March 2nd, 2010 Dr. Carli
“CAPSULE” – A NON-SURGICAL APPROACH:
Capsular contracture, or more simply “capsule”, is the most common complication of breast augmentation. Once a capsule has formed, the treatment is surgical. Little can be done to prevent or predict this complication. The nation-wide incidence is 11%, which is lower than 20 years ago. In my practice, this incidence has continued to go down over the past 18 years, and is now about 2-3%. Like all plastic surgeons, I tried and used different techniques to avoid the problem with more or less success; always looking for some type of new technique or technology. However, by combining several ways I have noticed some definite improvement in prevention and non-surgical treatment of an early capsule.
PREVENTION:
In 1995, Jaime Planas, a well known plastic surgeon from Barcelona, Spain, presented a large series of cases using ultrasound for three to four weeks, twice a week after each capsulectomy (surgical excision of the capsule) to minimize the risk of capsule recurrence.
His result was encouraging. He finished his article saying that he had started doing the same regimen after each breast augmentation, and felt it was promising. He said that he would wait until he had a very large service before publishing his result in regards to the use of ultrasound status post breast augmentation.
Five years later, in 2000, Jorge Planas, the son of Jaime Planas, a plastic surgeon like his father, published an article showing that the routine use of ultrasound after breast augmentation can lower the incidence of capsule formation. I had started in 1995, after his first article, and had the same impression. Our practice does not charge for this service.
The same year, in 2000, Andre Camirand, a renowned plastic surgeon from Montreal Canada, published a series of more than 3000 breast augmentations, all treated with a compression strap for the first two to three months status post surgery. He explained the mechanism of that treatment, based on elementary knowledge of scar tissue formation. Though somewhat bothersome, I use the strap on my patients. Again, I noticed less capsule formation. I also use the strap after a capsulectomy, and notice fewer capsules as well.
In 2003, Schlessinger, from Honolulu, Hawaii, published another large series minimizing capsule formation by giving Accolate to his patients after a breast augmentation for two to three months. His rationale was that one cause of capsule formation is inflammation, which can be partially controlled by Accolate; a medication for the treatment of asthma. The only contraindication is a liver condition since Accolate can be hepatotoxic. Accolate is now used nation-wide, and seems to be effective.
These three modalities combined have resulted in a positive result. At my Riverside Plastic Surgery practiceI rarely see a capsule in patients who follow these instructions. Combined, they do prevent capsule formation; however I cannot determine which helps the most. If a patient seems to form an early capsule, in spite of that combined technique, I prolong the treatment.
In April 2008, a new tool became available. Claude LeLouarn, from Paris, France, published a new approach; again based on the theory against inflammation. Schlessinger uses Accolate, a systemic medication, to fight inflammation. Le Louarn thought of using Flector Tissue Gel, which is an anti-inflammatory patch that delivers the anti-inflammatory agent via a percutaneous bioadhesive impregnation system. These patches measure 10 X 14 cm and contains 180 grams of diclofenac-epolamine, which is the active substance.
The whole breast needs to be covered by one or two patches, depending upon the size of the breast. It is kept on 24 hours per day and changed daily for three weeks. There is no toxicity, and it can be covered by insurance, as Accolate can be. Without insurance, the cost is still minimal. Within the past two years, I used it in three patients with an early capsule that had formed within three months after surgery.
According to LeLouarn, there is no response if Flector is used on a capsule that is already six months old. At this point the inflammation process is complete and the scar tissue has formed.
In conclusion, there are non-surgical ways to prevent and treat an early capsule.
Surgery may still be indicated, but it is a last recourse and much less necessary than in the past.
Feel free to contact us about Capsular Contracture in Riverside, Inland Empire at (951) 688-8660.
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January 21st, 2010 Dr. Carli
Thermage, IPL and Erbium laser are the three non invasive ways to enhance the appearance of your skin. The Magnolia Surgery Center in Riverside is equiped with a IPL and Erbium laser. The choice is yours.
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March 24th, 2009 Dr. Carli
Silicone vs. Saline
Since 1992, when it was banned, we could no longer offer silicone to our patients. I switched to “saline” and wrote an article on the subject, deploring this ban.
Not familiar with saline, after using it for a few years, I discovered its advantages over silicone.
These advantages are:
1. Saline allows a better size symmetry. Indeed, silicone cannot be as close because it is prefilled and goes by 30-40 cc increments. This precludes more accurate size adjustment during the surgery.
2. This incidence of capsular contracture is somewhat higher with silicone. This is due to two reasons:
Reason 1: The so-called “low bleed” of silicone gel through the envelope of the implant. Though minimal in new implants, it can be a problem.
Reason 2: The new silicone implants have silicone gel that is more cohesive than the old ones in order to leak less. This has made the “armpit” (transaxillary approach) no longer possible, because the implant is no longer soft enough. We must go through the “nipple” or “under the breast” to insert the implant. The main advantage of the armpit is minimizing the tissue trauma caused by the other two techniques. The less the trauma, the lower the incidence of hematoma (bleed), seroma (serum fluid collection), and the less the risk of capsular contracture.
3. If a problem results from a breast implant, it is usually more difficult to treat if the implant is silicone versus saline. The silicone gel can contaminate the pocket, with formation of silicone granuloma (mass of scar tissue).
4. In the case of rupture, the saline leak is immediately diagnosed. The breast flattens down and it is very easy to correct. A silicone leak is not diagnosed clinically. There is no sign of rupture. This is why the manufacturers (Mentor and Allergan) stipulate, “It is recommended that a first MRI evaluation take place starting three years after implant surgery and then every two years after that, even if you are experiencing no implant problems”. This precaution implies a more difficult and expensive followup, since an MRI is not usually covered by insurance for this type of indication.
5. Finally, the cost can be another consideration since silicone is twice as expensive as saline. The higher cost of silicone might lead one to believe that silicone is better. It is incorrect. The silicone engineering is more costly, but the main reason is the consequence of the silicone crisis. This crisis has cost the manufacturers about one billion dollars, lost in lawsuits and compensations. That money needs to be recovered some how.
All of this said, the return of silicone is quite welcome.
It allows the women to have the choice. If they want it, it is available.
It allows me to recommend and use it when indicated. Indeed, it is definitely indicated when women have tissue that is too thin to cover a saline implant, which is rougher on the tissue than silicone. In that case, silicone is better because the saline implant may become palpable. The possibility of rippling is a little higher with silicone, but rippling is possible with both saline and silicone implants.
The patient now has the choice between the two types of implants. I hope that they understand the advantages of each type before making an educated choice. I remain at the disposal of our patients to recommend one or the other on a case-to-case basis.
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March 4th, 2009 Dr. Carli
Magnolia Plastic Surgery is now providing a free initial limited time plastic surgery consultation here in our Riverside office. You will have a free consultation with board certified plastic surgeon Dr. Alexander Carli, who will explain your surgical options, finance options and answer any questions you might have in regards to your procedure. Also Click here to view our current specials. Take advantage of this opportunity to meet with Dr. Carli by calling 951 688-8660 now!
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February 25th, 2009 Dr. Carli
Skin care is a lifelong commitment. Everybody’s skin is different. Whether your skin is, for example, filled with acne, pigmented, sallow, lined or lacking luster, using the right products and receiving treatments such as chemical peels is essential in correcting and preventing what ails you. Let’s face it (no pun intended) your face is the first thing people notice. With so many practitioners out there and little salons popping up, where does one turn? You want quality. You need expertise. You definitely deserve the attention and customer service. Look no further than to Dr. Carli’s Esthetics. Finding a skilled paramedical esthetician who will partner with you every step of the way is the key to unlocking what holds you and your confidence prisoner. Her name is, Erin Turner.
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February 18th, 2009 Dr. Carli
Magnolia Plastic Surgery Introduces Latisse
A New Innovation In Eyelashes
Dr Alexander Carli and the asthetic staff at Magnolia Plastic Surgery proudly introduces Latisse, the first and only prescription eyelash treatment which is approved by the FDA to grow your lashes longer, fuller and darker.
Latisse works effectively because of its active ingredient: bimatoprost. Research suggests that the growth of eyelashes occurs by increasing the percent of hairs during the growth phase. Bimatoprost helps lashes grow longer, thicker and darker because it can also prolong this growth phase.
Lattise is easy to use, FDA approved and effective. It was developed through years of research by Allergan, a pharmaceutical leader with over 60 years of expertise in prescription eye care products.
Now you can grow longer, fuller darker lashes. Let the professional staff at Magnolia Plastic Surgery provide you with more details about this exciting new product! Call Today 951 688-8660.
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February 4th, 2009 Dr. Carli
Since September 15, 2008, Plastic Surgery is almost at a standstill. Understandably so. Cosmetic Surgery being a luxury, it is the lowest priority. Though realize the crisis will not be forever, we all save.
The financial “Tsunami” is not just financial. Part of it is a psychological reaction as we have seen in the last crisis between 1990 – 1995, when companies were folding and/or leaving California.
The main question again, is how long? Nobody knows. So, should we wait or should we spend to look and feel better? We are not sure.
More than ever, the decision to go for cosmetic surgery is based on money. So is the competition among cosmetic surgeons.
We try to guess. Nothing is sure but one thing. A lot of Cosmetic Surgeons or “self-called” Cosmetic surgeons are making an all out effort to attract potential “clients” with potent promises. For example, breast augmentation for $2,999 as advertised on a billboard on Highway 60 East. The magazines and other media are used for “inexpensive surgery and great deals”.
People, once more, be careful.
“You get what you pay for” and “it is too good to be true” are time tested adages. Try to remember and don’t get fooled. These ads are false. They keep from you essential information such as the credentials of the surgeons, the type of surgical facility and the pre-and post-operative care.
You think you save money when actually you pay a high price for a second rate, at best, surgery. There are so many ways to lower a fee by lowering the quality of care.
The media are paid to claim anything. The one’s paying can be and are sometimes unscrupulous.
You think you get a deal. It is a poor deal as you may realize too late. If you don’t have the money, wait. Do not become the prey of the market. Do not add a cosmetic problem to your financial one.
In these hard times, our practice works with you. Our financial department can assist you with options that can help to make your surgery affordable without compromising the quality of care. Meanwhile, you can scrutinize every aspect of our practice, including specials, on our website http://www.magnoliaplasticsurgery.com
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