Ear Lobe Repair
July 7th, 2009
Ear lobe stretching is really nothing new, although it seems to be quite fashionable now. The tribes near the Ubangi River like the Suyas have been practicing lip stretching for centuries. They find the changes in anatomy to be physically attractive, while culturally consistent. The ability to stretch the skin is one of the remarkable aspects of the human body. The skin not only stretches, but also grows to accommodate stretching force. Similarly results of pregnancy, as it stretches a woman’s abdominal skin is the most familiar. Obesity essentially does the same thing, by gradually stretching skin due to significant weight gain. In many cases, when weight is then lost, stretched skin fails to regain its elasticity and often sags. These permanent changes in anatomy are the reasons why tummy tucks, thigh lifts and arm lifts are done.
Tissue expansion is the purposeful stretching of skin using a “medical saline filled balloon.” When extra skin is needed, plastic surgeons use this device to “grow” extra skin. Breast reconstruction done following cancer surgery is the most common use of this particular technique.
Earlobe stretching, like facial tattoos can become unwanted in western culture due to its cultural inconsistency or changes in current fashion fads. Notions of what is beautiful or desirable are constantly changing perceptions. As a person’s life and life situations change, requests to repair the purposeful ear stretching or remove the tattoo often arrive on my doorstep. Recently a patient with stretched earlobes requested a repair. They were to become employed in a rather conservative company. The stretched earlobe appearance made them feel uncomfortable in their new cultural setting. Repair was simple and easily accomplished, since the largest diameter inserted was no greater than an inch. Unfortunately, stretched areas larger than one inch can pose real reconstruction issues and more complicated surgery is needed to correct large holes made by stretching the skin.
Recreational Diprovan
July 6th, 2009
General anesthesia is used in my operating room to complete cosmetic surgeries like breast enlargement, tummy tucks, and liposuction. There are many drugs used in during these cases. They can be categorized by how they work. Muscle relaxants paralyze muscle tissue. Narcotics help reduce pain. Vasopressors restore low blood pressure. General anesthetic agents induce sleep and maintain the sleep state during anesthesia.
There are two main general anesthetic agents that I use. One is a gas called Ultane (sevoflurane). It is administered by trained professional medical staff through a breathing tube through the lungs. The other is Diprivan or propofol.
Diprovan is administered through the vein. It is frequently used to induce sleep in the operating room, intensive care unit, and emergency room. Patients may stop breathing when Diprovan is given. In all of the settings where Diprovan is used appropriately, the medical staff has the training and capacity to care for this cessation of breathing when it occurs. Accredited surgical facilities must have this capacity.
Prior to this past week, I was unaware of ANY use of Diprovan outside the clinical settings that include access to immediate breathing support. We procure this drug through our medication provider. It is certainly not part of any formulary outside hospitals or surgery clinics. You simply cannot go to your local pharmacy to fill a prescription for Diprovan. They do not have it! So, how Jackson supposedly gained access to it remains for law enforcement to figure out.
Recreational use of Diprovan obviously is extremely dangerous. Yet I can understand its appeal. Many patients who awaken after surgery where Diprovan was the only general anesthetic agent used, report extreme euphoria and pleasure. Still, I am shocked at the reports of the possible use of Diprovan by Michael Jackson. I will be truly dismayed if his personal medical staff were complicit in accessing the drug and facilitated its use by Jackson. It is my opinion that this would be a devastating embarrassment for most American physicians who take an oath when becoming doctors, “to do no harm.” Jackson’s untimely death is a tragedy that most likely could have been prevented.
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