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. 

Thank goodness for DVR. Nip / Tuck is all set to record tonight, and my husband can still watch Game 1.

Since I didn't actually blog on last week's episode, here it is in a nutshell:

• Teddy dumped Sean and he met an even bigger wacko who stabbed him in the leg so he could score oxycontin from the E.R.
• Liz dropped her ruthless divorce suit.
• Doctors Troy and McNamara removed tattoos and extreme body modification scars from a disturbed young man, who then apparently turned around and brutally killed his parents for making him have his facial "art" removed. (art which included a skull tattoo covering the entire back of his bald head, and the number "666" carved into his forehead, among other things.)

Something was a little "off" about that last story line, so perhaps things are not as they seem. I am chomping at the bit to see where it goes.

Why oh why do baseball games have to take so long?

Plastic Surgery 2009, the annual conference for members of the American Society of Plastic Surgeons (ASPS), wrapped up yesterday in Seattle. While many topics were discussed during the five-day event, the most-debated discussions seemed to center around breasts, with special focus on both augmentation and reconstruction.

For reconstruction, the use of Alloderm (donated human skin tissue) was discussed, while fat transfer was a big topic for both reconstruction and cosmetic augmentation of the breasts. Fat transfer especially sparked significant interest, both for its potential and for its risks. One study brought to light at the conference detailed increased metastisis and greater tumor growth in breast tissue of lab mice with cancer that received fat transfers into the area.

Another popular topic of discussion at the conference addressed the challenges presented by the fact that patients are doing most of their research regarding plastic surgery online. While there is a lot of valuable information available on the internet (here at About.com, for example), there is also a lot of mis-information. Even when the information is technically accurate, surgeons are quick to point out that a little knowledge can be a dangerous thing. Patients should not make the mistake of thinking that reading about a procedure online will tell them if it's the right procedure for them.

See plastic surgery before and after photos.

According to a recently published statement, reality star/celebrity chef Gordan Ramsay has admitted to having cosmetic fillers injected to smooth out the deep grooves in his chin (which were presumably there as a result of decades of sustained scowling and general miserable-ness). Recent photos show a smoother chin than before, but leave me wondering why he didn't go for a little Botox as well for the deep forehead lines?

To make this story even sillier, rumor has it he had the injections on the advice of fellow nasty-tempered celeb, Simon Cowell. It's too bad cosmetic surgery can't improve an unattractive personality.

See plastic surgery before and after photos.

My inbox is often inundated with emails from this PR firm and that one, each touting the latest and greatest in "new" procedures and "breakthrough" techniques. Because it's my job to keep up with any plastic surgery-related news, I almost always at least look into what they're pushing. Occasionally, I find something worth writing about. More often, these purported breakthroughs amount to nothing more than cleverly-worded smoke and mirrors.

The funny thing about many of these over-hyped procedures is that they're actually not new at all. Often, these techniques are merely a re-packaging of a procedure that's as old as dirt. All the marketing geniuses have done is given it a catchy new name and sell the rights to market it in a sort of cosmetic surgery franchise deal.

At the other end of the don't-buy-into-the-hype spectrum are procedures that actually are new -- too new, in fact. Even after receiving FDA approval, there is often no true long-term data on the safety and effectiveness of brand new medical devices or filler materials.

For most surgical procedures, there is no FDA-approval even needed. Any surgeon can announce that he's developed some new technique that will revolutionize the way face lifts are done. But how does he know what the face will look like ten years down the road after he uses his new technique? Yes, it could be spectacular. Or not. You should think long and hard about whether you're comfortable with being the proverbial guinea pig.

I'm not here to tell you which procedures to avoid or which ones are better choices. Only you can make those decisions (with the guidance of a well-qualified surgeon to help you). What I will tell you is that, with the exception of certain minimally invasive procedures like Botox injections or dermal fillers, many of the most-advertised "name brand" procedures tend to have the lowest patient satisfaction rates.

I'm certainly not saying that newer procedures can't give you great results or should be avoided. I love learning and writing about all the exciting new developments in cosmetic procedures. I'm especially excited about the potential of less invasive procedures like non-surgical skin-tightening, REX for frown lines, and acoustic wave therapy for cellulite. However, though these developments are interesting and have some patients singing their praises, they are still relatively new, and they are not for everyone .

In summary, my point is that you shouldn't assume a big advertising and PR budget correlates with great results. Do your research. Your decision to have (or not have) surgery should be based on facts and logic, not on marketing hype and emotion.

Stepping down off of my soapbox now...

Pear-shaped women of the world, rejoice! Recent studies suggest that thigh fat may be helpful in preventing metabolic syndrome -- a collection of factors that indicate a person has an increased risk for diabetes, heart disease, and other degenerative (and often, obesity-related) disease. In fact, a 2009 study published in the British Medical Journal stated that those with a thigh circumference under 55cm (about 21 1/2 inches) have nearly double the risk for heart disease. While this does not  mean it's a good idea to reach for that second piece of pie, it does drive home the fact that what passes for the "ideal body" in fashion magazines may not match up with science.

So, if you were considering liposuction for thinner thighs, don't fail to consider the long term effects. Some research has indicated that liposuction might be linked to subsequent weight gain in some individuals. The kicker is that if you do gain weight after liposuction, it is likely you will gain it in areas other than the area that was treated in your surgery. This means that if you had fat sucked out of your thighs, and you gain weight, it will be more likely to end up around your middle, where it increases your risk for heart disease and diabetes.

In other words, if you aren't extremely careful to avoid weight gain after liposuction, you could end up merely trading "good" fat for bad. If you truly can't stand your saddle bags for one minute longer and decide you must have liposuction, do talk to your surgeon about your concerns. Consider a more conservative approach that improves your body contours while still leaving some of your protective thigh fat in place.

See liposuction before and after photos.

Finally, Nip / Tuck is back. And it's just as bizarre as ever. The oddly and creepily-narrated season premiere finds Doctors McNamara and Troy suffering the effects of the economic downturn. To make matters worse, Christian's scorned wife Lizzy decides to take him to the cleaners with a high-profile divorce lawyer at her side, and his beloved yacht is seized just because he missed a few payments. I feel your pain, Dr. Troy. I just hate it when that happens.

Rose McGowan is an interesting re-cast as Dr. McNamara's anesthesiologist girlfriend, Teddy. What I found puzzling, though, is that it almost seems the character has been not only re-cast, but completely re-worked. (Are we supposed to forget that Teddy is a deeply disturbed murderess and accept her new loyal and loving girlfriend act just because she's now a brunette?)

Interspersed personal dramas aside, the main takeaway for me was the re-introduction of Mario Lopez as Dr. Mike Hamoui, playing a new addition to the practice. Dr. Mike is a good-looking, smooth-talking Don Juan of a surgeon who specializes in performing only one procedure -- vaginal rejuvenation. The fun really begins when the doctors decide to capitalize on this niche market by producing a late-night-TV infomercial touting the "new" procedure they've developed, which they're calling the "vaginal uplift".  In the commercial, the three surgeons appear shirtless on the sand surrounded by a bevy of buxom (no doubt surgically enhanced) beach babes. And can we talk about the multiple gratuitous crotch-focused camera shots (see photo) which are presumably there just in case we didn't fully understand what the word "vaginal" means)?

Other highlights: The infomercial does manage to bring in at least one new patient -- a man who is looking for "that six-pack surgery" (liposculpture of the abdominal area) so he can look like Dr. Mike without his shirt on. Liz and Christian get into a nasty fight in the middle of a surgery. Matt holds up a coffee shop with a toy gun (in full mime-face, no less). Lizzy's divorce lawyer offers Christian an indecent proposal. And Dr. Mike talks a woman into the vaginal rejuvenation procedure by means of blatant seduction.

A couple of graphic surgery scenes later (including one in which the stressed and sleep-deprived Dr. McNamara leaves a surgical instrument inside of a tummy tuck patient), it was over. And I was left wishing for a 2-hour season premiere.

Lessons learned from the Nip / Tuck Season Premiere?

1. Make sure your plastic surgeon is not currently suffering from acute insomnia.
2. Ask if your anesthesiologist and surgeon are romantically involved. If they are, make sure they're not currently mad at each other.
3. If your surgeon starts stripping his own clothes off during your consultation, just walk away.

See plastic surgery before and after photos.