Cosmetic Surgery is Surgery. It is a fact that most people forget and treat it as simple cosmetic touch ups. Whenever an invasive procedure is performed, there is a risk of complications that patients need to understand. And even if the procedure is not invasive, things can go wrong. A skin cream can create a severe allergic reaction, or lead to skin breakdown, or burn, or infection. A surgical procedure can lead to a whole spectrum of potential surgical horrors. It is therefore of utmost importance that patients make sure that the person who will take their health into their hands has the proper training and proper tools to do so. There are too many frauds advertising themselves as having skills and training in things they have no business doing. These people are very good in hiding their true identity. Even other doctors have been fooled in the past. So how do you protect yourself? Talk to your family doctor. Contact the Ontario College of Physicians and Surgeons and look at your doctor’s specialty designation. You can also see what disciplinary action has been taken against this doctor.

Patients BEWARE. Only you can truly safeguard yourself against fraud.

Martin Jugenburg,MD, FRCSC
Toronto, ON

A recent report of a case-control study from The Netherlands (de Jong et al) reported an association of breast implants with anaplastic large T-cell lymphoma, however the study had limitations and referred only to saline implants.
In a recent issue of the Plastic and Reconstructive Surgery Journal, an article by Lipworth et al examined this issue. To determine whether breast implants are associated with an increased lymphoma risk, the authors have reviewed the evidence from five long-term follow-up studies that looked at the incidence of non-Hodgkin’s lymphoma in breast implant patients. These studies involved over 43,000 women with cosmetic breast implants, who were observed over 37 years.
In this group of 43 000, 48 women developed non-Hodgkin’s lymphoma. An average group of any 43 000 women would be expected to have 53.9 cases. This leads to a conclusion that breast implants do not increase the risk of non-Hodgkin’s lymphoma as compared to the average female population.

Based on the epidemiologic studies published to date, there is no evidence of an excess of non-Hodgkin’s lymphoma incidence overall among women with cosmetic silicone-filled breast implants.

Thus Breast Implants remain safe and do not cause rare illnesses.

Martin Jugenburg,MD, FRCSC
Toronto, ON

Aging baby boomers have shown an increasing interest in maintaining a youthful exterior. As a result of this, a corresponding increase in topical antiaging formulations (creams, ointments, cleansers) also known as cosmeceuticals has been seen. These products come with a seemingly limitless number of key active ingredients and claims of reducing the signs of aging and/or maintaining a youthful appearance.

The term cosmeceutical was introduced by Albert Kligman in 1984, referring to substances that claim to have both cosmetic and therapeutic effect. Many contain biologically active ingredients, and in general, but claims of efficacy are largely unproven in scientific trials. There is limited research being done on cosmeceuticals in academic dermatology, with most of the large studies coming from industry sponsored studies which taints the results with potential bias.

Although some product claims for the active ingredients used in cosmeceutical formulations are evidence-based, people often place their confidence in the claims made by the product. Without testing the actual product, it is possible that at inadequate concentrations or ineffective formulations are present, and any beneficial effect will become nullified.

Martin Jugenburg,MD, FRCSC
Toronto, ON

Skin cancer is the most common cancer in both man and women. Although breast, lung, prostate and colon cancer tend to be highly publicized, it is actually skin cancer that is the most common neoplasm of them all. Basal Cell Carcinoma is most common, followed by Squamous Cell Carcinoma, with Melanoma being less common (although it is the deadliest of the three)
Skin cancer detection usually involves observation (the doctor visually examines the skin) and if there is any concern, a biopsy is taken ( a piece of skin is cut out) and is sent to be examined by a pathologist. There, the skin sample is examined under a microscope, and various histochemical and genetic tests can be performed to identify the exact nature of the lesion.
Now an Israeli firm claims to have developed a new technology that works based on the principle that cancerous cells proliferate faster than healthy cells, and their accelerated metabolic activity releases energy at a higher frequency. The Israeli device then scans for this activity. While it sounds promising, tests are needed to determine how precise and accurate this assessment technology will be.

Skin Cancer

Martin Jugenburg,MD, FRCSC
Toronto, ON

I recently performed a breast reduction on a patient who returned on her one week visit upset about the way she looked. In particular, this patient had a large reduction, thus to reduce her breast scar length I closed her wounds in a manner that caused significant puckering of the skin. She was not ready for the look of it. I showed her pictures of other patients with similar looking wounds right after surgery and three months later when everything settled down and you could barely see the scar. But I could still tell she was terrified and scared that she was going to spend the rest of her life with terrible scars. So… the lesson learned: I have to stress to patients that right after surgery they will not look pretty, but things will settle down. Swelling and bruising that will take up to 4 weeks to go away, and it takes about 3 months for tissues to settle down before the real final appearance is seen….

Martin Jugenburg,MD, FRCSC
Toronto, ON

Ontario is attempting to improve ER wait times through various means. These include financial penalties to the ERs where the wait is too long, trying to more efficiently distribute patients through the various ERs, and pushing people out faster to make room for other incoming patients. So here are some questions:
1) If ERs are cash strapped already, how will a financial penalty allow the ‘bad’ ERs from getting any better???
2) When the entire system is underfunded, squeezed, and abused, how will one small part of it get better while the rest of the system remains problematic?
3) How do you get patients out of the ER and onto a ward or a into a nursing home/chronic care facility quicker if those facilities are already stretched to the max and lack the appropriate funding???
People complain about all the waste and inefficiency in our healthcare system. So I ask one last question. After years and years of cutbacks, restructings, and improvements, how much more juice can be squeezed out of this old dried up lemon?

Martin Jugenburg,MD, FRCSC
Toronto, ON

Tummy Tuck is a procedure to recontour the abdominal area. Excess skin and fat from the abdomen is removed, abdominal muscles are tightened and the contour of the abdomen is improved.
However, not all patients will benefit equally from this procedure. The ideal patient will have none to very mild abdominal bulge, and will have notable amount of excess skin. If you can actually hold the excess skin/fat in your hands then you will have a great result. On the other hand, if your abdomen is protruding and feels firm, you may have minimal improvement after a tummy tuck. In patients with large firm tummies, I recommend weight loss. I refer patients to bariatric doctors, who can guide these patients through diet and/or bariatric surgery to loose weight. The reason for this is that if the abdomen is protruding and firm, then the majority of the fat is inside the abdomen. The abdominal cavity, which contains the stomach, the liver, the colon and intestines, is filled with fat and this fat can not be removed through cosmetic surgery.

For weight loss, rather than body contouring, The Surgical Weight Loss Clinic in Toronto is the ideal place to visit prior to a tummy tuck to address intra-abdominal fat.

More information on tummy tuck surgery can be found on our Toronto Cosmetic Surgery website

Martin Jugenburg,MD, FRCSC
(www.plastica.ca)
Toronto, ON

From NYTimes:
For many cancer patients undergoing mastectomies, reconstructive breast surgery can seem like a first step to reclaiming their bodies.

But even as promising new operations are gaining traction at academic medical centers, plastic surgeons often fail to tell patients about them. One reason is that not all surgeons have trained to perform the latest procedures. Another reason is money: some complex surgeries are less profitable for doctors and hospitals, so they have less of an incentive to offer them, doctors say.

To raise awareness of breast reconstruction and to market it to patients, the American Society of Plastic Surgeons has adopted the vocabulary of the movement to support a woman’s freedom to choose an abortion, adjusting it for women with breast cancer. Although women “don’t choose their diagnosis, they can choose to go ahead with reconstruction or not, and with the aid of a knowledgeable plastic surgeon they can choose what their options might be,” Dr. Linda G. Phillips, a plastic surgeon in Galveston, Tex., said in a telephone news conference organized by the plastic surgery society to mark Breast Cancer Awareness Month in October. “Then they have that much more power over their lives if they have that power to choose.”

But for many patients, the options may be limited because their doctors are not proficient in the latest procedures. Dr. Michael F. McGuire, the president-elect of the American Society of Plastic Surgeons, said it is not unusual for surgeons to omit telling patients about operations they do not perform.

For many of these women, the operations were more about feeling whole again than about restoring their appearance.

Implant surgery is the most popular reconstruction method in the United States. Often performed immediately after a mastectomy, it initially involves the least surgery — usually a short procedure to insert a temporary balloonlike device called an expander — and the shortest recovery time.

But implants come with the likelihood of future operations. Within four years of implant reconstruction, more than one third of reconstruction patients in clinical studies had undergone a second operation, primarily to fix problems like ruptures and infections, and a few for cosmetic reasons, according to studies submitted by implant makers to the Food and Drug Administration. (Reconstructive patients are more likely to develop complications after implant surgery than cosmetic patients with healthy breast tissue.)

Complication rates for newer flap procedures like the one Ms. Hodges had have not been well studied, though many surgeons say they are less likely to require follow-up operations. The most common flap procedure, named a TRAM flap, for the rectus abdominis muscle, cuts away a portion of abdominal fat, as well as underlying muscle containing blood vessels, and uses the tissue to rebuild a breast. The vessels provide a blood supply for the new breast mound. The procedure promises a more lifelike look and feel, but it carries a risk of a weaker abdominal wall and hernia.

Another flap method, the DIEP free flap, is the newest and most intricate, named for the abdomen’s deep inferior epigastric perforator vessels. It involves moving abdominal fat and blood vessels, but no muscle. The DIEP flap theoretically holds out the promise of a reduced likelihood of abdominal problems. But Dr. Alderman cautioned that researchers have not yet conducted rigorous national studies that would establish a complication rate. Sometimes the flaps fail and need to be surgically removed.

Dr. Martin Jugenburg (www.microsurgeon.ca)(www.plastica.ca)

Martin Jugenburg,MD, FRCSC
Toronto, ON

Frostbite is probably rare in a place like Miami, but here in Canada this time of the year patients with frostbite do present in the ER.
Frostbite may happen to a person working outside or someone who accidentally gets stuck in the cold. Skin, especially when moist, becomes prone to injury. It turn reddish and numb. In more severe cases blisters appear. Blisters represent severe injury to the outer layer of the skin. If severe injury penetrates deep, then blisters do not form, and the skin simply dies as in a severe (full thickness) burn.
Treatment of frostbite is immediate warming with gentle warmth. Do not overheat the skin to avoid potentially burning yourself. After rewarming, Aloe Vera creams are helpful and soothing.
If you feel like your frostbite is severe, you should seek medical attention at your local hospital.

Martin Jugenburg,MD, FRCSC
(www.plastica.ca)
Toronto, ON

I have recently seen a pamphlet for company that arranges cosmetic surgery trips to a South American country. It reminded me that medical tourism still exists. And it left me wondering: why do people go to other countries to have their cosmetic surgery? I’ve always been baffled by this. Money is clearly the main issue here. BUT there’s a big ‘but’…… When your health, well being, and life are on the line, are you really trying to find the cheapest surgeon???

Traveling to international destination, often to less developed countries puts you at risk. Assuming that the surgeon who will be performing you surgery is properly trained, you still don’t know whether or not the faciliity he works out of is properly equiped. Is he using the proper instruments. Breast implants, for example, are mady by various companies. Are getting a cheaper Chinese or Russian product??? How do you know. But here is the biggest problem… what if you develop a complication? While serious complications are rare, no surgeon can ever give you a 100% guarantee that a complication will not occur. And if it does, and it is serious enough to require hospitalization…. do you really want to be admitted to the local hospital in Guatemala or India? How much will that cost you? Will you get the same level of care you would have received in your home country?

Plastic Surgeon in North America are not the only ones with the knowledge and skill to perform cosmetic surgery. The issue here is, however, that when you travel to another country you have no knowledge of their system. You may get scammed by a person with no plastic surgery training whatsoever. You may be taken to a hospital with no supplies. Next time you go to the Carribean or another part of the world, take a look at their hospital system. Some healthcare systems require that the family bring in their own toilet paper, tovels, and medications.

Don’t risk your life. If you decide to travel for cosmetic surgery, make sure your surgeon has the proper certification and that there is a proper health care support system available.

Martin Jugenburg,MD, FRCSC
Toronto, ON