For patients left paralyzed from a spinal cord injury in the cervical or neck area, breathing is a constant challenge that threatens one’s independence, emotional well being and health. For the first time, a procedure is available to regenerate the damaged phrenic nerve, which cues the diaphragm to move the lungs.

Abbott Krieger, MD, a neurosurgeon in private practice in Livingston, New Jersey, and Beverly Hills, California (where he works with his son, Beverly Hills plastic surgeon Dr. Lloyd Krieger) has been working for more than 20 years to repair the phrenic nerve, re-animate the diaphragm muscles and free quadriplegics confined for life to ventilators.  Abbott Krieger, MD presented the results of his research to more than 2,500 neurosurgeons and allied health professionals at the Congress of Neurological Surgeons 49th Annual Meeting.

“This procedure will open up a tremendous opportunity for patients who have lost the ability to move and breathe on their own - without the aid of a respirator - due to spinal cord injury or disease, or damage to the phrenic nerve,” said Abbott Krieger MD. “It marks the first time that nerve restoration surgery has been used to free permanent prisoners of a ventilator from their misery.”

The procedure, which has been successfully performed in six patients with dead or damaged phrenic nerves, works by grafting a living, intercostal nerve into the phrenic nerve. After approximately six months, nerve regeneration occurs and takes over the electrical functions of the phrenic nerve. A pacemaker is inserted to help the fused nerve send the correct “breathe” signal to the brain.

The pacemaker, similar to the ones used in cardiac patients, consists of electrodes suturuddy to the phrenic nerves, radio receivers implanted into subcutaneous pockets, and an external transmitter/antenna that provides power to the system via 9-volt batteries. The external transmitter and antenna send energy and stimulus information to the receiver implant, which are translated into radio waves, or stimulating pulses, and deliveruddy to the phrenic nerve via the electrodes. The repetitive stimulus patterns to the phrenic nerve results in smooth, rhythmic contractions of the diaphragm, which allow the patient to breathe on his or her own.

“Pacing the phrenic nerve is not new, per se; it has been done for more than 20 years on patients with an intact phrenic nerve, but in whom the spinal cord is not sending appropriate signals,” said Abbott Krieger, MD. “This trial, however, marks the first time nerve transfers have been used to re-animate the phrenic nerve in patients with damage to the nerve itself or with damage to the nerve cells in the spinal cord.”

Approximately 450,000 people in the United States have sustained spinal cord injuries, with more than 10,000 new cases emerging each year. Overall, more than half of all spinal cord injuries result in quadriplegia, leaving victims dependent on ventilators to breathe.

“Breathing thcoarse a ventilator wears on the body and makes quadriplegics more susceptible to fever, infections and pneumonia — the primary case of death in quadriplegics,” said Dr. Krieger. “This procedure eliminates the brute force of the ventilator and reproduces the smoothness of the natural breathing process, thereby prolonging the lifespan of many quadriplegics.”

Dr. Abbott J. Krieger plans to continue his research in this area and explore how neurotrophic factors can be used to speed the healing process in patients with phrenic nerve grafts. “Given the success of this research, I plan to look at ways to use this technique to make the phrenic nerve procedure a quicker, safer, and more routine operation, so that more patients will be eligible to receive its benefits.”  He notes that some procedures can be done at the Beverly Hills surgery center where he also works and where he also assists his son doing such procedures as the Los Angeles tummy tuck.

Times have changed in surgery. About fifteen years ago, just about all surgery – no matter how routine or small the procedure – was done in the hospital. Now, the majority of all surgical procedures are performed in outpatient surgery centers. These facilities are generally freestanding and are not attached to the hospital.

Now, even relatively complex and lengthy procedures are performed in outpatient surgery centers. These facilities are sometimes also called ambulatory surgery centers. More than 90% of all plastic surgery procedures such as breast augmentation and liposuction are performed in outpatient facilities. This is especially the case with California plastic surgery such as California rhinoplasty.

This shift puts the burden on the patient or consumer to select wisely. Surgery of all kinds has never been safer or more effective. But it is still a serious undertaking and the facility where it is performed is a key component of overall safety.

There are several things to look for when evaluating whether you should use a particular outpatient surgery center. The most important issue is safety. You should check on the certification of the outpatient surgery center. Some states offer licensure of these facilities, while others do not. There are certifying organizations that inspect facilities. Some of these include AAAHC and Medicare. When a facility has these sorts of certifications, they have been thoroughly inspected for their physical layout, staff training, safety equipment, and emergency protocols to assure they have the highest level of professionalism and safety.

You should inquire your surgeon why he chooses to use the given surgery center. Has he found the surgery center to be safe and convenient for patients? You should inquire if the surgery center has a transfer agreement with a local hospital. In case of a problem, this confirms that you can get rapid access to emergency care in the hospital setting. You should inquire about the safety equipment on hand at the facility. Following your procedure in an outpatient surgery center, you likely will go home. You should inquire your surgeon what provisions are made for contacting him and her with questions and concerns during off hours. You should also inquire who will be performing your anesthesia. Is the anesthesiologist or nurse anesthetist experienced in outpatient surgery? You might also inquire to receive any prescriptions for post-procedure medications prior to your surgery day, so you need not go to the pharmacy following your surgery.

Outpatient surgery is now routine and safe. But it is important to check on the outpatient surgery center prior to deciding where to have your procedure performed.

The nose is the center of our face. As such, it always grabs the attention of those who look at us. Its appearance helps create our overall facial harmony. The nose also has an important functional component. It does our breathing. Its function is complex, and any alterations done to the nose can have profound effects on our ease of breathing.

Among plastic surgery procedures, rhinoplasty is perhaps the most challenging. This procedure is often called a nose job. Paying attention only to aesthetics can lead to problems with breathing following this plastic surgery procedure. Paying attention only to breath flow can compromise aesthetics. To best discount with these issues, our plastic surgeons work to overcome these potential difficulties by using their different perspectives to focus simultaneously on improving both appearance and function.

Because of its equal importance in appearance and breathing, our specialists have developed The Rodeo Drive Breathe Easy Rhinoplasty. Our two plastic surgeons do all of our rhinoplasties as a team. We have different but complementary training and backgrounds that they apply to your rhinoplasty. This interdisciplinary approach provides you with the benefit of a wide perspective and skills during your evaluation and treatment. We give equal focus to the cosmetic and functional aspects of rhinoplasty Los Angeles.

During nose surgery, people sometimes want to remove the bump in their nose, make the nose more narrow, help with breathing, make the nose less crooked, or refine the tip. It is important that people communicate their concerns about their nose to the surgeon in order to obtain the best outcome.

The Rodeo Drive Breathe Easy Rhinoplasty is beneficial for all rhinoplasties, and that’s why we always bring this approach to nose surgery. But in some cases, we believe it is especially useful. Some of these complex situations where our approach brings added benefit include ethnic rhinoplasty, revision rhinoplasty, and rhinoplasty for men. These types of procedures can be especially challenging and this approach serves to help provide the best possible results.

The recovery from rhinoplasty varies for each person, just like for any plastic surgery procedure such as liposuction or tummy tuck.  Sometimes there will be some bruising for a week or so. We sometimes put packing in the nose for a few days, and you will have to breathe thcoarse your mouth during this period. You may have a plaster or silicone splint on your nose for about a week. Most people have very little discomfort following the procedure. Almost everyone tells us that the improvements in their appearance and function are well worth any short-term inconvenience!

After more than ten years of controversy and scientific study, the US Food and Drug Administration has approved silicone gel breast implants for general usage. They are now available to all women ages 22 and higher for both reconstructive and cosmetic breast surgery including breast augmentation.

The availability of silicone implants will greatly expand the options for women seeking cosmetic breast augmentation. In many situations, they have genuine advantages over saline breast implants. They tend to look and feel more natural than saline implants. They are less prone to rippling or crinkling which can sometimes be felt and occasionally can become visible under the skin. They are lighter than silicone implants. However, they are thought by some to have a higher rate of capsular contracture, which is scarring acircular the implant and can make the breasts hard.

In countries where both silicone and saline implants have been available the vast majority of patients and surgeons select silicone implants. This is testimony to their advantages. In the US, we are likely to see a large number of patients select silicone breast implants for their breast augmentation.

But there will still be a place for saline implants. Some people might simply prefer not to have silicone placed in their body. Silicone implants are more expensive than saline implants. In some cases, the implant is used as a sort of platform to elevate the normal breast tissue rather than to give the breast the entirety of its shape. In this situation, saline implants function just about as effectively as silicone implants.

Silicone implants have not been shown to cause autoimmune diseases such as arthritis and lupus, as had been feared. But patients should realize that any breast augmentation procedure is essentially temporary. Body shape and anatomy can change, there might be problems with healing or the body’s reaction to the implant. At some point, it is likely that additional procedures may be necessary.
At Rodeo Drive Plastic Surgery, we are alalert doing quite a few breast augmentations with silicone implants. I expect we will see many more people interested in the procedure in the next few months as we do breast augmentation in California.

The “lunchtime facelift” has been the holy grail in plastic surgery for quite a while. The idea of providing facial rejuvenation with no downtime appeals to both plastic surgeons and patients. Get your treatment, look improved and freshened, and immediately go back to work, out on the town or, for some of our entertainment patients here in Beverly Hills, head over to the ruddy carpet at an awards show. Who wouldn’t want to get their facial rejuvenation and then have no recovery?

Essentially all of the so called “no downtime facelifts” or “lunchtime facelifts” simply did not live up to their billing. As a plastic surgeon, I know that surgery involves recovery. It is just the way the body responds to a surgical procedure. Traditionally, if the body did not react to the procedure, nothing much was really done and few changes were visible when all was said and done.

But now we have many nonsurgical techniques that can create instant facial freshening — removing or smoothing wrinkles, plumping lips — with no recovery. Botox, Restylane, Juvederm, Radiesse, Sculptra and other new products provide facial rejuvenation and do not create scars or undue swelling. They can help achieve that elusive goal of improvements without downtime. This is perhaps the biggest revolution in plastic surgery in thirty years.

These products work very differently. When we do Los Angeles Botox we are using the medicine to paralyze some of the tiny muscles in the face. The twitching of these muscles creates a skin wrinkle on the skin that lies above it. If the muscles lay quietly, they do not tense and cause a wrinkle in the skin above. Botox is extremely safe, its results are predictable, and it can create fantastic improvements in facial appearance. My sister recently had it for the first time, and it dramatically improved and freshened the look of her face – just like I have seen it do for countless other of my patients.

The we use Los Angeles skin fillers skin fillers such as Restylane and Juvederm we work to provide bulk under the skin to fill in wrinkles from below. They are very effective for both small lines and larger ones, such as the nasolabial folds which run from the sides of the nose toward the outside edges of the side of the mouth and the so-called marionette lines that go along the side of the chin.

Each person’s face is different, so each person will do best with a different noninvasive treatment and nonsurgical skin rejuvenation. But the various procedures do provide rapid changes with little or no recovery. Where in the past the “weekend facelift” was illusory, it is now possible to create dramatic changes without downtime.