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Patients can decrease the frequency of Botox� Cosmetic injections after approximately two years and still receive most of the same wrinkle-smoothing cosmetic benefits, according to new research at Oregon Health & Science University.
“After two years of treatment at recommended intervals, patients can potentially cut the frequency, and thus the cost, of their Botox� treatments by half,” said Roger A. Dailey, M.D., F.A.C.S., professor and Lester Jones Endowed Chair of oculofacial plastic surgery in the OHSU School of Medicine. The results of Dailey’s work were presented at a meeting of American Society of Aesthetic Plastic Surgeon on April 24 in Washington, D.C. The research was sponsored by an unrestricted educational grant from Allergen, Inc., the maker of Botox� Cosmetic.
The Botox� research effort also demonstrated that the injections have a wrinkle preventing – or prophylactic – effect. Patients who begin receiving injections between their 30s and 50s are able to prevent wrinkles from forming and eliminate existing wrinkles, said Dailey, head of the Casey Aesthetic Facial Surgery Center, which opened in 1991 as part of Casey Eye Institute.
Based on previous studies, doctors advised patients who wished to reduce wrinkles in the glabellar region – the area between the eyebrows – that they needed to have Botox� Cosmetic injections every three months to maintain the cosmetic wrinkle-smoothing benefits. Such frequent treatment, however, deterred some patients, Dailey said.
Dailey studied 50 women ages 30 to 50, who received regular Botox� injections for two years. “We found that after the patient receives Botox� Cosmetic injections every four months for two years, the frequency of the injections can be changed to every six months and still achieve good results,” Dailey said. “This demonstrates patients have the ability to achieve good results with broader treatment schedules and ultimately at a lower overall treatment cost.
Botox� has been approved for cosmetic use for eight years. In 2008, more than 5 million patients in the United States received cosmetic Botox� treatments, according to Allergen, the manufacturer. About 313,000 of those patients were men.
Source:
Oregon Health & Science University
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The University of Pittsburgh Medical Center has become the third health system in the United States to win approval to do one of the world’s most dramatic operations — human face transplants.
The Institutional Review Board, which must sign off on all experimental, research-oriented initiatives at the medical center, gave the green light to the face transplant proposal on Thursday.
While UPMC still has many steps to go through before it can do its first face transplant, the program’s endorsement shows just how far the procedure has come since the turn of the century, when face transplants were considered mostly a fantasy.
It is almost impossible to predict when the first face transplant will be done here, said Dr. Joseph Losee, a plastic surgeon at Children’s Hospital of Pittsburgh of UPMC who has headed the face-transplant initiative.
Only now can UPMC begin to evaluate candidates for the surgery, he said. Under the procedures approved by the review board, patients can be considered for the operation if they have a “devastating facial deformity,” either because of congenital malformations like neurofibromatosis or because of trauma such as accidents, burns or gunshots wounds.
Once potential candidates have been approved, there is then the uncertainty of finding an appropriate donor, Losee said.
Not only are there special challenges in getting a family to donate a loved one’s face, he said, but a face-transplant donor must match the recipient in gender, size and skin tone and texture.
One thing UPMC will not have to do is to recruit new surgeons, Losee said.
The center’s plastic surgeons already are highly trained in “free flap” reconstructive surgery, he said, in which tissue is transferred from one part of the body to another. One example: using parts of people’s leg bones to help rebuild their jaws after facial injuries.
Despite the skills that exist within the institution, Losee said, the face-transplant program has been worth pursuing because “our current reconstructive modalities cannot approximate normal human appearance. We cannot make a nose, we cannot make lips, we cannot make eyelids that approximate normal human appearance.”
The other primary motivation is that having a somewhat normal face is vital for basic human interaction.
“Facial expression is key to normal human interaction, and with a devastating facial deformity it is very hard to have normal facial interaction,”he said.
Patients who get successful face transplants will “be able to engage in social functions without being the negative center of attention.”
That was a factor for both of the first two American face-transplant recipients. Connie Culp, who received her new face in December 2008 at the Cleveland Clinic, had lost most of the middle of her face from a gunshot blast. James Maki, who received a face transplant at Brigham and Women’s Hospital in Boston in April 2009, suffered a similar injury after falling onto an electrified train rail.
UPMC also becomes the third program in the nation with approval for face and hand transplants. The Cleveland Clinic and Brigham and Women’s Hospital have had dual approval for some time, but so far have only done a single face transplant each. UPMC has done three hand-transplant surgeries since last year.
A key part of the UPMC program for both types of transplants is keeping the doses of immunosuppressive medications as low as possible using a regimen called the Pittsburgh Protocol.
Transplant recipients must take lifelong medications to prevent their bodies from rejecting the foreign tissue. By giving hand- or face-transplant recipients some of the donor’s bone marrow in the days after the operation, UPMC doctors can help their bodies accept the new tissue and use lower-than-normal doses of anti-rejection drugs.
Face transplants in some cases may improve patients’ functions, such as breathing, eating and swallowing, Losee said, but he feels improving their appearance is justification enough.
Nose jobs, breast implants and Botox all come with their share of risks and those seeking the procedures should find appropriate, certified doctors, warned The Quebec College of Physicians Tuesday.
The advisory comes on the heels of four suspensions by Quebec doctors for inappropriate conduct, and an effort by the medical body to set stricter guidelines.
Cosmetic procedures from plastic surgery to injections has risen dramatically in recent years, prompting the College to create a working study group in 2008. The group is compiling a directory for potential clients.
The directory, not yet complete, will include a list of doctors, note their credentials, and explain what surgeries they are qualified to perform, as well as the risks associated with each procedure.
“There are 20,000 physicians in Quebec, and there are not 20,000 doing (plastic surgery) for patients. It’s only a few, in fact,” said Dr. Yves Lamontagne, president of the Quebec College of Physicians.
Lamontagne is aiming to create a small bank of about 120 specialized plastic surgeons in the province who would advertize themselves as such and would be properly trained in elective procedures.
Dr. Gilles Beauregard of the Quebec Association of Plastic Surgeons supports the decision.
“When you do surgery you have to cut the skin, and whenever you do surgery, you need training,” he said.
The college also wants to curb the current practice of manufacturers of products such as Botox and Restylane instructing doctors how to use their products, instead of doctors making the appropriate decisions themselves, based on their training.
“Physicians go for a course, like a weekend somewhere paid by the company, and they start doing the thing the week after. This has to be controlled much better than it is now,” said Lamontagne.
Once the college’s directory is complete – sometime next year – it will be posted on its website.
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you get a request from your teenage graduate for a nose job, breast implant, liposuction, think twice, says Phoenix plastic surgeon Dr. Chasby Sacks.
Sacks agrees with Dr. Roxanne Guy, president of the American Society of Plastic Surgeons, that it’s becoming trendy for teens to seek plastic surgery these days, but he thinks most of those surgeries should wait.
Television shows depicting extreme makeovers, as well as society’s growing acceptance of plastic surgery in general, are fueling teens’ desires, according to Guy and other experts.
Sacks agrees.
“Photos we see in magazines, even teen magazines, to a certain extent may precipite the idea in young teenagers that they need to get cosmetic surgery in order to look like that,” Sacks said.
He said he supports cosmetic surgery for younger teens when medically necessary or when a particular feature causes the child tremendous stress — “if a particular teenager has, for example, protruding ears, for which they may have been teased a lot.”
But, he said, “If somebody, for example, at age 15, was looking for DD breasts, then I think that could be very inappropriate and would not be acceptable and certainly I would not perform that.”
If a teen wants work done as a gift, Sacks suggested parents think twice.
He said it’s a parents’ job to help children cope with insecurities, instead of letting them go under the knife.
“I would agree that the ideas may come from the media, but they should be put out of the head for a while by the parents,” Sacks said. “If it’s happening — if these very young teenagers are getting cosmetic surgery, then I think parents are to blame for not guiding them in the right direction.”
Sacks said teens can make their own mature decision about the issue later in life.
She calls it an investment in herself. An East Texan underwent plastic surgery to hide years of health problems. She is among the growing number of Americans who are fighting age with “fillers and facelifts.”
Lee is a grandmother of five who loves to travel by R.V. with her husband. But, she says health issues have made it hard to age gracefully.
“I’ve been in the hospital several times [and had] lots of treatments and it just made me look tired [and] hollowed out,” said Lee.
Tired of looking sick all the time, Lee decided to get a facelift.
“I just felt like this would make me look better and feel better,” she shared.
“A facelift gives a total facial rejuvenation,” said Dr. James Motlagh, with Tyler Plastic Surgery. “It works everywhere from the temple area to the neck. This whole area is pulled and tightened.”
Dr. Motlagh says a facelift is one of the most invasive cosmetic surgeries.
“We are getting up underneath someone’s skin and we are tightening it up in two layers,” Motlagh explained. “We are tightening the layer above the muscle, which is the actual foundation of the facelift and that is what makes the facelift last. The second one is getting rid of access skin which is the icing on the cake.”
The American Society of Plastic Surgeons say the average cost of a facelift is $6,000.
“This procedure can turn back the clock anywhere from 10 to 20 years,” said Motlagh. “So to some people that is priceless.”
Dr. Motlagh warns this investment that may not be for everyone.
“Most patients have to be in fairly good health or low physical problems,” he explained. “They should not be smokers at all.”
Lee says this investment in herself not only makes her appear healthier, but feel healthier as well.
“I have been around close family and friends that just say you look good,” said Lee.
Dr. Motlagh says a patient should allow six weeks for a full recover after a facelift.
A Tijuana cosmetic surgery clinic where a Chula Vista woman died a week ago following a liposuction procedure has been shut down temporarily by Baja California health inspectors.
The Millennium Cosmetic & Laser Institute in Tijuana’s Rio Zone was found to have “several irregularities,” including deficiencies in the operating areas and in record-keeping procedures, a spokesman for the Baja California Health Department said Friday. In addition, the clinic’s director, Dr. Louis May Villanueva, was asked to present additional documentation of his medical credentials, the spokesman said.
The inspection was triggered by reports of the death of Maria de Lourdes Trinidad Mendivil, 48, who went to the clinic May 22 to remove pockets of fat in her abdomen. May performed the procedure.
An autopsy determined the woman had died of a heart attack, according to the Baja California Attorney General’s Office. Investigators are trying to determine whether any medical errors were committed that could have contributed to her death.
Blood clots are a risk in many surgical procedures, and when they form they can travel to the heart and cause cardiac arrest.
The clinic could reopen as soon as the irregularities are rectified, according to the health department. If they are not, the clinic could be closed permanently.
May has a medical license, but is not a plastic surgeon. In Mexico, as in the United States, the law does not require liposuction procedures be conducted by a plastic surgeon.
May, who lives in Bonita, said on the clinic’s website that he earned his medical degree from the University of Michoacan in Mexico. In an interview earlier this week, May said staff members performed a routine blood analysis and electrocardiograph on Trinidad Mendivil before the procedure and “everything was perfect.”
The surgery lasted about 75 minutes and Trinidad Mendivil was awake throughout, as she was under light sedation and local anesthesia. May said that she told him she was feeling fine after the procedure, and he left the operating room. “Ten minutes later, I got word that she had a heart (attack),” he said.
When he returned to the operating room, three other clinic doctors and three nurses were working on Trinidad Mendivil, trying to resuscitate her. He blamed the death on a blood clot that likely formed during or after the surgery. She was not transported to a nearby hospital, because it would have interrupted efforts to revive her, he said. “We had everything here,” May said.
Family members say May refused to meet with them at the clinic. May said he spoke to the first ones to arrive at the clinic, but left on the advice of his attorney after more arrived and began to threaten him.
May declined Friday to comment on the clinic’s closing.
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