Laser Treatment of Burn Scars on the Today Show: Miracle or Not?

On May 28^th the Today Show ran a very interesting segment about a very touching story of very pretty triplets that were badly burned in infancy and were treated with a new laser treatment to improve their burn scars.  The laser was the Lumenis Encore laser and the Deep FX laser, also made by Lumenis.

I have received many phone calls from excited patients who have burn scars or have relatives with burn scars, requesting the “new miracle laser that cures burn scars on the face and body”.  I want to say that I have the very laser that was featured and I am a huge fan of Lumenis lasers.  I also want to say that I am a bit disappointed that the general public may have come away from this feature with the idea that a huge breakthrough in burn treatment has been discovered.  I truly hope that it will advance the treatment of burn scars because that would truly be a huge advancement for humanity and the people that suffer from burn scars.  As a father of two severely disabled young sons, I personally know a parents heartache of seeing a disfigured child.

One problem of the media taking hold of a “new” treatment is that it is frequently presented as a huge worldwide breakthrough in medical advancements.  Sometimes it may be, but most frequently, these stories sensationalize these treatments and put the cart before the horse.  The problem is that viewers get the idea that this is world changing technology.  If a treatment is available that could truly and radically improve burn scars, it would be Noble Prize worthy, not just Today Show worthy.  We have seen the Today Show (and Oprah and other shows) present such “huge surgical advances” as the Thread Lift, The Fraxel laser, the Liquid Facelift and many other procedures that sounded sensational, but proved to be almost useless, let alone a breakthrough.  The key phrase with so many of these treatments is that “the results exceed the expectations”.

Dr. Jill Weibel is a friend of mine and she is one of the nicest and most compassionate doctors I have met and a leader in laser technology.  I believe this type of laser treatment for burns is in the really early stages of usage and that much more long term follow up must be done.  A study by a university burn center with long term follow up would be news worthy.  Single treatments with admittedly minor improvement (the video I saw showed one of the triplets stating that she thinks that she and her boyfriend can see a little improvement is not testimony for a medical breakthrough.  I say this realizing that she has only had a single treatment and perhaps more improvement will be observable with additional treatments.  I hope this is the case because Lumenis is a credible company that would love to be part of such a break through.  I do think, however, that the “miracle” hype on this story is premature and has been presented in too much of a sensational way.  The only bad thing about this is that it can lead the tens of thousands of burn patients to think that something has arrived to change their life.  I wish it were true, but I personally don’t think it is.  I really want it to be true.

Too often the media sensationalizes medical treatments and the public gets misled.  I am not expecting this treatment to be as sensational as presented and it is my fear that like the numerous patients that have contacted me that thousands of others around the country may be given false hope.  My phone rand many times after this story ran and I too have used the Deep FX technology on scars.  The thought of improvement with the new is exciting but it is too early to brand it as a “miracle”.  As academic surgeons like Dr. Weibel and others continue to blaze new trails with this type of fractional laser, the cosmetic treatment of burn scars may become a reality.

To find out more about cosmetic facial surgery visit www.lovethatface.com

 

Joe Niamtu, III DMD

Cosmetic Facial Surgery

Richmond, Virgina

The First Face Transplant in the USA

Dr. Niamtu with Dr. Maria Siemionow 

There are a lot of disadvantages of lecturing all over the world in terms of travel, inconvenience and time away from home, but this is greatly outweighed by the advantages of making friends with special people.  While serving as the co-chair of the American Academy of Cosmetic Surgery meeting in Phoenix in 2007 one of my duties was to procure world class experts to discuss topics of interest for cosmetic surgery.  This had been right around the time of the French performing the world’s first face transplant.  I became aware of Dr. Maria Siemionow, a transplant surgeon from the Cleveland Clinic.  I was thrilled when Maria agreed to be the featured speaker for our meeting which led to a friendship.  This was several years ago and she detailed her work with animal models in preparation for the first U.S. transplant.  It was pretty fascinating as an incredible amount of work from all walks of medicine are needed to coordinate such an undertaking.  On the surgical side there are transplant, vascular, plastic, ENT, maxillofacial, craniofacial and other surgeons.  On the medical side there are numerous specialties that deal with the host and donor rejection issues and there are psychologists that counsel the patient, families, etc.  More work than you would ever imagine.  Most people think that the work is what happens in the operating room for 20 plus hours of surgery, but that may be the easy part.

This is a very emotional issue with incredible medical ethical implications.  There is much less emotion when transplanting tendons in the knee, corneas in eye or even heart transplants, as these organs are hidden and do not express emotion.  Ethicists do not accept this type of surgery for cosmetic reasons, but rather as last ditch efforts to correct deformities so horrific that the patient has no chance of a normal life in their current state.  The lady in France was mauled by dogs, the patient in Cleveland was a victim of severe trauma.  These unfortunate patients are disfigured to the point of being unable to cope with the isolation of not being able to leave their home.

Think about the psychological ramifications of this type of surgery.  The recipient patient may resemble the deceased donor.  What about the relatives of the donor possibly seeing someone with a new face that resembles their deceased loved ones?  What about the recipient patient knowing that their face is part of someone who is not living?  None of this is to be taken lightly.  Many problems exist with tissue rejection as human immune systems vigorously reject foreign tissue and patients must undergo extensive pharmacologic treatment including massive steroid doses.  The treatment can be worse than the cure.  This is not a procedure where you simply go have an operation and simply heal.  This is not a facelift, this is a face transplant.  There are good possibilities that many of the functions of the transplanted face will not work.  The muscles may not move, the new face may be expressionless.  No taste, no smell, no feeling.  In effect the new face may be a living mask, but to the recipient it may be the only possible option to appear human, just as a donor heart may be the only chance a patient with heart disease has to live. 

Also the fact exists that the entire transplant may fail and the patient could be more disfigured than they were before the surgery, or they could become so sick from the medical treatment they could die.  Again, there are many considerations with this type of surgery.

What will the future hold?  If we can work out the rejection problems, it could be possible that these procedures could be predictable.  If that happens, replacing missing facial anatomy may be a possibility.  On the other hand, as cloning and stem cell research develop, we may be able to “grow” new anatomy and the entire transplant situation may go down in history as weird science.  In any event, it is a very situation that challenges all aspects of medical and human ethics.  In the movie “Face Off” John Travolta and Nicholas Cage exchanged faces seemingly as simple as putting on a Halloween mask.  This technology may never happen but if it does where does it stop?  Assuming it became an extremely predictable, would an older patient ethically be able to have a younger face transplanted?

All of this makes for deep thinking and undoubtedly will be the plot of more movies and books.  Maria Siemionow and her team deserve the greatest respect for their unfaltering research and work leading to this historic event.  I am honored to have her as a friend.  Time will tell how society views the process.

To find out about cosmetic facial surgery in Richmond, Virginia visit  www.lovethatface.com

 

Joe Niamtu, III DMD

Cosmetic Facial Surgery

Richmond, Virginia

www.lovethatface.com

Can Cosmetic Surgery Change Your Life?

I recently came across this article about cosmetic surgery improving the quality of one’s life. An excerpt is shown below. Report: Facial Plastic Surgery Improves Quality of Life Facial plastic surgery improves patients’ quality of life, but the effects are different for men and women, researchers report in the March/April issue of the Archives of Facial Plastic Surgery.Jason A. Litner, MD, of the University of Toronto and colleagues conducted a study of 93 facial plastic surgery patients, of whom 82 (88%) were female. While 49% of patients underwent rhinoplasty, the remainder underwent surgery for the aging face. They were assessed after surgery and again 3 months later using the 59-item Derriford Appearance Scale (DAS59).Overall, there were significant improvements in DAS59 scores across all the domains of the scale and for all females, the researchers report. For men, the quality-of-life improvements were only in terms of general self-consciousness of facial appearance, and the quality-of-life domains most affected by rhinoplasty and surgery for the aging face were different.“Studies such as ours call attention to the fact that cosmetic surgery is not a superfluous ‘want’ but rather an answer to an important health concern that, in the patients’ eyes, cuts to the very heart of social desirability. It can, therefore, have implications for psychological happiness and quality of life equivalent to or, perhaps, greater than any other medical intervention,” the authors conclude.

The above article is interesting as it showed that the study respondents felt that cosmetic facial surgery improved their quality of life.  I have seen this many times in my own practice, but never push the concept on my patients.  Every day, patients return to the office after having small and or large procedures.  The look better, they feel better and seem to have a glow about them.  At consultation, I never promise that a procedure will change someone’s life, and in fact, I get a bit nervous when that is a patient’s primary reason for seeking surgery.  Cosmetic surgery can change one’s life in many ways, but it won’t save a bad marriage or guarantee a job promotion.  When patients ask “how much younger will I look” that may send up a red flag on their true intentions of having cosmetic surgery.  Obviously we all expect to look younger after cosmetic procedures, but it is impossible to quantify.  A doctor can’t tell a patient “if you do this, you will look 17 years younger”!  There is no way to measure or guarantee that.  Believe me, it sometimes happens.  There are some of my patients that have multiple procedures (laser resurfacing and facelift especially) that do look decades younger, but I never promise that. 

I do think there is a certain glow that most patients feel after having successful facial and neck rejuvenation.  They frequently seem to have a bit more pep in their step, pay more attention to hair make up and clothes.  Patients have related it to me with the analogy of how one feels when they take their car to the carwash.  You drive in with a dirty car and although you leave with the same car, it really makes you feel good to drive out with a better looking vehicle.  One patient told me that they have that same feeling, every day, since having their cosmetic facial surgery.  Another example is how a woman feels when they get their hair done.  They feel like a new person when they leave the beauty salon.

The bottom line is that cosmetic facial surgery (or any cosmetic surgery) can add to self confidence and boost self esteem and  the mood of most patients.  There is no guarantee that every patient will feel like this, but in my practice, I see it often.  This is one of the most rewarding things for a cosmetic surgeon when he or she sees their work making a positive influence in a patient’s life.  There is also no stronger marketing effort as a satisfied patient will spread the work of the surgeon’s skill.

A rational patient and surgeon should not expect miracles but should look forward to many positive changes that accompany cosmetic facial surgeries.

 

Joe Niamtu, III DMD

Cosmetic Facial Surgery

Richmond, Virginia