Excessive sweating is a not uncommon problem that can result in the need for frequent antiperspirant applications and even constant clothes changing. Known as axillary hyperhidrosis, it is an embarrassing and very problematic problem for those so affected. The historic treatments have been strong astrigents which often are minimally effective or with limited duration of effect. The introduction of Botox injections was a revolutionary treatment for axillary hyperhidrosis that is dramatically effective even though its effect are only temporary and fairly expensive.

The new miraDry treatment, however, offers a lasting non-surgical solution as an office treatment. The miraDry is a device that delivers electromagnetic energy, similar to a microwave, to the underside of the skin where the sweat glands reside. The device delivers controlled energy waves to permanently shrink the sweat glands. Because the device involves the creation of heat, the underarms must first be numbed.

Get lasting results with a quick, non-invasive procedure performed in your physician’s office. The miraDry procedure uses the only non-invasive technology that is FDA cleared to provide lasting results. The procedure uses precisely controlled energy to eliminate underarm sweat glands. Because the sweat glands don’t grow back once eliminated, the results are dramatic and lasting.

The miraDry technique involves two procedures that are spaced 3 months apart to achieve the best results. Because the sweat glands don’t grow back after the treatments a partial to complete reduction in overactive sweating is achieved. This is an FDA-approved device and treatment in which the clinical studies showed an average 82% reductionin sweating.

There is no downtime after ther procedure. Patients may resume all normal activities right after the treatment. There usually is some mild soreness and swelling in the treated areas which takes about a week to go away. Temporary numbness of the armpits is also common which will take longer than the swelling to go away. These are all expected reactions from a device whose effects are based on ‘microwaving’ the sweat glands.

Dr. Barry Eppley

Indianapolis, Indiana

While many people enjoy the apparent healthy glow of a good tan, the long-term consequences of looking ‘bronzed’ are far less glorious. Like smoking from many decades ago, most people know it is not good for you but just can not resist doing it. This is particularly true amongst teens and young people who are infused with an understandable perception of immortality.

The Food and Drug Administration (FDA) has now proposed that indoor tanning beds be labeled with consumer warnings about the risks of developing skin cancer from their use. This is just a warning and does not preclude anyone, even a minor, from using them. But it will have in the warning a recommendation that warns young people not to use them. If approved, and I have no doubt it eventually will, this would reclassify sunlamps from a Class 1 device to a Class 2 device signifying the increased health risk with their use.

Despite the position of the tanning industry that indoor tanning beds do not pose any health risks, the reality is that sunlamps do damage your skin and increase your risk of developing skin cancer. According to the American Academy of Dermatology, the use of tanning beds increases the risk of developing the most severe form of skin cancer, melanoma, by a striking 75 percent.

While plastic surgery always has and always will be dominated by female patients, more and more men are taking advantage of the changes that it has to offer. This is a reflection of a multitude of factors coming together including refined surgical techniques, new products and a fashion trend towards more masculinizing appearances of the face and body.

For the face, I have seen a strong trend towards the desire for more defined and strong jawlines. Men want not only a more pronounced chin but a jawline that goes with it. This includes more angular and defined jaw angles and a more straight jawline that connects it with the chin. To create this effect, more men are having a three-piece jaw implant approach of one chin and two jaw angle implants…as opposed to just an isolated chin augmentation procedure.

Men are also seeking stronger more ethnic noses as well. Men do not want smaller, dainty or upturned noses. They prefer noses that have a high, but straight, dorsal line. Even a small hump on the bridge may be acceptable if it is just a slight bump. They want a more narrow nasal tip but not an over rotated one. A straight and not too long of a nose is more important than a perfectly straight dorsal line for some men. I have done a few noses recently where the men prefered to leave just a little bump on the nasal bridge…to look better but still like their original nose somewhat.

While Botox and injectable fillers will always play a very small role in male facial rejuvenation, other slightly more invasive procedures are of more interest. A little liposuction under the chinj or along the neckline can help clean up the jawline in relatively short order. Fat reducing skin tightening devices, like Exilis, are also popular when a guy sees some neck or jowl line skin laxity developing. While the results are more subtle not the magnitude of surgery, the lack of downtime is very appealing.

Body procedures in men are becoming increasingly dominated by chest reshaping efforts. At the smallest level, the protruding nipple is a problem for men of all ages and nipple reductions are a simple and quick reduction procedure done in the office. Gynecomastia problems are often much smaller today than in the past. ‘Puffy nipples’ problems have become more common than the larger breast mound gynecomastia issues from years ago. Men simply don’t like any protrusions from their chest other than a well-shaped pectoralis chest muscle profile. Using either small cannula liposuction to reshape the pectoral outlines or creating increased muscle size by the placement of pectoral implants, men are making changes to their chest that diet and exercise can not create.

Men are becoming more familiar and comfortable with what plastic surgery has to offer. But their desires and needs are somewhat different than that of women and it is important that they seek improvements through plastic surgeons who are in tune with these more contemporary male aesthetic procedures.

Dr. Barry Eppley

Indianapolis, Indiana

The internet is full of information on plastic surgery and many other beauty treatments. But how reliable is it? Can you trust what you read and would you go under the knife based on information that you have ‘Goggled’? Everyone’s knows that just because it is found and indexed highly on a web search does not necessarily make it gospel.

Thus the role of reliable information on a topic is internet gold if you can find. When it comes to plastic surgery, nothing would be more reliable than information provided by a board-certified plastic surgeon. And what if you can ask a question and get 10 or 15 plastic surgeons to answer that very question. That could be the equivalent of a mini-educational seminar.

This is the role that the website, Real Self, plays for plastic surgery. Started in 2006, it has over 3 million visitors each month and several thousand doctors of different educational backgrounds poised to answer patient questions from all over the world. The answers are based on each doctor’s own clinical experience and no two answers may be the same.

The decision to get a breast augmentation, tummy tuck or rhinoplasty for example are big ones for each person considering them. They require a big commitment of time and money and everyone is counseled to do their research. The opportunity to talk to get feedback from multiple plastic surgeons and to other people who have had the procedure or are considering it makes the whole experience more transparent.

Although they may be as many as 5,000 physicians who are enrolled on Real self to help answer patient questions, the 80:20 rule applies just like it does in many situations in life. The vast majority of information is provided by a minority of physician participants. Dr. Barry Eppley, Indianapolis board-certified plastic surgeon, was recently honored as a Real Self top 100 doctor by the company. Having answered over 2,500 patient questions, this places Dr. Eppley in the top 100 of all Real Self physicians. Answers have been given to a diverse number of primary and secondary plastic surgery problems.

The annual 2012 statistics report from the American Society of Plastic Surgeons is in and its review is always noteworthy. As it provides an overview of what board-certified plastic surgeons have done, it does not incorporate cosmetic procedures than any other physicians may do…so it is not the total real number of all the cosmetic procedures that occur in the U.S.. But it does come from the greatest concentration of physicians who perform the broadest range and the greatest number of cosmetic procedures so it’s numbers do have a lot of value.

Over 14 million cosmetic procedures were performed in 2012, a number that is about 5% greater than the year before. Breaking that number down between surgery and non-surgery, actual cosmetic surgery was down 2% while the collection of procedures that are minimally invasive were up by 6%. This is a trend that has been going on for years now as more and more people of all ages participate in the benefits of Botox, injectable fillers and various laser and medical skin treatments. The neuromuscular modulators, such as Botox, rose to greater than 6 million performed for the first time ever.

The top five non-surgical procedures, which overall increased 6%, included Botox +8%, injectable fillers +5%, chemical peels +2%, laser hair removal +4% and microdermabrasion +8%.

The top five surgical procedures, which was down by 2%, included breast augmentation -7%, rhinoplasty 0% change, eyelid lifts +4%, liposuction -1% and facelifts +6%.

As can be seen by the numbers, facial rejuvenation procedures rose the most in both surgical and non-surgical areas as a reflection of an aging population that sees the value of maintaining a less tired and more youthful appearance. It is also a reflection of the burgeoning number of options available for facial rejuvenation from injections to numerous energy-based devices. By the numbers the following facial procedures showed increases: intense pulsed light +10%, laser resurfacing +9%, Botox +8%, microdermabrasion +8%, injectable fillers +5%, facelift surgery +6% and eyelid lifts +4%.

In the body contouring area long dominated by female breast and abdominal procedures, the number of men (even though they are still way lower in total numbers to women) showed a strong increase. Male body contouring was up lead by an increase in the numbers of gynecomastia procedures performed which was up by 5%. The greatest surge in all the body contouring procedures, however, were arm lifts or brachioplasties. While last year’s surprise winner for a great increase in number of procedures performed was chin augmentation, this year it is armlifts. More bariatric patients, improved liposuction technologies and a female cultural focus on better looking arms is behind the greater numbers of arm reshaping procedures.

Dr. Barry Eppley

Indianapolis, Indiana

While everyone knows that the most psychologically healthy reason to have cosmetic surgery is based on internal motivations, some patients do experience external stimuli for it. I have had many ‘couple’ consultations where the husband, fiancee or significant other was just there for support for the female seeking some cosmetic enhancements. In almost every case the male was quick to say that they were just there to be supportive not to sway anyone’s opinion about the ‘need’ for plastic surgery.

Men are quick to state, even though they are never asked, that the desire for their partner’s surgical requests is their partner’s alone. They may say that because they do not want me to think that their partners  are ‘forced’ to be there or maybe because thay secretly do want them to have the procedure but just don’t want to seem too eager.

This question was indirectly answered in a recent survey that appeared in a UK publication. In this survey, relationship-related questions were asked of over 1,200 men. Questions such as would you want your significant other to ever have plastic surgery and, if so, what surgery do you think she needs or should have? Would you be bold enough to tell her?

Interestingly, about a quarter of the men admitted that they did want their significant other to improve their appearance by undergoing plastic surgery. (only 20% said no)  Of all the procedures listed, liposuction and breast augmentation topped most men’s wish list at 57% and 49% respectively. Rhinoplasty and Botox were at the bottom of the desired enhancements. A surprising 42% wanted their partner’s to have corrective dental work but this was a UK survery after all.

Despite the wish of some men for their partner’s to have aesthetic enhancements, less than half were willing to admit it to their partner. They weren’t willing do so because they didn’t want to upset their partner. Not surprisingly, fear of retaliation, an argument, or abandonment inhibited about a quarter of men from disclosing their cosmetic surgery wish list. Most interestly, the majority of men who wouldn’t admit to it said it was primarily because they felt their partner’s looks couldn’t be significantly improved even with surgery.

I don’t think the results if this survery were particularly surprising. Some men would like their partners to have plastic surgery, others don’t. Many men don’t think that plastic surgery can even help their partner’s appearance. Most men don’t want to tell their partners, even if they think it would improve their level of attractiveness, because they know that such admissions are often counterproductive. That may explain the men I see in their partner’s consultations who are so quick to state ‘they don’t care if she has plastic surgery or not…it is all their idea.’

Dr. Barry Eppley

Indianapolis, Indiana

Elective plastic surgery done for cosmetic gain always take a careful look at the patient’s general health beforehand. With some notable exceptions (morbid obesity, diabetes, smokers) it is fair to say that any person under the age 50 is unlikely to have medical problems that would exclude them from having almost any type of plastic surgery safely. Most certainly, the most athletic and fit individuals would seem to be ideal candidates to undergo a surgical experience without incident. Recent reports have pointed out, however, that there is one unique athletic patient that is at risk of the heart stopping (asystole) during surgery. Several cases have now emerged in young women who were endurance trained (marathon runners) with presurgical slow heart rates below 60 (bradycardia) that are at risk for cardiac arrest during surgery. The exact mechanism is not fully understood why this can potentially happen. Ironically the most very fit, perhaps unnaturally fit, patient has an increased cardiac risk for surgery in general if they have a low heart rate. While no deaths have been reported from these events happening in surgery, plastic surgeon and anesthesiologist need to be on guard in the athletic patient with a slow heart rate.

As tax day is upon us, many are pondering what deductions of expenses they can and should take. In that spirit I occasionally will get asked by a patient whether the costs from their plastic surgery are tax-deductible. Most are joking of course but a few I think are serious. As I am a plastic surgeon and have no knowledge about tax law, I recommend they ask a tax expert, lawyer or accountant, about their filing questions.

It would be hard to imagine that any type of cosmetic surgery would ever be deductible, but apparently there have been a handful of patients that have been able to take their procedures as a legitimate expense. In an article that appeared today in the journal Plastic Surgery Practice written by a tax expert, several successful tax cases were reviewed. One case was an exotic dancer whose breast implants were so large that were considered a legitimate expense to benefit her career. The other was a case of transgender surgery as the underlying condition was deemed medical in origin due to the diagnosis.

According to the article and the tax experts, cosmetic surgery may be considered a deduction if it satisfies two criteria. It must be a condition of employment and that the procedures do not create benefits for everyday use. In addition while partial deductions can be taken for expenses paid for medical care, cosmetic surgery is specifically excluded unless it is considered corrective. (I assume this falls into the classic distinction between what we as plastic surgeons call reconstructive vs. cosmetic) This would appear to mean those phsyical deformities that emanate from either congenital, traumatic or disease origins. They cite the most notable example of the difference between placing implants and other procedures for elective breast augmentation (cosmetic) vs that of re-creating a lost breast from cancer. (reconstruction) Another example would be the difference between a typical tummy tuck vs that of an abdominal panniculectomy due to the differences in medical symptoms that the pannus causes.

As a plastic surgeon, it appears that the tax distinction between pure cosmetic surgery and that of reconstructive surgery is very similar as to how medical insurance determines coverage of specific plastic surgery procedures. But the best answer for that comes from the patient’s tax advisor.

Dr. Barry Eppley

Indianapolis, Indiana

Eyebrows, particularly for women, play an important part of facial attractiveness. Most think of beautiful eyebrows as their shape and degree of and location of their arch. But recent studies show that eyebrow shape is not the only feature that makes them attractive. Eyebrow projection may be just as important as shape. Eyebrows that have high walls, a slight prominence below the brow bone, helps frame the eye like a frame for a picture. Higher walls allow for greater projection of the eyebrow which correlates to perceived facial attractiveness. The area between the eyelid and the brow bone, known as the oblique frame, is what helps frame the eye not necessarily the brow bone itself. Studies show that women with higher oblique frames are consistently rated as more attractive. What is the best way to have a more prominent oblique frame…fat injections. A few ccs of fat judiciously and carefully placed in the oblique frame area may do as much for eyebrow attractiveness as its shape.

Stem cells has understandably caught the imagination of both plastic surgeons and patients alike with their regenerative potential. This has led over the past few years to surgeons promoting their benefits to patients by so-called stem cell-enhanced or derived procedures. From facelifts to fat grafts, the moniker of the words ‘stem cells’ confers an improved method which leads to better or more long-lasting results. Such promotions have been done even though the FDA has not approved any stem cell therapies for cosmetic use.

Manufacturers of devices that can create stem cell concentrates have also emerged. This is usually done by taking fat obtained by liposuction, processing it through an on-site machine, and then a near immediate stem cell preparation obtained for patient re-introduction, usually by injection, is available. Laboratories also began offering services that will also take a patient’s fat, extract the stem cells, and grow them in cell culture to be available for use weeks later. The patient’s stem cells could also be stored and used in the future if desired.

Despite the initial tremendous enthusiasm and unregulated behavior when it comes to stem cell use, that has come to an abrupt end in the past year. The American Society of Plastic Surgeons and the American Society of Aesthetic Plastic Surgeons issued policy statements that their members should avoid offering and marketing stem cell procedures. This position is based on the scant human evidence in the medical literature to support the benefits of injecting stem cells into patients. While there may be real benefits to the use of stem cells, it is way too early to know what their actual benefits are, how they might work and what are the best indications for their use. Long-term controlled human studies need to be done for various plastic surgery indications to determine their efficacy…just like the approach used for drugs.

While plastic surgeons have been admonished by their own societies to cease stem cell therapies, the manufacturers and laboratories of stem cell-derived devices have received more stern edicts. Recent legal rulings have sided with the FDA that all companies processing stem cells or selling machines that extract and concentrate stem cells must do so through a formal FDA regulatory process involving controlled human clinical trials. There will no fast-tracking or short cutting to human use based on the comparative use of processing blood and blood-derived products. Basically the legal ruling is that fat is not blood and and large studies involving human participants is needed.

Adult stem cells are found in various locations throughout the body, but fat has the highest concentration of them. Obtaining stem cells from liposuction-derived fat has brought their potential use to quick fruition. But with this potential may come unknown risks that are more likely to be revealed (if indeed they do exist) in controlled human clinical trials than theoretical plastic surgery procedures that are highly marketed.

Dr. Barry Eppley

Indianapolis, Indiana