Surgical Anesthesia in Young Children Linked to Effects on IQ and Brain Structure

According to a study published in the journal Pediatrics, children who received general anesthesia for surgery before age 4 had diminished language comprehension, lower IQ and decreased gray matter density in posterior regions of their brain.

These findings were reported in the June edition from researchers at Cincinnati Children’s Hospital Medical Center. The team say this knowledge could make it possible to develop mitigating strategies for what the authors describe as a potential dilemma for child health, and recommend additional studies to determine anesthesia’s precise molecular effects on the brain, and contribution to diminished brain function and composition.

Andreas Loeppke, MD, PhD, FAAP and lead author of the study stated that “he ultimate goal of our laboratory and clinical research is to improve safety and outcomes in young children who have no choice but to undergo surgery with anesthesia to treat their serious health concerns.”

Loepke and his colleagues have published previous studies showing widespread cell death, permanent deletion of neurons and neurocognitive impairment in laboratory rats and mice after exposure to general anesthesia. These studies have raised concerns about similar effects in young children during a particularly sensitive neurodevelopmental period in early life, which researchers say could interfere with the refinement of neuronal networks and lead to long­term functional abnormalities.

In this study, Loeppke and his colleagues compared the scores of 53 healthy participants of a language development study (ages 5 to 18 years with no history of surgery) with the scores of 53 children in the same age range who had undergone surgery before the age of 4.

According to the researchers, the average test scores for all 106 children in the study were within population norms regardless of surgical history. However, children exposed to anesthesia scored significantly lower in listening comprehension and performance IQ compared with children who had not undergone surgery. The researchers also report that decreased language and IQ scores were associated with lower gray matter density in the occipital cortex and cerebellum of the brain.

By using extensive analysis of surgical and other medical records the researchers were able to match the children for age, gender, handedness and socioeconomic status – all confounding factors of cognition and brain structure. The types of surgeries and length of exposure to anesthetics were also factored in and the anesthetics used during the surgeries included common agents such as sevoflurane, isoflurane or halothane (used alone or in combination) and nitrous oxide.

Brain structural comparisons were conducted by MRI scans. and the children included in the study did not have a history of neurologic or psychological illness, head trauma or any other associated conditions. Neurocognitive assessments included the Oral and Written Language Scales and the Wechsler Intelligence Scale.

Loeppke and his team’s current study estimates that of the 6 million children who undergo surgery in the United States each year could experience a loss in the potential loss of 5 or 6 IQ,and that the lifetime potential earnings loss could total $540 billion. Previous research from 2008 had estimated the loss of 1 IQ point to decrease a person’s lifetime earnings potential by $18,000.

He and his team advise parents who are concerned to discuss with their pediatrician and surgeon the risks of a surgical procedure – and the potential risk of anesthetic exposure – versus the risks of not having a surgery, and insists that current methods are still very safe.

“It is important to note that no surgeries are truly elective in young children,” Loepke says.

“Many surgical procedures early in life treat life­threatening conditions, avert serious health complications, or improve quality of life. These cannot be easily postponed or avoided.”

He also stressed that researchers at Cincinnati Children’s are actively looking for alternative anesthetic techniques in their ongoing laboratory studies, and that there is ongoing research into drugs are being tested that show potential for lessening the harmful effects of anesthetics in laboratory rats and mice. Additionally, the medical center is participating in an international clinical trial to test an alternative anesthetic regimen in young children undergoing urological procedures.

Surgeries for Hanging Skin Removal Boom in Wake of Weight Loss Surgeries

According to the American Society of Plastic Surgeons, weight loss surgeries are on the rise, and with it we’ve seen increases in the frequency of procedures associated with weight loss, such as tummy tucks, breast lifts, thigh and upper arm lifts.

“We’re seeing exponential growth in concurrent surgeries, and we’re realizing that this is really a continuum of care for these patients” stated ASPS President Dr. Scot Glasberg in an interview with Reuters “Hanging skin can be very painful and get in the way for daily activities.”

In the latest report from the ASPS an estimated 1.7 million cosmetic surgeries were performedby board­certified surgeons in the United States. Breast lifts were up 3% since 2013 and 75 percent since 2000, with an estimated 92,724 performed in 2014. Among people who experienced massive weight loss, the procedures increased by 10% just since 2013.

Tummy tuck and thigh lift procedures increased by five% between 2013 and 2014 and more than 70% each since 2000. Upper arm lifts are up over 4000% compared with statistics reported in the year 2000, skyrocketing from about 300 to 16,000.

According to the American Society for Metabolic and Bariatric Surgery, there were almost 180,000 weight loss surgeries in the U.S. in 2013.

University of Michigan in Ann Arbor chief of minimally invasive surgery Dr. Justin B. Dimick states that “bariatric surgery has become much more common over the past decade, as these patients lose weight they may have excess ‘loose’ skin and need plastic surgery procedures to remove it a year or two later.”

Roughly one in five people who have weight loss surgery will need body contouring as well, he said.

Currently, insurance covers most bariatric surgeries but covers less than half of post­weight loss body contouring procedures, according to Glasberg. He states that those who can get body contouring after weight loss are some of the happiest patients in his practice, he said, and warned that patients pursuing weight loss surgery and body contouring should make sure they see a board certified plastic surgeon at an accredited facility.

Migraine Surgery Found Effective For Teens With Severe Headaches

A recent study indicates that new surgery options for may be beneficial for teens with severe migraines that don’t respond to typical treatments, a young migraine surgery may be beneficial.

Researchers of the American Society of Plastic Surgeons (ASPS) note in a news release that the surgery works via “trigger sites” in the nerve branches that produce headaches, identified by preoperative evaluation.

“Our data demonstrate that surgery for refractory migraine headaches in the adolescent population may improve and potentially completely ameliorate symptoms for some,” researchers state. The trigger sites are detected based on a constellation of symptoms, including nerve blocks, ultrasound doppler and CT scans.

The surgery was conducted in 14 patients under the age of 18, including 11 females and three males, the average of 16 years old, some of which had reduced headache activity after undergoing cosmetic forehead procedures from 2000. All patients experienced debilitating migraine attacks that continued despite recommended medications, Average follow­up was about three years, and at least one year in all patients.

The findings revealed that the surgery was highly effective in reducing migraines, and that the average headache frequency decreased from 25 per month before surgery to five per month afterward. Participants indicated that the average migraine severity score then decreased from 8.2 to 4.3 on a ten­point scale, and that the average migraine times also decreased from about 12 to 4 hours. Additionally, 5 of the 14 patients reported being migraine­free following surgery, while one patient had no change in migraine frequency but less attacks over shorter periods.

Bahman Guyuron, MD Emeritus professor of plastic surgery at Case School of Medicine, Cleveland noted that “identifying the adolescent patient who would benefit from surgery is the most important aspect of surgical intervention” and that he and his colleagues emphasized the need for “more in­depth and prospective studies” to confirm the effectiveness of migraine surgery, and to weigh the risks and benefits of surgery for younger patients.

What is Cleft Palate Surgery?

A cleft lip  (cheiloschisis) and cleft palate (palatoschisis) are among the most common birth defects affecting children in North America.

The incomplete formation of the upper lip (cleft lip) or roof of the mouth (cleft palate) can occur individually, though occasionally both defects may occur together.

The conditions can vary in severity and may involve one or both sides of the face.

A cleft, or separation of the upper lip and/or the roof of the mouth, occurs during fetal development when certain components of the upper lip and roof of the mouth fail to form normally.

This can be corrected through cleft lip and cleft palate surgery, which restores function and a more normal appearance. It can also improve a child’s ability to eat, speak, hear and breathe.

An early intervention by a team of specialists who can evaluate and define a course of treatment is essential in proper cleft lip and/or cleft palate repair. Treatment may include: surgical repair of the cleft, speech rehabilitation and dental restoration.


What is a Chemical Peel?

A chemical peel removes the outer layers of your skin to create a smooth texture using a chemical solution. It is one of the least invasive ways to improve the appearance of a patient’s skin, and can resolve many skin issues which can be caused by sun exposure, acne, and aging.

Though they are used mostly on the face, the can also be used to improve the skin on patients’ necks or hands.

A chemical peel can help improve:

  • Acne or acne scars
  • Age and liver spots
  • Fine lines and wrinkles
  • Freckles
  • Irregular skin pigmentation
  • Rough skin and scaly patches
  • Scars
  • Sun-damaged skin

However, a chemical peel can’t do the following:

  • Treat deep facial lines
  • Tighten loose or sagging skin
  • Remove broken capillaries
  • Change pore size
  • Remove deep scars

What is a Body Lift?

A body lift improves the shape and tone of the underlying tissue that supports fat and skin.

The procedure removes excess sagging fat and skin, and can improve an irregular, dimpled skin surface commonly known as cellulite.

A body lift may include these areas:

  • Abdominal area – locally or extending around the sides and into the lower back area
  • Buttocks which may be low, flat or shaped unevenly
  • Groin that may sag into inner thigh
  • Thigh – the inner, outer, or posterior thigh, or the thigh’s circumference

Some factors which may contribute to poor tissue elasticity are aging, sun damage, pregnancy, significant fluctuations in weight, and genetic factors.

However, a body lift is not intended strictly for the removal of excess fat. In cases where where the skin has good elasticity, liposuction is generally used to remove excess fat deposits.

In cases where skin elasticity is poor, a combination of liposuction and body lift techniques may be recommended.


Study Finds that Plastic Surgery Can Make People Perceive You as More Likeable

A recent study published in the journal JAMA Facial Plastic Surgery found that women who underwent facial rejuvenation surgery were perceived not only to be more attractive than before,  but also more likeable than before the surgery.

The findings illustrate what is known as “facial profiling,” or how our brains collect information based on other people’s visual cues, including their facial expressions.

Dr. Michael Reilly a plastic surgeon at the Georgetown University Medical Center and the study’s lead author, stated that “our judgements of people’s resting facial expressions are an overgeneralization of the dynamic facial expression that they most closely resemble — meaning that if the corners of someone’s mouth are turned down at rest, they are not going to be judged as likeable or as socially skilled since it appears that they are sad or angry. If the cheeks are full and high, they are going to be judged they opposite, since they appear to be happy.”

The new study shows that these perceptions can be manipulated through plastic surgery because it changes the appearance of a person’s resting facial expression.

To perform the study researchers took before-and-after photos of 30 caucasian women who had recently undergone various facial plastic surgery procedures, including face-lift, eyebrow lift, neck lift, eyelid surgery and/or chin implant surgery. They then had the photos rated by study participants for traits such as aggressiveness, extroversion, likeability, trustworthiness, risk-seeking and social skills.

Their findings indicate that the women’s post-operative photos were rated as being more likeable, more feminine, higher in social skills, and more attractive overall. However, there we no significant change in levels of perceived trustworthiness, risk-seeking, extroversion or aggressiveness.

This is likely why the face-lift and lower eyelid procedures resulted in the greatest changes in perceived personality: because these surgeries turn the corners of the mouth up and lessen the look of tiredness around the eyes, making the women’s faces appear more social.

However, some women’s personalities were actually rated more negatively after their surgeries. Dr. Reilly explains that “patients need to be aware of the greater changes that are happening to a patient’s aura when they undergo facial-altering surgery… our theory is that if there is any detectable unnaturalness to the patient’s look after surgery, this can negatively impact their overall aura.”

Link Between Migraines and Carpal Tunnel, Study Finds

A new report in Plastic and Reconstructive Surgery-Global Open has found that patients with carpal tunnel syndrome are more than twice as likely to have migraine headaches.

These findings are the result of research by by Dr. Huay-Zong Law and colleagues of University of Texas Southwestern Medical Center at Dallas, who also state that migraine patients also have higher odds of carpal tunnel syndrome  – indicating a correlation between the two.

Dr. Law and colleagues analyzed data from nearly 26,000 American participants who responded to a national health survey, which asked participants if  they had had carpal tunnel syndrome during the past year or “severe headache or migraine” during the past three months.

The research showed that 3.7 percent of respondents carpal tunnel syndrome and 16.3 percent had migraine headache, and associations between the two conditions were analyzed with
adjustment for patient- and health-related risk factors.

Migraine was present in 34 percent of respondents with CTS, compared to 16 percent of those without CTS, indicating a link between the two.

After adjustment for other factors, the odds of having migraine were 2.6 times higher for those with CTS.

Among shared risk factors were female sex, obesity, diabetes, and smoking. Carpal tunnel syndrome was associated with older age and migraine with younger age, and while both appeared to be less present in Asians, Hispanics showed a lower rate of CTS.

Because of the poorly misunderstood nature of these two conditions they can often lead to high costs and disability. CTS is the most common of a group of related conditions called compression neuropathies, with symptoms related to pressure on nerves.

According to Dr. Law, these findings go against the historical interpretation of a migraine as a compression neuropathy, stating: “there is some evidence that migraine headache may be triggered by nerve compression in the head and neck, with some patients responding to nerve decompression by surgical release.”

The new study is the first to show an association between CTS and migraine in that they share some “common systemic or neurologic risk factor,” the researchers write., though the connection remains unclear.

Fat Grafting Technique Improves on Results of Breast Augmentation

A technique using a transplantation of a small amount of the patient’s own fat cells can produce better cosmetic outcomes, according to a study in the April issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).

Dr. Francisco G. Bravo of Clinica Gomez Bravo, Madrid reports that the technique can achieve a more natural-appearing cleavage, which avoids the “separated breasts” appearance that can occur after breast augmentation.

This conclusion comes as the result of analyses performed by Dr. Bravo of the outcomes of breast augmentation surgery in 59 women. 38 underwent conventional surgery using breast implants only, while the other 21 received combination technique using breast implants plus “selective para-sternal fat grafting.”

This approach involved a small amount of the patient’s own fat being harvested from elsewhere in the body-such as the thighs or abdomen. The fat is processed and carefully placed along the inner (medial) borders of the breasts, with the goal being a more natural shape and to soften the “medial transition zone” between the sternum (breastbone) and the implant edges.

Following surgery Dr Bravo compared the results by measuring the distance between the medial border of the breasts, or “vertical aesthetic line” (VAL), and by rating the “attractiveness” of paired breasts of photographs shown to 20 observers, which were digitally altered to show a narrower or wider VAL.

Though both groups of women reported higher satisfaction rates, the technique resulted in a more natural cleavage  in patients undergoing the fat grafting technique.

There were no complications related to fat grafting-likely reflecting the small amounts of fat transplanted and the gentle “micro-grafting” technique used.

Fat grafting between the sternum and implant on both sides appears to provide a significant cosmetic advantage, as it produces a smoother transition between the breasts and avoids the artificial “separated breasts” appearance. The results of Dr Bravo’s findings also support the concept that the VAL is a useful concept for plastic surgeons to consider in achieving a more attractive, natural appearance after breast augmentation.

Plastic Surgeons Consider Skin Retraction, Not Just Fat Removal, As Technique Evolves

According to Two senior plastic surgeons in different parts of the world have shown that low complication rates and excellent results with liposucture of the hips, flanks, and thighs

In the report plastic surgeons Yixin Zhang, MD, PhD, of Shanghai JiaoTong University and Manuel Francesco Castello, MD, of Clinica Villa Salaria, Rome, conclude that, “based on our 20 years of experience and observations on three-dimensional liposuction, we can suggest it a reliable method with proven results.” In the report they and their coauthors describe and analyze their technique and outcomes of lower-body liposculpture in more than 4,000 patients.

They write that liposculpture “is a very sophisticated method that goes beyond the simple aspiration of adipose tissue [fat] and allows the surgeon to modify the shape of the body and recontour the profile.”

The key part of the technique is not only to remove underlying fat, but also to guide and promote skin retraction after fat removal. This includes thinning of the skin to allow it to retract and adapt to the new shape.

The new report outlines each step of the procedure, from initial evaluations, to preoperative marking, patient preparation and liposuction technique. Postoperative care includes compression garments and bandages to guide skin adaptation to the carefully sculpted underlying fat.

They note that their cosmetic results have been well-maintained during follow-up, including in patients with pregnancies or weight loss or gain. “If performed correctly, three-dimensional liposuction of trunk, hips and thighs can yield very satisfying outcomes because of the excellent contour and enhanced skin retraction provided by the thin cutaneous [skin] adipose flap,” they write.

Complications rates were low, with only one serious complication—an infection that responded to antibiotics—in more than 4,000 patients.

Drs Zhang and Castello and coauthors believe their experience demonstrates the excellent cosmetic results and safety record of three-dimensional liposculpture of the hips, flanks, and thighs—and highlights the role of techniques aimed at promoting good skin adaptation to the new shape.