Pravin Puri MD again voted as one of the TOP DOCS in Plastic Surgery for 2021

 

Dear Dr. Pravin Puri, We are pleased to inform you that you have been selected by a vote of your peers to be included in Hour Detroit magazine’s 2021 list of Top Docs. The list will be published in the October issue of Hour Detroit as well as online at www.hourdetroit.com.    Hour Detroit’s Top Docs list is based on a peer-review survey of approximately 23,000 physicians in metropolitan Detroit. Thousands of votes were cast honoring excellence in 93 different specialties. There is no commercial relationship to the listings. No payment is required to be listed and listings cannot be purchased.  Dr. Puri has now been voted as a TOP DOC in Plastic, Reconstructive and Cosmetic Surgery 5 out of the past 7 years!

Moderna COVID-19 vaccine’s associated side effects in patients with dermal fillers

 

What are dermal fillers? Dermal fillers help to diminish facial lines and restore volume and fullness in the face. As we age, our faces naturally lose subcutaneous fat. The facial skin also stretches a bit, adding to this loss of facial volume. Dermal fillers can be used to add more volume to the lips, soften facial creases and wrinkles and enhance facial contours. Common places to use dermal fillers are the lips, nasolabial folds, marionette lines and cheeks.

 

 

There are several different types of dermal fillers. Dermal fillers differ in chemical make-up, longevity, and have varying degrees of softness. Softer fillers are used in the lips, for example, while sturdier fillers might be desired to enhance cheekbones. For many people, the use of “off-the-shelf” fillers can be a simple office-based procedure that can nicely enhance your appearance. These dermal fillers are very predictable, and have relatively minimal risks and side effects. One of the most common fillers is hyaluronic acid because of its compatibility with the human body. Hyaluronic acid is a natural substance found in your body. High concentrations are found in soft connective tissues and in the fluid surrounding your eyes. It's also in some cartilage and joint fluids, as well as skin tissue. It is extracted and reformulated and now has become one of the most popular kinds of injectable fillers. Common brand names include Juvéderm and Restylane. When this gel is injected, it acts like an inflated cushion to support facial structures and tissues that may have lost volume or elasticity due to normal aging. It also brings water to the surface of skin to keep it looking fresh and supple.

 

Of note, Botox is not a dermal filler. Botox acts by diminishing active lines such as glabellar frown lines, forehead lines and crows feet lines. As of this date, there has not been side effects  from Botox related to the COVID-19 vaccine.

 

In December 2020, the FDA approved the Moderna COVID-19 vaccine. During Moderna’s initial studies, 3 patients out of 15,184 receiving the MODERNA SARS-CoV-2 mRNA vaccine had developed facial swelling after vaccination. The three patients were in Moderna’s Phase Three trial and developed facial (2 patients) and lip (1 patient) swelling. Two of the patients had a history of dermal filler placement 6 months and 2 weeks prior to vaccination. One patient had lip dermal filler 2 days after receiving the vaccine. All events (swelling and inflammation) occurred within two days of receiving the vaccine dose. All patients reported complete resolution of these effects by treatment with oral steroids and antihistamines which quickly resolved the reactions.

 

Therefore, the FDA is reporting that people with cosmetic facial fillers could experience localized facial swelling and inflammation after receiving the Moderna vaccine for COVID-19. The reactions have been mild, and physicians say this information should not stop people from getting the vaccine when able.

 

I feel that dermal fillers should be administered by board-certified physicians who are experts in both the injection of dermal fillers and management of complications arising from them.

 

Pravin P. Puri MD once again voted as a "Top Doc" in Plastic Surgery by Hour Detroit Magazine for 2020

Every year, approximately 23,000 physicians (M.D.s and D.O.s) in metropolitan Detroit are sent ballots by Hour Detroit Magazine. Physicians are allowed a one-time vote for “respected, qualified and talented medical professionals – doctors to whom they would refer a loved one”.  Thousands of votes were cast honoring excellence in 94 specialties. There is no commercial relationship to the listings. No payment is required to be listed and listings cannot be purchased. Dr. Puri has been voted as a “TOP DOC” in the field of Plastic and Reconstructive surgery in multiple years including this year. The Top Docs list is published in the October 2020 issue of Hour Detroit Magazine.

 

Breast Implant Associated Anaplastic Large Cell Lymphoma

Recently, there has been media attention regarding Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL).  Because I do a significant amount of breast augmentation as well as breast reconstruction for patients who have undergone mastectomies for breast cancer, I have a lot of patients with breast implants.  I therefore decided to write a short list of frequently ask questions regarding this disease.

Q: What is Breast Implant Associated Anaplastic Large Cell Lymthoma (BIA-ALCL)?

A: Breast implant associated anaplastic large cell lymphoma is an uncommon lymphoma that has only been reported in patients with a history of a textured breast implant.  It is not a cancer of the breast tissue itself, but of the scar envelope (called the capsule) that the body naturally forms around a breast implant.  Oncology organizations currently classify BIA-ALCL as a lymphoma.  It is a spectrum of disease that ranges from a fluid collection within the capsule to a rare lymphoma.  Because this is such a rare disease, there is currently ongoing research that is being done to better understand and define BIA-ALCL.

Q: What are the symptoms of Breast Implant Associated Anaplastic Large Cell Lymthoma (BIA-ALCL)?

A: The first symptom of BIA-ALCL is usually a swelling of the breast between 2 and 28 years after the insertion of breast implants.  The average presentation is 8 years after implantation of the breast implant.  The swelling is due to a collection of fluid surrounding the implant.  This causes the breast to enlarge significantly over a period of days or weeks.  It can also present as a lump in the breast or arm pit.  It is usually completely curable if diagnosed early.

Q: What are the risks of developing BIA-ALCL?

A: Current conservative estimates suggest that greater than 35 million women worldwide have textured breast implants, with 1.5 million breast implants inserted in 2016 alone.  It is estimated that there are approximately 3 million women with textured breast implants in the current US population.  As of December 2018, the American Society of plastic surgeons has received reports of approximately 656 confirmed or suspected cases of BIA-ALCL worldwide and 257 reported cases in the United States.  Therefore, it is felt to be an uncommon disease.

An analysis of global BIA-ALCL cases has revealed a substantial variation in the incidence around the world with the lowest incidence in Europe, China in Brazil and the highest incidence in Australia and New Zealand.  Scandinavian countries, which have excellent implant registries, have had almost no reported cases.  It is therefore felt that genetic predisposition and ethnicity may play an important role.

There seems to be a significant difference in the risk of developing BIA-ALCL depending upon the type of implant that is used.  The outer shell of a breast implant can be either smooth or textured.  As of this writing, there have been no cases of BIA-ALCL reported in women exposed to smooth implants only.  Furthermore, no reports of the disease had been identified before the introduction of surface textured implants.  When looking at textured implants, there are several different types of surface texturing depending and how rough the surface is.  There are micro-textured, macro textured and polyurethane surfaces that have increasing amount of texturing.  It is currently felt that the more textured implants seem to have a higher risk.  The risk can be explained by the textured grade of the implants as follows:

Grade 1 (smooth surface only) - The current risk is felt to be ZERO

Grade 2 (micro-textured implants) - The current risk is felt to be 1 in 60,631

Grade 3 (macro textured implants) - The current risk is felt to be 1 in 3,817

Grade 4 (polyurethane surface) – The current risk is felt to be 1 in 2,832

Q: Is it a problem with silicone or saline implants?

A:  BIA-ALCL appears to purely be related to the surface of the implant and not with the implant is filled with.

Q: If it is a problem with textured implants, why would a physician use textured implants?

A: There are 2 primary reasons that a surgeon may recommend a textured surface implant.  First, some data has shown a lower rate of capsular contracture (which is when firm scar tissue forms around an implant) with use of textured implants.  Second, all tear drop or anatomic-shaped implants have a textured surface to help hold them in place.

Q: Should patients have their textured implants removed because of the risk of BIA-ALCL?

A: Neither the FDA nor any plastic surgery society currently recommends that women should preventatively remove textured breast implants to prevent BIA-ALCL.

Q: Should women with breast implants be screened for BIA-ALCL?

A: There is no blood test to specifically screen for BIA-ALCL.  The expert opinion is that asymptomatic women without breast changes do not require more than routine mammograms and breast exams.  But, if the patient experiences a change in the breast implants, especially if there is a swelling or a lump, she should undergo examination, imaging and consultation with a plastic surgeon.  If there is fluid around the implant, the fluid should be aspirated under ultrasound guidance and sent for analysis.



Pravin P. Puri M.D. again voted one of the Top Docs in Plastic Surgery

Every year, approximately 23,000 physicians (M.D.s and D.O.s) in metropolitan Detroit are sent ballots by Hour Detroit Magazine. Physicians are allowed a one-time vote for “respected, qualified and talented medical professionals – doctors to whom they would refer a loved one”.  Thousands of votes were cast honoring excellence in 94 specialties. There is no commercial relationship to the listings. No payment is required to be listed and listings cannot be purchased. Pravin Puri M.D. was once again honored as a Top Doc in Plastic and Reconstructive Surgery for 2018. He was also voted as a Top Doc in 2015 and 2017. The Top Doc list is published in the October 2018 edition of Hour Magazine.

Click here to see the 2018 Top Doc List

American Society of Plastic Surgeons Weighs in On Growing Popularity of Teen Plastic Surgery

Over the past several years, there has been an increasing trend for teenagers to consider plastic surgical procedures. This may be driven by social media, the internet as well as the use of smart phones. Common surgeries  inquired about include rhinoplasty, otoplasty, breast reduction, breast augmentation and liposuction. There are currently very few guidelines in place to assure that teen plastic surgeries are performed appropriately. An article published in the September 2018 issue of Plastic and Reconstructive Surgery discusses teenage plastic surgery.


Click here to read the entire article

Pravin Puri M.D. voted one of the Top Docs in Plastic Surgery

In April 2017, state licensed physicians (M.D.s and D.O.s) in Wayne, Oakland, Macomb, Washtenaw and Livingston Counties were sent ballots by Hour Detroit Magazine. Each physician was allowed a one-time vote for “respected, qualified and talented medical professionals – doctors to whom they would refer a loved one”.  They compiled a list of physicians from different specialties that was published in Hour Detroit Magazine in October 2017. The votes are now in:

Pravin Puri MD was voted as one of the Top Docs in the field of Plastic and Reconstructive Surgery.

It should be noted that being honored on this list is not an advertisement and physicians cannot pay a fee to be listed as a Top Doc. Doctors can only be voted in by their peers.