Washington, DC, MAY 2013 – For the third consecutive year, rhinoplasty or nose surgery, continues to be the “most popular” facial plastic surgery procedure, according to a recent survey by the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS).

Found to be the most common surgical procedure for both men and women under 35, and the most in-demand facial plastic surgery among men, rhinoplasty has seen a recent resurgence in interest.

So why the uptick in rhino-popularity?

“Our nose is one of the first things people see when they look at us and is very important to overall facial balance,” according to Robert M. Kellman, MD, President of the AAFPRS. “A well-done rhinoplasty can enhance overall facial features by restoring balance and symmetry. A natural-looking nose should blend harmoniously with facial features, rather than stand out as a prominent feature on your face.”

- Before and after a nose surgery in Argentina

‘Not All Fat Grafting Is the Same’—Different Techniques for Different Uses

Arlington Heights, Ill. – As fat grafting becomes incorporated into clinical practice, plastic surgeons propose a new approach to classifying these emerging techniques-emphasizing the need to match the right technique to the right clinical situation, reports a study in the September issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).

“Not all fat grafting is the same,” write ASPS Member Surgeons Daniel Del Vecchio, MD, Boston, and Rod Rohrich, MD, of University of Texas Southwestern Medical Center, Dallas. “Fat grafting, once thought to be a simple technique with variable results, is a much more complex procedure with at least four definable subtypes.”

In Fat Grafting, ‘Different Problems Require Different Solutions’

Renewed interest in techniques using the patient’s own fat for cosmetic and reconstructive plastic surgery has been noted in recent years. In these procedures, fat harvested from one part of the body is transferred to other areas-for example, fat obtained from the thighs using liposuction has been used for breast augmentation and reshaping.

That may sound fairly simple, but in recent years, fat grafting has “exploded into a complex menu of clinical choices.” Plastic surgeons have reported “impressive clinical outcomes” using a wide range of different techniques and additives. The result is “a confusing picture as to which fat grafting technique is best,” Drs. Del Vecchio and Rohrich write.

To clarify this situation, the authors propose a classification of clinical fat grafting techniques. Their classification seeks to match the technique to the individual patient’s situation, based on four factors:

• Method of fat harvesting
• Method of cell processing
• Method of fat transplantation
• Management of the recipient site

- Buttock Augmentation with fat grafting

For example, they present illustrative cases where smaller volumes of fat were needed to restore loss of fatty tissue in the facial area and reconstructive surgery on a chronic leg wound. In these patients, small amounts of fat were manually harvested from the abdomen using a small syringe.

In contrast, for patients undergoing cosmetic breast augmentation or breast reconstruction after mastectomy, larger amounts of fat were needed. In these cases, fat was harvested from liposuction of the thighs. In these situations, some form of “pre-expansion” of the recipient site in the breast was needed to make room for the larger volume of fat.

Different techniques were also warranted depending on the state of the tissue in the recipient area-for example, inflammation in the chronic leg wound and tissue damage caused by radiation at the mastectomy site. These and other factors may affect the technique used to process fat after harvesting. The most important issues related to fat survival after transplantation may also vary across different clinical situations.

While fat grafting-sometimes called fat transfer or transplantation-is not a new procedure, its development has not been straightforward. At one time, the ASPS opposed the use of fat grafting in the breast, citing possible problems in early detection of breast cancer. More recently, several studies in Plastic and Reconstructive Surgery have reported good results with various fat grafting procedures in a wide range of clinical situations.

Drs. Del Vecchio and Rohrich hope their classification system will provide a useful starting point to maximize the “vast reconstructive and cosmetic potential” of clinical fat grafting. They conclude, “As the true physiology of un-manipulated and stem cell-enriched fat grafts become better delineated, our choices for technical solutions will better fit the clinical problems we face.”

- Sublimis Argentina offers affordable gastric bypass surgery abroad

A new study shows that although gastric bypass surgery reverses Type 2 diabetes in a large percentage of obese patients, the disease recurs in about 21 percent of them within three to five years. The study results were presented at The Endocrine Society’s 94th Annual Meeting in Houston.

“The recurrence rate was mainly influenced by a longstanding history of Type 2 diabetes before the surgery,” said the study’s lead author, Yessica Ramos, MD, an internal medicine resident at Mayo Clinic Arizona in Scottsdale. “This suggests that early surgical intervention in the obese, diabetic population will improve the durability of remission of Type 2 diabetes.”

Ramos and her co-investigators studied the medical records of 72 obese patients with Type 2 diabetes who underwent a Roux-en-Y gastric bypass operation between 2000 and 2007 and had at least three years of follow-up visits. Of these, 66 patients (92 percent) had a reversal of their diabetes at some point, the authors reported.

- Before and after a Gastric Bypass Surgery

Within three to five years after surgery, however, 14 (21 percent) of the 66 patients experienced a recurrence of their Type 2 diabetes, as documented by bloodwork or restarting use of diabetes medications. The patients who did not have recurrence of diabetes lost more weight initially and maintained a lower mean weight throughout the five years of follow-up, although both groups regained similar amounts of weight. There was no significant association between higher recurrence rate and body mass index before surgery, the authors found.

They did find that the longer the duration of Type 2 diabetes before surgery, the higher the probability of diabetes recurrence. Study patients with more than a five-year duration of Type 2 diabetes before they had bariatric surgery were 3.8 times more likely to have recurrence of type 2 diabetes compared to patients with less than a 5 year history of diabetes.

“Providers and patients need to be aware of this information, to have a better idea of the expected outcome and be able to make an informed decision about pursuing gastric bypass surgery,” Ramos said.

- Massive study outlines success for assisted reproductive technology

- Sublimis Argentina offers fertility treatments abroad such as IVF, ICSI and Egg Donation

East Lansing, Mich. — A groundbreaking study of nearly 250,000 U.S. women reveals live birth rates approaching natural fertility can be achieved using assisted reproductive technology, where eggs are removed from a woman’s ovaries, combined with sperm and then returned to the woman’s body.

The research, led by Michigan State University’s Barbara Luke and published in the New England Journal of Medicine, highlights what factors help or hinder getting pregnant using assisted reproductive technology, or ART. The results indicate that when there are favorable patient and embryo characteristics, live birth rates with ART can approach those of natural fertility.

“This is good news for women who are trying to have a child,” said Luke, a researcher in the College of Human Medicine’s Department of Obstetrics, Gynecology and Reproductive Biology.

The number of ART treatments has more than doubled in the past 10 years, and live birth rates traditionally have been reported per cycle, or per one course of treatment. While that is easily calculated and is the method used by national registries across the world, Luke’s team sought to estimate cumulative success rates with continued treatment.

“Women and families want to know the overall chances they will get pregnant, not necessarily whether they will get pregnant during a specific cycle,” Luke said.

Data were obtained from the Society for Assisted Reproductive Technology’s Clinic Outcome Reporting System for women undergoing treatment between 2004 and 2009. The system contains data on more than 90 percent of all clinics performing ART treatments in the United States.

The study of 246,740 women revealed 57 percent of women achieved a live birth via ART treatment, and 30 percent of all ART cycles resulted in a live birth. Success rates declined with increasing age for women using their own eggs, especially for those ages 38 years and older, but not for women using donor eggs.

The estimated natural fertility rate of the general population is about 20 percent per month, and estimated rates of conceiving spontaneously are 45 percent, 65 percent and 85 percent after three, six and 12 months, respectively.

The study looked at factors such as patient age, diagnosis, response to treatment, cryopreservation and the stage at which embryos were transferred. Two major factors that influence ART success are favorable patient characteristics (specifically age) and good embryo quality. Among older women, live birth rates can be substantially improved with continued treatment and a change to donor eggs.

“Although the decision to use donor eggs is a very personal one, these analyses provide information regarding the likelihood of a live birth using this option,” said Luke.

These results also could guide regulations governing health insurance coverage for infertility treatment. The number of treatment cycles covered by insurance is typically limited to two or three. The findings demonstrate that when using a woman’s own eggs, the success rates continue to rise beyond two to three cycles; additionally, the study may help providers and women decide when it is appropriate to change to donor eggs.

- Study Reveals Improved Satisfaction, Well-Being and Sexual Functioning

- Sublimis Argentina offers breast augmentation abroad

Arlington Heights, Ill. – Women undergoing breast augmentation surgery report substantial improvement in several key areas of quality of life, reports a study in the July issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).

“Cosmetic breast augmentation can have a significant and profound positive impact on a woman’s satisfaction with her breasts [and] her psychosocial and sexual well-being,” according to the report by ASPS Member Surgeon Colleen M. McCarthy, MD of Memorial Sloan-Kettering Cancer Center, New York, and coauthors.

Questionnaire Shows Benefits After Breast Augmentation

The researchers developed and evaluated a questionnaire to evaluate changes in health-related quality of life after cosmetic breast augmentation. Quality of life is increasingly regarded as an important factor in evaluating the benefits of many types of medical or surgical treatments.

- Before and after a breast augmentation surgery in Argentina

The BREAST-Q© questionnaire evaluated changes in six areas: satisfaction with breasts and with overall outcome, psychosocial, sexual, and physical well-being, and satisfaction with care. Forty-one women completed the questionnaire six months before and after undergoing cosmetic breast augmentation surgery with implants.

The group results showed significant improvement in three out of the six areas. On a 0-to-100 scale, average scores increased from 27 to 70 for satisfaction with breasts, from 45 to 78 for psychosocial well-being, and from 35 to 72 for sexual well-being.

More than 80 percent of women reported “significant improvement” in satisfaction in these three areas. The gains in quality of life were considered very large-similar in magnitude to the improvement in symptoms after hip replacement surgery.

Breast augmentation is the most common cosmetic surgical procedure performed in the United States. According to ASPS statistics, more than 300,000 women underwent cosmetic breast augmentation in 2011. Dissatisfaction with breast size or shape can negatively affect a woman’s quality of life in several ways, including self-perceived attractiveness and sexuality.

In recent years, the U.S. Food and Drug Administration has urged ongoing follow-up of women receiving breast implants to document not only the safety but also the effectiveness of breast augmentation. Dr. McCarthy and colleagues write, “This means that, more than ever before, it is vital to provide reliable and valid evidence regarding patient outcomes of breast augmentation, especially…health-related quality of life and patient satisfaction.”

The new study shows that implant-based breast augmentation can significantly improve a woman’s quality of life in several key areas. It also demonstrates the ability of the BREAST-Q to “capture the impact of surgery from a patient perspective.”

The researchers believe their findings are directly relevant to plastic surgeons working with individual patients. The BREAST-Q can provide “tangible evidence” of patient satisfaction, improve communication, and help in establishing the expected results of cosmetic breast augmentation. Using the BREAST-Q in future studies and clinical practice will also be useful in providing “benchmarks” for patient satisfaction and quality of life-especially psychological outcomes.

- Sublimis Argentina offers affordable bariatric surgery abroad

Chicago — Among obese individuals, having bariatric surgery was associated with a reduced long-term incidence of cardiovascular deaths and events such as heart attack and stroke, according to a study in the January 4 issue of JAMA.

Most epidemiological studies have shown that obesity is associated with increased cardiovascular events and death. “Weight loss might protect against cardiovascular events, but solid evidence is lacking,” according to background information in the article.

Lars Sjostrom, M.D., Ph.D., of the University of Gothenburg, Sweden, and colleagues conducted a study to test the hypothesis that bariatric surgery is associated with a reduced incidence of cardiovascular events and examined the relationship between weight change and cardiovascular events. The study (Swedish Obese Subjects [SOS]) is an ongoing, nonrandomized, prospective, controlled study conducted at 25 public surgical departments and 480 primary health care centers in Sweden, and includes 2,010 obese participants who underwent bariatric surgery and 2,037 matched obese controls who received usual care.

Patients were recruited between September 1987 and January 2001. Date of analysis was December 31, 2009, with median (midpoint) follow-up of 14.7 years. Inclusion criteria were age 37 to 60 years and a body mass index of at least 34 in men and at least 38 in women. Surgery patients underwent gastric bypass (13.2 percent), banding (18.7 percent), or vertical banded gastroplasty (68.1 percent), and controls received usual care in the Swedish primary health care system. Physical and biochemical examinations and database cross-checks were undertaken at preplanned intervals. The average changes in body weight after 2, 10,15, and 20 years were -23 percent, -17 percent, -16 percent, and -18 percent in the surgery group and 0 percent, 1 percent, -1 percent, and -1 percent in the control group, respectively.

- Before and after bariatric surgery in Argentina

During follow-up, there were 49 cardiovascular deaths among the patients in the control group and 28 cardiovascular deaths among the patients in the surgery group. In total (fatal and nonfatal), there were 234 cardiovascular events among patients in the control group and 199 cardiovascular events among patients in the surgery group. After adjustment for a number of variables, bariatric surgery was associated with a reduced number of fatal cardiovascular deaths and a lower incidence of total cardiovascular events.

Bariatric surgery was associated with reduced number of fatal heart attack deaths (22 in the surgery group vs. 37 in the control group), with analysis indicating that bariatric surgery was related both to reduced fatal heart attack incidence and total heart attack incidence. Also, bariatric surgery was associated both with reduced number of fatal stroke events and total stroke events.

However, the researchers found no significant relationship between weight change and cardiovascular events in the surgery or control group. The authors suggest that the lack of association between weight loss and reduction of cardiovascular events could be related to inadequate statistical power to detect this relationship. “Alternatively, following relatively modest weight loss induced by bariatric surgery, there is no further risk reduction attributable to greater, subsequent weight loss. Our negative findings also emphasize the need to explore weight loss independent of effects of bariatric surgery.”

“In conclusion, this is the first prospective, controlled intervention to our knowledge reporting that bariatric surgery is associated with reduced incidence of cardiovascular deaths and cardiovascular events. These results– together with our previously reported associations between bariatric surgery and favorable outcomes regarding long-term changes of body weight, cardiovascular risk factors, quality of life, diabetes, cancer, and mortality– demonstrate that there are many benefits to bariatric surgery and that some of these benefits are independent of the degree of the surgically induced weight loss.”

Undergoing Bariatric Surgery Associated With Obese Family Members Adopting Healthier Lifestyles

Having an obese family member undergo gastric bypass surgery for weight loss appears to be associated with additional benefits of weight loss and improved healthy behaviors of obese family members, according to a report of Archives of Surgery, one of the JAMA/Archives journals.

One of the biggest risks for becoming an obese child is having an obese parent, and data show that childhood obesity is strongly associated with obesity in adulthood, according to background information in the article. “The obesity rate in children of mothers who have had Roux-en-Y gastric bypass is 52 percent lower after surgery compared with the obesity rate in children born to the same mothers before surgery,” the authors write. “If one member of the family makes drastic lifestyle changes following surgery, it is possible that other family members will adopt similar healthy habits.”

- Before and after bariatric surgery in Argentina

Gavitt A. Woodard, M.D., and colleagues from Stanford University School of Medicine, Stanford, Calif., observed the weight and lifestyle changes of patients who underwent Roux-en-Y gastric bypass surgery and their family members. The study was conducted between January 2007 and December 2009, and included 85 participants; 35 bariatric surgery patients, 35 adult family members and 15 children under 18 years of age. Obese adult family members were define as having a BMI greater than 30 and obese children were defined as having a BMI at the 95th percentile or higher, using the BMI for sex and age growth charts of the Centers for Disease Control and Prevention (CDC).

The weight loss in patients observed by the authors one year following surgery was typical for patients undergoing gastric bypass surgery at the study institution. The mean (average) weight loss of all adult family members decreased from 220 pounds to 198 pounds but was not statistically significant. However, among obese family members, the weight decreased from 234 to 226 pounds, a difference that did reach statistical significance. The same results were observed for waist circumference, as the results among all adult family members did not change significantly (from 108 cm to 105 cm; 42.5 inches to 41.3 inches), but did significantly decrease among obese adult family members (from 119 to 111 cm; 46.9 inches to 43.7 inches).

In obese children only, the authors observed a lower BMI than was expected for their growth curve at the one-year follow-up, however this finding did not reach statistical significance.

One year following surgery, both patients and adult family members had significant changes in their eating habits, with patients significantly increasing cognitive control of eating while decreasing uncontrolled and emotional eating. Adult family members showed no significant changes in cognitive control of eating, but did significantly decrease uncontrolled eating and emotional eating. Additionally, children of bariatric patients were twice as likely to report being on a diet to lose weight one year post-surgery. Children also benefited from fewer daily hours of television watching and increased hours of physical activity after a parent underwent bariatric surgery.

For more information about Bariatric Surgery in Argentina please do not hesitate to contact us.

Hair Restoration Surgery Market Increased 47% Worldwide In 2010

- Middle East and Asia Experience Largest Gains

- Note: Sublimis Argentina offers affordable hair transplant abroad. Contact us for further information.

Despite slow economic growth worldwide, the demand for procedures to correct hair loss proved to be stronger than ever, according to statistics released from a recent member survey conducted by the International Society of Hair Restoration Surgery (ISHRS) – the world’s leading medical authority on hair loss and hair restoration.  From 2008 to 2010, the total extrapolated market size for hair restoration surgery increased 47.9 percent.

Specifically, the extrapolated worldwide number of surgical hair restoration procedures performed in 2010 was approximately 279,381, up 11 percent from 2008. Since the ISHRS starting compiling membership data in 2004, the number of procedures performed around the world jumped 66 percent – with the Middle East (454 percent increase) and Asia (345 percent increase) experiencing the largest growth.

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