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Plastic surgery techniques advance around globe

Vancouver, British Columbia — Houston plastic surgeon Thomas Biggs, M.D., says he not only has learned new approaches to commonly performed procedures, he also has learned that some newer procedures — such as the buttock lift — are safe and accepted among plastic surgeons from around the world.

Dr. Biggs, who is clinical professor of plastic surgery at Baylor College of Medicine, president of the International Society of Aesthetic Plastic Surgery and editor-in-chief of the journal Aesthetic Plastic Surgery, moderated a session at the recent meeting of the American Society for Aesthetic Plastic Surgery during which international researchers presented information on about 30 papers.

He offers these pearls:

  • Surgeons are performing facelift surgery in younger patients with less need for extensive incisions by using a series of purse-string sutures, passed through the SMAS.

  • Doctors can get increased efficiency with fat injection by using simple technical tips.

"For a long time, we would inject fat; then, within six weeks it would all be absorbed," he says. "We now know better ways to do it. One approach is never to let the fat dry out after it has been taken from the injection site. Make sure it stays moist; make sure it is not traumatized. Make sure to inject it in thin strands, so that it can be vascularized in the area. We have also learned that it does much better if injected into a well-vascularized area, such as muscle. (This knowledge) has encouraged me to be more aggressive with fat injection."

  • There are new ways to elevate the middle third of the face, or cheeks, through an incision of the temporal area, without having to make the incision down in front of the ear.

  • Dr. Biggs says he has gained greater insight into the upper lid and how it is imperative that surgeons leave fat, and sometimes even inject fat, just below the brow to give more fullness to the upper lid.

"For many years, physicians have been removing skin and fat from the upper lids thinking they were achieving some kind of an enhanced appearance; the truth is that our desire is to increase, not decrease, the fullness in the tissues around the upper lid. We ought to remove less skin and increase the volume," he explains.

  • Dr. Biggs says he received confirmation that buttock augmentation is an accepted and safe procedure. Surgeons reviewed more efficient and safer ways for performing the procedure by making an incision in the midline and creating a pocket on top of the muscle, but under the fascia, to insert the silicone prosthesis.

"(Now, I understand that) legitimate physicians are doing this and they have done large numbers of these," he says. "The incidence of problems is very low and the incidence of happy and satisfied patients is very high."

  • Brazil has an abundance of forward-thinking plastic surgeons, according to Dr. Biggs. One presented a technique for improving the shape of the breast after a reduction mammoplasty or mastopexy. The paper indicated that surgeons should create a chest wall-based flap "that we pass under a loop of pectoralis muscle, which holds the flap in the upper pole, permanently. This creates a better and more natural shape," Dr. Biggs says.

  • Dr. Biggs says surgeons in the past would be hesitant to perform a combination liposuction and abdominoplasty procedure. But new research out of Brazil indicates that surgeons can do concomitant liposuction safely by doing an abdominoplasty and preserving the perforator vessels.

  • The increasing use of fillers stood out in the research. European researchers presented long-term data indicating that the newer fillers, including Restylane, are safe and last for about five months.

The purpose of these international sessions, according to Dr. Biggs, is to "No. 1, learn new techniques from around the world; No. 2, confirm that the technique you are currently using is an adequate way of doing the procedure or in need for more exploration."

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