Dupuytren’s Contracture Cleveland

February 2nd, 2012

Non Surgical solution to Crooked Fingers

Take a look at your palm right now to see and feel if you have a palm nodule or a fibrous cord. What you are looking for is a lump or a hard cord under your palm or finger skin. Many people from Eastern and Northern European heritage have to a 60% chance of developing this benign condition. But any ethnicity can develop a finger that is flexed and won’t extend, which is called a flexion contracture. If your relative has such a condition that also gave them a crooked finger, you may have a family risk of Dupuytren’s contracture. If you do have early palmar fibrosis it may take a long time to progress to anything that inhibits your daily hand function. And not all cords need treatment or surgery, unless they progress to contract your fingers or palms.

What is new about the treatment of this debilitating condition is the use of an enzyme called collagenase. Collagen is the protein building block of all connective tissue found in the human body, collagenase destroys the chemical bonds in collagen. Scientists in Australia used two kinds of purified collagenase from a sterile source to create a drug to dissolve the cords that caused the contractions found in the fingers and palms of people who have Dupuytren’s disorder.

This drug, named Xiaflex, came on the market after years of successful use in Australia, and finally met with FDA approval in February of 2010. I first used collagenase in the laboratory when I worked at the Medical College of Pennsylvania, doing electron microscope research in protein chemistry. As I watched that scientific literature progress through the lengthy FDA approval process, I knew I would adopt this new use of existing bio-technology to help my patients. I was lucky to be one of the early hand surgeons to use this drug, saving my patients a lot of surgery.

The drug comes to me as a dry frozen pellet. I reconstitute it a few minutes before use, as it quickly degrades. It is injected into the finger cords, which pinches a little. Some swelling or bruising at the injection sites can occur. The hand is then dressed and left alone for the day. When I see the patient the next day, I give them a shot of local anesthetic so I can do what is called an extension procedure. That means I manipulate the finger to break the collagenase weakened cord, allowing the finger to achieve normal range of motion. The results can be dramatic and rapid, liberating a finger that often hasn’t moved for years!

Shrinking skin is common complication of a finger stuck in flexion contracture for so long. So sometimes when I extend the stuck finger, there is not enough skin to allow it to reach its full range of motion. I caution some patients that they may need a little skin graft if that happens. Sometimes we can just dress it with gauze and Neosporin® and allow the skin to just heal over the next 3 weeks or so.

A Norwegian study found that over 30% of patients over age 60 developed flexion contracture. Diabetes and alcohol intake were once thought to be factors associated with Dupuytren’s contracture, but more recent epidemiological studies have shown no such association. I have seen men and women of a broad range of ages that have sought my opinion about Dupuytren’s contracture. They have all responded to initial injections. Patients can have up to three injections in each joint spaced out a month apart. The risk of the injection into the cord is that the drug can go into the tendon and dissolve it – the collagenase doesn’t know the difference between tendon and Dupuytren’s cord. But that is the reason that the manufacturer only allows hand surgeons to administer the drug. The recurrence for the cord after injection is the same as the recurrence after surgery.

And remember…Think Health!

Breast Reconstruction Cleveland

January 30th, 2012

Breast reconstruction has changed over the years and right now the most popular method of making a new breast is called TRAM breast reconstruction. TRAM stands for transverse rectus myocutaneous flap, but it’s obviously easier to simply call it TRAM.

Women who elect a TRAM reconstruction will have the supple tummy tissue relocated into the area where the breast was. Then the skin that’s removed is closed down into a tummy tuck line. Now what that means for you is you can get a flat tummy and new breast volume.

Many women ask if they can have the tissue taken from another area. You can, like from the back or even your backside, but there are some downsides to those other areas.

The best benefit of the TRAM is that it re-makes a new breast shape using your own tissue. It doesn’t require an implant to give you that volume lost from mastectomy. Women studied who have had TRAM breast reconstruction were the most satisfied with the cosmetic outcome of their breast,  even years later.

When I’m meeting a women initially to discuss breast reconstruction, she may have just recently found out that she has cancer. As you would expect, her primary focus is on survival and thriving after the cancer. That’s one of the very reasons I went into plastic surgery, because I can be the careful steward of your decision-making process, including whether you choose to do implant reconstruction or do no reconstruction at all.

Sometimes you may want to wait until your needs of radiation and chemotherapy are decided before you make the decision to have reconstruction. But we do know for sure that the desire to look normal does not compromise your recovery or survival. That has been studied extensively. The mind-body connection of looking good and feeling well is an important one. TRAM breast reconstruction puts you on the pathway by making you feel natural and beautiful.

If you’d like to explore your breast reconstruction options, I encourage you to contact my office or log on to my website.

And remember… Think Health.

Nose Surgery Cleveland

January 26th, 2012

When I talk to my patients about rhinoplasty and septoplasty, I like to use a car analogy. How the nose looks is the outside chassis. It’s cosmetic, and the corrective surgery is called rhinoplasty. How the nose breathes and works is how it drives, and THAT is often covered by insurance and is called septoplasty. The two operations can be combined into one procedure so you can reshape the exterior at the same you have the internal structures repaired.

Snoring arises primarily because of the crooked anatomy inside the nose and factors found in back of the throat including the tonsils. Snoring can be made worse because of factors like obesity, reflux, from coffee and alcohol intake, or from seasonal allergies. These factors can be minimized through behavioral changes and medications, but only a septoplasty operation can repair and straighten the cartilage between your nostrils, allowing the air to flow more smoothly, with less turbulence.

The turbinate structures inside your nose serve to warm and humidify the air, but can grow quite large and obstruct the smooth airflow. When the airflow is blocked, it makes it hard for you to breathe when you are relaxed and asleep. Turbinate surgery is used to correct size imbalances and restore proper airflow. This procedure, septoplasty and rhinoplasty are often performed together and referred to as a septo-rhinoplasty.

Cosmetic rhinoplasty starts by talking to you and listening to you about your goals for reshaping of your nose, which is a very individual decision. The unique variations of your nose will be discussed in person with the simple use of a mirror, as well as using some technology called Mirror Imaging software, in which the image we obtain can be morphed to determine what your outcome can be when your swelling has gone down and you have healed.

Rhinoplasty techniques are designed to take advantage of modifying the skin, cartilage and bone structure of your unique situation to meet several basic goals:
•    Adjust the tip projection
•    Make the nose smaller
•    Straighten the nose
•    Narrow the nose
•    Make the tip of the nose less bulbous or full
•    Turn the tip up
•    Remove a bump or hump on the bridge of the nose

So if your goal is to improve a central feature of your face or improve your breathing, click over to my website to review some results you’ll love at PaulVanekMD.com. A consultation with Mirror Imaging can have you see if the possible results will meet your expectations, before you have the procedure.

Until then, thanks for letting me help you Think Health.

Breast Asymmetry Cleveland

January 24th, 2012

According to a study by the ASPS, undergoing surgery to correct breast asymmetry had a significant effect on the self-esteem and quality of life of the women who participated in the study. The study participants had an overwhelming increase in vitality, mental health and self-esteem. Of course the degree of asymmetry one has determines who wants to correct it. Small asymmetries that I see are not ever addressed surgically. Bigger asymmetries create bigger concerns and are the point of our discussion today.

Professional women who have to be in front of an audience all day, teachers, business women, lawyers and doctors alike have shared with me their self-consciousness about their different sized breasts and the difficulty of having to deal with their professional duties when they have to be distracted by clothing and appearance.

You can readily imagine the problems facing a woman who wears a 38G cup on the left side and has a lot smaller breast on the other. The back pain, neck pain, shoulder grooving, and rashes she experienced year ’round were a constant concern for this busy mom. She had been referred to me by her physician after back exercises and physical therapy were unsuccessful in solving the problem.

Five weeks after surgery she was moving great, had better clothing choices and her back discomfort was essentially gone. She was able to exercise and her scars were on the way to fading away.

Another patient had fewer symptoms from the size difference, but a challenging problem. In the fourth grade her breasts started developing differently. She had a conical breast on the left that was a lot smaller than her right breast, which was also a lot droopier. She wanted them to match.

This is an example of beginning with the end in mind. Because her goals were to be more size matched, more perky and larger than she was when she started out, her surgical problem would require 2 procedures.

During the first procedure, the left breast required an expansion with an incision under the fold of her constricted, underdeveloped breast. The gland volume of the right side was reduced to match the gland volume of the left side, establishing a shared baseline. Then the right breast was enhanced with an implant. She went home for the day and then came back the next after a night’s rest so we could make sure the expander in left breast would result in a match to the right breast.

A few months later we took out the expander from the left breast and put in a saline implant to match the target goal of the right side. The left breast, as expected, needed to have a lift to make her look symmetric. So she now has the same size breast gland and the same size implants on both sides. This makes a difference over the long term as the breasts will “behave” the same way over time.

A year later, you can imagine the improvement she feels in many aspects of her life. Self-esteem, clothing choices, self-consciousness, even physical activity were reported to me to be better for her.

Mammograms are not affected by these procedures, as the implant patient has them behind her muscle. Differential breast reduction surgeries are still surveyed by mammograms in a routine way.

For more information please contact my office or click on my website.

And remember…Think Health!

Mommy Makeover Cleveland

January 19th, 2012

Did you know that three procedures typically included in a Mommy Makeover – breast augmentation, tummy tuck and breast lift – were 2010’s first, fifth and seventh most popular procedures respectively?

Of course one reason why mommies put off cosmetic improvement is the time away from their hectic work and family schedules required to undergo a surgical procedure. While time is a precious commodity for all of us these days, stop and think about how much your beauty and health are worth to you. Would you be able to accomplish more with a body that looks and feels younger? Many of my patients say, “Absolutely!” and tell us they wish they had their plastic surgery after childbirth and pregnancy sooner.

Other women are worried about focusing on themselves, rather than their families. Many of my patients find that it’s essential to do both: recognize that how you feel as a mom is transmitted as a strength to your family. It is not self-centered or vain to take care of yourself or to want to feel youthful, sexy and self-confident. Having a positive self-image restored certainly benefits you, and can improve your interactions with your loved ones. You may be a mommy, but never forget that you are still your own person.

“So how do I decide what I need?”, you may ask. Here’s the basic rule: If you have excess fat in your abdomen, in addition to excess skin and sagging muscles, then an abdominoplasty would probably give you the best result.

If your main concern is excess abdominal fat, then you’re probably a candidate for Vaser liposuction alone. Liposuction with Vaser will selectively remove excess fat deposits, but it may not cause all the excess skin to shrink down. If you have excess skin already, it could appear even more loose and sagging after liposuction. With an abdominoplasty, this wouldn’t be a problem because excess skin would be removed along with excess fat. In addition, an abdominoplasty will repair weakened abdominal muscles, for a slimmer and tighter figure.

Of course, depending on your shape, you can combine a tummy tuck with Vaser liposuction safely. A lipoabdominoplasty is a technique that removes excess skin and thins the abdominal wall fat layer. This “surround sound” Vaser treatment uses ultrasound energy to liquefy the fat cells selectively on the back, flanks, abdomen, and around the breast areas.

If the shape of your breasts is your concern after pregnancy and child rearing, a breast lift will restore your breasts to a youthful position. Many women notice a loss of breast volume after childbirth and as they get older, a breast augmentation can be combined with a lift to restore volume and raise the breasts to a youthful position. Both of these procedures are commonly combined with the aforementioned abdominal procedures in a Mommy Makeover.

Individual results will of course vary. When discussing your options with me, we will review the concepts of combining procedures, for a single anesthesia, a single recovery, one period of downtime and the kind of time off you should plan for given your individual schedule.

If you are ready to learn more about Mommy Makeover, call my office or click over to my website at PaulVanekMD.com to see more before and after photos.

Until then, thanks for letting me help you… Think Health.

Lipo Cleveland

January 18th, 2012

What you need to know about liposuction?

The spectrum of treatments to remove unwanted fat includes direct excision, hollow cannula suction and tumescent liposuction, which is the instillation of fluid containing adrenaline and low-concentration, local anesthesia into the fat layer space. With more technological innovation came the more selective methods in the early 1990’s that utilized a specific energy to target just the fat. The innovation of ultrasonic liposuction has progressed to lower the energy and make the wavelength more specific to the fat cell. This third generation treatment method is called Vaser liposuction or Vaser® LipoSelection. The reason it is called that is because it is so selective for the fat density. It spares injury to the collagen, the nerves, the blood vessels and the lymphatics found integrated in the three dimensions of the layer we wish to treat.

When we look at the laser methods, the lack of selectivity is immediately evident because the wavelengths of the laser energy essentially don’t selectively treat the fat. The laser cooks all the tissues. And while it may reduce the fat layer, laser liposuction techniques destroy tissue you want to keep like nerves and lymphatics.

Because of my background in biophysics research, my review of the literature, as well as research I personally performed, I have concluded that Vaser liposuction is a clearly superior liposuction method for my patients. When compared to traditional liposuction methods in the same patient, my co-investigators and I found that the skin contracture was 53% better on the Vaser-treated side. Vaser treatment was also shown to have 23% less blood loss compared to the regular liposuction side. These findings were presented at the Michigan Society of Plastic Surgery and have been accepted for publication in the Journal of Plastic and Reconstructive Surgery.

If you are ready to learn more about liposuction, call my office or click over to my website at PaulVanekMD.com to see more before and after photos.

Until then, thanks for letting me help you… Think Health!

Gynecomastia Cleveland

January 12th, 2012

What you Need to Know About Gynecomastia

Many men palpably feel the anxiety associated with their gynecomastia condition. Ladies, if this sounds like the story of a man in your life, you should gently tell him that there is a simple, definitive gynecomastia treatment that will permanently improve his situation, as it has for the 18,000 men who underwent the treatment in 2010.

The basis for this condition includes obesity, family history, age and female hormone-related development, and drug side effects. Excess alcohol intake and excess thyroid hormone also contribute to enlarged male breasts. There is a fairly lengthy list of drugs that have the side effect of enlarging the male breast, that ironically don’t have the same effects on the female breast! Malnutrition, steroids, amphetamines, marijuana and heroin can alter hormone levels and result in enlarged male breasts.

The common factor is excessive estrogen production, which affects the shape of the male breast. The solution begins with your family doctor evaluating your underlying stressors and checking for adrenal or pituitary hormone imbalances. Once those uncommon conditions are checked out and hormonal issues resolved, the next step is selective elimination of the fatty breast tissue and tightening the skin envelope. That’s where plastic surgery comes in.

The old way to remove extra male fatty breast tissue, from a general surgical standpoint, is called a sub-cutaneous mastectomy. The traditional dilemma has been that if we take out the breast tissue, will there be a collapsed sac of excess skin left over? But that dilemma has been effectively resolved because of a new technology called Vaser® LipoSelection.
Vaser LipoSelection is the most selective treatment method to liquefy the fatty breast tissue and reduce the size of the anatomic region. The skin is stimulated to “shrink wrap” around the smaller chest because the ultrasound energy also works to tighten the skin envelope. Some patients have fibrous breast tissue directly under the nipple that does not respond to ultrasound, and this needs to be removed with a small incision at the same time. This technology was first introduced 2003. My practice was the first to bring Vaser LipoSelection technology to Ohio.

When patients were scientifically studied, the Vaser ultrasound patients had 56% more “shrink wrap-effect” on their skin compared to traditional methods of liposuction. The other research finding is that the patients had 23% less blood loss with Vaser treatment.

The way the ultrasound works allows us to selectively focus on fatty breast tissue. The tiny probe is passed under the skin after a bit of local anesthetic mixed with IV fluid is pulsed under the skin. This causes the ultrasound to selectively conduct through a specific tissue density and release the fat cells from their connective tissue network. The nerves, blood vessels, lymphatics, and collagen are a different density, so the Vaser energy does not disrupt their integrity. The ultrasound doesn’t heat the tissues either, so there is no collateral damage. Vaser is considered the more gentle way to get rid of fat and gland tissue in the chest compared to regular liposuction, which features a lot of internal rasping.

In short, Vaser energy selectively knocks out the bad guys and leaves the stuff you want to leave behind. So you feel less tender, have less bruising and swelling, and a good likelihood that you’ll have normal sensation after Vaser liposuction treatment.

Recovery involves a restriction of heavy lifting for about 2 weeks. The ¼-inch incisions are found in the chest crease and in the armpit. If you have a sedentary job you can probably drive to work in 1 to 2 days and just wear an Under Armour shirt as a compression garment under your regular clothing. If you have a job that requires heavy lifting, I will write a light duty note. I do not want you to work out for about 2 weeks post-op, but you can walk as far as you want right away to keep fit.

If you are tired of wearing 3 sweatshirts to camouflage your chest, if you hope you never get picked to be on the “skins team”, or are self-conscious about the appearance of your chest, then give me a call or click over to my website at PaulVanekMD.com to get educated about Vaser treatment of gynecomastia.

Until then, it’s been great to let me help you… Think Health.

Breast Reduction Cleveland

January 8th, 2012

What You Need To Know About Breast Reduction

Did you know that 113,511 breast reductions were performed in 2009? That makes it the fifth most popular cosmetic surgery in the nation. But most women do not just have this done to look better, they want to function better in their daily lives.

In consultations with prospective breast reduction patients, many women discuss feeling awkward, top heavy, disproportionate. They talk about having people stare at their chests, how they sometimes play second-fiddle to their breasts, and of having to wear multiple bras.

But there are physical symptoms, like shoulder grooving, notching, back pain, tingling in the arms, postural issues, and the inability to participate in athletics comfortably or competitively.

So while it is common to have breast surgery for cosmetic reasons, it is also a frequent occurrence for women to have breast reduction surgery for medical reasons. Accordingly, insurance coverage is based upon symptoms as well as the amount of breast tissue that is required to be removed. This is determined at the time of our consultation.

According to a Swedish study, breast reduction surgery also reduced the patients risk of breast cancer by 28%, which is a comforting thought for those who are having the procedure for other reasons. Johin Boice, director of the International Epidemiology Center in Rockville, Maryland said, “In those over 50 that number is reduced by 43%, and it means that removing meaningful proportions of the breast does in fact lower your risk of breast cancer appreciably.”

Breast reduction is a surgical procedure which is designed to modify and improve the appearance and size of the breasts. It involves a certain amount of trauma, and it isn’t for everyone. People who have serious chronic illnesses, conditions that impair healing, heart or lung problems, or diabetes may not be able to undergo surgery.

Smoking and large-scale drinking can increase a patient’s chances for serious complications. As such, interested patients should quit smoking and limit their alcohol intake during the weeks and months preceding their breast reduction.

The surgery works best on patients whose breasts are large, but not exceptionally so. Women whose breasts are larger than size DD may not experience ideal results. Some patients experience a loss of breast sensation after a breast reduction, and the ability to breastfeed can also be negatively affected by this surgery. If these issues are a concern, there are types of breast reduction which have a greater chance for maintaining breast sensation and lactation. Similarly, certain types of breast reduction are more likely to cause scarring than others, so make sure that you pick the sort of technique that will get you the results that you want.

And remember… Think Health!

Blepharoplasty Cleveland

January 5th, 2012

Think of the normal upper eyelid as a window shade with a spring at the top called the levator muscle. The shade is the fascia that connects the muscle to a stick on the bottom called the lid margin, which is made of cartilage. That shade can become very loose from sun damage or smoking. Or how you picked your parents! Also, the fat pads above the eyelid can droop and weigh down the lid. Sometimes there are problems with the elevator muscle function, and sometimes the window shade gets too long or gets detached from the stick on the bottom.

Functional problems involving the levator mechanism of the eye can be found in either one or both eyes, and affect young and older people. The eyelid incision is made in the crease of the upper lid, and the levator is assessed during surgery. The extra skin and fat are reduced during the operation, and the proper function of the lid elevator mechanism is repaired. The skin heals in about 7 days, and during that time you should limit strenuous activity.

The lower eyelid is like a hammock of ligament and muscle, with the eyeball in the center. The 3-dimensional eyelid has a layer that holds back the fat pads around the eyeball, like a retaining wall. As we age, the retaining wall gets lax, and the fat pads protrude. The hammock sometimes gets lax and needs tightening. The muscle laxity and tired appearance can be improved by surgically tightening it up, repositioning it and removing some fat conservatively. The loose, extra skin is also removed after the lid margin is restored to its youthful position. This sometimes needs an incision at the base of the eyelash line where the lid meets the eyelashes. The scar is barely perceptible, and the surgery can be done with you awake or sedated, depending on your temperament. The improvement of your appearance is dramatic! Well rested, relaxed and natural are the common views of my patients who choose to have their eyelids surgically rejuvenated.

So, lid problems can either be cosmetic, meaning you don’t like how it looks, or functional, which means it doesn’t work right. In either case, if a patient’s ability to see is impaired, the corrective procedure may be covered by insurance.  In order to be covered by your insurance, obstruction of the visual fields must be demonstrated and documented with photography and visual field testing.  Using a simple test of visual fields, and physical measurements in the office, I am able to determine whether your problem will be covered by your insurance.

Like any surgery, blepharoplasty comes with risks of scarring, an unnatural appearance, and delays in healing. Patients with a dry eye condition or cornea problems should be especially cautious if contemplating eyelid surgery.

For more information on eyelid surgery, and for a gallery of before and after pictures, click over to PaulVanekMD.com.

And remember… Think Health.

Abdominoplasty Cleveland

January 3rd, 2012

Did you know that last year there were 116,352 abdominoplasties or tummy tuck procedures performed? That makes it the fifth most common cosmetic surgical procedure in 2010.

Hi, I’m Dr. Paul Vanek, a board-certified plastic surgeon and board-certified general surgeon. Welcome to Think Health.

So what is a tummy tuck? It’s a procedure that tightens your ab muscles, pulls your skin tight over the muscles, and removes excess. It starts with an incision in Victoria Secret territory, which we call a bikini incision. The skin is elevated from the connective tissue and fascia, exposing the separated muscle fascia layer. We never really go inside the abdomen where the organs are. The muscle layer separation is not a hernia, but is called a diastasis recti. That separation is sutured back together into the position of the muscles before weight gain or pregnancy. The belly button stalk is brought out into proper location after the skin above the belly button is lowered down like a window shade to the line above the pubic area. A LOT of the skin with stretch marks is removed.  If you have stretch marks above the belly button, there will be some left, but they will be lowered down to end up above the pubic area where they can be covered by undergarments.

Almost all women have a friend who has had a C-section or a hysterectomy. I mention this because during a C-section the lower stomach muscles are divided which is what contributes to the lifting restrictions during recovery. During a tummy tuck those same muscles which have separated in the midline are sutured together, both above and below the belly button. Because there is no muscle cutting, the recovery pain is a lot less. Women who have had a C-section almost always remark that their tummy tuck pain was different and less than their C-section.

While no surgery is without risk, the combination of Vaser® liposuction technique, tummy tuck and breast reshaping surgery can be safely combined for a dramatic results. As an example, one of my patients, whose photos can be found in my Before & After gallery, had Vaser liposuction in multiple areas, a breast lift and a tummy tuck and buttock contouring as part of a Mommy Makeover. By six weeks post-op, she was six dress sizes smaller! She was able to resume her busy business travel schedule in about 2 weeks after her surgery, and obviously she’s delighted with her revolutionary body contouring intervention.

When my patients initially inquire about their options for body contouring, they cannot imagine the dramatic outcomes we can achieve. Check out my Before & After gallery, and to review video presentations on tummy tucks and my other procedures. No surgery is without risks and those are reviewed with you during your consultation.

And remember… Think Health!

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