A Blog by Kenneth Rothaus, MD

Dr.Rothaus has been very busy lately with numerous speaking engagements both locally and internationally.  

In May,  Dr.Rothaus was invited to speak at in Israel at the Haddasah Hospital/University in Jerusalem and Tel Hashomer Hospital in Tel Aviv. At these prestigious institutions, Dr.Rothuas spoke to local plastic surgeons about SlimLipo laser liposuction, giving his impressions of the procedure and discussing his own research findings related to its safety and efficacy. His talk was extremely well-received and generated much discusion.

More locally, Dr.Rothaus spoke at the St.Regis Hotel in New York City this past weekend.  Again, he was a guest lecturer on SlimLipo.  Dr.Rothaus is now widely considered to be one of the more experienced SlimLipo surgeons in the world.  He has sent the past several years developing and refining the techniques that he has been traveling around the world teaching to other plastic surgeons.  

Dr.Rothaus is very pleased to announce that effective immediately he will be the FIRST and for the present ONLY New York City plastic surgery practice offering Exilis technology. Exilis uses radiofrequency energy for targeted, effective and rapid body contouring and facial rejuvenation. This high-frequency energy causes heating of the deep tissues.  This is felt to result in the decrease in fat cell volume, allowing for sculpting and reshaping, while simultaneously increasing collagen production resulting in tightened, smoother skin. The treatment is painless, non-invasive and very quick.  Best results are visible after 4 weekly 15 minute sessions. More information about Exilis may be found at their website, www.exilis.com .  Dr.Rothaus is very impressed with the technology and is very excited to offer this to his patients.

When I began my surgery and plastic surgery residencies, I was baffled by the commonly issued recommendation that sutured wounds MUST be kept dry to prevent infection.  Patients were counseled to cover the area when showering or to avoid washing the area completely during the period immediately after surgery.  This always seemed counterintuitive to me from a hygiene perspective. Shouldn't we encourage our patients to keep wounds clean by gently washing with soap and water?  The wounds are generally sealed after 12hours and the suture materials now use are monofilament synthetics which behave quite differently from the silk sutures used in the past.   I decided to go with my clinical judgement and always instructed my surgical patients to wash the wound sites.  For example, if you have had a facelift in my practice, you will know that your written instructions indicated that you should shampoo your hair daily after surgery.  By following this common sense approach, I have a post-op infection rate of virtually zero in my practice.  Recently, an 800 patient Australian study verified my thoughts exactly. Thus, it remains my clinical judgement which is being confirmed by larger studies, that patients can shower and wash their wounds with no additional fear of infection and may, in fact, decrease their infection rate and other wound related morbidity.  Any patient must, of course, discuss their particular diagnosis, wound, medical problem and care with their individual physician and surgeon and should not rely on this or any other blog for definitive medical advice, care or treatment.

Summer is finally here and as the sundresses, shorts and sandals emerge from the back of the closet, its important to remember to ward off sun damage to your skin by using a high-quality sunblock or suncreen that protects against ultraviolet (UV) rays. Sunlight contains three types of UV rays - UVA, UVB and UVC. Fortunately, the ozone layer blocks out the most dangerous UVC rays and some of the UVB rats.  Long-wave UVA rays pass through the ozone layer unfiltered, deeply penetrate the skin and are known to cause photoaging and wrinkling.  Short-wave UVB rays cause sunburn and are implicated in basal cell and squamous cell carcinomas.

UV radiation can be blocked by chemical or mechanical sublocks. Chemical sunblocks are typically synthetic compounds which work by absorbing the UV light.  They are absorbed into the skin and often into the systemic circulation.  They can be degraded by the UV light and and can take up to 20 minutes after application to the skin to reach effectiveness.  Therefore, it is important to apply a chemical suncreen before sun exposure and then again at regular intervals during.  Some chemical sunblock ingredients include dixoybenzone, oxybenzone, PABA and PABA esters and cinnamates. 

Mechanical sunblocks reflect and scatter UVA/UVB light.  These sunscreens typically contain titaniun dioxide and zinc oxide as active ingredients.  I prefer mechanical sunblocks as they begin to work immediately after application and systemic absorption tends not to be a problem.  In the past, these preparations were thicker, opaque, and somewhat  cosmetically unacceptable (think the white blob of sunblock on a lifeguard's nose). With currently available technology such as micronization, the titanium and iron particles have been processed to be much smaller resulting in translucent suspensions that are thinner and smoother than in the past. 

As far as the Sun Protection Factor (SPF), you should aim to use a suncreen with at least an SPF of 30. Chemical sunblocks typically do not provide additional protection beyond SPF 30.  Mechanical sunblocks are usually by their very composition at least SPF 45-50, so you by choosing a mechanical sunblock, you are automatically at what I consider to be the a maximally efficacious level.  In either case, frequent reapplication is of the chosen sunblock is key to skin protection. Additionally, don't forget to employ some other common sense tactics such as wearing a wide brimmed,sunglasses and protective clothing, as well as avoiding the sun during the hours of 10am and 2pm to maximize your skin's protection.

 

 

 

 

 

Recently the New York Times ran an article on using only local anesthesia for breast augmentation.  Although this was a relatively short article, my comments could almost go on ad infinitum.

The main point of the "Skin Deep" article was that patients now have the choice of having their breast augmentation done under local anesthesia with or without sedation when they choose to have their procedure performed by a certain subset of physicians.  According to one Texas cosmetic surgeon quoted in the article, when he performs breast augmentaions his patients are "talking to him the entire time". After insertion of the implant, his patients are "propped up on the operating table, look in a mirror and have their say."

Lets take it point by point:

1-The surgeon quoted in the article is not a board-certified plastic surgeon. He isn't even a plastic surgeon. He is an OB-GYN who we can generously assume has had some sort of recent post-residency training to learn how to perform this procedure (perhaps the two-day, weekend seminar mentioned in the article?).  

It would be unusual to find a board-certified plastic surgeon with years of training learning how to perform this procedures advocating local anesthesia only. I would never assume that I have the same capabilities to perform a cesarean-section to deliver a baby as a board-certified OB-GYN (even if I spent a weekend learning how!).  A board-certified plastic surgeon has spent 5 to seven years or more after medical school training and perfecting his skills. How can a weekend seminar possibly compare to that?

2- Breast implants are placed in one of two pockets: either above the muscle and directly under the breast (subglandular) or under the muscle itself (subpectoral). Subpectoral placement is, however, a much more painful procedure as the muscle is elevated off the chest wall and divided along its lower edge to create pocket in which to place the implant. This would be virtually impossible under local anesthesia without sedation - much too painful for the average patient.  Therefore, by limiting yourself to local anesthesia, you are effectively limiting the type of surgery you can have, perhaps resulting in a less than idea implant placement.

3-Are these practitioners advocating local anesthesia alone because it allows them to circumvent the need to have their operating rooms accredited?  Accreditation is a time-consuming and expensive ordeal in which every aspect of the facility (from physical lay-out of the operating room to meticulous maintenance of safety equipment to the proper training of all health care professionals) is subject to strict regulations and scrutiny.  The American Society of Plastic Surgeons requires all member plastic surgeons performing procedures under anesthsia in their offices to have the space accredited by a certifying organization.  Furthermore, New York State requires accreditation for physician giving any intravenous sedation in their office.  

4-Non-board certified practitioners claim that local anesthesia makes for safer surgery, but there are NO peer-reviewed studies of which we are aware that have shown that breast augmentation done under local anesthesia by non-board certified surgeons in non-accredited ORs makes for better outcomes with less trauma to the patient.

 I threatened to go ad infinitum, but I think I made my point. 

 

 

  

 

  

We are very happy to announce that Dr.Rothaus will be featured on "The Dr.Oz Show" this coming week!

Dr.Rothaus was asked to be in a segment called "Age Erasers" in which he discussed and demonstrated SlimLipo to treat the notorious "turkey waddle".  Last week a camera crew visited the Manhattan office and filmed Dr.Rothaus performing the surgery on one of his patients.  A few days later, Dr.Rothaus and his very happy patient went to Dr.Oz's studio where they filmed a discussion with Dr.Oz.  The program will air on Channel 5 on Wednesday March 17 at 3pm and repeat on Thursday March 18 at 11am.  Please tune in and let us know what you think!

Recently the VISIA Complexion Analysis System has been in the news as a device which allows you to "know your skin's true age." The device allows the cosmetic practitioner and patient to see sun damage, fine wrinkles and other developing skin flaws. I am not sure that I would say what one sees with this device determines the age of the skin, but rather the amount of damage related to the environment including sun exposure, cigarette smoking, etc. that has been to your genetically predetermined rate of aging.

I do see some benefit, however, in providing the patient and physician with a baseline visual display of the skin.  This provides a means by which the physician and patient can visualize and record areas that require treatment and then measure the efficacy of any treatment programs.  The VISIA system is not the only such system on the market.  Furthermore, I would hesitate to alarm patients by telling them that 'their skin is ten years older than the rest of them!" as this is just marketing at its best!

Dr.Rothaus was recently asked by Ulthera Inc to be part of a select group of plastic surgeons to evaluate a new  cosmetic technology. Ulthera has developed a tool that uses micro-focused ultrasound to create areas of thermal coagulation (mild injury) below the skin. Over a 3 month period, skin tightening reportedly occurs.  The device is currently being used at the brow, cheeks and neck to tighten and tone sagging skin. Ulthera is reporting very promising results, the device is FDA approved, and has been used in Europe on several thousad patients.  Dr.Rothaus recently tested the device on seven volunteers from his staff members.  The procedure is non-invasive and takes about 30 minutes for the entire face to be treated.  Dr.Rothaus's "test subjects" reported  a pain level of 3-5 out of 10.  We are all eager to see the results of this pilot study and will keep you posted. If Dr.Rothaus feels the results are real and significant, he will be offering this non-surgical procedure in his offices.