Face Transplants

Although I am not direclty involved in performing face transplants, I have been following the procedure's progress over the last several years.   Most recently, a group in Brigham and Woman's Hospital in Boston perfromed a full face transplant and the patient is now doing well and making good recovery. 

People that receive face transplants are those that have full facial burns or trauma which have left them severely disfigured.  They have to undergo a battery of medical and psychiatric tests to make sure they will be good candidates. The procedure itself involves a team of plastic surgeons who transplant the nerves, skin, and facial muscles of a donor onto the recipient.  The surgery takes many hours and involves the use of careful microsurgery.

Unfortunately in this particular case, the patient also lost his eyes from his injury which are not able to be transplanted. 

Read more in LA Times.

Beauty and Fashion Exhibit to Open in LA

This should be an interesting exhibit to check out.  It's the first of its kind--demonstrating beauty in all forms from modeling shoots to photos demonstrating lip and botox injections.  All of these subjects are examined in “Beauty Culture,” the first fashion- and beauty-themed exhibition to be held at the Annenberg Space for Photography in Los Angeles, the heartland of Hollywood goddesses and plastic surgery, which opens on May 21 and runs through Nov. 27.

Read more in NY Times.

An interesting surgery I performed today...

I performed an interesting case today on a patient with constant tearing and irritation in her eyes.  On examination, she has has very lax (or loose) lower lids which do not help in her ability to blink well and drain her tears effectively. You can see this by the rounding to her eyelids in the corner of each eye.  In addition she has small, stenotic openings to her tear drainage system.  The tiny openings you see along the eyelid (close to the nose) actually drain the tears from the ocular surface into the nose and mouth. In order to help her, I had to address both of her problems which were causing her to tear constantly. First, I performed a lower lid resuspension technique to allow for tighter and better positioned lower lids in order to help her blink more effectively. This is also called an ectropion repair.  Next, I attempted to dilate her stenotic tear drainage system to allow for better drainage by placing a baloon dilator to dilate the canaliculi.  My team and I recently published the use of this in a prior medical study (see below link).  Silicone tubes were then placed to intubate the tear drainage system and I will remove those in my office in several weeks. Overall, she tolerated everything well and was home the same day. 

 

See link to my prior blog on our study on canalicular stenois.

 

What are effective scar treatments???

This is a great article summarizing the challenges in scar treatment.  I actually find silicone sheets quite effective for some early scars.  In cases of hypertrophic healing (excessive scarring) or abnormally raised edges, carefully thought-out regimen of low dose steroid injections may be beneficial.  Care must be taken not to inject high doses of steroids around thin skin, such as the eyelids, though.  Laser resurfacing can also be helpful in selected cases.   Read more in LA Times!

Is a Well-Rested Doctor a Better Doctor?

Do better hours for medical students and residents result in better patient care? It's difficult to tell since no real well-controlled study has been published.

Work hour limits have improved the lifestyle of junior doctors, but decreasing their fatigue seems to have had little effect on how patients actually do. Read more in NY Times.

Recent publication out regarding the finding of a new but rare type of orbital tumor we discovered.

I was part of a team of New York Oculoplastic Surgeons who identified a rare type of orbital tumor (located next to the eyeball but within the orbit itself) and the clinical findings and treatment were described in this month's Ophthalmic Plastic and Reconstructive Surgery Journal.  "A rare variant of adenoid cystic carcinoma is the dedifferentiated sarcomatoid form, which has previously been reported in the hard and soft palate, maxillary sinus, submandibular glands, and nasal cavity. The authors report the first case of a dedifferentiated sarcomatoid adenoid cystic carcinoma occurring in the lacrimal gland, that of a 52-year-old man. The patient presented with a 4-month history of diplopia, decreased vision, and right upper eyelid swelling. Radiographic imaging showed a soft tissue mass in the extraconal compartment superolateral to the right eye. The patient subsequently underwent surgical debulking. Histologic examination of the tissue revealed classic cribiform adenoid cystic carcinoma and a sarcomatous component consisting of malignant spindle cells and fusiform cells arranged in whorls. Dedifferentiation is a well-established phenomenon in salivary gland tumors that is associated with aggressive behavior and poor prognosis; however, the exact nature of such dedifferentiated neoplasms remains unclear." 

See Abstract Text in Pubmed.gov.

It's not just females who had an increase in plastic surgery last year, but also men.

More and more men are seeing plastic surgeons for either non invasive procedures (such as Botox and subdermal fillers such as juvederm, restylane, fat injections) or surgical procedures such as blepharoplasties (eyelid lifts) and face lifts.   The baby boomers are now at the age of noticing their aging changes and want them addressed, male or female.  Believe it or not, up to 20% of my Facial Aesthetic practice is males in their 30's to 50s that come in for Botox and fillers (juvederm and restylane).  The most common reason I see males is for Botox to their forehead and eyelid crows feet wrinkles.  In general, males end up needing more Botox for a particular area than woman do.  But at the end of the day, the feedback is that the males enjoy looking "less-tired" at work and have less of the "frowning" appearance.  All of these surely equates to better performance at work!

Read more here