As we age, our dermis thins, facial skin loosens, and wrinkles develop.  There are several alternatives to treat the aging face. If a patient is not interested in a face lift, but wants a long lasting result, the two alternatives are:

1. laser resurfacing
2. regenerative fat grafts

What is the difference between these two techniques? A LOT!  In summary, laser resurfacing technologies destroy tissue (which the body repairs), while fat grafting (fat injections) builds up and regenerates tissues. Most lasers shoot a high energy beam which vaporizes cells, whereas fat grafting techniques mobilize teams of repair cells to bring more blood supply and nutrients to your face.

I believe that stem cell enhanced fat grafting offers an advantage to lasers currently being used by plastic surgeons and dermatologists. Fat grafts are the most natural way to get a long lasting youthful rejuvenation of your face. Fat grafting is your own Fountain of Youth.

How do lasers work to tighten the skin?
With laser, a beam of energy is used to obliterate layers in the epidermis and dermis beneath your skin. The cells in those layers are totally vaporized. Once that layer has been destroyed the body sends a signal to repair. Your body repairs the tissue by forming a scar (or “building collagen”) in the destroyed tissue layer. The scar which forms beneath the skin has the effect of tightening the skin and and adding a little mass to the subcutaneous tissues. However, this does come at the expense of scar tissue and reduction of the dermal layer which gives structure to the skin.

Another problem with laser occurs when a patient loses weight following laser resurfacing treatment.  I have seen some patients have a collapse of the structure of the dermis in the face. As the patients loses her own fat, which provided structural support, the laser treated skin sometimes does not hold up well. Fortunately, I have been able to offer these patients fat grafting, which restructures the dermis and adds volume back to the face.

So what is fat grafting and why is it considered a regenerative technique?
Fat grafting harnesses the power of stem cells that occur naturally in your own fat.  These naturally occurring fat stem cells are carefully extracted by liposuction from unwanted areas, processed with minimal manipulation, and then reinjected during the same operative session into areas that need rejuvenation.  The stem cell enriched fat restores volume and youthful fullness to your face. The naturally occurring stem cells in your own adipose fat tissue, or ADSC’s, make new blood vessels which bring blood supply and nourishment to your aging skin.

Fat grafting is a natural way to restore volume and a youthful glow to the aging face. I use fat grafting as a stand alone procedure and also in combination with the face lift procedure. An added bonus with fat grafting is that the skin continues to improve months  after the surgery. The newly created blood vessels in the fat graft continue to re-energize the tissue with a new source of  nutrients.

Ricardo L Rodriguez
Board Certified Plastic Surgeon

*Read more about adipose derived stem cells and the future of plastic surgery.

**How long do fat transfers last?

Baltimore, Maryland

Getting snowed in has it’s advantages. Fifty inches in one week is enough for any human being. If you are a plastic surgeon fascinated with adult stem cells from adipose fat, it gives one time to transcribe your thoughts. One has more time to reflect, pontificate, and borrow ideas.

You’ve gotta credit Sarah Palin–the stuff you write on your hand–it’s important stuff.

Here’s the hand that describes the future elixir of heath care:

(Translation:adipose fat contains a higher population of adult stem cells than bone marrow. Stem cell therapies will move much faster to market if  the FDA allows your own autologous minimally manipulated stem cells to be considered as a ’tissue’ and not a ‘drug’.)

To learn more about adipose stem cells (ASC’s) and how they heal tissue and have the capacity to cure diseases visit our fat stem cell archives.

Staff Writer
CosmeticSurg.net

We do a lot of brazilian butt lifts. The brazilian butt lift augments and enhances your buttocks using fat from unwanted areas of your body. The procedure is a total body resculpting of your abdomen, flanks, and buttocks. The question I often get asked is “Doctor will I lose the effect of the brazilian butt lift if I lose weight after the surgery?”

The answer is: If the fat is processed and grafted correctly-you will not lose the effects.

To illustrate the point, I went back and looked at the photos of one of my patients who had the brazilian butt lift surgery, lost approximately 10% of her body weight after the post op period, and then gained all of the weight back at the end of the one year period.

In the video below , her pre-op is on the left. Eight months following the surgery, in the photo on the right, she lost a little over 10 pounds. You can see that her buttocks are still prominent ,and her new curves show off very nicely. Watch the video to see all of the details.

Even with her weight loss, her buttocks are prominent and she maintains the buttocks ’shelf’. If the procedure is done correctly, your new curves should stay with you. Properly processed fat will engraft and take. You will have a new body shape. Weight fluctuations after the brazilian butt lift will take the shape of your new body shape. If you gain or lose weight you will not go back to your curveless body figure. The wonder of fat grafting is that it can truly change your body proportions. Any weight gain or loss should correspond with the new figure.

Below is the summary of the patient’s history : Pre-op, 8 months post-op with 10% weight loss, and 1 year post op with full weight gain back to original weight:

Note: This video is part of my ‘Stem Cell Series’ as properly processed fat will contain a population of your own naturally occurring adult stem cells. These stem cells enable your fat graft to survive and ‘take’ as the stem cells help to build blood supply to the fat graft. Stem cells from your own autologous adipose fat is Plastic Surgery’s New Frontier. Stay tuned for more!

For months, we have been hearing the debate on ways to reduce healthcare costs.  Thus far, nearly everything introduced requires vast amount of government expenditures and seriously upsets people who actually like the health care plan that they currently have.  It is astounding that the most important way to lower health care cost rarely , if ever, gets discussed. Curious?–read on. How do we lower health care costs? As the Governor of Minnesota would say—prepare to be dazzled. . . . . .

The answer to lowering health care costs is to require all providers (doctors, hospitals, surgery centers, labs, anesthesia)  to disclose what things cost before the service is rendered. Yes, as a matter of informed consent, the cost of a routine medical service should be disclosed to the consumer.

If  this one mandate was made (to disclose pricing), health care pricing would be in the ‘free market competition’ and prices would start dropping like a rock. Consumers would start to shop for scheduled services and prices would come down, quickly. This is exactly what happens in a free market economy   and this is what has been happening in Plastic Surgery for decades.

Plastic Surgery is one of the few elective areas of medicine where most services are NOT covered by insurance. Thus, Plastic Surgery has always been subject to free market forces. Well guess what?–prices (adjusted for inflation) of most cosmetic procedures have gradually gone DOWN over the years , not up. Since there is a well trained supply of Plastic Surgeons in the U.S.,  pricing disclosure CREATES COMPETITION of these medical services and prices are forced down.

A facelift performed now is less expensive (inflation adjusted) than a facelift performed 20 years ago.  Since there is a high supply of qualified Plastic Surgeons performing Breast Augmentation procedures, breast augmentation prices keep going down. Since many medical specialties are now offering Botox,  there is a high supply, and  prices fall year over year because patients can price shop among the competition. However, highly specialized procedures, such as the brazilian butt lift or stem cell enhanced fat grafting, with limited supply of experienced surgeons delivering excellent results can command higher prices.

It’s good ole supply and demand and Larry Kudlow’s free market path to prosperity.

With Plastic Surgery, there are only a couple of insurance covered procedures, so let me walk you through health care’s current mode of pricing secrecy.

Let’s say you want a breast reduction procedure. The major components of the breast reduction surgery are:

Total Cost= Surgeon’s fee + Operating Room Fee + Anesthesia.

You have a insurance policy that will pay 80% . So, you, the patient are responsible for paying 20% of the allowed procedure amount. So, you, the patient want to find what your 20% will cost. How do you find out?

Here in Maryland, your plastic surgeon performing the breast reduction WILL tell you his surgeon’s fee in advance of the surgery. However,  there is no consumer database of operating room fees so a patient can compare costs between a  hospital and an out patient surgery center. Furthermore, if you call a hospital  to ask what the procedure will cost, they basically give you a run around. It takes a while to get a straight answer. I know because I have picked up the phone myself to get prices of a breast reduction procedure–and I know how to ask it.   I wanted to know the difference in cost between having a breast reduction done in a Maryland  hospital vs. having it done in our own out-patient surgery center.  What is the difference in cost for a patient?

It is important to note that your surgeon can perform a breast reduction the exact same way, under the exact same type of anesthesia whether it is in a Hospital or an accredited Out Patient Surgery Center.  Your surgeon’s fee is identical regardless of where the procedure is performed. However, the difference in operating room costs at a hospital vs. an out patient surgery center are world’s apart.

Estimated Average Operating Room fee (with recovery for a 4 hour breast reduction prodedure):

Hospital OR= $6,200

Accredited surgery center= $1200  (based on BCBS participating allowable)

HUGE difference! The additional cost to have the procedure performed in the hospital is:
insurance company: $5000 addional for the insurance company,
patient: if the patient has a 20% co-pay, her co-pay is either $1240 in the hospital, or $240 in a surgery center.

So, why aren’t patients choosing surgery centers over hospitals for this particular procedure?? It’s so much cheaper and it’s the same procedure! The answer is that patients DO NOT KNOW what the difference is. Hospitals and other health care providers do not have to disclose what they charge to the patient BEFORE the procedure is rendered.

Can you imagine if the rest of the world operated this way?

The simple solution is for Congress to mandate that ALL health care providers disclose their pricing BEFORE the service is rendered. This should be mandatory for all routine services and scheduled surgeries.  Services that should  obviously be exempt would be ACUTE care, where there is really no time for disclosure.

Congress should require doctors, hospitals, surgery centers, labs , anesthesia providers to disclose their fees. This mandate would set forces in motion to lower health care prices. It could be as easy as requiring each company to list the prices at their website. Many plastic surgeons have been doing this for years. Mandatory health care pricing disclosure would be a wonderful FIRST EASY step to reform health care pricing.  Except for the cost of writing the bill, it wouldn’t cost the taxpayers a single penny.

Leeza Rodriguez, staff writer

CosmeticSurg, http://www.cosmeticsurg.net

Here are my top predictions for cosmetic surgery trends in 2010:

1. Stem Cells from Adipose tissue- The year 2010 ushers in a new decade where science , beauty, and your own fat consummate a marriage that promises to deliver one of the most disruptive medical technologies of the century. Stem cells from our own autologous fat has the power to rejuvenate tissue , heal wounds, and cure diseases. Adult stem cells derived from your own adipose tissue is the new elixir of healthcare.
2. Fat injections -There will be a dramatic increase in cosmetic surgery procedures ultilizing fat injections. Fat injections are used to restore and revitalize tissue in your face, breast, hands, buttocks, and other areas of the body. Done correctly, fat injections are permanent.
3. Butt augmentation -For butt augmentation, fewer surgeons will use buttock implants due to their notorious complication rates. Instead, the Brazilian Butt Lift Technique of fat grafting becomes the main method of butt augmentation.
4. Stem cell facelift- After a well known Hollywood actress has the stem cell facelift , this autologous stem cell enhanced fat injection technique becomes the new rage for facial rejuvenation.
5. Breast augmentation-Women who are interested in a minimal cup size change for breast augmentation will increasingly elect to have fat injections to the breast, instead of breast implants.
6. Lumpectomy reconstruction- Clinical trials continue to endorse autologous stem cell enhanced fat injections as a lumpectomy reconstruction alternative.
7. Plastic Surgeons in REGEN industry- As researchers come to agreement that adipose tissue is the* most prolific source of adult stem cells*, Plastic Surgeons become the new ambassadors of the REGEN industry. The REGEN industry uses the power of your own cells to treat and cure diseases. The REGEN industry joins Pharma, Biotech, and Medical Devices, as the new pillar of the Healthcare Industry.

Happy New Year!

Ricardo L Rodriguez, MD

Board Certified Plastic Surgeon http://www.cosmeticsurg.net

© copyright  CosmeticSurg.net , 2010  (permission to copy article or part of article  with URL credit to this post URL)

Thanks to the lobbying efforts of the ASPS, Allergan, and plastic surgery portals such as RealSelf.com, women can continue to  improve their cosmetic appearance without taxation! For the past few weeks, the proposed 5% tax on cosmetic surgery became known as the Botax. The cosmetic surgery tax would have discriminated against women, since more than 90% of all cosmetic surgery is performed on women.

A last minute amendment to the new Obamacare Health Care bill, HR 3590, dropped the 5% cosmetic surgery tax , but included a 10% tax on tanning services. This tan tax was put in as a substitute for the initially proposed 5% tax on cosmetic surgery. If this bill becomes enacted into law, the tan tax will become effective  for tan services rendered after July 1, 2010.
Specifically, the tan tax is applicable to tanning booths which use ultraviolet radiation in the frequency of 200 nanometers to 400 nanometers. Exempt from the tan tax is ‘phototherapy services’ .

The exclusion of tax on cosmetic surgery is a win for women and we salute our lobbyist for a job well done!  While we are happy about our own outcome, we can’t help but wonder if this new tax will stifle the tanning industry.

Here is the amendment included in the bill:

SEC. 10907. EXCISE TAX ON INDOOR TANNING SERVICES IN
LIEU OF ELECTIVE COSMETIC MEDICAL PRO-CEDURES.

(a) IN GENERAL.—The provisions of, and amend- ments made by, section 9017 of this Act are hereby deemed null, void, and of no effect.
(b) EXCISE TAX ON INDOOR TANNING SERVICES.— Subtitle D of the Internal Revenue Code of 1986, as amended by this Act, is amended by adding at the end the following new chapter:

‘‘CHAPTER 49—COSMETIC SERVICES
‘‘Sec. 5000B. Imposition of tax on indoor tanning services.

‘‘SEC. 5000B. IMPOSITION OF TAX ON INDOOR TANNING SERVICES.
‘‘(a) IN GENERAL.—There is hereby imposed on any indoor tanning service a tax equal to 10 percent of the amount paid for such service (determined without regard to this section), whether paid by insurance or otherwise.
‘‘(b) INDOOR TANNING SERVICE.—For purposes of this section—
‘‘(1) IN GENERAL.—The term ‘indoor tanning service’ means a service employing any electronic product designed to incorporate 1 or more ultravioletBAI09R08 S.L.C. 374
1 lamps and intended for the irradiation of an indi-
2 vidual by ultraviolet radiation, with wavelengths in
3 air between 200 and 400 nanometers, to induce skin
4 tanning.
5 ‘‘(2) EXCLUSION OF PHOTOTHERAPY SERV-
6 ICES.—Such term does not include any phototherapy
7 service performed by a licensed medical professional.
8 ‘‘(c) PAYMENT OF TAX.—
9 ‘‘(1) IN GENERAL.—The tax imposed by this
10 section shall be paid by the individual on whom the
11 service is performed.
12 ‘‘(2) COLLECTION.—Every person receiving a
13 payment for services on which a tax is imposed
14 under subsection (a) shall collect the amount of the
15 tax from the individual on whom the service is per-
16 formed and remit such tax quarterly to the Sec-
17 retary at such time and in such manner as provided
18 by the Secretary.
19 ‘‘(3) SECONDARY LIABILITY.—Where any tax

20 imposed by subsection (a) is not paid at the time

21 payments for indoor tanning services are made, then

22 to the extent that such tax is not collected, such tax
23 shall be paid by the person who performs the serv-
24 ice.’’.
BAI09R08 S.L.C. 375

(c) CLERICAL AMENDMENT.—The table of chapter for subtitle D of the Internal Revenue Code of 1986, as amended by this Act, is amended by inserting after the item relating to chapter 48 the following new item:

‘‘CHAPTER 49—COSMETIC SERVICES’’. (d) EFFECTIVE DATE.—The amendments made by
this section shall apply to services performed on or after July 1, 2010.

http://www.cosmeticsurg.net

Congrats to Molly Plummer, of Maxx Factor quartet, who will be competing tomorrow night in NBC’s first annual Sing-Off. The competition is a voices only, a capella competition and will be broadcast on NBC throughout the Holidays. Eight groups from around the country were selected for the competition. Molly is our financial coordinator at CosmeticSurg . Dr. Rodriguez and the entire staff at CosmeticSurg wish Molly good luck!

I see this question all over the Internet: Are fat graphs permanent? The answer is:

When done correctly, fat grafts are permanent. When done incorrectly, they don’t last and you will need a redo.

So, how do we do them correctly? First, the physician must employ correct techniques ; and second, the patient must follow the post op recovery restrictions.

For the surgeon, the following techniques should be performed:

• Right extraction pressure with low suction
• Various types of laser lipo will kill the fat cells –these techniques should not be used for extraction
• Fat cells should not be washed
• Proper centrifugation techniques
• Proper isolation and injection techniques to ensure that the good fat is enriched with some of your own stem cells. Fat must be reinjected in small quantities to allow blood supply to grow into the new fat grafts.

After the surgery, the patient must not put pressure on the graphs for a period of 2-3 weeks. In the example of the brazilian butt lift, patients should ideally not sit on the new fat grafts for 3 weeks to allow a full ‘take’.

When the above techniques and protocols are used, my fat grafts have been permanent.

Ricardo L Rodriguez, MD

Other posts on fat grafting:

Fat injections-are they permanent?

How long do fat grafts last?

Why do some women get more breast cleavage with breast augmentation than others? There are many reasons, but one of them is a function of your chest wall type.

Some patients have a chest wall shape that is not really straight. Those patients either have a
concave, hollow chest, in which the chest slopes towards the middle, or they may have an
outward curved chest wall, or bird like chest, in which the middle part of the chest is the highest part like the women in the video still shown below.

These conditions are medically referred to as:

• Pectus excavatum- the concave breast, which is sunken in the middle
• Pectus carinatum- the bird like , or outward curved chest wall

Some of my patients have a mild degree of one of these chest forms.  They may not even realize it. To determine if your chest wall has a mild form of either of the two, stand to the side in front of a mirror. It is easy to see the pectus carinatum (outward curved), as you will see that your middle sternum bone is higher in the center.   For the concave breast, the pectus excavatum, you would see the opposite, a sunken area along the middle axis.

If you have pectus excavatum type of chest wall then you are lucky in regards to breast augmentation!  This type of breast wall will naturally give you a more defined cleavage with breast implants because the implants will migrate towards the center.Cleavage on these women will be more defined. Additionally, these women usually have the option of going with high profile or moderate profile implants .

Women with the pectus carinatum , however, do not enjoy the same freedom of implant selection. If you have a chest which is curved outward, the implants will have a tendancy to shift to the sides, away from your cleavage line.  Thus, your cleavage will always be softer, or not as close together. In these cases, I recommend choosing a high profile implant because it has more projection , and less diameter.  The high profile projection will give you the most cleavage possible . In terms of the shape, the smaller diameter  of a high profile implant will sit more upright on the chest wall and not go off to the side as much.

To learn more about the type of chest wall you have and how it affects your implants selection watch my video above. If you have any questions please post them to my blog.

Ricardo L Rodriguez, MD

http://www.cosmeticsurg.net

The proposed bill would levy a 5% tax on cosmetic surgery procedures. Consider this: According to the American Society of Plastic Surgeons 2008 Statistics, women had 91% of all the cosmetic surgeries performed.

So, let’s see– this bill would be discriminating against women!!!

Page 2045

SEC. 9017. EXCISE TAX ON ELECTIVE COSMETIC MEDICAL PROCEDURES.
(a) IN GENERAL.-Subtitle D of the Internal Revenue Code of 1986, as amended by this Act, is amended by adding at the end the following new chapter:
“CHAPTER 49-ELECTIVE COSMETIC MEDICAL PROCEDURES” Sec. 5000B. Imposition of tax on elective cosmetic medical procedures.

SEC. 5000B. IMPOSITION OF TAX ON ELECTIVE COSMETIC MEDICAL PROCEDURES.
(a) IN GENERAL.-There is hereby imposed on any cosmetic surgery and medical procedure a tax equal to 5 percent of the amount paid for such procedure (determined without regard to this section), whether paid by insurance or otherwise.
(b) COSMETIC SURGERY AND MEDICAL PROCEDURE.-For purposes of this section, the term ‘cosmetic surgery and medical procedure’ means any cosmetic surgery (as defined in section 213(d)(9)(B)) or other similar procedure which-
(1) is performed by a licensed medical professional, and
(2) is not necessary to ameliorate a deformity arising from, or directly related to, a congenital abnormality, a personal injury resulting from an accident or trauma, or disfiguring disease.
(c) PAYMENT OF TAX.-
(1) IN GENERAL.-The tax imposed by this section shall be paid by the individual on whom the procedure is performed.
(2) COLLECTION.-Every person receiving a payment for procedures on which a tax is imposed under subsection (a) shall collect the amount of the
tax from the individual on whom the procedure is performed and remit such tax quarterly to the Secretary at such time and in such manner as provided
by the Secretary.
(3) SECONDARY LIABILITY.-Where any tax imposed by subsection (a) is not paid at the time payments for cosmetic surgery and medical procedures are made, then to the extent that such tax is not collected, such tax shall be paid by the person who performs the procedure.”.
(b) CLERICAL AMENDMENT.-The table of chapters for subtitle D of the Internal Revenue Code of 1986, as amended by this Act, is amended by inserting after the item relating to chapter 48 the following new item:
“CHAPTER 49-ELECTIVE COSMETIC MEDICAL PROCEDURES”.