Plastic Surgery in the OC

California passes "Donda West" bill

2009-10-19T08:35:00.000-07:00

The La Times and USA Today had a blurb a couple of days ago about Arnold Schwarzenegger signing the "Donda West" bill. No one really reported on it but it is identical to the bill that he vetoed at the end of September 2008, citing that it was less urgent than many other issues.

The key section of the bill says: "Prohibits a cosmetic surgery procedure from being performed by a physician and surgeon unless, prior to surgery, the patient has received a physical examination by, and written clearance for, the procedure from either the physician and surgeon who will be performing the surgery or another licensed physician and surgeon...

The author states that this measure is not directed at the many good plastic surgeons who require their patients to have a medical clearance before elective cosmetic surgery. The author believes that explicitly requiring in law a physical examination prior to surgery will reduce the risk of complications, including death, during or after cosmetic surgical procedures."

This probably won't change how board-certified plastic surgeons like myself really do things: my nurse and I always do a full history and physical, trying to flush out any medical problems that may need be to looked into further before surgery. It's probably more intended for non-plastic cosmetic surgeons, dermatologists who perform liposuction, and dentists.

Thanks for reading,

Dr. Andrew Smith
Irvine & Corona, California

In the news: Allergan suing FDA

2009-10-05T11:41:00.000-07:00

According to an April 11 story in the NY Times by Natasha Singer, almost half of Botox's global sales are from off-label uses.

Botox is only "approved by the FDA for use cosmetically as a wrinkle treatment and medically for eye-muscle disorders, excessive underarm sweating and cervical dystonia in adults, which causes abnormal head positions and neck pain."

For wrinkles, by the way, it's only indicated for glabella and crows feet, anything other than that is considered off label. Using it elsewhere is legal, but it's not legal for Allergan to market said uses, or educate doctors about how it can be used off-label.

The LA Times is reporting that Allergan is suing the FDA, arguing that the right to free-speech should allow them to share information about off-label uses with doctors. From the article:

"Allergan says companies should be allowed to provide physicians with information on risks, benefits, dosage levels, limitations and what patients to treat in off-label uses, said Caroline Van Hove, an Allergan spokeswoman.

The company has compiled information about off-label uses of Botox, including benefits and safety issues, and would like to provide it to doctors, Van Hove said."

In my experience, Botox is pretty commonly used for the remainder of the forehead (outside of the glabellar area), it's used to raise the outer portion of the eyebrows, and less commonly used in the lips in conjuction with filler for the lips to soften lines and make the fillers last longer.

I've also seen quite a few patients request it for underarm and hand sweating.

Thanks for reading,

Dr. Andrew Smith
Irvine & Corona, California

Nothing wrong with upcoming robot technology

2009-09-28T14:08:00.000-07:00

A lot of people have asked for my opinion on the advances in robotic technology, and how it might be used in surgery for the future, especially after CNN has covered it so much recently.

The article makes a good parallel between industry moving from a rock and chisel to machine tools to the strides that medicine has made. A robot arm is not replacing a doctor's scalpel anytime; it is a high-tech tool that requires a surgeon's skill, manipulation, and decision making. There's definitely something there when it comes to enhancing surgery and helping facilitate procedures.

For plastic surgery, I think its application is mostly with minimally invasive procedures; forehead lifts, minimally invasive facelifts, etc.

Thanks for reading,

Dr. Andrew Smith
Irvine & Corona, California

Kathy Griffin: Liposuction was botched due to unrealistic expectations

2009-09-14T15:14:00.000-07:00

Kathy Griffin was recently quoted in the NY Daily News on going for liposuction with a goal of looking like Jennifer Aniston. The procedure was botched, resulting in a result that "looks like a CSI crime-scene photo."

After already having numerous plastic surgeries, and standing at a petite 5'3 115 pounds, she probably didn't have a lot of body fat left for liposuction. Patients have to have realistic expectations, and it's on the plastic surgeon to find out what the patient wants to get out of the procedure. Somewhere along the line, that wasn't done properly for Ms. Griffin.

I often see patients who had too much liposuction. The most common problem are craters, and wavy skin appearance. Fat grafting is one of the more useful techniques for smoothing that out.

And now that's two straight posts about women who want to look like Jennifer Aniston.

Thanks for reading,

Dr. Andrew Smith
Irvine & Corona, California

My take: Smaller breast trend driven by fashion, not economy

2009-09-11T12:19:00.000-07:00

Colin Stewart's In Your Face blog recently posted about the trend of smaller breast sizes becoming en vogue, citing celebrity examples like Drew Barrymore, Kelly Osborne, Denise Richards, and Tara Reid. The aforementioned stars either had oversized implants replaced with smaller models, or had breast reductions.

The American Society of Plastic Surgeons , of which I am a member, does not keep statistics on what breast size patients are opting for. A shame, because it would be pretty fascinating to watch over time. I agree with the surgeons quoted in the post in saying that women going for breast implants are opting for smaller implants than in years past. A more conservative, natural look is what is en vogue right now.

I feel this is driven by fashion. Many women come in with a picture of Jennifer Aniston as an ideal. The jury is out on whether Aniston has had a breast lift or augmentation (see this Make Me Heal article from 2007), but she's doing something right if you can't tell.

Thanks for reading,

Dr. Andrew Smith
Irvine & Corona, California

Welcome to my blog!

2009-09-02T08:59:00.000-07:00

I'm Dr. Andrew Smith. I'm starting this blog to put out my thoughts and opinions on the oldest and newest plastic surgery procedures and trends. You can also follow me on Twitter, for contests, announcements of events and lots of fun and informative details about face, body and breast enhancements. Follow me there to find out when my blog is posting and get involved with our contests and giveaways involving Irvine and Corona beauty businesses!

Dr. Andrew Smith MD FACS
Irvine, CA
Corona, CA