Articles Provided by Dr. Johnson of Memphis

Plastic Surgery related articles featuring Dr. Johnson in Memphis.
The Latest in Cosmetic Surgery / Body Sculpting Trends
American Society for Aesthetic Plastic Surgery (ASAPS)

More and more patients are coming to Dr. Ronald J. Johnson for body sculpting to put curves back in the right places. Body sculpting, or contouring, has become much easier thanks to technological advances in liposuction and other minimally invasive procedures. Dr. Johnson has extensive experience in the field of body sculpting and uses the most advanced techniques and technology available today.

Historically, liposuction was developed to treat small, localized deposits of excess fat on individuals who were at or near their optimal weight. Over the years, scientific advancements have extended the application to remove larger volumes. However, many individuals continue to seek out the expertise of aesthetic surgeons in sculpting isolated areas of the body by the artful removal of small amounts of fat.

The focus is on small "figure faults," notes Los Angeles plastic surgeon Peter B. Fodor, MD, a panelist at the annual meeting of the American Society for Aesthetic Plastic Surgery (ASAPS) in Los Angeles, who reported on abdominal "etching." In this technique, the experienced aesthetic surgeon creates the coveted "washboard" abdomen by removing small amounts of fat in a specialized way that actually enhances muscle definition in this area. Noting that "not everyone qualifies" as a candidate, Fodor reports that physically fit individuals may seek out this procedure to produce the appearance of a finely sculpted abdomen, an effect that may not be achieved by weight loss or exercise alone.

Knees, calves, and ankles are other areas that respond well to liposculpturing techniques. ASAPS panelist Richard A. Mladick, MD, a Virginia Beach plastic surgeon, maintains that "excellent corrections can usually be obtained by following careful contouring methods." Patients may have a "shapeless" leg with generalized fat around the calf or localized fat accumulations around the ankle or the knee.

The position of the cannulas as well as the "level" of the fat deposits help to determine the final result. Localized ankle bulges, for example, require only two tiny incisions. Anatomically, the tissues of the ankle consist of just a single layer of fat, so that all liposculpting in this area automatically occurs at the superficial level, just below the skin.

Liposculpting also can be effective in the face and neck. In these areas, the surgeon must be careful to leave enough fat to avoid a harsh "architectural" look.

Liposculpting is a sophisticated technique that can yield superior results. However, with the superficial technique, a higher risk of postoperative contour irregularities exists. Therefore, the training and experience of a board-certified plastic surgeon who understands all aspects of liposuction is essential to achieving a satisfactory result.



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Facts About Cosmetic Surgery
American Society for Aesthetic Plastic Surgery (ASAPS)

Dr. Johnson believes in giving his patients as much information as possible before they decide on cosmetic surgery. Some of the facts related to cosmetic surgery and its growing acceptance in our country are highlighted below.

There were over 2 million cosmetic surgical and non-surgical procedures performed nationwide in 1997.

  • Nearly 2.1 million surgical and non-surgical cosmetic procedures were performed in 1997, according to new statistical data released by the American Society for Aesthetic Plastic Surgery (ASAPS). The ASAPS research includes survey data from doctors certified by several American Board of Medical Specialties recognized boards, including the American Board of Plastic Surgery and is the best estimate to date of total cosmetic procedures performed nationwide.
  • Top procedures nationally were chemical peel (481,227), collagen injections (347,168), liposuction (176,863), cosmetic eyelid surgery (159, 232) and laser skin resurfacing (154,153).
  • Men accounted for 14% of cosmetic procedures. The top three procedures for men were hair transplantation (50,566), nose reshaping (44,452), and liposuction (28,308).
  • Baby boomers (35-50) had 46% of all the cosmetic procedures performed. About 24% of procedures were for people ages 19-34, and 22% for ages 51-64.
  • Eighty-five percent (85%) of cosmetic procedures were for Caucasians, 6% for Hispanics, 4% for African-Americans and 4% for people of Asian descent.
  • ASAPS members, who are plastic surgeons certified by the American Board of Plastic Surgery, each performed an average of 320 cosmetic procedures in 1997. The most frequently performed procedures by ASAPS members were liposuction, cosmetic eyelid surgery, breast augmentation and facelift.



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Quick Facts: Who Has Cosmetic Procedures & Where They Are Performed
American Society for Aesthetic Plastic Surgery (ASAPS)

Patients for Cosmetic Procedures by Race or Ethnicity (% of Total Procedures)

  • Caucasian (85%)
  • Hispanic (6%)
  • African-American (4%)
  • Asian (4%)
  • Other (1%)

    Patients for Cosmetic Procedures by Age (% of Total Procedures)

  • 35-50 (46%)
  • 19-34 (24%)
  • 51-64 (22%)
  • 65+ (6%)
  • 18 and under (3%)

    Other Age-Related Facts

  • 35% of facelifts are performed on people 50 or younger.
  • 52% of cosmetic eyelid surgeries are performed on people 50 or younger.
  • 79% of liposuctions are performed on people 50 or younger.
  • 13% of nose reshaping surgeries are performed on people 18 or younger.

    Top Cosmetic Procedures for Baby Boomers

  • Chemical Peel (244,011 -- 51% of all chemical peel procedures performed)
  • Collagen Injection (196,538 -- 57% of all collagen injections)
  • Liposuction (77,660 -- 44% of all liposuction surgeries)
  • Cosmetic Eyelid Surgery (73,176 -- 46% of all cosmetic eyelid surgeries)
  • Laser Skin Resurfacing (69,364 -- 45% of all laser skin resurfacing procedures)

    Where are Cosmetic Procedures Performed (% of Total Procedures)

  • Office-based Surgical Facility (46%)
  • Hospital (30%)
  • Free-standing Surgicenter (23%)
  • Other (1%)

    *Figures may not add exactly to totals and percentages may not equal 100% due to rounding.



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    The most popular aesthetic surgical procedures
    Ronald J. Johnson, M.D., F.A.C.S.

    Dr. Johnson's patients are often curious about the types of cosmetic surgery available and which are most popular. Interesting new research reveals the facts behind these trends. As a member of the American Society for Aesthetic Plastic Surgery (ASAPS), Dr. Johnson keeps abreast of these trends and advances in aesthetic surgical procedures. In fact, a recent survey by the American Society for Aesthetic Plastic Surgery reveals that while new technologies are making a significant impact on the practice of aesthetic (cosmetic) surgery, in many instances surgeons still favor more "conventional" modes of treatment.

    "Technology offers many new options to plastic surgeons and their patients," says James H. Carraway, MD, chair of the ASAPS scientific program. "However, the 'tried and true' methods are often excellent for treating certain kinds of problems, and not every patient is a good candidate for some of the newer techniques."



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    Questions Answered
    Ronald J. Johnson, M.D., F.A.C.S.

    Some of the questions answered by this recent ASAPS research include:

    How widespread is the use of an endoscope in performing "minimal incision" aesthetic plastic surgery? A little over half (52%) of responding ASAPS members say they sometimes perform endoscopic aesthetic surgery. Use of the endoscope allows the plastic surgeon to perform intricate operations through tiny incisions that can be well concealed. According to the survey, most of the plastic surgeons who perform endoscopic aesthetic surgery use the endoscope for brow lifts (forehead lifts) and to remove or modify the muscles that cause frown lines. However, the conventional brow lift technique, which does not use an endoscope and requires a longer incision across the top of the head, is still more popular. Sixty-five percent (65%) of all the surgeons surveyed say they most often use the conventional brow lift technique, while 31% most often use the endoscope.

    Use of an endoscope to assist in performing a facelift is still not widespread (11% say they sometimes use it). Use of endoscope in browlift is showing real promise. Only 10% of aesthetic plastic surgeons say they sometimes use an endoscope when performing a "tummy tuck."



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    Use of lasers widespread
    Ronald J. Johnson, M.D., F.A.C.S.

    How widespread is the use of a laser for resurfacing the skin? Fifty-eight percent (58%) of the ASAPS respondents say they have incorporated skin resurfacing with the pulsed carbon dioxide laser into their aesthetic practices. Laser skin resurfacing is in a virtual tie with chemical peeling in terms of which is the more frequently used skin treatment; chemical peels enjoy a slight edge with 51% of surgeons using them more often.

    Which chemical peeling solutions are used most often? Nearly half of the ASAPS surgeons (49%) say that among the various chemical peeling solutions they most frequently use trichloroacetic acid (TCA), which is commonly applied at concentrations that produce a medium-depth peel. Alpha hydroxy acid peels, the lightest peeling solutions, are used most frequently by 29% of the surgeons. Phenol, generally the deepest peeling solution, is used most frequently by 23% of the survey respondents. The survey results reflect the growing demand for facial peels that freshen the skin with less "down time" for recovery.

    Which is preferred, a "knife of light" or a "knife of steel"? In addition to resurfacing the skin, the carbon dioxide laser can be used as a surgical cutting tool. However, only 8% of ASAPS members say they use it in this way when performing eyelid surgery, and 2% say they use the laser instead of a scalpel when performing a facelift.



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    Fat for the face
    Ronald J. Johnson, M.D., F.A.C.S.

    Which injectable or implantable substances are most popular for the treatment of facial wrinkles and depressions? Compared to other injectable or implantable substances, collagen is used most frequently by ASAPS members (61%) for the treatment of facial wrinkles and depressions. Second in popularity is injected fat, with 38% of the plastic surgeons saying they most frequently use fat from the patient's own body to smooth facial creases and irregularities. A small percentage of surgeons sometimes use Gore-Tex (5%) and fibril (2%), but less than 1% of the doctors say they use these materials most frequently.

    How popular is the tumescent technique for liposuction? Sixty-five percent (65%) of the plastic surgeons surveyed say they use the tumescent technique when performing liposuction. This technique involves the infusion of large quantities of fluid into the areas of the body to be suctioned. Another 15% of surgeons say they use the "superwet" technique, which is similar but infuses a somewhat smaller volume of fluid. Some surgeons feel that these techniques help to minimize postoperative swelling and bruising.

    Dr. Johnson has had extensive experience in all of these procedures and is also an active participant in national clinical trials (see silicone breast implants.)



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    Practice Profiles
    Ronald J. Johnson, M.D., F.A.C.S.

    The survey also asked whether plastic surgeons offer such amenities as aesthetician services and skincare products through their aesthetic practices. Forty percent (40%) of ASAPS members say they employ or contract the services of an aesthetician or cosmetologist. Seventy-four percent (74%) offer patients the convenience of skincare products available in the surgeon's office.

    "Plastic surgeons are sensitive to the needs of patients for guidance on postsurgical makeup, which can help them feel more comfortable about going back to work and resuming social activities at earlier stages of their recovery," says ASAPS President James L. Baker, Jr., MD, of Winter Park, Fla. "Pre- and postsurgical skin care, as well, are becoming an increasingly important part of what plastic surgeons do to help patients achieve and maintain optimal results from facelifts, laser resurfacing and chemical peels."



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    Quick Overview of Cosmetic Procedures From Head-to-Toe
    ASAPS Consumer Survey of 1000 American Households

    Facial Cosmetic Procedures

    • Board-certified plastic surgeons (including ASAPS members), as well as other physician specialists, perform non-surgical facial cosmetic procedures such as Botox® injection, chemical peel, collagen injection, dermabrasion, fat injection and laser skin resurfacing.
    • Non-surgical cosmetic procedures to the face account for 54% of the total cosmetic procedures performed in 1997.
    • Plastic surgery is a surgical specialty, and board-certified plastic surgeons (including ASAPS members) are highly trained to perform surgical cosmetic procedures of the face such as cosmetic eyelid surgery, cheek implants, chin augmentation, facelift, forehead lift and nose reshaping.
    • Surgical cosmetic procedures of the face account for 23% of the total cosmetic procedures performed in 1997.

    Breast Surgery

    • Board-certified plastic surgeons (including ASAPS members) perform the vast majority of cosmetic breast surgeries including breast augmentation, breast lift and breast reduction.
    • Breast augmentation is the most frequently performed breast surgery (101,176 performed in 1997).
    • Breast reduction is the second most frequently performed plastic surgery of the breast (47,874 in 1997). This operation often may be covered by insurance.
    • Breast lift is the third most frequently performed cosmetic breast surgery (19,882 in 1997).
    • Male breast reduction (gynecomastia surgery) is the eighth most frequently performed cosmetic surgery procedure for males (11,168 in 1997).

    Body Contouring

    • Board-certified plastic surgeons (including ASAPS members) perform the vast majority of body contouring surgeries including tummy tuck, buttock lift, liposuction, lower body lift, thigh lift and upper arm lift.
    • Liposuction is the most frequently performed body contouring procedure (176,863 performed in 1997).
    • Lower body lift, thigh lift and upper arm lift are performed only if patients are willing to accept the significant scars in exchange for looking better in clothing.



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    Americans' General Approval of Cosmetic Surgery
    Ronald J. Johnson, M.D., F.A.C.S.

    Americans' General Approval of Cosmetic Surgery

    • 57% of women say they approve of cosmetic surgery.
    • 58% of men say they approve.
    • 69% of female baby boomers (ages 35-50) say they approve.
    • 38% of people ages 18-24 say they approve.


    Changes in Attitudes Toward Cosmetic Surgery Compared to 10 Years Ago

    • 66% of Americans have the same attitude toward cosmetic surgery as 10 years ago.
    • 24% of Americans say their attitude toward cosmetic surgery is more favorable.
    • 8% of Americans say their attitude toward cosmetic surgery is less favorable.


    Openness About Having Cosmetic Surgery

    • 77% of Americans say that, if they had cosmetic surgery in the future, they would not be embarrassed if others (in addition to family and close friends) knew about it.
    • 77% of women would not be embarrassed.
    • 76% of men would not be embarrassed.
    • 82% of Americans over age 55 would not be embarrassed.
    • 62% of Americans ages 18-24 would not be embarrassed.


    Approval of Cosmetic Surgery In Relation to Household Income

    • 66% of people with incomes above $50,000 approve of cosmetic surgery.
    • 59% with incomes of $41,000-$50,000 approve.
    • 58% with incomes of $26,000-40,000 approve.
    • 47% with incomes of $15,000 to $25,000 approve.
    • 40% with incomes under $15,000 approve.


    Approval of Cosmetic Surgery in Relation to Race/Ethnicity

    • 60% of white Americans approve of cosmetic surgery.
    • 45% of non-white Americans approve.
    • 25% of white Americans have a more favorable attitude than 10 years ago.
    • 17% of non-white Americans have a more favorable attitude than 10 years ago.
    • 7% of white Americans have a less favorable attitude than 10 years ago.
    • 14% of non-white Americans have a less favorable attitude than 10 years ago.


    *Figures may not add exactly to totals and percentages may not equal 100% due to rounding.



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    News on Gel or Silicone Breast Implants
    Ronald J. Johnson, M.D., F.A.C.S.

    News on Gel or Silicone Breast Implants

    A great deal of controversy has arisen over the use of gel-filled breast implants during the past decade. During this time, Dr. Johnson has been involved in two national clinical trials related to this topic. In fact, Dr. Johnson is one of a limited number of practices in the United States that is permitted to use gel-filled implants.

    The latest developments arising from the Federal studies are revealed here.

    Federal Review says Silicone-Implants Do Not Cause Cancer. Are Silicone Breast Implants Back?

    During the past 11 years, Dr. Ronald J. Johnson has participated in two national clinical trials on silicone breast implants. His work contributed to the findings released to a Federal Review Panel. This Federal review of more than 100 studies on the medical effects of silicone breast implants has concluded that the devices do not cause breast cancer. The study suggests that, if anything, implants may actually decrease the risk of breast cancer. Although the studies were consistent in finding a decreased breast cancer risk in women with implants, it is unclear whether this finding is related to the implants.

    A report on the Federal review is published in the September 17 issue of The Journal of the National Cancer Institute. The report gives silicone breast implants a "clean bill of health" as far as breast cancer is concerned.
    S. Lori Brown of the Food and Drug Administration, a co-author of the review, said that the possibility of breast implants being linked to some types of connective tissue disease is only of "borderline" statistical significance. Because such diseases are so rare, it may never be possible to accurately interpret these statistical results.

    The overwhelming consensus of the studies examining this issue to date is that no significant association exists between implants and connective tissue disease.

    Louise A. Brinton of the National Cancer Institute says that a 15-year study of 13,500 women with breast implants is now being evaluated. This is the largest such study conducted to date and should provide even more definitive data on the health effects of breast implants.

    In the news

    Are Silicone Breast Implants Back?

    MEMPHIS, TN: The long-awaited findings of a court-appointed panel of scientists were released in December, reporting no proven links between silicone breast implants and diseases claimed by women suing implant manufacturers.

    Ronald J. Johnson, M.D., of The Plastic Surgery Group of Memphis, is a plastic surgeon who has been doing breast implant surgery for over 25 years for patients from all around the United States. In the area of silicone implants, he is one of a select group of Board Certified Plastic Surgeons in the Country who has been participating in two national clinical studies of silicone or "gel" breast implants. Dr. Johnson's group is the only approved private practice site in Memphis and in this region of the United States participating in the McGhan Study.

    Four areas of women's health related to breast implants were studied.

    Dr. Johnson said, "This four-member panel was appointed in August 1996 by U.S. District Court Judge Sam Pointer of Birmingham. This is the judge who is coordinating federal breast implant litigation. The purpose of this respected panel was to analyze scientific claims on the effect of silicone breast implants on women. This panel, representing the four major clinical areas related to connective tissue diseases, found no links between silicone implants and women's illnesses. The panel included a toxicologist, immunologist, epidemiologist and a rheumatologist.

    Silicone breast implants came on the market in the 1960's, and twenty years later women began blaming various maladies on their implants. Dr. Marcia Angell, executive editor of the New England Journal of Medicine said, "Many women developed symptoms that any woman over 25 could develop."

    "In fact, with each passing year as peer-reviewed studies emerge on the topic from Harvard, Mayo Clinic, and Johns Hopkins, evidence is mounting to support their findings that there is literally no link between silicone implants and these various diseases," said Dr. Johnson.

    From the ban to the McGhan
    Study of silicone breast implants.

    Shortly after the 1992 ban on silicone implants by Dr. David Kessler, then head of the FDA, a national clinical trial was approved to study the long-term effects of silicone implants in patients. Dr. Johnson was one of a group of plastic surgeons in the United States to participate in the 'Mentor Study'.

    "Silicone implants are still not available to women in this country, other than through a clinical study," Dr. Johnson explains. Two major national studies are now in progress, the Mentor and the McGhan clinical trials. We have been involved in both studies since their beginning, and have had excellent results with our patients participating in these programs."

    Why does the demand for silicone breast implants persist?

    The reason for the continuing demand for silicone breast implants has primarily been aesthetic. Dr. Johnson has performed hundreds of surgeries using both saline-filled and gel-filled implants. He explains, "Not all women have enough breast tissue of their own to shape around saline-filled implants. Often slender women do not have enough breast tissue mass to effectively cover the more watery properties of a saline-filled implant. Some women complain that it feels like a 'baggie' filled with water. Gel-filled implants provide a much more authentic feel to the augmented breast. I have had patients ask that I replace their gel implants with saline, only to have them return a few years later, wanting to return to a gel implant. They just prefer the feel of the gel implant."

    During the silicone breast implant ban in the United States, several other materials have been tested, but with mixed results. Breast implants with vegetable and soybean oil were tested, but they provided little improvement over the saline-filled implants, and their use has declined markedly in the past year. Patients and surgeons alike reported less-than-satisfactory aesthetic results.



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  • Ronald J. Johnson, M.D., F.A.C.S.
    Wolf River Plastic Surgery
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    Germantown
    7910 Wolf River Blvd.
    Germantown, TN 38138
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