The Nose Clinic is perhaps the only clinic in the world to have ‘gone green.’  On Wednesday 11 January 2012, we added an important footnote to medical history. We performed a delicate Rhinoplasty procedure – a three hour operation – entirely on solar energy. This follows the recent installation of specially designed solar panels, on the roof of our clinic. These panels capture sun energy to power the electronic equipment in our specially designed Rhinoplasty theatre.

Electricity generated by the solar panels  routes from the roof  through an ‘inverter’ directly to the theatre where it powers the lighting, the vital life-sign monitors, the surgeon’s Zenon headlamp (used during surgery), the overhead projector (for projecting surgical  pre-planning images onto a screen), and even the satellite music piped into the theatre during surgery.

“Before we started, we switched off all utility power at the mains switch. This automatically activated the supply of solar electricity to the theatre,” explained our surgeon, Dr Pieter Swanepoel. “All our equipment and lights worked perfectly throughout the three hour operation.”

Some of the solar generated energy trickles through to a bank of deep cycle batteries that store power for use during overcast weather.  The system is designed to switch instantly to main power when needed, but by and large, we expect to run happily and steadily off our alternate source of power (excluding of course, the autoclave used to sterilise our instruments. This equipment draws a staggering amount of current for short periods; just too much for the solar panels, but this may change as time passes).

‘Going green’ we believe, is the only way to go,” says Dr Swanepoel” and it fits superbly with our location on undisturbed African bushveldt on the slopes of the Bronberg mountains east of Pretoria.

The same goal exists for rhinoplasty performed on Asians as for rhinoplasty performed on Caucasians, which is to build a natural-appearing structure that blends harmoniously with the face. As a group, Asians require augmentation of the nose to achieve this result, in contrast to Caucasians who usually require reduction. As with other types of surgery performed on Asians, successful surgery results in a feature consistent with the patient’s ethnic identity. Thus, the goal of surgery should be an attractive Asian nose, not the creation of an attractive Caucasian nose on an Asian face. For more information on aesthetic medicine, including news and CME activities, visit Medscape’s Aesthetic Medicine Resource Center.

This article courtesy of  medscape.com – read the full article here

More and more men are willing to have a little nip and tuck to improve the way they look and feel, but many of them aren’t quite ready to let the world know about it.

“Even though cosmetic surgery procedures are on the rise in men and some don’t mind sharing their experiences, overall most men will not and choose to be more discreet,” said Mayo Clinic Florida plastic surgeon Sarvam TerKonda, who also serves as medical director of Mayo’s Breast Center.

Cosmetic surgery has always been more popular with women patients than with men, but according to the American Society for Aesthetic Plastic Surgery, the demand for plastic surgery procedures increased nearly 9 percent in 2010, with men accounting for 8 percent of the total. The society says there’s been an 88 percent increase in procedures performed on men since 1997.

Rebecca Glasser of Parkway Plastic Surgery on the Southside said she’s seen an increase in her male patients looking for easy outpatient procedures.

“I’ve had a lot of requests for botox and fillers,” said the board-certified plastic surgeon. “Men want to look good for the same reasons women seek cosmetic procedures.”

Glasser said one reason she thinks more men are opting for cosmetic surgery procedures is that their significant others are encouraging it.

“I think men want the same goals as their wives and girlfriend,” explained Glasser. “Baby boomers want to turn back the clock no matter what gender.”

TerKonda agrees, and said another factor is that some men feel pressured to feel rejuvenated in the workforce.

“Everyone wants to put their best foot forward and that includes enhancing their appearance,” said TerKonda.

Barry Lind of Avondale said he chose to have plastic surgery after losing a considerable amount of weight left him looking like a “12-year-old St. Bernard.”

“After successfully losing 30 pounds over two years, I decided to get a neck reduction at age 47,” Lind, 52, said in an email. “That consisted of liposuction and tightening of my neck muscles.”

And a year later, Lind said he went back for a chin implant.

“I’ve maintained my weight, and I look great,” said Lind. “No regrets.”

joy.freiha@jacksonville.com,

Read more at Jacksonville.com: http://jacksonville.com/news/health-and-fitness/2011-08-31/story/more-men-getting-plastic-surgery-though-theyre-not-likely#ixzz1XcToisLh

In the surgeries — closed rhinoplasty and open rhinoplasty — an otolaryngologist (ear, nose, and throat specialist), a maxillofacial surgeon (jaw, face, and neck specialist), or a plastic surgeon, creates a functional, aesthetic, and facially proportionate nose by separating the nasal skin and the soft tissues from the osseo-cartilaginous nasal framework, correcting them as required for form and function, suturing the incisions, and applying a stent to immobilize the corrected (new) nose to ensure the proper healing of the surgical cuts.[1]

Access the full Wikipedia article here.

FROM the moment you sit down for an hourlong consultation, any facial plastic surgeons worth their salt are trying to determine whether you are the kind of patient who is best turned away.

Are you the “great expectations” patient who covets the camera-ready nose of a certain red-carpet walker? Or do you consider yourself an expert who knows precisely how your brows should be lifted and how far?

Or, perhaps, you have a few facial rejuvenations behind you and a BlackBerry full of coming consultations, because you are still looking for a Dr. Perfect to wind back the clock?

“There have always been problem patients,” said Dr. Peter Adamson, a facial plastic surgeon in the department of head and neck surgery at the University of Toronto. “It’s just that now with such a growing interest and availability of procedures, we’re seeing more of them and perhaps more varied types.”

Dr. Adamson, who has written and lectured extensively about patient selection, has identified no fewer than a dozen archetypal problem patients that he warns fellow facial plastic surgeons to be wary of. He calls them the “Dangerous Dozen.”

“The point is, it’s best to identify these potential problem patients early on to determine if the risks of operating on them outweigh the chances of them achieving satisfaction,” he said.

Despite the financial incentive to take on any patient, facial plastic surgeons, who only do cosmetic enhancements from the neck up, say that operating on someone who has unreasonable expectations can have stark consequences for their livelihood and reputation: Doctors may have to do revision surgery. Postoperative follow-up is very time consuming — not to mention the potential damage a single disgruntled patient can do over the Internet.

Videos of the kinds of patients surgeons should avoid were shown for the first time at the 2007 annual meeting of the American Academy of Facial Plastic and Reconstructive Surgery. A standing-room-only panel discussion followed.

Facial Plastic Surgery Clinics of North America, a medical journal, devoted its May issue to difficult patients. Some doctors wrung their hands over their vulnerability; others shared practical solutions such as beware of the cloying patient who butters you up with compliments. It can be their way of convincing themselves that you can do no wrong.

“Doctors are paying more attention to this issue,” said Dr. Donn Chatham, a facial plastic surgeon based in Louisville, Ky. “A problem patient can be very destructive to a practice. They can be disruptive in the waiting room and take up inordinate amounts of a staff and surgeon’s time. They can also use extreme measures.”

Malpractice can be hard to prove when it comes to elective cosmetic procedures, especially if there is no postsurgical medical problem. Whether or not a nose job looks smashing or horrible is subjective.

Facial plastic surgeons say some of their most taxing cases involve former patients who do not sue but instead vent their frustration online in the comments section of plastic surgery Web sites like makemeheal.com or realself.com.

The most disgruntled and Internet-savvy may go further to create complaint sites in the hopes that patients see these sites when they search for a doctor online.

One such site, which was created by a former patient in 2005 who was suing a facial plastic surgeon in California for malpractice, detailed how she thought her brow lift and cheek implants left her looking permanently surprised. The doctor filed a cross complaint to have the Web site dismantled, but a California court ruled in favor of the patient, citing freedom of speech.

PATIENT selection is not a perfect science, nor is it a skill taught in medical schools. Rather, a facial plastic surgeon learns which patients to turn away as a fellow in another surgeon’s practice, then hones this skill on the job.

“I have been training fellows for years,” said Dr. Vito Quatela, a facial plastic surgeon in Rochester and the president of the American Academy of Facial Plastic and Reconstructive Surgery. “The No. 1 call I get once they leave is about this very topic, the difficult patient, and how to handle him or her.”

Facial plastic surgeons estimate that roughly 10 to 15 percent of the potential patients in consultations harbor outright hostility toward past surgeons or have unrealistic expectations about how radically surgery can transform the chin they hate.

“Many times the motivating factor of someone wanting a change in their appearance has more to do with an emotional issue than the actual physical issue,” Dr. Chatham said. “They may want to get a marriage proposal, save a marriage or hold on to a job, and no amount of surgery no matter how well done can guarantee that’s going to happen.

“When it doesn’t, that’s when the patient can come back to blame the doctor and if we’ve allowed that patient into our practice, then we are going to suffer.”

Patients are most likely to cause trouble when they have heightened or unfeasible expectations, said Wendy Lewis, a consultant to candidates of aesthetic enhancement surgery.

“A lot of people do not take into account that, yes, if you get a nose job, your nose may look different, maybe very different, and maybe not like the nose you’ve imagined,” said Ms. Lewis, the author of “Plastic Makes Perfect.” “Unless there’s been very clear communication about expectations between a doctor and patient, a lot can go awry in the post-op phase.”

Ms. Lewis says television makeover programs are partly to blame.

“I used to tell my staff, ‘Be careful on Tuesday morning,’ because we’d get the calls from the viewers of ‘The Swan,’ who watched on Monday nights, and would want come in, having a lot of the wrong ideas about what was possible,” she said, referring to a 2004 show in which contestants would undergo extensive plastic surgery.

Increasingly, facial plastic surgeons also employ a staff member or two to vet their potential patient pool before they sit down with prospective patients.

“Just five years ago about 40 percent of the practices I consulted with had a patient-care coordinator or coordinators on staff to help assess potential patients,” said Robin Bogner, the founder of RMB Virtual, which consults with dozens of facial plastic surgery practices nationwide. “Now 90 percent do.”

A STAFF member concerned about a patient’s unrealistic expectations may leave a Post-it on the patient’s chart or take the doctor aside. But ultimately, it is the surgeon’s call.

Once a note of caution is raised, “the hope is that they’ll turn someone down,” Ms. Bogner said. “But it’s not always the case.”

A patient-doctor consultation is, in essence, a two-way assessment, said Dr. Jonathan Sykes, a professor of facial plastic and reconstructive surgery at University of California, Davis.

“The patient is selecting the doctor and vice versa. But, whereas preoperatively it is the patient who is most vulnerable, now, postoperatively it is the surgeon.”

That vulnerability is something Dr. Richard Goode, a facial plastic surgeon in Palo Alto, Calif., has come to accept.

“We do all we can,” said Dr. Goode, who is also an otolaryngology professor at the Stanford University School of Medicine, “but no matter how beautiful the results may look to us, to our staff, to the patient’s friends and family, if the patient is not satisfied, it can be very painful for us, too.”

One patient, dissatisfied with a rhinoplasty, went over Dr. Goode’s head to his superior, the dean of Stanford’s medical school, to complain about how awful she thought her new nose looked.

The patient worked her way through his various colleagues at the university, who found nothing wrong with her new nose, Dr. Goode said.

She eventually dropped her argument months later.

But, Dr. Goode said, it was grueling.

“I’ve been in practice for many years and sure I remember some of my successes, the good relationships I’ve built with patients,” he said. “But it’s the ones who turned, the ones who became difficult patients that haunted the practice and could not be satisfied, those are the ones I’ll never forget.”

(CBS) You’ve heard of keeping your chin up?

Well, a growing number of men are choosing to keep their chins out as much as possible — by having chin implants — as they try to make themselves look better, a New York plastic surgeon says.

Dr. Darrick Antell, a spokesperson for the American Society Of Plastic Surgeons, says he examined the profiles of 42 of the top CEOs on the Fortune 500 list. The results? Ninety-four percent of those he looked at had chins that were either average or above average in prominence, when compared to the general population.

Many male movie stars also have strong chins.

In general, Antell says, plastic surgery is getting more popular among men, though nowhere near as many are having it as women. In order of popularity, men are having nose jobs, eyelid surgery, and liposuction.

On The Early Show Friday, Antell told co-anchor Maggie Rodriguez, “Oftentimes, the chin is an overlooked part of the face, and it can make a positive impact both in men and women in how they look.

Why the study>

“I was always interested in CEOs. It’s been known they tend to be taller than the average population; they’re good-looking, well spoken people. And I was curious that they might have stronger chins also.”

Some examples of high-profile people who have strong chins: “Warren Buffett in terms of the business world. Also John Mack and, on a softer chin would be Bill Gates. (His) chin is a little soft, but he’s a self-made man. He wasn’t hired for the job. In terms of stars, George Clooney, Arnold Schwarzenegger, Brad Pitt, they all have strong chins.

“And that’s not something you can exercise to make bigger. You either have it or you don’t. Surgery’s the only option (if you don’t).”

Antell explained that a chin implant is a soft, rubbery, flexible material that can be inserted with a small incision. “It sits right on the chin,” he says, “to give you a stronger impression. And it also increases the distance under the chin to give you a cleaner look and minimize the double-chin.

“They’re typically in there for life once they’re put in. But if, for some reason, you decided you didn’t like it, short-term after the surgery, you could take it out. I’ve rarely had to do that.

“I’ve seen a doubling in the last five years of people having chin implants. Sometimes it’ll be done in conjunction with a face-lift or liposuction to minimize the double-chin.”

Article first appeared in the  Herald Sun

GPs with just a few weeks’ training in surgery are performing cosmetic operations.

“A lot of people are having tummy tucks, eyelid lifts and breast operations that are not done by specialist surgeons,” said Assoc Prof Rod Cooter, president of the Australian College of Plastic Surgeons.

“A lot of these people purport to be plastic surgeons but they may not have specialist surgical qualifications and it’s hard for the public to work it out.

“It’s the masquerading that’s the issue, and legislators need to qualify who is a surgeon and who is not.”

Plastic surgeon Dr Chris Moss said one of the problems was that doctors “can call themselves a surgeon just because they perform surgery – even if they have not done any specialist surgical training”.

The debate reflects the turf war between plastic surgeons – who have at least six years of medical training and six of specialty surgery training – and cosmetic doctors who have a medical degree but are not trained as surgeons.

In Victoria both are permitted to perform surgery.

But cosmetic doctors say they are highly trained and specialised, and have excellent results.

Dr Gavin Chan, who specialises in non-surgical procedures, said patients should look at a doctor’s experience and reputation and use a trusted referral source.

Australian Institute of Health and Welfare figures show just 0.8 per cent of all medical indemnity claims are lodged against cosmetic and plastic surgeons.

Archives of Facial Plastic Surgery

Surgical Technique
Arch Facial Plast Surg Jul/Aug 2007 2007;9(4):285-289.

Pieter F. Swanepoel, MD; Robert Fysh

Laminated Dorsal Beam Graft to Eliminate Postoperative Twisting Complications

By MIKAELA CONLEY
July 27, 2011

Most people looking to get a nose job, or rhinoplasty, hope for a better-looking nose, but a new study found that 33 percent of them show signs of body dysmorphic disorder, or BDD, a chronic mental illness characterized by excessive worry over appearance that interferes with daily life. The condition does not improve after plastic surgery, and oftentimes, symptoms worsen post-surgery.

The study, published in the journal Plastic and Reconstructive Surgery, surveyed more than 250 Belgian patients seeking plastic surgery to improve the appearance of their nose. Researchers found that one-third of those patients had moderate to severe symptoms of BDD.

Symptoms of BDD include extreme self-consciousness, excessive grooming, frequent examination in the mirror or avoiding mirrors all together and steering clear of social situations because of one’s appearance.

“This study shows that the prevalence of BDD symptoms in a cosmetic rhinoplasty population is high and that the severity of symptoms has a clearly negative effect on daily functioning,” the authors concluded.

People who already had one nose job and sought a second one were even more likely to have self-image issues. Also of note, the shape of a person’s nose did not relate to the severity of BDD symptoms.

“Almost everybody is going to have some degree of unhappiness with their appearance, but when concern becomes excessive and interferes with day-to-day functioning, where the person can’t stop thinking about it, that’s when we start to worry about body dysmorphic disorder,” said David B. Sarwer, a Philadelphia-based psychologist who wrote an editorial about the study.

“When somebody comes in, especially for a nose, it’s important to ask that patient about their psychological history,” said Dr. Malcolm Roth, director of plastic surgery at Maimonides Medical Center in Brooklyn.

Roth said rhinoplasty is the most difficult plastic surgery procedure to perform, but along with the procedure’s complexity, the nose also holds importance for another reason.

“When you look in the mirror, it’s the first thing you see,” said Roth. “If someone is unhappy with aspects of their current life situation, the nose is often the first thing they’re going to see and they may blame the nose for their having social or work issues.”

Experts say the study highlights the need to be particularly aware of this psychological condition during the screening and consultation.

“It’s important to express to the patient that this is a significant change and a serious decision,” continued Roth. “Sometimes it’s appropriate to suggest that the patient speak with a psychologist to discuss what exactly it is they want and why they want it.”

And if doctors find that a patient shows too many symptoms of BDD to follow through with the procedure, Roth said, “I always tell surgeons, you never regret the operations you didn’t do.”

American Society of Plastic Surgeons President Dr. Phillip Haeck said he was confident that board certified surgeons screened patients thoroughly, but it’s the thousands of noncertified surgeons who still offer the same services that he worries about.

“Hopefully board certified surgeons are perceptive enough to turn these people down for surgery, but there are a lot of people who are not board certified, and my concern is that these people will shop around until someone will do their surgery,” said Haeck. “The lesson here is for plastic surgeons to remember to say ‘no.’”