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December 30, 2008
Dr. Kamran Jafri
Happy Holidays & New Years to All
I wish to extend to everyone warm greetings and wishes for a Happy Holiday Season and New Years.
This is a special time for everyone - wether as a spiritual / religous time of observance, time for family and loved ones, a chance to shop 'til you drop, party 'til the morning, take some much needed vacation or symbolically marking the passage of time in our lives - I wish for everyone good health, blessings, happiness and continued personal growth and prosperity.
It is clear that our World has become very complex and it doesn't take too many days before we hear of another incidence of continued violence, disease, famine and corruption. It can be a lot to bear and sometimes it's just easier to tune it all out. I would ask though that we all make a small commitment to do our part to keep positive and promote goodness and well being in our lives. It doesn't take much - small gestures of kindness, a determined will to focus on the good in the World and making sure that we are doing the very best we can with all facets of our own individual lives.
These things add up - they always have and always will.
December 17, 2008
Dr. Kamran Jafri
Fat Injections : Restoring volume to the Aging Face
When I meet with Patients in consultation regarding surgery for facial rejuvenation they tend to focus mostly on pulling and stretching their skin up into a more youthful position. Most Patients are also very aware that the muscles of the face (the SMAS layer) must also be pulled up and tightened.
Very few Patient's however are aware of a third area that needs to be addressed as well : loss of volume in the aging face.
As we age three key things occur that result in the signs of aging (ie. jowls, smile lines, turkey necks) :
1. Skin gets weaker : collagen is the key ingredient in our skin that provides it with good tone and elasticity. As we age many factors kick in which affects the quality of our skin such as genetics, sun exposure and smoking. A skin weakens, wrinkles develop and gravity causes sagging where once there was none.
2. Muscles & Tissues descend : the muscles that make up our jowls and necks also begin to gradually weaken as we age. This fact, combined with weakening of the overlying skin, results in a descent of theses tissues causing jowls and turkey necks to appear (as many say "overnight").
3. Facial Fat disappears : with aging the fat in our face starts to lose it's bulk and ability to support the overlying tissues. Some areas of fat (malar fat pad) descend along with the jowls. This loss of fat results in loss of volume to the face and causes a gaunt and aged look (the common analogy is to think of our face as a grape that gradually loses volume to become a raisin).
The first two areas are readily addressed with surgical procedures (facelift or necklift) and are further complemented with noninvasive procedures (Botox, fillers, chemical peels).
The third area, volume restoration is a little trickier.
While fillers can be used successfully, in many patients this may require large amounts of filler to get the desired results. Using large amounts of filler like this quickly becomes financially and clinically undesirable.
Autologous Fat Grafting becomes a nice option when dealing with Patients who have had larger amounts of volume loss and desire to regain a "fuller" and more youthful looking face. In most cases the procedure can be done with local anesthesia or IV sedation. The basic outline is as follows:
1. The specific areas of volume restoration are identified and discussed with the Patient. These areas commonly include the cheeks, smiles lines, lips, area under the cheekbone and around the eyes. Not all the areas need to be done and a customized approach is developed for each Patient.
2. The fat is taken from the Patient's own body (autologous). The belly, thighs or arms can be used for the removal.
3. The fat is removed as gently as possible by syringes - this is key so as to preserve as many fat cells as possible. Extra fat is taken for sterile storage in case future injections are needed.
4. The fat is then centifruged and "purified" (excess liquid, blood and fatty components are removed leaving behind healthy fat cells).
5. These fat cells are then injected into the areas where there is volume deficit using small and specially designed cannulas. There is no need for incisions or sutures.
6. Patients do get some swelling and bruising in areas where the fat was injected, this is diminished with icing and arnica montana. So while not a deeply invasive procedure with prolonged recovery, some time should be allocated by the Patient to allow the swelling & bruising to resolve.
7. The body slowly incorporates the fat by growing blood vessels into it providing the new fat with nourishment. In most cases about 60-70% of the fat can survive and stay in place for several years. Due to the fact that some fat dies off, areas are initially overinjected so that a nice result is obtained.
8. Patients are followed over several weeks and additional injections are added with the stored fat as needed or requested. While it is desirable to have only one injection procedure, the unpredictable nature of fat can require additional injections to get the results desired.
Results are very satisfying and long lasting.
December 15, 2008
Dr. Kamran Jafri
Why Today's Wall Street is good for Plastic Surgery
There has been much talk lately about the roller coaster ride that Wall Street has been navigating and what effect this has had on the field of Plastic Surgery. Most discussion focuses on the economic impact on practices and which procedures are increasing in demand and which ones are going down. Much of the talk also focuses on items like revenue generating, efficient marketing tools, and cash flow management strategies. Mostly the discussions seem to focus on what potential negative impact is occurring.
In my opinion however, there is actually a good deal of positive impact that today's Wall Street is having on the field of Plastic Surgery.
I serve as an expert consultant to bankers who are looking into making investments in the Plastic Surgery industry. During the last three years there has been a boom in the number of companies offering Physician & Patient related services - from electronic medical records to lasers to facial fillers. In point of fact, the boom was so robust that there existed a glut of companies offering an ever growing list of questionably useful services. The long and short of it was that as a "cottage industry" there was way too much unfettered growth followed by fairly easy access to capital in turn causing there to be an unnecessary number of companies offering redundant services. With an overall "laissez-faire" attitude, the quality of these services and the clinical effectiveness of the products took a dive - look at Thermage or Thread Lifts as prime examples. On today's Wall Street, investment dollars are harder to come by - this means that any investments that are made will only be towards well researched and proven services with far less leeway for potentially useful services. If you want the financial backing you better be bringing forth a damn worthwhile product, technique or service!
Another positive impact will be a reduction in "fringe practitioners" - noncore Physicians who offer cosmetic services on the side of their primary specialty. I accept the argument that there may be some OB/GYNs, dentists or Family doctors who certainly can do a good job with Botox or fillers, but it is way too common an experience that I see Patients who have suffered from ill effects from these treatments. These problems and complications could have been entirely avoided if they had seen a Board Certified Plastic Surgeon instead. Again as Wall Street streamlines itself, a positive impact will be that fewer "weekend boot camps" will exist where noncore Physicians can sign up, pay a fee and get a "certificate" that makes them an "expert". The non-invasive treatments like Botox, fillers, and chemical peels need to be taken seriously and require a daily dedicated commitment from the Physician to ensure that they are up to date on all the latest information and safety profiles of any and all treatments offered to their Patients.
Lastly, as Surgeons we will benefit greatly as well. As Patients will be looking to make sure that their hard earned money is spent wisely they will expect (and should receive) the best care possible. This means that as Surgeons we will all have to make sure that we are only offering and providing the best care and treatments available. The desire by some Surgeons to open a Spa, run a practice and be able to devote time to Patient care will shift towards more effective treatments and personalized care. In an already hyper-competitive practice environment, we will be forced to make sure that every Patient gets the most "bang for their buck". I think this will translate into more and more Surgeons focusing on two on three specific areas on interest and being really, really good at them. I think the days of being a jack of all trades and master of none will be over soon. This is great for Patients since they will be able to choose from highly focused and specialized Surgeons and not have to worry about "dabblers" (ie. a Surgeon who does 90% Breast Surgery but the occasional Rhinoplasty calling themselves a "Nose Job Expert").
This is a good time for Plastic Surgery and I look forward to the very near future where a little of the "fat" that has come into the profession gets trimmed away so that we as a whole are back to being the specialized and respected Surgeons who have passionately and ethically practiced the art & science of Plastic Surgery.
The irony is hard to miss - Plastic Surgery itself is getting a makeover (a very good one at that) that promises to help both Physicians & Patients alike.
