Latisse™: A revolutionary new treatment for eyelashes April 27, 2009

Recently, an exciting new treatment for eyelashes has become available.  Latisse™ is a new prescription strength medication that was recently approved by the FDA.

 

The treatment has been shown to be a safe and remarkably effective way to grow longer, darker and thicker eyelashes.

 

Latisse™ is quite easy to use.  Each night patients merely need to remove makeup and contact lenses, wash their face, and apply the medication.  The application consists of placing a single drop of Latisse™ near the tip of the disposable applicator brush, and then immediately applying the medication to the skin of the upper eyelid near the base of the eyelash.  The medication does not need to be separately applied to the lower eyelids.

 

Although gradual changes can be seen within the first few weeks of starting Latisse™, the majority of patients should see significant improvement within 8 weeks.

 

Side effects tend to be rare and mild in nature.  The two most common are itching and redness of the eye.  Other possible complications include darkening of the upper eyelid skin where most women apply eyeliner and darkening of the colored part of the eye.  Patients who stop using Latisse™ can expect their eyelashes to return to their normal appearance within a few months.

 

Patients with a history of an allergic reaction to any of the ingredients in Latisse™, should not use the medication.  Also, patient’s with a history of glaucoma or who have risk factors for this condition should consult with their ophthalmologist before starting Latisse™.

 

Please call our office at 877-389-0368 to set up an appointment to see if this new treatment is an option for you.  Also, more information can be obtained at www.latisse.com.

 

Dr. Kelly Gallego is a board certified plastic surgeon with offices in Newport Beach and Corona, CA.  Please visit his website at www.GallegoPlasticSurgery.com

My recent trip to India January 19, 2009

Recently, I embarked on an adventure to India.  The trip was part of an exchange program sponsored by The Smile Train (smiletrain.org), a charitable organization primarily dedicated to helping patients with cleft deformities in the developing world.  I left roughly a week after the terrorist attacks in Mumbai, so as you can imagine my mom, sister and girlfriend were more than just a little nervous about me going.

 

Passing time at the airport in London

 

 

 

The trip lasted 11 days, although because of the distances traveled, I was only in India for a week.  The town I visited is called Hisar.  It is in the state of Haryana in northwest India about a three hour drive from Delhi.  Because of a paucity of tourist sites, the town itself is infrequently visited by Americans.  Thus, many of the inhabitants viewed me as quite a novelty.  

 

 

 

This was my first trip with The Smile Train, so I was a little uncertain of exactly what to expect.  Instead of going with a team, the Smile Train exchange program allows individual plastic surgeons to plan their own trips to credentialed sites in the developing world.   While in Hisar, my time was spent almost exclusively with Dr. Sunil Soni, an incredibly well trained Indian plastic surgeon.  Dr. Soni’s practice is full of variety with the majority of his time spent treating patients with clefts, burns, hand problems, trauma, hypospadias, and occasionally cosmetic concerns. 

Dr. Sunil Soni, myself, and the scrub nurse a.k.a. "half ticket"

 

 

 

The medical building we worked in is set up a bit differently than the ones here in America.  The building itself has four levels.  In the basement was the laboratory, pharmacy and physical therapy room.  The first floor had the operating room, and doctors’ offices.  Dr. Soni shares the building with his brother Monish, an orthopedic surgeon.  The second floor had the patient rooms with roughly 20 beds.  The top floor was the apartment where Dr. Soni lived with his family.  Larger, standard hospitals also exist in India, but this privately owned set up is much more common.

 

 

Dr. Soni's Hospital

 

 

During the week that I was there, we did quite a few procedures.  As you can imagine, I tried to take as many pictures as possible.

 

A 16 year old boy with an unrepaired cleft lip

 

A young boy with a hand deformity

 

A young girl who was thrown from a car

 

We operated on patients with cleft lips, cleft palates, other cleft deformities, burns, serious infections, trauma, hand deformities, lower extremity wounds, and we even did a breast reduction (one of my more common procedures in the U.S.).   A handful of procedures I did myself, but the majority of cases were done by Dr. Soni with me either assisting or just observing.  The staff was very well trained and treated me like royalty.

 

Dr. Soni's Staff

 

 

Dr. Soni’s wife, Archna, was a tremendous hostess and did her best to make me feel welcome.  Everyday, we had lunch and dinner in Dr. Soni’s home.  I was able to sample a wide variety of classic Indian foods.  Much of the cuisine is vegetarian and a lot of it was quite spicy.  In addition, we also had a few meals at the family home where Dr. Soni’s parents live with Monish and his wife and daughter.  Dr. Soni’s father is also a plastic surgeon as is his youngest brother.

 

Dr. Soni with his father, Dr. S.K. Soni

 

 

 

Much of my time was spent discussing American and Indian cultures.  Apart from the differences, I learned that many similarities also exist.  The Indian people I met were all very hard workers.  They typically work everyday, and only occasionally work a half day on Sunday.  I told Dr. Soni a number of times that in the U.S. we call those people “workaholics.”  In addition to work, I was also able to attend a wedding feast, have drinks with the guys one night, and spent an afternoon touring the city including a local Hindu temple.

 

 

Celebrating at a wedding feast with my new friends

 

 

There were a number of experiences that really made an impression on me.  One of the more interesting sights is the massive numbers of cows that wander the streets. 

Cows wandering the streets

 

 

 

As most people know, cows are sacred in India and they are pretty much allowed to do as they please.  Routinely, cars have to swerve around a cow walking down the middle of the highway.  Another fascinating thing was the driving habits of the Indians.  No offense to any of my Indian friends, but they drive like maniacs over there.  For Indians, the horn is as important as the steering wheel or the brakes, if not more so.  The roads are crowded with big trucks, cars, three wheeled taxis (sometimes with ten people crammed inside), motorcycles (sometimes with four passengers), and carts pulled by a variety of animals including bullocks and camels.

 

 

Cart being pulled by a camel

 

A standard taxi

 

 

It would be difficult for me to overstate just how much tea i drank while in India.  Anytime we sat down for more than a couple of minutes, someone brought us tea which they call “chai.”  They weren’t real big on coffee in India.  I ordered it a couple of times, but it mostly tasted like tea.

 

Of course, one of the most difficult thing to see in India is the poverty.  Although, the Indian economy has been growing rapidly, a large portion of the population remains exceedingly poor.  The city streets were often lined with men from rural areas who had travelled to Hisar in search of work.  Many of these men perform manual labor and are paid the equivalent of $3 a day.  We saw a number of patients who had been injured on the job.  Some of the electrical burns are especially challenging.  In particular, we took care of a 16 year old guy who had suffered a severe electrical burn.  For mostly financial reasons, he didn’t present to the clinic for about three weeks.  He had been treated by a local “healer” with what appeared to be ink.  It’s a wonder he didn’t lose his hand.

 

A severe electrical burn apparently treated with ink

 

 

Overall, it was a tremendous, life changing trip.  Although, it turned out a little different than I expected, it was quite rewarding and extremely educational.  Before embarking on the trip I was very excited about all the people I was going to help, and the huge difference I was going to make (sometimes, surgeons get these “delusions of grandeur”).  However, while in India I was reminded that often the greatest value of trips like this one is how they help me.  These experiences improve my understand of the world outside of my comfortable surroundings.  Exposures of this nature assist me in reviving those portions of my heart that can become numb over the years.  I would strongly encourage anyone reading this to consider a similar adventure.

 

The Soni brothers with their families

 

 

   

Hyperhidrosis and The Distressing Problem of Excessive Sweating July 18, 2008

Hyperhydrosis is a condition that involves excessive sweating from the underarms, the palms, the soles of the feet or the face and head.  Patients frequently complain that the appearance of soaked underarms is a major source of embarrassment.  Many patients also lament how sweaty palms also can give the appearance of extreme anxiety.  It is not uncommon for patients to complain that their professional and social lives have been disrupted by this condition.  The majority of patients have suffered for years prior to seeking help for their condition.      

 

The primary function of sweat secretion is to assist in regulating body temperature.  Sweat glands are distributed throughout the body, but are more concentrated in the underarms, palms and soles of the feet.   Most cases of hyperhidrosis have no detectable cause and can affect up to 1% of the population.  Affected individuals appear to have an elevated baseline level of sweat secretion and an exaggerated response to other normal stimuli.

 

The overall goal of treatment is to reduce the volume of sweat secreted to a level that does not cause anxiety and embarrassment.  The ideal treatment should be safe, effective and relatively inexpensive.  Conservative treatments include prescription antiperspirants, oral medications, and iontophoresis.   Prescription strength antiperspirants are effective for many patients, but drawbacks include the short duration of effect, skin irritation, and some agents can stain the skin.  Anticholinergic medications have many side effects including dry mouth, blurred vision, urinary retention, and constipation.  Both antianxiety and antidepressant medications have been useful in helping patients deal with hyperhidrosis.  However, they are only useful for short periods, can cause dependency, and are associated with lethargy and drowsiness.  Iontophoresis uses a battery powered device to provide direct current to the hands and feet while they are submerged in water.  The treatments only block secretion temporarily, can be uncomfortable, sometimes cause skin irritation, and require maintenance therapy.

 

For many physicians Botox® injections have become the treatment of choice.  Botulinum toxin is a protein produced by the bacteria clostridium botulinum.  Currently it is used to treat a variey of functional and aesthetic conditions.  It is most useful in focal areas of hyperhidrosis, such as the underarms.  The treatment requires multiple small injections to the affected area.  Injections are appropriately spaced 1-2cm apart and typically 50 units is adequate for one axilla or one palm.  Some studies have shown patients can expect a 70 to 80 percent reduction of sweat excretion in the axillae and 26 to 31 percent in the palms.  The duration of effect varies from 3-8 months depending on the patient and the dose used.  Complications are minor for the most part and include:  bleeding, numbness, and inadequate reduction in sweat secretion.  In addition, decreased grip strength can occur with injections to the palms.  The only real major drawback of this treatment is the discomfort experienced when treating the palms and soles of the feet.  Generally, treatments of the axillae tend to be well tolerated.

 

Surgical treatment is reserved for the more aggressive forms of hyperhidrosis that remain unresponsive to conservative therapy.  In the past, underarm skin and fat was directly excised to remove overactive sweat glands.  Another surgical technique that has been advocated is liposuction of the underarm region.  This method appears to disrupt the nerve supply to the sweat glands, but because it has not been widely used, its efficacy is unknown.  Currently, the surgical procedure of choice in these most severe presentations of hyperhidrosis is thoracoscopic sympathectomy which directly disrupts the nerves supplying the sweat glands of the palm and the underarms.  This minimally invasive procedure utilizes small incisions on the chest wall and an endoscope to gain access to the portion of the chest cavity where the nerves are located.  General anesthesia and an overnight stay in the hospital are necessary.  Patients can typically return to their normal behavior within a few days.  Success rates are high for palmar hyperhidrosis, but tend to much lower for hyperhidrosis involving the underarms.  Complications, although rare, can be quite serious and even life threatening.  Side effects include compensatory sweating in up to 50 percent of patients, gustatory sweating in up to 1/3 of patients and permanent changes to the palmer skin.

 

In conclusion, hyperhidrosis can be very distressing, but fortunately there are a number of safe and effective treatments from many which most patients can benefit. 

 

Dr. Kelly Gallego is a Board Certified plastic surgeon with offices in Irvine and Corona, CA.  He specializes in all types of cosmetic plastic surgery including breast enhancement, rhinoplasty, and body contouring.  For more information on visit his website at www.GallegoPlasticSurgery.com.

Gynecomastia and Male Breast Reduction Surgery June 24, 2008

Gynecomastia is a relatively common disorder affecting men that involves an abnormal development of breast tissue.  Male breast reduction is the term commonly used to describe the surgical treatment of gynecomastia.  There are a variety of causes of abnormal breast development in males including medications, recreational drug use, steroids, hormonal imbalances and genetic conditions.  In most cases, no precise cause can be determined.  Affected patients typically feel very self conscious and the psychological impact of this condition can be severe.  I have heard it said that “gynecomastia is akin to a woman having a full beard.”  Many patients have shared how they have not taken off their shirts in public for decades if ever at all.

Treatment options vary from liposuction alone to the removal of breast tissue and excess skin.  The most appropriate procedure really depends on the presence of excess fatty tissue, the amount of breast tissue and the quality of the skin.  Most patients choose to undergo surgery with a general anesthetic.  Male breast reduction surgery can last anywhere from 1 to 3 hours depending on the actual technique used.  Complications typically are uncommon and minor in nature.  These include infection, bleeding, unsightly scars, contour deformities, recurrence, asymmetry, and loss of nipple sensation.

After surgery, patients usually require oral pain medication for 3 to 4 days and return to work within a week.  Normal activity can be slowly resumed within a few weeks.  A compression vest is worn for roughly six weeks while the swelling resolves.  Most patients feel back to normal by around six weeks or so.  The surgical results should last indefinitely. 

I have always considered gynecomastia one the more rewarding conditions to treat in my practice.  For more information I recommend checking out the gynecomastia page on our website by clicking here.

Dr. Kelly Gallego is a Board Certified plastic surgeon with offices in Irvine and Corona, CA.  He specializes in all types of cosmetic plastic surgery including breast enhancement, rhinoplasty, and body contouring.  His web address is www.GallegoPlasticSurgery.com.

 

  

 

Who is doing your Botox® Injections? March 25, 2008

Yesterday I had an interesting conversation I feel like writing about.  I was speaking with an emergency medicine physician.  After 30 years in the emergency room, he now performs a narrow array of non-surgical cosmetic procedures such as Botox® injections and laser treatments.  Typically he performs the procedures at the homes of his patients. 

He made a statement to the effect that as a plastic surgeon, I have “instant credibility” with patients.  He believes that plastic surgeons are the “recognized experts” in the field of cosmetic improvements.  It made me wonder why any patient would want to have a cosmetic procedure performed by someone other than a plastic surgeon. 

Typically plastic surgeons undergo a board certification process verifying appropriate training and the passage of multiple exams related to, among other things, cosmetic procedures.  No specialty understands the facial anatomy and the wide range of cosmetic treatments better than board certified plastic surgeons.   

Non-plastic surgeons mostly learn how to do injections at weekend courses or from other colleagues.  The drive is obviously related to the apparent financial benefits of performing cosmetic procedures.  I imagine some physicians also just get tired of their specialty and they view “injectables” as easy to learn and a welcome alternative to arguing with insurance companies. 

I guess I just find the whole issue intriguing.  I am a board certified plastic surgeon.  Would anyone object to me taking care of heart attack patients in the emergency room or delivering babies in order to make some extra money?  I think the answers are obvious. 

My recommendation for your next Botox® treatment:  your health is the most important thing you have, don’t entrust it to anyone other than a “recognized expert.”

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Dr. Kelly Gallego is a board certified plastic surgeon with offices in Irvine and Corona, CA.

What is a “Board Certified Plastic Surgeon?” March 25, 2008

There seems to be a fair amount of confusion as to the definition and the importance of the term:  Board Certified Plastic Surgeon.

First, let me define the term.  Board certification is a credentialing process where physicians voluntarily complete a list of requirements in order to be certified by a particular specialty board.  Specialty boards require training at an approved program and the completion of an examination process.  Each specialty does it a little differently.  Some boards administer their exams during the training process, others wait until after a doctor has been in practice.  Some specialties require an oral exam, some do not.

The American Board of Medical Specialties (ABMS) recognizes 24 specialty boards that meet certain rigorous standards.  For plastic surgery, the American Board of Plastic Surgery is the only recognized board.  Other boards exist, but are not recognized as meeting the appropriate standards as determined by the ABMS.  Currently there are more than 75 non-ABMS recognized boards.  Examples of these include the American Board of Cosmetic Surgery, and the American Board of Facial Plastic and Reconstructive Surgery. 

In addition, some surgeons who perform cosmetic procedures are board certified in an unrelated field such as head and neck surgery, ophthalmology or obstetrics and gynecology.  Before a consultaion for any cosmetic procedure, patients should always inquire as to whether the surgeon is board certified by the American Board of Plastic Surgery.

The American Board of Plastic Surgery (ABPS) requires the following in order to become board certified.  First, a candidate must complete prerequisite training followed by requisite training at an approved plastic surgery training program.  Next, candidates must pass a comprehensive written exam which is usually taken within the first year after training.  Finally, candidates must pass an oral examination which strenuously evaluates a candidate’s knowledge base, judgement and ethical standards.  Only after completing each of these steps are candidates considered board certified.  The official term is a Diplomate of the American Board of Plastic Surgery.  The ABPS requires re-certification every ten years.

Now to the question of importance.  Are there knowledgeable surgeons who are not board certified?  Sure.  Are there any unethical surgeons who are board certified?  Yes.  Board certification by the American Board of Plastic Surgery does not guarantee a good cosmetic result.  It does not insure that your experience will be free of any complications.  However, it does prove that a plastic surgeon has completed the required training in plastic surgery, and has passed a set of rigorous exams.  When it comes to your health, what could be more important than finding a plastic surgeon who has been appropriately trained and who has proven their knowledge and ethics through a demanding examination process?

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New information regarding Retin A October 24, 2007

Retinoic Acid/ Retin A has been used for years in the treatment of sun damaged skin and acne.

Research has shown that Retin A can help to produce smoother skin, reduce fine wrinkles, decrease sallowness, and improve the overall appearance of the skin.  It assists with cell turnover, lightens pigment, increases collagen production, and reduces cell matrix degradation.

Some of the more common side effects include redness, dryness, peeling, skin irritation, and a burning sensation.  Retin A tends to increase the effects of UV light on the skin, so the use of sunscreens are absolutely necessary.

We use Retin A as part of our Obagi Nu-derm skin care line.  In concert with the other products in this line, Retin A helps to restore the skin to its previously healthy state.

A recent study in the journal Experimental Dermatology, showed that patients who used Retin A in conjunction with Nia 24 experienced less side effects without affecting the positive results of the treatment.  Nia 24 is a skin care treatment for sun damaged skin that uses the active ingredient Pro-Niacin™.

Fore more information, check out the Nia 24 link on our website.

scar treatment June 8, 2007

Pardon me for plagarizing myself (if that is possible).  This is a little tidbit I wrote for next month’s Body Beautiful Magazine. 

 

Scars occur at sites where a full thickness injury has taken place.  This includes surgical incisions, lacerations, deep burns and other types of wounds.  Some scars are thin, light in color and barely noticeable.  Others, such as keloid and hypertrophic scars, can be wide, raised and a real source of concern for some patients.  These unsightly scars, examples of overhealing, are more common in certain skin types and involving certain areas of the body.  Frequently they are associated with symptoms such as itching, pain, and burning.  It is important to remember that most scars improve over time and typically take at least one year to attain their final appearance.

 

As a plastic surgeon, I believe it is much more efficient to prevent poor scars than it is to treat them.  Prevention includes sound surgical technique and adequate prevention of infection.  Tension on the closure can be decreased by taping incisions and by using dissolving sutures which remain in the wound for a minimum of six weeks.  Patients are frequently encouraged to massage their scars to make them softer and flatter.  Even with the best efforts to prevent them, problem scars can still occur.

 

Numerous techniques have been used to prevent and treat unsightly scars.  The most commonly used methods are surgery, silicone dressings, pressure, and corticosteroids.  Other methods include radiation, cryosurgery, lasers, vitamin E, and other topical medications.  Often treatments are combined to decrease the likelihood of recurrence.

 

During the last couple of years, a lot of effort has gone into the production of topical scar treatments.  A promising new topical treatment which uses a multimodality approach is Scarguard®.  Scarguard® uses a combination of silicone, vitamin E, hydrocortisone, and pressure to treat poor scars.  It is easy to apply, dries almost immediately, does not stick to clothing, and is relatively inexpensive compared to some other methods.

 

I have recently begun offering Scarguard® to my patients.  I am enthusiastic that it will be an effective means to prevent and treat troublesome scars.  For more information, please contact my office at 877-389-0368 or visit our website at www.gallegoplasticsurgery.com.

silicone gel breast implants June 6, 2007

So what are the advantages and disadvantages of the new silicone gel breast implants?

 The major advantage of silicone gel implants is that they feel softer.  Most patients say they feel  a little more like natural breasts.  They also have a decreased chance of rippling or wrinkling which can be real issue in thin patients.

The main disadvantage is that silicone gel implants are more expensive than saline implants, costing roughly $900 more per procedure.  Gel implants are prefilled which means they cannot be placed through an armpit or axillary incision. Also, incisions in general need to be made longer to allow for the placement of the implant. 

 Finally, silicone gel implants require an MRI every three years to screen for implant failure or rupture.

 The most important issue is that both implants are equally safe.   None of the concerns regarding safety in the early 1990’s have been shown to be valid.

dermal fillers April 25, 2007

What’s new in the world of dermal fillers?

 

Dermal fillers are substances injected into or under the skin to correct wrinkles and deep folds, to add volume, and for lip augmentation.  Recently, there has been a sharp increase in the use of dermal fillers owing to the fact that they are less expensive and less invasive than surgery, there is minimal down time, and they are quite effective in staving off those first few visible signs of aging.

 

As a plastic surgeon, I administer dermal fillers in my office quite frequently.  Patients undergo a thorough assessment of their facial lines, wrinkles and folds.  Usually patients receive local anesthesia prior to the treatment.  The total treatment time for a new patient is roughly 30-45 minutes.  Patients can expect their results to last anywhere from six to twelve months.  Adverse reactions are typically rare and short lived; the most common ones being redness, pain, swelling, firmness, bruising, bumpiness, and itching.

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               

Two of the more popular dermal fillers in my practice are Restylane® (Q-Med AB) and Juvederm™ (Allergan).  Both are composed of hyaluronic acid which is a biodegradable, complex sugar found in all animals and is a major component of the skin, bones, cartilage and connective tissue.  By absorbing large amounts of water, it helps to hydrate skin and adds volume.  Other commonly used dermal fillers include fat, collagen, Artecoll, and Radiance.

 

Restylane® was first approved by the FDA in December of 2003.  Juvederm™ was recently approved in January of this year.  Its makers are calling it the “next generation” in dermal fillers.  They claim that their product’s increased cross linking and flow characteristics make it easier to administer and increases its duration of effect.

 

Both products have been compared to collagen in studies and have been shown to be superior in a number of ways.  However to date there have been no head to head studies comparing Juvederm™ to Restylane®.  Obviously, it will take time to determine which of the two will become the market leader in the future.

 

For more information, I recommend scheduling an appointment with my office to determine if dermal fillers are right for you.  Also, some of my patients have found the following websites helpful:  www.juvedermusa.com and www.restylaneusa.com.