David Goldberg, MD, published some interesting news on his Cosmetic MD Nation blog, related to military efforts to recreate tissue and muscle in its soldiers who are wounded in war. The implications are tremendous -- based on history, I would not be surprised that once the Pentagon is able to recreate limbs lost in war, we might be able to recreate breasts lost to cancer and, ultimately, replace aging parts of other areas of our bodies, as well... Pentagon Study to Regrow Soldiers' Limbs:

The goal of Phase Two is to turn those undifferentiated cells into muscle tissue. Muscle tissue was chosen because it’s the type of tissue that’s routinely regenerated; ie, working out in the gym causes muscle tissue to develop, as any dedicated body builder knows. Laying about, such as in the case of invalids, causes the muscles to become weak. In the body, if muscle tissue is traumatized past a certain point, and is destroyed, a scar results. Scientists are hoping that by creating muscle tissue outside the body, they can avoid this scarring process.

To convert the undifferentiated cells into muscle cells, the cells must have myosin and actin—two proteins key to forming cellular cytoskeleton which will eventually build muscle filaments. Once this is accomplished, the cells will be placed into a matrix of tiny biomaterial threads. A this point the scientists aren’t certain whether collagens or fibrinogens will be part of the thread. This is one of the many mysteries in the process that will, ultimately, be solved.

Cellthera Inc. and the Worcester Polytechnic Institute (WPI) just got a one-year, $570,000 grant from Darpa, the Pentagon’s research division, to grow the new tissues. "The goal is to genuinely replace a muscle that’s lost," stated biotechnology professor Raymond Page. "I appreciate that’s a very aggressive goal." And it’s only one part in a more ambitious Darpa program, Restorative Injury Repair, that aims to "fully restore the function of complex tissue (muscle, nerves, skin, etc.) after traumatic injury on the battlefield."

As in many cases of medical and scientific advances, what starts on the battlefield may, ultimately, end up in the operating suite of an aesthetic plastic surgeon. Facial surgery got its modern-day start by Vilray Blair, the first chief of the Division of Plastic and Reconstructive Surgery at Washington University who treated wounded WWI soldiers with facial injuries, setting the standards for craniofacial reconstructive procedures, many of which were later affirmed in face lifting procedures.

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Some of you might enjoy reading a slightly alternate version of the history of plastic surgery. Posted on Islamdigest.net on April 21st, 2010:

While plastic surgery may seem like a modern activity that technology has created, it has a long history that extends to over 4,000 years ago.

Surgical operations to repair facial injuries have been documented to over 4,000 years ago. Physicians in India implemented the transfer of skin grafts to help areas where the skin was damaged in only 800 B.C.

Eastern medicine practices easily and quickly developed plastic surgery. However, the western European countries struggled to develop in it as well as medicine.

Slowly, the techniques used in India were incorporated by the West and plastic surgery began to develop at an extremely slow pace. Over the years these techniques were refined and began to be used to treat more ailments.

Throughout the Greco-Roman period medicine took leaps and bounds. Their discoveries were documented in various texts.

Roman physician Aulus Cornelius Celsus wrote a text entitled “De Medicina.” This text detailed surgical procedures for repairing the structure of ears, lips, and noses.

Later during the Byzantine period, Oribasius put together a comprehensive encyclopedia concerning medical topics. This encyclopedia was called the “Synagogue Medicae.”

The “Synagogue Medicae” was 70 volumes long. Within these volumes there are many detailed plastic surgery procedures.

Medical discoveries advancing both the field of medicine and the field of plastic surgery faltered when Rome fell. During this time Christianity spread and caused people to believe in mysticism and religion instead of advancing science.

Pope Innocent III even prohibited surgery of any form as illegal under Church law. When surgery was practiced, it often endangered the life of the person undergoing the operation due to the poor hygiene standards and general un-cleanliness.

Despite these obstacles, an operation to repair a cleft lip was successfully developed. As civilization left the medieval age and entered the renaissance science began to pick up again.

During this time period, there were many more discoveries in relation to science and technology. Surgery evolved to become much safer and successful than it had been previously.

An Islamic text from this time period called “Imperial Surgery” by Serafeddin Sabuncuoglu detailed maxillofacial surgery and eyelid surgery. He also explained the new treatment called gynecomastia.

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The trend in cosmetic surgery has been to offer the patient less invasiveness, less downtime, with less pain. Some practitioners have decided to push this concept into the area of breast augmentation surgery. The New York Times recently published an article that put the spotlight on a doctor in Texas who does his breast augmentation surgery with the patient wide awake on local anethesia. This is not a fluke -- it is a bonafide trend that appears to be going on across the US. My guess is that most plastic surgeons wouldn't begin to try this, but the fact that "some 100 doctors across the nation" are doing it, according to the article, makes it a trend worth following. Awake for Breast Implants? If You Wish:

Dr. Robert L. True of Colleyville, Tex... advocate[s] local anesthesia and sedation for aesthetic surgeries like breast augmentations.

“They are talking to me the entire time,” Dr. True, an obstetrician and gynecologist by training, said of the 75 patients whose breasts he has enlarged in his accredited facility. Once the new implants are in, his patients are propped up on the operating table, look in a mirror and have their say. “They like that little bit of autonomy,” he said.

A lot of plastic surgeons consider it out of the question to do a breast augmentation without an anesthesiologist or nurse anesthetist on hand, partly because of the risk to the patient if something goes wrong. These doctors say they cannot do their best work — dissecting a pocket for an implant, then securing it — without total control.

But lately, a set of doctors, most of whom have not come up through plastic surgery, has been touting the awake option as a boon to patient choice and as a safer option than general anesthesia. Breast augmentation is often done in hospitals and accredited offices, but awake breast surgery is usually done in an office that might not have been vetted for safety by an accrediting organization.

“Problem is, doctors are doing large procedures on local with quote-unquote sedation to circumvent the need for accreditation,” said Dr. Lawrence S. Reed, the president of the American Association for the Accreditation of Ambulatory Surgery Facilities.

The article is a bit of a jaw-dropper, implicitly damning all those gynecologists, podiatrists, and other subspecialists who do the 2-week cosmetic surgery course and -- bam! -- they are suddenly offering not just fillers and injectables but full-blown surgical procedures. The article also gets real good when actual plastic surgeons pipe up with their objections to this practice.

“Two-day courses, it’s just crazy,” said Dr. William P. Adams Jr., a plastic surgeon in Dallas who teaches residents at the University of Texas Southwestern Medical Center. “It took us six years to fully train plastic surgeons to do breast augmentation.” He said it was irresponsible to let fuzzy-headed patients choose their implants. “They don’t let people drive after a six-pack of beers,” said Dr. Adams, who is an investigator for Mentor and Allergan, makers of breast implants (and a consultant for Allergan). “How well will people choose an implant size after narcotics?"

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