTM system is a non-invasive, broad spectrum device that operates on the principle of selective photothermolysis in which intense pulsed light is used to selectively destroy target tissue. Its revolutionary technology enables physicians to effectively treat a variety of skin types and hairs of every color and rooted at various depths of the skin. Another difference is MultiLight’s flexibility . The treatment parameters can be selectively chosen to allow the epidermis to cool, this minimizing damage to surrounding tissue. In addition, MulitLightTM has a much larger spot size (8 x 35 mm) than a laser, enabling it to quickly cover extensive areas of treatment and reduce treatment time.

3. How does MultiLightTM remove hair?
The HR capability of MultiLightTM uses intense pulse light to eliminate unwanted hair of all colors from all parts of the body in skin. When the light is absorbed by the melanin pigment found in the hair follicle, hair shaft, or bulb, it raises their temperature to a high enough level to destroy the targeted hair structures and stunt hair growth. MultiLight’s unique method of hair removal, called photo-epilation, enables the physician to harness the pulsed light so that it penetrates deeply enough and with sufficient energy to destroy the hair follicles without harming the surrounding tissue.

4. Can all hair colors and parts of the body be treated?
The system’s unique design offers customized treatment, according to the patient’s hair color, texture and location on the body. MultiLight removes all hair colors from all parts of the body including the chin, upper lip, cheeks, legs, arms, underarms, and back – as well as sensitive area like the ears, nose, chest, and bikini line.

5. How does MultiLight compare with other hair removal methods?
Shaving, waxing, and depilatory creams are all temporary methods that must be repeated on a regular basis. Hair removal with the Multilight process offers longer lasting results even when compared to some of the laser products.

6. What is treatment like?
Treatment sessions are done on an out-patient basis at the clinic. First a cool gel with the hand held treatment unit is applied to the skin. The actual pulse involves a pulse of intense light similar to a flash of a camera. One may feel a mild sting similar to the snap of a rubber band. No local anesthesia or pain medication is required. Each session lasts for about 15-30 minutes.

7. How does MultiLightTM compare with electrolysis?
Electrolysis is a tedious, invasive and painful process that involves inserting a needle into each hair follicle and delivering an electrical charge to destroy them one at a time. Electrolysis often requires years of treatment at regular intervals, and its success is highly dependent on the operator. MultiLight non-invasively treats hundreds of hair follicles spontaneously.

8. What are the side effects of hair removal with the MultiLight?
Potential side effects are generally few and temporary. There may be redness or swelling at the treatment site, and this usually disappears within a day. Occasionally, changes in pigmentation can be observed, but typically these go away in several weeks. Other seldom seen side effects may include blistering and purpura.

9. Who are the candidates for treatment?
Most people, including children, can be treated with the MultiLight process; however, a doctor should determine if a person’s condition is suitable for these treatments. This may require a consultation visit.

10. How many treatments are required?
The number of treatments required for hair removal varies depending upon hair color and location on the body. Several treatments maybe required, with each session lasting 10-30 minutes.

11. Are there restrictions on activity after treatment?
Patients can return to work the same day and resume all regular activities. One should limit exposure to the sun, which is always a good idea.

12. Is MultiLightTM cleared by the USFDA?
Yes, ESC Medical Systems received clearance on June 1998, from the U.S. Food and Drug Administration to market MultiLight, a new version of its PhotoDerm and EpiLight intense pulsed light system.

Persistent Myths about Liposuction

Persistent Myths about Liposuction


Several well written articles have been published in weekly magazines about liposuction, everything about the operation have been discussed quite a lot in TV talk shows, doctors spend more time explaining to their patients how it is done and what to expect after the surgery, yet, if we consider the kind of questions today’s prospective patients ask about the procedure one cannot help but conclude that there is still a lot of things about Liposuction the public does not understand. Hopefully this article will further enlightened the people’s perception of one of the most common plastic surgery operations being done today.

We may also wonder why despite of the ready availability of information regarding surgical operations in multimedia and the Internet a lot of people still harbor wrong notions about the operation and its results. Plastic surgeons can only surmise that this could be due to adverse news on persistent complications, undesirable results and unfortunately, mortality that occurs in patients done by untrained or inadequately trained doctors, who because of sheer daringness have proclaimed themselves to be experts in Liposuction and its possible complications. The public beware! If you are careful in avoiding purchasing fake clothing, shoes, bags or jewelry, you should be more careful in avoiding fake surgeons.

The following are the more common wrong beliefs patients still bring up during consultation about liposuction.


Will the suctioned fat grow back? Are the results permanent?

One of the fundamental bases for liposuction is the hypothesis, first introduced by Bjorntorp and accepted by most plastic surgeons that fat cells in the adult do not multiply. Consequently, in the adult there is a fixed reserve of cell that can store fat. Once the fat is removed or destroyed by liposuction or by whatever means it cannot be restored. When the patient gains weight, the fat is stored in the fat cells remaining that were not removed by lipo. If the liposuction is done well, meaning, the removal of fat results in a proportionately sculptured body, and the patient gains weight, then the body becomes bigger but the desired curvy shape is maintained.

Since fat is not restored after removal, plastic surgeons are also very careful not to remove too much. Excessive removal of fat in localized areas results in permanent dimpling which is not corrected by regaining weight. The only way to correct this is to harvest fat from another site and transfer it to the depressed areas. This is called Fat Grafting and the fat has to come from the same person. Therefore whether the results are desirable or not they are definitely permanent.


What happened in patients who have to come back for a second or third liposuction?

There are several reasons why the patient regained their weight and fat deposits and have to be suctioned again. The most common cause is that the first liposuction was very conservative. This means that the surgeon left behind a significant amount of fat. This fat layer could still increase in thickness because of increase in size and not in number. Each fat cell has a potential of increasing its size by about 100 times. This means that you do not have to double your weight for your fat layer to double in thickness. Everybody knows that a mere weight gain of 5 or 10 lbs would readily add inches to your waistline

The other reason is that the doctor may not be familiar or trained, or may not have the equipment necessary to perform high volume suction. This means that even if there are fat deposits that still need suctioning the doctor will limit the surgery because they will not be comfortable if they perform suctioning aggressively.

Still another reason is that there are still doctors whose technique of liposuction is to do it part by body part. The reason is that they feel that it is safer to do it this way rather than doing it one time. Most plastic surgeons do not agree with this technique because it only does it come out more expensive but finer results are more difficult to achieve.

What happens to the overlying skin, will I have more wrinkles?

When fat is removed the overlying skin becomes loose and flabby. If the traditional suction techniques are used patients will usually need a tummy tuck or an abdominoplasty to correct the loose skin. With the newer Superficial Technique the fat near the undersurface of the skin is also removed, resulting in tightening of the skin due to the process of contraction. The skin will become wrinkled and loose specially when the swelling is gone but this improves gradually over a period of 6 to 12 months. If after this period the looseness is still not to the satisfaction of the patient, then a tummy tuck is done, this time only a limited procedure is perform. This means lesser surgery, faster healing and best of all shorter scars.

I have had several lipo procedures done and I am not happy because I still have bulges can I have another liposuction?

As long as there is fat to be removed, Liposuction can be performed several times. Although it is more difficult for the surgeon, newer techniques and machines (like the Power Cannula), make it easier and less tiring for the surgeon to produce finer results.
Repeat Liposuction doesn’t necessarily mean a more painful or longer recovery.





Doc, “napakamahal naman? “

Patients usually shop around for the right doctor. The price package should not be the only basis of their choice. First and foremost should be the training and credentials of their surgeon. I have always maintained that since Liposuction is a surgical procedure with its attendant surgical complications, this is done best and safest by a Plastic Surgeon, not by a dermatologist, not by the so called cosmetic surgeon, not by a general surgeon, and certainly not by a nurse. When pricing is considered avoid doctors who would ask for exorbitant fees, doctors who would charge you very cheap should also be avoided. Ask around and you will have a general idea what the average cost would be. Always remember to get the best value for your hard earned money. Know from your doctor exactly what you are paying for!

"Definitely something you'd like to see...Beauty through experts hands."

Definitely something you'd like to see....Beauty through experts hands. ""When you look in the mirror, we want you to like what you see"When it comes to cosmetic surgery, there's no room for error. You must do it right the first time. So medical expertise and success record are very important things to consider when choosing the right cosmetic surgeon.

The New Life Center teams are all Fellows, Diplomates, and/or Members of trusted associations like the Philippine Board of Plastic Surgery, the Philippine Association of Plastic, Reconstructive and Aesthetic Surgeons, Philippine Medical Association, among others.

They are also active volunteers of the worldwide mission, Operation:Smile. You'll be pleased to know that we match our talent with the best tools of the trade!

Services includes:
Botox// Brow Lift/ Facelift// Blepharoplasty// Rhinoplasty// Lip Enhancement// Chin Augmentation//Brest Surgeries// Whole Body LIposuction// Tummy Tuck// Vein Treatments// Scar Revision Techniques// etc.

For Free Consultation: Please call 0922.520.5735