Evolence - an injectable dermal filler derived from pig collagen - was pulled from the market yesterday (November 4, 2009) by it's maker, Johnson & Johnson, who stated that the product is now up for sale. (The Evolence website now declares that it's "under construction".)

Though no reasons have yet been given for the pulling of the product, some doctors are speculating about three contributing factors:

• stiff competition from more "established" and aggressively marketed fillers like Juvederm and Restylane
• low patient satisfaction rates: According to online patient reviews on realself.com, only 35% of patients would recommend Evolence. Chief patient complaints have been pain, bruising and lumps.
• a higher learning curve and more difficulty injecting for administering physicians: Evolence is a thicker and stiffer filler, requiring a larger needle and more massage to avoid lumps. (More massage may exacerbate the bruising mentioned above.)

Of course, if you are considering dermal fillers to fill out your nasolabial folds, plump up your lips, add fullness to your cheeks or under-eye area, or to give your entire face a "liquid lift", there is no need to despair. There are still plenty of other dermal fillers available on the market, most with a relatively high patient satisfaction level in comparison to Evolence.

We love you, Mary. You're an American icon. Which is why we find your post-plastic surgery face so upsetting. We worry that your eyes and brows have been pulled up so high that you can't close your eyes at night to go to sleep. We worry about you getting enough nutrition (since we fear it might be painful to chew with your mouth pulled so far back to the sides of your face).

Posting this photo is just our way of begging you, Mary: Please don't have any more surgery.

Manhattan-based plastic surgeon, David Shafer, MD, has recently launched what he describes as the world's first plastic surgery app for the iPhone.

The Shafer Plastic Surgery App is an interactive program that allows users access to Dr. Shafer's database of more than 1,000 FAQs (and their answers) covering invasive cosmetic surgical procedures as well as non-invasive procedures like the use of  cosmetic injectables.

The full version of the app costs $2.99, and allows people to ask questions directly to Shafer, resulting in the addition of new (relevant) questions and answers to the full-access database. Thanks to these built-in automatic updates, the database is continually evolving to provide the most up-to-date information available.

If you're not ready to shell out the 3 bucks, there is a "lite" version, which gives users a sampling of existing Qs and As. The lite version is free at the App Store. Both versions include bio information about Dr. Shafer and direct links to Shafer's website. 

If you're not an iPhone user, take heart: You can always use your Blackberry to surf the web and get answers to all your plastic surgery-related questions right here on About.com...or hey, maybe there's a market for an AboutPlasticSurgery App by yours truly? Something to think about.

Shiloh Pepin, known by much of the U.S. as the "mermaid girl" after being interviewed by Oprah Winfrey on her show in September, died on October 23, 2009 at Maine Medical Center. At the time of her death, Shiloh had lived for an almost unheard of 10 years with sirenomelia, known in the vernacular as mermaid syndrome. The outwardly distinctive characteristic shared by those with sirenomelia is the fusion on what should be two legs into a single appendage resembling a mermaid's tail.

Reconstructive plastic surgery to separate the legs and construct rudimentary outward genitalia is only a small part of treatment of this disorder, which also invloves the severe malformation (or even absence of) bladder, kidneys, reproductive organs, and bowels. Shiloh was one of only 3 people worldwide in known history to have survived past the first year of life without extensive reconstructive and other surgeries (such as the 2 kidney transplants she received during her brief lifetime). In fact, most infants born with this disease live only a matter of days.

Shiloh, whose parents were told she would live only a few days after her birth, said on Oprah that she didn't want to undergo the complex reconstructive surgery which would be needed to separate her legs -- an operation which is performed in multiple stages, using multiple recontructive tehniques including tissue expansion, skin grafts, and/or flap surgery. Even without the surgery, she defied the odds and outlived all expectations.

Following the Oprah episode, there were those who found Shiloh inspiring, and others who were put off by her curt answers and/or Oprah's questions. Regardless of the controversy and what anyone may have thought about the much-ballyhooed Oprah interview, I know the hearts of a nation are going out to her family in this sorrowful time.

What can we take away from Shiloh's story? Perhaps increased hope for longer and better lives for those born with serious birth defects. Perhaps increased compassion leading to better funding and staffing for charitable organizations that help provide reconstructive surgery to children with birth defects. And perhaps a different perspective on the importance of our crows feet and other cosmetic concerns.