In Poland, 33-year-old man received a life-saving face transplant 3 weeks after being injured at work.
Face transplant scar incredibly complicated and rare procedures that usually will are extensive preparation.
From what we understand, this patient's condition was extreme and his life was at risk due to the inability of eating, breathing and open wounds.
The patient worked as a stone mason and suffered a machine injury which severely damaged his upper jaw and face. An attempted replant of his own face failed and therefore, he was taken to the Cancer Center and Instituted of Oncology in Gliwice, Poland, where a 27 hour face and bone transplant was performed on May 15.
Surgery reconstructed his facial skeleton, as well as his palate, soft tissues, and lips. The donor was also a young man, but required appropriate matching prior to the transplant.
The doctors performing the surgery stated that this was the only shot that the patient had surviving his injuries. They assume the patient will return to normal life. He will require immunosuppressive drugs for the rest of his life in order to keep his body from injecting the donated facial tissue.
After a brief hiatus from the FDA review, we have finally received approval to start the BRAVA with AFT.
Food and Drug Administration (FDA) has completed its review of our investigational device exemption (IDE) application for the referenced clinical study. The FDA has determined that “there are no subject protection concerns that preclude initiation of the investigation”
and has approved Brava.
In essence, we have been given permission to resume the referenced study. Furthermore, the FDA categorized the Brava device as a “CMS Reimbursement Category B1” type. A category B1 designation now allows the device to obtain insurance reimbursement via the Centers for Medicare and Medicaid Services (CMS) and presumably, by private insurers as well, on a going forward basis, so long as they are participants of the current clinical trials.
Both reconstructive breast surgery
patients and patients who want regular breast augmentation surgery
will be candidates for this treatment. We are ready to start evaluating patients and performing this ground breaking procedure.
Please call our office for an appointment. 415-668-2122.
If I were to pick one question that I get asked over and over again, it would be about stretch marks. Stretch marks are a form of scarring of the skin. It's caused by stretching or tearing of the dermis (the intermediate layer of your skin, not visible externally, that helps your skin retain its shape). They are a result of tearing and stretching of the skin associated with rapid growth or weight changes. stretch marks can also be influenced by hormonal changes associated with pregnancy, puberty, bodybuilding and hormone replacement therapy.
Initially the stretch marks appear as reddish or purple lines, but will eventually faded to a lighter color depending on the skin type. Stretch marks can appear anywhere in the body, but more commonly occur in places were large amounts of fat are stored (abdomen, breasts, upper arms, thighs and buttocks). They pose no health risk, and did not compromise the body stability to function normally.
They're have been a few things that promote stretch marks. High body mass index, low maternal age, weight gain over 30 pounds and higher birth weight were independently associated with the occurrence of stretch marks in a few studies. Additionally, teenagers are at the highest risk of developing severe stretch marks.
75-90% woman developed stretch marks to some degree during pregnancy. Elevated hormonal levels during pregnancy will cause stretch marks to appear around the sixth or seventh month of pregnancy. This is also one the skin tends to be subjected to higher levels of stretching forces. A German research team tested the application of massaging and cream and found that only one third of women with this treatment developed stretch marks while two thirds of the untreated controlled group developed stretch marks. Unfortunately, it was not clear from the paper that this was a double-blind study.
A few other studies found that the daily application of vitamin E oil was associated with less severe stretch marks during pregnancy. During pregnancy, do recommend that woman daily skin moisturized in order to prevent itchiness from the dry, and stretch skin. It may also be preventative in regards to decrease in the amount of stretch marks.
It seems that every month or so I get a new advertisement for some type of cream or laser or therapy for the improvement of mature stretch marks. Pulsed dye laser, fractional laser, and special creams have shown some mild to moderate effects, but nothing, other than surgery has effectively removed stretch marks.
The most common surgery we use to improve abdominal contour and remove lower abdominal stretch marks is an abdominoplasty
(tummy tuck). Liposuction
alone will not improve the appearance of stretch marks and in some cases it may make the situation worse by increasing the amount of loose skin.
Hope this helps.
A study that was published in April of this year in the Journal of Plastic and Reconstructive Surgery, showed that he even mild gynecomastia (male breast tissue) can have negative effects on mental and emotional health in teenage boys.
In the study, 47 teenage boys who are being evaluated for gynecomastia took a series of psychological questionnaires. The results were compared to a group of boys without gynecomastia.
The boys with gynecomastia had lower test scores on quality of life, indicating problems in several areas. He also had lower scores in general health, social functioning and mental health even when adjusted for weight and obesity (BMI).
Lower scores in areas of self-esteem and quality of life appear to be related to gynecomastia directly, rather than obesity. These teenage boys also scored higher on a test of attitudes towards food and eating. There was no difference in the rate of eating disorders between groups.
Treatment for gynecomastia typically involves male breast reduction surgery. If your teenage boy is suffering from enlarged male breasts, please contact Dr. Bermudez for gynecomastia surgery in San Francisco
today for an evaluation.
I hope this helps.
There are many factors that lead to a successful outcome in patients who undergo post-bariatric plastic surgery. Patient expectations, overall health, quality and location of the excess skin, gender, amount of weight loss, etc... If I had to pick one thing that would predict your outcome without examining you...BMI or body mass index. See link below to check yours out.
Your BMI prior to the procedures can give you a rough idea if you are a good candidate for surgery as well as your outcome.
In general, BMI >35 , in my opinion, should avoid body contouring surgery
until they have reduced that number. BMI 30-35, can proceed with surgery, but will not have a fantastic result and may require additional procedures, at additional cost.
will not reduce the amount of excess skin and has to be used cautiously in the chest and abdomen. This is where a reduction in your BMI might be more beneficial. You can't "debulk" the entire trunk with liposuction. I use it sparingly in the trunk (chest and abdomen) and more frequently in the extremities (arms and legs) as a debulking procedure.
A patient came in this week with complaints of neck and shoulder pain, bra strap grooving and a rash underneath her breasts. She was a petite and 38DD. Her breasts were heavy and dense.
2 weeks ago I saw a woman who also said she was a 38DD cup, however, she had recently undergone massive weight loss (losing over 150 lbs. in 18 months) and felt that she lost shape and fullness to her breasts.
Same size, 2 very different problems.
The first patient is a classic example of someone who is a candidate for a breast reduction, which will reduce the size of her breasts and lift them to a most aesthetically pleasing shape.
The second patient needs a breast lift
(mastopexy) with or without augmentation, depending on the patient’s wishes. Including an implant may improve the fullness which is lacking in many of these patients.
The best way to know whether to get a breast lift with implants, or breast reduction is to consult with a professional. Contact Dr. Bermudez, a trusted San Francisco breast surgeon
today for a no-obligation consultation.
, like all medical devices, do not last forever. The manufacturers quote anywhere from 10-15 years. Most patients will require replacement of their implants at that interval. The most common reasons to have implants exchanges are patient’s desires to change the size of their implants (usually larger), capsular contracture and/or implant leak.
Imaging studies, like MRI , can be used to detect "silent leaks" and are recommended every 3 years (FDA). Some studies have showed that high resolution ultrasound can be as effective in diagnosis of a leaking implant. At our breast health center, we routinely screen with ultrasound as it is a cheaper and easier alternative than MRI. Your medical insurance carrier may or may not cover this expense.
Saline implants do not require the regular imaging. If they leak, your body will absorb the saline (salt water) and the breast volume on that side will decrease. You'll probably figure out that you have a leak before you see your surgeon.
Both saline and silicone implants have a rubberized silicone shell. Both are prone to leak, roughly at the same rate. Silicone has a higher rate of capsular contracture than saline. We are not sure why, but probably due to the absorption of the saline....
Silicone implants feel and look better, especially in women who have very little breast tissue.
Think of the the silicone implant as a high maintenance luxury vehicle (i.e. Ferrari), where the saline is like a good solid lower maintenance luxury car (think Acura). Not as hot as the Ferrari, but still a really nice ride!
Another option for breast augmentation is fat grafting and the BRAVA device. This avoids the use of implants.
In this procedure, fat is harvested from your body and transferred to your breasts. Prior to surgery, you wear a BRAVA device to enlarge the tissue prior to grafting. You wear the BRAVA device for 2-4 weeks. The surgery is longer and requires more preoperative preparation, but if you are a candidate, can average about 250-300cc augmentation. I am currently enrolled in the FDA study.
Here are a couple of videos on the procedure:
All the best.
On February 20, 2013, the FDA approved the Natrelle 410 highly cohesive anatomically shaped silicone implant. Candidates for implantation must be at least 22 years of age or have undergone reconstruction after treatment for breast cancer.
The new Natrelle 410 implants containing more cross-linking compared to silicone gel used in other implants. The increased cross-linking results in a silicone that is firmer. Although these the new implants may not be appropriate for all patients, it’s nice to have additional options to give the consumer a broader choice.
The FDA has based its approval on a study of over 941 women who received the implants and followed them over 7 years. Most complications and outcomes were similar to those found in previous breast implant studies including capsular contracture, reoperation, asymmetry, implant removal and infection. In addition, investigators found fissures or cracks in some of the Natrelle 410 implants. This "gel fracture
," as it is referred to, is unique to this implant.
I always remind patient’s that breast implants are not lifetime devices. I counseled my patients the patient fully understand the risks associated with breast implants before considering augmentation or reconstruction surgery. Long-term monitoring of these and all implants is essential.
If you are thinking about breast reconstruction
or breast augmentation, please do not hesitate to contact
our office for consultation.
I hope this new information helps.
Now that winter is here,it is time to rejuvenate and correct your skin. Sun exposure is the biggest environmental cause of skin aging. Blemishes appear, skin wrinkles and loses its luster secondary to the UVA and UVB light rays. Our minimally invasive treatments
such as Laser Micropeel combined with an array of skin care products such as Obagi Nu-Derm System, Obagi Professional-C, and Procyte, can transform and correct much of the damage which has occurred due to excessive sun exposure.
is a special pulsed infrared laser that treats and softens wrinkles and other blemishes. It also improves collagen production. This treatment helps restore your skin to its natural beauty, making it softer, smoother, and more vibrant. Dr. Bermudez will evaluate how many treatments will be necessary in order to give you the best results and he will also discuss post treatment effects and care with you. There should be minimal discomfort associated with this procedure as a topical anesthetic cream is used. You may feel warming of the skin or a rubber snap like sensation while it is being performed. It is crucial to follow Dr. Bermudez’s aftercare instructions to the best possible results.
Obagi Nu-Derm System
is a physician-prescribed skin care system that corrects and transforms your skin at the cellular level. As your skin ages, the turnover of skin cells and the sloughing off of old damaged skin cells. Collagen and elastin start to slowly break down, causing the skin to lose its elasticity, resulting in wrinkles and sagging. Daily UV exposure accelerates this process and causes uneven pigmentation. Obagi Nu-Derm System has demonstrated best results in improving mild to moderate photodamaged skin.
The initial step is a complete evaluation by Dr. Bermudez
and his skin care team. This is followed by non-invasive skincare procedures
performed in the office tailored to your specific needs. Most patients only require a topical anesthetic cream, but for the more sensitive patients, a “dental block” with local anesthesia can be performed.
I get this question on a daily basis. Most of the preoperative directions are intuitive, but some are not. Here are some general guidelines, but as with all surgical procedures, check with your surgeon for detailed specifics.
Make sure you get plenty of rest, maintain exercise patterns and diminish stress as much as possible.
Patients should not ingest alcohol or use tobacco 2 weeks prior to surgery.
Tobacco use is associated with increased risk for major complication for almost all procedures. Alcohol use can interfere with narcotics use for pain control and lead to stomach ulcers and liver problems. Patients should discontinue use of aspirin, nonsteroidal anti-inflammatory agents, anticoagulants, vitamin E, multivitamins, fish and flax seed oil, homeopathic remedies, and Alka-Seltzer 2 weeks prior to surgery. These substances have been shown to increase bleeding perioperatively. Arnica montana is believed to reduce postoperative edema and bruising when used in the perioperative period.
On the morning of surgery, patients should refrain from using cosmetics, perfumes, after-shave lotions, colognes, or moisturizers.
On the day of surgery, instruct patients to wear comfortable clothes with a button-down shirt and to bring a scarf and sunglasses.