New Cosmetic Surgery

I was recently consulted by a patient whose breasts were worn and stretched out of shape after several implants, and she was suffering as a result. As by their very nature the implants covered very few soft parts and their weight had caused her breasts to stretch more and more, increasingly larger implants were needed after the initial implants, which made the thinning and stretching problem worse.

This is a constantly recurring problem with silicone implants. Just a few days ago the director of a German clinic contacted me regarding a similar case. He asked me whether stem cell-enriched autologous fat transfer could help here.

Implants are obviously always palpable, in most cases also visible, and they stretch the breast tissue; it is necessary to explain to every patient that after a few years implants need to be replaced for the sake of appearance because of stretching of the breast tissue, and that follow-up operations must therefore be reckoned with. This means that if one doesn’t want oversized, soccer ball-like breasts, they must be tightened by reduction surgery in order to make them (restore them to) a reasonable size.

I believe that after surgical tightening there are two options for achieving a better appearance:

Breast augmentation using only stem cell-enriched autologous fat. Obviously the augmentation won’t be as impressive, but it will look a lot more natural. This would be the way to go if the patient is generally unhappy with her implants and wants to get rid of them at all costs.

Inserting new implants and attempting to fill out/round out the edges of the implants as well as the subcutaneous tissue in the breast/chest region with stem cell-enriched autologous fat. The augmentation by the implant is maintained without having to displace as much volume.

Because the only way to solve the problem of further tissue stretching by the implant is to refrain from more implants, I prefer the first option, even though the augmentation is less striking than with silicone. However, the breasts stay in shape and the patient can enjoy them for years to come without having to plan on expensive follow-up operations that are fraught with complications.

Shouldn’t silicone implants be dispensed with altogether? That is precisely the question.

Heinrich, MD

I get a lot of e-mails from interested women around the world with questions on the subject of breast augmentation with stem cells. This method has since become established as a pillar of New Cosmetic Surgery and spares many patients from silicone and plastic surgery. Today I received a letter from an interested English lady, in which she wrote that she had a consultation in a clinic that offered CAL (Cell-Assisted Lipotransfer) for breast augmentation. The doctors at that clinic told her that although they recently started offering CAL (= the stem cell method), they would not recommend it because they weren’t that satisfied with the results.

In most cases such statements come from plastic surgeons who prefer silicone implants and do not like to admit that they are not familiar with breast augmentation with stem cell-enriched autologous fat. Again and again patients are referred to me by foreign clinics, where they also use the stem cell method, but still do not have as much experience with it as we do here in Vienna. Because doctors know that I have operated on more patients in Europe with this method than anyone else, they are always advising patients to fly to Vienna to see me.

Many details are critical to success with this method – including, for example, obtaining fat the right way: standard liposuction with regular cannulas only works with patients who are well-endowed with fat pads. For more slender patients, it is necessary to resort to narrower diameter microcannulas for obtaining fat, as it is not possible to obtain enough fat using regular cannulas without leaving unsightly dents. Liposuction with microcannulas is the only way to obtain enough fat in a minimally invasive manner, also in regions that would be prohibitive for liposuction with regular cannulas.

A critical factor for success with the stem cell method is the doctor having sufficient interdisciplinary training in order to truly understand the process and ramifications of stem cell isolation and stem cell implantation. Purely surgical training focuses on manual reconstructive-operating skills with the scalpel. There is no place for training in the area of liposuction, autologous fat transplantation, or even stem cell technology and tissue engineering.

Only the training as a general practitioner (specializing in cosmetic surgery, anti-aging, and stem cell medicine) guarantees you that your doctor is up-to-date technologically and will not automatically resort to the scalpel and silicone, in spite of the fact that better, more modern, and less invasive methods have been around for some time!

Heinrich, MD

As every reader of my blog knows, I have been working for a long time with Hormonal Regeneration and hence I know how effective an individualized holistic treatment with bioidentical hormones can be in most cases. The effect of this individualized therapy, in which the levels of all hormones are raised to the optimum values of young adults, is superb! In many cases plastic surgery and cosmetic operations such as face lifts and eyelid correction can be avoided, and when combined with microcannular liposuction, it quite often eases the otherwise difficult process of weight loss!

As an important component of New Cosmetic Surgery, Hormonal Regeneration indeed visibly, tangibly, and sustainably rejuvenates. However, it also requires numerous administrations of hormones in the form of capsules, creams, shots, and powders. Furthermore, it is a rather elaborate and also expensive process, which is why it is not an option as a long-term therapy for the vast majority of patients at the present time.

In my mind anyway, a practical solution would be a biodentical hormone therapy, which would cost less and could be administered in the form of a single pill! My research resulted in just such a compact, inexpensive, low-dose therapy with bioidentical hormones: it is produced in a few variants that are suitable for most patients. To put it another way, anti-aging in a box! I came up with the name Instant Chi for this therapy!

Instant Chi is taken in the form of a capsule a day, generally in the morning. Instant Chi contains bioidentical hormones in perfect balance, and when taken regularly it regenerates and strengthens the body! Obviously the regenerative action of Instant Chi is neither as intensive nor as all-encompassing as an individualized Hormonal Regeneration, but it does work so well that anybody can notice the difference in themselves in terms of resiliency, stress tolerance, and good health after taking it for just a few weeks! Furthermore, the success with Instant Chi motivates many of my patients to take the next step and invest more in a complete Hormonal Regeneration rest cure!

In the meantime, Instant Chi provides these patients with relief from “burnout” – namely the consequences of chronic overtaxation of the endocrine glands from stress and an unnatural lifestyle! Many patients delight in telling me how much more radiant and vital they look after taking Instant Chi even for just a short while!

Enough talk – I invite you to try Instant Chi for a few weeks and see for yourself! You too will be convinced after you try it!

Heinrich, MD

A consumer test on “Consultation with Cosmetic Surgeons” met once again with a response from the media. Although we were not part of this test, here are a few of my thoughts:

Amongst other things in the test, long waiting times for patients in the waiting rooms of various cosmetic surgeons were criticized. Waiting times are annoying, as everyone knows. They cannot be avoided completely, however, especially if the cosmetic surgeon is in great demand and tries to take a real interest in his patients. How long this takes depends on each individual case and cannot be calculated in advance.

For this reason, in addition to the normal appointments in my Clinic DDr. Heinrich we also offer VIP appointments at a higher price where there is no waiting time, and if wished these can also be outside of normal clinic hours.

In addition to this, the test brings up the old myth again that there is a special section in surgery that trains cosmetic surgeons. This representation is incorrect; numerous doctors who are general practitioners, dermatologists, gynaecologists, ENT specialists or have other specialised fields prove the opposite and are successful cosmetic surgeons.

There is of course no such thing as a “Board certified Cosmetic Surgeon”. The medical training in all specialist fields has the treatment of disease or physical ailments as its goal. Doctors of all specialist fields gain special knowledge of cosmetic surgery only within the framework of voluntary additional training. Here the original specialist field of the doctor is not the important thing, but the talents and focus on the techniques used.

In addition to this, cosmetic surgery is undergoing a change at the moment. Instead of treatments with scalpel and silicone under general anaesthetic, gentle and careful out-patient treatment is being done, such as liposuction with microcannulas or breast augmentation with stem cell-enriched body fat. The repertoire of the methods of this “New Cosmetic Surgery” come from various sectors of medical knowledge. Doctors who have undergone an interdisciplinary basic training and in addition to surgery have learnt to think also in terms of internal medicine will feel more at home here.

If you are interested in having cosmetic surgery, I advise you for this reason to check whether the cosmetic surgeon is a general practitioner with additional training in the field of cosmetic surgery and anti-aging medicine – in this case the results of your operation will probably be better without scalpel and silicone!

Heinrich, MD

Even if you feel sorry for Mr. Clooney’s girlfriend – both as a man and a cosmetic surgeon I can understand him. There is hardly anything less erotic than bulging silicone breasts! It is therefore indeed time for patients all over the world – as could be read recently in Profil – to have the excesses of an exaggerated and no longer up-to-date aesthetic surgery put right! Unnatural-looking silicone breasts, lifted, over-tightened doll faces – from the point of view of doctors this could all soon be a thing of the past. An interdisciplinary beauty and rejuvenatory medical treatment, the “New Cosmetic Surgery” is currently being developed from the scalpel and tightening cosmetic surgery, where silicone, tightening and scalpels will be unnecessary in most cases!

Instead of liberal cuts with the scalpel, the “New Cosmetic Surgery” uses minimally invasive, gentle cosmetic operations under local anaesthetic; instead of silicone, stem cells won through microcannulation from the body’s own fat tissue, whereby, for example, permanent, natural-looking, silicone-free breast augmentation has long been possible as well as bio-identical hormones and growth factors!

If Mr. Clooney’s girlfriend had decided on a modest and completely natural-looking breast augmentation with stem cell enriched body fat, he is certain to have stayed with her. He would probably have asked himself why her breasts were larger and fuller without assuming that medical skills had lent a helping hand.

Heinrich, MD

Egypt has always fascinated me. I recently looked through an impressive report on excavations in ancient Tanis. It was here – which remained largely unnoticed – that the untouched tombs of the Pharaohs Psusennes and Shishak were discovered.

Here I also had the opportunity of looking at photos of several mummies from this later era of the New Kingdom. They all looked as if they had been treated extensively with plastic surgery, Botox and fillers: no wrinkles, rounded features, yet lifeless, pallid and old. At that time the faces of cadavers had begun to be treated with various “fillers” before being preserved with powdered natron, in order to achieve full, wrinkle-free cheeks despite dehydration.

I am often asked why I do not offer Botox even though there is no doubt that it is a very effective therapy against wrinkles. If a face is treated with Botox and fillers over a long period of time, tissue changes develop which give the face an eerie, lifeless appearance similar to a mummy. Botox does not just paralyse muscles, which smooths out wrinkles, but it also makes the skin thinner, paler and drier, which means that it looks older. It particularly causes the glands of the subcutaneous layers of the skin to atrophy (an effect used in the treatment of excessive sweating of hands or armpits).

Is there an alternative in the treatment of wrinkles? Yes, New Cosmetic Surgery can indeed offer something better: growth factors. These are particular tissue hormones that are introduced into the skin by means of a special form of mesotherapy; and of course the therapy with the body’s own stem cells, won through liposuction with microcannulas! Both therapies have the effect of rejuvenating the facial skin, making it tighter and reducing wrinkles.

In spite of this, can it still make sense to use Botox in plastic surgery? Yes, for example, if facial movements need to be reduced for several months following surgery to encourage perfect healing in the facial area.

Many women would like to have been princesses in Pharaoh Shishak’s court, but very few would like to look like a mummy during their lifetime if they have the choice. For this reason I am optimistic that the new, natural methods will become accepted and that the mummy look will soon be a thing of the past.

Heinrich, MD

Some time ago a patient consulted me, not about breast augmentation or liposuction but about hormonal regeneration and also showed me – more or less incidentally – her breasts. 20 years ago she had begun with a small 100 ml implant and after several implant removals she now had huge implants of 800 ml on each side. And she is not an isolated case!

Through their hardness and weight, silicone implants stretch and cause wear in every breast to such an extent that after several years either a surgical tightening or a much bigger implant becomes necessary in order to prevent wrinkles and sagging. At some stage there is then a balloon, which in this case does not float but instead pulls the breasts down even more. This is where there needs to be some rethinking in cosmetic medicine. Plastic surgeons must  tell their patients what they can expect in the years following the implantation.

They can expect a breast that is a major construction site with several follow-up operations. As the complication rate with implant operations is said to be 8 to 10 % even with experienced plastic surgeons (which means that it is probably higher than admitted), you can work out what the probability of undesirable complications in 5 operations will be: ¹/₁₀ × 5 = 50 %! I can only appeal to your common sense – avoid plastic surgery for cosmetic problems whenever possible! Do not make your breast a silicone problem zone!

If you wish for breast augmentation, please use the more gentle methods of the New Cosmetic Surgery, breast augmentation with stem cell enriched body fat. This is of course somewhat more expensive than silicone, but consider the fact that you will need only one more injection at the most if your breast was originally too small for an adequate augmentation in one treatment. The complication rate is also much lower. With silicone, on the other hand, you are set up for about 5 replacement operations plus at least one tightening operation in the next 20 years, and you have a “good” chance of complications. And to be honest, who today thinks artificial balloon breasts are sexy? It is a known fact that George Clooney left his girlfriend because of 280 ml of silicone…

Heinrich, MD

Austrian television and many other media recently reported about an unusual Miss Hungary contest: in the Miss Hungary Plastic Surgery contest only candidates who had previously undergone plastic surgery were eligible to take part. The title was finally won by a 22 year-old hostess whom surgeons had not only assisted with injections – a Botox treatment alone would not have sufficed for eligibility in the Miss contest.

According to the reports, however, the winners were not just the girls who had been “prettied up” with implants but also the plastic surgeons who had helped nature with their scalpels and silicone. One candidate had even undergone an operation to her toes in order to get apparently closer to the ideal of a “perfect body”. However, in the light of current trends and developments in the area of cosmetic medicine, this contest seems positively out of date.

There is no doubt that for some time the trend in cosmetic medicine has been going in the direction of restoration of natural beauty and health. In other words, a healthy body always radiates beauty too, and natural beauty can lead to a better sense of well-being.

The goal of New Cosmetic Surgery is increased beauty and health through methods that are as gentle and natural as possible. Breast augmentation through silicone implants and operative face-lifting can in many cases be replaced by treatment using the body’s own fat enriched with stem cells – the consequences are natural results without scars and foreign body implants. Stubborn fat deposits can be removed gently by means of specially developed and patented microcannulas; in many cases it is sufficient to set hormonal imbalance right by means of bio-identical hormones (Hormonal Regeneration®) to achieve cosmetic improvement.

On the other hand, anyone wanting to look particularly artificial can in future fall back on implants and plastic surgery. Whether the results will earn a prize outside of a Miss Plastic Surgery contest is questionable.

Heinrich, MD

In Austrian television recently the theme of the Club 2 programme was “Silicone and slimness mania”. Amongst others, Dr. Mang, Dr. Holle, Cordula Reyer, as well as a philosopher, a music manager and a media sociologist took part in the discussion. I thought the discussion philosophically very inspiring in part, but even the cosmetic surgeons did not call the child by its name: people create demand, demand creates supply, the media reports on supply offers and this creates further demand. Doctors who enjoy cosmetic work offer their services. Patients choose between the services and suppliers offered and in this way create trends in cosmetic surgery.

It was inappropriate and incorrect that Dr. Holle, plastic and reconstructive surgeon, placed the blame for botched up cosmetic surgery on cosmetic surgeons who are not Board certified Plastic Surgeons. It was actually plastic surgeons who disfigured Michael Jackson.

Cosmetic surgeons who have specialised in plastic and reconstructive surgery have learnt surgically sophisticated and complex reconstructive operations during their training, and naturally tend towards a generous use of the scalpel, i.e. to perform complex and invasive operations. This, of course, is often unavoidable in reconstructive surgery following accidents or in the removal of tumours, but it is mostly “too much” in cosmetic medicine – also because the rate of unnatural results and complications increases greatly with invasive surgery.

Apart from this it is not true, as Dr. Holle maintains, that plastic surgeons learn cosmetic operations during their hospital training. Not one of the plastic surgeons working in Austria today learnt cosmetic surgery during their specialist training. This is also just as true of plastic surgeons in other countries, as we doctors know. Or would you allow a surgeon in training in a training hospital to perform cosmetic surgery on you?

All doctors who want to work in cosmetic medicine have to learn this initially in additional courses. Whether a plastic surgeon (like Dr. Holle), an ENT doctor (like Dr. Mang) or a general practitioner (like me). It is shown later who possesses the talent for this and whom the patients trust.

Heinrich, MD

The La Donna exhibition took place in the Vienna city hall from the middle to the end of the week. The topic of liposuction was raised during a panel discussion with other specialists on beauty and slimness, not least because apart from myself there were two other doctors present who like to offer liposuction for figure correction. In this discussion I spoke mainly about breast augmentation with stem cells, but naturally also made a contribution to the topic of liposuction.

There are still many misconceptions in this area of cosmetic surgery. Thus most cosmetic surgeons still do not know that the use of microcannulas (1.5–2 mm in diameter) make scar-free liposuction with a minimal after care of a few days  possible.

There are often controversial discussions on whether liposuction should be done before or after losing weight. My experience shows that it should be done beforehand, firstly because it makes further loss of weight easier and secondly because it creates space allowing the tissue to tighten up better during the subsequent weight loss. After a substantial weight loss the fat cells are so “sapped” that it is difficult to perform liposuction on them: they do not burst as easily as full fat cells when pierced by the liposuction cannula.

In many cases of weight loss, of course, liposuction is neither necessary nor effective. Only a consultation with the cosmetic surgeon can clarify things here. If you decide on this measure, however, then please have it done before your diet rather than afterwards.

Heinrich, MD