Stop Smoking

The ill effects of smoking on the body are well known, yet millions of people continue to smoke. This includes roughly 4.5 million adults over age 65.  Quitting smoking has become so important that Medicare recently announced that they will be providing counseling for any of its recipients who are trying to “kick the habit.”

The association between cigarette smoking and delayed wound healing is well recognized. The documented effects of the toxic components of cigarette smoke–particularly nicotine, carbon monoxide, and hydrogen cyanide–suggest potential mechanisms by which smoking may undermine expeditious wound repair. Nicotine is a vasoconstrictor that reduces nutritional blood flow to the skin, resulting in tissue ischemia and impaired healing of injured tissue. Nicotine also increases platelet adhesiveness, raising the risk of thrombotic microvascular occlusion and tissue ischemia. In addition, proliferation of the body’s wound healing cellular cascade (i.e. red blood cells, fibroblasts, and macrophages) is reduced by nicotine. Carbon monoxide diminishes oxygen transport and metabolism, whereas hydrogen cyanide inhibits the enzyme systems necessary for oxidative metabolism and oxygen transport at the cellular level. Slower healing has been observed clinically in smokers with wounds resulting from trauma, disease, or surgical procedures. The reduced capacity for wound repair is a particular concern in patients undergoing plastic or reconstructive surgery. Compared with nonsmokers, smokers have a higher incidence of unsatisfactory healing after face-lift surgery, as well as a greater degree of complications following breast surgery. Smokers should be advised to stop smoking prior to elective surgery or when recovering from wounds resulting from trauma, disease, or surgery.

Pedicled TRAM Flap for breast reconstruction

Right Orbital Floor Fracture

Pictured above is a CT scan of my patient following a blunt force traumatic injury to the face. This CT scan slice, shown in the coronal plane, shows a Blow-Out type fracture of the right orbital floor where a significant portion of the orbital floor bone has descended into the maxillary sinus below.

Pure orbital floor fractures, referred to as isolated floor fractures, result from impact injury to the globe and upper eyelid. The offending object is usually large enough not to perforate the globe and small enough not to result in fracture of the orbital rim. Orbital floor fractures are secondary to a sudden increase in intraorbital hydraulic pressure. A high-velocity object that impacts the globe and upper eyelid transmits kinetic energy to the structures around the eye. This energy results in pressure with a downward momentum, heading toward the floor of the eye socket. Most fractures occur in the posterior medial region that is comprised of the thinnest bones.

After facial trauma, patients may describe any of a variety of symptoms: decreased visual acuity, blepharoptosis, double vision (especially in upgaze), and numbness (hypesthesia, dysesthesia, or hyperalgesia) in the distribution of the infraorbital nerve. This usually translates into numbness of the cheek below the eyelid, the side of the nose and the upper lip.  In addition, patients may complain of nasal bleeding and eyelid swelling following nose blowing.

Periorbital ecchymosis and edema (bruising and swelling) accompanied by pain are obvious external signs and symptoms, respectively. Enophthalmos (“sunken in” eyeball) is possible but initially can be obscured by surrounding tissue swelling. This swelling can restrict ocular motility, giving the impression of soft tissue or inferior rectus entrapment. Bleeding in and around the eyeball can manifest with proptosis (or prominence/bulging) of the eyeball. A bony step-off of the orbital rim and point tenderness are also possible.

Beverly Hills 90210

From the original 90210 to you, Happy 9-02-10! As we all know, Beverly Hills 90210 is this country’s mecca for plastic surgery. As a Board-Certified Plastic Surgeon, I want to celebrate this special day by making a special offer to all of my patients, and my patients’ friends across the country.

For any patients that book surgery for breast augmentation or breast augmentation revision within the next 30 days, I will be offering a special limited-time offer of 25% off the normal surgeons fee.*  You must mention “Dr. Brenner’s Beverly Hills 90210 special” when you come in for your consultation in order to take advantage of this unique opportunity.

*Please note/Disclaimer: all patients must be deemed an appropriate surgical candidate by Dr. Brenner. Offer only valid for appropriate candidates following a complete evaluation by Dr. Brenner. Discount applies to the surgeon’s fee only. Fees for the operating facility and anesthesia services are separate and distinct. Offer valid for newly scheduled surgery only. Offer is not retro-active and is non-transferable. Offer has no actual cash value.

Cesarean (C-Section) delivery, C-section Incision, C-section scar

According to government scientists, more women will be giving birth by C-section for the foreseeable future. This is according to a new study (published in the American Journal of Obstetrics & Gynecology) that is troubling some maternal health experts.

Currently, C-section deliveries account for about one third of births in the United States. According to researchers at the National Institute of Health, not only are repeat mothers carrying a high rate of C-section, but nearly one third of first time mothers are undergoing C-section delivery as well. In the study, women whose labor was induced were twice as likely to have a Cesarean section. Since the mid 1990s, the C-section rate in the U.S. has increased by more than 50 percent. This is in contrast to Scandinavian countries where the rate of C-section is closer to 20 percent.

You may ask: Why should a Plastic Surgeon be concerned about the increasing rate of C-section? The simple answer is that in image-conscious Los Angeles, I see a great number of patients (both first time moms and veteran moms) who are concerned about their C-section scars. Many of my patients come to see me specifically to have their C-section scar revised. This can be done as a stand alone procedure, or as part of a Mommy Makeover. I have also noticed a new trend amongst patients who come to see me before they deliver specifically so that I can close their C-section incision immediately after they deliver. For more information and to find out if this is an option for you, please contact my office.

A Venezuelan politician is offering breast implants as a prize in a raffle to raise funds for his election campaign, according to reports.

Certainly melanoma can be a very serious and sometimes deadly type of skin cancer. However, there is a new drug that extends progression-free survival in patients dying of advanced melanoma.

The  majority of patients with advanced, metastatic melanoma gain only a few months extra survival from standard treatment. But early tests show that an experimental drug, named PLX4032 by Plexxikon and Roche Pharmaceuticals, offers far greater benefits. The findings are particularly amazing as they come from a very early, phase I clinical trial. Study leader Keith T. Flaherty, MD, is director of developmental therapeutics at Massachusetts General Hospital. According to Dr. Flaherty, “For those who respond to treatment, the average duration of progression-free survival is nine months.”  “Some patients are over a year and a half and cruising to two years. In melanoma, that is good.  The average time for standard treatment is two months.”

There is a catch. The drug targets a specific genetic mutation that helps melanoma tumor cells grow.  About 40% to 60% of melanoma patients have tumors with this mutation. For those who don’t, the drug offers no help and possible harm. Fortunately, a simple genetic test identifies patients likely to respond to the drug.

Details of the study:

1) In its initial phase, the study enrolled 55 patients, 49 with metastatic melanoma.

2) An additional 32 patients with metastatic melanoma enrolled in the study’s extension phase.

3) All patients carried the BRAF mutation targeted by the new drug.

4) 81% of patients with BRAF-positive melanoma responded to treatment.

5) Duration of response ranged from two to over 18 months.

6) Three of the melanoma patients no longer had detectable tumor in their bodies. (Dr.  Flaherty says such “complete responses” are not the same as cures).

Like other medications, this drug (a pill taken twice daily) does have side effects. The most common ones are a rash,  sun sensitivity, joint discomfort, and fatigue. A number of patients also developed non-deadly squamous-cell carcinomas on the skin.  These side effects tend to be moderate and manageable.

The drug’s most important drawback is that it isn’t a cure. Eventually, tumor cells find new ways to grow and become resistant to the new drug.

If you are taking any medications on this list, they should be discontinued 10-14 days prior to surgery and only Tylenol (and Tylenol-based products) should be taken for pain. All other medications that you are currently taking must be specifically cleared by Dr. Brenner and your primary care physician prior to surgery. It is absolutely necessary that all of your current medications be specifically cleared by your doctor and the nursing staff. Please be aware that this could include cold medications, eye drops, nasal sprays and over-the-counter (non-prescription) medications. This is not an exhaustive list, as new medications are introduced into the market place all of the time. If you do not find your particular medication here and you are unsure of its effects, simply discuss it with Dr. Brenner.

Aspirin Medications to Avoid:

#: 4-Way Cold tabs; 5-Aminosalicylic Acid,

A: Acetilsalicylic Acid, Adprin-B products, Alka-Seltzer products, Amigesic, Anacin products, Anexsia w/ Codine, Argesic-SA, Arthra-G, Arthriten products, Arthritis foundation products, Arthritis Pain Formula, Arthritis Strength BC Powder, Arthropan,  ASA,  Asacol, Ascriptin products, Aspergum, Asprimox products, Axotal, Azdone, Azulfidine products,

B: B.A.C., Backache Maximum Strength Relief, Bayer products, BC Powder, Bismatrol products, Buffered aspirin, Bufferin products, Buffetts 11, Buffex, Butal/ASA/Caff,  Butalbital Compound,

C: Cama Athritis Pain Reliever, Carisoprodol Compound, Cheracol, Choline Magnesium Trisalicylate, Choline Salicylate, Cope, Coricidin, Cortisone Medications,

D: Damason-P, Darvon Compound-65,  Darvon/ASA, Dipentum,  Disalcid, Doan’s products, Dolobid, Dristan, Duragesic,

E: Easprin,  Ecotrin products, Empirin products, Equagesic, Excedrin products,

F: Fiorgen PF, Fiorinal Products,

G: Gelpirin, Genprin, Gensan, Goddy’s Extra Strength Headache Powders, Halfprin products,

I: Isollyl Improved,

J:—-

K: Kaodene,

L: Lanorinal, Lortab ASA,

M: Magan, Magnaprin products, Magnesium Salicylate, Magsal, Marnal, Marthritic, Meprobamate, Mesalamine, Methocarbamol, Micrainin, Mobidin, Mobigesic, Momentum, Mono-Gesic,

N: Night-time Effervescent Cold, Norgesic products, Norwich products,

O: Olsalazine, Orphengesic products, Oxycodone,

P: Pabalate Products, P-A-C, Pain Reliever Tabs,  Panasal, Pentasa, Pepto-Bismol, Percodan Products, Phenaphen/Codeine #3, Pink Bismuth, Propoxyphene Compound products,

Q:—-

R: Robaxisal, Rowasa, Roxeprin,

S: Saleto products, Salflex, Salicylate Products, Salsalate, Salsitab, Scot-Tussin Original 5-Action, Sine-off, Sinutab, Sodium Salicylate, Sodol Compound, Soma Compound, St. Joseph Aspirin, Sulfasalazine, Supac, Suprax, Synalgos-DC,

T: Talwin, Triaminicin, Tricosal, Trilisate, Tussanil DH, Tussirex products,

U: Ursinus-Inlay,

V: Vanquish,

W: Wesprin, Willow Bark products,

Z: Zorprin,

Ibuprofen Medications to Avoid:

A: Actron, Acular (opthalmic), Advil products, Aleve, Anaprox products, Ansaid,

B: —-

C: Cataflam, Clinoril,

D: Daypro, Diclofenac, Dimetapp Sinus, Dristan Sinus,

E: Etodolac,

F: Feldene, Fenoprofen, Fluribiprofen,

G: Genpril,

H: Haltran,

I: IBU, Ibuprin, Ibuprofen, Ibuprohm, Indochron E-R, Indocin products, Indomethacin products,

J: —-

K: Ketoprofen, Ketorolac,

L: Lodine,

M: Meclofenamate, Meclomen, Mefenamic Acid, Menadol, Midol products, Motrin products,

N: Nabumetone, Nalfon products, Naprelan, Naprosyn products, Naprox X, Naproxen, Nuprin,

O: Ocufen (opthalmic), Orudis products, Oruvail, Oxaprozin,

P: Piroxicam, Ponstel, Profenal,

Q: —-

R: Relafen, Rhinocaps,

S: Sine-aid products, Sulindac, Suprofen,

T: Tolectin products, Tolmentin, Toradol,

U: —-

V: Voltaren,

W-Z: —-

Other Medications & Herbal Supplements to Avoid:

#: 4-way with Codeine,

A: A.C.A, A-A Compound, Accutrim, Actifed, Adapin, Amitriptyline, Amoxapine, Anafranil, Anexsia, Anisindione, Anturane, Arthritis Bufferin, Asendin, Aventyl,

B: BC tablets,

C: Children’s Advil, Clinoril C, Clomipramime, Contac, Coumadin,

D: Dalteparen injection, Desipramine, Dicumerol, Dipyridamole, Doxepin, Doxycycline,

E: Elavil, Emagrin, Endep, Enoxaprin injection, Etrafon products,

F: Fish Oils, Flagyl, Fragmin injection, Furadantin,

G: Garlic, Ginkgo Biloba, Ginseng,

H: Heparin, Hydrocortisone,

I: Imipramime, Isollyl,

J: Janimine,

K: —-

L: Limbitrol products, Lovenox injection, Ludiomil,

M: Macrodantin, Maprotilline, Mellaril, Miradon,

N: Norpramin, Nortryptyline,

O: Opasal,

P: Pamelor, Pan-PAC, Pentoxyfylline, Persantine, Pertofrane, Phenylpropanolamine, Plavix, Prednisone, Protamine, Protriptyline, Pyrroxate,

Q: —-

R: Ru-Tuss,

S: Salatin, Sinequan,Sinex, Sofarin, Soltice, Sparine, Stelazine, St. John’s Wort, Sulfinpyrazone, Surmontil,

T: Tenuate, Tenuate Dospan, Thorazine, Ticlid, Ticlopidine, Tofranil, Trental, Triavil, Trimipramine,

U: Ursinus,

V: Vibramycin, Vitamin E, Vivactil,

W: Warfarin,

X-Z: —-

With the recent economic shifts, more and more patients are needing to rely on the Emergency Rooms for their care. As a a result, many E.R.s have become inundated with patients presenting with problems that are not truly emergencies. This has recently resulted in waiting times that are longer than normal. Long waiting times are deleterious if you in fact have a true medical or surgical emergency. After all, medical emergencies were the reason that E.R.s were developed in the first place. Recently, some hospitals have started posting the emergency room waiting times online. In fact, some will even give the option of sending you text updates directly to your mobile phone.

Starting in 2012, hospitals are supposed to begin reporting to Medicare how fast their E.R.s move certain patients through. This is a first effort at increasing quality of care across the board. In 2008, ER visits hit a new high of more than 123 million, up from 117 million in 2007. In the mean time, if you have been to an Emergency Room lately, you know that waiting times for issues that are not true emergencies can last for hours.

So I say, try to avoid going to the E.R. if you can.  Believe it or not as a plastic surgeon, I treat many patients with injuries who present to the Emergency Room initially. However, many of these cases can be cared for outside of the hospital in our office or in an outpatient surgery center.  Surgical issues such as  facial lacerations, minor hand injuries, eye socket fractures, cheek fractures, nasal bone fractures and minor burns can usually be cared for as an outpatient. Should you, a friend or a loved one incur these types of minor injuries, try to avoid the urge to immediately flood the ER. Instead, call your doctor or Dr. Brenner so that you can be evaluated in an office setting. For minor injuries, this strategy will ultimately be more time efficient and more cost efficient for you.

Orbital floor (eye socket) fractures are a very common traumatic injury.  Orbital floor fractures frequently occur from blunt force trauma to the cheek, temple or even the eyeball (globe) itself.  The bone on the bottom of the eye socket is thin, similar to an eggshell, and sits above an air-filled cavity called the maxillary sinus.  When a significant impact occurs in and around the eye this thin bone commonly will burst allowing the eye itself, along with the surrounding soft tissues, to descend into the maxillary sinus. Believe it or not, this serves as a protective mechanism for the eye so that it will not rupture. Orbital floor fractures can occur alone, but also commonly occur in association with other facial injuries such as cheek bone fractures (ZMC or Zygomatico-Maxillary Complex fractures), naso-septal fractures and  nasal bone fractures.

Common signs and symptoms of an orbital floor fracture:

1) Recent history of blunt force trauma to the face and facial bones.

2) Significant bruising and swelling around the eye and on the eyelids. (aka periorbital ecchymosis & edema).

3) Eyeball that appears sunken in. (aka enopthalmos).

4) Inability to move the affected eye upwards, downwards and side-to-side (aka gaze restriction).

5) Significant double vision (aka diplopia).

If you have sustained a facial injury, and suspect that you may have a facial bone fracture, you should contact Dr. Brenner for an immediate evaluation.

Septoplasty is an operation designed to remove the deviated portion of the nasal septum. This operation is performed for patients with nasal airway obstruction, who are unable to move air through their nose. The septum pictured above is the load-bearing portion of the septum (also known as the “L” strut) that usually remains following removal of the twisted and deviated portion. This particular septum required complete removal and reconstruction before being placed back into the nose. This is known as Extracorporeal Septoplasty.

Cosmetic use of Xeomin (Merz Pharmaceuticals] will be considered off-label use as of its initial US launch in September 2010. The drug was approved by the FDA in August 2010 only for treating neuromuscular conditions (i.e cervical dystonia &blepharospasm).

8 things you need to know about the release of Xeomen:

1) It is not yet approved to treat dynamic wrinkles (rhytids) between the brows and on the forehead.

2) Xeomin (incobotulinumtoxin A), has a unique formulation and does not contain any complexing proteins.

3) Xeomin’s formulation is not seen as a potential advantage over Dysport or Botox when it comes to cosmetic use. The doses used to smooth forehead wrinkles and frown lines is so low, there is no noticeable difference.

4) It may be more difficult to control spreading or migration of Xeomin (than with Botox), which may lead to muscle relaxation that causes droopy eyebrows and other undesirable results.

5) The effects of Xeomin injections for wrinkle reduction are anticipated to closely mirror the effects of Botox injections.

6) The unit measurements of Xeomen and Botox are expected to be about the same. Botox is currently distributed in 100-unit vials.  Xeomin will be distributed in 50-unit and 100-unit vials.

7)  Xeomin will not require refrigeration prior to reconstitution.  Botox and Dysport do require refrigeration at all times.

8) Since the introduction of Dysport onto the cosmetic market did not affect the price point on Botox injections, it is unlikely that the introduction of Xeomin will either.

While breast reconstruction after a mastectomy is covered by insurers in New York, many poor, minority, and less educated women do not seek out the procedure. Now, NY Gov. David A. Paterson has signed into law a bill that is aimed at reversing this trend.

“A disproportionate number of women who are at a socioeconomic disadvantage do not get breast reconstruction surgery after a mastectomy for one of several reasons. Either they are unaware of it as an option, they do not know it is covered by their insurance programs, they do not know where to gain access to the procedures, or it is never mentioned to them by their other doctors,” said Evan Garfein, MD, the plastic and reconstructive surgeon at Montefiore Medical Center who authored the Bill.

He hopes that the new law (A10094B/S6993-B/Information and Access to Breast Reconstruction Surgery) will correct this disparity. It requires hospitals in New York to inform breast cancer patients about the availability of, and insurance coverage for, breast reconstruction before they undergo “mastectomy surgery, lymph node dissection or a lumpectomy.”

While Congress passed the Women’s Health and Cancer Rights Act in 1998, which guaranteed universal coverage for reconstruction after surgery, and New York soon passed comparable provisions into its laws, disparities in access remain.

“Breast reconstruction has been repeatedly shown to improve the quality of life and overall well-being of women who have been treated for breast cancer,” said Dr. Garfein. “This new law will ensure that breast cancer patients from all socioeconomic groups are informed about their options regarding breast reconstruction and about where to get the procedure.”

One-Third of Women With Breast Cancer Choose Reconstruction

Breast reconstruction is not for everyone. Each year, a quarter of a million women are diagnosed with breast cancer, according to the American Cancer Society. Of those who undergo mastectomy, 30-40 percent, depending on the study, receive breast reconstruction.

Discussing Reconstruction Before a Mastectomy is Key

Today, there are many reconstruction options for patients who have breast surgery, including saline and silicone gel implants, and several types of reconstruction using the patient’s own tissues from the abdomen, thigh, back or buttocks.

The new law underscores that patients should discuss this range of reconstruction choices before deciding between a mastectomy (the total removal of the cancerous breast) or a lumpectomy (removal of part of the breast), and that the discussion involve both the cancer surgeon, who removes the cancer from the breast, and the plastic surgeon, who would perform the breast reconstruction. The surgical team and the patient can then decide if reconstruction should be performed at all, and if so, whether that should happen at the same time as the cancer surgery (as is now the standard), or at a later date.

Many women who choose not to have reconstruction do so because of personal preferences, their overall health, the stage of their breast cancer, or to avoid the risks of additional surgery. Some women, however, don’t receive reconstruction because it wasn’t offered to them and they didn’t know to ask about it. It is this group that the legislation targets.

Any type of major surgery carries a risk of bleeding, infection and an adverse reaction to anesthesia. Risk of complications is usually associated with how large the procedure is, as well as the surgeons skills and specific training. The following risks, unpleasant side effects, or complications are possible:

• Bruising – Bruising will occur to some extent with all liposuction patients. Bruising can be more severe for patients who have been taking anti-inflammatory medications or aspirin. Patients with a tendency to bleed are also at higher risk of bad bruising. Ask Dr. Brenner about medications to avoid prior to surgery.
• Inflammation – Swelling after liposuction is inevitable. In some cases, swelling may be prolonged and could take up to six months to settle. Sometimes fluid may continue to ooze from the incisions after surgery.
• Thrombophlebitis – This entity consists of a blood clot that forms in a superficial vein, causing inflammation of that vein. This may affect liposuction patients, especially inside the knee and on the inside of the upper thigh (when these areas have been treated).
• Deep Venous Thrombosis
• Contour irregularities – For patients who have poor skin elasticity, have healed in an unusual way, or have fat removal that has been uneven, the skin may appear withered, wavy or bumpy. This undesirable result may be permanent. During surgery, the cannula may also cause damage to the skin leading to discoloration.
• Seromas-Seromas may form under the skin (temporary pockets of fluid), which may need to be drained.
• Numbness – The operative site(s) may feel numb for a while; this is usually only temporary. There may also be temporary nerve irritation.
• Infections – Although rare, skin infections may occur after liposuction surgery. Sometimes this needs to be treated surgically, with the risk of scarring.
• Internal organ punctures – This entity is very rare when liposuction is performed properly and safely. If the cannula is inserted incorrectly and  goes in too deeply one of the internal organs (in the chest or abdomen)  may be punctured. Further surgery may be required. Internal organ punctures can be life-threatening.
• Kidney or heart problems – As fluids are being injected and or suctioned, the change in the body’s fluid levels may cause kidney or heart problems. This is why it is important to have surgery in an accredited surgical facility with appropriate safety precautions and to be looked after by seasoned anesthesia staff.
• Fat embolism – Fat cells can enter the blood stream and travel to the lungs or other body parts. Although this entity occurs commonly on a microscopic scale, should larger fat particles travel to the lung it could lead to problems with lung function (decreased ability to ventilate and absorb oxygen) which could be life-threatening.
• Pulmonary edema -This entity can be a result of massive amounts of fluid being injected into the body. Fluid rarely if ever accumulates in the lungs when moderate volumes, and sound surgical judgment are used.
• Allergic reaction – Any patient may have an allergic reaction to medications or material used during surgery. It is important to communicate any known allergies to Dr. Brenner during your consultation.
• Skin burns – The cannula movement may cause friction burns to the skin or nerves.
• Lidocaine toxicity – In the super-wet or tumescent methods, large amounts of tumescent fluid may be inserted into the body’s tissues. Should an excessive dose (amount) of lidocaine be placed into the tumescent fluid, high serum lidocaine levels can develop.  When  lidocaine levels become  too high (beyond recommended doses), patients can experience lidocaine poisoning (toxicity). The symptoms of lidocaine toxicity include initial feelings of tingling and numbness and possible strange sensations. When even higher levels develop, seizures can occur,  followed by unconsciousness, and possibly respiratory or cardiac arrest. Again, these complications are exceedingly rare when proper technique and good surgical judgment are utilized.
• Anesthesia-related problems: Anesthesia itself carries with it a finite risk of potential complications. These include allergic reactions to medications, airway issues and in rare cases, potentially death. This is why a sound pre-operative work-up is essential.

A seroma is a pocket of clear serous fluid that sometimes develops in the body after surgery. When small blood vessels are disrupted, blood plasma can seep out into the surgical area. Further, the inflammatory process can lead to additional fluid exudate. Seromas are different from hematoma (collections of blood), and from abscesses (collections of pus). Seromas can also sometimes be caused by injury, such as when the initial swelling from a blow or fall does not fully subside. The remaining fluid causes a seroma that the body usually gradually absorbs over time (often taking many days or weeks); however, a knot of calcified tissue sometimes remains.

Seromas are particularly common after some plastic surgical procedures where large areas are undermined, leading to large raw surfaces.  Seromas are usually preventable by placement of a drain at the time of surgery. However, seromas can develop after the drain is removed. Further, seromas can occur if care is not taken and a patient inadvertently pulls a drain out after surgery. Many patients find that it makes their initial recovery period more difficult, and some need repeated visits to their doctor to have the seroma fluid drained.

Pictured above is about 35 cc of seroma fluid that was drained from a patient following removal of a large lipoma. The patient accidentally pulled out her drain (that was placed during surgery), on the first post-operative night. As a result, the fluid accumulated at the surgical site and required removal with needle aspiration.

Most Board-Certified Plastic Surgeons agree that liposuction should ideally be used when patients are unable to lose specific areas of fatty deposits even after they have reached their target weight and modified their lifestyle to incorporate regular effective exercise.

When humans gain weight each fat cell increases in size and volume. The actual total number of fat cells in the body does not increase or decrease with weight gain or loss, respectively. Liposuction reduces the number of fat cells in isolated areas. How much is removed from a specific area depends on its appearance and the volume of fat. Contour changes resulting from liposuction can be long-lasting, as long as the patient’s weight does not fluctuate significantly.

Liposuction is only done in relatively small areas of the human body.  It is not a treatment for obesity or long-term weight loss. It should not be used if the person wants to get rid of stretch marks, cellulite, dimpling, or other skin surface irregularities. Dr. Brenner commonly performs liposuction in combination with other surgical procedures during a Mommy Makeover.

Patients should discuss their weight concerns with Dr. Brenner at the time of consultation.  The surgical consultation is a very important time for exchange of information with Dr. Brenner.  This is the time that you will inform Dr. Brenner all about you, and also the perfect opportunity for you to ask Dr. Brenner any questions that you may have.   .

Liposuction should be considered after a great deal of thought and discussion with Dr. Brenner. Results frequently are and should include subtle changes in contour.

The following body areas are commonly targeted for liposuction treatment:

• Abdomen
• Back
• Buttocks
• Chest
• Inner knees
• Hips
• Flanks (love-handles)
• Neckline and the area under the chin (submental)
• Thighs – saddlebags (outer thighs), and inner thighs
• Upper arms

According to the American Society of Aesthetic Plastic Surgery, liposuction is performed more commonly on the thighs and abdomen of women, and the abdomen and flanks (sides, love-handles) of men. The best liposuction candidates are those who have good skin tone and elasticity, where the skin molds itself into new contours. People whose skin lacks elasticity may end up with loose-looking skin in areas where the procedure was done.

Liposuction patients need to be in good health. If you are affected by any major medical problems, Dr. Brenner will have you consult with your primary care physician prior to surgery.

Liposuction is sometimes used to treat certain conditions, including:

• Gynecomastia - sometimes fat accumulates under a man’s nipples. Liposuction can remove some of the fat, reducing the swelling.

• Extreme weight loss after obesity – for patients who suffer from morbid obesity, and go on to lose a significant amount of weight (hopefully at least 40% of his/her BMI) through diet modification, exercise and perhaps a gastric band or bypass procedure, excess skin and other abnormalities may need treatment. Frequently liposuction is used in conjunction with open body contouring to correct many abnormalities.

• Lipodystrophy syndrome – fat accumulates in one part of the body and is lost in another. Liposuction can improve the patient’s appearance by providing a more natural looking body fat distribution.

• Lymphedema – a chronic (long-term) condition in which excess lymph (fluid) collects in tissues, causing edema (swelling). The edema commonly occurs in the arms or legs. The fluid accumulation occurs faster than it can be drained away. Liposuction is sometimes used to reduce swelling, discomfort and pain. However, most surgeons tend only to use liposuction with patients who have severe symptoms. After the operation patients have to wear a compression bandage for several months, sometimes up to a year after the operation.

All patients who receive Mentor MemoryGel® breast implants are automatically eligible for the Mentor Lifetime Product Replacement Policy. This means that Mentor will provide replacement of a Mentor product of any size in the same or similar style as the originally implanted product free of charge for the lifetime of the patient. Upon request of Dr. Brenner, a different implant style may be selected(subject to a charge of the difference between product list prices). What this means to you is that should a confirmed rupture occur, you are eligible for up to two replacement breast implants or any size in a similar style…at no charge.

The Mentor MemoryGel® Breast Implant Premier Advantage Limited Warranty applies to surgeries occurring after May 1, 2009. It offers up to $3,500 in financial assistance. This includes Mentor’s Lifetime product replacement policy. This applies to expenses occurring from a confirmed rupture for up to 10 years from the date of implant surgery. The warranty pays up to $3,500 (*operating room and anesthesia charges to be given payment priority) financial assistance for operating room, anesthesia, and surgical charges not covered by insurance and applies only to implant surgeries conducted after May 1, 2009. This may include free contralateral (opposite side) implant replacement upon Dr. Brenner’s request. The terms are non-cancellable.

What events are covered?

*Mentor Premier Advantage only covers ruptures due to loss of shell integrity, including patient trauma and unknown causes.

What events are not covered?

The Mentor Premier Advantage coverages do not apply to the following:

*Adverse reactions other than rupture.

**Removal of intact implants due to capsular contracture, wrinkling or rippling.

***Loss of implant shell integrity resulting from re-operative procedures, open capsulotomy, or closed compression capsulotomy procedures.

****Removal of intact implants for size alteration.

*****Events that are covered by insurance.

Liposuction (aka liposculpture and suction lipectomy) is a form of plastic surgery that breaks up and removes fat from various possible parts of the body.  Liposuction is performed most commonly in the abdomen, thighs,  flanks and back, and can also be performed  in the buttocks, neck, chin, and calves. The fat is removed using a hollow cannula (connected to a suction device)  that is inserted under the skin through small incisions. Liposuction can be performed as a stand alone procedure, or in conjunction with breast surgery as part of a Mommy Makeover.

Every year in the United states, over 400,000 liposuction procedures are carried out. Patients who undergo liposuction generally have a stable body weight, and would like to remove undesirable deposits of fat in specific parts of the body.  Liposuction  is not a weight-loss method and therefore not an appropriate treatment for obesity. Liposuction will not remove cellulite, dimples or stretch marks from the skin.

Liposuction permanently removes fat cells from the body. It can alter the shape of a body. However, if the patient goes on to gain weight after the operation there is a risk that the remaining fat cells grow bigger.

The amount of fat than can be safely removed in one setting  is limited. Liposuction has a number of possible risks, including infection, prolonged swelling, seroma formation, fat embolus, venous thrombosis, exacerbation of overlying (pre-existing) skin laxity, numbness and scarring. If too much fat is removed there may be lumpiness or irregularities in the skin. Many experts agree that the surgical risks are related to the amount of fat removed.

Some medical conditions may benefit from liposuction, including:

• Lipomas - benign fatty tumors.
• Gynecomastia - where fatty breast tissue has developed in men.
• Lipodystrophy syndrome – a lipid  metabolism disturbance in which there is too much fat in some parts of the body and partial or total absence of fat in other parts. The most well known type is associated with and a side effect of some HIV medications (anti-retroviral therapy).

Although men account for about 15% of the current Botox® use in the United States, the number is quickly growing. In my Los Angeles-based Plastic Surgery practice, men account for about 20% of Botox® users. Although most practitioners typically treat men and women similarly with respect to Botox® dosing, that trend may be changing.  At the 61st Annual American Academy of Dermatology meeting, doctors presented a study showing that men need twice the amount of Botox® than women to achieve similar results.  This difference is mostly due to the greater tone of facial muscles and thickness of facial skin in men, and may vary for between patients.

Dr. Alastair Carruthers, the Clinical Professor of Dermatology at the University of British Columbia, studied the safety and efficacy of four dose ranges of Botox® Cosmetic when used on male frown lines. Carruthers found that men treated with 40-80 units of Botox® had the most satisfactory treatment results. In women, only 20-40 units of Botox® are needed to achieve optimum results. The findings are useful in establishing the proper dose for optimal results on men.

There has been a rapid incline in the amount of non-surgical cosmetic procedures among men. Male cosmetic surgery has become more commonplace in the media and no longer is associated with social stigmata. Furthermore, growing competition in the workplace has resulted in men taking extra measures to ensure job security.

Dr. Brenner commonly uses saline-filled breast implants from Mentor. All Mentor breast implants come with a Lifetime Product Replacement Policy at no additional charge. Once you receive Mentor saline breast implants, you are automatically enrolled in the Mentor Advantage Limited Warranty.

What does this mean to you? Should a confirmed device deflation occur, you are eligible for one to two replacement breast implants of any size in a similar style, at no charge. When you sign up for surgery with Dr. Brenner, you have two options:

1) The Mentor Standard Advantage ($1,200 toward out-of-pocket costs). This warranty is free of charge to all patients who are implanted with Mentor saline-filled implant products. This warranty includes: The Mentor lifetime product replacement policy(check with Mentor for details), up to $1,200 financial assistance for operating room, anesthesia, and surgical charges not covered by insurance for 10 years; free contralateral (opposite side) implant replacement upon surgeon request; and non-cancelable terms.

2) The Optional Mentor Enhanced Advantage ($2,400 toward out-of-pocket costs). This optional warranty is available for saline-filled breast implant products and, to be eligible, must be purchased for an enrollment fee of $100 within 45 days from implantation (*there is only one warranty payout per enrollment fee; enrollment in the program for replacement device will require additional $100 enrollment fee.) The Enhanced Advantage replaces the Mentor Standard Advantage allowing for a total financial reimbursement of up to $2,400. Here is what is included: Lifetime product replacement policy(as above), up to $2,400 financial assistance for operating room, anesthesia, and surgical charges not covered by insurance for 10 years, free contralateral (opposite side) implant replacement upon surgeon request, and non-cancelable terms.

What events are covered?

*deflation due to crease fold failure, patient trauma, or unknown cause.

**Loss of valve integrity.

What events are not covered?

*Adverse reactions other than deflation.

**Removal of intact implants due to capsular contracture, wrinkling or rippling.

***Loss of implant shell integrity resulting from reoperative procedures, open capsulotomy, or closed compression capsulotomy procedures.

****Removal of intact implants for size alteration.

In partnership with STOP CANCER, I.C.O.N./Cure for a Cause and Krav Maga Worldwide/The Marni Fund will be holding a 5K Run/Walk with proceeds benefiting cancer research at UCLA, USC and City of Hope Comprehensive Cancer Centers.

The collaboration of a rapidly growing international hair care products company, a unique and world-renowned self-defense organization, all in partnership with STOP CANCER, serves as an extraordinary demonstration of the success of fundraising partnerships to accomplish an enormously important mission: developing new therapeutics, diagnostic procedures and the ultimate goal … a cure for a disease that touches so many lives.

As part of STOP CANCER’s unique arrangement with the three NCI-designated Comprehensive Cancer Centers, each Research Award granted to scientists is matched by each of these institutions in the form of in-kind support, effectively doubling its value.

As a Board-Certified Plastic Surgeon, every week I enjoy helping cancer patients rebuild and restore their lives through reconstructive plastic surgery. I am proud to be a member of STOP CANCER, a wonderful organization that is helping attack cancer on a whole new level.  If you would like to support me, or even better join me in this most worthy charitable endeavor, please visit the respective links to learn more.

Your charitable donation can help amplify my hard work.

Thank you,
Kevin Brenner, MD

Magnetic Resonance Imaging of the breasts can be used to image breast implants to check for ruptures or leaks. MR imaging may also be used as an adjunctive tool to conventional mammography for women with implants.

MRI gives radiologists significant freedom in acquiring direct views of the breasts in any plane or orientation. This is because the MRI system switches magnetic fields and radio waves to achieve the acquisition of different views while x-ray mammography requires re-orientation of the breast and mammography system for each view desired. MR also allows the doctors to easily visualize the muscle and chest wall in the vicinity of the breast, which may be important to check for the spread of cancer.

MRI can also be used to image breast tissue and cosmetic implants. Implants can obscure some of the breast tissue on conventional x-ray mammography images. This is because x-rays used for mammographic imaging of the breasts cannot penetrate silicone or saline implants well enough to image the overlying or underlying breast tissue. MRI does not have this limitation.

MRI can image the breast tissue that is compressed by an implant. However, x-ray mammography is still the best tool for evaluating breast tissue and for screening and diagnosing breast cancer. MRI requires intravenous gadolinium contrast, is much more expensive than conventional mammography and has limitations in sensitivity and specificity. There is no routine recommendation for using MRI as a cancer screening tool in women with implants, although it can be helpful in selected cases.

Magnetic resonance is the imaging method of choice to evaluate breast implants and to check for ruptures or leaks. MRI provides very good spatial resolution (detail) and excellent contrast resolution and enables MR to clearly visualize breast implants and their condition.

If you have had breast augmentation with Mentor MemoryGel ™ implants, you can make some money when you refer your friends to Dr. Brenner for the same operation. The new Love Your Look Mentor Memory™ Gel Breast Implant Referral Program offers you the opportunity to be rewarded for telling your friends about your plastic surgery experience.  You can receive a $50 American Express Gift Cheque for each friend (up to two friends) who has breast augmentation surgery with Dr. Brenner using Mentor Memory Gel ™ breast implants. For more information, ask Dr. Brenner at your next visit.

*This offer is not valid to patients residing in Texas and Florida. Remember that age restrictions do exist for silicone gel implants. This offer is only open to cosmetic augmentation patients.

Women at high risk include those who:

• have a known BRCA1 or BRCA2 gene mutation
• have a first-degree relative (parent, brother, sister, or child) with a BRCA1 or BRCA2 gene mutation, but have not had genetic testing themselves
• have a lifetime risk of breast cancer of 20% to 25% or greater, according to risk assessment tools that are based mainly on family history (see below)
• had radiation therapy to the chest when they were between the ages of 10 and 30 years
• have Li-Fraumeni syndrome, Cowden syndrome, or Bannayan-Riley-Ruvalcaba syndrome, or have first-degree relatives with one of these syndromes

Women at moderately increased risk include those who:

• have a lifetime risk of breast cancer of 15% to 20%, according to risk assessment tools that are based mainly on family history (see below)
• have a personal history of breast cancer, ductal carcinoma in situ (DCIS), lobular carcinoma in situ (LCIS), atypical ductal hyperplasia (ADH), or atypical lobular hyperplasia (ALH)
• have extremely dense breasts or unevenly dense breasts when viewed by mammograms

If MRI is used, it should be in addition to, not instead of, a screening mammogram. This is because while an MRI is a more sensitive test (it’s more likely to detect cancer than a mammogram), it may still miss some cancers that a mammogram would detect.

For most women at high risk, screening with MRI and mammograms should begin at age 30 years and continue for as long as a woman is in good health. But because the evidence is limited regarding the best age at which to start screening, this decision should be based on shared decision making between patients and their health care providers, taking into account personal circumstances and preferences.

Several risk assessment tools, with names such as the Gail model, the Claus model, and the Tyrer-Cuzick model, are available to help health professionals estimate a woman’s breast cancer risk. These tools give approximate, rather than precise, estimates of breast cancer risk based on different combinations of risk factors and different data sets. As a result, they may give different risk estimates for the same woman. Their results should be discussed by a woman and her doctor when being used to decide whether to start MRI screening.

It is recommended that women who get screening MRI do so at a facility that can do an MRI-guided breast biopsy at the same time if needed. Otherwise, the woman will have to have a second MRI exam at another facility at the time of biopsy.

There is no evidence right now that MRI will be an effective screening tool for women at average risk. While MRI is more sensitive than mammograms, it also has a higher false-positive rate (it is more likely to find something that turns out not to be cancer). This would lead to unneeded biopsies and other tests in many of these women.

The American Cancer Society believes the use of mammograms, MRI (in women at high risk), clinical breast exams, and finding and reporting breast changes early, according to the recommendations outlined above, offers women the best chance to reduce their risk of dying from breast cancer. This combined approach is clearly better than any one exam or test alone. Without question, breast physical exam without a mammogram would miss the opportunity to detect many breast cancers that are too small for a woman or her doctor to feel but can be seen on mammograms. Although mammograms are a sensitive screening method, a small percentage of breast cancers do not show up on mammograms but can be felt by a woman or her doctors. For women at high risk of breast cancer, such as those with BRCA gene mutations or a strong family history, both MRI and mammogram exams of the breast are recommended.

• Research has shown that BSE plays a small role in finding breast cancer compared with finding a breast lump by chance or simply being aware of what is normal for each woman. Some women feel very comfortable doing BSE regularly (usually monthly after their period) which involves a systematic step-by-step approach to examining the look and feel of their breasts. Other women are more comfortable simply looking and feeling their breasts in a less systematic approach, such as while showering or getting dressed or doing an occasional thorough exam. Sometimes, women are so concerned about “doing it right” that they become stressed over the technique. Doing BSE regularly is one way for women to know how their breasts normally look and feel and to notice any changes. The goal, with or without BSE, is to report any breast changes to a doctor or nurse right away.
• Women who choose to do BSE should have their BSE technique reviewed during their physical exam by a health professional. It is okay for women to choose not to do BSE or not to do it on a regular schedule. However, by doing the exam regularly, you get to know how your breasts normally look and feel and you can more readily detect any signs or symptoms if a change occurs, such as development of a lump or swelling, skin irritation or dimpling, nipple pain or retraction (turning inward), redness or scaliness of the nipple or breast skin, or a discharge other than breast milk. Should you notice any changes you should see your health care provider as soon as possible for evaluation. Remember that most of the time, however, these breast changes are not cancer.

1) The incisions heal well and are frequently imperceptible one year after surgery.

2) Many patients will require some degree of lift in conjunction with their augmentation and this almost always involves an incision around the nipple.

3) Many women simply prefer to have an incision around the areola instead of in the fold below.

In addition to the excellent reasons listed above,  studies have shown that there is no significant difference in nipple-areolar post-operative sensitivity between women whose implants are placed through an infra-mammary incision versus a peri-areolar incision (Plast. Reconstr. Surg 117: 1694, 2006).

• CBE is a complement to mammograms and an opportunity for women and their doctor or nurse to discuss changes in their breasts, early detection testing, and factors in the woman’s history that might make her more likely to have breast cancer.
• There may be some benefit in having the CBE shortly before the mammogram. The exam should include instruction for the purpose of getting more familiar with your own breasts. Women should also be given information about the benefits and limitations of CBE and breast self exam (BSE). Breast cancer risk is very low for women in their 20s and gradually increases with age. Women should be told to promptly report any new breast symptoms to a health professional.

• Current evidence supporting mammograms is even stronger than in the past. In particular, recent evidence has confirmed that mammograms offer substantial benefit for women in their 40s. Women can feel confident about the benefits associated with regular mammograms for finding cancer early. However, mammograms also have limitations. A mammogram will miss some cancers, and it sometimes leads to follow up of findings that are not cancer, including biopsies.
• Women should be told about the benefits, limitations, and potential harms linked with regular screening. Mammograms can miss some cancers. But despite their limitations, they remain a very effective and valuable tool for decreasing suffering and death from breast cancer.
• Mammograms for older women should be based on the individual, her health, and other serious illnesses, such as congestive heart failure, end-stage renal disease, chronic obstructive pulmonary disease, and moderate-to-severe dementia. Age alone should not be the reason to stop having regular mammograms. As long as a woman is in good health and would be a candidate for treatment, she should continue to be screened with a mammogram.

2. Women in their 20s and 30s should have a clinical breast exam (CBE) as part of a periodic (regular) health exam by a health professional, at least every 3 years. After age 40, women should have a breast exam by a health professional every year.

3. Breast self exam (BSE) is an option for women starting in their 20s. Women should be told about the benefits and limitations of BSE. Women should report any breast changes to their health professional right away.

4. Women at high risk (greater than 20% lifetime risk) should get an MRI and a mammogram every year. Women at moderately increased risk (15% to 20% lifetime risk) should talk with their doctors about the benefits and limitations of adding MRI screening to their yearly mammogram. Yearly MRI screening is not recommended for women whose lifetime risk of breast cancer is less than 15%.

Women with breast implants should follow the same American Cancer Society (ACS) program of recommended mammograms as women without breast implants. However, due to the implant, several special mammography views must be taken to allow visualization of both the breast tissue and the implant. For this reason, diagnostic mammography is usually performed on patients with breast implants (as opposed to screening mammography that is typically performed on asymptomatic women without implants).

Examination of augmented breasts is more time consuming; therefore, the imaging location performing the mammography should be informed of the presence of implants when the mammogram is scheduled. Patients with implants should also inform the physician and the technologist performing the exam that they have implants.

The x-rays used for mammographic imaging of the breasts cannot penetrate silicone or saline implants well enough to image the overlying or underlying breast tissue. Therefore, some breast tissue (up to 25%) may not be seen on the mammogram, as it will be covered up by the implant. In order to visualize as much breast tissue as possible, women with implants undergo four additional views as well as the four standard images taken during diagnostic mammography. In these additional x-ray pictures, called Eklund views or implant displacement (ID) views, the implant is pushed back against the chest wall and the breast is pulled forward over it. This allows better imaging of the forward most part of each breast. The implant displacement views are not as successful in women who have capsular contratures (formation of hard scar tissue around the implants). The ID views are easiest to obtain in a women whose implants are placed underneath the chest muscle (sub-pectoral).

Standard mammography views are taken first. The breast and implant are compressed with moderate force:

Image displacement mammography views (also called Eklund views) are performed with the implant pushed back against the chest wall. The compression paddle is applied to the breast tissue, which is pulled forward:

You should monitor your breast implants for signs of symptomatic rupture when you check your breasts during your monthly “self breast exams.” You should examine your breast tissue by feeling for lumps, and then examine your implants as well. Move the implants around while looking in the mirror. Look for any changes in shape, size, and feel of the implants. You know your own breasts better than anyone…so pay attention to how they normally feel.

It is important to understand that breast implants are not lifetime devices. Breast implants rupture when the shell develops a tear or hole. Rupture can occur at any time after implantation. However, ruptures are more likely to occur the longer the implant has been implanted in the breast. Known causes of implant rupture include: damage to the implant during implantation, folding or wrinkling of the implant shell, excessive force to the chest (i.e. the technique of  ‘closed capsulotomy‘…which is contraindicated), trauma (i.e. direct blunt trauma such as from a seat belt during an automobile accident), compression during mammography, and severe capsular contracture. Breast implants may also simply wear out over time.

A major factor in the course of your healing is whether you follow the instructions given by Dr. Brenner verbally and in writing. Such guidelines are designed to promote the healing process and to prevent the occurrence of anything which may interfere with recovery. It is imperative that you recognize that you are a partner in this process and have a responsibility to follow instructions carefully. The instructions, based on broad experience, are designed to give you the best opportunity for healing without delay or surprise.

Unexpected occurrences in plastic surgery are infrequent, but they do occur. When complications arise, they often are the result of a patient’s variable healing capacity or even a patient’s failure to follow instructions. Rest assured, that Dr. Brenner will assist you in any way possible should such events occur.

warning: This herb should NEVER be taken in raw form.  This plant, like many medicinal plants if ingested, can cause intestinal bleeding, abdominal cramping and sickness.  Homeopathy is the medicinal use of tinctures and suspensions using herbs and other plants and should never be consumed without proper preparation.  Only respectable homeopathic remedies and tinctures should be consumed.

Arnica Montana has been used in Europe for centuries to treat swelling, soreness and bruising. This product is oftern misunderstood when confused with ingesting the arnica plant in its raw form. (DO NOT INGEST ARNICA IN ITS RAW NATURAL FORM). When properly prepared, Arnica may significantly decrease the healing time or the appearance of such following surgery. There are many different formulations from different companies. Sublingual (under the tongue) types are the most often recommended for plastic surgery.

1. Confirm your surgery time. We will call you to confirm the time of your surgery. If you will be away from your home phone, office phone or cell phone, please remember to call Dr. Brenner’s office to confirm your time at 310.777.5400.

2. Do not drink alcohol the night before surgery. Doing so may increase your risk of post-surgical nausea and vomiting.

3. Eating & drinking. Do not eat or drink anything after 12:00 midnight, the night before your operation. This includes water and gum. If you take a daily medication, you may take it with a small sip of water in the early morning on the day of your surgery. It is not safe to administer anesthesia to anyone who has consumed solid food or liquids during the 8 hours before surgery.

4. Transportation. Transportation must be provided to and from surgery. You may NOT be released from the surgical center in a taxi or with a limosine driver. You will need an adult to stay with you for the first 24 hours post-anesthesia.

5. Cleansing. Please shower and wash the surgical areas with shampoo and soap. No special prescription soaps are necessary.

6. Make-up and contact lenses.  Please do not wear moisturizers, creams, lotions, or makeup on the day of surgery. Do not wear contact lenses on the day of surgery.

7. Check-in and arrival. You will be asked to arrive at the surgery center one hour prior to your operation. This will allow ample time for you to complete any last minute paperwork,  and for the nurse and anesthesia provider to meet with you and review your medical history.

Your stay in the recovery room will last from one to four hours, depending on how soon you are ready to leave. Most patients are fully awake within 30-60 minutes after surgery but may not remember much about their stay in the recovery room.

2. Your surgery will be performed at ROX Center in a state-of-the-art operating suite. Specialists using modern equipment and techniques will attend to you. The team includes an anesthetist,  a trained operating room technician and a registered nurse in charge of the operating room.

3. When you arrive at ROX Center, you will be escorted to the surgery suite. You will be asked to change into a gown and you will be given foot covers. Dr. Brenner and the anesthetist will meet with you before you enter the operating room. This is the time for final surgical planning; it is also when we will do basic preparation or draw on your skin as needed. There will be time for last minute questions.

4. Once you enter the operating room, the staff will do everything they can to make you feel secure. You will feel comfortable on a deeply padded operating table, and the nurse or the anesthetist will start an intravenous drip in your arm. At the same time, to ensure your safety, our staff will connect you to monitoring devices. Medicines that will make you drowsy will flow through the tubing into a vein in your arm.

Bromelain is an enzyme that digests protein.  Bromelain has been shown to be helpful in aiding digestion, as an anti-inflammatory for the relief of joint inflammation (very helpful for athletic injuries, carpal tunnel syndrome and arthritic conditions),  and for relief after traumatic injury and after surgery. New research has also demonstrated important immune system and heart health benefits that may be derived with the use of Bromelain.

Disclaimer:
The information presented herein  is intended for educational purposes only. These statements have not been evaluated by the FDA and are not intended to diagnose, cure, treat, or prevent disease. Individual results may vary.

History:
Bromelain is one of a group of proteolytic enzymes that are capable of digesting protein and is found in the stem and fruit of the pineapple plant.  It is extracted from the pineapple by filtration or by chemical processing, and both are safe and effective.

Beneficial Uses:
Bromelain is considered an aid to good digestion, because it intensifies the digestive process by breaking down protein, and facilitates the passing of food to the intestine.

Bromelain has been called an herbal anti-inflammatory and is widely used after traumatic injuries and surgery.  It is said to “release” inflammation by breaking down proteins in swollen tissues and is thought to reduce swelling in virtually all kinds of inflammatory reactions.  Bromelain apparently inhibits formation of prostaglandin E-2, a chemical that causes inflammation, and it also helps to stimulate the production of prostaglandin E-1, an anti-inflammatory chemical.

Women may find relief from premenstrual syndrome (PMS) with the use of Bromelain supplements. It is believed to balance the body’s production of prostaglandins, a class of regulatory hormones, including a number of substances that cause smooth muscles to contract.  As a smooth muscle relaxant, Bromelain is thought to decrease spasms of the cervix that accompany PMS.

Recommended Dosage:
Take one (1) capsule, 1-2  times each day with water at mealtimes.

Contraindications:
Those who are taking any blood thinning medications (Coumadin, warfarin, etc.) should not use Bromelain Herbal Supplement. Pregnant women, people with high blood pressure, liver or kidney disease and those who are taking any prescription medications should take Bromelain only under the direction of a knowledgeable healthcare provider. Prolonged use (more than eight/ten days successively) is not recommended, and individuals who are allergic to pineapples should not use Bromelain.  Bromelain may cause nausea, excessive menstrual bleeding and gastric distress. It is not recommended for children.

Bromelain

It is the week before your plastic surgical procedure with Dr. Brenner and you may be wondering if there is anything that you will need to do. Here are a few suggestions:

1. Make sure all of your questions are answered. You have already spent some time with Dr. Brenner during your consultation and during your pre-operative visit. However, you may come up with some new un-answered questions since leaving his office. Now is the time to contact Dr. Brenner’s office and discuss these questions.

2. Take Bromelain and Arnica Montana. These herbs aid with bruising and swelling. They may be purchased over the counter at a health food store or drug store. For Bromelain:  take 1 tab twice daily. For Arnica Montana: take four tabs, four times per day. Begin taking these herbs about 4 days prior to surgery and discontinue 4 days after surgery. If it is the day before surgery and you suddenly realize that you forgot to take these for the last three days, do not worry. Just start taking them today.

3. Purchase a stool softener. A common side effect of narcotic pain relievers is constipation. It is beneficial to have a stool softener (i.e. Colace or Dulcolax) on hand if needed.

1. Complete blood count (CBC): this lab checks your red blood cell, white blood cell and platelet count.

2. Comprehensive metabolic profile (CMP): this lab checks your electrolytes, kidney & liver function, and protein levels.

3. Coagulation profile (PT, INR & PTT): this lab checks your ability to form blood clots.

4. HIV & Hepatitis serologies: these labs check your exposure to & possible infection with these viruses

5. HCG (women of childbearing age only): this lab checks if you are pregnant.

6. EKG (electrocardiogram)

7. CXR (chest xray)

8. Medical clearance examination by your primary care physician.

1. Requested labs: it is required to have your labs drawn, and EKG (if requested) NO LATER that 2 weeks prior to your surgery date. Lab work cannot be more than 6 weeks old (4 weeks if your surgery will be at the hospital). A chest XRAY may be requested if you have a history of smoking, an underlying lung disorder or other condition that may affect the condition of your lungs. If you have not had your labs drawn prior to your schedule PRE-OP day, we will either draw your blood for you or have you go to a lab close by. If you go to an outside lab, please verify with the lab that they will fax your lab results to our office. This is for your safety. Our most important priority is to insure you are completely healthy for surgery.

2. Stop smoking: Smoking reduces circulation to the skin and impedes healing. It is best to avoid smoking, second hand smoke and tobacco replacements, such as nicotine patches or gum in the peri-operative period.

3. Take supplements: Start taking multivitamins, Vitamin C twice daily and zinc to improve your general health and healing once you have scheduled your surgery.

4. Do not take aspirin or ibuprofen: Stop taking medications containing aspirin including ibuprofen, Motrin, Aleve and all similar medications. Review the list of ‘drugs to avoid’ very carefully. Such drugs can cause bleeding problems during and after surgery. Instead, use medications containing acetaminophen (such as Tylenol).

5. Fill your prescriptions: You will be given prescriptions for medications. Please have them filled BEFORE the day of surgery and bring them with you the day of surgery. You will begin taking all of your prescribed medications AFTER surgery (this includes all antibiotics and pain pills).

In case you missed Dr. Kevin Brenner on Extra TV discussing The Keller Funnel, you can watch it here. The Keller Funnel is a new device developed specifically to assist with the placement of silicone gel breast implants. Using the funnel allows Dr. Brenner to place silicone gel implants through a smaller incision with a reduced amount of direct contact with the sterile device. This streamlined technique minimizes the risk of implant contamination and total time under anesthesia.

Read more about The Keller Funnel here.

It is important to understand that breast implants are used to make the breast larger. The implants alone may not adequately lift the breast, or correct the effects of pregnancy, weight loss, or skin stretching. Sometimes, Dr. Brenner may suggest that breast lifting will be required to help regain a perky appearance to your breast.

If an offer for a plastic surgery operation sounds “too good to be true,” it probably is. How does ‘free’ plastic surgery sound? Well, if you have ever considered discount cosmetic surgery, think again. In many cases, you get what you pay for.  While flashy billboards promising dirt-cheap prices on plastic surgery have been popping up around the nation, consumers must realize that undergoing surgery is not like buying a used car.

An article on StyleList.com investigated the dangers of discount plastic surgery and why it is so cheap. Call it clever marketing, however, the doctors performing these operations may not be board-certified plastic surgeons, and even worse, not even doctors! Have we forgotten the tragic death of former Miss Argentina, who died at age 38 following a butt augmentation? If you have, Solange Magnano died following a blood clot that was a result of undergoing a highly controversial buttock augmentation procedure in Argentina using polymethlymetharcylate (tiny glass beads) instead of the more traditional techniques of her own fat or silicone gel implant.  True, there are hidden dangers when it comes to medical tourism, but there are also hidden dangers right here at home.

One of the reasons why some doctors discount their operations is because they are able to cut costs in the anesthesia department. If you deduct all anesthesia-related costs from an opeation, surgery will be fairly cheap, but much less safe. The use of local anesthesia combined with minimal oral sedation is marketed to consumers as a safer alternative. However, being awake for many operations is not really safer. When doctors perform cosmetic surgery using only local anesthestics, they are able to get away with doing so in a regular medical office which is not regulated in the same fashion as an accredited surgical facility. Mandated safety features are simply not the same in office-based facilities that are not accredited.  This leaves the patient with a much higher anesthetic-related risk and even possible exposure to pathogens and greater risk of infection.  Another danger arises when you consider that some of the doctors performing these procedures aren’t even trained beyond a 2 day “weekend course” and have little to no prior experience in operating on the human body.

So how can you make sure you are making the right choice when choosing a cosmetic surgeon?

1. Verify that the doctor is a board-certified plastic surgeon.
2. Check with your state medical board to see if there are any complaints against the surgeon, or if their license may be suspended
3. Check online reviews of doctors.
4. If a price seems too good to be true, it probably is. The American Society of Plastic Surgeons has the average national pricing for cosmetic procedures available on their website.
5. Ask around from friends who have had plastic surgery. See who they have gone to and if they liked their results.
6. Use online resources like RealSelf.com and MakeMeHeal.com to hear other patients’ plastic surgery stories. This way, you can cross-reference your consultation with the experiences of other people who have undergone the same procedure.
7. Trust your gut! If you have a bad feeling about the doctor, that feeling is most likely valid.

Symptoms of nasal perforation relate to its size and location and  include:

1) A sensation of nasal obstruction (as a result of turbulent air flow)

2) Dry, irritated nasal mucosa (a result of reduction of nasal temperature and humidity)

3) Increased mucous production (a.k.a secondary rhinorrhea)

4) New intranasal crusting

5) Low grade bleeding (epistaxis) in cases where the mucosa fails to heal completely.

6) Pain (as the result of a low grade infection of underlying structures)

7) A whistling sound during nasal breathing.

8) Collapse of the support structures (resulting in saddle nose deformity)

Causes of nasal septal perforations include:

1) Iatrogenic: These cases resulting from previous nasal septal surgery are the most common cause.

2) Trauma: These cases may result after a traumatic injury that causes nasal septal fracture & septal hematomas.

3) Inflammation: These cases occur in patients with systemic inflammatory of auto-antibody conditions such as: Lupus, Crohn’s disease, polyarteritis nodosa, antiphospholipid antibody syndrome, rheumatoid arthritis, sarcoidosis, Wegener’s granulomatosis, leprosy and tuberculosis.

4) Infection: These cases occur less frequently as a result of infection with Syphilis, HIV, fungus or varicella.

5) Neoplastic:  Other rare causes include carcinoma, T-cell lymphoma and cryoglobulinemias.

6) Nasal drug use: Cocaine abuse is the worst and most common offender. However, overuse of over-the-counter nasal sprays like oxymetazoline, phenylephrine and menthol inhalers have also been implicated.

2. Malignancy (active or in a patient’s history)

3. Thrombophilia disorders.*

4. Obesity (particularly for obese patients <40 years of age)

5. Use of oral contraceptives, tamoxifen, hormone replacement therapy or estrogen-containing drugs.

*Inherited and acquired Thrombophilia disorders include:

Factor V Leiden mutation

Prothrombin 20210A mutation (found only in whites)

Protein S deficiency

Protein C deficiency

High levels of: Fibrinogen, Plasminogen, Factor VIII, Factor IX, Thrombin activatable fibrinolysis inhibitor or Protein C inhibitor.

Low levels of tissue factor pathway inhibitor (TFPI)

Hyperhomocysteinemia (plasma homocysteine level >18.5 mmol/L)

Antiphospholipid antibodies (lupus anticoagulant & anti-cardiolipin)

2. Local anesthetics come in 2 general categories; those made with an “amide” end & those made with an”ester” end.

3. People who have allergies to local anesthetic agents, usually have an allergy to the “ester” type. This mainly has to do with the manner in which your body breaks down, or metabolizes, the “ester” type.

4. “Ester” type local anesthetics include: Procaine, Chloroprocaine, Tetracaine & Cocaine.

5. True allergy to Lidocaine (the most commonly used “amide” type) is exceedingly rare.

2. The inner deep layer of skin (dermis) takes much longer to heal as your body’s cell lay down scar in the form of a protein called fibrin.

3. In order for the dermis to heal, your body deposits many different cell types into the area of the scar. These cells secrete many chemicals (cytokines) which lead to swelling and red coloration of the scar. This is why new scars almost always appear thick and pink or red in color.

4. Internal absorbable sutures keep the dermis together while your body heals this newly repaired incision.

5. Scars that occur in younger and tighter skin tend to heal less well than those that occur in skin that is older and has more wrinkles. At least there is one great benefit to aging!

The hemostatic system in our bodies is always striving for constant equilibrium. Blood within our arteries and veins must be maintained in a fluid state so that it can circulate. At the same time, our systems must be able to convert liquid blood into a gel when some type of injury occurs to the blood vessel. This is known as “clot formation.” Clot formation occurs through two separation systems in our blood. The first involves cells known as platelets and the second involves clotting proteins.  During clot formation, a series of chemical processes take place that can both activate and inactivate these platelets and clotting proteins. The triggers for these processes are quite simple and include:

1) Venous stasis (the blood in the veins is more sluggish than normal & does not flow swiftly)

2) Blood vessel wall damage (caused by inflammation, or trauma..such as a cut, surgical or otherwise)

3) Hypercoagulability (a state in which the bloods ability to form clots is heightened)

Venous stasis likely plays the major role in thrombus formation related to surgery.  DVT can arise when the return flow of blood in veins is impaired. Both anesthesia and immobilization can cause venous stasis; anesthesia can do so by decreasing the tone of vein walls…and immobilization by placing a physical obstruction to returning blood flow. When venous return from the lower extremities is slowed during surgery, the decreased blood flow prevents the activated clotting factors from clearing as quickly as they normally would. This can lead to increased formation of venous clots, especially near the valves that live  within the veins.  Hypercoagulability is also known to contribute to the risk of clot formation. If you know or suspect that you may suffer from a condition that places you in a hypercoagulable state, be sure to alert Dr. Brenner of this information at the time of consultation prior to surgery.

1) The breast often has significant and sometimes asymmetric breast volume loss, with a flat & deflated appearance.

2) The breast tissue suffers from a dramatic loss of skin elasticity & has a tremendous skin excess relative to breast tissue volume.

3) The nipple position is commonly too far medial (toward the midline of the chest).

4) The axillary fold (area of the chest wall below the armpit) is prominent & blurs the border between the breast and the chest wall.

Every patient’s breast anatomy differs, do there are many techniques that can be utilized when it comes to breast lifting.

Mentor and Allergan silicone gel-filled breast implants are approved for: (1) reconstruction (primary reconstruction and revision-reconstruction) in women of any age and (2) augmentation (primary augmentation and revision-augmentation) in women 22 years or older.

FDA restricts the marketing of breast implants for augmentation to women of a minium age because young women’s breasts continue to develop through their late teens and early 20s and because there is a concern that young women may not be mature enough to make an informed decision about the potential risks. However, there is there is no age restriction on the marketing of these products for reconstruction, so as to allow young women to have access to breast implants to replace breast tissue that has been removed due to cancer or trauma or that has failed to develop properly due to a severe breast abnormality.

• damage during implantation or during other surgical procedures
• folding or wrinkling of the implant shell
• trauma or other excessive force to the chest
• compression of the breast during mammography.

When the air temperature is higher than 98°F, human skin will actually absorb heat instead of dissipating it. Therefore, the more contact the skin has with 98°F-plus air, the hotter a person will feel. Although suncreen (SPF 30 or higher) is a must, you’ll actually feel cooler by shielding also your skin.  One great way to beat the heat and protect your skin is by wearing lightweight, light-colored clothing that reflects away some of the sun’s energy to help keep cool. So don’t stay inside; enjoy your summer!!!

Kelo-cote^® gel self-dries to a waterproof, gas permeable membrane that acts like an extra layer of skin. It helps to soften, flatten and smooth the scar^, while maintaining the moisture balance and elasticity of the adjacent skin. It has also been shown to reduce the discoloration and itching associated with scars.

For the management and prevention of scars, Kelo-cote^® can be used as soon as all of your surgical incisions are completely healed.  It is usually advisable to wait about two to three weeks after surgery before using silicone gels. For optimal application strategies, discuss with Dr. Brenner prior to use.

SILICONE: If your silicone gel-filled breast implant ruptures, it is likely that neither you nor your doctor will know. This is known as a silent rupture. This is why MRI is recommended at three years after implantation and then every two years thereafter to screen for rupture. However, sometimes there are symptoms. These symptoms include hard knots or lumps surrounding the implant or in the armpit, change or loss of size or shape of the breast or implant, pain, tingling, swelling, numbness, burning, or hardening of the breast.

2.  Many post-bariatric body contouring patients have a malabsorptive state caused gastric bypass surgery.

3. The stress of major body contouring surgery will likely increase a body’s protein/calorie requirement by 20%.

4. Patients who get “dumping syndrome” after gastric bypass are more likely to have electrolyte & nutritional imbalance.

5.  Normal protein requirements are about 1 gram/kg weight/day.

• reoperations (additional surgeries), with or without removal of the device
• capsular contracture (hardening of the area around the implant)
• breast pain
• changes in nipple and breast sensation
• rupture with deflation for saline-filled implants
• rupture with or without symptoms for silicone gel-filled implants
• migration of silicone gel for silicone gel-filled breast implants.

• In May 2000, Mentor and Allergan (formerly Inamed) received approval for saline-filled breast implants. These implants were approved for breast augmentation in women 18 years or older and for breast reconstruction in women of any age.

• In November 2006, Allergan and Mentor received approval for their silicone gel-filled breast implants. These implants were approved for breast augmentation in women 22 years or older and for breast reconstruction in women of any age.

All breast implants other than these four approved devices are considered investigational devices, including the more-cohesive (“gummy bear”) implants. For a woman to receive an investigational breast implant in the U.S., she must enroll in a clinical study.

1) Moderate Profile: widest base, least projection.

2) Moderate Plus Profile: in between….

3) High Profile: narrowest base, most projection.

In general, women who have a larger chest wall dimension and wider base dimension to their breast will be well matched with a Moderate Profile style implant. Women who are more petite will tend to benefit with a higher profile implant that has a narrow base.

Sheyla Hershey (who is NOT Dr. Brenner’s patient) is no stranger to plastic surgery, claiming she has had more than 30 procedures. But her last breast augmentation in pursuit of claiming the largest breasts in the world has given her a dangerous staphylocccal infection in both breasts. Hershey’s doctors told her they are concerned the infection could spread to her bloodstream. Should that occur, then Ms. Hershey could have bigger problems than just losing her size 38KKK breasts implants. These are the types of problems commonly seen with overly large implants. Breast surgery with implants of this proportion would never be permitted in the United States, due to federal requirements and regulations, but Hershey was able to get the surgery in Brazil. Because of the infected tissue resulting from the staph infection, Hershey may end up with smaller breasts than she had when she started having augmentations.

Breast implant infection is a well known potential risk of breast augmentation surgery. Although some superficial post-operative breast infections can be treated conservatively with antibiotics, once the actual implant becomes infected, it must be removed. This is just one potential danger of medical tourism which clearly demonstrates why safety is such an important part of your plastic surgery experience.

1) Breast volume and fullness are adequate when you wear your bra, but your breasts sag significantly when you take your bra off: MASTOPEXY ALONE IS THE CORRECT OPERATION.

2) Breast volume and fullness are inadequate, whether or not you wear your bra, and your breasts do not sag when you take off your bra: BREAST AUGMENTATION ALONE IS THE CORRECT OPERATION.

3) Breast volume and fullness are inadequate, and your breasts sag when your bra comes off: BREAST AUGMENTATION WITH A MASTOPEXY IS THE CORRECT OPERATION.

4) Breast volume is excessive causing back pain, bra strap grooving, rashes in the breast folds: BREAST REDUCTION IS THE CORRECT OPERATION.

Although this algorithm seems very easy and straightforward, there are many subtleties to breast rejuvenation surgery. If you are not sure which category is right for you, then your next step is to discuss your concerns with Dr. Brenner during your private consultation.

In the study (S. Kawada, M. Ohtani, N. Ishii. Increased oxygen tension attenuates acute ultraviolet-B-induced skin angiogenesis and wrinkle formation. AJP: Regulatory, Integrative and Comparative Physiology, 2010; DOI:), mice who were placed in an oxygen chamber after exposure to UVB radiation developed fewer wrinkles and showed fewer signs of tissue damage than mice who were exposed to UVB radiation alone.

What are the implications for humans?

Learn ways to lose weight and help reduce your risk.

BMI provides a reliable indicator of body fatness for most people and is used to screen for weight categories that may lead to health problems.

BMI does not measure body fat directly, but research has shown that BMI correlates to direct measures of body fat, such as underwater weighing and dual energy x-ray absorptiometry (DXA). BMI can be considered an alternative for direct measures of body fat. Additionally, BMI is an inexpensive and easy-to-perform method of screening for weight categories that may lead to health problems.

Candidates for surgical weight loss include:

1) Patients with a BMI greater than >40kg/m2 who are considered severely obese.

2) Patient with a BMI of 35 or higher who also have  at least one other serious obesity related medical conditions. These conditions severely hinder the life of the obese individual and  include heart disease, sleep apnea, and severe arthritis of the lower extremities, diabetes, and pulmonary hypertension.  You can ask our expert team at RoxBariatric if you are a candidate for Bariatric Surgery.

1) Abnormally thick fibrotic scars with expansion into the normal surrounding tissue
2) Caused by surgery, ear piercing, burns, abrasions, tatoos, immunizations and insect bites
3) Able to appear months and even years after the original injury occurred
4) Often characterized by itching, pain, tenderness, burning, ulceration & poor cosmesis
5) Relatively resistant to treatment
6) Known to have high recurrence rates
7) Stubborn, especially on the earlobe where they have a highest recurrence rates (up to 80%)
8) Best treated with radiotherapy combined with surgical excision which decreases recurrence rates to 10-20%

Obese patients that undergo bariatric surgery and then go on to lose significant amounts of weight do frequently experience resolution their systemic obesity-related diseases (i.e. hypertension and diabetes).  However, it has been widely recognized by plastic surgeons that many of the changes that occur in the actual skin do not return to normal once the weight has been lost. A recent study (J Plas Recon Surg  Vol 125, Num 1, Jan 2010, p343.) examined surgical skin specimens from patients that underwent post-bariatric body contouring, including lower body lifts. The investigators showed that the general collagen architecture of the bariatric skin specimens were abnormal and “loose” in comparison to non-bariatric skin samples. The specimens showed a marked decrease in the thickness of collagen bundles in the dermis of the skin, as well as multiple areas of collagen resorption throughout. These changes may be the result of chronic skin infections, which are common in the obese and post-bariatric populations, and also a major source of complaint of patients who present for panniculectomy surgery.

History of Stop Cancer

Philanthropist, entrepreneur, corporate executive, art collector, medical doctor, citizen-diplomat, friend of heads-of-state, world traveler and visionary—Dr. Armand Hammer, chairman and founder of Occidental Petroleum Corporation was all of these and more. Until his death in December 1990 at age 92-1/2, he literally worked around the clock seven days a week.

As Chairman of President Ronald Reagan’s Cancer Panel for 8 years, Dr. Hammer learned that the preponderance of requests for cancer research grants were unfilled at the National Cancer Institute (NCI) due to lack of funds. Consequently, in 1988 in partnership with Sherry Lansing, former Chairman of Paramount Pictures, he founded the non-profit, volunteer, nationally focused campaign STOP CANCER, dedicated to funding cancer research.

Dr. Armand Hammer
and Prince Charles
Following Armand Hammer’s passing, STOP CANCER was reorganized in 1991 with Sherry Lansing as Chair and Arlene and David Ray as Founding Presidents. At the suggestion of the Director of the NCI, the focus of the now-permanent organization became local with the establishment of Research Career Development Awards and Seed Grants to selected young scientists at Los Angeles County’s three Comprehensive Cancer Centers, UCLA’s Jonsson, USC’s Norris and the City of Hope Center.

Dr. Hammer would be proud of the accomplishments of STOP CANCER and its hardworking volunteer members and staff who have raised since 1988, including the original STOP CANCER campaign funds, nearly $50 million for cancer research. He would be happy knowing that Dr. Ray R. Irani, his successor as chairman and CEO of Occidental, picked up the torch to help carry on the quest to vanquish cancer. Over the years Dr. Irani and Occidental have most generously supported STOP CANCER. Ray Irani received the First STOP CANCER Humanitarian Award at the organization’s Annual Research Awards Dinner on November 5, 2003.

The dedication, the enthusiasm and the perseverance that Armand Hammer brought to the mission of STOP CANCER inspire today’s indomitable volunteers to help fulfill his dream of a cure for cancer in our lifetime—if not in his.

Anti-oxidants are compounds that combat Free Radicals and protect our body from oxidative stresses. Anti-oxidants travel through our bodies, scavenging, and eliminating already-created Free Radicals. By doing this, anti-oxidants reduce pathways of cellular damage, repair Free-Radical induced damage and actually stimulate age-reversal changes on a cellular level.

Common antioxidants include:

Vitamin E: available orally & topically. It has a natural photoprotective effect and moisturizing capability.
Vitamin C: available orally. It protects & rejuvenates skin. Smoking depletes its reservoirs.
Alpha-Lipoic Acid: available topically. ALA 1-4% creams many benefit skin aging.
Ubiquinones (Co-enzyme Q10): available orally.

Polyphenols (found in plants)
Catechin (found in green tea)
Procyanidins (found in grape seed extract). It speeds wound healing, helps other vitamins absorb.
Ferulic Acid (found in Whole grains, spinach, parsley, grapes & Rhubarb) It protects skin from UV damage.
Pomegranate: has an anti-oxidant effect against athersclerosis.
Coffee berry: contains many polyphenols that confer UVA adn UVB protection.

Isoflavones: (found in soy) may have potential for protection/prevention from carcinogenesis.
Carotenoids: (Lycopene, Lutein & Beta Carotene) found to be photo-protectants.

Be sure to ask questions: It’s very important to ask Dr. Brenner questions about your procedure. It’s natural to feel some anxiety, whether it’s excitement for your anticipated new look or a bit of preoperative stress. Don’t be shy about discussing these feelings with your plastic surgeon.

Your partnership with Dr. Brenner doesn’t end once your surgery is completed. The relationship you establish with Dr. Brenner is one that will continue. While the results of many plastic surgical procedures are often permanent, there can be changes as you age or due to other circumstances. That’s why it is suggested that you maintain a regular schedule of follow-up examinations. By staying in touch with Dr. Brenner, you can enjoy the benefits of continued quality care.

* An extremely low rate of serious complications (less than half of 1 percent)
* An extremely low mortality rate (less than one in 57,000)
* The advantage of lower costs

1) superior weight loss when compared with vertical gastric banding
2) excellent long-term reduction in EWL
3) helps resolve or eliminate co-morbidities such as high blood pressure (hypertension) & Diabetes

Disadvantages:

1) There is a potential for leaks from the intestinal anastomoses (where they get sewn together).
2) Severe dumping syndrome
3) Procedure-related complications like internal hernias and gastric distension.

1 Breast Augmentation (289,000)

2 Nose Reshaping (256,000)

3 Eyelid Surgery (203,000)

4 Liposuction (198,000)

5 Tummy Tuck (115,000)

1) Are you certified by the American Board of Plastic Surgery?
2) Are you a member of the American Society of Plastic Surgeons?
3) Were you trained specifically in the field of plastic surgery?
4) How many years of plastic surgery training have you had?
5) Do you have hospital privileges to perform this procedure? If so, at which hospitals?
6) Is the office-based surgical facility accredited by a nationally- or state-recognized accrediting agency,or is it state-licensed or Medicare-certified?
7) How many procedures of this type have you performed?
8) Am I a good candidate for this procedure?
9) Where and how will you perform my procedure?
10) How long of a recovery period can I expect, & what kind of help will I need during my recovery?
11) What are the risks and complications associated with my procedure?
12) How are complications handled?
13) What are my options if I am dissatisfied with the outcome of my surgery?
14) Do you have before-and-after photos I can look at and what results are reasonable for me?

1) 62% of plastic surgeons had undergone at least one type of minimally invasive cosmetic procedure.

2) Female plastic surgeons had significantly more minimally invasive cosmetic procedures, compared with males. (84.9% vs. 57%)

3) The most common procedure was Botox injections (31.5%).

4) About 1/3 of plastic surgeons had at least one type of cosmetic surgery.

5) The most common cosmetic surgical procedure was liposuction of the trunk or extremity (18.6%)

6) Male plastic surgeons were more likely to have a procedure than men in the general population.

Advantages:

1) The band is adjustable. You can come into the office to have the band deflated or inflated based on your degree of intake.

2) The operation is simple and quick.

3) No incisions are made on the intestines, which reduces the potential morbidity and mortality of these operations.

4) The band is removable. If the patient fails to lose weight from this procedure, the band may be removed and another surgical weight loss technique may be utilized.

Disadvantages:

1) Frequent post-operative visits are required before getting the band to the correct degree of inflation.

2) The band can slip along the stomach. This occurs in 5-10% of patients.

3) Determined patients can “eat around” the band. The band does not necessarily prevent intake of hi-caloric liquids.

4) The band is a foreign body. It can erode into the intestine. It can also become infected.

To determine if you are a candidate for Lap Band surgery, contact our team at Rox Bariatric.

Lentigo maligna melanoma is invasive melanoma that develops in an area of lentigo maligna. This represents advancement of lentigo maligna, whereby a new “vertical growth phase” has begun. Appropriate treatment consists of excision and staging. Although some physicians have used Moh’s micrographic surgery for these type of lesions, evaluation of pigmented melanocytic lesions like this using Moh’s (which is a unique type of frozen section analysis) have been associated with both high false-positive and high false-negative rates, around 20-50%.  Many physicians agree that permanent-section analysis is the most sensitive for evaluating the subtle microscopic/histologic changes typical of these lesions.

Once complete excision of these lesions is confirmed by a pathologist, then reconstruction of the defect can be performed.

Diastasis of this muscle occurs principally in two populations: newborns and pregnant women.

In the newborn, the rectus abdominis is not fully developed and may not be sealed together at midline. Diastasis recti is more common in premature and African American newborns.
In pregnant or postpartum women, the defect is caused by the stretching of the rectus abdominis by the growing uterus. It is more common in multiparous women (i.e. women who have had multiple pregnancies) due to repeated episodes of stretching. When the defect occurs during pregnancy, the uterus can sometimes be seen bulging through the abdominal wall beneath the skin.

Diastasis Recti rarely corrects itself completely. Although the elasticity of the abdominal tissues will often “spring back” over a six to twelve month period after delivery, a woman’s abdomen rarely returns to its pre-pregnancy form. Absolute correction most commonly can be accomplished with an abdominoplasty.

However, a study presented Saturday at the annual meeting of the American Society for Metabolic & Bariatric Surgery suggests that the waiting period is ineffective. Researchers followed 440 people who had either laparoscopic gastric bypass or laparoscopic adjustable gastric banding. Of these, 116 people were required by their health insurance plan to wait six months. The study showed there was no significant difference between the two groups in weight loss prior to surgery or one year after surgery.

According to the study’s author, typically all patients receive nutritional and psychological counseling about their post-surgical lifestyle in advance of the surgery. That approach is sufficient, he suggests. However, given the cost of surgery and the importance of lifestyle changes to success, it doesn’t seem unreasonable for insurers to ask that patients prepare for the surgery and its aftermath — whether that takes one month or six.

Universal Detection Technology (OTCBB: UNDT), a developer of early-warning monitoring technologies to protect people from bioterrorism and other infectious health threats has created bioweapons detection kits, certified last year by the U.S. Department of Homeland Security. While these kits have little clinical application, they are ideally suited for law enforcement teams uncovering counterfeit Botox detection labs in the field, as well as rapidly identifying suspicious agents discovered in unsecured locations. The kits are designed to detect and identify up to five separate threats using one sample in a single, easy-to-use device.

Rest assured that this Homeland Security concern will in no way cross-over into the clinical use of Botox for treatment of facial fine lines and wrinkles. Dr. Brenner, like most Board-Certified Plastic Surgeons, uses only real Botox, manufactured by Allergan Corporation, and tightly regulated by the FDA.

Squamous cell carcinomas are graded based on their appearance under the microscope. Low grade lesions are well-differentiated and demonstrate less invasive growth patterns. Low grade lesions are generally associated with an excellent prognosis when compared to the more aggressive high-grade, poorly differentiated lesions.

Squamous cell carcinomas are frequently treated with curettage (scraping) or electrodessication (destruction with electric current). Larger lesions or recurrent lesions should be excised. When the lesions occur in cosmetically critical areas such as on the many parts of the face, Moh’s technique for excision may be used to help minimize loss of surrounding normal tissue. Once the tumors have been definitively cleared, reconstruction of the defect can be accomplished. Dr. Brenner has extensive experience in caring for these types of defects, creatively tailoring each operation to the individual defect.

PIP implants are a type of silicone breast implant that are only available in Europe (not in the U.S.). Although they are not as popular as the silicone implants that are made in the United States (by Mentor Corp. and Allergan Corp.), they are also thought to not be nearly as safe. According to a recent investigation, the company that makes PIP implants changed the composition of the outer shell. As a result, the implants appear to have a much higher rate of rupture. Further, the silicone that they have been using is not the same medical grade silicone used in the U.S.

If you think that you have PIP implants in place,the BAAPS is recommending immediate evaluation of your implants with imaging to determine if one is ruptured. If one is ruptured, they should both be removed.

To learn more, read further.

The students were given a questionnaire normally used to identify drug and alcohol addiction. The survey was reworked to accurately reflect the subjects’ relationships with indoor tanning. Of the 421 students, 229 had used tanning beds. Of the 229 subjects, 160 met the researcher’s criteria for tanning addiction.

According to the results, more than one-third of students were considered tanning addicts based on the questionnaire that measured their levels of depression, anxiety and substance abuse in relation to their tanning habits. Additionally, the study claimed that students addicted to tanning beds were also more inclined to have increased anxiety and abuse other addictive substances. “In addition to appearance enhancement, motivations [for tanning] include relaxation, improved mood, and socialization,” the researchers concluded.

Since research is regularly released proving the harmful effects of indoor tanning, it is imperative for consumers to examine different options to obtaining that summer glow (i.e. spray tans, bronzers). While taking added measures to prevent harmful exposure to UVA and UVB rays is essential, it is also crucial to have regular check-ups with a physician to uncover early signs of skin cancer. For Los Angeles residents, it is also important to understand the harmful side effects of the Southern California sun and the increased risks of skin cancer.

1) Acrochordons (Skin tags)
2) Lipomas (fatty tumors)
3) Dermatofibromas
4) Sebaceous Hyperplasia
5) Angiofibroma
6) Neurofibroma
7) Xanthelasma

Gynecomastia results from an imbalance in the ratio of circulating hormones (estrogen and progesterone). Most commonly, the exact cause is unknown (aka idiopathic). However, there are many conditions that can result in male breast enlargement. These include: breast cancer, testicular cancer, disorders or hormone production, liver disease, kidney disease, hyperthyroidism, and drugs (both prescription drugs and illicit drugs).

Gynecomastia usually manifests as a firm, mobile disk of tissue underlying the nipple-areolar complex. This may occur in one or both breasts.

When discussing gynecomastia with your surgeon, it is important to relate the duration and timing of your breast changes, and the specifics of your symptoms and any symptom progression. You must also be honest with your surgeon in terms of any and all medications that you use, including over the counter drugs, illicit street drugs and alcohol.

In the majority of pubertal boys, gynecomastia usually resolves without intervention within two years. However, surgical intervention is indicated if the enlarged tissue does not regress, the patient experiences physical pain, the patient experiences emotional distress (i.e. is self-conscious or is being teased by his peers) or if there is suspicion of a malignant process. Psychological distress is one of the most common reasons that patients come to Dr. Brenner to have gynecomastia treated.

There are four main types of Basal Cell Carcinoma: Nodular (& micronodular), Superficial, Infiltrating, and Morpheaform.

The infiltrating and morpheaform subtypes often exhibit focal areas of invasion and may be locally aggressive. These two types have the highest rates of recurrence and positive margins. Nodular and superficial spreading types tend to be more indolent and slower growing tumors.

Although some of the smaller lesions may be treated with Cryotherapy (freezing the lesion) or with topical chemotherapy (5-FU), Dr. Brenner prefers that these tumors be cleared surgically using direct excision. Direct excision can be performed and confirmed with frozen section analysis by a pathologist. Alternatively, a dermatologist familiar with Moh’s technique can remove the tumor. Reconstruction of the resulting defect can be performed once removal of the tumor has been confirmed. The type of reconstruction that is used depends on the size of the defect as well as the location of the defect. Dr. Brenner can discuss the multitude of surgical options with you during your consultation.

Common causes of Nasal Airway Obstruction include:
1) Septal deviation
2) Previous cosmetic nasal surgery causing internal valve collapse
3) Turbinate enlargement
4) Nasal trauma with nasal bone fracture or septal fracture

Common symptoms of nasal airway obstruction include:
1) Inability to move nasal air
2) Mouth breathing (especially while sleeping)
3) Need for long term nasal spray use (Afrin, etc.)
4) Change in nasal appearance (i.e. collapse) after previous surgery

Both hypertrophic scars and keloids can be treated with steroid injections. However, when scars become painful, itchy or disfiguring, excision of the scars and reconstruction may be warranted. Although recurrence rates for keloids can be very high, recent studies have shown that post-operative treatment with low-dose radiation can reduce recurrence.

The photos seen show a patient that had removal of two keloid scars from her ear.

Before, Left Ear Keloid Scar Removal

After, Left Ear Keloid Scar Removal

NOTICE TO CONSUMERS: Medical doctors are licensed and regulated by the Medical Board of California (800) 633-2322 www.mbc.ca.gov

The purpose of this new requirement (Title 16, California Code of Regulations section 1355.4) is to inform consumers where to go for information or with a complaint about California medical doctors.

Dr. Brenner has held an unrestricted license as a physician and surgeon issued by the Medical Board of California since 2002.

“Board Certified in Plastic Surgery” means that a surgeon has been awarded Board Certification by the American Board of Plastic Surgery.

Board Certification in Plastic Surgery is awarded only after finishing a formal residency in Plastic Surgery and also passing a rigorous written examination (usually taken 6 or 18 months after completion of all training) and a difficult oral examination which includes cases from a surgeon’s own practice (usually taken at least 18 months following completion of all training).

Criteria that Plastic Surgeons must complete prior to taking the American Board of Plastic Surgery exams include:

1. College (usually 4 years)
2. Medical School (usually 4 years)
3. Internship in General Surgery (1 year)
4. Residency in either General Surgery, Otolaryngology, Orthopedic Surgery, Urology or Neurosurgery (usually 4 to 7 more years)*
5. Additional residency in Plastic Surgery (2 to 3 more years)*
6. Additional fellowships (specializations) may be performed in addition to the above training

*a combined residency of 3 or more years of general surgery plus 3 years of plastic surgery now is also accepted

Board Certification in Plastic Surgery can only be awarded by the The American Board of Plastic Surgery.

Board Certification in Plastic Surgery can not be awarded by any other organization. If a physician is awarded a “board certification” by any board other than The American Board of Plastic Surgery, then they are not truly a Board Certified Plastic Surgeon.

The Keller Funnel is revolutionizing silicone implant placement. By using the funnel during breast augmentation, I am able to:
1) Use smaller incisions
2) Decrease surgery time
3) Minimize stress forces on the implant shell
4) Reduce any potential contamination of the device from the sterilized skin.

1) Smoking
2) Trauma to the breast
3) Radiation injury
4) Breast implant pocket hematoma
5) Breast implant pocket seroma
6) Breast implant infection
7) Initial implant placement in the subglandular position.

Capsular contracture occurs across a spectrum of severity. Baker has classified the types of capsular contracture as follows:

Grade I: The breast is soft and appears natural.
Grade II: The breast feels slightly firm, but appears natural.
Grade III: The breast feels firm, and is starting to look abnormal or distorted.
Grade IV: The breast feels hard, is painful and appears distorted in shape.

There are non-operative ways to manage capsular contracture when it is diagnosed early. These include aggressive implant massage and occasionally the use of Accolate. For severe cases, the breast capsule needs to be removed surgically. It is extremely important for patients to contact their surgeon early, as soon as they develop any symptoms that may be consistent with the development of capsular contracture.

Tuberous breasts are not simply small or underdeveloped breasts. It is an actual deformity that occurs during the process of breast bud maturation that results in herniation of the nipple-areola complex through a fibrous band of breast tissue. The effect of the deformity on the appearance of the breast can range from mild to severe, and typical characteristics include:

* enlarged, puffy areola
* unusually wide spacing between the breasts
* scant amounts of breast tissue (especially in the lower poles)
* sagging (or ptosis) of a portion or entirety of the breast
* higher than normal breast fold
* narrow breast base

The condition can affect the ability of women to breastfeed as in some cases the breasts, including the milk glands, have not developed enough to produce breast milk. Fortunately, other physical aspects of fertility and pregnancy are not affected by the condition. The appearance of tuberous breasts can potentially be treated surgically, with a variety of techniques including: tissue expansion, breast augmentation, breast lifting and breast parenchymal re-shaping. The procedure to correct the appearance of tuberous breasts can be more complicated than a regular breast augmentation, and commonly requires a combination of techniques. In rare cases, tissue expansion of the breast skin envelope may be required prior to definitive augmentation.

If you have think you have this problem, your next step is to contact Dr. Brenner’s office for an in-depth, in-person consultation.

The Rox Bariatric Center is dedicated to helping people live a more active and satisfying lifestyle, by improving their health and self-esteem, through long-term weight loss Results! Our multi-disciplinary team works together to provide a comprehensive approach for long term weight and lifestyle management. Inclusive in our program are specialists in the following disciplines:

* Medical Weight Loss
* Surgical Weight Loss
* Plastic Surgical Body Contouring
* Nutrition
* Behavioral Therapy
* Lifestyle Modification

Call 310.248.6252 to schedule your consultation!

or visit www.roxbariatric.com for more information.

Check out the article here.

Take Years Off Your Face — Without Plastic Surgery!

Read more about Lifechangers: Nip-Tuck Like a Start on ExtraTV

Accent, Zerona, Purigenex Collagen Face Mask, Juvederm, Restylane, Botox, Clarisonic skin care system and more!

For more information, please visit: Rox Spa 90210

Breast implants can be placed in one of two locations. The left photo shows placement below the breast gland (sub-glandular). The right photo shows placement below the breast gland and pectoralis major muscle (sub-muscular). In most patients, I prefer to place implants in the sub-muscular position. There are several reasons for this:

1) There is more of your own tissue between the implant and the external environment.
2) The implants appear more natural, especially in the upper poles.
3) There is a reduced incidence of implant infection, extrusion & capsular contracture.
4) There is a reduced incidence of visible rippling of the implant.

Following breast augmentation surgery, the sensation to your nipples may change. Some women will develop increased sensation; some will have decreased sensation. Most changes in sensation are temporary and therefore will return to normal. Because sensory feedback from the nipple helps stimulate milk production, in cases where sensation is impaired, milk production may be reduced.

For patients that have breast augmentation alone (without breast lift or reduction), the chance of having impaired milk production is exceedingly low. However, if your breasts were augmented because of underdeveloped breasts (breast hypoplasia) or tuberous breast deformity (constricted breast), you may have trouble producing enough milk.

People are often surprised to learn that I have a significant number of pediatric patients. However, many people are unaware of the problems that children have that are frequently treated by Plastic Surgeons. I routinely see kids in my office and the emergency room with problems such as: dog bites, facial fractures & facial lacerations.  However, I also take care of many elective pediatric problems, such as: congenital moles (Nevi); pre-cancerous (atypical) skin lesions, juvenile breast hypertrophy, & nasal airway obstruction.  If you have a friend or family member with any of these problems, please contact my office at 310-777-5400 to learn more.

*Purigenex Micronized Collagen Face Mask
*Zerona Laser
*Accent RFA
*Pixel Fractionated Erbium Laser
*Botox
*Restylane Injections

Will be a very fun night!!

Just got back from the Lifecell Surgeon’s forum in Las Vegas. This was a great meeting about the use of Alloderm (Irradiated Cadaveric Skin) in Breast Reconstruction Surgery. The best new information, however, was about the new applications available for Alloderm use in Revisional Breast Implant surgery. This product will give us a new option for women with very bad capsular contracture. If you have very hard, distorted implants as a result of capsular contracture, please contact my office for additional information.

Today I performed a very interesting case utilizing diced rib cartilage as a graft to the face. The patient is a 53 year old male who had a brain tumor removed years ago. The neurosurgeons were required to make an incision above his eyebrow in order to gain access to and temporarily remove a portion of his temporal bone. Fortunately he is now disease free. However, he developed absorption of some of this bone which was associated with significant soft tissue atrophy in the area. As a result, the patient had a very large visible indentation of the tissues around his orbit (eye socket) as well as titanium plates and screws that were palpable and almost visible. In order to reconstruct this defect and restore somewhat normal anatomy, I removed the cartilage portion of two of his ribs, diced them up, filled the defect and then covered them up with connective tissue from his scalp. This was a very interesting case and he will get an amazing result which will likely be life-changing.