Fashion And Beauty

A plastic surgery team at Brigham and Women’s Hospital, Boston, led by Dr. B Pomahac, has carried out a partial face transplant. This is the second partial face transplant to be performed in the United States.

The seven plastic surgeons, as well as an ENT (ear, nose and throat) surgeon, along with nurses, anesthesiologists and residents spent 17 non-stop hours replacing the mid-face area of a patient. The patient’s hard palate, nose, facial skin, muscles for facial animation, upper lip, and nose were all replaced.

Kevin O’Connor, Senior Vice President, New England Organ Bank, said “Advances in transplantation only happen when there are individuals and families who can see past their own tragic circumstances and agree to donation. A gift such as this holds the promise of health and hope for a patient in need and it was New England Organ Bank’s honor to work with such a remarkable donor family.”

The patient wishes to remain anonymous. Therefore there will be no new conference or interviews with the patient present.

The New England Organ Bank, after talking with the donor family, obtained consent for the donation of the tissue graft from the face. For face donations family consent is required – being a registered organ and tissue donor, details of which can be included in a driving license, is not enough.

Brigham and Women’s Hospital (BWH) is a leading transplantation center of excellence with a worldwide reputation. In 1954 a kidney was successfully transplanted form one brother to another by Dr. Joseph Murray and team at BHW. Dr. Murray went on to receive the Nobel Prize for medicine in 1990.

100 kidney transplants were performed, as well as 30 lung transplants at BWH in 2008. 560 heart transplants have been performed at BWH since 1984.

While improving your self-esteem and lowering your pants size are significant benefits of weight-loss surgery, the health benefits can be dramatic. Nick Nicholson, M.D., weight loss surgeon on the medical staff at Baylor Regional Medical Center at Plano, explains how the surgery can actually improve certain health conditions.

- Reversal of Type 2 diabetes “Because obesity is the primary risk factor for Type 2 diabetes, weight-loss surgery can have a profound impact on the condition,” says Dr. Nicholson. Published in the March 2009 issue of The American Journal of Medicine, a study revealed that 82 percent of patients who had weight-loss surgery reversed their diabetes in less than two years, and 62 percent remained diabetes free two years following surgery.

- Improved fertility Although most obese women are not infertile, according to the American Society for Reproductive Medicine, ovulatory functions and pregnancy rates frequently improve significantly after weight loss in obese women.

- Improvement or elimination of hypertension A study published in the Journal of the American Medical Association in 2004 stated that hypertension was eliminated in 61.7 percent of weight-loss surgery patients and significantly improved in 78.5 percent of patients.

- Easing of joint pain Weight-loss surgery can ease the pain caused by the stress of extra weight on joints; a 2004 study showed the number of painful joints and other painful areas reported by the obese adults in the study was cut in half six to 12 months after weight-loss surgery. Plus, researchers in Austria have found that weight-loss surgery can help resolve the chronic inflammation associated with rheumatoid arthritis.

- Increased longevity Studies at the University of Alabama in Birmingham and at the Erasmus Medical Center in the Netherlands conclude that obesity can cut a person’s life span by up to 20 years. Researchers with the Pennington Biomedical Research Center have found that weight-loss surgery for severely obese patients appears to decrease overall mortality.

“Partnered with improved quality of life, the medical benefits of weight-loss surgery can’t be taken lightly; the surgery can truly lead to greater physical and emotional health and wellness,” adds Dr. Nicholson.

New research shows that human teeth lost some enamel hardness after the application of several different products used in the home to whiten teeth. The study suggests that future generations of such products might be reformulated in an effort to reduce these side effects.

The researchers noted that teeth typically can restore their previous hardness after losing small amounts of enamel calcification. But this is the first study to show at a nanometer scale – measuring in billionths of a meter – how human teeth are affected by the popular home whiteners.

“There is some significant reduction in nano-hardness of enamel, but we are talking on a very minute scale. So even though it may not be visible to the human eye, it’s important for research because that’s how we improve products,” said Shereen Azer, assistant professor of restorative and prosthetic dentistry at Ohio State University and lead author of the study.

Azer and colleagues applied the recommended treatments of five name-brand home whiteners to samples of human teeth and compared the effects to tooth samples that received no treatment. In all cases, the products reduced the hardness of the enamel as well as what is called the elastic modulus or stiffness, a measure of the ability of the tooth surface to bounce back in response to applied force.

Many studies have sought to determine how tooth whitening affects tooth enamel hardness, but results have been inconclusive. Azer said that previous studies measured the loss of enamel hardness in microns, or millionths of a meter, rather than on the nanometer scale used in his study.

“So this just gives us a better understanding of precisely how these products affect human teeth,” he said.

The research is published in a recent issue of the Journal of Dentistry.

Tooth bleaching products contain solutions of various strengths of either hydrogen peroxide or carbamide peroxide, which provide the whitening effect. They bleach teeth by producing unstable free radicals that attack pigment molecules in the organic parts of enamel. The reduction in pigment means the molecules no longer reflect light, so the teeth appear whiter.

Enamel, which is almost entirely inorganic and translucent, appears yellow in most teeth because it reflects the color of the dentin underneath, which is naturally yellow.

“Especially nowadays, people tend to see beauty in white teeth,” Azer said. “And bleaching does have a beautiful effect, but not without side effects.”

The study did not test for two other common side effects of tooth whitening, gum irritation and tooth sensitivity. Azer said these side effects have been addressed by other products, such as toothpastes and treatment gels designed to lessen sensitivity and irritation.

He and colleagues used extracted molars to assemble 65 human tooth samples measuring 4 millimeters square and 2 millimeters deep for the study. Ten samples were used in a pilot study that determined they could achieve accurate results for the research under dry conditions rather than wet conditions simulating the presence of saliva.

Of the remaining samples, five were left untreated, and 50 were divided into five groups of 10 each to undergo treatment.

The researchers used whitening strips on two groups of samples and trays filled with whitening gel on three groups. The treatment times included up to 60 minutes once per day or 60 minutes twice per day according to manufacturer recommendations. All treatments lasted for three weeks except for one tray method, which lasted 10 days.

The treatments included both over-the-counter and professionally provided products to be used in the home.

The scientists used a specialized tool to apply force to test the enamel hardness and stiffness (the surface ability to bounce back), and an atomic force microscope to observe the tiny nanometer-scale effects on the teeth.

The average loss of enamel ranged from 1.2 to 2 nanometers on the treated teeth. The control teeth, on average, actually gained 0.4 nanometers of hardness in comparison over the treatment time frame. The surface ability to bounce back from applied force was reduced by an average of between 6 percent and 18.8 percent among the treated teeth, depending on the type of treatment.

Among the different products, most of the reductions in hardness and elastic modulus were similar. However, there was a significant difference between one strip treatment method and one tray method, with the tray method reducing enamel hardness more dramatically than the strip treatment.

Enamel is the hardest structure in the human body. It protects teeth and maintains the integrity of the bite. But enamel is subject to abrasion by certain products and even too-vigorous brushing, which is why it is important to figure out ways to reduce damage to this part of the tooth, Azer said.

“In the case of these products, manufacturers might be able to alter the concentrations of the materials and the vehicles used to apply the bleach,” he said.

The study did not address how to restore hardness to bleached teeth, but Azer noted that extensive research has indicated that fluoride treatments, including the use of fluoride toothpaste, can promote enamel remineralization.

The products used in the study were Crest Whitestrips Premium Plus, Crest Whitestrips Supreme, Nite White ACP, Oral B Rembrandt and Treswhite Opalescence. The final three are tray treatments.

Azer conducted the research with Camilo Machado and Robert Rashid of the Division of Restorative and Prosthetic Dentistry and Eliana Sanchez of the Division of Primary Care, all in Ohio State’s College of Dentistry.

For many people, the words “natural” or “herbal” are virtually synonymous with safety and purity. Products available over-the-counter without a doctor’s prescription are often mistakenly believed to be free of significant risks. A report in the March/April issue of Aesthetic Surgery Journal warns that more than 40% of plastic surgery patients use herbal supplements in the two weeks prior to undergoing surgery. And, while some herbal supplements may provide benefits during recovery, commonly used herbal medications such as ginkgo biloba, ginseng, garlic, echinacea, valerian root and others can have deleterious effects when combined with surgery. When undergoing plastic surgery, the most significant and potentially dangerous effects of alternative medicines occur during the operative and immediate postoperative periods. “In considering the dizzying array of supplements available, the main concerns of the plastic surgeon are interaction with other medications, cardiovascular effects, alteration of coagulation [bleeding] and sedative effects,” says David J. Rowe, MD, lead author and Assistant Professor of Plastic Surgery at University Hospitals Case Medical Center, Lyndhurst, OH.

Unfortunately, as many as 70% of patients may not disclose the use of alternative medications to their surgeon or conventional health care provider, sometimes because they feel these physicians have little knowledge or interest in naturopathic medicine, or they feel physicians may disapprove of such treatments. Some patients simply fail to recognize the relevance of supplement usage to their current medical or surgical care. Patients need to be aware that full disclosure of all medications – both those that are prescribed and those that are obtained over-the-counter – is extremely important to their health and safety. They should also understand that inconsistent and unregulated manufacturing standards and lack of regulation for many herbal supplements mean that quality and dosage may vary considerably among products.

“This article was written to help plastic surgeons and their patients identify potentially harmful herbal supplements, based on the most current scientific research,” says Dr. Rowe. “On the positive side, we also discuss how providing the correct supplements and nutrients after aesthetic surgery can be very therapeutic.”

The authors recommend that patients be provided with a comprehensive list of supplements that must be avoided in the perioperative period to minimize potential surgical complications.

“Despite the fact that the dangerous side effects of some herbal supplements have been widely publicized, plastic surgeons still find that many patients do not fully appreciate the importance of discontinuing these treatments before surgery,” says Alan Gold, MD, president of the American Society for Aesthetic Plastic Surgery (ASAPS). “Physicians must have at least fundamental knowledge of the common herbal medications and their effects, and then be very proactive in discussing patients’ use of herbal supplements during the history, consultation and informed consent process. Stopping certain herbal supplements prior to surgery is just as critical as stopping aspirin, ibuprofen and many other common drugs.”

GREYSON INTERNATIONAL, INC. has been awarded trademark approval for Trilexon®, a new delivery system which will improve the effectiveness of virtually every topical application in today’s cosmetic market and every over-the-counter topical drug application.

The first products featuring the Trilexon® system are skin-care products that are currently in the preparation stage to be sold in the marketplace.

“We are pleased to announce that Trilexon® is now a registered trademark of Greyson International,” said Greyson International President and CEO Harvey Tauman. “This is a very important step for us as we move forward from the developmental and research stage into the marketing and sales stage for Greyson’s products and applications.”

Free Hand lotion is available today that will both prevent and lighten age spots. You might not think this is possible, because age spots are supposed to be caused by too much sun on the skin, and we’re usually told it will take something painful like surgery, or dermabrasion, or chemical bleaches, to lighten them.

Not so.

The best hand lotion to prevent and lighten age spots does it with natural ingredients. You don’t have to undergo expensive and painful treatments to lighten age spots.

And you don’t have to spend your whole life away from natural sunshine to prevent age spots. Moderate sunlight is good and healthful. It’s the free and natural source of Vitamin D — and we’re seeing more and more research articles these days on how terribly low in Vitamin D many of us are, and the many illnesses that seem directly related to low Vitamin D levels.

The best ingredient I’ve ever seen to lighten skin, including age spots and freckles, is an extract from a purely Natural Hand Lotion . Not only does it not hurt, or irritate your skin, it actually nourishes the skin, soothes irritations and helps to reverse the damage of skin aging.

It’s an extract of the root of the nutgrass plant from India, where it has long been used in Ayurvedic herbal medicine. Nutgrass contains natural oils and flavonoids that have great healing properties for the skin. Quite by accident, in studies of this use in skin care, it was discovered to block melanin production in the skin! And melanin is the skin pigment that turns our skin brown, in both age spots and freckles.

Extrapon Nutgrass Root is the trademarked name of the extract. In clinical trials, it reduced melanin production in the skin by more than 40 percent, and was also found to have anti-aging properties for the skin. It’s a natural way to whiten your skin, with no harmful side effects.

There are several other remarkable nourishing ingredients in the hand lotion I use to prevent and lighten age spots, but Extrapone Nutgrass Root is the key skin-lightening ingredient and I strongly recommend you check it out.

It’s where aesthetic medicine meets the art of beauty. Plastic surgeons, OB-GYNs, dermatologists, internists, and anti-aging physicians looking to refine or introduce non-invasive cosmetic surgery techniques now have a qualified training program by the American Association of Aesthetic Medicine and Surgery (AAAMS). With over 200 active members and more than 100 physicians trained last year, AAAMS stands as the authority of training cutting edge, non-invasive cosmetic procedures.

The next training session, Aesthetic Medicine 101 offers courses and certification in Botox(R), dermal fillers, chemical peels, liquid facelift, and aesthetic facial analysis, which will be held March 26 – 27, 2009 in Beverly Hills, California.

Dr. Sam Assassa, the President of AAAMS and a pioneer in aesthetics medicine along with other AAAMS faculty members will train participants with live demonstrations showcasing groundbreaking techniques. This intensive, hands-on training session will cover procedures such as chemical peels, Cosmetic Botox(R) training, dermal fillers, mesotherapy, and general facial rejuvenation.

What: Aesthetic Medicine 101
Where: Hyatt Regency Century Plaza, Beverly Hills, CA
When: March 26 – 26, 2009
Why: Non surgical aesthetic procedures and Botox training from Dr. Sam Assassa, AAAMS President

“The physicians, RNs and medical professionals who attend AAAMS training sessions learn cutting edge medical aesthetics techniques,” said Dr. Assassa. “AAAMS is committed to teaching the artistic act of aesthetics in a practical, clear-cut approach with safety in mind. It gives aesthetic physicians cutting edge guidance and education in this rapidly growing field.”

The American Association of Aesthetic Medicine and Surgery (AAAMS) hosts cosmetic surgery conferences throughout the year, focusing on a variety of aesthetic, non-invasive cosmetic surgery techniques and procedures that are highly sought after by physicians from all over the world for certification in the aesthetic medicine and surgery specialty.

“AAAMS offers the most comprehensive courses available, making the time for individualized attention to each participant’s questions,” said Julie Benzie, an RN and recent course participant. “I would recommend this course to any level of provider who would like training in aesthetic medicine.”

After his first weight-loss surgery three years ago, Paul Martin considered getting a tattoo designed around the four small surgical scars on his side-say, a golf green.

After a second weight-loss surgery in December, Martin didn’t have any new scars to add to the design. “I woke up with just a slight sore throat,” he says about the procedure, which took about two hours. “There wasn’t any pain because there weren’t any incisions.”

Martin, 53 years old, is among the first patients at Stanford Hospital & Clinics to be treated using what is called natural orifice surgery. In his case, the entire surgery was performed through his throat.

“We went down his throat with a device that looks like a regular endoscope, with a ‘duckbill’ on the end,” the surgeon, John Morton, MD, said. “In the duckbill is a tiny instrument like a sewing machine, with a needle that has plastic sutures.”

Morton, who is also associate professor of surgery, stitched pleats in the stoma, the opening between the patient’s intestine and the small pouch that had been created in the earlier surgery. He then tightened the pleats around the endoscope, reducing the stoma from 20 millimeters to 14, helping to control the amount of food Martin could digest.

Morton described the procedure he performed as part of a continuum of evolving practices. “They’re innovations in what I call ‘minimal access’ surgery,” he said. “We’re moving away from small, multiple incisions, to just one scar or, in some cases, no scar. It’s something we can offer that hopefully will decrease pain and allow for quicker recovery.”

As Morton and other surgeons at Stanford continue to refine no-scar and single-incision procedures, he predicted that more flexible instruments, which will help surgeons work in smaller areas and around corners, will be developed. “That’s a prime direction for the hospital’s Surgical Innovations Program, that we look for new tools and new technologies to help us perform these procedures,” he said.

Other bodily openings that surgeons nationwide have used for natural orifice surgery include the mouth, vagina, rectum and penis. Instead of taking out gall bladders through painful incisions in the abdominal wall, for example, surgeons have removed the organs through these so-called natural orifices, reducing patients’ pain and recovery times.

For another patient who wanted weight-loss surgery, Morton, a specialist in bariatric surgery, chose a different approach. David Pierson, a 32-year-old construction supervisor who had struggled with obesity since he was 12, was a good candidate for lap-band gastric bypass surgery. The twist? The entire procedure was performed through one small incision in the patient’s belly button-the first such surgery in Northern California.

Morton inserted the laparoscopic instruments and camera required for the lap-band procedure through Pierson’s belly button, which he calls an “ideal” entry point. “The instruments went in one direction-up. The only challenging part was tying knots on the inside. But it was pretty smooth, and looks great,” he said. “We know that one incision is less painful than four or five, and the lower the incision, the less the pain.” By going through the belly button, he avoided making a larger incision closer to the rib cage, which would have caused pain because of the muscles pulling on it.

Pierson said he woke up from the two-hour surgery feeling like his stomach “had been worked on-like I’d been trying to do crunches.” He spent one night in the hospital and returned to work the following week. “I couldn’t see the incision for two days,” because of a bandage, Pierson recalled. “But when it came off, it just looked like little stitches.”

In the operation on Martin-a stomach plication procedure called Stomaphyx-no trace was visible after Morton inserted the instruments down the patient’s throat. Indeed, Martin called it a “tune up” to correct a slight weight gain he experienced after his 2006 gastric bypass surgery. Before that first operation, Martin said, he “huffed and puffed” and had to use an electric cart to get around the construction sites he manages. Now he walks those sites and climbs stairs. Since December, he has lost 17 pounds.

After the operation two years ago, Martin had initially lost more than 150 pounds, before regaining some weight. Such weight regain is rare, noted Morton. Of the 1,200 procedures he has performed, he said, only 20 patients have regained more than five percent of the weight they lost. “But obesity is a chronic disease, and there can be relapses,” he added. “So you find options for patients.”

Women with early-stage breast cancer who have undergone breast augmentation may be treated successfully with a partial-breast radiation treatment called brachytherapy, according to a study presented today at the annual meeting of the Radiological Society of North America (RSNA). Patients treated with brachytherapy have better cosmetic outcomes and avoid the risk of the implant hardening, compared to patients who undergo whole-breast radiation therapy.

“We are seeing an increasing number of breast cancer patients with augmentation,” said Robert R. Kuske Jr., M.D., clinical professor at the University of Arizona Health Sciences Center and radiation oncologist at Arizona Oncology Services in Scottsdale, Ariz. “By nature, these women are concerned about their appearance and we need to have options for them.”

According to the American Society of Plastic Surgeons, breast augmentation is the most popular cosmetic surgery in the U.S. with 347,500 procedures performed in 2007. This represents an increase of 64 percent since 2000.

Approximately one in eight women who undergo breast augmentation will develop breast cancer at some point in their lives.

The most common breast cancer treatment for patients with breast implants is skin-sparing mastectomy and implant exchange. Whole-breast radiation therapy after lumpectomy is an option, but carries a substantial risk during the healing process of scar tissue wrapping around the implant, causing it to become rock-hard and extremely painful. This condition, known as capsular contracture, also distorts the appearance of the breast.

Dr. Kuske set out to determine if partial-breast radiation with brachytherapy might offer a better outcome for women with implants wishing to avoid mastectomy.

Breast brachytherapy is a radiation treatment that can be given in higher doses to a small, targeted area of the breast after lumpectomy. Radioactive “seeds” are guided into place through small plastic tubes, or catheters, with the aid of imaging and a computer. The seeds emit high doses of radiation in short bursts.

Scar tissue is minimal, the implant remains unaffected and treatment time is shortened from 6 1/2 weeks with whole-breast radiation therapy to five days with brachytherapy.

For the study, 65 women who were diagnosed with small, early stage malignant tumors were treated with brachytherapy after a lumpectomy. The women received two doses per day, separated by six hours, over a five-day period. Follow-up was six months to five years. None of the patients experienced tumor recurrence during the follow-up period. Cosmetic outcome was determined to be good to excellent in 100 percent of patients with 95 percent judged excellent. Implant hardening was not observed in any of the patients.

“Compared to traditional treatments, brachytherapy offers an excellent alternative for these women,” Dr. Kuske said. “It offers very high rates of tumor control with fewer side effects and is easier on their lifestyle.”

Notes:

Disclosure: Dr. Kuske is a consultant for Nucletron and for Cianna Medical.

Copies of RSNA 2008 news releases and electronic images will be available online at http://www.RSNA.org/press08 beginning Monday, Dec. 1.

RSNA is an association of more than 42,000 radiologists, radiation oncologists, medical physicists and related scientists committed to excellence in patient care through education and research. The Society is based in Oak Brook,