Saturday, December 31, 2005

Pulsed Magnetic Fields and Plastic Surgery

I've been helping with beta-testing an interesting device this past six months made by a company called Ivivi

This technology involves pulsed electro-magnetic fields (PEMF) which has a number of interesting effects when used on patients. The effect of pulsed magnetic fields tuned to certain frequencies (as opposed to the regular static magnet you'd buy off the shelf) is modulation of some of the side-effects that cells recieve with inflamation, trauma, or in this case, elective Plastic Surgery.

Clinically what you see is less pain and swelling. It's been my impression that pain control is comparable to the now common Marcaine pain-pumps that have become common as a adjunct to narcotics for post-op pain control. However, the potential benefits of PEMF devices like the Ivivi go much farther.

In animal models you also see an tremendous increase in blood vessel stimulation. The potential uses for this extend far beyond Plastic Surgery. Current clinical trials are exploring many areas including arthritis, migraines, preventing hair loss during chemotherapy, increased wound healing, and non-surgical treatment of coronary artery disease.

Given the long safety history of similar technology and the inexpensive price we're likely to see with the devices, expect for this device to potentially have a large impact in some areas of health care. Don't be surprised if this technology doesn't trickle down to over the counter-style devices in the future.

Wednesday, December 28, 2005

Thread lifts - the jury is out

The "Thread-lift" procedure has become very popular recently. The concept involves a suture with uni-directional bards that's threaded under the skin and secured, producing points of vector-like pull. It's being heavily marketed, especially by many providers who don't perform traditional facelifts. The advantage of this procedure is rapid recovery with little down time, as well as being an office-based procedure under local.

However, nothing in life is free. What's becoming clear in physician to physician contacts is some of the limitations and complications associated with it. Namely - early relaxation, palpable threads, and unnatural looking vectors of pull. Some of this was highlighted in the New York times recently in an article that can be found at:
NY Times

I had the privledge of training under one of the early beta-testers for the original desighn of the threads & I have to say that the early results are very impressive. However, it's clear that a lot of problems have been seen. I think a lot of this is in patient selection. If you need a facelift, this isn't going to work (at least for long). It's particularly problematic for early relaxation when used for neck-suspension or brow elevation with "heavy" necks or brows.

The best quote about the threadlift (which is dead accurate) is that this procedure is for "Those who want a face-lift but don't need it." Those would be the late 30 to mid 40 year old with good skin and minimal laxity. This is a new and somewhat controversial area in lowering the traditional age-range for facial cosmetic surgery. What's going to happen as you age with permanent suture material holding focal points in your face? My guess is that you'll see some very bizarre looking people with laxity around the fixed barbs. Will this be an uncorrectable or difficult to treat deformity? No one knows yet. what we do know from anecdotal reports is that doing a face-lift after barbs is potentially more difficult do because of inflamation and scar.

Sticker shock is also something I noticed with this. These threads cost nearly $100/each presently and that is either marked up by the Physician or the charge for the procedure is increased to get the total. The bill on these comes pretty close to a full facelift at times and can be the source of some surprise when the patient is quoted on this.

The bottom line is the role for these is being sorted out. There are a lot of Physicians putting these in anyone and you're getting a lot of problems from it. Better patient selection is going to provide better & longer lasting results. These may in fact prove most ideal for patients showing early relaxation from a traditional lift of the brow, neck, of face rather then replacing those procedures

Tuesday, December 27, 2005

Who's a Plastic Surgeon? (and who is not)

Many patients may not know it by looking thru the yellow pages or on the internet, but the doctor you're looking at for a "Plastic surgeon" may not even be trained in Surgery at all. In fact they may well not even be a medical doctor. Financial pressures from falling reimbursement for insurance cases has led a whole new group of providers to try and reinvent themselves as providers for cosmetic surgeries.

One of the educational activities of the Amer. Society of Plastic surgery (ASPS) has been to educate the public on exactly the distinction between how we (plastic surgeons) and they are trained. This includes the emphasis on whether or not your surgeon is "board certified" or "board eligible" in Plastic Surgery. To many people's eyes, this campaigns has been a failure to this point.

This would seem to be a pretty low bar, no? As it stands, there is very deliberate confusion put out by an alphabet soup of cosmetic surgery "boards" all of which are trying to tag along to the pop-culture cache of traditional Plastic Surgery procedures(and their potential associated financial rewards). Does it make sense that may ENT's, OBGYN's, General surgeons, dermatologist, ER physicians, and even dentists have unilaterally decided they're qualified to do cosmetic procedures far outside their areas of proctored training?

Well that horse is long out of the barn. Look in your yellow pages under Plastic Surgeons notice a number of ads for "Facial Plastic Surgeon" (who are ENT's) or "Cosmetic Surgeons" (who can be anybody) without making any distinction that these providers AREN'T Plastic Surgeons. The Yellow Pages don't care who you are as long as your check clears.

Thursday, December 22, 2005


Welcome to Plastic Surgery 101. Blogging is a new adventure for me so I'm not sure which direction things are going to go here. What I'd like to do is highlight some of the areas of Plastic Surgery that are confusing to most people & explain/comment on things in a way that's both fun to read & informative.

My name is Dr. Robert Oliver , Jr. & I'm a Plastic Surgeon in Birmingham, Alabama. I was fully trained in both General and Plastic Surgey before focusing my interest in Cosmetic Plastic Surgery and breast reconstruction. I've joined my father, Dr. Robert Oliver Sr., in practice in 2005.

Stay tuned for content update!

Dr. Rob Oliver