Friday, November, 27, 2015

Smoking Linked to Slower Healing

KANSAS CITY – While reconstructive plastic surgery and cosmetic plastic surgery are growing in popularity each year in the United States, there is one risk factor that puts Missourians in a high-risk category: tobacco use. Missouri has the ninth-highest smoking rate in the nation.

Not only is smoking linked to lung cancer, heart disease, premature birth and stroke, it is linked to impaired wound healing after surgery, says Dr. Brad Storm a board-certified plastic surgeon at Premier Plastic Surgery of Kansas City. PPSKC clients are educated about the dangers of smoking, and smokers are given information about local smoking cessation programs.


According to a 2014 Gallup Poll, one in four (25.2%) adults in Missouri smoke. Nearly 10,000 Missourians die annually from tobacco-related illnesses, and more than 1,100 additional deaths are caused by exposure to secondhand smoke, states the Missouri Department of Health and Senior Services.

In 2013, the average national smoking rate was 19.7% of the population – down from 21.1% in 2008. According to the Gallup Poll, cigarette use is lowest in Utah (12.2%), California (15%) and Minnesota (15.8%) and highest in Mississippi, Arkansas, Tennessee, West Virginia and Kentucky. One-third of the adults in Kentucky and West Virginia smoke. [Read more…]

Is Melasma Cancerous?

KANSAS CITY – The terms “melasma” and “melanoma” sound similar and are both words you might hear in the doctor’s office or a dermatologist; however, they mean very different things.

“Melanoma” is a type of skin cancer that starts in the melanocytes, the skin’s pigment-producing cells. It can occur anywhere on the body, but most commonly shows up on skin that receives the most sun exposure. It may look like a changing mole or a new pigmented growth on the skin.

Melasma or Melanoma?

Melasma or Melanoma?

“Melasma” also involves the skin but is not cancerous. Patients with melasma, who come to Premier Plastic Surgery of Kansas City (PPSKS), typically present with brown to brown-gray patches on the face. Common sites include the cheeks, chin, forehead and the bridge of the nose. Women have more cases of melasma than men, who only make up 10% of all cases.

“We don’t know what causes melasma,” says Dr. Federico Gonzalez, a board-certified plastic surgeon with Premier Plastic Surgery. “Researchers think it’s just an increase in the production of cells which release the pigment called melanin, darkening the skin.”

“Melasma is a universal condition seen in many cultures”, says Dr. Gonzalez. Asian, Hispanic, Latin, Middle Eastern, Indian, Mediterranean and those of North African descent tend to develop markings of melasma more often than other ethnicities. Melasma also runs in families.  Pregnancy is a common trigger. Other hormonal disturbances in the body may rile up pigment-producing cells: birth control pills, patch contraceptives and hormone replacement medications. Sun exposure, cosmetics and anti-seizure medicines are also thought to be linked to the development of melasma.

While melasma is a cosmetic concern, melanoma is a skin cancer that needs to be treated immediately. If left untreated, a melanoma may become life-threatening since it is aggressive and can spread rapidly.

“Regular skin screening is important,” says Dr. Gonzalez. “Normal moles are tan, black or brown and have distinctive borders. They are oval or round and should be no more than a quarter inch across.”

If a mole is large, bleeding, itchy, or unusual in shape, texture or growth it should be checked by a doctor. Excision of an unusual mole is a simple and potentially life-saving procedure.

Non-cancerous melasma is treated with skin-rejuvenating:

  • Makeup application
  • Skin care products and sunscreen
  • Hydroquinone, tretinoin or corticosteroid gel
  • Chemical peels with glycolic acid
  • Microdermabrasion
  • Laser Resurfacing

If you would like to consult with Dr. Gonzalez, ask about laser resurfacing, or speak with a professional in the Premier Skin Care Center, call (913) 782-0707 between 9 a.m. and 5 p.m. weekdays.

Plastic Surgery Part of Aftercare Following Extreme Weight Loss

KANSAS  CITY – The Journal of the American Medical Association’s internal medicine edition just published an article stating that more than 67 million Americans over age 25 were obese. This startling figure is based on data collected between 2007 and 2012 as part of an ongoing study conducted by the Centers for Disease Control and Prevention.


It is not surprising that thousands and thousands of people in the United States are turning to bariatric surgery to address their morbid obesity.  In 2013, 179,000 Americans had weight-loss surgery, according to the American Society of Plastic Surgeons (ASPS). Forty-two percent of those procedures involved a gastric sleeve. Thirty-four percent had Roux en-Y (RNY) – or gastric bypass surgery, and about 14 percent chose gastric banding.

Over time, the majority of bariatric patients lose a massive amount of weight. In the process, they must create new eating habits, be diligent about exercise, and address the emotional and psychological changes that follow extreme weight loss. Follow-up care often includes plastic surgery to remove excess skin and to surgically sculpt specific areas of the body – for example, brachioplasty, an arm lift to remove “bat wings.”

“It is not uncommon to see extreme weight-loss patients at Premier Plastic Surgery of Kansas City a year after their surgeries,” says Dr. Federico Gonzalez, a board-certified plastic surgeon. “They’ve lost the weight, but excess skin in the upper arms, chest, belly, thighs and face is left behind. The extra skin may cause discomfort or problems in getting clothes to fit. My colleagues and I can address these issues.”

According to ASPS, the world’s largest organization of board-certified plastic surgeons, thigh lifts and upper arm lifts were the most popular surgical procedures selected in 2014, following significant weight loss. Breast lifts increased 10 percent, and the number of tummy tucks jumped 4 percent. ASPS began specifically tracking procedures related to bariatric surgery in 2009.

“A person’s troubles are not over once they’ve had weight-loss surgery,” says Dr. Moore. “In fact, that’s just the beginning of the process. The weight loss is great, but sagging skin can be painful, unsightly and discouraging. Resistance training for muscle growth helps support some of the tissue, but more often than not follow-up surgeries are warranted.”

If you have had – or are planning to have – bariatric surgery and need a board-certified plastic surgeon as part of your aftercare team, please call the office of Dr. Federico Gonzalez at (913) 782-0707 between the hours of 9 a.m. and 5 p.m. Monday-Friday. Premier Plastic Surgery of Kansas City’s suite is No. 370 in Doctors Building No. 1 at 20375 W. 151st Street in Olathe, KS, 66061.

Contact Lens Use Linked to Lid Droop

KANSAS CITY – More than 30 million people in the United States wear contact lenses, according to the Centers for Disease Control and Prevention (CDC). One in four of those contact wearers are older than 45, and two-thirds are women.


Why would plastic surgeons be interested in these statistics about contact lens wearers? Dr. Federico Gonzalez, a board-certified plastic surgeon at Premier Plastic Surgery of Kansas City (PPSKC), explains:

“Researchers have found a correlation between contact wearers and drooping eyelids. While contacts provide obvious vision benefits, it appears upper lid laxity may be a side effect. I’d love to see more research devoted to this topic, especially in how these findings might impact the field of plastic surgery.”

In a study conducted by Dr. Bahman Guyuron, a plastic surgeon in Cleveland, Ohio, both hard and soft lenses were linked to “ptosis” of the upper eyelids, a medical condition that affects facial aesthetics, as well as vision in some cases. Data on 96 pairs of identical twins was used in the study published recently in Aesthetic Surgery Journal, the official publication of the American Society for Aesthetic Plastic Surgery (ASAPS). Each twin in the study had some degree of upper eyelid laxity, but when measured, hard lens wearers showed more severity – with a mean ptosis of 1.84 mm. Soft lens wearers showed 21.7 percent less slackness with a mean of 1.41 mm. Measurements for subjects who did not wear lenses averaged 1.00 mm.

Researchers also looked at other external factors, including smoking habits, body mass index, sun exposure, alcohol consumption, work-related stress and sleep habits — “none of which had a statistically significant impact on eyelid droopiness,” according to conclusions published in the journal report.

“A millimeter is a small unit of measurement – like a grain of salt, but it’s significant when it involves the eyelids,” explained Dr. Gonzalez. “Drooping eyelids can hinder vision, as well as give a person the appearance of being tired or much older than they actually feel. Eyelid surgery can address those problems.”

Hard plastic contact lenses were first made in the United States around the time of World War II. Soft contact lenses were introduced in 1971. Today, 80 percent of lens wearers use soft contacts, according to the CDC. Contact lenses are regulated by the U.S. Food and Drug Administration. While the surgical term “blepharoplasty” was not coined until the early 1800s, a reference to eyelid excision was made in the first-century book “De Medicina” by Roman encyclopedia writer Aulus Cornelius Celsus.

After analyzing digital photographs and social and medical questionnaires, researchers attributed repeated tugging on the eyelids during placement and removal of contacts for the greater degree of lid droopiness on some twins. To read more about the study, visit the Aesthetic Surgery Journal website.

PPSKC’s certified plastic surgeons – Drs. Gonzalez, Moore and Storm – are highly experienced in the artistry of blepharoplasty, or eyelid surgery. If you live in the Kansas City area and would like an expert opinion about droopy eyelids, bags under the eyes, or eyelid asymmetry, call (913) 782-0707 to set up a consultation.

What is Gynecomastia?

KANSAS CITY – More than 11 million cosmetic surgical and nonsurgical procedures were performed in the United States in 2013, according to the American Society for Aesthetic Plastic Surgery. One million – or 9.4 percent – of those patients were men. The top five plastic surgery procedures chosen by men included liposuction, eyelid surgery, nose surgery, ear surgery and male breast reduction – all operations offered by board-certified plastic surgeon Dr. John B. Moore at Premier Plastic Surgery of Kansas City.


Overdeveloped or enlarged breasts – or “gynecomastia” – are a fairly common condition among teens and men over the age of 50. In fact, “60 percent of all disorders of the male breast and 85 percent of male breast masses” can be attributed to excess glandular tissue, the hallmark of gynecomastia, according to National Institutes of Health (NIH) in Bethesda, Md.

A decrease in testosterone in relationship to the body’s estrogen levels – in advanced age, puberty and infancy – can trigger gynecomastia. Conditions including pituitary insufficiency, hyperthyroidism, kidney failure, adrenal or testicular tumors, cirrhosis of the liver, and malnutrition are also associated with development of breast tissue in men. Herbal supplements, soy in the diet, and plant oils in beauty products also have been linked to gynecomastia, possibly because of “their weak estrogenic activity,” according to information posted by Mayo Clinic.

Being overweight can cause an accumulation of excess fat in the chest area, giving the appearance of feminine breasts. This is called “pseudogynecomastia” and usually can be addressed by lowering body fat, gaining muscle, or undergoing liposuction.

Up to 65 percent of young male teens experience the development of extra breast tissue; however, more than half of those boys will have a regression within 18-36 months after the onset of puberty, says Dr. Moore. Approximately 60 percent of men in their 70s present with extra breast tissue due to changing hormone levels, medicines, or health challenges, he notes.

Men with gynecomastia are often self-conscious about the feminine contour of their chests and try to mask the problem by wearing extra clothing and avoiding intimacy and other physical activities such as swimming. In these cases, it’s always a good idea to rule out contributing medical conditions. Some men learn to live with their bodies’ changes, while others are bothered enough to take the additional step of male breast reduction surgery, in which a plastic surgeon removes excessive glandular tissue, fat and skin.

“I want to assure men who have this condition that they are not alone,” says Dr. Moore. “In fact, one out of every four men between the ages of 50 and 80 has the same issue to some degree. So if you want to talk to an empathetic doctor about it, I would be happy to look at your case and let you know what we can do for you. Just call the office at (913) 782-0707 to set up a consultation with me or with one of my colleagues.”

Office hours at Premier Plastic Surgery of Kansas City are 9 a.m. to 5 p.m. Monday-Friday.

Will Diabetes Affect Cosmetic Surgery?

KANSAS CITY – We see a lot of good surgical candidates walk through the doors at Premier Plastic Surgery. They are healthy, physically fit, well-nourished and psychologically sound. Unfortunately, we consult with many men and women who are less than optimal patients for elective cosmetic procedures. They are looking for answers like anyone else, but come in with a lot of added risk factors.

A triad of problems tops the list of things that could potentially compromise surgery and healing:

  • Poor medication management
  • Smoking
  • Diabetes

diabetes-cosmetic-surgeryIt’s vital that patients fully disclose their medical history and current lifestyle habits. This includes all health conditions, as well as use of alcohol, drugs, tobacco, homeopathic products, over-the-counter medications, and prescriptions. Many of these items compromise blood clotting, anesthesia, organ function, blood pressure and wound healing. To do their best work, Premier’s board-certified plastic surgeons – Dr. John B Moore, Dr. Brad Storm and Dr. Federico Gonzalez – need to know everything. This facilitates case management and risk reduction.

Smokers must cease their habit several weeks pre- and post-operation – if not permanently. Diabetics must have their blood sugar strictly under control before surgery and afterward. Smokers and diabetics are notoriously poor healers, so these cases must be managed closely to promote satisfactory outcomes.

Diabetes and Plastic Surgery

Diabetic surgery patients have a particularly challenging road, depending on their age, fitness, circulation, kidney health, current treatment protocol, immune system condition, and their ability to strictly control diet and blood sugar levels. Surgery involves a degree of physical and mental stress, which impacts hormone levels. In the diabetic, these changes can contribute to lower insulin secretion, increased insulin resistance, reduced cellular glucose uptake, and a buildup of acidic ketones in the bloodstream.

High urinary output may make diabetics prone to dehydration. In post-op surgery patients, excessive urination takes vital fluids away from cells trying to heal and may cause other complications. Hydration, electrolyte levels, and renal health must be watched closely in diabetic patients.

Nerve damage, fragile skin, cardiovascular inflammation, and an increased risk of infection and tissue death are also concerns for plastic surgeons considering surgery on clients with diabetes. Wounds take longer to heal, exposing incisions to contaminants for a longer period of time. Following wound care instructions is of utmost importance. Weighing a potential patient’s ability to comply with post-op protocol is a vital part of the consultation process.

Reducing Risks before Cosmetic Surgery

  • Keep blood glucose within target zone
  • Eat a nutritious, protein-rich diet
  • Maintain hydration
  • Avoid cigarettes, alcohol and drugs
  • Exercise
  • Keep stress levels low
  • See your family doctor regularly

By following the aforementioned lifestyle routine, you will become a better surgical candidate. Needless to say, non-insulin dependence is the goal, whether you are considering cosmetic surgery or not.

If you have diabetes and would like to consult with one of our physicians about the possibility of having a breast lift, nose job, or liposuction, please call our office at (913) 782-0707. We’ll weigh the benefits and risks together. And, don’t forget that we offer a wide range of non-invasive cosmetic procedures and products in our Premier Skin Care Center.

Keller Funnel 2 Breast Augmentation Technology Enhances TLC at Premier Plastic Surgery

KANSAS CITY – At Premier Plastic Surgery of Kansas City, we strive to offer the latest and greatest. We’re not keen on delivering yesterday’s news.

If there’s buzz in the field of cosmetic surgery, we make it our business to know what it’s all about. Whether it’s the latest operating room innovation or a set of revised medical statistics, we check it out. If it meets our approval, we transfer the benefit to our clients, says Dr. John B Moore IV, who founded Premier more than 20 years ago.

One such device – the Keller Funnel™2 – is a perfect example. This simple tool is a no-touch breast implant delivery system that has refined placement of silicone gel implants.

  • The funnel is clear, allowing better surgical field visualization.
  • The device aids orientation of implants before placement.
  • The funnel’s no-touch system is designed to lower bacterial contamination risk.
  • The tool’s hydrophilic coating decreases friction, helping implants slide into place easily.
  • The funnel reduces insertion challenges regardless of the texture or size of prefilled silicone implants, reducing incision size, reducing stress on the implant, reducing the chance of leaking implants, and cutting down on time under anesthesia.

keller-funnelThe Keller Funnel™2 is the next generation of a device introduced in 2009 by its inventor, Dr. Kevin Keller. Technology has allowed refinement of the surface material, making the funnel slicker and even more effective than the original design. Once the implant is oriented correctly in the funnel, the surgeon simply places the tip into the surgically prepared skin pocket and squeezes the funnel gently. This propels the implant into position.

The high-tech plastic funnel is designed to reduce manual prodding of the implant and surgical site, potentially cutting down on bruising, on damage to the implant shell, and on development of post-operative tissue contracture. The funnel’s graphics make it easy to trim and size the cone properly, regardless of whether the implants are small and round, high-profile, or sized for buttocks or calves. After one use, the funnel is discarded. “The main thing we’ve noticed since we began using the funnel is a decrease in implant capsule contractures and softer breasts,” reports Dr. Moore.

Want to know more? Click here to watch a short video clip of the funnel in action. (It’s a surgery video, so if you’re squeamish, skip it.) Or, you may ask more about the funnel during a consultation with Dr. Moore or one of his colleagues, Dr. Brad Storm and Dr. Federico Gonzalez. All three board-certified plastic surgeons use the funnel in their implant surgeries.

To schedule a breast augmentation consultation, call the office at (913) 782-0707 or leave an online message in our email box. Office hours are 9 a.m. – 5 p.m. Monday-Friday. We are located in Suite 370 of Doctors Building No. 1, 20375 W. 151st St., in Olathe, KS, 66061.

Dr. Brad Storm: VECTRA Imaging Enhances Standard of Care at Premier Plastic

KANSAS CITY – MRIs and CT scans are invaluable technology for looking inside the bodies of medical patients. It’s not a stretch to say these tools have changed the face of medicine. A similar device is revolutionizing the way plastic surgeons analyze problem areas on cosmetic surgery clients, says Dr. Brad Storm of Premier Plastic Surgery of Kansas City.

Premier Plastic Surgery is now using VECTRA® M3, a high-resolution, six-camera imaging system. Like a half dozen extra sets of eyes, the VECTRA device digitally captures the angles, proportions and subtle contours of a patient’s body and records the data in its computer. The software developed by Canfield Scientific, Inc. then produces a three-dimensional model – an image that can be rotated and viewed from all sides by both Dr. Storm and the patient.

VECTRA-image-sculptureVECTRA Imaging Breast Augmentation Example

Instead of a lifeless two-dimensional photograph, the patient can view his or her likeness and then see how proposed changes would look as the image is digitally changed. With VECTRA, a nose bump can be flattened, a chin can be extended, and breasts can be made to look fuller – all digitally on the screen.

By alternating between profile and frontal shots – and all the angles in between – a patient can get a truer sense of what surgical changes would be most flattering. For example, medium-sized breast implants might be best paired with a lift procedure rather than opting for bigger implants. A weak facial profile could be improved with rhinoplasty, a chin implant, or a combination of the two.  The simulator makes this possible to visualize.

“We always are striving to enhance our standard of care,” says Dr. Storm, “and VECTRA has been a pivotal change in the consultation process.

Instead of just talking about what changes a patient desires, he or she can use VECTRA to show exactly what they are imagining. With a 3-D image on the computer screen, both doctor and patient can agree on a “starting point” and then discuss proposed changes. Not only does the imaging improve communication, patients say it makes their final decision easier and gives peace of mind for aesthetic and reconstructive procedures.

The Vectra can’t exactly predict the future result, it is merely a consultation tool. Premier Plastic Surgery is one of the very few practices in the Kansas City area using VECTRA imaging. We think you will agree Vectra will make your decision making process easier.  Call (913) 782-0707 to set up a consultation with Dr. Storm or one of his colleagues.

Mommy Makeovers a Popular Option at Premier Plastic Surgery of Kansas City

Kansas City’s reputation is based on more than its barbecue and  jazz!

[Read more…]

FDA Approves Allergan’s Natrelle 410 Silicone-Gel Breast Implant; Establishes National Breast Implant Registry with the ASPS

natrelle-410Based on seven years of data from 941 women, the FDA has approved Allergan, Inc.’s Natrelle 410 silicone-gel breast implant for breast augmentation and reconstructive surgery.   Allergan, as part of the FDA-approval process, has agreed to officiate over a series of post-approval studies.  These studies will assess long-term safety, and effective outcomes as well as any associated risks with rare diseases.

According to Dr. Jeffrey Shuren, Director of the FDA’s Center for Devices and Radiological Health, “Women should fully understand the risks associated with breast implants before considering augmentation or reconstruction surgery, and they should recognize that long-term monitoring is essential.”

Other conditions Allergan must  meet for FINAL FDA approval include submission of a report based on a 10-year clinical study, and participation in developing the National Breast Implant Registry (NBIR) in collaboration with the FDA and the American Society of Plastic Surgeons (ASPA).

dr-brad-storm-2“At Premier Plastic Surgery we are very excited about the FDA announcement that the 410 cohesive gel implant is more widely available.  I’ve used this implant for the last 7 years for breast reconstruction cases and the most complicated breast augmentation patients thru an FDA research protocol and I’m very happy the FDA has allowed the use of this implant for more straight forward breast augmentation cases.  In plastic surgery there are numerous situations in which the quality of the final result depends in part on the devices and technologies available.  While the cohesive anatomical implant won’t replace the round gel implant and is not appropriate for all, it will allow better final results for a significant group of patients.”  – Dr. Brad Storm.

The basis of this registry is to track cases of breast implants among women, and create a device surveillance registry to collect data on short and long-term safety outcomes associated with breast implants.  Overall, the main focus is to monitor the safety and efficacy of these devices in patients who have used them.  Since initiating the 10-year profile study, a cooperative research and development agreement has been signed by the FDA and the ASPS.  Review of historical data, discussions on the aggregation of data and validation of inquiries continue on a weekly basis.

According to Shuren, the FDA will continue to look at results from the post-approval study to rate long-term safety and effectiveness.   The silicone gel used in the Natrelle 410 implant contains more cross-linking than Allergan’s previously approved implant, resulting in an implant that is significantly firmer.  The Natrelle 410 breast implant is the fourth FDA-approved silicone gel implant to be available in the United States.