Advances In Plastic Surgery

By Dr. Robert Peterson
Interviewed by Melissa Moniz
Wednesday - January 23, 2008
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Dr. Robert Peterson
Dr. Robert Peterson

Dr. Robert Peterson
Chief of Plastic Surgery at Kapiolani Medical Center for Women and Children
Interviewed by Melissa Moniz

Can you discuss the differences between plastic surgery and cosmetic surgery?

Plastic surgery is a field of specialization within medicine. There are training programs that are sent up by the medical schools around the country in plastic surgery. It is a specific curriculum which includes cosmetic surgery, reconstructive surgery, burns, hand surgery, etc. The term plastic comes from the Greek word plastikos which means to mold or form. It involves changing the form. Cosmetic surgery is a non-specific term. There are no medical school cosmetic surgery programs, and cosmetic surgery does not require the degree of rigorous surgical training and medical school oversight that plastic surgery does.


How long have you been a plastic surgeon?

I have been practicing here since 1991.

Since you’ve been in the profession, how do you think it has changed over the years?

There are several things that have been big changes. There’s been a trend to less invasive surgery. Since I got into it, the biggest change has been the use of tumescent liposuction, which is using a large quantity of dilute local anesthesia in different procedures. The high quantity of dilute anesthesia minimizes the amount of blood loss, decreases bruising and makes it a lot more comfortable in the post-operative period. It also allows us to do surgeries that we could only do with general anesthesia before, meaning we can now do it with just IV sedation. The second thing is all the injectable products: Botox, Restylane and the other fillers have really increased what we can do to take care of wrinkles in the face without having to do surgery. The use of devices - the lasers and skin-tightening treatments - allow us to give pretty good improvement in additional ways that can complement surgery or can make it so we can get some improvement without even have to do surgery. If we can do things without having to do surgery, that’s much preferable.

Dr. Robert Peterson performs a skin-smoothing procedure on a patient
Dr. Robert Peterson performs a skin-smoothing procedure on a patient

Do you perform more surgical or non-surgical procedures?

I think that we perform more non-surgical procedures in terms of the number of patients, but in terms of time - we spend more time doing surgery.

Of the surgical procedures, which is the most difficult to execute or master?

Plastic surgeons are all pretty much in agreement that the hardest surgery is nose surgery.

When a patient comes in to inquire about a surgical procedure, what are the steps taken?

For us, what happens is people come in for a consultation. At the consultation we try to get an idea of what things they want to improve and what their goals are. Then we talk to them about the different options that are available in both surgical and non-surgical. We try to get a feel of what works best for their lifestyle - how much time they can take off, what their budget is, what their fears are and how long they want the results to last. As a rule there is a trade-off with non-invasive procedures - you have less recovery time and it’s cheaper, but they don’t last as long, and there’s a limit to how much change you can achieve. If someone wants a big change, then surgery is a better option.

What are the most commonly requested non-surgical and surgical procedures?

The most commonly requested non-surgical procedure is Botox. The most commonly requested surgical procedure varies a little bit from month to month, but over the course of a year it’s probably breast augmentation. Liposuction has its month when it’s very popular, and some months are big for facial procedures.

What is lipodissolve?

Liposdissolve is a combination of two medicines: phosphatidyl choline and deoxycholate. The deoxycholate breaks the fat cells, then the fat cells die and the fat leaks out. Then the phosphatidyl choline dissolves the fat and holds it in the body, until the body can come in and clean it up. It works pretty well, however, it is limited. Following the procedure it’s sore because there’s an inflammation as the body is cleaning up the dead fat cells. And it’s also limited because you can’t do too much at once because, if you have a big area of fat that’s been killed, then it can be too sore and can cause tissue irregularities. So it works very well for small areas. It’s not a replacement for lipo-suction, when you have to take out a large area of fat. We do lipodissolve with Vela Shape, which is the latest FDA-approved device for body contouring. It basically tightens the skin so we can take away fat and tighten the skin. That has been working pretty well on arms, the tummy, the neck and the thighs.


What is the maximum amount of fat that you can remove in one liposuction procedure?

You could remove very large amounts, but it turns out that when you do that, liposuction, which is normally an extremely safe procedure, becomes quite dangerous. There were some famous bad outcomes in California in the late ‘90s of people trying to take out too much fat, so at one of our plastic surgery meetings they reviewed this and made a strong recommendation not to take out more than 10 pounds of fat at one procedure. Since then, everyone has been restricting themselves to a 10-pound limit; this has made it much safer with fewer problems.

Do you think shows on TV, such as Dr. 90210, put a positive or negative light on plastic surgery?

I think it increases people’s awareness of what’s out there, but I think anyone who is actually going to have the procedure done is going to want to talk with a physician to learn more about the risks and the recovery, which usually isn’t shown on the TV shows. The TV shows give a nice overview of what can be done, but there’s also a lot more to it than that.

What are the biggest misconceptions about plastic surgery?

There are a couple. One is that plastic surgeons don’t make scars - that’s not true. Anytime someone gets a cut, the way the body heals is by scar tissue, that’s unavoidable. What is true is that plastic surgeons are very skillful in repairing things that minimize the amount of scarring. More importantly, because we get to decide where the surgery is going to be, we get to put the scar someplace hidden. Another common misconception is that silicone breast implants are dangerous. That is overblown, and the recent FDA approval, after extensive study of the issue, seems to show that they are reasonably safe. And the third is because of the name plastic surgery, some people seem to think that we use plastic. Although we do use implants of sorts, it’s usually made of silicone rubber.

What are the differences between saline and silicone breast implants?

The advantages of the saline are that you can put it into a much smaller incision. The saline implants come empty, so you put them in, then fill them up. The silicone implants come pre-filled, so you have to make a larger incision to put them in. That’s a deciding factor for a lot of people. The other thing is that silicone implants cost more. In terms of the feel - silicone implants feel more like the natural breast tissue. The recovery time is about the same for the both of them.

Where do you think the plastic surgery profession is headed?

There are a couple of things that are ongoing trends. We now have the first set of devices that will shrink skin. I think that will continue to improve, and as that improves it will make it so that we are doing fewer and fewer surgeries. The ability to take away fat deposits without having to do open procedures is another example of those kinds of things. I think there has been an ongoing trend of reusing fat - taking fat from one part of the body and reusing it in other parts. I think that will continue and get more and more popular over time. People lose fat in their face as they get older, and so we take fat from their stomach and put that in their face. You can take fat from the stomach and put that into the breast, but the reason we don’t do that is that it can interfere with mammography. It works great, so I think if we had a different way to detect breast cancer, then that would be a popular option.

 

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