The obesity epidemic trend continues to push new patients to cosmetic clinics

Obesity remains a growing trend across the US (and the world) and there should be a corresponding growth in cosmetic treatments that treat obese patients.

According to the Center for Disease Control and Prevention, in the US alone, around 36.5% people are obese. This is a cause for any number of health-related alarms, but will continune to drive new cosmetic medical technologies to address the effects. While any number of clinics are offering liposuction for to remove love handles or a lettle extra belly fat, more is being uncovered about the effects of plastic or cosmetic surgery especially to Massive Weight Loss (MWL) patients who have undergone bariatric surgery.

It is important to note the psychological effects and the experiences faced by patients after surgery. Studies show that most patients appear to have a positive reaction towards their newer self, but there are also negative effects that some patients report.

In the studies referenced below, researchers find that majority of their sample patients were better able to identify with their new selves (However, the sample size was only 20) and the researchers used physical health; self-esteem/appearance; social acceptance; mental health; intimacy/sexuality; social network; and self-efficacy towards eating as measures.

Findings

  • Greatest change was found in physical health (Score = 21.06)
  • The surgery seems a success for the patients considering their perception of self and their body image.
  • A minority (n = 4) find it difficult to adjust with their new bodies and needed both recuperation and intervention be available after their bariatric and plastic surgery.
  • With regard to identity transformation, the majority are satisfied with their results and embraced their new body conformation.
  • Confidence played a major part with several participants as it helped them get through any issues they have encountered.

So how should providers at each end of the spectrum (bariatric surgery vs tumescent liposuction, Thermage, etc) set up patient expectations?

Clinicians, including support staff, should be prepped to answer questions and identify patients who might be at risk for acceptance of their new look including:

  • Discuss with patients the possible outcomes that may occur against the patient’s expectations. 
  • Staff should be educated on how best to deal with patients who might have unrealistic expectations.
  • Any cosmetic 'fat removal' treatment should be accompanied by a diet and excercise plan. (You might want to consider getting local gyms to offer a discount for your patients as a form of co-marketing.)

 

References:
Gilmartin, SJ, Long, A and Soldin, M (2015) Identity transformation and a changed lifestyle following dramatic weight loss and body contouring surgery: An exploratory study. Journal of Health Psychology, 20 (10). 1318 - 1327. ISSN 1359-1053

Jumbe, S., Meyrick, J. and Harcourt, D. (2016) Patient’s experienceof life after weight loss surgery: Psychological adjustment. In: Appearance Matters 7, Royal College of Surgeons, London, 28-30 June 2016. Available from: http://eprints.uwe.ac.uk/29251
Avashia, Y., Nair, N., Berhane, C & Panthaki, Z. (2013). Preoperative evaluation of the postbariatric patient. In Thaller, S. & Cohen M. (Eds.), Cosmetic Surgery After Massive Weight Loss. London: JP Medical Ltd.

Are Facial Exercises Effective?

Are Facial Exercises Effective?

A recent study in JAMA Dermatology finds that facial exercises are effective for the sample size. Those who participated in the study are women in their 40s to 60s. The types of exercises were not disclosed. The sample underwent a daily exercise or alternate day exercise spanning 20 weeks. The exercise regimen was effective for those who underwent the study, and it is recommended by the researchers to achieve mid and lower face fullness.

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Medical Spa Report: $3.6 billion US Market in 2016?

According to an independent study: the US medical spa market will hit $3.6 billion in 2016, it's expected to grow 18% yearly, and average net medspa profits are 14%.

Medical Spa ReportThe rest of the world is not covered but if you're outside the US this is still interesting. The study is 127 pages in length, has 32 tables, and costs $1,495 so get ready to open your wallet if you want to read the entire report (or just read the findings here).

Approximately 2,100 “medical spas” or “med spas” are now operating in the United States. Medical spas only emerged ten years ago and exploded in number between 2007 and 2009. However, a major shake-out took place as franchises failed and the recession hit—exposing overoptimistic revenue assumptions and poor management. As primary care MDs seek to replace lost income, and as baby boomers age, demand should grow for minimally or non-invasive cosmetic procedures made possible by new laser equipment.

Intersting Findings:

  • Marketdata estimates that revenues of the 2,100 U.S. medical spas reached $1.94 billion in 2012, and will hit $3.6 billion by 2016.
  • Average revenues per facility are $924,000—with about 80% coming from procedures and 20% form retail product sales.
  • The market is forecast to grow 18% per year. Fully 58% of med spas expected sales to grow more than 5% last year.
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Soft Tissue Fillers May Be Causing Blindness in Patients?

The rising popularity of soft tissue fillers has led to a rise in reports of side effects such as blindess.

The FDA approved the use of soft tissue fillers for the correction of moderate to severe facial wrinkles and skin folds (like the nasolabial folds). Some soft tissue fillers are approved for the restoration or correction of facial fat loss in people with HIV.

But according to the Food and Drug Administration, there are risks associated with the use of these fillers.

 Any soft tissue filler can cause long-term side effects, permanent side effects, or both. However, most side effects associated with soft tissue fillers happen shortly after injection and most go away in less than two weeks.

Swelling and pain after hand treatment may last a month or more. In some cases, side effects may appear weeks, months, or years after injection.

Among the rare side effects reported to the FDA are severe allergic reactions which require immediate emergency medical assistance, migration or movement of filler material from the site of injection, leakage, or rupture of the filler material at the injection site or through the skin (which may result from tissue reaction or infection).

There were also rare reports of formation of permanent hard nodules in the face or hand, vision abnormalities, including blindness, stroke, injury to the blood supply, and damage to the skin or the lips.

Recent reports by the American Society for Dermatologic Surgery, Inc. and published by Wolters Kluwer Health, Inc. showed that with the rising popularity of soft tissue fillers has led to a rise in reports of adverse events.

The study conducted a literature review of the reported cases of blindness after the filler injection. The study also examined some prevention and management strategies that may be done.

The results were as follows:

  • 98 cases of vision changes from filler were identified.
  • The sites that were high risk for complications were the glabella (38.8%), nasal region (25.5%), nasolabial fold (13.3%), and forehead (12.2%).
  • Autologous fat (47.9%) was the most common filler type to cause this complication, followed by hyaluronic acid (23.5%).
  • The most common symptoms were immediate vision loss and pain and most of the cases of vision loss did not recover.
  • Central nervous system complications were seen in 23.5% of the cases. No treatments were found to be consistently successful in treating blindness. 

Even though the risk of blindness from fillers is rare, researchers concluded that it is critical for injecting physicians to have a firm knowledge of the vascular anatomy and to understand key prevention and management strategies.

For more information: http://journals.lww.com/dermatologicsurgery/Abstract/2015/10000/Avoiding_and_Treating_Blindness_From_Fillers___A.1.aspx

Optimizing Your Clinics Email Marketing

Email marketing is a good way for businesses to engage both potential and existing customers. In 2015, email users are nearly around 2.6 billion and this is expected to exponentially increase to over 2.9 billion in the year 2019.

medical spa email marketing

Emails are very useful in the business world and as well as consumers - mainly due to its use for notification consisting of online sales.

Further, survey says that 91% of consumers check their email at least daily and 55% of companies surveyed say they generate more than 10% of sales from email.

Data from the Direct Marketing Association reveal that 66% of online consumers made transactions out of an email marketing message.

Email marketing allows you to be efficient. You can save a lot of your precious time after optimizing your autoresponder sequence or your sales funnel. Automation takes over and does most of the work for you.

But first, you have to plan about the results you want to achieve when hatching plans to grow your list. Map out how email marketing can be incorporated in your overall marketing scheme.

So, how do you improve your patient interaction through email marketing?

Start with what you write as a keyword in your subject line. A study shows that those with keywords confirm, features, upgrade, magic and raffle are likely to be reported as spam so it is best to avoid them unless you were able to built up a list that really trusts you and your brand.

Make a great first impression on your new subscriber through the welcome email or the autoresponder sequence.

When do you send them?

Try sending them on days other than Tuesday and Thursday and email your customers between the hours of 2 PM and 5 PM.

MailChimp’s Email Genome Project reveals that more mails are sent on Tuesday and Thursday than any other day of the week so you might want to test sending emails on other days so you will have less competition. This will pave the way for increased inbox space and click through rates.

People are more likely to open their email between 2 PM to 5 PM, regardless of time zone, according to the Email Genome Project.

Where do you link your email?

Try sending your email traffic to a dedicated landing page because this is usually the one that has a higher conversion rate. Also, you might want to include social share buttons in your emails as this can also generate higher click through rates.

Got other email marketing advices? Share them by posting your comments below. =)

Antidepressant Use in Plastic Surgery

"Stopping antidepressants before plastic and reconstructive surgery is unlikely to reduce complications--and might increase the risk of postoperative problems related to the patient's underlying depression."

This was reported by Dr. Isabel Teo of Ninewells Hospital, Dundee, and medical student Christopher Tam Song of University of Edinburgh after making a comprehensive literature review of the PubMed and Cochrane databases.

A total of 26 studies which assessed the effects of antidepressants on different plastic surgery risks were included for comparison including: risk of bleeding, risk of breast cancer, risk of breast cancer recurrence, breast enlargement, and other uique complications.

Evidences gathered has not debarred the increase in bleeding risk, breast cancer, or other adverse outcomes, according to the research review found in the issue of the Plastic and Reconstructive Surgery Journal.

Researchers Dr. Teo and Mr. Song stated that their review did not find consistent evidence of increased complications related to antidepressants. They said that risks associated with the stopping of prescribed antidepressant therapy in "psychologically vulnerable" patients likely outweigh any increase in complications.

According to them, discontinuation of antidepressants before surgery in the absence of a careful evaluation should be avoided. "Discontinuation syndrome" may happen to patients whose use of antidepressants - particularly the widely used selective serotonin reuptake inhibitors (SSRIs) - is stopped before surgery.

In conclusion, they said that:

This review does not support the cessation of antidepressants in patients before plastic surgery, as the numbers needed to harm are low and the implications of withdrawal may prove to be detrimental to postoperative management. 

However, the use of antidepressants for mental disorders may also implicate key patient risk factors for surgical complications, and sufficient exploration into the patient’s indications for the prescription is crucial. Evidence so far does not suggest that antidepressants increase the risk of breast cancer or recurrence in general, but caution should be exercised for those specifically on concurrent tamoxifen and paroxetine treatment.

Read more on: http://journals.lww.com/plasreconsurg/Fulltext/2015/11000/Assessing_the_Risks_Associated_with_Antidepressant.32.aspx

The New "Natural" Breast - Ideal Proportion is Key

A recent study in the Journal of Plastic and Reconstructive Surgery reveals the ideal proportions that may be used as a basis for helping your patients define the perfect breast.

You've all seen it happen; every woman wants perfects breasts and is convinced she knows what that means. Why then, is she dissatisfied when you deliver the modifications she's asked for? It turns out there's a new standard of beauty and a new study to help you, and your clients, achieve it.

In a recent survey, 1,315 men and women were asked to rate the attractiveness of breasts shown to them in three-quarter profile.  The results showed a clear pattern; the best chests have 45% fullness above the nipple line and 55% fullness below in a slightly teardrop shape.  Upward pointing nipples, a mildly concave upperslope and a convex and smooth lower slope were also key. Ironically, the traditional emphasis on upper pole fullness is not what patients now want. Round is out, natural is in!

So, how do you transfer the old ideal to the new real? Use these tips to guide your consultation:

  • Educate - find out what she already knows about the procedure and use this  knowledge as a basis to discuss the safest and healthiest way to achieve the result. Augment what they "know" with your expert medical opinion.
  • Communicate - Eveyone woamn has her own opinions about ideal shape and size. It is also critical to know whether a natural or augmented look is desired. Also useful is a  discussion of implant location, fill material and resulting profile in addition to size. It is also key to help her understand that a naked breast will have a shape that differs from a clothed breast.
  • Be specific - Size and proportion alone isn't enough.  Discuss frame size, body shape and activity level with your patient.
  • Use images - Pictures, drawings and 3D imaging are all excellent tools to guide the process.

In the end, a common standard of beauty may be ideal, but your goal is to also help a woman be beautifully real.  If beauty is in the eye of the beholder, use her as a collaborator to achieve both of your goals.

Read more about the survey discussed above at: http://journals.lww.com/plasreconsurg/Fulltext/2014/09000/Population_Analysis_of_the_Perfect_Breast___A.8.aspx?WT.mc_id=HPxADx20100319xMP

Improved Method for Treatment of Burns

The use of meshed split skin autographs (SSGs) combined with autologous cultured proliferating epidermal cells provided better wound healing and less scarring compared to using SSGs alone.

In a 40-patient clinical trial, researchers from The Netherlands found that such technique provided better results for patients who suffered serious and deep burns. The usual method of treating burns was the use of split skin autographs.

The new technique developed by the researchers used autologous (self-donated), cultured proliferating epidermal cells that were “harvested” from a small donor site, and “seeded” in a collagen carrier that could, in theory, enhance the wound healing rate and improve scar quality.

Dr. Shinn-Zong Lin, Vice-Superintendent for the Center of Neuropsychiatry, professor of Neurosurgery at China Medical University Hospital, and coeditor-in-chief for Cell Transplantationwas quoted saying that this study offers a promising, improved therapeutic method for treating severe burns.

According to Dr. Esther Middelkoop of the VU University Medical Center in Amsterdam, a co-author of the study,

The rate of epithelialization in the experimental treatment was statistically significantly better when compared to the standard treatment. We also established improved pigmentation for the wounds treated with cultured ECs. Scar quality impacts patients’ lives in many ways due to cosmetic and functional concerns.

Additionally, there is a high economic burden on patients due to extended hospital stays and the cost of rehabilitation and reconstructive therapies. Because of this, additional research in burn wound treatment and the improvement of scar quality will always be of the highest priority.

It was revealed that epithelial cells applied to a carrier system could, in fact, reduce wound healing time and improve both short-term and long-term functional as well as cosmetic scar quality.

It was observed that the primary outcome was wound closure after five to seven days, said the researchers. Secondary outcomes were safety and scar quality, which were measured at three and 12 months.

Read more on: http://ingentaconnect.com/content/cog/ct/pre-prints/content-CT-1380_Gardien_et_al

OTC Vitamin Lowers Non-Melanoma Skin Cancer Risk

Can a simple vitamin taken in conjunction with sensible sun protection significantly lower the risk of common, non-melanoma skin cancer in high-risk patients?

A recent study completed at the University of Sydney and Royal Prince Alfred Hospital in Australia supports this claim. Senior author and professor of dermatology Dr. Diona Damian found evidence that skin cancers may be reduced with a year of treatment of nicotinamide.

A type of vitamin B3, nicotinamide is considered to be safe and affordable and is available in most countries as an over-the-counter drug. The study showed that nicotinamide was very well tolerated with no difference in adverse events, blood results, or blood pressure.

Nicotinamide differs from nicotinic acid and niacin, two other forms of vitamin B3. Nicotonic acid commonly causes headaches, flushing, and low blood pressure, but these side effects are not seen with nicotinamide.

Previous studies suggest that nicotinamide enhances the repair of DNA in skin cells damaged by sunlight. Additionally, nicotinamide appears to protect the skin's immune system from UV radiation by providing skin cells an extra energy boost when they are in repair-mode after sun exposure.

Skin cancer is known to be the most common form of cancer in fair-skinned populations in the world and it is considered to be four times as common as all other cancers combined. More than half of the population of Australia is affected by non-melanoma skin cancer.

Non-melanoma skin cancer is caused by sun exposure. The 386 participants involved in Dr. Damian’s study had a history of skin cancer, increasing their risk for additional skin cancers.

The patients were asked to take the pill twice-daily pill for a period of 12 months. Nicotinamide reduced the incidence of new non-melanoma skin cancers by 23%, relative to placebo controls, and cut the incidence of pre-cancerous sun spots by around 15%.

The average number of actinic keratoses (pre-cancerous sun spots) in the nicotinamide group was consistently lower during treatment, ranging from an 11% reduction at three months, to a 20% reduction at nine months.

Dr. Damian hopes that these findings can be immediately translated into clinical practice. However, she adds that people who are at high risk of skin cancer still need to practice sun safe behavior, use sunscreens, and have regular check-ups with their doctors.

More about this on: http://www.sciencedaily.com/releases/2015/10/151021185104.htm

Have Researchers Found the Best Method of Harvesting Autologous Fat?

A study published in the Journal of the American Society of Plastic Surgeons sought to examine the method that will optimize the process of harvesting lipoaspirate before grafting.

Dr. Emily Cleveland, together with her colleagues from the New York University Institute of Reconstructive Plastic Surgery, examined various articles on the methods of processing human fat for autologous grafting in an evidence-based review.

They found that there was no single viable method that may be advocated as the best technique for lipoaspirate process.

Autologous fat harvested through liposuction techniques is used by both cosmetic and reconstructive surgeons. As a filler, it has several advantages including availability, biocompatibilty, ease of harvest without risk of allergic reaction or rejection, and it's inexpensive.

This technique has been used in several procedures including, but not limited to, facial rejuvenation, breast augmentation and reconstruction, treatment of congenital anomalies, and improvement of soft-tissue damage due to radiation therapy.

Despite its advantages, the autologous fat transfer technique is also wrought with setbacks. Viability and the retention of fat graft cannot be predicted with certainty because of lack of clear data pinpointing factors which may be responsible for the variability in results.

However, there is a wide belief among practitioners that the lack of standardized procedure, especially with that of postharvest fat processing, significantly contributes to the variability. Currently, several techniques of fat harvest before transplantation are used.

Among them are the use of simple decantation, cotton gauze rolling, centrifugation, and washing in physiologic solutions.

In the study, randomized controlled trials, clinical trials, and comparative studies comparing at least two of the following techniques were included: decanting, cotton gauze (Telfa) rolling, centrifugation, washing, filtration, and stromal vascular fraction isolation.

Results of the study were as follows:

  • There is a lack of superior method for processing harvested lipoaspirate.
  • Simple decantation has previously been demonstrated to preserve a large number of intact and nucleated adipocytes. However, it allows a significantly greater amount of aqueous and lipid contaminants to remain in the specimen, particularly hematogenous cells and other materials that are believed to be proinflammatory and thus harmful to graft survival. Recent publications further confirm this, demonstrating lower rates of decanted graft viability relative to centrifuged and washed specimens.
  • There are limited data to suggest that cotton gauze rolling of the lipoaspirate produces a graft largely free of contaminants, with superior in vitro adipose-derived mesenchymal stem cell content and high rates of in vivo retention but the technique is quite labor intensive.
  • Centrifugation is perhaps the most widely used technique for postharvest fat processing, and has previously been considered the criterion standard. The most commonly used settings are those described by Coleman, in which lipoaspirate is spun at 1200 g (3000 rpm) for 3 minutes, followed by discarding the aqueous inferior layer and wicking off the free oil top layer. The middle adipose layer is then grafted. Some have suggested this may not be the most viable technique, in that it fails to incorporate the “pellet,” which contains the highest number of adipose-derived mesenchymal stem cells in the harvested specimen. Recent literature has demonstrated lower rates of graft viability after centrifugation relative to washing,although equivalent or superior results have been shown by some after “soft” centrifugation (400 g for 1 minute). Nevertheless, other research continues to support the equal effectiveness of standard centrifugation in preserving adipose-derived mesenchymal stem cells and producing viable in vivo grafts.
  • Washing the lipoaspirate has previously been demonstrated to preserve both a large number of mesenchymal stem cells and a large number of adipocytes, thus satisfying both theories for graft survival. Several commercially available technologies that use washing techniques also appear promising for efficient, effective processing of lipoaspirate. This finding is somewhat confounded, however, by the use of multimodality technologies such as those used by Salinas et al. (washing then Telfa rolling or centrifugation), and processing with the Puregraft and Revolve systems, which first filter the lipoaspirate before washing. In addition, limited or no data are available to demonstrate in vivo superiority of these techniques.
  •  Filtration methods appear to eliminate contaminants, and maintain viable adipocytes and a large portion of adipose-derived mesenchymal stem cells. This processing technique may be more efficient in producing viable graft material for large-volume fat transfers, which are becoming increasingly popular among both cosmetic and reconstructive surgeons. The Tissu-Trans Filtron inline filtration system holds promise, but there are to date only extremely limited data available to support its use.
  • Similarly, there is only limited evidence to date to support the supplementation of processed lipoaspirate with additional stromal vascular fraction. Although viable isolation methods have been developed, a great deal of further research is required to determine whether this additional cost and effort is justified by superior clinical outcomes. The Celution 800/CRS System may be a viable method for isolating stromal vascular fraction in clinical settings for augmentation of autologous fat used for grafting; however, no subsequent in vivo study was performed to demonstrate its superiority relative to the other proprietary systems examined in this study. 

In conclusion, the authors said that they 

 did not find compelling evidence to advocate a single technique as the superior method for processing lipoaspirate in preparation for autologous fat grafting. A paucity of high-quality data continues to limit the clinician’s ability to determine the optimal method for purifying harvested adipose tissue. Novel automated technologies hold promise, particularly for large-volume fat grafting; however, extensive additional research is required to understand their true utility and efficiency in clinical settings.

More information about the study can be found at: http://journals.lww.com/plasreconsurg/Fulltext/2015/10000/Roll,_Spin,_Wash,_or_Filter__Processing_of.16.aspx?WT.mc_id=HPxADx20100319xMP

Viability of Autologous Fat Calf Grafting

Research shows that autologous calf fat grafting is a viable alternative to traditional implant-based calf augmentation for congenital calf discrepancies and aesthetic pseudo-varus deformity.

According to the study published in the official publication of the American Society for Aesthetic Plastic Surgery (ASAPS), Aesthetic Surgery Journal, fat grafting for slender calves provides results that are comparable to those obtainable via traditional methods. 

Some patients who want to undergo calf implants are concerned with the risks associated with the surgery and the possibility that strenuous exercise may cause the implant to move. Some plastic surgeons use silicone implants that is selected based on the patient's anatomy. These implants are placed under the fascia of the original calf muscle that is strong enough to withstand physical sporting activities.

Researchers Gerhard S. Mundinger and James E. Vogel pointed out in the research that there are few studies published regarding the advantages of fat grafting for calf augmentation and re-shaping compared with the traditional silicone calf implants.

According to Dr. James E. Vogel,

Autologous fat augmentation offers a number of advantages over calf implants, including liposuction in adjacent areas to improve calf contour, smaller incisions, additional augmentation through subsequent fat grafting, durable results, lack of foreign body reaction, and precise patient-specific adjustments not possible with off-the-shelf implants.

Medial and lateral calf augmentation was accomplished with injection of prepared autologous lipoaspirate intramuscularly and subcutaneously.

Thirteen patients underwent calf augmentation and reshaping with autologous fat grafting over a period of five years. Ten patients underwent bilateral calf augmentation, and three cases were performed for congenital leg discrepancies.

Prior to the fat transfer, local anesthesia was injected to utilize the smallest amount of effective anesthetic volume. This was also done to precisely place it into the muscle resulting in less sedation and more rapid postoperative recovery.

Fat was harvested from the abdomen, lateral thigh, medial thigh, waistline, flanks, axilla, upper back, and hips. Irrespective of the fat harvest site, liposuction was also performed at the knee to improve contour.

A mean of 157 cc of separated fat was transferred per leg, with roughly 60% and 40% transferred into the medial and lateral calf, respectively. Injections were first performed directly into the calf muscles and then into the subcutaneous calf tissue.

Four patients underwent a second round of autologous fat injection for further calf augmentation because they desired additional volume. Fat volume was judged to be sufficient when the calf was minimally firm but not tense. At a mean of 19.6 months of follow-up, durable augmentation in calf contour was documented by comparison of standardized preoperative and postoperative photographs.

The research concluded that the use of autologous fat transfer is a viable option compared to the use of traditional silicone implants.

Read more on: http://asj.oxfordjournals.org/content/early/2015/09/01/asj.sjv166

Search for the Best Hyaluronic Acid Filler

The October issue of the official medical journal of the American Society of Plastic Surgeons (ASPS) reports a new and validated method for providing standard cohesivity ratings for hyaluronic acid dermal fillers.

The search for the best hyaluronic filler comes after the surge of interest in the use of dermal fillers to enhance shallow contours, soften facial creases and wrinkles and improve the appearance of recessed scars.

Dermal fillers can be very helpful in those with early signs of aging, or as a value-added part of facial rejuvenation surgery. These fillers are often injected in medspas or a surgeon's office and are predictable, with relatively minimal risks and side effects.

In 2014, ASPS data revealed that around 2.3 million dermal filler injections were done. Statistics from the Cosmetic Surgery National Data Bank and other market research show that dermal filler market in the United States is valued at a whooping $1 billion.

Hyaluronic acid dermal fillers are natural, gel-based products which are highly compatible with the body, making them the most commonly used dermal filler in the industry. Plastic surgeons are now looking for evidences that will aid them in selecting the product that will give the best result for their patients.

Though there is a wide range of available products, there still exists a lack of scientific data to support the rheologic or the flow-related properties of the available dermal fillers in the market.

Dr. Hema Sundaram, a dermatologist in Rockville, MD, Samuel Gavard Molliard, a scientist in Geneva, Switzerland, and colleagues used the ratings of cohesivity and other biophysical properties to identify the dermal filler that is suited to each procedure being done.

The biophysical characteristics of hyaluronic acid gel fillers reflect individual manufacturing processes. They confer rheologic properties that provide scientific rationale with Evidence Level II clinical correlation for selection of appropriate fillers for specific clinical applications.

Cohesivity measures the capacity of a material to "stick together" and not dissociate. It is a key property that maintains gel integrity, contributes to tissue support with natural contours, and diminishes surface irregularities.

Researchers point out that products with higher cohesivity scores are not always the best. The ranking system aims to ‘provide a scientific rationale for the intuitive selection of different products for specific clinical objectives.’

According to Dr. Sundaram and colleagues, fillers with higher cohesivity may be better used for more superficial placement, or placement in mobile areas such as around the mouth or eyes while products with lower cohesivity may be effective for use as ‘deep volumizers’.

The researchers developed a standard test for comparing the cohesivity of hyaluronic acid dermal fillers. Samples of each filler gel were dyed, then squeezed into water and stirred using automated technology.

A panel of plastic surgeon and dermatologist specialists experienced in using HA fillers then rated each sample’s cohesivity on an original five-point scale, known as the Gavard-Sundaram scale.

Cohesivity scores of the FDA-approved fillers varied across the full range of the scale: from ‘fully dispersed’ to ‘fully cohesive’. Cohesivity was rated high for one product, medium to high for three, low to medium for one, and low for one.

Aside from the data on cohesivity, researchers believe that comparative data on other rheologic properties (such as elasticity and viscosity) can make dermal filler procedures more sophisticated and successful.

----

Results of the study "Cohesivity of Hyaluronic Acid Fillers: Development and Clinical Implications of a Novel Assay, Pilot Validation with a Five-Point Grading Scale, and Evaluation of Six U.S. Food and Drug Administration–Approved Fillers" may be read on: http://journals.lww.com/plasreconsurg/Fulltext/2015/10000/Cohesivity_of_Hyaluronic_Acid_Fillers__.11.aspx

Scar Management Techniques for Surgeons

Each year, it is estimated that around 100 million people in developed countries acquire scars after undergoing elective surgery and surgery for trauma. In a purely cosmetic surgical procedure such as an aesthetic breast surgery, scarring is viewed as a source of dissatisfaction among patients.

Prevention and treatment of unaesthetic scar formation after an operation greatly rests on plastic surgeons who perform these operations. Scarring may have several unpleasant aesthetic and psychological consequences to the patients including diminished self esteem, stigmatization, anxiety and depression.

In a study published at Journal of Plastic, Reconstructive & Aesthetic Surgery, an international, multidisciplinary group of 24 experts developed a set of practical, evidence-based guidelines for the management of linear, hypertrophic and keloid scars which could be useful for surgeons, dermatologists, general practitioners and other physicians involved in the prevention and the treatment of scars.

Here are some of the results:

1. After a surgery, prevention of abnormal scar formation should be a priority. In an elective surgery, the position and length of scar is to be greatly considered. As much as possible, the incision should be parallel to the relaxed skin tension lines. During the operation, the surgeon should ensure that excessive tension on the wound edges is avoided. Several measures may also be done to reduce inflammation, provide rapid wound closure, reduce the risk of infection, and provide an early surgical wound coverage.

2. Following a wound closure, scar prevention consists of three phases: tension relief, hydration/taping/occlusion, and pressure garments. Recent studies show that offloading mechanical forces using a stress-shielding device made from silicone polymer sheets and pressure-sensitive adhesive significantly reduced scar formation. Also, the use of botulinum toxin A decreases tensile forces on post-surgical scars and results in significant improvements in the cosmetic appearances of scars compared with placebo injections.

3. Silicone products may help to prevent excessive scar formation by restoring the water barrier through occlusion and hydration of the stratum corneum and need to be used as soon as the wound/suture is healed. Moisturizing emollient and humectant creams and moisture-retentive dressings such as silicone sheets and fluid silicone gel have been shown to be beneficial for itching scars, and can also reduce the size and pain or discomfort associated with scars as well as improving their appearance.

4. Randomized studies in animals and humans have shown that ultraviolet radiation increases scar pigmentation and worsens their clinical appearance. A preventive measure of avoiding exposure to sunlight and the continued use of sunscreens with a high to maximum sun protection factor (>50) until the scar has matured is recommended.

5. For patients with linear hypertrophic scars who have further scar maturation after 6 months, silicone therapy should be continued for as long as necessary. For those with an ongoing hypertrophy, more invasive measures are indicated such as the use of intralesional corticosteroids. This is the only invasive management option which currently has enough supporting evidence to be recommended in evidence-based guidelines.

Additional injectable treatment options which may help to treat hypertrophic scars (and keloids) include bleomycin, 5-fluorouracil and verapamil, although the evidence to support these is currently more limited than for intralesional corticosteroids. If the patient develops a permanent (>1 year) hypertrophic scar, surgical scar revision may be considered.

Pressure therapy has recently been considered as an ‘evidence-based’ modality for the treatment of scars. The mechanism of its action remains poorly understood despite its widespread use around the world. Part of the effect of pressure could involve reduction of oxygen tension in the wound through occlusion of small blood vessels resulting in a decrease of (myo)fibroblast proliferation and collagen synthesis. Pressure therapy can also provide symptomatic treatment benefits such as the alleviation of oedema, itchiness and pain which may contribute to the patient's well-being.

Laser therapy is another invasive option which can be used to treat the surface texture of abnormal scars and may also be suitable for the treatment of residual redness, telangiectasias or hyperpigmentation. This has also been advocated for the prevention or minimization of both post-surgical and traumatic scars, and even in combination with botulinum toxin. An increasing number of articles being published on the successful management of hypertrophic scars with lasers is increasing the interest in this therapeutic modality.

6. Keloids are also best treated in centres with specialized expertise. Patients with growing minor or major keloids should first be treated with silicones in combination with pressure therapy and intralesional injections of corticosteroids. Some experts recommend that the lateral parts of keloids should not be excised, but should be joined together and left in situ. However, others have objected to this proposal and consider that the cells from these lateral parts of the keloid are more active in terms of collagen production.

Both electron beam irradiation and brachytherapy with iridium 192 can be used after surgical removal of the keloid to reduce recurrence rates. Objections were raised because of the potential risk of inducing malignancy but a study conducted has concluded that the risk of malignancy attributable to keloid radiation therapy is minimal.

Cryotherapy may also be used as an invasive treatment modality for keloids. In a study of 10 patients, scar volume was significantly reduced by 54% after one intralesional treatment with no recurrence over an 18-month follow-up period.

7. Silicone therapy is advocated as a non-invasive first-line prophylactic and treatment option for both hypertrophic scars and keloids. For non-invasive scar management options. silicone sheets and silicone gels are universally considered as the gold standard in scar management and the only non-invasive preventive and therapeutic measure for which there is enough supporting data to make evidence-based recommendations.

Silicone therapy is easy to use and is associated with only minimal side effects such as pruritus, contact dermatitis and dry skin. This therapy is believed to prevent and treat scars through occlusion and subsequent hydration of the scar tissue. Several clinical studies have indicated the beneficial effects of silicone gels in the prevention and treatment of scars. Several comparative studies with silicone sheets have shown that fluid silicone gels have at least equivalent efficacy although patients may find the gel formulations easier to use.

Scars may leave several psychological impacts on patients after their surgery. It is important that appropriate scar management measures are done and tailored to the needs of the individual patient and wound requirement. Preventive measures should be prioritized and applied before, during, and after wound closure.

For more details, you may visit:

http://www.jprasurg.com/article/S1748-6815(14)00173-9/fulltext

Motivations for Cosmetic Procedure in Numbers

Great news for Med Spa practitioners! American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) studies reveal that nearly 75% of adult men and women in Texas are considering or have had a cosmetic procedure on the face or neck. The other 25% of the 160 Texans surveyed are undecided, which suggests most people in Dallas have a never-say-never attitude about having nips and tucks.

Here are the survey results about the motivations why Texans are interested in aesthetic surgery:

  •  22% say that they were frustrated because of their pictures on social media
  •  31% of the men, compared to 19% of the women were more concerned about looking better in their selfies
  • 13% were motivated because of upcoming major life events, such as a wedding celebration, 
  • 15% were motivated to go under the knife, laser, needle and more in order to remain professionally competitive
  • nearly 33% of the men said they considered facial plastic surgery to stay competitive in the workforce, compared to 10% of women
  • 40% said they’re most bothered by their necks
  • 39% are bothered by their eyes
  • 33% are bothered by their lips, followed by noses and foreheads

According to AFPRS President Stephen S. Park, M.D., 

Over the last five years, the selfie craze has exploded across all age groups. Photographs on social media can deliver a distorted image of reality, holding up a magnifying glass to flaws, real or perceived. This is causing plastic surgery requests to skyrocket in both teens as well as adults.

More on:http://cosmeticsurgerytimes.modernmedicine.com/cosmetic-surgery-times/news/nip-tuck-survey-why-texans-want-treatment

FDA Approved Saline-filled Breast Implants

Ideal Implant Incorporated has recently announced the FDA approval of its Structured Breast Implant for use in the United States and Canada.

The breast implant was designed by a plastic surgeon and it is the first to provide women with the feel of silicone gel-filled implants combined with the safety of only saline inside. The natural feel of the breast implant is attributed to its patented unique design and internal structure which was a product of more than 10 years of research and clinical studies.

As to its design, the company's website provides the following:

Years of research and testing led to this innovative design, with a series of implant shells nested together and two separate chambers, which hold the saline filler. The internal structure controls movement of the saline, and is designed to reduce folding and wrinkling, thought to be the main cause of implant rupture and deflation. On the outside, the edges have been lowered for better contouring to the chest wall.

According to Robert Hamas, MD, a Dallas plastic surgeon:

Now, for the first time, women can have a breast implant that offers them a natural feel without silicone gel. It has only saline inside for their safety and peace of mind. Unlike silicone gel implants that have a high incidence of silent rupture that requires an MRI scan for detection, with the Ideal Implant, a women can look in the mirror each day and have the confidence of knowing her implants are intact.

In a study, patient satisfaction for those who received their first breast implants were at 94.3% while those who had replacements for their previous implants was at 90.6%. The high satisfaction rating among women were attributed to the natural feel of the implants coupled with ease of mind because of its saline-filled components. The surgeon satisfaction was also high at 95.9% for primary implants and 91.7% for replacements.

 

For more info,

you may visit www.idealimplant.com

or contact Adeena Fried, 917-633-4380, idealimplant@evolvemkd.com

Fear of the Unknown in Cosmetic Surgery

A study commissioned by CCR Expo reveals that only half of the women who are interested in cosmetic surgery actually undergo the procedure.

Aside from cost, CCR Expo research reveals that there is actually fear of botched treatment as seen in media, wariness in the results (patients fear that they might not like what they will see in the mirror), and not knowing if the practitioners themselves are qualified to perform the procedure.

The annual CCR Expo, or the Clinical Cosmetic and Reconstructive Expo 2015, will be held on October 8-9, 2015 at the Olympia National Hall, London, United Kingdom. Prior to the event, three surveys were conducted among to know the opinion of various individuals including aesthetic practitioners, medics such as general practitioners and dentists, and the women patients who constitute majority of the patients undergoing such treatments.

Notwithstanding the governments efforts to regulate and "clean up" the cosmetic surgery arena, research revealed that patients and practitioners alike have a lot of fears. This is attributed to the fact that the aesthetic sector is largely unregulated.

Practitioner's View 

  •  There are too many untrained cosmetic providers who perform procedures that damage the reputation of credible and qualified practitioners.
  •  There is a lack of training and expertise in the following: facial anatomy, diagnosing and coping with complications, wrong treatments, and the use of unproven products.
  • Medical colleagues see that there is a strong prejudice for practicing aestheticians and the later are regardes as "beneath them". On the other hand, the survey also revealed that colleagues saw the field as lucrative but they got scared to enter because of lack of knowledge.
  • 90% of the surveyed GPs and dentists had considered providing aesthetic treatments, yet they did not push through because of: lack of specialized training, concerns in tax regulations and botched jobs, not understanding its legal frameworks, and the marketing involved.

According to CCR Expo organizer Peter Jones:

We don’t necessarily encourage more clinicians to join the aesthetics arena, but our research clearly shows there is a strong desire for more clarity in the sector, alongside some understandable concerns. At CCR Expo our logic is, if you’re going to do it, then do it right! This is why we have put together a full programme and roster of experts who can offer support and guidance to those who do wish to enter this field, so they have the tools enabling them to practise ethically and safely.

Clinicians have honed their careers over many years – sometimes decades, and being protective of their reputation is entirely natural. We are here to help them train andmaintain their hard-earned standing, whilst also helping keep the public safe. They certainly deserve no less.

More on: https://www.prime-journal.com/fears-continue-to-grow-around-aesthetics-sector/