Migraine headaches and Botox

For treatment of migraine with botulinum toxin (Botox etc.), it is subject to insurance treatment in Europe and the United States, if a patient has no abnormality with MRI etc, a definite diagnosis by a headache expert such as neurology internal medicine is made. These people are being treated with peace of mind at almost all specialized medical institutions.

In Japan, it is unauthorized as an insurance treatment, so the doctor’s decision is left to the discretion, but our clinic’s guidelines are similar to those in the West (we use the PREEMPT protocol and FDA guideline). However, if local treatment is desired with mild migraine, we will also conduct partial treatment on a trial basis, so please consult us. In that case, the treatment cost is from 20,000 yen.

For more details, please visit this page. Thank you.

Risks of malignancy from previous breast augmentation

If you had a breast augmentation surgery in the past and were not sure about the type of implants used, you need to know the followings. In recent years rare cases of malignant lymphoma called anaplastic large cell lymphoma (ALCL) have been reportedly among people who had breast augmentation surgery in the past. This type of tumor is localized in the breast tissue and can happen after more than 10 years from the previous surgery. It is also noted that the rough surface implants called textured type is the one related to this condition.

If you are not aware which type of breast implants placed in the past, you should consult board-certified plastic surgeon about risks. In case of removal or exchange of the existing implants and if your old implants are the textured type, the entire capsules need to be removed surgically. This kind of surgical treatment requires inpatient care in a hospital setting.

Labial plasty

Surgical treatment for hypertrophy of the labia minora is also called labial plasty in English. The doctor of our clinic is an American board-certified plastic surgeon, and he was chief resident of plastic surgery at UCLA in the United States more than 20 years ago. Around that time, it became a method taught by a female genital plastic surgery specialist. Specifically, unlike the normal method, the cut surface of the labia is processed into a wedge shape, resulting in a thin and natural finish.

Inverted nipples – insurance coverage

Many people are worried about not being able to breastfeed because their nipples do not come out properly. If your nipples come out with a little stimulus or massage, you can often breastfeed during pregnancy by wearing a silicone cap or other device, which is usually not covered by insurance.

On the other hand, if the nipple does not come out at all when stimulated or with orthodontic devices, it may be a severe inverted nipple. In this case, one-day surgery with local anesthesia can be used under Japanese health insurance. There are various surgical styles for inverted nipples, but we are considering breastfeeding in the future as much as possible.

Specifically, after removing the strong fibrous scar tissue that is pulling the nipple downward, it is reinforced so that the nipple does not sink into the base (bottom part) of the areola. In addition, perform 2-3 Z-plasty on the boundary between the areola and the nipple to push up the nipple. The above is the general method, but in addition to this, in the case of the severity of the inverted nipple and the case of recurrence, a different surgical method is also adopted.

At our clinic, we always ask what is best for each patient’s condition in all surgery and treatment, and try to get the best result.

Rainy season and headaches

The rainy season is coming soon this year. It’s also a bad time for people with migraines and other types of headaches. It has been more than 10 years since Botox has been used to treat migraine in the United States. We have been using Botox for many years to treat headaches, but Botox may be the second choice in cases where other methods are not effective enough or side effects prevent us from taking existing medicines.

As we’ve mentioned several times before, why Botox is effective for headaches and why changes in barometric pressure, such as the rainy season, are discovered in 2021, Looking back at the Nobel Prize in Physiology or Medicine, you can understand to some extent. Dr. Davis and colleagues at the University of California have discovered that blood vessels on the surface of the brain have receptors for spicy sensation and pain (called TRPV1). It is now also known that this receptor is antagonized by Clostridium botulinum toxin (Botox).

There are also receptors in the brain that are sensitive to changes in barometric pressure. It can be said that the involvement of these factors in the development of headache has expanded the treatment options for headache by adding to the previous theories such as contraction and dilation of blood vessels and serotonin levels in the brain.

Our clinic has been treating headaches with Botox for over 10 years in line with US FDA protocols and guidelines.

Same day surgery with local anesthesia

Happy new year! We look forward to working with you this year as well.

At our clinic, we perform many surgical procedures on a day trip. In most cases, local anesthesia is used, so you can safely walk home alone without any attendance.

This category of procedures includes scar repair, scalp, ear plasty including standing ears, nose and facial surgery (including double eyelids, mini face lift), liposuction of face and neck, and removal of skin lesions ( (Face and various things), nipple, areola formation, breast lift, armpit, abdominal liposuction, gynecological formation, tattoo removal, gynecomastia, thigh, lower limb liposuction, eyelid ptosis, various trauma ,And so on.

On the other hand, if you wish to have general anesthesia due to extensive liposuction, you can do it as a day trip if you are accompanied.

In addition, large-scale breast augmentation surgery, breast augmentation bag and capsule removal, breast reduction surgery, and Tammy Tuck are performed under general anesthesia after being admitted to a university hospital. In 2021, many patients underwent various treatments in this way.

About complications

Complications can always occur in the treatment of plastic surgery, whether surgical or non-surgical.

As for laser equipment used in the field of aesthetic medicine, new models rooted in new technology are appearing every few years, partly due to the influence of rapid technological progress. For example, a tattoo that has been put into the body has been treated with a new model of pico laser in recent years. If the patient’s skin condition matches the characteristics of the device, I think it will bring great results. On the other hand, it may not work, in which case these new models can produce high energy, which can lead to the ugly consequences of large scars on the treated area, such as reddish-brown hypertrophic scars. Some patients who come to our hospital have recently received such treatment at another medical institution and have fallen into such a merger certificate and are sometimes asked to do something about it.

In addition, in the case of double eyelid surgery that does not cut, a very thick synthetic thread is exposed on the conjunctival surface, causing inflammation. I have encountered many cases where the problem was complicated by re-surgery, leaving the thread behind.

In addition, we sometimes see cases where an unlicensed subcutaneous injection is placed on the face, leaving lumps and bumps permanently in the face.

Returning to the description at the beginning, there are always potential complications in medical practice. In English, this is called Pros and Cons, and there is a system that explains to the patient before the procedure and then treats it.

If you are receiving treatment such as aesthetic medicine or plastic surgery at one of the medical institutions and are suffering from some complications, please feel free to contact us as we are also consulting.

Prominent Ear

Standing ears (Prominent Ear: Is the shape of the ears strange?)

For those who think that the shape of their ears is strange by nature, we have a lecture. Among them, the state in which the ears are raised forward is called “Prominent ear” in clinical medicine. Many Japanese people don’t seem to care if their ears are a little raised, but in Europe and the United States, they are often the target of bullying, and they are often treated by surgery at an early age.

Even in Japan, if your ears are highly raised, you are covered by insurance, and in this case, you generally need to be at least 30 ° above your skull. These treatments are handled by plastic surgeons and are delicate operations that require detailed preoperative design and ingenuity in surgical procedures.

Surgery is a one-day operation with local anesthesia, in which the cartilage of the ear is modified to make near-normal creases, and sometimes the entire ear is bent toward the skull. Detailed counseling with a specialist is important, as one fixed method may not work.

About double eyelids (especially non-cutting method)

We have performed many cases of double eyelids that are non-cutting. As a feature, it uses a very fine special thread (same as that used for heart surgery) to fix one or three points to the firm structure called tarsal plate. This method is also generally called the buried suture method, but in our method, it is a “complete buried suture method”, and the thread is not exposed on the inner side of the conjunctiva of the eyelid.

The director of this clinic has a total of more than 1500 cases since he was in practice in the United States, and has used this method for various races other than Japanese. From our experience, this method is especially recommended for the younger generation who seek for double eyelids. This is because the incision method cannot be redone. With our three-point fixed burial method, less than 10% of cases will lose double lines in the future, which is about the same as the incision method.

We also use our method to treat eyelid slack in older patients, which can be corrected very effectively. The same method is used for Caucasian people, and it often results in a ntural finish than Asian people.

We also perform incision-based eyelid surgery, but unless there is a compelling reason to do so (very strong sagging, too much fat, ptosis, etc.), the non-incision method is used. And, we think it’s a good way.

Mesotherapy

Mesotherapy is a therapy that was used in European countries such as France and Spain in the olden days, and it is a method of reducing the fat that is of concern to the body by injection. However, the injection ingredients used were various, and some of them were secret ingredients, so there were some parts that could not be said to be a widely verified medical practice.

In recent years, as a result of re-verification in the United States, it is becoming recognized that two main components are effective. One of its constituents is a substance called phosphatidylcholine (PTC), and the other is deoxycoric acid (DCA). These ingredients are substances originally contained in human bile. PTC is mainly used to treat accumulated fat in various parts of the body, and DCA is FDA-approved under the trade name Kybella in the United States and is mainly used to treat areas such as the lower jaw and neck. ..

Many PTCs are made from soybeans and are contraindicated for people with soybean allergies. It is also often a little painful. Kybella in the United States has less pain associated with treatment, but the visible effects are not immediate and may require 4 to 6 treatments.

Liposuction revisited (tumescent)

There are various types of slimming techniques, but it is liposuction that makes it easy to predict the results and can expect large changes with a smaller number of times. It is hard to say what is the current method because there have been various historical changes in liposuction, but we use the American method called “Tumescent”.

This method was developed by Dr. Klein of California nearly 40 years ago. By injecting a highly diluted local anesthetic solution into adipose tissue with a fine injection needle, it is safe with extremely small bleeding volume. It was an epoch-making idea that liposuction could be performed effectively and safely. We’ve been doing liposuction this way for over 25 years, including when we lived in the United States, and it’s safe enough that we’ve rarely experienced any complications in the past. Another feature is that in many cases it can be done with only local anesthesia.

Today as well, using this method, liposuction of the lower body of a foreign patient was performed only with local anesthesia. Unlike general anesthesia, you can get up and walk home immediately after the procedure. This method can be used to treat any area where local fat is accumulated, for example, it can be applied to almost all body parts such as the chin, upper arm, face, abdomen, buttocks, and lower limbs. Since it is under local anesthesia, it is not possible to perform extensive liposuction, but since it is treated little by little, downtime is short and work can be done without much rest. Of course, it is also possible to perform a wide range of liposuction with general anesthesia.

Hyaluronic acid injection and risk of blindness

Hyaluronic acid is a substance that is naturally present in our skin and other tissues, and it is commercialized so that it can be injected and used as a medicine. It’s a very effective way to increase the volume of nasolabial folds, marionette lines or cheeks and lips.

However, on the other hand, great care must be taken when injecting into the part called the T zone, that is, between the eyebrows and the base of the nose. This part is characterized in part by the running of blood vessels, which are especially prone to blockage of blood vessels that go to the center of the forehead, sometimes progressing from embolism to tissue necrosis. In rare cases, it may regurgitate into the blood vessels in the orbit and clog the artery of the eyeball. It has also been reported that vision and vision are impaired and sometimes blindness.

To prevent these serious complications, there are precautions such as not pushing the syringe hard and not piercing the tissue deeply, but caution and experience may be important.

For the above reasons, when injecting hyaluronic acid near the T zone, we give careful consent to the effects on eyesight and visual field with informed consent before performing the procedure carefully.

What is the relationship between the 2021 Nobel Prize (medicine) and migraine, and what is Botox?

You may not know the story of the Nobel Prize because it does not appear in the media so much, but the 2021 Nobel Prize in Physiology or Medicine discovered an ion channel receptor that feels spicy (capsaicin). It was given to Professor Julius David of the University of California, San Francisco.

The previously unknown receptor for spiciness (capsaicin) is called TRPV1, and it was also found that if it is too irritating, it feels “painful”. This TRPV1 is also present in the trigeminal neuralgia model for pain, and it is thought that botulinum toxin preparations such as Botox suppress the reaction on the blood vessels and the surface membranes of the brain.

Furthermore, TRPV1 may be involved in the transmission of signals to the ganglia of the brain (thalamus) and spinal cord via receptors that detect changes in pressure, which are also suppressed by Clostridium botulinum toxin preparations. It has been suggested that it can be blocked by Botox.

We feel that the mechanism of Botox for migraine, which was not well understood until now, is being elucidated.

Breast augmentation at an university hospital

Today, the director of our hospital performed breast augmentation surgery at a university hospital. It is an operation performed in the hospital under general anesthesia. The reason for doing it at a university hospital was to use a large implant of 300cc or more and to approach under the pectoralis major muscle. Smaller implants and submammary approaches may be possible with outpatient day surgery.

The benefits of performing these surgeries at a university hospital include using a large endoscopic device or multiple cases when large-scale chest muscle detachment is required or when adhesions that are difficult to detach are found in the space under the muscle. The wisdom of plastic surgeons is to help you work more safely and accurately. In fact, in today’s surgery, it was not easy to get under the pectoralis major muscle.

Today’s surgery was performed by a team of four specialists, including the director of our hospital, who is a part-time lecturer at the university, and an associate professor class. The work was carried out in collaboration with anesthesiology specialists and a skilled nursing team. Another benefit of performing surgery at a university hospital is that it can be performed with such team medical care. It enables safer, more efficient and more accurate procedures.

In addition to various breast surgeries, the director of this hospital also performs face lift, nasal plastic surgery and body work at the university hospital.

Partial liposuction with local anesthesia

At our clinic, we use a method called “partial” liposuction. This is a method of treating only the lower abdomen with a small amount of local anesthesia for patients who are concerned about abdominal fat. This way you can safely go on a day trip without much pain. The following areas, such as the upper abdomen and flanks, can be treated on a day trip at intervals of 2-3 weeks or more.

The essential liposuction technique is to use a diluted anesthetic solution called Tumecent, which was developed in the United States, and then use a thin suction machine called a microcannula made in the United States to perform liposuction. By doing this, you can expect a quick recovery with less damage to the tissue. Our American board-certified plastic surgeons have a proven track record of doing many liposuctions in this way over the past 20 years.