Analysis examines safety of vaginal and plastic surgery combination procedures

September 5th, 2012 admin

Whether patients are traveling a long distance to have their procedures performed or they are simply more financially conscious or pressed for time, there is a growing trend for patients to undergo more than one procedure at a time, according to an obstetrician/gynecologist who performs laser vaginal rejuvenation and related procedures in Los Angeles.

“We have lots of patients who travel (and) desire several procedures at the same time,” says David Matlock, M.D., adding that these routine requests for combined surgical procedures prompted he and his partner, Alexander Simopoulos, M.D., both of the Laser Vaginal Rejuvenation Institute of Los Angeles, to perform a retrospective analysis of safety and complication rates in long-duration combined procedures in their patient population.

QUESTION OF SAFETY “When you have a patient who’s having a hysterectomy, it’s not that uncommon to also get a request to remove fat,” says Dr. Matlock, who teaches other OB/GYNs, urologists and aesthetic surgeons his proprietary Laser Vaginal Rejuvenation and Designer Laser Vaginoplasty procedures at the Laser Vaginal Rejuvenation Institute of America.

If a surgeon doesn’t do liposuction, that surgeon should recruit a team member who can, Dr. Matlock says. “We (OB/GYNs) have a full complement of services we need to provide to the patient,” he says. “When I teach (surgeons), I tell them they need to align themselves with a good plastic/reconstructive surgeon.”

The relationship works both ways, he says. “Normally, the OB/GYN is (also) a good referral source to the plastic/reconstructive surgeon.”

Drs. Matlock and Simopoulos have a regular long-standing relationship with John Diaz, M.D., a Beverly Hills plastic and reconstructive surgeon who performs the plastic surgery portions of their combined procedures.

However, Dr. Matlock says this: “If an OB/GYN is calling in a plastic surgeon to perform a procedure at the same time he or she is performing other vaginal procedures, the safety data does not exist in the literature. That plastic surgeon may hesitate to join the OB/GYN in the operating room to assist in performing a combination of procedures, he explains.

There is published data available on combined plastic surgery with hysterectomies, Dr. Matlock says, but there’s also an increase in pulmonary embolism, and it’s generally not advisable to do a tummy tuck with a hysterectomy.1,2

There’s also a general belief that longer surgery times — beyond four or five hours — increase the chance for complication rates, Dr. Matlock says. “That’s the consensus out there,” he says, adding that that is why he and his partner decided to take a look at it.

“We want to make sure that it’s safe,” he says. “We want to make sure none of these procedures are increasing the complication risk of anything else or in general increasing the complication rate. That’s why we wanted to do it.”

A PILOT STUDY In the study, Drs. Matlock and Simopoulos reviewed 47 female patients’ charts from September 2005 to September 2006 who underwent combined plastic and gynecologic surgery that lasted an average of five or more hours. Plastic surgery procedures included blunt suction lipectomy, autologous fat transfer to the buttock, abdominoplasty, lipoabdominoplasty, breast surgery and face surgery. Gynecologic surgery included anterior or posterior colporrhaphy, reduction labioplasty, autologous fat transfer to the labia majora and perineoplasty.

Patients were excluded if they had a hysterectomy as part of their combined procedures, had a BMI greater than 35, were heavy smokers (more than a pack per day), had diabetes, had peripheral vascular disease or used psychotropic medications.

Drs. Matlock and Simopoulos compiled patient demographic information, American Society of Anesthesiologists physical status level and anesthesia type, estimated blood loss and operative time. They evaluated major complications (death, myocardial infarction, deep venous thrombosis, pulmonary embolism, hemorrhage requiring transfusion) and minor complications (hematoma, seroma, infection, skin necrosis and tissue dehiscence).

In their analysis, the doctors found that almost half (43 percent) of patients were from out of state or country, with an average age of 39 years (range, 22 to 53). The average BMI was 24.4 (range, 18.7 to 32.9). All patients had an ASA score of 1 and received general anesthesia.

There were no major complications and only minimal minor complications related to the gynecological surgeries (nine cases of perineal or clitoral hood dehiscences) and plastic surgeries (two cases of axillary/umbilical cellulitis, and one case each of areolar hypoesthesia and of suprapubic skin necrosis). All minor complications were effectively treated on an outpatient basis.

Drs. Matlock and Simopoulos found that long-duration plastic-gynecologic surgery was safe in their specific selected subset of patients, with only minimal complications.

References:
1. Voss SC, Sharp HC, Scott JR. Obstet Gynecol. 1986;67(2):181-186.
2. Perry AW. Ann Plast Surg. 1986;16(2):121-124.

Advanced Surgical Bodybuilding Intra-Operativre Ultrasound Guided Autologous Fat Transfer to the Biceps and Triceps

February 20th, 2012 admin

The philosophy at our Advanced Surgical Bodybuilding Institute of Beverly Hills is clear. The mark of innovation not only begins with an idea but also with a proven record of results to substantiate what begins as a theory. The use of autologous fat derived from a liposuction procedure was hypothesized as being able to increase muscle mass if injected into a host muscle group. The theory of ultrasound guided subfascial muscle injection of autologous fat to effect muscle change is an exciting and new way to achieve lasting muscle growth and perhaps even muscle strength. For decades, the use of anabolic steroids and other growth enhancing derivatives have focused on the ability to cause hypertrophy of muscle tissue. We are now not merely confined to the limited domain of hypertrophy. We now have the ability to enter the elusive realm of myocyte hyperplasia.

It all begins with the harvesting of adipose tissue during a liposuction or lipectomy procedure. All forms of preaspirative disruption, manual, laser, vaser, cold could potentially be included as a method of deriving lipoaspirate in any open or closed system. It has been established that adipose tissue contains stem cells. The injection of processed combinations of adipose and adipose derived stem cells from lipoaspirate or excisional lipectomy within muscle tissue beneath the myofascia or directly within muscle tissue under direct ultrasound guidance could theoretically enhance muscle growth in the following manner: autologous fat is living tissue and remains alive if it becomes revascularized in a transplanted area, in this case either subfascial or intramuscular. The fat itself, and hence the stem cells, have a greater than 95 % viability as seen in the medical literature. The revascularization and retention of processed adipose cells to provide an apparent hypertrophy of the muscle tissue occurs in the following manner: the non embryonic stem cells normally found in processed adipose tissue form new myocytes (muscle cells) resulting in muscle hyperplasia as well as by a mass effect of the subfascial filler resulting in enhanced myofasial pliability allowing for increased muscle hypertrophy if subject is in a proper anabolic state. Muscle fascia is a connective tissue sheath firmly adhered to the underlying muscle and is thought to minimize reduction of muscular force by decreasing friction during muscle movement. Muscle fascia may divide muscle groups into separate bundles by intramuscular septa. Myofascia (muscle fascia) has limited pliability and may act as a limiting agent in muscle hypertrophy. By altering the limiting effects of muscle fascia, we can surprass the subject’s genetically limiting ability to enhance muscle growth beyond their threshold level. We can even tailor make an individual’s physique. For example, some subject’s biceps may be able to gain adequate hypertrophy yet still remain long and without the attractive peak seen in a full biceps flexion. By adding more fat in the lateral biceps head we can build a more noticeable peak for an individual desiring this. Likewise, most subjects can adequately build the lateral head of the triceps muscle and we can overcome the smaller relative medial head tricep size by adding more adipose tissue there.

In our landmark 10 subject pilot study, we evaluated AFT in the biceps and triceps (IRB approved).    Pre- and post-operative circumference (cm) of the biceps and triceps relaxed and flexed were carefully measured and sonographic volume measurement of biceps  and triceps were taken, before surgery and 6 and 12 week follow-up. We injected a mean total of 200 cc into biceps/triceps combined. This resulted in a ~1” increase in circumference at time of procedure (p<0.001) with the increase sustained over time (p<0.02). The subjects were thrilled with the results. We did not encounter any major or mild complications. We found that the use of the ultrasound with blunt needle guidance allowed for precise subfascial and intramuscular fat placement as well as avoidance of vessels and nerves. Great care must also occur preoperatively; marking of muscle groups with flexion as well as surveying the individual’s anatomy for superficial vasculature is vital for success and avoidance of complications.

We want to take this protocol and optimize our results even further. We know the stem cells injected in the muscle groups potentially can be coaxed into becoming myocytes themselves, thus causing hyperplasia and not merely hypertrophy. But how can this be further enhanced? We are devising a protocol with our procedure to utilize platelet rich plasma (PRP). PRP is rich in growth factors, cytokines, cell activators and modulators. By adding PRP to our carefully processed adipose and adipose derived stem cell injectables, we may be able to further promote not only fat retention with this procedure, but to also stimulate stem cell differentiation for maximal results. The amount of PRP required will require careful investigation and trial, but this promising approach has the potential to set the stage for incredible gains in muscle mass. This will not be limited solely to this procedure. We hope to use this for our Brazilian Butt Augmentation, a procedure we are world renowned in for achieving a natural and beautifully enhanced buttock.

With these developments, we may come to a point where gains in muscle mass rarely seen without the use of anabolic steroids and growth hormone may be naturally attained with the use of one’s own body fat, and perhaps even most importantly, without the negative side effects and subsequent loss of strength and mass once these drugs have ceased being used. This is the “Designer Steroid” in its purest form, with the ability to tailor make an approach to enhance what was the individual’s previously genetically programmed weak areas. The sky is truly the limit here.

A Personal Statement By Dr. Matlock

November 17th, 2011 admin

Dr. Matlock PicFirst of all, I would like to acknowledge all of our wonderful patients that we have had the pleasure of caring for since 1983. Many of you have referred friends and family members and for that we are grateful. The highest compliment ……(put the statement in here)….. From all of us at the office, we wish you and yours health, happiness and prosperity.

When you go to the doctor, the doctor hears all about you, rarely do you ever get to hear about the doctor. Well, let me tell you a little about myself that you won’t see in my curriculum vitae. I am a little obsessive compulsive (OC), which is good because it served me well by excelling in college, medical school and graduate school (MBA). More importantly, it makes me a very meticulous cosmetic surgeon whose personal goal is always perfection.

One quirky thing about the OC is weight. You see I have this thing about weight. Like my daughter Jessica says, “daddy doesn’t like fat!” No doubt that this is good for our liposculpturing patients because I’m out to get every ounce of fat.

Although the men in my family are endowed genetically with slim physiques, weight and diet are constant mental companions of mine. Perhaps the fact that in the past 23 years I have sucked out about 5 TONS OF FAT from over 6,000 patients, is a contributing factor. There is no doubt that I am obsessed with my diet and for the past 25 years I have voluntarily abstained from all red meat and pork as well as maintained a low carb/fat, high protein diet. Oh not to mention the vitamins I take daily (multivitamins with minerals, stress B complex, vitamin E, omega-3, resveratrol, glucosamine/chondroitin).

My philosophy of exercise gives it just as much importances as other aspects of my professional life. My 4 day routine consist of weight training, cardio and stretching. What I know about my body and genetics is this, no matter how I train, eat and supplement, I will never be able to build muscles like those in muscle magazine. Not even training with the professional bodybuilder Rene Toney (pictured below).

 

Professional Bodybuilder Rene Toney

I told Rene from the beginning I wasn’t going to bulk and she (yes that is correct, Rene is a woman) said I’ll get you there. After 6 months of grueling weight training, eating five times a day, drinking the protein drinks until it was coming out of my ears, I finally threw in the towel. I was tired of getting my ass kicked by Rene and being unable to walk to the car. Rene also conceded and said, stick with your “model body” your fine.

By model body she means the “cut look” like on the Dolce and Gabbana model below.

Model Body

Now don’t get me wrong, I had a nice body with nice ABS etc but I would do almost anything for that “chiseled” look.

Fast forward to around 2005. A Columbian plastic surgeon friend of my developed out a new procedure called Vaser Hi Def Liposculpturing. The purpose of the technique was to take people with good toned bodies and give them that chiseled look. I was trained in the technique and about 5 years ago I featured on of my cases on Dr. 90210. I was amazed at what I could do for other men and women such as Marcus below (before and after picture).

Marcus

Marcus

I as well as my patients were fascinated with this procedure. My fascination turned to thought, my thought turned to action and I had my colleague do mine three years ago.

Dr.  Matclock Abs
                                                       WHERES THE CATWALK!!!!!!!!

By adding Vaser Hi Def Liposculpturing (vhdlipo.com) to our practice our male population has jumped from 1% to over 25%. So ladies tell you husbands, boyfriends, brothers and friends what this fascinating procedure can do for them.