Q&A with Dr. Amirlak

Q:

A procedure you did in 2011 received quite a bit of media attention. What was unique about that patient’s case?

A:

One of my patients was a Gulf War veteran, whose forearm was caught in a pipe at work and almost torn off. He was flown to UT Southwestern from Longview. However, a significant amount of time passed between the accident and him arriving at UT Southwestern. His arm was in danger of being amputated.

What was unique was that I had to transfuse blood from his leg to his hand to keep the mangled part “alive” while I was doing the surgery, which took about 14 hours. That kind of “rigged-up” transfusion had never been done before here. We reattached his forearm. The patient is now gaining excellent function of his hand.

Q:

What are some of the latest nonsurgical treatment options for common issues, such as carpal tunnel syndrome?

A:

For carpal tunnel, we often recommend that patients wear a stent or brace while they sleep. We can also treat carpal tunnel temporarily with a steroid injection to relieve the pressure.

And for Dupuytren’s contracture, we use an injectable enzyme called Xiaflex. We’ve seen phenomenal results with this nonsurgical option.

Q:

Why do some hand disorders cause patients to develop nerve compression problems?

A:

That’s because of swelling of some structures in the hand. And that swelling can come from repetitive use, pregnancy, or age. The compartments in the hand are very tight, and they press on the nerve. As surgeons, if we can’t find a medical solution to relieve the swelling, we’ll often decompress these compartments surgically to relieve the pressure on the nerve.

Q:

For breast augmentation and reconstruction, you’re one of the few doctors in the country who uses the BRAVA bra and fat injections. What is the benefit of that kind of procedure?

A:

The BRAVA Bra is a safe, non-implant-based alternative to breast reconstruction and augmentation. We inject the patient’s own fat into the breast area. If the patient wears the BRAVA cup for about a month after surgery, it actually increases the volume of the breast. We have seen great results in patients who’ve tried this method.

Q:

For facial rejuvenation, nonsurgical options like Ulthera have gained a lot of attention.  How do you decide if a nonsurgical option is best?

A:

Some patients opt against surgery because it has a longer recovery period. Ulthera is a good alternative, and it produces minimal to mild improvements in the face and neck area. It’s not a face lift, and the results vary with the individual. But it can produce results that are pleasing.

Not all patients can achieve the results they desire using nonsurgical procedures. Surgery may be the best answer for some patients who want to look more youthful. For example, the effects of a face lift are long lasting. A patient can take 10 years off their age, and results last for about 10 to 15 years.

Q:

What should people with darker skin keep in mind when considering facial rejuvenation surgery or nonsurgical treatments?

A:

There are six different kinds of skin, with “1” being the whitest and “6” the darkest. However, we don’t just consider the color of skin. We also look at ethnic background because there is a lot of variation in skin tones among people of African-American, Mediterranean, and Hispanic origin.

Generally, people with darker skin scar worse after surgery, and the scar tends to be more visible. They also tend to have more keloids after surgery.

When considering lasers or chemical peels, they also have to think about how the skin will respond. There could be pronounced color changes in the skin. But it really depends on the skin type.

Q:

What’s one of the biggest myths about cosmetic surgery?

A:

That patients can get a face lift on their lunch breaks. Patients have to be very careful of these extreme ads that offer results that are too good to be true. In many cases, the Internet photos have been manipulated to show what they call “miraculous” results. Typically, those results are not long lasting as well.

Patients should do their research before considering any type of cosmetic procedure. The plastic surgeon should be trained in the type of procedure they are seeking. And most important, the surgeon should be certified by the American Board of Plastic Surgery.