Angelina Jolie’s preventative double mastectomy and subsequent breast reconstruction resulted in a firestorm of publicity.

Not only did it create dialogue about what to do when testing positive for the defective BRCA 1gene as Jolie had, but also about the type of reconstruction.

The defective BRCA1 gene increases breast cancer risk by an estimated 87 percent.

In Jolie’s case, the facts that her mother, her maternal grandmother and most recently, her aunt died of the disease added weight to her decision. Breast cancer risk drops to below 5 percent after a preventative double mastectomy.

Jolie’s choice of “teardrop” implants also ignited discussion. Teardrop or shaped implants are contoured and are considered the most natural, both in look and feel.

Jolie’s three surgeries were done through the creases underneath her breasts, a common procedure which minimizes incision lines.

The first focused on saving the nipples and the second was a total mastectomy, in which the breast tissue was removed and tissue expanders were put in place. No cancer was found.

While some women have implants at the same time as the mastectomy, Jolie chose to have a third surgery for their final placement to help ensure the best cosmetic outcome. The surgery also utilized donor skin to provide support and contour to the implants. From start to finish, all three surgeries took less than three months.

Both Jolie and her physician are pleased with the results. Adds Jolie: “I have been very happy just to see the discussion about women’s health expanded, and that means the world to me and after losing my mom.”

Angeline Jolie by oparazzi photos on Flickr

Most patients undergoing an endoscopic brow lift are pleased with the results and would recommend the procedure, according to a recently published study in JAMA Facial Plastic Surgery.

The telephone survey, which examined satisfaction, recovery and outcomes, involved 57 patients who had undergone either a brow lift alone or concurrently with a facelift.

Also known as a forehead lift, a brow lift can result in more alert and youthful appearance, improving so-called frown lines. It can also help minimize creases across the forehead or high on the bridge of the nose as well as correcting low or sagging brows. In some cases, brow lifts have also reduced or even helped eliminate migraine headaches.

Researchers found that 93 percent of patients reported the procedure as successful and 96 percent would recommend it. Nearly three-fourths of those surveyed stated that they had been told looked younger and less tired and that the procedure helped bolster their self-confidence.

Along with a quick recovery of about a week– return to normal activities after more than two weeks was mostly reported by those who also underwent a facelift – scars and swelling were minimal, as were complications such as numbness. And 50 percent of the patients who reported headaches prior to surgery experienced a reduction in their frequency and intensity.

Such surveys not only enhance research but assist consumers in making informed decisions. Additionally “relying on patient-reported information helps us to better understand the surgical experience and to improve preoperative counseling,” the authors write.

Photo by nicksarebi on Flickr

With guidance from a board certified plastic surgeon, you can choose a breast reconstruction type that restores a feminine shape after mastectomy or lumpectomy.

Implants

Implants can either be filled with either a saline solution (most common) or silicone gel. Depending upon the situation, one-stage immediate breast reconstruction may be performed the same time as mastectomy.

Here, the implant may be put in the space where breast tissue was removed or behind the chest muscles. Or, more commonly, the implant may be done via two-stage or delayed reconstruction where the surgeon implants a tissue expander. A salt water solution is injected to fill the expander over time, usually 4-6 months.

Once the skin over the breast area is stretched, the expander may be removed and replaced with an implant or may even be left in place as the final implant. The FDA also recently approved cohesive silicone gel implants, which contain a firm silicone that holds its shape better than previous implants.

Tissue Flap Procedures

The two most common types of tissue flap procedures are the TRAM (transverse rectus abdominis muscle) flap, which takes tissue from the lower stomach and the latissimus dorsi flap, which uses tissue from the upper back.

These operations require two surgical sites and leave scars where the tissue was taken and on the reconstructed breast. The newer DIEP (deep inferior epigastric artery perforator) flap procedure uses fat and skin from the belly and also the muscle to form the breast mound. This results is a “two-fer” that provides a tummy tuck in addition to breast reconstruction.

Photo by merrick310 on Flickr

This video shows Natalie Robinson’s before-and-after photos. The ones she “couldn’t wait to take.” Over the last 36 months, Natalie has lost more than 170 pounds, and before having surgery to remove excess skin on her arms.

“They’re a reminder of that heavier person and you couldn’t get rid of it and it was just something else to worry about.” So Natalie decided to have arm lift surgery to tone her upper arms.

She had a type of upper arm procedure called brachioplasty, which is rising in popularity. “We did do more brachioplasties last year than we did the year before and we’ll probably do more this year,” said Natalie’s plastic surgeon Dr. David Reath. “We get rid of the skin, we leave a scar,” he explains. So as long as there’s enough improvement to be made in the shape of the arm to justify the scar, then it’s a great procedure.”

Brachioplasty was enough for Natalie. Despite the dramatic weight loss she had achieved on her own, she knew that when it came to the shape of her arms, she would need a plastic surgeon’s help. “Very happy,” she says. “It was well worth the investment. I would do it again.”

The actress and director revealed that she recently chose to have a double mastectomy after doctors told her she had the breast cancer gene BRCA1, meaning Jolie has an (estimated) 87 percent risk of getting the disease.

She decided to be “proactive” and undergo a preventive double mastectomy, followed by breast reconstruction with implants. The procedures were completed just last month.

About her reconstruction, she writes:

“Nine weeks later, the final surgery is completed with the reconstruction of the breasts with an implant. There have been many advances in this procedure in the last few years, and the results can be beautiful.”

Photo by the Foreign and Commonwealth Office

An FDA panel has recommended approval of Juvéderm Voluma XC for cheek augmentation, which would make it the first injectable dermal filler with indications for volume restoration in the mid-face. If approval takes place – and the FDA generally follows advisory committee recommendations — it could become official later this year.

A gel composed of hyaluronic acid suspended in phosphate buffered saline with 0.3 percent Lidocaine, Juvéderm Voluma helps restore deep volume loss and smooths the mid-face, rejuvenating sunken areas around the cheeks, re-creating youthful contour and fullness in the chin. The results are instant, natural looking and can last up to 18 months. There’s little if any downtime – most people resume normal activities immediately.

Based on the clinical trial data presented, the FDA’s General and Plastic Surgery Devices Panel agreed that the product is effective and safe and the benefits outweigh the risks. The most frequent common treatment site responses (CTRs) reported in the trial were tenderness, swelling, and firmness. FDA reviewers noted that the incidence of CTRs decreased for subjects receiving touch-up and repeat treatments. More than half (52.8 percent) of subjects received the optional retreatment at the end of the extended follow-up period “suggesting these subjects perceived an acceptable benefit/risk profile for [its] continued use,” the reviewers said.

An additional consensus was that Juvéderm Voluma XC fills more than cheeks, meeting the needs of what people want in plastic surgery. According to the American Society for Dermatologic Surgery (ASDS), in 2012 nearly 2 million people had soft tissue filler augmentation, representing a 205 percent increase since 2000.

Photo by Alaskan Dude on Flickr

After mastectomy, you may feel overwhelmed by the physical and emotional ramifications of diagnosis, surgery and breast reconstruction. But with hospital stays averaging three days or less, it’s important to know what to expect. These brief checklists can help guide you through the process.

Before leaving the hospital, you’ll receive instructions on:

• Taking pain medication
• Caring for the bandage over your incision and, if still inserted, a surgical drain
• Managing stitches and staples (most stitches dissolve, while staples are removed later during an office visit)
• Recognizing signs of infection and lymphedema, the swelling of the soft tissues caused by fluid buildup
• Wearing a prosthesis or a bra (often depends on type of surgery and time needed to heal).

When you get home:

• Recovery times vary, depending upon the type of surgery.
• Get plenty of rest. It’s normal to experience fatigue for several weeks after mastectomy.
• Take pain medication only as needed
• Take sponge baths until your doctor removes drains and/or sutures
• Ask for help — have friends and family pitch in around the house

In the months following mastectomy:

• As nerves regrow, you may experience phantom sensations or pain in the area around the mastectomy. Analgesics such as such as acetaminophen and ibuprofen can usually take care of this.
• Expect some fatigue, although if it persists and remains constant, consult your physician.
• Throughout your recovery, it’s important to start exercising soon after surgery. Along with preventing arm and shoulder stiffness, exercise will keep the area limber and help initiate healing.

Your healthcare team should provide written, illustrated instructions for a routine tailored to your needs. Follow all post-operative instructions from your provider. The above checklist is for discussion only and should not replace your provider’s specific instructions for recovery after mastectomy.

Juvederm and Restylane are safe, effective, FDA-cleared treatments for facial wrinkles and folds. They’re the most popular dermal fillers available, making up the majority of treatments using injectable fillers. Both are made with hyaluronic acid, a natural component of your skin and connective tissues.

Compared to the collagen-based fillers of the past, Restylane and Juvederm represent a big step forward. They not only last longer, but you can receive treatment the same day as the consultation, with no allergy test or waiting time necessary.

Product Breakdown:

• Lasting results: According to Allergan, Juvederm is the only hyaluronic acid filler that’s FDA approved to last one year with a single treatment. On Restylane’s website, clinical studies are cited, showing that Restylane lasts 18 months when patients returned for a touch-up treatment at 4.5 or 9 months.
• Cost: the cost of Restylane is about the same as Juvederm. However, Juvederm is sold in a complete syringe, while Restylane is available in two sizes, which can be more economical.
• Consistency: Juvederm injectable gel is smoother than Restylane, which does not necessarily improve the treatment or its results.
• FDA approved indications: Both products are approved and primarily used to treat nasolabial folds, or smile lines. Restylane has an additional indication for lip augmentation.
• Patient Rewards: Allergan offers the Brilliant Distinctions program that includes Botox, Juvederm, Latisse, and Natrelle breast implants. A less robust offering called “Restylane Rewards” is available through Medicis, the maker of Restylane.

Trust Your Plastic Surgeon to Recommend the Best Filler

Both plastic surgeons and patients have their own preferences based on past experience with each product. When it’s time to decide between them, trust your surgeon’s recommendation first, because it takes a trained hand to administer Juvederm, Restylane or any other dermal filler. These treatments provide temporary results. So if you don’t like the outcome, you can always try the other filler during your next visit.

Photo by @boetter on Flickr

Facial fillers are some of the most popular non-surgical cosmetic treatments available. Often combined with Botox, fillers can temporarily reduce the appearance of age-related wrinkles and folds, including nasolabial folds, lip lines, laugh lines, and marionette lines.

A recent study in Facial Plastic Surgery concluded that “complications are rare following treatment with injectable soft tissue fillers.”

Doctors Steven M. Daines and Edwin F. Williams performed over 2,000 injectable filler treatments in their private New York City practice, using a variety of different fillers. During their 4-year study, the most common side effect they found was nodule or granuloma formation. The filler with the highest complication rate, at 2.6 percent, was calcium hydroxylapatite.

How Do Fillers Work?

While many people still confuse Botox and fillers, these two medicine work in different ways. Rather than acting on the facial muscles to relax wrinkles, they fill it with a substance that boosts volume in the tissue for a period of time. Some fillers, such as poly-L-lactic acid, work by stimulating collagen deposition, which takes time and achieves results gradually. Others, such as the popular hylauronic acid, bind to water in your skin, and act as a cushioning agent. With any filler, the goal is to increase tissue volume and thereby augment the tissue that has become depleted and wrinkled.

6 Types of Injectable Fillers

Surgeons offer a variety of different fillers. When it comes to choosing one, we consider your personal preferences and your cosmetic concerns, and then recommend a filler that can meet your needs. Here are the most common dermal fillers:

1. Fat grafting: this treatment uses your own body fat. After liposuction, fat is spun in a centrifuge to remove excess water. Through a series of micro-injections, the fat augments your facial tissues to reduce the appearance of wrinkles or folds.

2. Collagen fillers paved the way for many of today’s popular injectables. These fillers are sourced from human, bovine, or porcine tissue. As HA-based fillers like Juvederm and Restylane have gained popularity, collagen is used less often today. The results of a collagen filler injection last about 3 months.

3. Hyaluronic acid: Since FDA approval in 2003, non-animal stabilized hyaluronic acid (HA) dermal fillers have been extremely popular for non-invasive cosmetic applications. HA acts as a natural cell protector, hydrator, and cushioning agent in your tissues. It can be found in the soft connective tissue, skin, cartilage, joints, and the fluid around your eyes. Fillers that use HA include Juvederm, Restylane, Perlane, and Belotero. The results of a treatment last about 6 months to 1 year.

4. Calcium hydroxylapatite (or Radiesse) is a heavier dermal filler made with calcium-based microspheres suspended in a water-based gel – a mineral compound that is found naturally in teeth and bones. We use it to treat deep creases like the nasolabial folds and marionette lines. It may also augment the cheeks and other facial contours.

5. Poly-l-lactic acid (Sculptra Aesthetic) is a synthetic polymer that stimulates gradually collagen deposition. Treatment in the lower face can fill laugh lines or fill deep smile lines. Unlike other dermal fillers, polymer doesn’t produce instant results. A gradual process, involving multiple treatments, stimulates collagen production that corrects wrinkles, folds, and depleted tissue. The results are long-lasting.

6. PMMA fillers (ArteFill) consist of tiny PMMA microspheres that are suspended in a collagen gel. This semi-permanent filler is typically used to treat medium or deep wrinkles, especially nasolabial folds. It is currently being studied as a treatment for acne scars.

Learn More About Dermal Filler Safety

Still wondering about the safety of dermal fillers? Read more on the UCI website about injectable products, and contact us to schedule an appointment. We’ll be happy to discuss the benefits and risks of each wrinkle filler, so you can make an informed decision about treatment.

Through a peer nomination and selection process, Doctor Gregory Evans was recently named Top Doctor in the latest U.S. News and World Report.

31,000 top physicians from a variety of specialties were selected, but only 1 percent of them are plastic surgeons. Dr. Evans is honored to be among these excellent physicians.

A Peer Nomination Process

When another physician needs to refer you to a plastic surgeon, who do they choose? According to this year’s U.S. News and World Report, they are likely to refer you to Dr. Evans here at UC Irvine in Orange County.

To determine who is a “Top Doctor,” the magazine first identifies doctors by their location and hospital affiliation. They find thousands of physicians from a wide range of medical specialties.

Next, other licensed physicians nominate their colleagues online, choosing up to 10 from their own specialty and 3 from other medical specialties. A doctor cannot nominate herself, and cannot pay to be listed as a Top Doctor.

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