A new study suggests that laparoscopic adjustable gastric banding (LAGB) patients who also undergo body-contouring plastic surgery (BCPS) are more likely to maintain a lower Body Mass Index (BMI) than those who opt out of BCPS.

The study, led by Tel Aviv, Israel, plastic surgeons Tali Friedman, M.D., and Itay Wiser, M.D., notes that the mean endpoint BMI of patients who underwent BCPS was 24.6, as compared with those who did not, after a follow-up period of as long as 15 years. The authors contend the comparison may suggest that an LAGB procedure, together with BCPS, offers a safer option for specific high-risk patients looking for long-term massive weight loss.

According to the study, while LAGB surgery is the safest method for attaining massive weight loss, it is also the least effective in the long term: 30 to 50 percent of LAGB patients regain part or most of their post-surgery weight within four years. However, a 2013 study showed that patients who had undergone BCPS after the bariatric Roux-en-Y technique demonstrate improved long-term weight control compared with patients who chose not to undergo BCPS.

The Friedman/Wiser study involved patients ages 18 to 50 who had undergone LAGB surgery between 1997 and 2007, and compared the BMI totals and increases of LAGB patients who underwent BCPS with those of patients who did not.

“Not much is known regarding the factors that influence a patient’s ability to preserve the new minimal weight,” Drs. Friedman and Wiser tell Cosmetic Surgery Times. “Our study basically aimed to empirically assess the difference between those who have or haven’t undergone BCPS following LAGB, and proved the importance of BCPS as a positive prognostic factor for long-term BMI preservation.”

The study’s findings were presented at Plastic Surgery The Meeting, the annual scientific meeting of the American Society of Plastic Surgeons (ASPS), held recently in Chicago.

Results of a recently released study show that a new standardized assessment tool is an effective way to track surgeons’ progress in developing the skills they need to perform robot-assisted microsurgery.

The study, headed by Jesse C. Selber, M.D., director of clinical research in the Department of Plastic Surgery at M.D. Anderson Cancer Center in Houston, calls the Structured Assessment of Robotic Microsurgical Skills (SARMS) “the first validated instrument for assessing robotic microsurgical skills.”

The SARMS consists of 11 items—six evaluating microsurgery skills and five evaluating robotic skills. Initial assessments using the SARMS show that after a steep initial learning curve, surgical trainees display steady improvement in performing robot-assisted tasks. After the SARMS was validated, expert surgeons used it to grade videos of trainees performing robot-assisted microvascular anastomoses. Nine trainees were graded on five videos made as they gained experience with the robotic surgical system. Changes in scores in each area were assessed, as was the time required to complete the procedures.

The SARMS scores documented general improvement in microsurgical skills over five practice sessions. On a five-point scale, the trainees’ average ratings of overall skill and performance increased from about two to four, while average operative time gradually decreased from about 30 to just under 20 minutes.

“This study demonstrates that robotic surgical skills are measurable and can be acquired over a fairly short timeline.” Dr. Selber tells Cosmetic Surgery Times. “This has implications for the general plastic surgeon, who may want to apply these skills in his or her practice. Robotic techniques have limitless potential in both minimally invasive and open-field surgery, and plastic surgeons who acquire these skills will position themselves as leaders and innovators in the market place.”

The study appears in the October issue of Plastic and Reconstructive Surgery.

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Both dermatologists and cosmetic surgeons have a variety of advanced and direct techniques they regularly employ to combat the effects of photoaging. Taking a look behind the doors of one such practice, dermatologic surgeon Rebecca A. Kazin, M.D., F.A.A.D., Washington Institute of Dermatologic Laser Surgery, Washington, D.C., offers her practice pearls for the techniques she uses on her patients’ faces to turn back these undesirable effects of time.

Rebecca A. Kazin, M.D., F.A.A.D.From the perspective of photoaging prevention, Dr. Kazin emphasizes that the strategies for maintaining skin health align with society’s desire for a youthful appearance. “They, fortunately, go hand-in-hand. The treatments we recommend for photoaging prevention are great for maintaining skin health. Sunscreen, topical antioxidants, and retinoids are all great to prevent photoaging while promoting healthy skin.”

When treating the effects of photoaging, Dr. Kazin opts for a direct, yet minimally invasive strategy. “Regarding my peers, I think we all have our favorite techniques and tend to go to them first,” she says. “I tend to do a lot with injectables, then add laser. I have many colleagues who go to laser first.”

For Dr. Kazin, the type of treatment depends on the age of the patient as well. In younger adults Dr. Kazin will use lasers to treat the effects of photoaging. “For those aged 20 to 30, I am generally recommending lasers to treat any redness or discoloration on face or chest from prior sun exposure,” she says.

In those patients who are approaching their middle-age years, Dr. Kazin works on brightening the skin tone and addressing the formation of lines and wrinkles.

“Typically I start neuromodulators in the 30 to 40 year old to give a more refreshed appearance and prevent deepening of the lines between the brow and on the forehead.”

Patients who are older can experience volume loss, which can contribute to the aging effect. “Volume loss and the need for fillers increases in those 40 and older,” Dr. Kazin said. “I focus primarily on the midface to restore youthful facial proportions.”

Although elderly skin tends to be thinner and frail, Dr. Kazin still employs a direct approach to the aging face. “In patients 60 and older, I focus on ‘cleaning the canvas’ and typically recommend non-ablative resurfacing treatments to globally soften dyspigmentation, fine lines, and wrinkles.”

In terms of the future from a clinical perspective, Dr. Kazin believes the next generation of treatments will build on current technology with further improvements. For example, she believes laser hair removal will be done successfully on white or blond hair, and we will see the development of laser treatments to attempt to cure acne.

In the end, Dr. Kazin reminds us that beauty is dependent upon something more than aging. “Studies reveal that humans regard facial symmetry as beautiful,” she said. “Sometimes, subtle enhancements that simply restore facial symmetry can have a maximum impact.”