Top 20 advances in plastic surgery and aesthetic medicine in the past 20 years Part 1

To celebrate the 20th anniversary of the world’s first live plastic surgery webcast in 1998, we are counting down 20 advances in plastic surgery over the past 20 years. They are in no particular order, and the list is personal, because we were involved in developing and promoting several of them.

1. ADM Internal Bra for breast reconstruction and revision ADM is Acellular Dermal Matrix, which is derived from tissue.


It acts as a scaffold for the body’s own tissue to incorporate, resulting in a durable layer. There are several versions available now, but Alloderm and Strattice remain the most popular. I published the first article documenting this transformation into living tissue for breast revision and reconstruction, and the use of ADM’s has revolutionized breast reconstruction since. I later published a paper showing that it lasts at least 12 years, proving it’s longevity.

2. Development of different profiles for optimal sizing and personalization It sounds hard to fathom now, but in the 1990’s there was only one implant profile. Because breasts come in different sizes, shapes, and widths, choices were extremely limited. Both saline and silicone implants are now available in a seemingly infinite variety of dimensions, so that the choice can be personalized both to the patient’s anatomy and her preferences. I was an early proponent and (of course) published an article on how to best use the new profiles.

3. FDA clears silicone implants in 2006 In 1992, the FDA placed silicone breast implants on a restricted basis due to concerns that they may be related to health issues such as autoimmune disorders. Over the next 14 years they were subjected to more intense scrutiny and study than any medical device before or since. We actually participated in some of the clinical trials on silicone implants, and so were very comfortable with their safety when they were finally given the FDA’s green light. Patients immediately switched to silicone because they feel more natural than saline implants, and now saline is a relatively uncommon request.

4. Subfascial and split muscle to minimize animation deformity There will be a fair amount of debate about this one, but because most breast implants are placed under the pectoral muscle,


they are subject to distortion when the muscle is used. This is called animation deformity or hyperanimation, and affects 3 out of every 4 patients to some degree when the popular dual plane method is used. We now know that the muscle is weakened with this technique, because a portion of it is detached. The split muscle technique preserves muscle attachments, allows for muscle coverage of the implant over the upper pole where it is most needed, and minimizes animation. I have and presented on the technique extensively.


5. Exparel for long acting local analgesia in postsurgical pain control For a long time the primary option for dealing with pain after surgery was opioids, which have significant side effects. In 2011 Exparel, the first extended release local anesthetic became available. By blocking the pain at its source for up to 3 days, there is less need for opioid. We have found that pain scores and pain pill use is reduced by about 50% for tummy tucks and breast augmentation when Exparel is used. Some of our tummy tuck patients have gotten by with only Tylenol!