Dr. Michael Law

Recent comments

• Posted to Silikon 1000 Expert in the Raleigh/Durham Area? on 21 Mar 2011

  Silikon 1000 is sterile silicone oil (purified polydimethylsiloxane) manufactured by a Swiss company called Alcon, Inc. The product was developed for use by ophthalmologists to treat retinal detachment and is FDA-approved for that indication only. Subcutaneous injection of silicone oil for facial soft tissue augmentation is an off-label (non-FDA-approved) use, and remains controversial. Silicone granules are treated by the body as numerous, miniscule foreign objects and in many patients can elicit a chronic inflammatory response and granuloma (cyst) formation. Subcutaneous injection of silicone oil can also be complicated by acute and/or chronic infection as well as migration of the silicone particles. Infections may be difficult to treat as the silicone material, once injected subcutaneously, cannot be removed.
  
  Just to be clear, this is a very different material than what is used in contemporary silicone gel breast implants. Cohesive silicone gel implants are filled with silicone gel that is in a solid state, and which is contained by a solid silicone elastomer shell. Silicone oil, on the other hand, is a viscous liquid, which in fact is used as an industrial lubricant. Think hard about whether you want this kind of material injected into the subcutaneous tissues of your face. It's the only face you've got.
  
  Silicone material injected into the subcutaneous space may look fine in terms of soft tissue enhancement for week, months or even years, and then begin to manifest some of these unpleasant and difficult to treat problems at a later date. It never goes away, so the recipient is potentially at risk for these complications for the rest of their life. I personally could not in good conscience inject this material into anyone's face. I have evaluated patients with silicone granulomas (cysts) and/or chronic infection that developed over five years after subcutaneous injection, and there are reports of these complications appearing over 10 years following injection. I am certain that there are some patients who never manifest any of these problems, but why roll the dice?
  
  In the 21st century, patients seeking permanent facial soft tissue enhancement have the luxury of choosing a naturally occurring, non-toxic, safe, effective, and extremely well-tolerated filler: their own fat. Structural fat grafting is the process of harvesting fat from the trunk and/or thighs and transferring it to facial sites that require volume enhancement. It has no limitations anatomically - one can beautifully, naturally and permanently fill the temples, peri-orbital (eye) area, cheeks, lips, nasolabial folds, marionette lines, jawline, etc. It does not incite an inflammatory response or immune response, and it will never be rejected by the body. Fat also contains stem cells, which are dynamic cells that have a remarkable capacity to repair human tissues. Many facial fat grafting patients tell me that the quality of their skin improves dramatically in the months following fat grafting, and many plastic surgeons who perform a great deal of fat grafting procedures believe that stem cells are responsible for this effect (myself included).
  
  So if fatty soft tissue volume is what is missing (which is the primary process of facial aging), it makes perfect sense to replace it with fat. It doesn't make much sense to me to replace it with a material used as an industrial lubricant.
  
  Fat grafting is also a reasonable option cost-wise compared to non-fat soft tissue fillers, but cost is not the primary issue here. Your face is priceless, and you should treat it that way when considering the risks and potential complications of any injectable filler. Particularly ones that are not FDA-approved for injection into the subcutaneous tissue of the face.

• Posted to 90 percent of celebrities get work done, should they reveal? on 18 Apr 2009

  Celebrities are people too. They deserve privacy about certain things just like any of us do. Although on occassion I wish some celebrities would "fess up" about surgery if they are promoting a beauty product, claiming the product alone, and not surgery is responsible for their appearance, particularly when I know they have had a bit of help. However, I would never be one of the plastic surgeons who publicly points out celebrities in the media they believe have had plastic surgery. All of our patients, celebrities and otherwise need to feel like their plastic surgeon will never share details about their plastic surgery and that we respect the privacy of ALL of our patients

• Posted to "Uncorrectable" liposuction disaster: board-certification matters on 6 Dec 2008

  Exellent Blog Post. Thank you for sharing I'd like to also pint out the importance of finding a plastic surgeon with hospital priveleges for the procedure you are interested in having perfomed. Liposuction, as you may have heard in the popular media, is the most commonly performed surgical procedure each year in the United States. Here's a statistic that you may not have heard: the majority of physicians performing liposuction in the United States are not plastic surgeons; in fact, many do not have any formal surgical training whatsoever. It seems hard to believe, but many physicians performing liposuction have had no more training in liposuction than a 'weekend course'. One way to determine whether or not a physician has had appropriate training in a particular surgery is to confirm that they have hospital privileges for that procedure. I fear that some practitioners view liposuction as a 'simple' surgery, since it does not involve making large incisions, and it requires little, if any, suturing. Nothing could be further from the truth. Liposuction, in my mind, is a very challenging operation that requires careful planning and preparation, and a great deal of care and finesse when it is actually performed. It requires a three-dimensional understanding of the layers of human anatomy, an understanding that is second nature to a surgeon alone. I think that it is often an inadequate understanding of anatomy (and, perhaps, of the body's response to surgery) which leads to the poor results in liposuction and body contouring that unfortunately are so often seen. It is important that your physician has hospital priveleges for the procedure you are interested in having performed. A hospital has access to information and records that the general public does not. Hospitals also have tremendous exposure to liability for cosmetic surgery procedures performed within them. They therefore will only grant surgical privileges to physicians that can demonstrate appropriate training and experience. Although many aesthetic cosmetic surgery procedures are not performed in hospital operating rooms, the fact that a hospital has granted a surgeon privileges for a given procedure ensures that the surgeon has met an accepted standard of competence. It also means that your surgeon will be able to take care of you at a hospital should any complications from cosmetic surgery arise. If you are planning to have cosmetic surgery performed, you should do your due diligence to determine if your surgeon has the appropriate credentials. This issue can be settled by the following simple question: Does my surgeon have hospital privileges to perform my cosmetic surgery? Michael Law MD Board-Certified Plastic Surgeon Raleigh, North Carolina

• Posted to What questions should I ask during consultation? on 20 Sep 2008

  Important questions to ask when choosing a Plastic Surgeon When you are making the decision to have plastic surgery, there are a number of extremely important questions that must be answered. Chief among them are the following: What exactly is it that I want to achieve? Am I a good candidate for the surgery I'm interested in? Are there less invasive or even non-surgical techniques that could fulfill (or perhaps partially, but adequately, fulfill) my needs? What is the best technique for achieving that result that I want? Is my physician able to educate me about ALL possible surgical options? Is my physician qualified to perform the surgery I am interested in? Does your surgeon have hospital priveleges for the surgery you are interested in? Hospital Privileges? A hospital has access to information and records that the general public does not. Hospitals also have tremendous exposure to liability for procedures performed within them. They therefore will only grant surgical privileges to physicians that can demonstrate appropriate training and experience. Although many aesthetic surgical procedures are not performed in hospital operating rooms, the fact that a hospital has granted a surgeon privileges for a given procedure ensures that the surgeon has met an accepted standard of competence. It also means that your surgeon will be able to take care of you at a hospital should any complications from surgery arise.