Variety, personalization attract surgeon to plastic and reconstructive field

Staff reports 6:48 a.m. CDT August 18, 2014

This week’s Monday Q&A features Dr. Jill Murphy, a Nebraska native who graduated from the University of Nebraska — Lincoln and from medical school at the University of Nebraska Medical Center. She recently started practicing at Plastic Surgery Associates

Dr. Jill Murphy recently started working at Plastic Surgery Associates in Sioux Falls.(Photo: Elisha Page / Argus Leader)


This week’s Monday Q&A features Dr. Jill Murphy, a Nebraska native who graduated from the University of Nebraska — Lincoln and from medical school at the University of Nebraska Medical Center. She recently started practicing at Plastic Surgery Associates.

Question: What’s the best part about working in your field?

Answer: The best part about plastic surgery is the amazing variety of procedures that plastic surgeons can do. We are not confined to one area of the body, but can address surgical problems essentially from head to toe. There is also a lot of creativity involved in plastic surgery. It is definitely not “cookie-cutter” surgery. Many of the more complex procedures I have seen and done do not have a list of steps or instructions that can be found in a book. Instead, you have to draw from the fundamental principles and techniques that you have learned and put them together in a way that can solve each unique surgical situation that you are faced with. This does not just apply to the reconstructive side of plastic surgery. On the aesthetic side, every patient will have unique goals and anatomy which requires a personalized approach to help achieve the results desired. It’s this creativity that I really love about plastic surgery.

Q: What attracted you to Sioux Falls and Plastic Surgery Associates?

A: My husband and I were born and raised in the Midwest and did all of our medical training in the Midwest. We love the people, the atmosphere, the pace of life, pretty much everything about the Midwest. As we were looking for job opportunities after residency, we agreed that this is where we wanted to stay — we’re just not “coastal” people.

When I learned about the opportunity to join Plastic Surgery Associates of South Dakota, I was very excited. I had found an established and well-respected plastic surgery practice in the perfect location. Everyone I have met here so far has been incredibly kind and helpful, and the physicians offer a complete range of reconstructive and cosmetic procedures. With respect to their aesthetic practice, the focus is on natural-appearing results, rather than a Hollywood “plastic” appearance. Finding a group that emphasized these results was very important to me because that is the look I want to help people achieve.

As for the city, Sioux Falls is the perfect size for us. It has all the amenities of a big city but with a small town feel. There are plenty of opportunities for outdoor activities such as hunting and fishing. This was a very important factor for my husband, who loves outdoor activities and wants to share those types of experiences with our twin boys.

Q: What advice would you give to a young person thinking about entering your field?

A: A career in medicine is a huge commitment. It starts early with a lot of studying and test taking in order to be accepted into medical school. Once you are in medical school, you essentially lose control of your life for the duration of your medical and residency training. You will work long hours (up to 80 a week on paper, but a lot of times it is more than that). In the free time you do get, you will be studying because there is a tremendous amount of information that you have to learn in an impossibly short amount of time. You will accrue a huge amount of debt while all of this is happening, as well. Your family will need to be very understanding. It will not be your decision when you get to come home, when you have to leave for work, and whether or not you will get to be there for important moments such as family reunions, ballet recitals, football games, opening presents on Christmas Day, etc. When it’s all over, you might feel like you’ve given up your 20s and early 30s, and in some ways you really have.

That said, this is an amazing profession and you will get to play a unique and important role in many peoples’ lives. Surgery, specifically, allows you to work with your hands and your head, which is great for people who like a lot of variety in their work and love to constantly be doing something. This is a great profession for people who enjoy seeing and learning something new every day. It teaches you how to make the most of your free time, since you might have less free time than others. Despite the rigors of training and the intensity of this career in general, I would still do it again if I had the chance to go back.

Q: What motivates you to be active in your community or profession?

A: I’m very excited to become a part of the Sioux Falls community. My husband and I want to make this our home, and the more you learn about a place and get involved in the community, the easier that is. Finding activities for my boys to participate in is also very important to me. I want them to be able to experience a variety of activities while they are young so they can figure out what they like to do and hopefully focus on that as they grow up and turn it into a career they will love. With respect to plastic surgery, the desire to help people achieve their surgical goals and to continuously be improving the results I can deliver is what motivates me.

Q: Do you have a certain service organization or charity you like to support?

A: Not at the moment. I have volunteered for CASA (court appointed special advocates) in the past, and am currently applying to be a foster parent. My research in graduate school focused on breast cancer, so I’ve also got a special interest in that, as well.

— From staff reports

More Evidence Botox Works for Depression

Caroline Cassels   June 12, 2014

NEW YORK ― A single injection of cosmetic botulinum toxin (BTX), which is typically used to improve the appearance of facial wrinkles, may be an effective treatment for depression.

In one of the first studies to suggest this, investigators at the Hannover Medical School in Germany found that treating the facial muscles involved in emotion with botulinum alleviates depressive symptoms.

“Our emotions are expressed by facial muscles, which in turn send feedback signals to the brain to reinforce those emotions. Treating facial muscles with botulinum toxin interrupts this cycle,” study investigator Prof. Tillmann Kruger said at a press conference here at the American Psychiatric Association’s 2014 Annual Meeting.

Novel Approach

According to the investigators, positive effects on mood have been observed in patients who have undergone BTX treatment for glabellar frown lines. A previous open case series showed that depression remitted or improved after such treatment.

To confirm these results, Dr. Kruger and colleague M. Axel Wollmer, MD, from the Asklepios Clinic North Ochsenzoll in Hamburg, Germany, conducted a randomized, double-blind, placebo-controlled trial of BTX injection as an adjunctive treatment for major depression.

A total of 30 patients with high levels of chronic and treatment-resistant depression were enrolled in the study. Patients were randomly assigned to receive a single injection of BTX or a single injection of saline placebo.

The study’s primary end point was a change from baseline in depressive symptoms, as measured by the 17-item Hamilton Depression Rating Scale (HAMD17), during the 16-week study.

Six weeks after a single treatment, the BTX group experienced an average 47.1% reduction in HAMD17 scores vs 9.2% in the placebo group.

The investigators found that the effect size was even larger at the end of the study and that treatment-dependent clinical improvement was also reflected in the Beck Depression Inventory and the Clinical Global Impressions Scale.

“This study shows that a single treatment of the glabellar region with botulinum toxin may shortly accomplish a strong and sustained alleviation of depression in patients who did not improve sufficiently on previous medication. It supports the concept that the facial musculature not only expresses but also regulates mood states,” the investigators write.

Dr. Kruger said BTX may offer a “novel, effective, well-accepted, and economic therapeutic tool for the treatment of major depression.”

These findings have since been replicated in 2 subsequent studies, one by Michelle Magid, MD, and colleagues, which was presented in March at the American Academy of Dermatology 72nd Annual Meeting and reported by Medscape Medical News at that time, and the other by Eric Finzi, MD, PhD, and colleagues, which was published in the May issue of Journal of Psychiatric Research and was also reported by Medscape Medical News.

Dr. Kruger reported that he and his colleagues are currently conducting a meta-analysis of the 3 randomized trials in an effort to “further corroborate this novel treatment approach.” The researchers are also testing BTX’s therapeutic potential in other psychiatric disorders.

Commenting on the study, press conference moderator Jeffrey Borenstein, MD, president and CEO of the Brain and Behavior Research Foundation in New York City and chair of the American Psychiatric Association’s Council on Communications, said that pursuing new treatments for depression is “crucial.”

Dr. Borenstein added that he would like to see this line of research pursued in studies that include larger numbers of patients.

Bitten by a dog as a child, plastic surgeon relates to his pediatric patients

University of Mississippi Medical Center’s Dr. Ricky Clay specializes in reconstructive surgery on patients who have suffered animal bites.

Stories of children attacked by dogs frequently make headlines, but what happens to the victims over the next few days, months and years rarely does. Plastic surgeons like University of Mississippi Medical Center’s Dr. Ricky Clay specialize in reconstructive surgery.

If a child’s face is injured, doctors work immediately to try to address it, but most of the scar revision is delayed while the child grows. Clay often works with children for years following a bite trying to minimize the appearance of scars.

“It’s a very long process. Everyone thinks that you can fix it,” Clay said. “But a child is growing. And scars grow proportionally with the child. And growth hormone that makes you get bigger makes your scars get thick and puffy and ugly and red.”

Surgeries are scheduled around growth spurts. Clay said the surgeries for children are often done before the child enters school to prevent name calling, then again before the child enters puberty. More surgeries follow as needed.

About 4.5 million Americans are bitten by dogs each year, according to the Centers for Disease Control and Prevention. Half of those are children. Dog attacks, especially those by pit bulls, have been in the news this year in the Jackson metro area. In June, two children were attacked by pit bulls in separate incidents in Hinds County. Christopher Malone, 3, died after being mauled by two pit bulls in Holmes County on March 31.

And on April 9, Victoria Wilcher, 4, was mauled by three pit bulls at her grandfather’s home in Simpson County.

Every bite is different, but Clay said his goal is to give children the best possible high school graduation picture.

“Plastic surgeons never use the term ‘normal,’ ” Clay said. “We try to put things back as close as we can. But scars are like diamonds. They’re forever. They never go away. If somebody looks closely at your face, they can always see it. Our job is to fix it so that the average person passing you on the sidewalk doesn’t notice it in a cursory glance.”

Lessening the appearance of scars can really make a difference in the lives of patients. Clay said one patient was a very angry and sullen teenager. She had a cheek that had been scarred. Clay was able to take fat from her lower abdomen to make her cheeks match for the first time in her life.

“When she came back for her six-month check-up, it was the first time I’d ever seen her smile,” Clay said.

The plastic surgeon often gets frustrated with the media’s focus on one particular breed. He has seen bites from all breeds, including Labrador retrievers and golden retrievers. The worst bite he’s ever seen came from a toy French poodle.

“Lady was going to kiss her little baby on the nose,” Clay said, “and it took the middle of her lip right out.”

Clay was bitten by a German shepherd when he was 3 or 4 years old, growing up in northeast Alabama. The neighbors had the dog chained to the clothesline in the backyard and couldn’t reach its water bowl.

“So helpful me toddles out there to take the dog its water bowl. So I went out, slide the water bowl over and it started drinking so I squatted down to pet the puppy,” Clay said. “And the next thing I knew it came up … I still have a memory of that dog’s mouth right there. I can see it in my mind.”

The “puppy,” as it turned out, was a trained guard dog who bit Clay on the face. Although he doesn’t have any lingering scars, it gives the doctor something in common with this patients.

“I can relate to the children who come in and have been bitten.”

Drug bust: Cocaine found in smuggler’s breast implants

BY NEW YORK DAILY NEWS Published: Friday, August 15, 2014, 3:07 PM Updated: Friday, August 15, 2014, 5:31 PM

The 43-year-old Venezuelan was stopped after she became nervous during a routine screening. She’s been detained at a Spanish hospital.


What a boob!

Spanish police have arrested a 43-year-old Venezuelan woman who landed in Madrid’s international airport trying to smuggle 3.7 pounds of cocaine via her breast implants.

Narcotics agents started to suspect something was up while they were performing routine screenings of passengers who had arrived from Bogota, Colombia, and the woman began acting strange. Her luggage searches didn’t reveal anything suspicious, but when female agents frisked her they noticed irregularities and deformities in both of the woman’s breasts.

The woman eventually copped to carrying implants stuffed with cocaine, according to a police statement. She was sent to a hospital and detained for an alleged crime against public health, the statement added.

Surprisingly, stuffing breast implants with contraband is not uncommon, according to Dr. Matthew Schulman, a New York City board-certified plastic surgeon.

“There were alerts put out several years ago about concerns about terrorists using breast implants as a way to move bombs, so it’s one of those things in the plastic surgery community we are aware of,” he said. “It’s probably done more often than people realize.”

But how? Replacing the saline in a saline breast implant with cocaine, Schulman speculates.

“There’s obvious risks with that because it was probably not done under sterile conditions, so there’s risk of infection and also the body absorbing that cocaine, which could cause sudden death from a cocaine overdose,” he said.

The woman might have thought she was in the clear because airport security personnel “are very reluctant to touch breasts” and other private parts, Schulman added.

At Newark Liberty and John F. Kennedy International Airports, criminals have unsuccessfully tried to smuggle drugs via luggage hand rails and liners, and also by swallowing them, said Howard Cheng, a spokesperson for Customs and Border Protection in New York.

Spain has a specially employed unit to inspect passengers coming from countries with a history of major drug production.

Seniors postponing retirement consider cosmetic surgery for a competitive edge

By Alix Pianin, The Fiscal Times August 17, 2014

After the recession hit, business at Dr. Mary Lee Peters’ plastic surgery practice grew steadily.

The downturn brought new types of patients to her Seattle office—people with severance packages who were still smarting from layoffs and too much time on their hands. Several put the money towards cosmetic surgeries, and Peters went to work helping them look “fresher” for their job interviews, she said.

That meant Botox and fillers for the more conservative patients, but “most of the time it would be somebody who would have their eyes done or their face done,” she said.

“People would use their money from being laid off, their severance pay … to get cosmetic surgery so they could look better for their next job interview,” Peters recalled in an interview with The Fiscal Times last week. “You’d be amazed at how often I’d see that. You would think that people would be scampering away from something like this.”

With a growing number of baby boomers postponing retirement, venturing back into the job market, or striving to retain their standing at work, more and more seniors are turning to cosmetic enhancements to gain a competitive edge.

The number of cosmetic procedures including surgery and minimally invasive procedures topped 15.1 million in 2013; people aged 55 and over made up an increasing number of the patient share, according to a February study by the American Society of Plastic Surgeons.

While the majority of cosmetic procedures were performed on 40- to 54-year-old patients, the 55+ set underwent 3.8 million procedures, or 26 percent. That’s up four percent from 2012, according to the report.

“Many people in their 50s and 60s who are looking for work find their age can be a real barrier to landing a new job, even though age discrimination in employment is illegal,” John Rother, former executive vice president of Policy, Strategy and International Affairs at AARP said in an interview, “Employers have many subtle ways of favoring younger, more attractive applicants.”

The result, said Rother, is that “many older women in particular, especially those in competitive job markets, are taking steps to improve their appearance in order to better compete against younger job applicants.”

In fact, $12.6 billion was spent on cosmetic procedures in the U.S. in 2013, an increase of 15 percent from the previous year. That was the fourth straight year of growth for the industry, according to the American Society of Plastic Surgeons.

Experts say the growth has been in minimally invasive treatments. Skin treatments such as Botox injections and soft tissue fillers are cheaper than traditional surgical procedures like facelifts and eyelid surgery, and they require less recovery time.

These approaches are especially appealing to older people in the workforce who think they are being outmatched when compared to peers who may appear younger and more energetic, said David Sarwer, professor of Psychology in Psychiatry and Surgery at the University of Pennsylvania.

“The more common scenario is when we have people who are talking more about, ‘I’m concerned that I’m falling behind, or I’m concerned that I haven’t gotten the promotion that I have wanted to get several years ago, and that’s why I’m having it done,’” said Sarwer.

Professionals or high ranking executives seek out Peters with similar concerns—they want to appear energetic and vital to their workplace in order to extend their careers for as long as possible. And some are in a difficult corner. A Federal Reserve survey released last week suggests that fallout from the recession will force many to work well past their planned retirement date—all the more incentive to keep a tight grip on a good job.

A new analysis of Census data found that the percentage of people 65 and older in the labor force increased from 12.1 percent in 1990 to 16.1 percent in 2010, according to Forbes. The Urban Institute forecasts that employees 50 years and older will account for 35 percent of the labor force by 2019.

“We live in a society with pretty serious ageism,” Peters said. “And it’s starting to make them angry that people are looking at them and saying, ‘Hey, when are you going to retire, why are you doing all this?’”

Whether plastic surgery and scores of other cosmetic treatments actually give a leg up to older Americans either entering or currently in the workforce is unclear.

“We really want patients to realize that … these procedures do not lead to Cinderella-like transformations in their lives,” Sarwer said. Researchers are still unsure how cosmetic procedures affect quality of life and self-esteem in patients.

“While some people may see you as more attractive, and they may have a positive impact on things like your body image and how you feel about your appearance, they in fact may not help you get a new job, or do things like save a failing marriage,” Sarwer said.

Dorothy Tannahill-Moran, a career coach who leads job searching classes for people 50 and older, advises her students to focus more on keeping their wardrobes current and matching the higher energy levels of younger would-be co-workers than zeroing in too much on plastic surgery.

“It’s a fairly easy leap to go from feeling like you’re at a disadvantage and having perhaps had a couple of blows dealt to you and then going, well, maybe if I clean up my act, if I go get plastic surgery, maybe that’s it,” she said in an interview. “I think there’s more going on than just how wrinkle-free your face might be.”

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