Liquid silicone, which is often used for breast augmentation and other cosmetic procedures, can cause respiratory failure if not injected properly by a licensed physician. A study of individuals who underwent illegal silicone injections revealed a high fatality rate from pulmonary silicone embolism, or obstruction of the lungs. The study was presented at the annual meeting of the Radiological Society of North America (RSNA).
"The illegal use of fluid silicone is a practice that carries life-threatening risks, and the community should be aware of the complications," said Carlos S. Restrepo, M.D., director of chest radiology at the University of Texas Health Science Center, San Antonio.
Dr. Restrepo and colleagues compiled the imaging findings of 44 patients with pulmonary embolism that resulted from illegal silicone injection, constituting the largest case series to date.
Seven patients who presented to the hospital with respiratory distress due to illicit silicone injection were studied, along with an additional 37 cases from the literature. Patients' demographic information, clinical presentation, imaging findings and outcome were analyzed.
"Twenty-five of the patients were transsexual males, and 19 were females," Dr. Restrepo said. "The most common sites of injection were the breast, hips, buttocks, vagina, chest and arms."
All 44 patients experienced respiratory difficulties after receiving the injections, and nearly half experienced fever. One-quarter of the patients died from resultant bleeding in the lungs.
Silicone that is injected improperly travels through the bloodstream and causes blood to coagulate in the lungs, creating circulatory obstructions that can be immediately life-threatening if not identified and treated quickly. The imaging findings of pulmonary silicone embolism include dark, hazy patches in the lung tissue on x-rays or computed tomography (CT) scans.
"Transsexual males in particular should be checked closely for signs of pulmonary embolism when they show symptoms of respiratory distress and fever," Dr. Restrepo emphasized. Male transsexuals often undergo cosmetic procedures of the breasts, genitalia and other areas to make them appear more feminine.
The U.S. Food and Drug Administration banned silicone injections in 1992, but people still seek them out because they are cheaper and easier to get than professional plastic surgery or hormone therapy and provide immediate results. In surgical clinics, transgender patients are often required to undergo psychological testing before receiving treatment.
Unfortunately, the illicit nature of the injections makes it hard to estimate how common they actually are. However, the increasing popularity of the "pumping party" - where a host will inject a number of people with silicone in the same sitting - indicates both the demand and the ready availability of the substance.
Dr. Restrepo expressed the difficulties of conducting long-term follow-up with patients who present with these complications, because of the underground nature of the practice. It is hoped, he said, that by making the public and the medical community aware of the symptoms and severe consequences of illegal silicone use, mortality risks and patient outcomes from this clandestine practice will improve.
Co-authors are Santiago Martinez-Jimenez, M.D., Jorge Carrillo, Aura L. Rivera and Santiago E. Rossi, M.D.
RSNA is an association of more than 40,000 radiologists, radiation oncologists, medical physicists and related scientists committed to promoting excellence in radiology through education and by fostering research, with the ultimate goal of improving patient care. The Society is based in Oak Brook, Ill.
The data in these releases may differ from those in the printed abstract and those actually presented at the meeting, as researchers continue to update their data right up until the meeting.
Contact: Maureen Morley
Radiological Society of North America
понедельник, 16 мая 2011 г.
Collagen Manufactured From Transgenic Tobacco Plants At Hebrew University
A scientist at the Hebrew University of Jerusalem's Robert H. Smith Faculty of Agriculture, Food and Environment has succeeded in producing a replica of human collagen from tobacco plants - an achievement with tremendous commercial implications for use in a variety of human medical procedures.
Natural human type I collagen is the most abundant protein in the human body and is the main protein found in all connective tissue. Commercially produced collagen (pro-collagen) is used in surgical implants and many wound healing devices in regenerative medicine. The current market for collagen-based medical devices in orthopedics and wound healing exceeds US $30 billion annually worldwide.
Currently, commercial collagen is produced from farm animals such as cows and pigs as well as from human cadavers. These materials are prone to harbor human pathogens such as viruses or prions (mad-cow disease). Human cadaver is scarce, and for certain indications possesses serious ethical issues.
Producing human recombinant type I pro-collagen requires the coordinated expression of five different genes. Prof. Oded Shoseyov of the Robert H. Smith Institute of Plant Sciences and Genetics in Agriculture has established the only laboratory in the world that has reported successful co-expression all the five essential genes in transgenic tobacco plants for the production of processed pro-collagen. For this work, Shoseyov was one of the recipients of a Kaye Innovation Award during the Hebrew University Board of Governors meeting in June.
Shoseyov's invention on has been patented, and the scientific findings behind it were published recently in the journal Biomacromolecules. A company, CollPlant Ltd., has been established based on patents and technology that were developed in Shoseyov's laboratory. It has raised US$15 million to establish the first commercial molecular farming company in Israel and is already manufacturing collagen-based products that have attracted collaborative commercial interest from companies in the US, Japan Europe and Israel.
Yissum, the technology transfer company of the Hebrew University, is one of the shareholders of CollPlant.. CollPlant is a public company traded in "TASE", and the potential revenue for the Hebrew University from this invention is estimated to reach into the multi-million dollar range.
The Kaye Awards have been given annually since 1994. Isaac Kaye of England, a prominent industrialist in the pharmaceutical industry, established the awards to encourage faculty, staff, and students of the Hebrew University to develop innovative methods and inventions with good commercial potential which will benefit the university and society.
Natural human type I collagen is the most abundant protein in the human body and is the main protein found in all connective tissue. Commercially produced collagen (pro-collagen) is used in surgical implants and many wound healing devices in regenerative medicine. The current market for collagen-based medical devices in orthopedics and wound healing exceeds US $30 billion annually worldwide.
Currently, commercial collagen is produced from farm animals such as cows and pigs as well as from human cadavers. These materials are prone to harbor human pathogens such as viruses or prions (mad-cow disease). Human cadaver is scarce, and for certain indications possesses serious ethical issues.
Producing human recombinant type I pro-collagen requires the coordinated expression of five different genes. Prof. Oded Shoseyov of the Robert H. Smith Institute of Plant Sciences and Genetics in Agriculture has established the only laboratory in the world that has reported successful co-expression all the five essential genes in transgenic tobacco plants for the production of processed pro-collagen. For this work, Shoseyov was one of the recipients of a Kaye Innovation Award during the Hebrew University Board of Governors meeting in June.
Shoseyov's invention on has been patented, and the scientific findings behind it were published recently in the journal Biomacromolecules. A company, CollPlant Ltd., has been established based on patents and technology that were developed in Shoseyov's laboratory. It has raised US$15 million to establish the first commercial molecular farming company in Israel and is already manufacturing collagen-based products that have attracted collaborative commercial interest from companies in the US, Japan Europe and Israel.
Yissum, the technology transfer company of the Hebrew University, is one of the shareholders of CollPlant.. CollPlant is a public company traded in "TASE", and the potential revenue for the Hebrew University from this invention is estimated to reach into the multi-million dollar range.
The Kaye Awards have been given annually since 1994. Isaac Kaye of England, a prominent industrialist in the pharmaceutical industry, established the awards to encourage faculty, staff, and students of the Hebrew University to develop innovative methods and inventions with good commercial potential which will benefit the university and society.
What Is Cosmetic Surgery? What Is Plastic Surgery?
Plastic surgery has two branches, cosmetic surgery and reconstructive plastic surgery. Cosmetic surgery is concerned with improving the aesthetic appearance of a person, while plastic surgery may include this, or just the reconstruction (reconstructive surgery). Reconstructive plastic surgery is concerned with improving function; however, it may also involve trying to approximate normal appearance, but that is not its primary function. Reconstructive plastic surgery is often referred as simply reconstructive surgery.
Some parts of the world completely separate cosmetic surgery and plastic surgery and term cosmetic surgery as elective surgery, non-essential surgery, surgery which the patient chooses to have; while plastic surgery is understood to mean surgery to reconstruct or improve appearance after injury or illness.
News on Cosmetic Surgery / Plastic Surgery
For the latest news and research on Cosmetic Surgery / Plastic Surgery, and to sign up to newsletters or news alerts, please visit our Cosmetic Surgery / Plastic Surgery News Section.
This article focuses on cosmetic surgery only.
According to official statistics, approximately 65,000 surgical cosmetic procedures were performed in 2008 in the UK - 50% more than in 2003. Breast enlargement was the most popular procedure, followed by rhinoplasty (nose job, nose reshaping), liposuction, and face-lifts. Cosmetic surgery in the USA is far more popular:
Surgical cosmetic procedures USA, 2007
Liposuction 456,828
Breast augmentation 399,440
Eyelid surgery 240,763
Abdominoplasty 185,335
Female breast reduction 153,087
Total - 1,435,444
(
Some parts of the world completely separate cosmetic surgery and plastic surgery and term cosmetic surgery as elective surgery, non-essential surgery, surgery which the patient chooses to have; while plastic surgery is understood to mean surgery to reconstruct or improve appearance after injury or illness.
News on Cosmetic Surgery / Plastic Surgery
For the latest news and research on Cosmetic Surgery / Plastic Surgery, and to sign up to newsletters or news alerts, please visit our Cosmetic Surgery / Plastic Surgery News Section.
This article focuses on cosmetic surgery only.
According to official statistics, approximately 65,000 surgical cosmetic procedures were performed in 2008 in the UK - 50% more than in 2003. Breast enlargement was the most popular procedure, followed by rhinoplasty (nose job, nose reshaping), liposuction, and face-lifts. Cosmetic surgery in the USA is far more popular:
Surgical cosmetic procedures USA, 2007
Liposuction 456,828
Breast augmentation 399,440
Eyelid surgery 240,763
Abdominoplasty 185,335
Female breast reduction 153,087
Total - 1,435,444
(
Surgeons Assemble On Capitol Hill For Landmark Advocacy Conference -Joint Surgical Advocacy Conference To Be Held March 9-11, 2008, In Washington
For the first time ever, surgeons from a wide variety of specialties are joining together to create a powerful, unified voice on Capitol Hill at the 2008 Joint Surgical Advocacy Conference (JSAC). The innovative three-day event will host more than 300 physicians from across the nation and focus on critical issues facing the U.S. healthcare system and surgery.
Surgeons will descend on Capitol Hill to urge Congress to fix the Medicare Sustainable Growth Rate (SGR) formula and avoid looming cuts in physician payments scheduled for July 1, 2008 and January 1, 2009. It is critical that Congress take action immediately to replace the Medicare cuts with positive updates based on practice cost increases, or seniors could face a crisis when accessing the healthcare they need. The Congressional meetings will also provide the opportunity for surgeons to discuss with legislators other important healthcare initiatives impacting their patients and clinical practices.
In addition to one-on-one interactions with their Members of Congress, the physicians will hear from distinguished guests. Attendees will be taught the ins-and-outs of the legislative process from Judy Schneider, a leading authority on Congress, and develop basic lobbying skills from Julius Hobson, Jr., senior policy advisor at Powell Goldstein LLP. Ronald Brownstein, formerly the Los Angeles Times national affairs columnist and now the political director for Atlantic Media Company, will discuss the 2008 election cycle.
Sponsors of the conference include the American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Association of Neurological Surgeons, American College of Osteopathic Surgeons, American College of Surgeons, American Society of Cataract and Refractive Surgery, American Society of Plastic Surgeons, Congress of Neurological Surgeons, and the Society of American Gastrointestinal and Endoscopic Surgeons. Combined, the organizations represent more than 100,000 surgeons nationwide.
Academy of Otolaryngology-Head and Neck Surgery
Surgeons will descend on Capitol Hill to urge Congress to fix the Medicare Sustainable Growth Rate (SGR) formula and avoid looming cuts in physician payments scheduled for July 1, 2008 and January 1, 2009. It is critical that Congress take action immediately to replace the Medicare cuts with positive updates based on practice cost increases, or seniors could face a crisis when accessing the healthcare they need. The Congressional meetings will also provide the opportunity for surgeons to discuss with legislators other important healthcare initiatives impacting their patients and clinical practices.
In addition to one-on-one interactions with their Members of Congress, the physicians will hear from distinguished guests. Attendees will be taught the ins-and-outs of the legislative process from Judy Schneider, a leading authority on Congress, and develop basic lobbying skills from Julius Hobson, Jr., senior policy advisor at Powell Goldstein LLP. Ronald Brownstein, formerly the Los Angeles Times national affairs columnist and now the political director for Atlantic Media Company, will discuss the 2008 election cycle.
Sponsors of the conference include the American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Association of Neurological Surgeons, American College of Osteopathic Surgeons, American College of Surgeons, American Society of Cataract and Refractive Surgery, American Society of Plastic Surgeons, Congress of Neurological Surgeons, and the Society of American Gastrointestinal and Endoscopic Surgeons. Combined, the organizations represent more than 100,000 surgeons nationwide.
Academy of Otolaryngology-Head and Neck Surgery
Common Hip Disorder Can Cause Sports Hernia
Sports hernias are commonly found in individuals with a mechanical disorder of the hip and can be resolved with surgery to fix the hip disorder alone in some cases, according to a recent study. The research, conducted by investigators at Hospital for Special Surgery, will be presented at the American Orthopedic Society for Sports Medicine 2011 Specialty Day meeting, held Feb. 19 in San Diego following the annual meeting of the American Academy of Orthopaedic Surgeons.
"If individuals have symptoms of athletic pubalgia otherwise known as sports hernia, doctors should carefully assess their hip joint to make sure there is not an underlying mechanical problem in the hip that may be the bigger problem in the overall function of the athlete," said Bryan Kelly, M.D., co-director of the Center for Hip Pain and Preservation at Hospital for Special Surgery who led the study. "If patients present with both sports hernia and femoro-acetabular impingement symptoms, you have to consider what the order of treatment should be or whether you should just treat one." He said the research suggests that treating the joint mechanics first is optimal and if problems persist, doctors can then try surgery for the sports hernia.
In recent years, a hip condition known as femoro-acetabular impingement (FAI) or hip impingement has become widely recognized in the medical community. The hip is a ball-and-socket joint where the upper end of the thigh bone fits into the cup-shaped socket of the pelvis. In a healthy hip joint, the ball rotates freely in the cup, but in some people a bony bump on the upper thigh bone produces a situation where there is inadequate space for the hip bone to move freely in the socket. The result is damage to the socket rim and the cartilage that lines the bones, which can lead to hip arthritis. In the past few years, doctors have thought that this condition may also cause sports hernias. A sports hernia is a tearing of the tissue that forms the inner part of the abdominal wall and inserts into the pubic bone.
To investigate how often FAI is associated with sports hernia, researchers examined the records of all professional athletes who underwent arthroscopic surgery at HSS for symptomatic FAI between April 2005 and April 2010. Patients were included if their FAI limited their ability to return to competitive play. The group, 38 in total, included nine baseball players, 13 football players, eight hockey players, five soccer players, two basketball players, and one skater. Retrospective data regarding prior athletic sports hernia surgery, ability to return to play, and duration until return to play was collected from all patients.
The investigators found that while 32 percent of the athletes had previously undergone surgery for their hernia, none of them had been able to return to their previous level of competition with the hernia surgery alone. One patient underwent hernia surgery at the same time as the FAI surgery. Thirty-nine percent of patients had hernia symptoms that resolved with FAI surgery alone and 36 of 38 patients were able to return to their previous level of play. All 12 patients that had both hernia and FAI surgery were able to return to professional competition. On average, athletes were able to return to their sport 5.9 months after arthroscopic surgery.
This is the first paper that has looked at the coincidence of FAI and sports hernia, and has practical implications for practice. "Groin pulls and lower abdominal muscle strains are frequently associated with hip joint mechanical problems, and patients should make sure that doctors are looking at both those locations as potential sources of the pain," said Dr. Kelly, who is also in the Sports Medicine and Shoulder Service at HSS. "Before this study we knew that both impingement in the hip joint and athletic pubalgia were the cause of decreased function and pain in athletes. Now we recognize that there is a close relationship between those two, and oftentimes the problems coexist and need to be looked at when treatment options are being discussed."
Other Hospital for Special Surgery investigators involved in the study include Asheesh Bedi, M.D., former resident who is now at the University of Michigan Medical Center; Sommer Hammoud, M.D.; Erin Magennis, B.A.; William Meyers, M.D., Drexel University College of Medicine; and Bryan Kelly, M.D.
A High Incidence of Athletic Pubalgia in Professional Athletes with Symptomatic FAI. AOSSM Specialty Day
Saturday, Feb. 19, 8:30 a.m. - 8:37 a.m. San Diego Convention Center, Ballroom 20A.
"If individuals have symptoms of athletic pubalgia otherwise known as sports hernia, doctors should carefully assess their hip joint to make sure there is not an underlying mechanical problem in the hip that may be the bigger problem in the overall function of the athlete," said Bryan Kelly, M.D., co-director of the Center for Hip Pain and Preservation at Hospital for Special Surgery who led the study. "If patients present with both sports hernia and femoro-acetabular impingement symptoms, you have to consider what the order of treatment should be or whether you should just treat one." He said the research suggests that treating the joint mechanics first is optimal and if problems persist, doctors can then try surgery for the sports hernia.
In recent years, a hip condition known as femoro-acetabular impingement (FAI) or hip impingement has become widely recognized in the medical community. The hip is a ball-and-socket joint where the upper end of the thigh bone fits into the cup-shaped socket of the pelvis. In a healthy hip joint, the ball rotates freely in the cup, but in some people a bony bump on the upper thigh bone produces a situation where there is inadequate space for the hip bone to move freely in the socket. The result is damage to the socket rim and the cartilage that lines the bones, which can lead to hip arthritis. In the past few years, doctors have thought that this condition may also cause sports hernias. A sports hernia is a tearing of the tissue that forms the inner part of the abdominal wall and inserts into the pubic bone.
To investigate how often FAI is associated with sports hernia, researchers examined the records of all professional athletes who underwent arthroscopic surgery at HSS for symptomatic FAI between April 2005 and April 2010. Patients were included if their FAI limited their ability to return to competitive play. The group, 38 in total, included nine baseball players, 13 football players, eight hockey players, five soccer players, two basketball players, and one skater. Retrospective data regarding prior athletic sports hernia surgery, ability to return to play, and duration until return to play was collected from all patients.
The investigators found that while 32 percent of the athletes had previously undergone surgery for their hernia, none of them had been able to return to their previous level of competition with the hernia surgery alone. One patient underwent hernia surgery at the same time as the FAI surgery. Thirty-nine percent of patients had hernia symptoms that resolved with FAI surgery alone and 36 of 38 patients were able to return to their previous level of play. All 12 patients that had both hernia and FAI surgery were able to return to professional competition. On average, athletes were able to return to their sport 5.9 months after arthroscopic surgery.
This is the first paper that has looked at the coincidence of FAI and sports hernia, and has practical implications for practice. "Groin pulls and lower abdominal muscle strains are frequently associated with hip joint mechanical problems, and patients should make sure that doctors are looking at both those locations as potential sources of the pain," said Dr. Kelly, who is also in the Sports Medicine and Shoulder Service at HSS. "Before this study we knew that both impingement in the hip joint and athletic pubalgia were the cause of decreased function and pain in athletes. Now we recognize that there is a close relationship between those two, and oftentimes the problems coexist and need to be looked at when treatment options are being discussed."
Other Hospital for Special Surgery investigators involved in the study include Asheesh Bedi, M.D., former resident who is now at the University of Michigan Medical Center; Sommer Hammoud, M.D.; Erin Magennis, B.A.; William Meyers, M.D., Drexel University College of Medicine; and Bryan Kelly, M.D.
A High Incidence of Athletic Pubalgia in Professional Athletes with Symptomatic FAI. AOSSM Specialty Day
Saturday, Feb. 19, 8:30 a.m. - 8:37 a.m. San Diego Convention Center, Ballroom 20A.
Link Between Gastric Bypass Surgery And Neurological Conditions
A decade-long study by neurologists at the University of Arkansas for Medical Sciences (UAMS) in Little Rock has found a link between the increasingly popular weight-loss surgery known as gastric bypass and several serious neurological conditions.
Katalin Juhasz Pocsine, M.D., associate professor in the UAMS Department of Neurology, is lead author of the study, which was published online May 22 in the medical journal Neurology (neurology/cgi/content/abstract/68/21/1843). The study concludes that patients who undergo gastric bypass surgery, also known as bariatric surgery, are at risk for long-term vitamin and mineral deficiencies and may develop a variety of neurological symptoms.
"The frequency of operations for treatment of obesity is rapidly growing in the United States," Juhasz Pocsine said. "These procedures are usually successful in reducing weight, but they are not without risk. Many of the complications patients experience affect the nervous system, and they are often disabling and irreversible."
More than 150 patients who came to the UAMS Neurology Clinic following gastric bypass were included in the report. In 26 of these patients, a link between the surgery and their neurological condition was found.
All of the patients involved in the study had previously undergone the Roux-en-Y gastric bypass procedure in which a small stomach pouch is created by stapling part of the stomach together and bypassing part of the small bowel, resulting in reduced food intake and a decreased ability to absorb the nutrients in food. The interval between surgery and onset of neurological symptoms ranged from 4 weeks to 18 years.
Additional authors include UAMS Department of Neurology faculty members Sami I. Harik, M.D., department chairman and professor of neurology; Stacy A. Rudnicki, M.D., associate professor of neurology; and Robert L. "Lee" Archer, M.D., associate professor of neurology.
The 26 people involved in the study were followed for several years by UAMS physicians and represent the largest compilation of gastric bypass patients with neurological complications ever reported.
"As is evident from our findings, the neurological complications of bariatric surgery involve most parts of the nervous system, and frequently more than one," Juhasz Pocsine said. "The conditions experienced by our patients spanned most regions of the nervous system from the cerebral cortex to the peripheral nerves."
Symptoms of the patients in the study included confusion, auditory hallucinations, optic neuropathy, weakness and loss of sensation in the legs, and pain in the feet, among other conditions. None of the patients had prior neurological symptoms.
Many of the patients also experienced multiple nutritional abnormalities, especially low serum copper, vitamin B12, vitamin D, iron and calcium.
"Attention should be given to long-term intake of vitamin and mineral supplements to prevent some of these complications and to avoid severe and rapid weight loss," Juhasz Pocsine said. "Patients should be made aware of the symptoms that herald these neurological complications, and physicians should attend to the wide-based nutritional deficiencies as early as possible."
UAMS is the state's only comprehensive academic health center, with five colleges, a graduate school, a medical center, six centers of excellence and a statewide network of regional centers. UAMS has about 2,430 students and 715 medical residents. It is one of the state's largest public employers with about 9,400 employees, including nearly 1,000 physicians who provide medical care to patients at UAMS, Arkansas Children's Hospital, the VA Medical Center and UAMS' Area Health Education Centers throughout the state. UAMS and its affiliates have an economic impact in Arkansas of $5 billion a year. For more information, visit uams.
University of Arkansas for Medical Sciences
4301 W. Markham St., Slot 716
Little Rock, AR 72205
United States
uams
Katalin Juhasz Pocsine, M.D., associate professor in the UAMS Department of Neurology, is lead author of the study, which was published online May 22 in the medical journal Neurology (neurology/cgi/content/abstract/68/21/1843). The study concludes that patients who undergo gastric bypass surgery, also known as bariatric surgery, are at risk for long-term vitamin and mineral deficiencies and may develop a variety of neurological symptoms.
"The frequency of operations for treatment of obesity is rapidly growing in the United States," Juhasz Pocsine said. "These procedures are usually successful in reducing weight, but they are not without risk. Many of the complications patients experience affect the nervous system, and they are often disabling and irreversible."
More than 150 patients who came to the UAMS Neurology Clinic following gastric bypass were included in the report. In 26 of these patients, a link between the surgery and their neurological condition was found.
All of the patients involved in the study had previously undergone the Roux-en-Y gastric bypass procedure in which a small stomach pouch is created by stapling part of the stomach together and bypassing part of the small bowel, resulting in reduced food intake and a decreased ability to absorb the nutrients in food. The interval between surgery and onset of neurological symptoms ranged from 4 weeks to 18 years.
Additional authors include UAMS Department of Neurology faculty members Sami I. Harik, M.D., department chairman and professor of neurology; Stacy A. Rudnicki, M.D., associate professor of neurology; and Robert L. "Lee" Archer, M.D., associate professor of neurology.
The 26 people involved in the study were followed for several years by UAMS physicians and represent the largest compilation of gastric bypass patients with neurological complications ever reported.
"As is evident from our findings, the neurological complications of bariatric surgery involve most parts of the nervous system, and frequently more than one," Juhasz Pocsine said. "The conditions experienced by our patients spanned most regions of the nervous system from the cerebral cortex to the peripheral nerves."
Symptoms of the patients in the study included confusion, auditory hallucinations, optic neuropathy, weakness and loss of sensation in the legs, and pain in the feet, among other conditions. None of the patients had prior neurological symptoms.
Many of the patients also experienced multiple nutritional abnormalities, especially low serum copper, vitamin B12, vitamin D, iron and calcium.
"Attention should be given to long-term intake of vitamin and mineral supplements to prevent some of these complications and to avoid severe and rapid weight loss," Juhasz Pocsine said. "Patients should be made aware of the symptoms that herald these neurological complications, and physicians should attend to the wide-based nutritional deficiencies as early as possible."
UAMS is the state's only comprehensive academic health center, with five colleges, a graduate school, a medical center, six centers of excellence and a statewide network of regional centers. UAMS has about 2,430 students and 715 medical residents. It is one of the state's largest public employers with about 9,400 employees, including nearly 1,000 physicians who provide medical care to patients at UAMS, Arkansas Children's Hospital, the VA Medical Center and UAMS' Area Health Education Centers throughout the state. UAMS and its affiliates have an economic impact in Arkansas of $5 billion a year. For more information, visit uams.
University of Arkansas for Medical Sciences
4301 W. Markham St., Slot 716
Little Rock, AR 72205
United States
uams
Plastic Surgeons Offer Guidelines To Prevent Serious ATV Injuries In Kids
Fourteen-year old Cristian Avina knows all too well the devastating injuries all-terrain vehicles (ATVs) can cause. Four months ago, Cristian and his sister, Rociel, hopped on an ATV for a little innocent fun in the desert near their home. Cristian was riding tandem with his sister when a bird flew into them causing him to lose control. The ATV crashed, sending Cristian and Rociel flying - neither was wearing a helmet. Cristian suffered serious head injuries, including an amputated ear.
"This has been a nightmare," said Martha Avina, Cristian and Rociel's mother. "Rociel was not badly hurt and went for help. Upon her return, she saw that her brother had been pecked at and his severed ear had been partially eaten by vultures. Cristian's ear could not be reattached - reconstructive plastic surgery to rebuild it started this summer."
Whether on vacation or out for recreation, many adults and children are hopping on ATVs for some warm weather fun. But ATVs are not toys. They can go more than 60 miles per hour, weigh more than 700 pounds and tip over easily. In fact, more than 135,000 Americans are injured in ATV-related accidents each year, 30 percent of them children, the U.S. Consumer Product Safety Commission (CPSC) reports.
The American Society of Maxillofacial Surgeons (ASMS) and the American Society of Plastic Surgeons (ASPS) are urging ATV riders, especially parents and children, to be more cautious and follow safety tips to help reduce the incidence of ATV-related injuries.
"Unfortunately, cases like Cristian's are not uncommon," said ASMS President Andrew Wexler, MD. "It will take multiple reconstructive surgeries - attaching an implant, providing soft tissue coverage and skin grafting - to rebuild Cristian's ear. Each year, plastic surgeons treat thousands of patients with severe head trauma, eye injuries, disfiguring lacerations and facial fractures from ATV accidents. These debilitating injuries may be avoided by following a few safety tips."
Plastic surgeons strongly recommend following the CPSC safety tips for ATV riders:
Get properly trained
Always wear protective gear - especially a helmet
Many ATV injuries are head injuries.
Additional protective gear includes closed toed shoes, goggles, gloves, long pants, and long-sleeved shirts to protect against cuts.
Children under 16 should never ride adult-sized ATVs
Children should only use ATVs that are appropriate for their age. Most injuries occur when a child is driving or riding an adult-sized ATV.
Never ride tandem
Most ATVs are designed for one person; a passenger can make it difficult for drivers to control the machine.
Don't ride on paved roads
ATVs can be very difficult to control on pavement; collisions with cars and other vehicles can be deadly.
Never ride at night
Don't ride under the influence
"When it comes to protective gear, it's especially important to wear a helmet, since many ATV-related injuries involve trauma to the head and face," said ASPS President Richard D'Amico, MD. "Studies show helmets can reduce non-fatal head injuries by 64 percent and deaths by 42 percent."
"ATVs can be treacherous and difficult to steer. They are not like riding a bicycle," said Dr. Wexler. "The injuries we see from these machines can be devastating."
The American Society of Maxillofacial Surgeons is the oldest organization representing maxillofacial plastic surgeons. The members of the ASMS are surgeons of high moral and ethical standing and professional attainment, who are experts in craniofacial restoration. The mission of the American Society of Maxillofacial Surgeons is to advance the science and practice of surgery of the facial region and the craniofacial skeleton. The Society accomplishes its mission through excellence in education and research, and through advocacy on behalf of patients and practitioners.
The American Society of Plastic Surgeons is the largest organization of board-certified plastic surgeons in the world. Representing more than 6,700 physician members, the Society is recognized as a leading authority and information source on cosmetic and reconstructive plastic surgery. ASPS comprises more than 90 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the Society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada. For more information, please visit plasticsurgery/.
"This has been a nightmare," said Martha Avina, Cristian and Rociel's mother. "Rociel was not badly hurt and went for help. Upon her return, she saw that her brother had been pecked at and his severed ear had been partially eaten by vultures. Cristian's ear could not be reattached - reconstructive plastic surgery to rebuild it started this summer."
Whether on vacation or out for recreation, many adults and children are hopping on ATVs for some warm weather fun. But ATVs are not toys. They can go more than 60 miles per hour, weigh more than 700 pounds and tip over easily. In fact, more than 135,000 Americans are injured in ATV-related accidents each year, 30 percent of them children, the U.S. Consumer Product Safety Commission (CPSC) reports.
The American Society of Maxillofacial Surgeons (ASMS) and the American Society of Plastic Surgeons (ASPS) are urging ATV riders, especially parents and children, to be more cautious and follow safety tips to help reduce the incidence of ATV-related injuries.
"Unfortunately, cases like Cristian's are not uncommon," said ASMS President Andrew Wexler, MD. "It will take multiple reconstructive surgeries - attaching an implant, providing soft tissue coverage and skin grafting - to rebuild Cristian's ear. Each year, plastic surgeons treat thousands of patients with severe head trauma, eye injuries, disfiguring lacerations and facial fractures from ATV accidents. These debilitating injuries may be avoided by following a few safety tips."
Plastic surgeons strongly recommend following the CPSC safety tips for ATV riders:
Get properly trained
Always wear protective gear - especially a helmet
Many ATV injuries are head injuries.
Additional protective gear includes closed toed shoes, goggles, gloves, long pants, and long-sleeved shirts to protect against cuts.
Children under 16 should never ride adult-sized ATVs
Children should only use ATVs that are appropriate for their age. Most injuries occur when a child is driving or riding an adult-sized ATV.
Never ride tandem
Most ATVs are designed for one person; a passenger can make it difficult for drivers to control the machine.
Don't ride on paved roads
ATVs can be very difficult to control on pavement; collisions with cars and other vehicles can be deadly.
Never ride at night
Don't ride under the influence
"When it comes to protective gear, it's especially important to wear a helmet, since many ATV-related injuries involve trauma to the head and face," said ASPS President Richard D'Amico, MD. "Studies show helmets can reduce non-fatal head injuries by 64 percent and deaths by 42 percent."
"ATVs can be treacherous and difficult to steer. They are not like riding a bicycle," said Dr. Wexler. "The injuries we see from these machines can be devastating."
The American Society of Maxillofacial Surgeons is the oldest organization representing maxillofacial plastic surgeons. The members of the ASMS are surgeons of high moral and ethical standing and professional attainment, who are experts in craniofacial restoration. The mission of the American Society of Maxillofacial Surgeons is to advance the science and practice of surgery of the facial region and the craniofacial skeleton. The Society accomplishes its mission through excellence in education and research, and through advocacy on behalf of patients and practitioners.
The American Society of Plastic Surgeons is the largest organization of board-certified plastic surgeons in the world. Representing more than 6,700 physician members, the Society is recognized as a leading authority and information source on cosmetic and reconstructive plastic surgery. ASPS comprises more than 90 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the Society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada. For more information, please visit plasticsurgery/.
World's first face transplant to take place at the Cleveland Ohio Clinic, USA
The world's first face transplant is going to take place at the Clevelant Ohio Clinic. Twelve severely disfigured people have been selected for this pioneering procedure. Maria Siemionow, lead surgeon, will choose who will be the first out of those 12.
Maria Siemionow has been researching into the feasibility of face transplants for several years. The twelve patients to be the first ever to undergo a face transplant consist of five men and seven women. They will each receive a new face from a cadaver (dead body).
US regulators approved the procedure - British and French authorities did not.
The patients to undergo this new medical procedure have been seriously disfigured by burns, serious accidents or personal tragedies. Current technologies can help people with serious disfigurements. However, patients still have unpleasant scars and tight 'unelastic' skin.
The UK and French authorities' main reason for not approving the procedure was a question of 'life and death' - it is not a life-saving operation. In many cases, the patient's health is fine (physical health). This procedure does not save a patient's life. There is also a risk of rejection, which would leave the patient with serious problems.
Although in most cases the patient's physical health is not affected by a facial disfigurement, some people with serious disfigurements have written to us explaining that the effects on their mental health is significant. Their general view is that mental health problems seriously affect their quality of life, and often lead to physical health problems.
Editor - us
Maria Siemionow has been researching into the feasibility of face transplants for several years. The twelve patients to be the first ever to undergo a face transplant consist of five men and seven women. They will each receive a new face from a cadaver (dead body).
US regulators approved the procedure - British and French authorities did not.
The patients to undergo this new medical procedure have been seriously disfigured by burns, serious accidents or personal tragedies. Current technologies can help people with serious disfigurements. However, patients still have unpleasant scars and tight 'unelastic' skin.
The UK and French authorities' main reason for not approving the procedure was a question of 'life and death' - it is not a life-saving operation. In many cases, the patient's health is fine (physical health). This procedure does not save a patient's life. There is also a risk of rejection, which would leave the patient with serious problems.
Although in most cases the patient's physical health is not affected by a facial disfigurement, some people with serious disfigurements have written to us explaining that the effects on their mental health is significant. Their general view is that mental health problems seriously affect their quality of life, and often lead to physical health problems.
Editor - us
SurgiCount Medical Announces The Successful Implementation Of The Safety-Sponge® System At The University Of Michigan Health System
SurgiCount Medical, the wholly-owned operating subsidiary of Patient Safety Technologies, Inc. (OTC Bulletin Board: PSTX) announced the successful implementation of the Safety-Sponge® System at the University of Michigan Health System located in Ann Arbor, Michigan. The Safety-Sponge® System is a proven solution to prevent one of the most common surgical errors, retained surgical sponges.
Since the founding of the University of Michigan Medical School in 1848, the academic medical center, now known as the U-M Health System, has been recognized as a leading innovator and health care provider in Michigan, nationally, and worldwide. It is consistently ranked among the nation's best by U.S. News and World Report, currently a member of the 2010-2011 Honor Roll, the only hospital in Michigan to make this list for 15 consecutive years and is also recognized for excellence in 15 specialty care areas. With nearly 900 beds across three hospitals, U-M Health System has over 43,000 patient admissions, and performs over 45,000 surgical procedures on inpatients and outpatients across a broad range of specialties.
"We are proud to include the University of Michigan Health System to the growing list of users of the Safety-Sponge® System and believe adding an institution of this caliber further validates the benefits and advantages of the solution. We look forward to supporting them in their ongoing effort to deliver excellence in patient care," stated Brian E. Stewart, President and CEO of Patient Safety Technologies.
"We have implemented the SurgiCount System to provide an added safety mechanism to the long-established practice of a manual sponge-counting process in our operating rooms," said Shawn Murphy MS, RN, Operating Room Director for UMHS. "The SurgiCount technology provides the protection of identifying and counting each sponge used during a surgical procedure and also helps to support a standard practice for counting sponges that improves our ability to deliver safer care for our patients."
Since the founding of the University of Michigan Medical School in 1848, the academic medical center, now known as the U-M Health System, has been recognized as a leading innovator and health care provider in Michigan, nationally, and worldwide. It is consistently ranked among the nation's best by U.S. News and World Report, currently a member of the 2010-2011 Honor Roll, the only hospital in Michigan to make this list for 15 consecutive years and is also recognized for excellence in 15 specialty care areas. With nearly 900 beds across three hospitals, U-M Health System has over 43,000 patient admissions, and performs over 45,000 surgical procedures on inpatients and outpatients across a broad range of specialties.
"We are proud to include the University of Michigan Health System to the growing list of users of the Safety-Sponge® System and believe adding an institution of this caliber further validates the benefits and advantages of the solution. We look forward to supporting them in their ongoing effort to deliver excellence in patient care," stated Brian E. Stewart, President and CEO of Patient Safety Technologies.
"We have implemented the SurgiCount System to provide an added safety mechanism to the long-established practice of a manual sponge-counting process in our operating rooms," said Shawn Murphy MS, RN, Operating Room Director for UMHS. "The SurgiCount technology provides the protection of identifying and counting each sponge used during a surgical procedure and also helps to support a standard practice for counting sponges that improves our ability to deliver safer care for our patients."
Face Transplant Recipient Doing Extremely Well
Isabelle Dinoire, who had a partial face transplant a year ago, can go out without people noticing her scars, said her doctor, Professor Devauchelle, Centre Hospitalier Universitaire, Amiens, France. Isabelle says she is now able to smile.
Devauchelle was interested to hear that people who had only seen her before her face was mauled are starting to recognize her - meaning she is beginning to look like her old self. It was expected that a face transplant recipient would look different - neither like her/his old self nor the donor.
Devauchelle said she does have scars, but they don't stand out. He added that she still occasionally experiences minor inflammations near wires deep beneath her skin. With a bit of make-up, he added, the scars are hardly noticeable.
Her face has restored its sensitivity to touch and temperature. She can drink and eat without difficulty now.
Since her operation, there have been two occasions when her body started to reject the foreign tissue. However, this was successfully treated with immunosuppressant drugs.
Even though doctors advised her to give up smoking, Isabelle continues to smoke.
Isabelle Dinoire lost parts of her face when her dog tried to revive her during a suicide attempt.
Centre Hospitalier Universitaire, Amiens, France
Devauchelle was interested to hear that people who had only seen her before her face was mauled are starting to recognize her - meaning she is beginning to look like her old self. It was expected that a face transplant recipient would look different - neither like her/his old self nor the donor.
Devauchelle said she does have scars, but they don't stand out. He added that she still occasionally experiences minor inflammations near wires deep beneath her skin. With a bit of make-up, he added, the scars are hardly noticeable.
Her face has restored its sensitivity to touch and temperature. She can drink and eat without difficulty now.
Since her operation, there have been two occasions when her body started to reject the foreign tissue. However, this was successfully treated with immunosuppressant drugs.
Even though doctors advised her to give up smoking, Isabelle continues to smoke.
Isabelle Dinoire lost parts of her face when her dog tried to revive her during a suicide attempt.
Centre Hospitalier Universitaire, Amiens, France
Got Fat?: Plastic Surgeons Review Fat-Melting And Fat-Grafting Procedures
New techniques and devices
for surgical and nonsurgical cosmetic enhancement are being introduced at a
rapid pace, but do these innovations really deliver what they promise? Are
the results of minimally invasive treatments, offering the benefit of
little or no downtime, comparable to more extensive procedures? Are these
new modalities safe and cost-effective for patients? These are the
questions that leading aesthetic plastic surgeons will explore during the
Hot Topics seminar at the annual meeting of the American Society for
Aesthetic Plastic Surgery (ASAPS), May 2-6 in San Diego, CA.
"Presentations at the annual Hot Topics seminar focus on some of the
most intriguing innovations in both surgical and nonsurgical cosmetic
treatments," says New York plastic surgeon Alan Gold, MD, president of the
Aesthetic Surgery Education and Research Foundation (ASERF), co-sponsor of
Hot Topics with the Plastic Surgery Educational Foundation (PSEF). "Every
year the Hot Topics seminar proves to be one of the most popular sessions,
so this year we there will be two Hot Topics programs - one at the
beginning of the Meeting and one at the end."
The following are among the presentations included in this year's Hot
Topics program:
-- Injection Lipolysis (Otherwise known as Mesotherapy or LipoDissolve):
V. Leroy Young, MD, a plastic surgeon in St. Louis, IL, will be
discussing ASERF's Clinical Trial on injection lipolysis. The
trial will study 10 patients receiving four injection lipolysis
treatments to one side of their abdomen. MRIs and biopsies will be
performed on the patients, and photographs of the patients will be taken
before and after injections are administered. The goal of this study is
to find out if injection lipolysis actually works -- and how exactly it
works. Safety concerns will be reviewed during the study.
-- Lipo-Transfer: Kotaro Yoshimura, MD, a plastic surgeon from Tokyo, will
be presenting new advances in Lipo Transfer. One common problem with
this procedure is the difficulty predicting the survival rate of
transplanted fat or the risk of fibrosis and calcification. To overcome
the problem, Dr. Yoshimura has developed a strategy called Cell-Assisted
Lipotransfer (CAL), which employs patients' adipose-derived stem
cells and can be applied to breast augmentation. He expects that this
technique will improve the survival rate and prevent post operative
atrophy of transplanted fat tissue.
-- Laser-Assisted Lipolysis: Arturo Prado, MD, Barry E. DiBernardo, MD,
and Jeffrey M. Kenkel, MD, will present on laser-assisted (fat
destroying) Lipolysis. Dr. Prado, a plastic surgeon in Chile, will
report on his randomized double-blind study that compared traditional
lipoplasty and laser-assisted lipoplasty. Dr. DiBernardo (Cutera,
Cynosure, Lumensis and Apira Science), a plastic surgeon in Montclair,
NJ, is going to discuss the first preliminary clinical trial of
SmartLipo. Dr. Kenkel (Palomar), a plastic surgeon in Dallas, TX, will
discuss his clinical experience with CoolLipo and ProLipo.
As plastic surgeons concerned about patient safety, we want to be sure
that the treatments we recommend are backed by good science and sufficient
clinical experience," says Foad Nahai, MD, ASAPS President and a plastic
surgeon in Atlanta, GA. "Many of these innovations in aesthetic surgery may
prove to be widely beneficial, but at the beginning they must be used
cautiously and, of course, only with the patient's full informed consent.
The American Society for Aesthetic Plastic Surgery (ASAPS), the
Aesthetic Surgery Education and Research Foundation (ASERF), and the Public
Surgery Education Foundation (PSEF), do not advocate or endorse the
procedures or technologies presented at the Hot Topics seminar. This
seminar is strictly for the purposes of research and education in cosmetic
plastic surgery. The reporting, advertising or clinical use of these
procedures and technologies should be conducted cautiously, responsibly and
with full disclosure of their unproven nature.
About ASAPS
The 2400-member American Society for Aesthetic Plastic Surgery (ASAPS)
is the only plastic surgery organization devoted entirely to the
advancement of cosmetic surgery. ASAPS is recognized throughout the world
as the authoritative source for cosmetic surgery education. U.S. members
are certified by the American Board of Plastic Surgery. Canadian members
are certified in plastic surgery by the Royal College of Physicians and
Surgeons of Canada.
American Society for Aesthetic Plastic Surgery
surgery
for surgical and nonsurgical cosmetic enhancement are being introduced at a
rapid pace, but do these innovations really deliver what they promise? Are
the results of minimally invasive treatments, offering the benefit of
little or no downtime, comparable to more extensive procedures? Are these
new modalities safe and cost-effective for patients? These are the
questions that leading aesthetic plastic surgeons will explore during the
Hot Topics seminar at the annual meeting of the American Society for
Aesthetic Plastic Surgery (ASAPS), May 2-6 in San Diego, CA.
"Presentations at the annual Hot Topics seminar focus on some of the
most intriguing innovations in both surgical and nonsurgical cosmetic
treatments," says New York plastic surgeon Alan Gold, MD, president of the
Aesthetic Surgery Education and Research Foundation (ASERF), co-sponsor of
Hot Topics with the Plastic Surgery Educational Foundation (PSEF). "Every
year the Hot Topics seminar proves to be one of the most popular sessions,
so this year we there will be two Hot Topics programs - one at the
beginning of the Meeting and one at the end."
The following are among the presentations included in this year's Hot
Topics program:
-- Injection Lipolysis (Otherwise known as Mesotherapy or LipoDissolve):
V. Leroy Young, MD, a plastic surgeon in St. Louis, IL, will be
discussing ASERF's Clinical Trial on injection lipolysis. The
trial will study 10 patients receiving four injection lipolysis
treatments to one side of their abdomen. MRIs and biopsies will be
performed on the patients, and photographs of the patients will be taken
before and after injections are administered. The goal of this study is
to find out if injection lipolysis actually works -- and how exactly it
works. Safety concerns will be reviewed during the study.
-- Lipo-Transfer: Kotaro Yoshimura, MD, a plastic surgeon from Tokyo, will
be presenting new advances in Lipo Transfer. One common problem with
this procedure is the difficulty predicting the survival rate of
transplanted fat or the risk of fibrosis and calcification. To overcome
the problem, Dr. Yoshimura has developed a strategy called Cell-Assisted
Lipotransfer (CAL), which employs patients' adipose-derived stem
cells and can be applied to breast augmentation. He expects that this
technique will improve the survival rate and prevent post operative
atrophy of transplanted fat tissue.
-- Laser-Assisted Lipolysis: Arturo Prado, MD, Barry E. DiBernardo, MD,
and Jeffrey M. Kenkel, MD, will present on laser-assisted (fat
destroying) Lipolysis. Dr. Prado, a plastic surgeon in Chile, will
report on his randomized double-blind study that compared traditional
lipoplasty and laser-assisted lipoplasty. Dr. DiBernardo (Cutera,
Cynosure, Lumensis and Apira Science), a plastic surgeon in Montclair,
NJ, is going to discuss the first preliminary clinical trial of
SmartLipo. Dr. Kenkel (Palomar), a plastic surgeon in Dallas, TX, will
discuss his clinical experience with CoolLipo and ProLipo.
As plastic surgeons concerned about patient safety, we want to be sure
that the treatments we recommend are backed by good science and sufficient
clinical experience," says Foad Nahai, MD, ASAPS President and a plastic
surgeon in Atlanta, GA. "Many of these innovations in aesthetic surgery may
prove to be widely beneficial, but at the beginning they must be used
cautiously and, of course, only with the patient's full informed consent.
The American Society for Aesthetic Plastic Surgery (ASAPS), the
Aesthetic Surgery Education and Research Foundation (ASERF), and the Public
Surgery Education Foundation (PSEF), do not advocate or endorse the
procedures or technologies presented at the Hot Topics seminar. This
seminar is strictly for the purposes of research and education in cosmetic
plastic surgery. The reporting, advertising or clinical use of these
procedures and technologies should be conducted cautiously, responsibly and
with full disclosure of their unproven nature.
About ASAPS
The 2400-member American Society for Aesthetic Plastic Surgery (ASAPS)
is the only plastic surgery organization devoted entirely to the
advancement of cosmetic surgery. ASAPS is recognized throughout the world
as the authoritative source for cosmetic surgery education. U.S. members
are certified by the American Board of Plastic Surgery. Canadian members
are certified in plastic surgery by the Royal College of Physicians and
Surgeons of Canada.
American Society for Aesthetic Plastic Surgery
surgery
Three Surgical Steps to Reconstructing Car Crash Victims' Upper Jaws; Function and Appearance Restored
A surgical process most often
associated with orthopedic surgery has been found effective in the intricate
reconstruction of patients with severe bone loss in the anterior maxilla --
the front portion of the upper jaw. Distraction osteogenesis reconstructs
skeletal deformities through the gradual, controlled displacement of
surgically created fractures to enable simultaneous expansion of soft tissue
and bone volume.
The March 2005 issue of the Journal of Oral and Maxillofacial Surgery
reports on the success of a surgical technique that employs distraction
osteogenesis, bone grafts and dental implants to achieve both functional and
aesthetic results for five patients whose injuries in motor vehicle accidents
left them with such severe bone and soft tissue loss in the front portion of
their upper jaws that traditional surgical procedures were insufficient to
correct their problems. Michael S. Block, DMD, the principal author of the
study ("Reconstruction of severe anterior maxillary defects using distraction
osteogenesis, bone grafts, and implants"), says the technique is promising.
"It can be a viable treatment option for the patient involved in a car
accident, or accidental shooting, or facing jaw tumor removal."
Dr. Block and David G. Baughman, DDS, MD, oral and maxillofacial surgeons
who both practice in New Orleans, La., utilized a treatment plan that combined
bone grafts, tissue expanders and the gradual movement of the underlying bone.
The distraction osteogenesis provided a platform for hard tissue grafting and
even more importantly, for the necessary soft tissue genesis needed to cover
the graft.
The process began with a preoperative workup during which diagnostic casts
were used to create a temporary appliance with teeth, which guided the OMS
during the distraction phase. Prior to and throughout the process, the
patients were educated about the entire treatment plan.
Identical treatment for 5 consecutive patients
According to the Journal study, "After a week for initial healing,
distraction was accomplished with 0.5 mm increments two times each day, until
the desired length of distraction was accomplished." All five patients needed
bone grafts following the distraction process because although adequate tissue
mass was attained, bone mass was inadequate. The grafting occurred between 8
and 14 weeks post-distraction. Four to six months later, seeing that the bone
was restored, the surgeons removed the screws that held the grafts in place
inside of the mouth. With the bone grafting complete, the final phase --
dental implants -- began.
Dental implant restorations proved an excellent way to restore function,
improving aesthetics and easily maintained. The Journal study shows that "In
all 5 patients, dental implants were placed ranging from 4 to 7 per patient,
depending on the span of the defect. A fixed prosthesis was placed in 2
patients with low smile lines and fixed/removable bar clip prostheses were
used in the remaining 3 patients. No implants have been lost with follow-up
ranging from 6 months to 3 years."
Dr. Block said that in addition to motor vehicle accidents causing the
critical trauma these five patients endured, some people might have similar
effects from severe periodontal disease or from shooting accidents.
The Journal of Oral and Maxillofacial Surgery is the peer-reviewed journal
of the American Association of Oral and Maxillofacial Surgeons, the
professional organization representing more than 7,000 oral and maxillofacial
surgeons in the United States. AAOMS supports its members' ability to
practice their specialty through education, research, and advocacy. AAOMS
members comply with rigorous continuing education requirements and submit to
periodic office examinations, ensuring the public that all office procedures
and personnel meet stringent national standards.
American Association of Oral and Maxillofacial Surgeons
aaoms
associated with orthopedic surgery has been found effective in the intricate
reconstruction of patients with severe bone loss in the anterior maxilla --
the front portion of the upper jaw. Distraction osteogenesis reconstructs
skeletal deformities through the gradual, controlled displacement of
surgically created fractures to enable simultaneous expansion of soft tissue
and bone volume.
The March 2005 issue of the Journal of Oral and Maxillofacial Surgery
reports on the success of a surgical technique that employs distraction
osteogenesis, bone grafts and dental implants to achieve both functional and
aesthetic results for five patients whose injuries in motor vehicle accidents
left them with such severe bone and soft tissue loss in the front portion of
their upper jaws that traditional surgical procedures were insufficient to
correct their problems. Michael S. Block, DMD, the principal author of the
study ("Reconstruction of severe anterior maxillary defects using distraction
osteogenesis, bone grafts, and implants"), says the technique is promising.
"It can be a viable treatment option for the patient involved in a car
accident, or accidental shooting, or facing jaw tumor removal."
Dr. Block and David G. Baughman, DDS, MD, oral and maxillofacial surgeons
who both practice in New Orleans, La., utilized a treatment plan that combined
bone grafts, tissue expanders and the gradual movement of the underlying bone.
The distraction osteogenesis provided a platform for hard tissue grafting and
even more importantly, for the necessary soft tissue genesis needed to cover
the graft.
The process began with a preoperative workup during which diagnostic casts
were used to create a temporary appliance with teeth, which guided the OMS
during the distraction phase. Prior to and throughout the process, the
patients were educated about the entire treatment plan.
Identical treatment for 5 consecutive patients
According to the Journal study, "After a week for initial healing,
distraction was accomplished with 0.5 mm increments two times each day, until
the desired length of distraction was accomplished." All five patients needed
bone grafts following the distraction process because although adequate tissue
mass was attained, bone mass was inadequate. The grafting occurred between 8
and 14 weeks post-distraction. Four to six months later, seeing that the bone
was restored, the surgeons removed the screws that held the grafts in place
inside of the mouth. With the bone grafting complete, the final phase --
dental implants -- began.
Dental implant restorations proved an excellent way to restore function,
improving aesthetics and easily maintained. The Journal study shows that "In
all 5 patients, dental implants were placed ranging from 4 to 7 per patient,
depending on the span of the defect. A fixed prosthesis was placed in 2
patients with low smile lines and fixed/removable bar clip prostheses were
used in the remaining 3 patients. No implants have been lost with follow-up
ranging from 6 months to 3 years."
Dr. Block said that in addition to motor vehicle accidents causing the
critical trauma these five patients endured, some people might have similar
effects from severe periodontal disease or from shooting accidents.
The Journal of Oral and Maxillofacial Surgery is the peer-reviewed journal
of the American Association of Oral and Maxillofacial Surgeons, the
professional organization representing more than 7,000 oral and maxillofacial
surgeons in the United States. AAOMS supports its members' ability to
practice their specialty through education, research, and advocacy. AAOMS
members comply with rigorous continuing education requirements and submit to
periodic office examinations, ensuring the public that all office procedures
and personnel meet stringent national standards.
American Association of Oral and Maxillofacial Surgeons
aaoms
Are Obese Adolescents Too Young For Bariatric Surgery?
Severely obese adolescents may desire or potentially benefit from bariatric surgery. However, half of primary care physicians say they would not recommend the procedure to a patient under the age of 18, according to research published in Obesity Surgery.
Childhood obesity has increased dramatically since the 1970s. Obese adolescents are more likely to suffer from type 2 diabetes, hypertension, non-alcoholic steotohepatitis, sleep apnea, choleolithiasis and premature death as adults.
Researchers surveyed a national random sample of pediatricians and family physicians for their opinions on referring adolescents for bariatric surgery. They discovered half of these physicians would not consider it for adolescent patients.
"We still have a lot to learn about the long term effects of bariatric surgery among adolescents," says Susan Woolford, M.D., M.P.H., medical director of the Pediatric Comprehensive Weight Management Center at the University of Michigan, "But recent studies suggest that it can be helpful to improve the health outcomes of severely obese adolescents."
"Physicians worry whether the risks will outweigh the benefits," adds Woolford, who is also an assistant professor in the department of pediatrics and communicable diseases at U-M. "How long adolescents will be able to sustain the weight loss and what the psychological outcomes would be in their future, are questions that are still being explored. If findings are similar to those in adults, there could be significant weight loss and health benefits."
Physicians who support the possibility of bariatric surgery for adolescents may do so because studies have indicated that obesity in adolescents has long-term health effects even if patients eventually lose weight, the authors write. Adolescent years can also be difficult socially and emotionally for extremely obese youth.
"With the increasing media presentations of surgeries for weight loss among the general public and Hollywood celebrities, more obese adolescents and their parents are likely to consider it," the authors write. Primary care physicians should be prepared to discuss this treatment option with families.
"Primary care physicians are on the front line of obesity treatment," says Woolford, "Their attitudes regarding bariatric surgery may affect whether or not an adolescent pursues the procedure."
The study also found almost all physicians endorsed participation in a monitored weight loss program as a prerequisite for bariatric surgery, though the minimum suggested duration for participation varied from three months to over 5 years.
For adolescents, participating in these programs could be helpful by providing time to make a stable decision regarding surgery and to adopt healthy habits that will improve their post-operative course, but the delay in surgery could also lead to further weight gain.
The authors suggest further studies should explore primary care physicians' knowledge regarding the risks and benefits of bariatric surgery for adolescents and the basis upon which they make referral decisions regarding bariatric surgery for their obese patients.
Additional authors: Along with Woolford, Sarah J. Clark, M.P.H., Achamyeleh Gebremariam, M.S., Matthew M. Davis, M.D., M.A.P.P. and Gary L. Freed, M.D., M.P.H., all of the University of Michigan.
Childhood obesity has increased dramatically since the 1970s. Obese adolescents are more likely to suffer from type 2 diabetes, hypertension, non-alcoholic steotohepatitis, sleep apnea, choleolithiasis and premature death as adults.
Researchers surveyed a national random sample of pediatricians and family physicians for their opinions on referring adolescents for bariatric surgery. They discovered half of these physicians would not consider it for adolescent patients.
"We still have a lot to learn about the long term effects of bariatric surgery among adolescents," says Susan Woolford, M.D., M.P.H., medical director of the Pediatric Comprehensive Weight Management Center at the University of Michigan, "But recent studies suggest that it can be helpful to improve the health outcomes of severely obese adolescents."
"Physicians worry whether the risks will outweigh the benefits," adds Woolford, who is also an assistant professor in the department of pediatrics and communicable diseases at U-M. "How long adolescents will be able to sustain the weight loss and what the psychological outcomes would be in their future, are questions that are still being explored. If findings are similar to those in adults, there could be significant weight loss and health benefits."
Physicians who support the possibility of bariatric surgery for adolescents may do so because studies have indicated that obesity in adolescents has long-term health effects even if patients eventually lose weight, the authors write. Adolescent years can also be difficult socially and emotionally for extremely obese youth.
"With the increasing media presentations of surgeries for weight loss among the general public and Hollywood celebrities, more obese adolescents and their parents are likely to consider it," the authors write. Primary care physicians should be prepared to discuss this treatment option with families.
"Primary care physicians are on the front line of obesity treatment," says Woolford, "Their attitudes regarding bariatric surgery may affect whether or not an adolescent pursues the procedure."
The study also found almost all physicians endorsed participation in a monitored weight loss program as a prerequisite for bariatric surgery, though the minimum suggested duration for participation varied from three months to over 5 years.
For adolescents, participating in these programs could be helpful by providing time to make a stable decision regarding surgery and to adopt healthy habits that will improve their post-operative course, but the delay in surgery could also lead to further weight gain.
The authors suggest further studies should explore primary care physicians' knowledge regarding the risks and benefits of bariatric surgery for adolescents and the basis upon which they make referral decisions regarding bariatric surgery for their obese patients.
Additional authors: Along with Woolford, Sarah J. Clark, M.P.H., Achamyeleh Gebremariam, M.S., Matthew M. Davis, M.D., M.A.P.P. and Gary L. Freed, M.D., M.P.H., all of the University of Michigan.
Keep Father Time From Marching On: New Laser Treatments Offer Gentle And Effective Skin Resurfacing In A Flash
For most people, the significant downtime involved in undergoing an invasive laser resurfacing procedure to reverse the obvious signs of aging skin is not realistic given today's busy, deadline-driven lifestyle. Now, a number of new minimally invasive laser skin resurfacing technologies are delivering noticeable improvements for people looking to freshen up their look without spending weeks under wraps, as is common with their invasive counterparts.
Speaking at the 66th Annual Meeting of the American Academy of Dermatology (Academy), dermatologist Jeffrey S. Dover, MD, FAAD, associate clinical professor of dermatology at Yale University Medical School in New Haven, Conn., shared his professional experience with three of the newer laser skin resurfacing procedures being used to treat fine lines, wrinkles, photodamage and uneven skin pigmentation.
"The search for safe and effective treatments to improve and rejuvenate the tone, color and texture of the aging face is never ending," said Dr. Dover. "Today, patients are interested in gentler skin rejuvenation options than those used previously, such as the CO2 laser, and will trade less dramatic results for less downtime and few, if any, side effects."
Fractional Laser Skin Resurfacing
One of the most versatile new laser technologies being used to treat aging skin is fractional laser skin resurfacing. Numerous clinical studies have shown this technology to be safe and effective in treating patients of all skin types, including skin of color, for fine lines, wrinkles, uneven skin tone and even acne scars.
Fractional laser resurfacing works by targeting damaged skin in columns of microscopic treatment zones, which include the outermost and underlying layers of skin known as the epidermis and the dermis. Fractional laser resurfacing thermally damages the tiny columns of skin while the surrounding healthy skin is left intact.
"One of the main benefits of fractional laser resurfacing is that it stimulates the production of new collagen during the body's natural healing process," said Dr. Dover. "Not only does the treated skin look better after a series of three to six treatments, but it also improves gradually as the new collagen forms with optimal results clearly noticeable in about four to six months. Patients really prefer this treatment over more invasive procedures, as they can usually get results comparable to a treatment that would have required weeks of healing time and longer-lasting side effects."
Plasma Skin Resurfacing
Another new technology that shows promise in improving photodamaged skin in initial studies is plasma skin resurfacing. Rather than using light or radiofrequency that are common in other laser resurfacing procedures, plasma resurfacing uses a nitrogen gas to generate plasma energy which is delivered to the targeted epidermis and dermis in either multiple, low-energy or single, high-energy millisecond pulses. Over a period of three to 10 days, depending on the level of energy used, the outermost layer of skin remains intact and acts as a "biological dressing" to protect the new epidermis and dermis forming underneath.
In a study published in the February 2007 issue of the Archives of Dermatology, Dr. Dover and his colleagues evaluated the effectiveness of multiple, low-energy, full-face plasma skin resurfacing treatments compared to a single, high-energy treatment. While single, high-energy plasma resurfacing treatments have been demonstrated to achieve successful results, patients typically require a week or more of healing time. Dr. Dover explained that his study was conducted to determine if comparable results could be achieved with less downtime by using multiple treatments at a lower energy.
"In the eight patients we studied that underwent full-face treatments every three weeks for a total of three treatments, we found a 37 percent reduction in wrinkles three months after treatment, with study participants noting a 68 percent improvement in overall facial appearance," said Dr. Dover. "We concluded that plasma skin resurfacing using the multiple low-energy treatment technique delivers significant improvement comparable to a single high-energy treatment, but with less healing time."
Superficial Erbium:YAG Laser Resurfacing
One of the most widely used lasers for skin resurfacing, the Erbium:YAG laser produces energy in varying wavelengths that penetrates the skin and is quickly absorbed by water, scattering the heat generated from the light of the laser. While patients with moderate to more severe wrinkles and photodamage are the best candidates for this laser treatment, the high amount of energy needed to improve aging skin requires the removal of part of the epidermis and the deeper tissues of the dermis. This more invasive procedure also requires a long healing time, as redness and swelling could last for several weeks.
Now, a modified version of this technology known as superficial Erbium:YAG laser resurfacing uses short-pulsed wavelengths to create a gentler treatment with fewer side effects and decreased downtime. Dr. Dover noted that this superficial laser procedure works well for patients with less extensive skin damage, such as mild wrinkles and slight skin discoloration, and the resulting mild redness and swelling generally only last for two to three days.
"The advantage of superficial Erbium:YAG laser resurfacing is that we can easily vary the amount of energy delivered to the skin to produce the desired effect," said Dr. Dover. "This technology has a proven track record, and it is a great option for patients who want noticeable results but a shorter healing time than the traditional high-powered procedure."
Choose the Right Physician
Since the success of any cosmetic procedure is highly dependent on the skill level of the physician, the Academy advises patients to do their homework
and discuss their options and expectations with their dermatologist before undergoing any of the latest skin resurfacing treatments.
"Although the pigmentary problems that have occurred with CO2 laser skin resurfacing have not been reported thus far with any of these new laser resurfacing techniques, it is extremely important that patients find a qualified physician who is familiar with the nuances of these therapies and can demonstrate his or her expertise through "before and after" photos or patient referrals," added Dr. Dover.
For more information on aging skin, go to skincarephysicians, a Web site developed by dermatologists that provides patients with up-to-date information on the treatment and management of disorders of the skin, hair and nails.
Headquartered in Schaumburg, Ill., the American Academy of Dermatology (Academy), founded in 1938, is the largest, most influential, and most representative of all dermatologic associations. With a membership of more than 15,000 physicians worldwide, the Academy is committed to: advancing the diagnosis and medical, surgical and cosmetic treatment of the skin, hair and nails; advocating high standards in clinical practice, education, and research in dermatology; and supporting and enhancing patient care for a lifetime of healthier skin, hair and nails.
American Academy of Dermatology
930 E. Woodfield Rd.
Schaumburg, IL 60173-4927
United States
aad
Speaking at the 66th Annual Meeting of the American Academy of Dermatology (Academy), dermatologist Jeffrey S. Dover, MD, FAAD, associate clinical professor of dermatology at Yale University Medical School in New Haven, Conn., shared his professional experience with three of the newer laser skin resurfacing procedures being used to treat fine lines, wrinkles, photodamage and uneven skin pigmentation.
"The search for safe and effective treatments to improve and rejuvenate the tone, color and texture of the aging face is never ending," said Dr. Dover. "Today, patients are interested in gentler skin rejuvenation options than those used previously, such as the CO2 laser, and will trade less dramatic results for less downtime and few, if any, side effects."
Fractional Laser Skin Resurfacing
One of the most versatile new laser technologies being used to treat aging skin is fractional laser skin resurfacing. Numerous clinical studies have shown this technology to be safe and effective in treating patients of all skin types, including skin of color, for fine lines, wrinkles, uneven skin tone and even acne scars.
Fractional laser resurfacing works by targeting damaged skin in columns of microscopic treatment zones, which include the outermost and underlying layers of skin known as the epidermis and the dermis. Fractional laser resurfacing thermally damages the tiny columns of skin while the surrounding healthy skin is left intact.
"One of the main benefits of fractional laser resurfacing is that it stimulates the production of new collagen during the body's natural healing process," said Dr. Dover. "Not only does the treated skin look better after a series of three to six treatments, but it also improves gradually as the new collagen forms with optimal results clearly noticeable in about four to six months. Patients really prefer this treatment over more invasive procedures, as they can usually get results comparable to a treatment that would have required weeks of healing time and longer-lasting side effects."
Plasma Skin Resurfacing
Another new technology that shows promise in improving photodamaged skin in initial studies is plasma skin resurfacing. Rather than using light or radiofrequency that are common in other laser resurfacing procedures, plasma resurfacing uses a nitrogen gas to generate plasma energy which is delivered to the targeted epidermis and dermis in either multiple, low-energy or single, high-energy millisecond pulses. Over a period of three to 10 days, depending on the level of energy used, the outermost layer of skin remains intact and acts as a "biological dressing" to protect the new epidermis and dermis forming underneath.
In a study published in the February 2007 issue of the Archives of Dermatology, Dr. Dover and his colleagues evaluated the effectiveness of multiple, low-energy, full-face plasma skin resurfacing treatments compared to a single, high-energy treatment. While single, high-energy plasma resurfacing treatments have been demonstrated to achieve successful results, patients typically require a week or more of healing time. Dr. Dover explained that his study was conducted to determine if comparable results could be achieved with less downtime by using multiple treatments at a lower energy.
"In the eight patients we studied that underwent full-face treatments every three weeks for a total of three treatments, we found a 37 percent reduction in wrinkles three months after treatment, with study participants noting a 68 percent improvement in overall facial appearance," said Dr. Dover. "We concluded that plasma skin resurfacing using the multiple low-energy treatment technique delivers significant improvement comparable to a single high-energy treatment, but with less healing time."
Superficial Erbium:YAG Laser Resurfacing
One of the most widely used lasers for skin resurfacing, the Erbium:YAG laser produces energy in varying wavelengths that penetrates the skin and is quickly absorbed by water, scattering the heat generated from the light of the laser. While patients with moderate to more severe wrinkles and photodamage are the best candidates for this laser treatment, the high amount of energy needed to improve aging skin requires the removal of part of the epidermis and the deeper tissues of the dermis. This more invasive procedure also requires a long healing time, as redness and swelling could last for several weeks.
Now, a modified version of this technology known as superficial Erbium:YAG laser resurfacing uses short-pulsed wavelengths to create a gentler treatment with fewer side effects and decreased downtime. Dr. Dover noted that this superficial laser procedure works well for patients with less extensive skin damage, such as mild wrinkles and slight skin discoloration, and the resulting mild redness and swelling generally only last for two to three days.
"The advantage of superficial Erbium:YAG laser resurfacing is that we can easily vary the amount of energy delivered to the skin to produce the desired effect," said Dr. Dover. "This technology has a proven track record, and it is a great option for patients who want noticeable results but a shorter healing time than the traditional high-powered procedure."
Choose the Right Physician
Since the success of any cosmetic procedure is highly dependent on the skill level of the physician, the Academy advises patients to do their homework
and discuss their options and expectations with their dermatologist before undergoing any of the latest skin resurfacing treatments.
"Although the pigmentary problems that have occurred with CO2 laser skin resurfacing have not been reported thus far with any of these new laser resurfacing techniques, it is extremely important that patients find a qualified physician who is familiar with the nuances of these therapies and can demonstrate his or her expertise through "before and after" photos or patient referrals," added Dr. Dover.
For more information on aging skin, go to skincarephysicians, a Web site developed by dermatologists that provides patients with up-to-date information on the treatment and management of disorders of the skin, hair and nails.
Headquartered in Schaumburg, Ill., the American Academy of Dermatology (Academy), founded in 1938, is the largest, most influential, and most representative of all dermatologic associations. With a membership of more than 15,000 physicians worldwide, the Academy is committed to: advancing the diagnosis and medical, surgical and cosmetic treatment of the skin, hair and nails; advocating high standards in clinical practice, education, and research in dermatology; and supporting and enhancing patient care for a lifetime of healthier skin, hair and nails.
American Academy of Dermatology
930 E. Woodfield Rd.
Schaumburg, IL 60173-4927
United States
aad
Dysport Proves Safe, Effective Anti-Wrinkle Treatment, Plastic Surgeons Find
The new anti-wrinkle facial filler Dysport, which could be used as an alternative to Botox, noticeably reduced frown lines between the eyes, according to users and independent reviewers in a study involving plastic surgeons at UT Southwestern Medical Center.
"Our study confirmed that Dysport (abobotulinumtoxinA) is a safe and effective tool in fighting wrinkles," said Dr. Rod Rohrich, chairman of plastic surgery at UT Southwestern and one of the study's authors. "It also confirmed that the dosage should be tailored to one's facial muscle mass to be most effective. So it's important to visit with a certified plastic surgeon to ensure the dosage is correct."
The study's findings showed that Dysport was:
* Most effective in women;
* More effective for African-American patients;
* Longer-lasting for African-American patients;
* Less effective for people 65 and older; and
* As effective for those who had previously been injected with a form of botulinum neurotoxin type A (such as Botox).
The Food and Drug Administration-approved study involved 816 participants with moderate to severe frown lines (called glabellar lines) at 27 centers in the U.S. The study is available online and will appear in Plastic and Reconstructive Surgery.
Study participants, who kept diaries for the first 14 days after being injected, were given the Dysport facial filler or a placebo. Surgeons injected Dysport in various levels, dependent on sex and facial mass, at five facial points. Self-assessments and assessments by independent reviewers were performed six times over a five-month follow-up period.
Eighty-seven percent of people given Dysport reported a reduction in wrinkles, compared with 5 percent of patients taking placebos who reported an improvement. An independent assessment showed improvement among 85 percent of patients receiving Dysport, compared with 3 percent of patients receiving the placebo.
It was found that Dysport took effect as quickly as 24 hours, with the median time about four days. The facial filler lasted 7 percent longer in African-Americans (median of 117 days, compared with 109 days in the overall population) in blinded assessments, and 20 percent longer in African-Americans (129 compared with 107 ) according to self-assessments by study participants.
The study also confirmed that dosing should be adjusted according to a person's facial muscle mass. Participants with the smallest muscle mass had the largest response (96 percent) by 30 days. That rate dropped as low as 80 percent in people with the highest facial muscle masses. The study is the first to examine effects from varying dose levels, which is more common in clinical practice, rather than the standardized dosing used for FDA approval tests.
"Most studies have evaluated Dysport with a standard dosage," Dr. Rohrich said. "This study evaluated the safety and effectiveness of different doses based on a person's specific muscle mass, which better mirrors what occurs in clinical practice. The size and use of the muscles that produce frown lines varies among individuals, so you want to customize treatment to the patient's face."
Dysport is a type of botulinum neurotoxin type A, similar to Botox. Both work by blocking nerve impulses to the facial muscles that create wrinkles. Dysport is produced by Scottsdale, Ariz.-based Medicis Aesthetics. Dr. Rohrich is a member of the Reloxin Investigational Group.
"Our study confirmed that Dysport (abobotulinumtoxinA) is a safe and effective tool in fighting wrinkles," said Dr. Rod Rohrich, chairman of plastic surgery at UT Southwestern and one of the study's authors. "It also confirmed that the dosage should be tailored to one's facial muscle mass to be most effective. So it's important to visit with a certified plastic surgeon to ensure the dosage is correct."
The study's findings showed that Dysport was:
* Most effective in women;
* More effective for African-American patients;
* Longer-lasting for African-American patients;
* Less effective for people 65 and older; and
* As effective for those who had previously been injected with a form of botulinum neurotoxin type A (such as Botox).
The Food and Drug Administration-approved study involved 816 participants with moderate to severe frown lines (called glabellar lines) at 27 centers in the U.S. The study is available online and will appear in Plastic and Reconstructive Surgery.
Study participants, who kept diaries for the first 14 days after being injected, were given the Dysport facial filler or a placebo. Surgeons injected Dysport in various levels, dependent on sex and facial mass, at five facial points. Self-assessments and assessments by independent reviewers were performed six times over a five-month follow-up period.
Eighty-seven percent of people given Dysport reported a reduction in wrinkles, compared with 5 percent of patients taking placebos who reported an improvement. An independent assessment showed improvement among 85 percent of patients receiving Dysport, compared with 3 percent of patients receiving the placebo.
It was found that Dysport took effect as quickly as 24 hours, with the median time about four days. The facial filler lasted 7 percent longer in African-Americans (median of 117 days, compared with 109 days in the overall population) in blinded assessments, and 20 percent longer in African-Americans (129 compared with 107 ) according to self-assessments by study participants.
The study also confirmed that dosing should be adjusted according to a person's facial muscle mass. Participants with the smallest muscle mass had the largest response (96 percent) by 30 days. That rate dropped as low as 80 percent in people with the highest facial muscle masses. The study is the first to examine effects from varying dose levels, which is more common in clinical practice, rather than the standardized dosing used for FDA approval tests.
"Most studies have evaluated Dysport with a standard dosage," Dr. Rohrich said. "This study evaluated the safety and effectiveness of different doses based on a person's specific muscle mass, which better mirrors what occurs in clinical practice. The size and use of the muscles that produce frown lines varies among individuals, so you want to customize treatment to the patient's face."
Dysport is a type of botulinum neurotoxin type A, similar to Botox. Both work by blocking nerve impulses to the facial muscles that create wrinkles. Dysport is produced by Scottsdale, Ariz.-based Medicis Aesthetics. Dr. Rohrich is a member of the Reloxin Investigational Group.
Mathematics Taking Guesswork Out Of Plastic Surgery Tissue Transfer
Plastic surgeons are turning to mathematics to take the guesswork out of efforts to ensure that live tissue segments that are selected to restore damaged body parts will have enough blood and oxygen to survive the surgical transfer.
In the world's first published mathematical model of tissue transfer, mathematicians have shown that they can use differential equations to determine which tissue segments selected for transfer from one part of the body to another location on the same body will receive the level of oxygen required to sustain the tissue.
The most common tissue transfers are used to restore body parts destroyed by cancer and trauma. The researchers say reliable mathematical modeling of the blood supply and oxygen in tissue segments will not only reduce failures in reconstructive surgery, but will also improve understanding of conditions in which an adequate blood supply is a basic problem, such as heart disease, cancer and stroke.
To obtain tissue for reconstructive surgery, plastic surgeons cut away a segment of tissue, called a flap, that is fed by a single set of perforator vessels an artery and vein that travel through underlying muscle to support skin and fat. Surgeons generally agree that vessels at least 1.5 millimeters in diameter are required to sustain oxygen flow within the flap intended for transfer.
"That guideline is based upon experience, trial and error. What we need is a more precise ability to determine what the necessary blood vessel size really is," said Michael Miller, professor of surgery and director of the division of plastic surgery at Ohio State University and a senior author of the research.
"I'm convinced that there is a relationship that's probably very predictive between the diameter and blood flow in the vessel and the ability of the piece of the tissue we're transferring to survive based on that."
Mathematicians working on the problem have set out to model that relationship. They have shown that under certain relationships between the size of the tissue flap and the diameter of the perforator vessel, the oxygen level in the flap will remain above 15 percent of the normal level, thus ensuring a successful flap transfer. If this relationship is not satisfied, the most distant tissue from the vessel will start to die something already observed by clinicians.
"This is still just a concept. But this initial system of five differential equations gives us a range between the flap size and the required diameter of the supporting artery that would ensure survival," said Avner Friedman, a senior author of the paper and a Distinguished University Professor at Ohio State.
The research appears this week in the online early edition of the Proceedings of the National Academy of Sciences.
The routine use of a patient's own tissue from the lower abdominal wall to restore deformities on the chest dates to 1982. In the early days of full removal and transfer of tissue, surgeons took muscle along with skin and fat, resulting in loss of strength where the muscle was removed.
"As time has gone on, we have learned that we don't have to take the muscle, but we can take a single blood vessel coming through the muscle and transfer the tissue on that vessel," Miller explained. "What we're finding is that the more we design flaps like this, the less reliable the tissue is becoming. The motivation to try to reduce injury to muscle is leading to an increase in problems with part of the flap failing because it doesn't have enough blood."
Miller asked Friedman, founding director of Ohio State's Mathematical Biosciences Institute, to work on a model that could add more predictability to tissue transfer.
To create the initial model, Friedman and colleagues needed to determine a number of values: the level of oxygen in the tissue, which comes from tiny capillaries spaced just microns apart; the rate of exchange of oxygen from vessels to tissue; and the pressure under which the blood is flowing in those vessels.
"The fact that there are thousands of capillaries makes it difficult to compute the oxygen levels, so we found a method of averaging. We average the oxygen concentration in the capillaries, think of capillaries as being uniformly spread all over, and look at the transport of oxygen from vessels into tissue," Friedman said.
The model's outcomes exploited clinical observations, in that if the oxygen pressure fell below 15 percent during the few days following the tissue transfer, fat tissue on the outer edges of the flap would start to die. When that happens on actual surgical cases, doctors must replace the dead tissue, and sometimes have to redo the entire operation.
More work lies ahead to make the model truly useful in a surgical setting, Miller and Friedman agreed.
In live human tissue, the pattern of blood vessels and capillaries is not uniformly spread throughout the flap. In many cases, there is a gap in the presence of branching vessels at the point at which the feeder artery and vein enter the fat and divide.
And to add accuracy to the parameters used in the equations, the researchers agree that animal studies of tissue transfer are needed to make the model more reliable.
Imaging technology is also expected to factor into the future of reconstructive surgery. Surgeons currently use three-dimensional CT scans to image a potential flap and the perforator vessels that are feeding that flap. But the imaging available to date can't display the entire vasculature of a flap.
Friedman said he and colleagues hope to provide surgeons with software that could be combined with advanced imaging to supply more reliable information about the likely survival of a tissue flap.
"The surgeon will take an image of a flap that will give an idea of the distribution of vessels. Then the surgeon will use the software to determine that with this given vasculature, a specific size of tissue can be cut," Friedman said.
Miller, a specialist in breast reconstruction, said the abdomen is a common source for tissue to be transferred because it contains a lot of tissue in a location that allows the resulting scar to be hidden by clothing.
"But theoretically, we can make flaps from anywhere on the body," he said. "The whole body is divided up on this vascular tree. So if you can isolate a flap of tissue on a blood supply, you can remove it and reattach it."
This research was supported by the National Science Foundation.
Co-authors of the work are Anastasios Matzavinos of Iowa State University's Department of Mathematics, a former visiting faculty member at Ohio State; Chiu-Yen Kao of Ohio State's Mathematical Biosciences Institute (MBI) and Department of Mathematics; J. Edward Green, a postdoctoral fellow in the MBI; and Alok Sutradhar, a postdoctoral fellow in plastic surgery.
In the world's first published mathematical model of tissue transfer, mathematicians have shown that they can use differential equations to determine which tissue segments selected for transfer from one part of the body to another location on the same body will receive the level of oxygen required to sustain the tissue.
The most common tissue transfers are used to restore body parts destroyed by cancer and trauma. The researchers say reliable mathematical modeling of the blood supply and oxygen in tissue segments will not only reduce failures in reconstructive surgery, but will also improve understanding of conditions in which an adequate blood supply is a basic problem, such as heart disease, cancer and stroke.
To obtain tissue for reconstructive surgery, plastic surgeons cut away a segment of tissue, called a flap, that is fed by a single set of perforator vessels an artery and vein that travel through underlying muscle to support skin and fat. Surgeons generally agree that vessels at least 1.5 millimeters in diameter are required to sustain oxygen flow within the flap intended for transfer.
"That guideline is based upon experience, trial and error. What we need is a more precise ability to determine what the necessary blood vessel size really is," said Michael Miller, professor of surgery and director of the division of plastic surgery at Ohio State University and a senior author of the research.
"I'm convinced that there is a relationship that's probably very predictive between the diameter and blood flow in the vessel and the ability of the piece of the tissue we're transferring to survive based on that."
Mathematicians working on the problem have set out to model that relationship. They have shown that under certain relationships between the size of the tissue flap and the diameter of the perforator vessel, the oxygen level in the flap will remain above 15 percent of the normal level, thus ensuring a successful flap transfer. If this relationship is not satisfied, the most distant tissue from the vessel will start to die something already observed by clinicians.
"This is still just a concept. But this initial system of five differential equations gives us a range between the flap size and the required diameter of the supporting artery that would ensure survival," said Avner Friedman, a senior author of the paper and a Distinguished University Professor at Ohio State.
The research appears this week in the online early edition of the Proceedings of the National Academy of Sciences.
The routine use of a patient's own tissue from the lower abdominal wall to restore deformities on the chest dates to 1982. In the early days of full removal and transfer of tissue, surgeons took muscle along with skin and fat, resulting in loss of strength where the muscle was removed.
"As time has gone on, we have learned that we don't have to take the muscle, but we can take a single blood vessel coming through the muscle and transfer the tissue on that vessel," Miller explained. "What we're finding is that the more we design flaps like this, the less reliable the tissue is becoming. The motivation to try to reduce injury to muscle is leading to an increase in problems with part of the flap failing because it doesn't have enough blood."
Miller asked Friedman, founding director of Ohio State's Mathematical Biosciences Institute, to work on a model that could add more predictability to tissue transfer.
To create the initial model, Friedman and colleagues needed to determine a number of values: the level of oxygen in the tissue, which comes from tiny capillaries spaced just microns apart; the rate of exchange of oxygen from vessels to tissue; and the pressure under which the blood is flowing in those vessels.
"The fact that there are thousands of capillaries makes it difficult to compute the oxygen levels, so we found a method of averaging. We average the oxygen concentration in the capillaries, think of capillaries as being uniformly spread all over, and look at the transport of oxygen from vessels into tissue," Friedman said.
The model's outcomes exploited clinical observations, in that if the oxygen pressure fell below 15 percent during the few days following the tissue transfer, fat tissue on the outer edges of the flap would start to die. When that happens on actual surgical cases, doctors must replace the dead tissue, and sometimes have to redo the entire operation.
More work lies ahead to make the model truly useful in a surgical setting, Miller and Friedman agreed.
In live human tissue, the pattern of blood vessels and capillaries is not uniformly spread throughout the flap. In many cases, there is a gap in the presence of branching vessels at the point at which the feeder artery and vein enter the fat and divide.
And to add accuracy to the parameters used in the equations, the researchers agree that animal studies of tissue transfer are needed to make the model more reliable.
Imaging technology is also expected to factor into the future of reconstructive surgery. Surgeons currently use three-dimensional CT scans to image a potential flap and the perforator vessels that are feeding that flap. But the imaging available to date can't display the entire vasculature of a flap.
Friedman said he and colleagues hope to provide surgeons with software that could be combined with advanced imaging to supply more reliable information about the likely survival of a tissue flap.
"The surgeon will take an image of a flap that will give an idea of the distribution of vessels. Then the surgeon will use the software to determine that with this given vasculature, a specific size of tissue can be cut," Friedman said.
Miller, a specialist in breast reconstruction, said the abdomen is a common source for tissue to be transferred because it contains a lot of tissue in a location that allows the resulting scar to be hidden by clothing.
"But theoretically, we can make flaps from anywhere on the body," he said. "The whole body is divided up on this vascular tree. So if you can isolate a flap of tissue on a blood supply, you can remove it and reattach it."
This research was supported by the National Science Foundation.
Co-authors of the work are Anastasios Matzavinos of Iowa State University's Department of Mathematics, a former visiting faculty member at Ohio State; Chiu-Yen Kao of Ohio State's Mathematical Biosciences Institute (MBI) and Department of Mathematics; J. Edward Green, a postdoctoral fellow in the MBI; and Alok Sutradhar, a postdoctoral fellow in plastic surgery.
Predicting Penile Length After Penile Prosthesis Implantation
UroToday - Dissatisfaction with penile prosthesis implantation is multifactorial. Patients commonly report penile shortening as a major issue; it may be perceived or real. Candidates for penile prosthesis commonly have chronic and advanced ED and therefore are predisposed or already have penile shortening. To reduce dissatisfaction with the procedure and medical/legal liability, proper preoperative counseling is invaluable.
Drs. Montague and Angermeier recently studied the utility of preoperative stretched penile length (SPL) as a predictor of post-implant functional length. Forty-nine patients received either an AMS 700 CX or CXM, or AMS 700 Ultrex depending on the presence or absence of fibrosis (tunica or corporal smooth muscle), respectively. Preoperative stretch, post-operative inflated and deflated lengths were compared.
In the fibrosis patients who received the AMS 700 CX/M, preoperative SPL was predictive in 38% and within 1-cm in 88%. In the non-fibrotic group who received the girth and length expanders (AMS Ultrex), preoperative SPL was predictive in 27% and within 1-cm in 70%. Moreover, with the expanders inflated, the Ultrex group reported penile lengthening of at least 1-cm and up to 3-cm in 15% of patients.
The authors concluded that preoperative SPL was useful for counseling patients on expected penile lengths post-implant. Those patients without fibrosis who undergo the AMS Ultrex implant should expect to gain anywhere from 1 to 3-cm of additional length. Girth was not measured.
By Raymond Pak, MD
Reference:
J Sex Med 2006; 3(Suppl 1) Abstract 102.
Montague DK, Angermeier KW.
Editorial Comments:
Those of us who treat male sexual dysfunction on a regular basis know that complaints about penile length are ubiquitous: patients with ED and no prior surgery complain the penis is shrinking; patients following successful implant complain the penis shorter; patients having successful surgical correction of Peyronie's curvature with grafting complain the penis is shorter; patients having prostatectomy complain the penis is shorter. There have been numerous studies over the years that have attempted to verify these complaints and isolate their specific pathologies.
Dr. Montague has documented a very practical resource for the implanting surgeon. This work suggests that stretched preoperative penile length is a good indicator of penile cylinder size. Furthermore, this simple 'visual aide' may serve as a useful adjunct to informed consent. Patient satisfaction and expectation are strongly linked in penile prosthetic surgery.
UroToday - the only urology website with original content written by global urology key opinion leaders actively engaged in clinical practice.
To access the latest urology news releases from UroToday, go to:
urotoday
Copyright © 2006 - UroToday
Drs. Montague and Angermeier recently studied the utility of preoperative stretched penile length (SPL) as a predictor of post-implant functional length. Forty-nine patients received either an AMS 700 CX or CXM, or AMS 700 Ultrex depending on the presence or absence of fibrosis (tunica or corporal smooth muscle), respectively. Preoperative stretch, post-operative inflated and deflated lengths were compared.
In the fibrosis patients who received the AMS 700 CX/M, preoperative SPL was predictive in 38% and within 1-cm in 88%. In the non-fibrotic group who received the girth and length expanders (AMS Ultrex), preoperative SPL was predictive in 27% and within 1-cm in 70%. Moreover, with the expanders inflated, the Ultrex group reported penile lengthening of at least 1-cm and up to 3-cm in 15% of patients.
The authors concluded that preoperative SPL was useful for counseling patients on expected penile lengths post-implant. Those patients without fibrosis who undergo the AMS Ultrex implant should expect to gain anywhere from 1 to 3-cm of additional length. Girth was not measured.
By Raymond Pak, MD
Reference:
J Sex Med 2006; 3(Suppl 1) Abstract 102.
Montague DK, Angermeier KW.
Editorial Comments:
Those of us who treat male sexual dysfunction on a regular basis know that complaints about penile length are ubiquitous: patients with ED and no prior surgery complain the penis is shrinking; patients following successful implant complain the penis shorter; patients having successful surgical correction of Peyronie's curvature with grafting complain the penis is shorter; patients having prostatectomy complain the penis is shorter. There have been numerous studies over the years that have attempted to verify these complaints and isolate their specific pathologies.
Dr. Montague has documented a very practical resource for the implanting surgeon. This work suggests that stretched preoperative penile length is a good indicator of penile cylinder size. Furthermore, this simple 'visual aide' may serve as a useful adjunct to informed consent. Patient satisfaction and expectation are strongly linked in penile prosthetic surgery.
UroToday - the only urology website with original content written by global urology key opinion leaders actively engaged in clinical practice.
To access the latest urology news releases from UroToday, go to:
urotoday
Copyright © 2006 - UroToday
Cleveland Clinic Surgeons Perform Nation's First Near-Total Face Transplant
A multi-disciplinary team of doctors and surgeons at Cleveland Clinic recently performed the first near-total face transplant in the United States.
In a 22-hour procedure performed within the past two weeks, surgeons transplanted 80 percent of a woman's face who suffered severe facial trauma -- essentially replacing her entire face, except for her upper eyelids, forehead, lower lip and chin. For the privacy and protection of those involved, no information will be released on the patient, the donor or their families. (A written statement from the patient's sibling is available at clevelandclinic/face)
This is the largest and most complex face transplant in the world, integrating different functional components such as nose and lower eyelids, as well as different tissue types including, skin, muscles, bony structures, arteries, veins and nerves.
"This work demonstrates the Cleveland Clinic's commitment to improving the lives of patients through innovation," said Delos M. "Toby" Cosgrove, M.D., President and CEO, Cleveland Clinic. "By advancing scientific research in microsurgery and transplantation, Cleveland Clinic is setting new standards of care. I'm extremely proud of the team who worked tirelessly to make a difference in this patient's life."
The transplant team was led by Maria Siemionow, M.D., Ph.D., Director of Plastic Surgery Research and Head of Microsurgery Training, who received worldwide attention in November 2004 when the Clinic's Institutional Review Board (IRB) announced that face transplantation is both ethical and possible by approving the first protocol for the surgery. Siemionow, a highly regarded scientist, has dedicated her professional life to researching and developing the methods doctors could use to substantially help patients with severe facial disfiguration.
"As a physician, one of the most rewarding things we can do is to restore the quality of life to a patient," said Siemionow (pronounced "SEMM-ih-nof"). "Patients with facial disfigurement have very difficult challenges in society. We hope that one day we may be able to help the tens of thousands of patients who are quietly suffering."
Frank A. Papay, M.D., Chairman of the Dermatology and Plastic Surgery Institute, said the surgery was made possible because of the multi-disciplinary team involved. "This work started with a medical team that had an extraordinary vision for what could be possible for patients who have suffered severe trauma to their faces. Cleveland Clinic's team has worked together to take that vision and make it a reality," Papay said. "In the end, we're all here for our patients to make their lives better."
Cleveland Clinic Dermatology and Plastic Surgery Institute led the face transplant surgery, partnering with the Cleveland Clinic Head & Neck Institute. Staff members from psychology/psychiatry, bioethics, social work, anesthesia, transplant, nursing, infectious disease, dentistry, ophthalmology, pharmacy, environmental services and security were also significantly involved.
The team included:
-- Maria Siemionow, M.D., Ph.D., Director of Plastic Surgery Research; Head of Microsurgery Training
-- Frank A. Papay, M.D., Chairman of the Dermatology and Plastic Surgery Institute
-- Daniel S. Alam, M.D., Facial Plastic Surgeon
-- Risal Djohan, M.D., Plastic Surgeon
-- Steven L. Bernard, M.D., Plastic Surgeon
-- Mark Hendrickson, M.D., Head of Hand Surgery
-- Robert F. Lohman, M.D., Plastic Surgeon
-- John J. Fung, M.D., Ph.D., Chairman of the Department of General Surgery; Director of the Transplant Center
-- Bijan Eghtesad, M.D., Staff Surgeon in the Departments of General Surgery and Transplantation
-- Chad Gordon, D.O., Fellow in the Department of Plastic Surgery
For information about the doctors' industry relationships, go to the Cleveland Clinic Web site and click on Find A Doctor to review each doctor's profile.
Press kits are available online at clevelandclinic/face.
About Cleveland Clinic
Cleveland Clinic, located in Cleveland, Ohio, is a not-for-profit multispecialty academic medical center that integrates clinical and hospital care with research and education. Cleveland Clinic was founded in 1921 by four renowned physicians with a vision of providing outstanding patient care based upon the principles of cooperation, compassion and innovation. U.S. News & World Report consistently names Cleveland Clinic as one of the nation's best hospitals in its annual "America's Best Hospitals" survey. Approximately 1,800 full-time salaried physicians and researchers at Cleveland Clinic and Cleveland Clinic Florida represent more than 100 medical specialties and subspecialties. In 2007, there were 3.5 million outpatient visits to Cleveland Clinic and 50,455 hospital admissions. Patients came for treatment from every state and from more than 80 countries. Cleveland Clinic's Web site address is clevelandclinic.
Cleveland Clinic
clevelandclinic
In a 22-hour procedure performed within the past two weeks, surgeons transplanted 80 percent of a woman's face who suffered severe facial trauma -- essentially replacing her entire face, except for her upper eyelids, forehead, lower lip and chin. For the privacy and protection of those involved, no information will be released on the patient, the donor or their families. (A written statement from the patient's sibling is available at clevelandclinic/face)
This is the largest and most complex face transplant in the world, integrating different functional components such as nose and lower eyelids, as well as different tissue types including, skin, muscles, bony structures, arteries, veins and nerves.
"This work demonstrates the Cleveland Clinic's commitment to improving the lives of patients through innovation," said Delos M. "Toby" Cosgrove, M.D., President and CEO, Cleveland Clinic. "By advancing scientific research in microsurgery and transplantation, Cleveland Clinic is setting new standards of care. I'm extremely proud of the team who worked tirelessly to make a difference in this patient's life."
The transplant team was led by Maria Siemionow, M.D., Ph.D., Director of Plastic Surgery Research and Head of Microsurgery Training, who received worldwide attention in November 2004 when the Clinic's Institutional Review Board (IRB) announced that face transplantation is both ethical and possible by approving the first protocol for the surgery. Siemionow, a highly regarded scientist, has dedicated her professional life to researching and developing the methods doctors could use to substantially help patients with severe facial disfiguration.
"As a physician, one of the most rewarding things we can do is to restore the quality of life to a patient," said Siemionow (pronounced "SEMM-ih-nof"). "Patients with facial disfigurement have very difficult challenges in society. We hope that one day we may be able to help the tens of thousands of patients who are quietly suffering."
Frank A. Papay, M.D., Chairman of the Dermatology and Plastic Surgery Institute, said the surgery was made possible because of the multi-disciplinary team involved. "This work started with a medical team that had an extraordinary vision for what could be possible for patients who have suffered severe trauma to their faces. Cleveland Clinic's team has worked together to take that vision and make it a reality," Papay said. "In the end, we're all here for our patients to make their lives better."
Cleveland Clinic Dermatology and Plastic Surgery Institute led the face transplant surgery, partnering with the Cleveland Clinic Head & Neck Institute. Staff members from psychology/psychiatry, bioethics, social work, anesthesia, transplant, nursing, infectious disease, dentistry, ophthalmology, pharmacy, environmental services and security were also significantly involved.
The team included:
-- Maria Siemionow, M.D., Ph.D., Director of Plastic Surgery Research; Head of Microsurgery Training
-- Frank A. Papay, M.D., Chairman of the Dermatology and Plastic Surgery Institute
-- Daniel S. Alam, M.D., Facial Plastic Surgeon
-- Risal Djohan, M.D., Plastic Surgeon
-- Steven L. Bernard, M.D., Plastic Surgeon
-- Mark Hendrickson, M.D., Head of Hand Surgery
-- Robert F. Lohman, M.D., Plastic Surgeon
-- John J. Fung, M.D., Ph.D., Chairman of the Department of General Surgery; Director of the Transplant Center
-- Bijan Eghtesad, M.D., Staff Surgeon in the Departments of General Surgery and Transplantation
-- Chad Gordon, D.O., Fellow in the Department of Plastic Surgery
For information about the doctors' industry relationships, go to the Cleveland Clinic Web site and click on Find A Doctor to review each doctor's profile.
Press kits are available online at clevelandclinic/face.
About Cleveland Clinic
Cleveland Clinic, located in Cleveland, Ohio, is a not-for-profit multispecialty academic medical center that integrates clinical and hospital care with research and education. Cleveland Clinic was founded in 1921 by four renowned physicians with a vision of providing outstanding patient care based upon the principles of cooperation, compassion and innovation. U.S. News & World Report consistently names Cleveland Clinic as one of the nation's best hospitals in its annual "America's Best Hospitals" survey. Approximately 1,800 full-time salaried physicians and researchers at Cleveland Clinic and Cleveland Clinic Florida represent more than 100 medical specialties and subspecialties. In 2007, there were 3.5 million outpatient visits to Cleveland Clinic and 50,455 hospital admissions. Patients came for treatment from every state and from more than 80 countries. Cleveland Clinic's Web site address is clevelandclinic.
Cleveland Clinic
clevelandclinic
Silicone Injections For Cosmetic Use
Background:
In 1991, the Food and Drug Administration (FDA) issued guidelines prohibiting the marketing of injectable liquid silicone for any cosmetic purpose. The FDA has since approved monitored clinical studies investigating the safety and efficacy of injectable silicone, but none has been completed as yet. Long-term follow-up will be key to evaluating any studies. In the meantime, some practitioners continue to purchase liquid silicone intended for the treatment of retinal detachment and inject it for aesthetic improvements. It is the position of the American Society for Aesthetic Plastic Surgery (ASAPS) that the safety of the use of liquid injectable silicone for cosmetic purposes is controversial, and that it should not be used outside legitimately approved clinical trials.
Reported Benefits:
Clinical investigation of liquid silicone injection for the correction of facial deformities took place from 1978 to 1988 under FDA-approved and monitored protocols. For many of these deformities, liquid silicone represented the only hope for treatment at that time. According to investigators, liquid silicone injections resulted in substantial improvements of the deformities with some complications. Good results have also been reported with the use of liquid injectable silicone for cosmetic purposes, such as correction of wrinkles, creases and scars. Unlike collagen or fat, liquid silicone does not need to be repeatedly injected to achieve the desired effect.
Other Considerations:
Once injected, liquid silicone cannot be altered or removed. Many reports of complications have been published, including severe complications from liquid silicone used for breast enlargement as long ago as the 1950s. Almost all of the problems noted were never seen by the injecting physician and tended to occur years after injection. Among the complications cited were:
- Movement of silicone to other parts of the body
- Inflammation and discoloration of surrounding tissue
- Formation of masses of chronically inflamed tissue
In addition, liquid silicone comes in different grades:
- Industrial: developed only for non-medical uses
- Medical grade: A silicone product has recently been approved by the FDA specifically for ophthalmic use in the treatment of retinal detachment. Although this product which generated most of the problems seen through the years, any cosmetic use would be "off label," and the same potential risks noted above would still be of concern.
ASAPS Position:
The safety of the injection of liquid silicone for cosmetic purposes remains highly controversial. Many other effective alternative treatments for wrinkles or acne scars are available and may be discussed with an aesthetic plastic surgeon certified by the American Board of Plastic Surgery. Liquid silicone from any source should never be injected into the breasts.
This document was updated from October, 2001.
The 2400-member American Society for Aesthetic Plastic Surgery (ASAPS) is the only plastic surgery organization devoted entirely to the advancement of cosmetic surgery. ASAPS is recognized throughout the world as the authoritative source for cosmetic surgery education. U.S. members are certified by the American Board of Plastic Surgery. Canadian members are certified in plastic surgery by the Royal College of Physicians and Surgeons of Canada.
American Society for Aesthetic Plastic Surgery
In 1991, the Food and Drug Administration (FDA) issued guidelines prohibiting the marketing of injectable liquid silicone for any cosmetic purpose. The FDA has since approved monitored clinical studies investigating the safety and efficacy of injectable silicone, but none has been completed as yet. Long-term follow-up will be key to evaluating any studies. In the meantime, some practitioners continue to purchase liquid silicone intended for the treatment of retinal detachment and inject it for aesthetic improvements. It is the position of the American Society for Aesthetic Plastic Surgery (ASAPS) that the safety of the use of liquid injectable silicone for cosmetic purposes is controversial, and that it should not be used outside legitimately approved clinical trials.
Reported Benefits:
Clinical investigation of liquid silicone injection for the correction of facial deformities took place from 1978 to 1988 under FDA-approved and monitored protocols. For many of these deformities, liquid silicone represented the only hope for treatment at that time. According to investigators, liquid silicone injections resulted in substantial improvements of the deformities with some complications. Good results have also been reported with the use of liquid injectable silicone for cosmetic purposes, such as correction of wrinkles, creases and scars. Unlike collagen or fat, liquid silicone does not need to be repeatedly injected to achieve the desired effect.
Other Considerations:
Once injected, liquid silicone cannot be altered or removed. Many reports of complications have been published, including severe complications from liquid silicone used for breast enlargement as long ago as the 1950s. Almost all of the problems noted were never seen by the injecting physician and tended to occur years after injection. Among the complications cited were:
- Movement of silicone to other parts of the body
- Inflammation and discoloration of surrounding tissue
- Formation of masses of chronically inflamed tissue
In addition, liquid silicone comes in different grades:
- Industrial: developed only for non-medical uses
- Medical grade: A silicone product has recently been approved by the FDA specifically for ophthalmic use in the treatment of retinal detachment. Although this product which generated most of the problems seen through the years, any cosmetic use would be "off label," and the same potential risks noted above would still be of concern.
ASAPS Position:
The safety of the injection of liquid silicone for cosmetic purposes remains highly controversial. Many other effective alternative treatments for wrinkles or acne scars are available and may be discussed with an aesthetic plastic surgeon certified by the American Board of Plastic Surgery. Liquid silicone from any source should never be injected into the breasts.
This document was updated from October, 2001.
The 2400-member American Society for Aesthetic Plastic Surgery (ASAPS) is the only plastic surgery organization devoted entirely to the advancement of cosmetic surgery. ASAPS is recognized throughout the world as the authoritative source for cosmetic surgery education. U.S. members are certified by the American Board of Plastic Surgery. Canadian members are certified in plastic surgery by the Royal College of Physicians and Surgeons of Canada.
American Society for Aesthetic Plastic Surgery
FDA Requires Boxed Warning For All Botulinum Toxin Products
Prompted by reports of serious adverse events, the U.S. Food and Drug Administration announced that safety label changes, including a boxed warning, and a Risk Evaluation and Mitigation Strategy (REMS), are necessary for all botulinum toxin products.
The agency said it took the action because of reports that the effects of the botulinum toxin may spread from the area of injection to other areas of the body, causing symptoms similar to those of botulism, including unexpected loss of strength or muscle weakness, hoarseness or trouble talking, trouble saying words clearly, loss of bladder control, trouble breathing, trouble swallowing, double vision, blurred vision and drooping eyelids.
These symptoms have mostly been reported in children with cerebral palsy being treated with the products for muscle spasticity, an unapproved use of the drugs. Symptoms have also been reported in adults treated both for approved and unapproved uses.
The agency also took the action because of the potential for serious risks associated with the lack of interchangeability among the three licensed botulinum toxin products.
"Updated labels for this class of products will help health care professionals and patients better understand the risks and benefits," said Russell Katz, M.D., director of the Division of Neurology Products in the FDA's Center for Drug Evaluation and Research. "Botulinum toxin products have benefits but can cause serious health problems and it is important that anyone who administers or uses these products understands these risks."
Product Names
The products required to add the new label and a REMS are Botox and Botox Cosmetic (botulinum toxin type A), marketed by Allergan; Myobloc (botulinum toxin type B), marketed by Solstice Neurosciences; and a new FDA-approved product, Dysport (abobotulinumtoxinA), marketed by Ipsen Biopharm Ltd.
Botox, Myobloc, and Dysport are approved by the FDA for the treatment of a condition marked by repetitive contraction of the neck muscles (cervical dystonia). Botox Cosmetic and Dysport are approved by the FDA for dermatologic use in the temporary improvement in the appearance of frown lines between the eyebrows called glabellar lines. In addition, Botox is approved for the treatment of severe underarm sweating (primary axillary hyperhidrosis), crossed eyes (strabismus), and abnormal tics and twitches of the eyelids (blepharospasm).
Recommendations for Health Care Professionals
The FDA has notified the manufacturers of Botox and Myobloc that label changes and a REMS are necessary to ensure that the benefits of the product outweigh the risks. The FDA approved a REMS for Dysport as part of the product approval. The REMS for each of these products will include a Medication Guide and a Communication Plan. Medication Guides are FDA-approved handouts given to patients, or their families and caregivers, when a medicine is dispensed. The Medication Guides will contain information about the risks associated with botulinum toxin products. The FDA is also requiring the manufacturers to collect safety data in children and adults with muscle spasticity to assess the signal of risk regarding distant spread of toxin effects.
Treatment of muscle spasticity is not an FDA-approved use of botulism toxin products. The doses used in treatment of muscle spasticity are often much higher than the doses for uses described in FDA-approved product label. Symptoms consistent with spread of toxin effects have been reported at doses comparable to or lower than doses used to treat cervical dystonia. For the FDA-approved dermatologic use of temporary improvement in the appearance of glabellar lines, the agency has not identified any definitive serious adverse event reports of a distant spread of toxin effect producing symptoms consistent with botulism when the botulinum toxin products are used in accordance with the approved label.
The companies that make Botox and Myobloc are required to submit the requested safety label changes, including the boxed warning and the Medication Guide, to the FDA within 30 days, or to provide a reason why they do not believe such changes are necessary. If they do not submit new language, or the FDA disagrees with the language the companies propose, the Food, Drug, and Cosmetic Act provides strict timelines for discussions regarding the changes. At the end of these discussions the agency is allowed to issue an order directing the label change as deemed appropriate to address the new safety information.
Health care professionals who use botulinum toxins should do the following:
- Understand that dosage strength (potency) expressed in "Units" is different among the botulinum toxin products; clinical doses expressed in units are not interchangeable from one product to another.
- Be alert to and educate patients and caregivers about the potential for effects following administration of botulinum toxins such as: unexpected loss of strength or muscle weakness, hoarseness or trouble talking, trouble saying words clearly, loss of bladder control, trouble breathing, trouble swallowing, double vision, blurred vision and drooping eyelids.
- Understand that these effects have been reported as early as several hours and as late as several weeks after treatment.
- Advise patients to seek immediate medical attention if they develop any of these symptoms.
Health care professionals and consumers may report serious adverse events (side effects) or product quality problems with the use of this product to the FDA's MedWatch Adverse Event Reporting program either online, by regular mail, fax or phone.
--Online: fda/MedWatch/report.htm
--Regular Mail: use postage-paid FDA form 3500 available at: fda/MedWatch/getforms.htm and mail to MedWatch, 5600 Fishers Lane, Rockville, MD 20852-9787
--Fax: 800-FDA-0178
--Phone: 800-FDA-1088
Today's action updates a February 2008 announcement that the FDA was conducting an ongoing safety review of botulinum toxin products. That announcement can be found here.
The FDA also issued a response to a citizen petition related to the risk of spread of botulinum toxin effects from the site of injection. This response provides additional detail regarding the FDA's analysis of this safety issue. The FDA's response to the Citizen Petition can be found here.
Source
U.S. Food and Drug Administration
View drug information on Botox; Myobloc.
The agency said it took the action because of reports that the effects of the botulinum toxin may spread from the area of injection to other areas of the body, causing symptoms similar to those of botulism, including unexpected loss of strength or muscle weakness, hoarseness or trouble talking, trouble saying words clearly, loss of bladder control, trouble breathing, trouble swallowing, double vision, blurred vision and drooping eyelids.
These symptoms have mostly been reported in children with cerebral palsy being treated with the products for muscle spasticity, an unapproved use of the drugs. Symptoms have also been reported in adults treated both for approved and unapproved uses.
The agency also took the action because of the potential for serious risks associated with the lack of interchangeability among the three licensed botulinum toxin products.
"Updated labels for this class of products will help health care professionals and patients better understand the risks and benefits," said Russell Katz, M.D., director of the Division of Neurology Products in the FDA's Center for Drug Evaluation and Research. "Botulinum toxin products have benefits but can cause serious health problems and it is important that anyone who administers or uses these products understands these risks."
Product Names
The products required to add the new label and a REMS are Botox and Botox Cosmetic (botulinum toxin type A), marketed by Allergan; Myobloc (botulinum toxin type B), marketed by Solstice Neurosciences; and a new FDA-approved product, Dysport (abobotulinumtoxinA), marketed by Ipsen Biopharm Ltd.
Botox, Myobloc, and Dysport are approved by the FDA for the treatment of a condition marked by repetitive contraction of the neck muscles (cervical dystonia). Botox Cosmetic and Dysport are approved by the FDA for dermatologic use in the temporary improvement in the appearance of frown lines between the eyebrows called glabellar lines. In addition, Botox is approved for the treatment of severe underarm sweating (primary axillary hyperhidrosis), crossed eyes (strabismus), and abnormal tics and twitches of the eyelids (blepharospasm).
Recommendations for Health Care Professionals
The FDA has notified the manufacturers of Botox and Myobloc that label changes and a REMS are necessary to ensure that the benefits of the product outweigh the risks. The FDA approved a REMS for Dysport as part of the product approval. The REMS for each of these products will include a Medication Guide and a Communication Plan. Medication Guides are FDA-approved handouts given to patients, or their families and caregivers, when a medicine is dispensed. The Medication Guides will contain information about the risks associated with botulinum toxin products. The FDA is also requiring the manufacturers to collect safety data in children and adults with muscle spasticity to assess the signal of risk regarding distant spread of toxin effects.
Treatment of muscle spasticity is not an FDA-approved use of botulism toxin products. The doses used in treatment of muscle spasticity are often much higher than the doses for uses described in FDA-approved product label. Symptoms consistent with spread of toxin effects have been reported at doses comparable to or lower than doses used to treat cervical dystonia. For the FDA-approved dermatologic use of temporary improvement in the appearance of glabellar lines, the agency has not identified any definitive serious adverse event reports of a distant spread of toxin effect producing symptoms consistent with botulism when the botulinum toxin products are used in accordance with the approved label.
The companies that make Botox and Myobloc are required to submit the requested safety label changes, including the boxed warning and the Medication Guide, to the FDA within 30 days, or to provide a reason why they do not believe such changes are necessary. If they do not submit new language, or the FDA disagrees with the language the companies propose, the Food, Drug, and Cosmetic Act provides strict timelines for discussions regarding the changes. At the end of these discussions the agency is allowed to issue an order directing the label change as deemed appropriate to address the new safety information.
Health care professionals who use botulinum toxins should do the following:
- Understand that dosage strength (potency) expressed in "Units" is different among the botulinum toxin products; clinical doses expressed in units are not interchangeable from one product to another.
- Be alert to and educate patients and caregivers about the potential for effects following administration of botulinum toxins such as: unexpected loss of strength or muscle weakness, hoarseness or trouble talking, trouble saying words clearly, loss of bladder control, trouble breathing, trouble swallowing, double vision, blurred vision and drooping eyelids.
- Understand that these effects have been reported as early as several hours and as late as several weeks after treatment.
- Advise patients to seek immediate medical attention if they develop any of these symptoms.
Health care professionals and consumers may report serious adverse events (side effects) or product quality problems with the use of this product to the FDA's MedWatch Adverse Event Reporting program either online, by regular mail, fax or phone.
--Online: fda/MedWatch/report.htm
--Regular Mail: use postage-paid FDA form 3500 available at: fda/MedWatch/getforms.htm and mail to MedWatch, 5600 Fishers Lane, Rockville, MD 20852-9787
--Fax: 800-FDA-0178
--Phone: 800-FDA-1088
Today's action updates a February 2008 announcement that the FDA was conducting an ongoing safety review of botulinum toxin products. That announcement can be found here.
The FDA also issued a response to a citizen petition related to the risk of spread of botulinum toxin effects from the site of injection. This response provides additional detail regarding the FDA's analysis of this safety issue. The FDA's response to the Citizen Petition can be found here.
Source
U.S. Food and Drug Administration
View drug information on Botox; Myobloc.
The Psychology Behind Cosmetic Surgery Decisions
Considering cosmetic surgery? An increasing number of women are opting for cosmetic surgery. In fact, in just 10 years' time, cosmetic surgery increased by more than 700 percent.
A tummy tuck here. An eyebrow lift there. For women with realistic expectations, cosmetic surgery can enhance body satisfaction, says the July issue of Mayo Clinic Women's HealthSource. The key word is realistic. Women who are happy with their overall appearance but who seek cosmetic surgery to alter just one aspect of their body often find that cosmetic surgery meets their physical and emotional needs.
Body image dissatisfaction is often associated with decreased self-esteem, self-confidence and psychological well-being. These emotional and psychological issues cause some women to turn to cosmetic surgery. If women feel they need a new face, a thinner waistline or bigger breasts to be likable and to feel good about themselves, cosmetic surgery may not be the answer. In fact, some studies show that extensive cosmetic surgery may make psychological issues worse.
Before surgery, consider the emotional and psychological reasons for wanting cosmetic surgery and talk with your cosmetic surgery team to make sure it's right for you.
This is a highlight from the July issue of Mayo Clinic Women's HealthSource. You may cite this publication as often as you wish. Mayo Clinic Women's HealthSource attribution is required. Also, you may reprint up to four articles annually without cost. More frequent reprinting is allowed for a fee. Include the following subscription information as your editorial policies permit: Call toll free for subscription information, 800-876-8633, extension 9PK1.
Mayo Clinic Women's HealthSource is published monthly to help women enjoy healthier, more productive lives. Revenue from subscriptions is used to support medical research at Mayo Clinic. To subscribe, please call 800-876-8633, extension 9PK1.
Mayo Clinic
200 First St. SW
Rochester, MN 55902
United States
mayo/news
A tummy tuck here. An eyebrow lift there. For women with realistic expectations, cosmetic surgery can enhance body satisfaction, says the July issue of Mayo Clinic Women's HealthSource. The key word is realistic. Women who are happy with their overall appearance but who seek cosmetic surgery to alter just one aspect of their body often find that cosmetic surgery meets their physical and emotional needs.
Body image dissatisfaction is often associated with decreased self-esteem, self-confidence and psychological well-being. These emotional and psychological issues cause some women to turn to cosmetic surgery. If women feel they need a new face, a thinner waistline or bigger breasts to be likable and to feel good about themselves, cosmetic surgery may not be the answer. In fact, some studies show that extensive cosmetic surgery may make psychological issues worse.
Before surgery, consider the emotional and psychological reasons for wanting cosmetic surgery and talk with your cosmetic surgery team to make sure it's right for you.
This is a highlight from the July issue of Mayo Clinic Women's HealthSource. You may cite this publication as often as you wish. Mayo Clinic Women's HealthSource attribution is required. Also, you may reprint up to four articles annually without cost. More frequent reprinting is allowed for a fee. Include the following subscription information as your editorial policies permit: Call toll free for subscription information, 800-876-8633, extension 9PK1.
Mayo Clinic Women's HealthSource is published monthly to help women enjoy healthier, more productive lives. Revenue from subscriptions is used to support medical research at Mayo Clinic. To subscribe, please call 800-876-8633, extension 9PK1.
Mayo Clinic
200 First St. SW
Rochester, MN 55902
United States
mayo/news
Videoconferencing Can Help Surgeons Make Their Rounds From A Distance
Using robotic teleconferencing to monitor patients after urologic surgery appears to result in similar patient outcomes and satisfaction as traditional bedside rounds, according to a report in the December issue of Archives of Surgery, one of the JAMA/Archives journals.
"The defining image of inpatient care is that of the physician conducting bedside rounds," the authors write as background information in the article. "This bedside interaction has come to be a measure of physician compassion. The reality for elective surgical patients is that established critical pathways define postoperative care. To be sure, these require timely physician oversight, but the value of the bedside visit may be secondary to objective vital signs and laboratory data."
Lars M. Ellison, M.D., then of the University of California, Davis, Sacramento, and now at Penobscot Bay Medical Center, Rockport, Maine, and colleagues conducted a randomized controlled trial involving 270 adults. Participants were all undergoing a urologic procedure requiring a hospital stay of 24 to 72 hours. The patients were randomly assigned to receive either traditional bedside rounds (136 patients) or robotic telerounds (134 patients) daily during their time in the hospital. "The telerounding robot is a 60-inch-tall wheel-driven device," the authors write. "The robot consists of the motor base unit, a central processing unit, a high-definition digital camera, a flat-screen monitor and a microphone. Data to and from the robot is transferred over a high-speed wireless network and is integrated with proprietary software. The physician connects remotely to the robot via a base station."
Both types of visits followed a set script and included reviewing objective data, including vital signs and laboratory results, as well as a discussion regarding treatment goals for the day.
Telerounding did not appear to lengthen hospital stays-both groups stayed an average of 2.8 days-or increase the complication rate. Sixteen percent of the patients in the standard round group and 13 percent in the teleround group developed complications, similar to the expected rate of complications for these types of procedures (16 percent). There were no instances in which detection of complications appeared to be delayed by telerounding.
Patient satisfaction was equally high in both groups. Most of those who received telerounds rated the audio and video quality as very good or excellent, 86 percent believed they could communicate easily via the telerounding device and two-thirds agreed they would rather see their own physician remotely than another physician in person.
"Economic realities and staff shortages have placed increasing burdens on physicians' time," the authors write. "Telerounding with hospitalized patients has the ability to ease time constraints through elimination of travel time. Videoconferencing systems give physicians the potential to directly assess their own patient's situation. This is optimal compared with current practices where partners or other health care professionals with little previous patient knowledge are called on to make assessments based purely on pathways rather than firsthand operative events."
Archives of Surgery. 2007;142(12):1177-1181.
"The defining image of inpatient care is that of the physician conducting bedside rounds," the authors write as background information in the article. "This bedside interaction has come to be a measure of physician compassion. The reality for elective surgical patients is that established critical pathways define postoperative care. To be sure, these require timely physician oversight, but the value of the bedside visit may be secondary to objective vital signs and laboratory data."
Lars M. Ellison, M.D., then of the University of California, Davis, Sacramento, and now at Penobscot Bay Medical Center, Rockport, Maine, and colleagues conducted a randomized controlled trial involving 270 adults. Participants were all undergoing a urologic procedure requiring a hospital stay of 24 to 72 hours. The patients were randomly assigned to receive either traditional bedside rounds (136 patients) or robotic telerounds (134 patients) daily during their time in the hospital. "The telerounding robot is a 60-inch-tall wheel-driven device," the authors write. "The robot consists of the motor base unit, a central processing unit, a high-definition digital camera, a flat-screen monitor and a microphone. Data to and from the robot is transferred over a high-speed wireless network and is integrated with proprietary software. The physician connects remotely to the robot via a base station."
Both types of visits followed a set script and included reviewing objective data, including vital signs and laboratory results, as well as a discussion regarding treatment goals for the day.
Telerounding did not appear to lengthen hospital stays-both groups stayed an average of 2.8 days-or increase the complication rate. Sixteen percent of the patients in the standard round group and 13 percent in the teleround group developed complications, similar to the expected rate of complications for these types of procedures (16 percent). There were no instances in which detection of complications appeared to be delayed by telerounding.
Patient satisfaction was equally high in both groups. Most of those who received telerounds rated the audio and video quality as very good or excellent, 86 percent believed they could communicate easily via the telerounding device and two-thirds agreed they would rather see their own physician remotely than another physician in person.
"Economic realities and staff shortages have placed increasing burdens on physicians' time," the authors write. "Telerounding with hospitalized patients has the ability to ease time constraints through elimination of travel time. Videoconferencing systems give physicians the potential to directly assess their own patient's situation. This is optimal compared with current practices where partners or other health care professionals with little previous patient knowledge are called on to make assessments based purely on pathways rather than firsthand operative events."
Archives of Surgery. 2007;142(12):1177-1181.
Why Do Eyelids Sag With Age? Study Answers Mystery
Many theories have sought to explain what causes the baggy lower eyelids that come with aging, but UCLA researchers have now found that fat expansion in the eye socket is the primary culprit.
As a result, researchers say, fat excision should be a component of treatment for patients seeking to address this common complaint.
The study, published in the September issue of the peer-reviewed Journal of Plastic and Reconstructive Surgery, is the first to examine the anatomy of multiple subjects to determine what happens to the lower eyelid with age. It is also the first to measure what happens to the face with age using high-resolution magnetic resonance imaging (MRI).
"A common treatment performed in the past and present is surgical excision of fat to treat a 'herniation of fat' - meaning that the amount of fat in the eye socket does not change but the cover that holds the fat in place, the orbital septum, is weakened or broken and fat slips out," said lead author Dr. Sean Darcy, a research associate in the division of plastic and reconstructive surgery at the David Geffen School of Medicine at UCLA and a plastic surgery resident at the University of California, Irvine. "This orbital septum weakening or herniation-of-fat theory is what most plastic surgeons have been taught.
"However, our study showed there is actually an increase in fat with age, and it is more likely that the fat increase causes the baggy eyelids rather than a weakened ligament," Darcy said. "There have been no studies to show that the orbital septum weakens."
The study looked at MRIs of 40 subjects (17 males and 23 females) between the ages of 12 and 80. The findings showed that the lower eyelid tissue increased with age and that the largest contributor to this size increase was fat increase.
According to a recent report by the American Society of Plastic Surgeons, nearly 241,000 Americans underwent eyelid surgery in 2007, making it one of the top four surgical cosmetic procedures performed.
Currently, many plastic surgeons performing procedures to treat baggy eyelids do not remove any fat at all. They reposition the fat or conduct more invasive tightening of the muscle that surrounds the eye, or they tighten the actual ligament that holds the eyeball in place. These procedures are performed despite there being no data indicating that these structures change with age.
"Our findings may change the way some plastic surgeons treat baggy eyes," said study co-author Dr. Timothy Miller, professor and chief of plastic surgery at the Geffen School. "Our study showed that a component of a patient's blepharoplasty procedure should almost routinely involve fat excision rather than these procedures."
Blepharoplasty refers to surgical rejuvenation of the upper or lower eyelids, or both, depending on the extent of aging or disease. The procedure is usually performed on the lower eyelid because the most common complaint patients have is that their eyes appear tired, puffy or baggy. The surgeon makes external incisions along the natural skin lines of the eyelid to remove the excess fat and improve the contour of the lower eyelid.
"Although baggy lower eyelids are a significant result of aging and fat expansion, there are other factors that can contribute too," Miller said. "We recommend that surgeons evaluate each component and address them accordingly in an individualized approach to blepharoplasty."
The next phase of research will be to perform MRIs of people with baggy eyelids.
The study was supported in part by a UCLA research-enabling grant and a U.S. Public Health Service grant.
Other study authors included Dr. Robert A. Goldberg, Dr. J. Pablo Villablanca, Dr. Joseph L. Demer and senior author Dr. George H. Rudkin, all of UCLA. None of the authors have any commercial associations or financial relationships that would pose a conflict of interest.
For more information on the UCLA Cosmetic Surgery Center and the UCLA Division of Plastic and Reconstructive Surgery, visit uclaplasticsurgery.
UCLA Cosmetic Surgery Center
As a result, researchers say, fat excision should be a component of treatment for patients seeking to address this common complaint.
The study, published in the September issue of the peer-reviewed Journal of Plastic and Reconstructive Surgery, is the first to examine the anatomy of multiple subjects to determine what happens to the lower eyelid with age. It is also the first to measure what happens to the face with age using high-resolution magnetic resonance imaging (MRI).
"A common treatment performed in the past and present is surgical excision of fat to treat a 'herniation of fat' - meaning that the amount of fat in the eye socket does not change but the cover that holds the fat in place, the orbital septum, is weakened or broken and fat slips out," said lead author Dr. Sean Darcy, a research associate in the division of plastic and reconstructive surgery at the David Geffen School of Medicine at UCLA and a plastic surgery resident at the University of California, Irvine. "This orbital septum weakening or herniation-of-fat theory is what most plastic surgeons have been taught.
"However, our study showed there is actually an increase in fat with age, and it is more likely that the fat increase causes the baggy eyelids rather than a weakened ligament," Darcy said. "There have been no studies to show that the orbital septum weakens."
The study looked at MRIs of 40 subjects (17 males and 23 females) between the ages of 12 and 80. The findings showed that the lower eyelid tissue increased with age and that the largest contributor to this size increase was fat increase.
According to a recent report by the American Society of Plastic Surgeons, nearly 241,000 Americans underwent eyelid surgery in 2007, making it one of the top four surgical cosmetic procedures performed.
Currently, many plastic surgeons performing procedures to treat baggy eyelids do not remove any fat at all. They reposition the fat or conduct more invasive tightening of the muscle that surrounds the eye, or they tighten the actual ligament that holds the eyeball in place. These procedures are performed despite there being no data indicating that these structures change with age.
"Our findings may change the way some plastic surgeons treat baggy eyes," said study co-author Dr. Timothy Miller, professor and chief of plastic surgery at the Geffen School. "Our study showed that a component of a patient's blepharoplasty procedure should almost routinely involve fat excision rather than these procedures."
Blepharoplasty refers to surgical rejuvenation of the upper or lower eyelids, or both, depending on the extent of aging or disease. The procedure is usually performed on the lower eyelid because the most common complaint patients have is that their eyes appear tired, puffy or baggy. The surgeon makes external incisions along the natural skin lines of the eyelid to remove the excess fat and improve the contour of the lower eyelid.
"Although baggy lower eyelids are a significant result of aging and fat expansion, there are other factors that can contribute too," Miller said. "We recommend that surgeons evaluate each component and address them accordingly in an individualized approach to blepharoplasty."
The next phase of research will be to perform MRIs of people with baggy eyelids.
The study was supported in part by a UCLA research-enabling grant and a U.S. Public Health Service grant.
Other study authors included Dr. Robert A. Goldberg, Dr. J. Pablo Villablanca, Dr. Joseph L. Demer and senior author Dr. George H. Rudkin, all of UCLA. None of the authors have any commercial associations or financial relationships that would pose a conflict of interest.
For more information on the UCLA Cosmetic Surgery Center and the UCLA Division of Plastic and Reconstructive Surgery, visit uclaplasticsurgery.
UCLA Cosmetic Surgery Center
Special Plastic Surgery Needed For Soaring Number Of Formerly Obese Patients After Gastric By-Pass Surgery
The number of surgical
body-contouring procedures performed on post-bariatric surgery patients
after significant weight loss is soaring (up 22 percent from 2004 to 2005
alone) according to the American Society of Plastic Surgeons. An article in
the June, 2006, issue of Plastic Reconstructive Surgery by the leading
practitioner of these techniques describes in detail how improved mid-body
lift techniques trim away the massive amounts of excess skin in the
post-bariatric surgery population.
"The radical weight loss following gastric by-pass leads to improved
blood pressure, and in many patients improves or eliminates diabetes
symptoms," said Berish Strauch, MD, chairman of the Department of Plastic
and Reconstructive Surgery at Montefiore Medical Center, and author of the
paper. "Nevertheless, patients are left with a massive sagging of the
entire body that leads to severe medical and cosmetic deformities," said
Dr. Strauch, who now finds that 80 percent of his surgical practice
involves post-bariatric surgery patients. "It is truly gratifying to be
able to give these patients the body they have dreamed of having."
"A traditional abdominoplasty (tummy tuck) is insufficient for these
patients, who after this kind of extreme weight loss require a special
operation called a circumferential abdominoplasty, a type of complicated,
mid-body lift, which we have modified," said Dr. Strauch.
"We trim excess skin from the stomach, thighs and buttocks in one
operation, rotating the patient carefully on the operating table during the
surgery," Dr. Strauch said. "At a later date, we perform plastic surgery on
other areas of the body. This staged approach improves the patients'
quality of life, has wonderful esthetic results and has proven to be safe
and effective."
Dr. Strauch describes 75 mid-body lift operations in the article. He
has performed more than 300 of these new procedures in the past five years.
Circumferential abdominoplasty is more extensive than a standard tummy
tuck, and involves additional operating room time, more blood loss and
increased recovery time, the article says. After recovery, typically three
months later, further body contouring procedures are considered such as
brachioplasty (trimming underarm 'wings') as well as breast, thigh, face,
neck and back lifts. Each of these procedures requires special techniques
for formerly obese patients, said Dr. Strauch.
He notes a remarkably low incidence of complications. Only one patient
has experienced deep vein clotting, and there have not been any cases of
pulmonary emboli or seroma problems.
Montefiore Medical Center, The University Hospital and Academic Medical
Center for the Albert Einstein College of Medicine, ranks among the top one
percent of all US hospitals based on its investments in medical innovation
and cutting-edge technology.
Montefiore invests more in order to enable compassionate, personalized
care and the most positive outcomes for patients and their families in New
York, the tri-state area and beyond.
Montefiore's unique combination of 'state-of-the-art' technology with
'state-of-the-heart' medical and nursing care in a teaching and research
environment offer patients access to world-class medical experts, the
newest and most innovative treatments and the best medical center
experience anywhere.
This 1,062 bed medical center includes the Henry and Lucy Moses
Division, the Jack D. Weiler Hospital and The Children's Hospital at
Montefiore, a large home healthcare agency and a 21-site medical group
practice located throughout the Bronx and nearby Westchester.
Montefiore treats all major illnesses and has distinguished centers of
excellence in cardiology and cardiac surgery, cancer care, tissue and organ
transplantation, children's health, women's health, surgery and the
surgical subspecialties. Montefiore Medical Center focuses on providing
family- centered healthcare in a nurturing environment that extends well
beyond its hospital and ambulatory settings.
Montefiore Medical Center
montefiore/
body-contouring procedures performed on post-bariatric surgery patients
after significant weight loss is soaring (up 22 percent from 2004 to 2005
alone) according to the American Society of Plastic Surgeons. An article in
the June, 2006, issue of Plastic Reconstructive Surgery by the leading
practitioner of these techniques describes in detail how improved mid-body
lift techniques trim away the massive amounts of excess skin in the
post-bariatric surgery population.
"The radical weight loss following gastric by-pass leads to improved
blood pressure, and in many patients improves or eliminates diabetes
symptoms," said Berish Strauch, MD, chairman of the Department of Plastic
and Reconstructive Surgery at Montefiore Medical Center, and author of the
paper. "Nevertheless, patients are left with a massive sagging of the
entire body that leads to severe medical and cosmetic deformities," said
Dr. Strauch, who now finds that 80 percent of his surgical practice
involves post-bariatric surgery patients. "It is truly gratifying to be
able to give these patients the body they have dreamed of having."
"A traditional abdominoplasty (tummy tuck) is insufficient for these
patients, who after this kind of extreme weight loss require a special
operation called a circumferential abdominoplasty, a type of complicated,
mid-body lift, which we have modified," said Dr. Strauch.
"We trim excess skin from the stomach, thighs and buttocks in one
operation, rotating the patient carefully on the operating table during the
surgery," Dr. Strauch said. "At a later date, we perform plastic surgery on
other areas of the body. This staged approach improves the patients'
quality of life, has wonderful esthetic results and has proven to be safe
and effective."
Dr. Strauch describes 75 mid-body lift operations in the article. He
has performed more than 300 of these new procedures in the past five years.
Circumferential abdominoplasty is more extensive than a standard tummy
tuck, and involves additional operating room time, more blood loss and
increased recovery time, the article says. After recovery, typically three
months later, further body contouring procedures are considered such as
brachioplasty (trimming underarm 'wings') as well as breast, thigh, face,
neck and back lifts. Each of these procedures requires special techniques
for formerly obese patients, said Dr. Strauch.
He notes a remarkably low incidence of complications. Only one patient
has experienced deep vein clotting, and there have not been any cases of
pulmonary emboli or seroma problems.
Montefiore Medical Center, The University Hospital and Academic Medical
Center for the Albert Einstein College of Medicine, ranks among the top one
percent of all US hospitals based on its investments in medical innovation
and cutting-edge technology.
Montefiore invests more in order to enable compassionate, personalized
care and the most positive outcomes for patients and their families in New
York, the tri-state area and beyond.
Montefiore's unique combination of 'state-of-the-art' technology with
'state-of-the-heart' medical and nursing care in a teaching and research
environment offer patients access to world-class medical experts, the
newest and most innovative treatments and the best medical center
experience anywhere.
This 1,062 bed medical center includes the Henry and Lucy Moses
Division, the Jack D. Weiler Hospital and The Children's Hospital at
Montefiore, a large home healthcare agency and a 21-site medical group
practice located throughout the Bronx and nearby Westchester.
Montefiore treats all major illnesses and has distinguished centers of
excellence in cardiology and cardiac surgery, cancer care, tissue and organ
transplantation, children's health, women's health, surgery and the
surgical subspecialties. Montefiore Medical Center focuses on providing
family- centered healthcare in a nurturing environment that extends well
beyond its hospital and ambulatory settings.
Montefiore Medical Center
montefiore/
Alma Lasers(TM) Receives FDA Clearance For The Accent(TM) Dual Mode RF System
Alma Lasers, a global
leader in laser, light-based and radio frequency (RF) technologies used in
aesthetic medicine, announced today that it has received clearance from the
U.S. Food and Drug Administration (FDA) to market the Accent(TM) Dual Mode
RF System in the United States.
Receiving its first FDA indication for the treatment of wrinkles and
rhytids, the Accent system has been used successfully by medical
professionals worldwide to treat a variety of dermatological and aesthetic
conditions.
"We're delighted to receive the marketing clearance for the Accent
product in the United States," stated Howard Kelly, CEO for Alma Lasers.
"The unique dual mode RF modalities of the Accent system will provide
physicians with the most advanced technology available in non-invasive
aesthetic medicine; creating a higher standard in patient satisfaction. The
company is committed to pursuing additional clearances from the FDA, in
order to expand the clinical indications for the Accent system in the
United States."
Non-invasive, non-ablative and virtually pain free, the Accent system
combines two radio frequency modes into one device. Each mode is delivered
by a discrete handpiece to enable volumetric RF thermotherapy at different
tissue depths within the body.
Ziv Karni, PhD, President and founder of Alma Lasers stated, "The
Accent product was engineered for safety and ease of use, while maximizing
efficacy. The continuous movement of either handpiece results in a gradual
build-up of heat to achieve the optimal therapeutic effect, while providing
greater patient comfort. With over one thousand Accent systems installed
worldwide, the product has enjoyed an unparalleled safety record."
"Non-invasive treatments are the largest and fastest growing category
in aesthetic medicine," said Yariv Matzliach, Executive Vice President of
Global Marketing for Alma Lasers. "Now with its first FDA indication, the
Accent system is poised to provide medical professionals and their patients
in the United States with a new level of safety, efficacy and satisfaction
in non-invasive treatments."
"We have found the Accent system to be very safe and relatively
comfortable with a high percentage of responders," states David H.
McDaniel, MD, Assistant Professor of Clinical Dermatology and Plastic
Surgery, Eastern Virginia Medical School, Director of the Institute of
Anti-Aging Research Center of Virginia, and a principal investigator in the
FDA study. "Compared to other RF devices we have used, treatment with the
Accent system is much less painful, faster and easier to perform. It also
allows more 'artistic' use on the face. Although responses vary, a high
percentage of treated subjects showed a visible response. Some observe an
immediate skin tightening of the face."
According to Maurice Sherman, MD, Associate Professor of Clinical
Surgery, University of California -- San Diego, and the owner of the Del
Mar Cosmetic Medical Center in southern California, "We obtained remarkably
good results with the Accent system. It was consistent for all of the
patients that followed the protocol. All of them showed an improvement.
Some dramatic, some moderate, but every patient expressed satisfaction with
the results. Everyone said that their skin felt tighter the day after the
first treatment." Added Dr. Sherman, "Of all the RF systems on the market
today, I feel the Accent is the most effective technology out there."
About Alma Lasers
Alma Lasers is a global developer, manufacturer and marketer of laser,
light-based and radio frequency devices for aesthetic applications.
The Company's mission is to provide modular, cost-effective and high
performance systems that enable medical practitioners to confidently offer
safe, effective and profitable aesthetic treatments. More information about
Alma Lasers can be found at almalasers.
Alma Lasers
almalasers
leader in laser, light-based and radio frequency (RF) technologies used in
aesthetic medicine, announced today that it has received clearance from the
U.S. Food and Drug Administration (FDA) to market the Accent(TM) Dual Mode
RF System in the United States.
Receiving its first FDA indication for the treatment of wrinkles and
rhytids, the Accent system has been used successfully by medical
professionals worldwide to treat a variety of dermatological and aesthetic
conditions.
"We're delighted to receive the marketing clearance for the Accent
product in the United States," stated Howard Kelly, CEO for Alma Lasers.
"The unique dual mode RF modalities of the Accent system will provide
physicians with the most advanced technology available in non-invasive
aesthetic medicine; creating a higher standard in patient satisfaction. The
company is committed to pursuing additional clearances from the FDA, in
order to expand the clinical indications for the Accent system in the
United States."
Non-invasive, non-ablative and virtually pain free, the Accent system
combines two radio frequency modes into one device. Each mode is delivered
by a discrete handpiece to enable volumetric RF thermotherapy at different
tissue depths within the body.
Ziv Karni, PhD, President and founder of Alma Lasers stated, "The
Accent product was engineered for safety and ease of use, while maximizing
efficacy. The continuous movement of either handpiece results in a gradual
build-up of heat to achieve the optimal therapeutic effect, while providing
greater patient comfort. With over one thousand Accent systems installed
worldwide, the product has enjoyed an unparalleled safety record."
"Non-invasive treatments are the largest and fastest growing category
in aesthetic medicine," said Yariv Matzliach, Executive Vice President of
Global Marketing for Alma Lasers. "Now with its first FDA indication, the
Accent system is poised to provide medical professionals and their patients
in the United States with a new level of safety, efficacy and satisfaction
in non-invasive treatments."
"We have found the Accent system to be very safe and relatively
comfortable with a high percentage of responders," states David H.
McDaniel, MD, Assistant Professor of Clinical Dermatology and Plastic
Surgery, Eastern Virginia Medical School, Director of the Institute of
Anti-Aging Research Center of Virginia, and a principal investigator in the
FDA study. "Compared to other RF devices we have used, treatment with the
Accent system is much less painful, faster and easier to perform. It also
allows more 'artistic' use on the face. Although responses vary, a high
percentage of treated subjects showed a visible response. Some observe an
immediate skin tightening of the face."
According to Maurice Sherman, MD, Associate Professor of Clinical
Surgery, University of California -- San Diego, and the owner of the Del
Mar Cosmetic Medical Center in southern California, "We obtained remarkably
good results with the Accent system. It was consistent for all of the
patients that followed the protocol. All of them showed an improvement.
Some dramatic, some moderate, but every patient expressed satisfaction with
the results. Everyone said that their skin felt tighter the day after the
first treatment." Added Dr. Sherman, "Of all the RF systems on the market
today, I feel the Accent is the most effective technology out there."
About Alma Lasers
Alma Lasers is a global developer, manufacturer and marketer of laser,
light-based and radio frequency devices for aesthetic applications.
The Company's mission is to provide modular, cost-effective and high
performance systems that enable medical practitioners to confidently offer
safe, effective and profitable aesthetic treatments. More information about
Alma Lasers can be found at almalasers.
Alma Lasers
almalasers
New York Plastic Surgeon Eases Common Fear Of Rhinoplasty Surgery By Eliminating Traditional Packing And Painful Removal
Dr. Oleh Slupchynskyj, Director of The Aesthetic Institute of New York and New Jersey, has revolutionized the rhinoplasty procedure by eliminating traditional packing and subsequent painful removal.
The pain associated with the post-operative removal of nasal packing is a well-known and commonly cited fear among rhinoplasty candidates. Slupchynskyj, a rhinoplasty specialist, has alleviated this fear by utilizing recent advancements in packing material. Using state-of-the-art, plant-based biopolymer materials which absorb overtime, Slupchynskyj is able to retain the clot promoting effects of conventional packing while eradicating the irritating and painful removal. "Rhinoplasty can be performed with minimal or no bleeding post-operatively, therefore with a majority of my patients, I don't use nasal packing," reports Slupchynskyj. He continues, "if it is necessary, I use a dissolvable packing which is much more comfortable for the patient and disintegrates over 24-hours."
Slupchynskyj's development is the latest of many contributions that he has made in the improvement of rhinoplasty procedures. He is the creator of a custom nasal "S" implant, designed specifically to address African American and Ethnic patients. The "S" implant was designed to augment the nasal frontal angle and dorsum of the nasal bone, thus offering a superior alternative to other and more common forms of nasal augmentation material available today.
Oleh Slupchynskyj, M.D. is the Director and Founder of The Aesthetic Institute of New York and New Jersey with offices in Manhattan and West Orange, New Jersey. Dr. Slupchynskyj is double board certified by the American Board of Facial Plastic Surgery and the American Board of Otolaryngology with training specific to the head, neck and face. He is named one of the "Top Surgeons" of 2009 by the Consumers' Research Council of America and is considered a face specialist. He is a member of the following Societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology, New York County Medical Society, American Academy of Otolaryngology Allergy, American Academy of Cosmetic Surgery.
The pain associated with the post-operative removal of nasal packing is a well-known and commonly cited fear among rhinoplasty candidates. Slupchynskyj, a rhinoplasty specialist, has alleviated this fear by utilizing recent advancements in packing material. Using state-of-the-art, plant-based biopolymer materials which absorb overtime, Slupchynskyj is able to retain the clot promoting effects of conventional packing while eradicating the irritating and painful removal. "Rhinoplasty can be performed with minimal or no bleeding post-operatively, therefore with a majority of my patients, I don't use nasal packing," reports Slupchynskyj. He continues, "if it is necessary, I use a dissolvable packing which is much more comfortable for the patient and disintegrates over 24-hours."
Slupchynskyj's development is the latest of many contributions that he has made in the improvement of rhinoplasty procedures. He is the creator of a custom nasal "S" implant, designed specifically to address African American and Ethnic patients. The "S" implant was designed to augment the nasal frontal angle and dorsum of the nasal bone, thus offering a superior alternative to other and more common forms of nasal augmentation material available today.
Oleh Slupchynskyj, M.D. is the Director and Founder of The Aesthetic Institute of New York and New Jersey with offices in Manhattan and West Orange, New Jersey. Dr. Slupchynskyj is double board certified by the American Board of Facial Plastic Surgery and the American Board of Otolaryngology with training specific to the head, neck and face. He is named one of the "Top Surgeons" of 2009 by the Consumers' Research Council of America and is considered a face specialist. He is a member of the following Societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology, New York County Medical Society, American Academy of Otolaryngology Allergy, American Academy of Cosmetic Surgery.
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