Monthly Archives: September 2010

Reasons for Revision Rhinoplasty

Rhinoplasty was the fourth most popular cosmetic procedure performed in 2009, with 138,258 operations performed according to the American Society for Aesthetic Plastic Surgery (ASAPS). NewBeauty reports that as many as 15% of those patients will seek out a revision procedure to address their dissatisfaction. While the reasons may vary from patient to patient, it is not uncommon for the person to seek out a different plastic surgeon the second time around.

The Archives of Facial Plastic Surgery recently published a study that examines the patient reasoning for revision rhinoplasty and how their perceptions may differ from that of the second surgeon to perform the surgery.

Of the 104 patients seeking revision rhinoplasty that were studied, the top aesthetic complaints were having a crooked middle third of the nose and an asymmetrical tip. The most common functional complaint was the blockage or breathing problems.

While 79% of the doctors shared the same concerns as their patients, 55% of them identified issues that did not coincide with their patients’ reasons for dissatisfaction.

The researchers concluded that this discrepancy could be attributed to the surgeon’s more systematic view of the nose as opposed to the patient’s less critical analysis of its anatomy. The researchers also suggest that surgeons may base their criticism of another doctor’s work off of a personal bias, whereas patients have a more subjective opinion.

It is important for a plastic surgeon to respect the requests and concerns of their patient, as long as it does not interfere with their health. Even if the surgeon identifies additional flaws that can be addressed with revision rhinoplasty, it is up to the patient as to whether or not to surgical address said issues.

If you are a Bakersfield resident that is considering revision rhinoplasty, I urge you to schedule a consultation at the California Institute of Cosmetic & Reconstructive Surgery.

To Your Health & Beauty,

Vipul R. Dev, M.D.


Study: Dysport More Effective Than Botox for Crow’s Feet

Since its FDA approval for cosmetic purposes in 2002, Botox has been used for the purpose of wrinkle reduction. Up until the FDA approval of Dysport in May of 2009, there was no other botulinum toxin treatment on the market other than Botox. While Dysport has had a slow introduction into the market, a new study may give it the extra boost it needs.

According to the study, which was presented at the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) 2010 Annual Fall Meeting, Dysport is significantly more effective than Botox Cosmetic for the treatment of crow’s feet.

Ninety subjects were assessed on day zero and day 30 following treatment by both Botox and Dysport. The double-blind study found that Dysport was hands-down more effective than the well-established Botox Cosmetic.

Botox has long been considered the gold standard of injectables, so this data showing Dysport’s stronger efficacy is compelling,” Corey D. Maas, MD, AAFPRS Group Vice President for Public and Regulatory Affairs, told Plastic Surgery Practice.

Based on the findings, patients who are interested in treating their crow’s feet may want to reconsider what product they ask for. The study also found that Dysport is more effective in treating hyperfunctional frown lines. For more information on Dysport in Bakersfield, please contact The California Institute of Cosmetic & Reconstructive Surgery for a consultation.

To Your Health & Beauty,

Vipul R. Dev, M.D.

The Skinny On Stem Cell Facelifts

Stem cells have been under investigation for years for their potential to treat numerous medical conditions. With the most recent findings, the use of stem cells for aesthetic purposes is gaining a lot of attention and popularity. Once specific procedure that patients are requesting is the stem cell facelift.

Although studies are still underway to prove the efficacy of stem cells for facial rejuvenation, many doctors are already offering this procedure. During the procedure, fat is removed from another part of the patient’s body and purified. After purification, the surgeon will inject the fat into different areas around the face.

The fat will plump the face in areas with skin is sagging, leaving it looking younger and refreshed. Stem cells also have the possibility to regenerate elastin and collagen, which in turn can help the skin bounce back to it’s original form. Even though this sounds promising, most anti-aging stem cell research is in its infancy.

For a long time, stem cell research was unable to be processed due to legal restrictions. Since stem cell research originally focused on embryonic cells, there was a lot of controversy surrounding how they were harvested. More recent research has found that stem cells are existent in human fat and has opened more doors for new studies.

Another benefit of stem cell facelifts is that no scalpel or incision is made in the face therefore there is no scarring and no need for general anesthesia. This results in minimal downtime for the patient. If you are a Bakersfield resident who has questions about the stem cell facelift, our knowledgeable staff at the California Institute of Cosmetic & Reconstructive Surgery is available to address your concerns.

To Your Health & Beauty,

Vipul R. Dev, M.D.

Nose Job Without the Knife

Remember when the only way to alter your nose was by going under the knife? Well now patients have the option to choose between rhinoplasty and the use of non-invasive dermal fillers.

The traditional rhinoplasty is great for patients seeking permanent and significant results. Surgery can fix irregularities such as a deviated septum and problems breathing or sleeping. Some patients also undergo rhinoplasty surgery to reduce the size of the nose or its arch.

Dermal fillers—such as Juvederm or Restylane—can be used to fix minor imperfections of the nose. For patients who have asymmetries, bumps or droopy tips, fillers may be a less expensive—however less permanent—fix. Dermal fillers are a great alternative for patients who are uneasy about undergoing surgery or permanently altering their appearance. Fillers can also be used on patients who have already undergone rhinoplasty and would further like to refine their results.

If you are considering having rhinoplasty after having fillers injected into your nose, it is important to inform your plastic surgeon of this. The hyaluronic acid found in dermal fillers takes time to break down, and skin damage can occur if the treated area is operated on.

If you are a Bakersfield resident that is considering rhinoplasty—either invasive or injectable—please contact our offices for a consultation. At the California Institute of Cosmetic & Reconstructive Surgery, we’ve got a nose for noses.

To Your Health & Beauty,

Vipul R. Dev, M.D.

Skin Tightening Advances Made by RF Technology

A new radiofrequency (RF) technology is setting the standard for skin tightening, Cosmetic Surgery Times Reports. The EndyMed PRO, made by EndyMed Medical, is an RF device that uses the company’s 3DEEP technology. EndyMed PRO reportedly offers safer procedures and superior aesthetic results.

The technology focuses RF energy past the epidermis deep into the dermis, causing skin tightening and collagen reproduction. By doing so, wrinkles are reduced and the texture and elasticity of the skin are restored.  The aesthetic long-term effects of 3DEEP are can be seen both superficially and in thermal images of the patient.

“EndyMed PRO is the latest innovation in noninvasive, pain-free, nonablative face- and body-tightening. The 3DEEP technology it uses focuses RF energy deep into the dermis, adjusting its depth and strength according to individual treatment requirements and varying skin impedance, from patient to patient and treatment to treatment, resulting in customized treatments with consistent and predictable outcomes,” says board-certified dermatologist and chief medical officer of EndyMed Medical, Yoram Harth, M.D., F.A.A.D.

Prior to this improved version of RF technology, intense pulse light (IPL) and lasers were used to treat loose skin and wrinkles. Dr. Harth claims that these treatments have minimal affect on the inner dermis, the part of the skin that influences skin tightening the most. RF energy, on the other hand, reaches deep enough into the tissue to successfully rejuvenate the skin.

The difference between 3DEEP and previous RF technologies is the 3DEEP offers a more focused, controlled energy that targets beyond the superficial layers of the skin. Older RF technologies required more power—which culminated in a more painful treatment—to achieve results similar to that of 3DEEP.

Currently, LipoSonix and BodyTite are two liposuction procedures that use RF energy to combine fat reduction with skin tightening.  LipoSonix and BodyTite are both in clinical trial stage and await FDA approval.

To Your Health & Beauty,

Vipul R. Dev, M.D.

Allergan Settles Botox Case for $600 Million

Allergan, the Orange County-based maker of Botox, has settled a case with the federal government for over $600 million. The L.A. Times reported that the settlement came about after the Justice Department pursued criminal charges against Allergan for marketing Botox for off-label use.

Allergan reportedly marketed Botox, the popular anti-wrinkle injectable, for the off-label purpose of migraine relief. While pharmaceutical firms are allowed to use their products for unapproved purposes, FDA approval is necessary in order to market the product to doctors and consumers.

It is estimated by the Justice Department that the settlement was one of the top ten largest healthcare settlements by the department.

The case came about more than two years ago following scrutiny by whistle-blower groups. Allergan promoted the popular injectable by lobbing health insurance companies to cover the off-label uses and by offering incentives to physicians who actively treated migraine patients with the drug. According to the Justice Department, Allergan spent $8 million alone on an online neurotoxin education organization to “stimulate increased use of Botox.”

was also promoted to treat a plethora of medical conditions—including blepharospasm, pain and cerebral palsy—that it was not FDA approved for. While cosmetic doses, which are relatively small, carry minimal side effect, therapeutic doses can be more dangerous. Botox and competing products carry “black box” warnings that the toxin can spread from the injection site and cause life-threatening symptoms, such as trouble swallowing or breathing.

Allergan is currently awaiting FDA approval for the use of Botox on migraine sufferers. With the decision expected at the end of October, the timing of this settlement may affect the FDA’s final verdict on Botox.

To Your Health & Beauty,

Vipul R. Dev, M.D.

Preventative Surgery May Halt Two Types of Cancer in Women

Cancer of the breast and ovaries are two serious diseases that kill tens of thousands of women each year. Approximately one in four hundred women have a predisposition for a higher risk of breast and ovarian cancer due to a genetic mutation. According to the New York Times, new research may sway doctors to recommend prophylactic mastectomies and oophorectomies—or removal of the ovaries—to these women before there are any signs of cancer.

During a study published in The Journal of the American Medical Association, scientists followed 2,482 women who inherited the BRCA1 or BRCA2 mutations. The women, who underwent genetic testing between 1974 and 2008, were tracked down in 2009.

Within three years of follow-up, none of the subjects who underwent a preventative mastectomy and only one percent who had their ovaries removed were diagnosed with cancer. On the contrary, seven percent of women who did not have a mastectomy developed breast cancer and six percent of women who underwent an oophorectomy were diagnoses with ovarian cancer.

The study, which was executed by Timothy R. Rebbeck, M.D., professor of epidemiology at the University of Pennsylvania School of Medicine, shows that preventative surgery can provide remarkable protection. While cancer can still develop from tissue that has not been removed, the study is a step in the right direction.

“It’s crucial for women to understand: this is their best chance to reduce risk,” said Dr. Rebbeck. “It’s very strong and nearly complete, but it’s not 100 percent. If you’re at high risk, this maximizes your chances of survival.”

To Your Health & Beauty,

Vipul R. Dev, M.D.