Fashion And Beauty

An editorial published in this week’s Lancet is highly optimistic regarding President-elect Obama’s ability to influence real change in health care policy - one of the United States’ most divisive political issues.

“Health system strengthening must be a top priority for the new administration if 46 million uninsured US residents are to have access to health care,” say the writers of the editorial. “Obama’s plans to offer a range of payment choices, his commitment to ensure that all children have health insurance, and the requirement that insurance companies cover pre-existing conditions are positive steps towards an inclusive health system. In addition, Medicaid and Medicare must be rebuilt, reinforced, and fully supported.”

They add that, “It was encouraging to hear UK Prime Minister Gordon Brown say at last week’s international conference on the Social Determinants of Health in London that Barack Obama is committed to tackling domestic and global inequality.”

According to the editorial, Obama’s plan for global health must consider climate change, two ongoing wars, and trade relations. The writers propose six steps with which Obama can effect meaningful change:

1. “Health equity and human security should be a stated objective of foreign policy.”
2. “The DHHS Director of Global Health Affairs, Bill Steiger - who has badly hurt America’s reputation in global health - should be replaced with a more experienced and appropriate politician.”
3. “Mark Dybul, the head of PEPFAR - the President’s Emergency Plan for AIDS Relief, undoubtedly the biggest triumph of the Bush administration despite its controversies - will likely be swiftly replaced. Strong leadership from a respected international expert, such as Jim Kim, could help to negate PEPFAR’s dogmatic and damaging policies - for example, its preference for abstinence-until-marriage programmes.”
4. “Just as George W Bush reinstated the global gag rule - a law that forces recipients of federal funding to agree that they will not perform or promote abortion as a method of family planning - in his first day in office, Obama could reverse this decision as soon as he is inaugurated and so improve women’s access to sexual and reproductive health in a single stroke.”
5. “A public commitment to agree to spend the internationally agreed target of 0.7% of gross national income on aid by 2015 would set a good example to the international community.”
6. “As a signal that the USA is committed to human rights, Obama could bring the USA in line with most other UN member states by ratifying the UN Convention on the Rights of the Child and the International Covenant on Economic, Social and Cultural Rights.”

The writers also hope that Obama will not be as antagonistic towards the UN system as the Bush administration was.

“The choice of the next UN Ambassador is pivotal to improving these relationships, in health as well as in other domains,” concludes the editorial. “An increase in support - including financial support - for WHO would be a sign that the USA wishes to re-engage with the global health community. President-elect Obama is a reminder about what is great about the USA and that, indeed, ‘change can happen’. The fruits of that change will be judged by tangible improvements to the welfare and health of Americans - and those affected by American foreign policy.”

Obama and health: change can happen
The Lancet (2008). 372[9651]: p. 1708.
Click Here to View Journal Website

Even as many of us yearn to wear the sheer, body-hugging fashions available today, we are stopped by our rear reflection and the sight of dreaded back fat rolls and lumps. A study published in the October issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS), reveals a new back lift procedure that removes these unsightly bumps and bulges while hiding the scar under the bra line.

“For many patients - even the very fit ones, such as an aerobics instructor - the upper to mid-line back where the rolls and bulges form was very frustrating,” said senior author Joseph Hunstad, MD and ASPS Member Surgeon. “This redundancy of skin occurs generally from aging and cannot be exercised away. For those who desire to wear form-fitting outfits, this procedure eliminates the problem.”

The study reviewed seven female patients who had the bra-line back lift between 2001 and 2007 with an average follow-up of 22 months. Pre-operative marks were placed to outline the patient’s brassiere, as well as delineate the excess back tissue to be removed. The procedure removed the redundant skin, sometimes up to 8 or 10 inches wide, and connected the remaining tissue together. According to the study, the procedure takes about an hour from start to finish. The authors have completed the bra-line back lift on 20 patients to date.

The study found minimal complications and about two weeks after surgery, patients were allowed to increase their activity levels based on their discomfort. Feedback from all seven patients was uniformly positive, according to the study.

The study concluded that the procedure is a safe and powerful method to contour the middle and upper back - literally removing all of the back rolls and folds. By placing the scar within the patient’s bra-line, it is easily concealed even by a two-piece bathing suit, according to the study.

“This is an exciting new procedure that gives patients concerned about this area of their body a possible new option to discuss with their plastic surgeon,” said James Wells, Chair of the ASPS Public Education Committee. “As with all new procedures that are not yet widely practiced, patients need to choose an ASPS Member Surgeon who has a comprehensive understanding of how bodies change over time, the impact of environment and lifestyle and the know-how to develop the best treatment plan for the best result.”

According to the ASPS, more than 19,500 lower back lifts were performed in 2007. Currently, statistics for upper back lifts are not available.

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.
ASPS Media Relations
American Society of Plastic Surgeons

A leading UK expert has expressed concern about the rise of vaginal surgery for purely cosmetic reasons, saying that while there are lots of claims in the popular press, and perhaps more alarmingly, made by some surgeons quoting comments from “satisfied clients”, these are not supported by the medical literature.

Linda Cardozo, Professor of Urogynaecology and Consultant Gynaecologist for Women’s Health at King’s College London, was speaking at the Royal College of Obstetricians and Gynaecologists 7th International Scientific Meeting (RCOG2008) in Montreal, Canada, that was held from 17th to 20th September.

Cardozo talked about the growing interest that cosmetic vaginal surgery has attracted in recent years, and that despite the voluminous popular press coverage, there exists little clinical or scientific evidence to guide gynaecological surgeons as to the safety and effectiveness of different procedures.

A recent search on Google for “cosmetic vaginal surgery” yielded over 45,000 references, compared with fewer than 100 on medical literature databases like PubMed and Medline. What scientific literature there is deals mostly with the correction of birth defects or intersex conditions, said Cardozo, and very little with cosmetic surgery done mainly for aesthetic reasons.

Examples of cosmetic vaginal surgery range from the purely aesthetic labiaplasty (reduces the size of the labia), hymenoplasty (restores the hymen) and “vaginal rejuvenation” to vaginal pelvic floor repair, a gynaecological reconstruction which is done partly to restore function and partly to enhance appearance.

Apart from testimonials from “satisfied clients” there is very little objective scientific evidence to support the claims of many surgeons who recommend cosmetic vaginal surgery; claims such as the procedure “restores normal anatomical relationships”, for example after the effects of childbirth or ageing. Some surgeons even suggest that the procedure “enhances sexual gratification”, said Cardozo.

In fact, if women seeking this type of cosmetic surgery were to be made aware of the medical literature that does exist, they might think twice about having it. For example, some literature on reconstructive pelvic surgery suggests that repeated surgery on the vagina increases the risk of scarring, loss of sensation and decreased sexual function: the opposite of what many clients want.

Cardozo suggests women considering cosmetic vaginal surgery as a way to restore sexual dysfunction should seriously consider other less physiologically invasive options first, such as psychosexual counselling and physiotherapy for the pelvic floor. Also, restoring normal pelvic function and anatomy has to consider three organ systems: the urinary organs, the sexual organs and the gastrointestinal organs.

Before choosing the most appropriate type of surgery, there needs to be a thorough assessment of function and the extent to which normal pelvic floor support has been lost, said Cardozo. It is not only a case of taking into account the doctor’s professional view, but also of assessing how each surgical option may affect the patient’s mental and physical state.

Specially designed and validated quality of life survey tools for condition-specific sexual dysfunction should be routinely administered as part of pre-operative assessment and discussion of aims and potential outcomes of any vaginal surgery, said Cardozo. The doctor should also think about whether a psychological assessment might also be beneficial, and perhaps do more careful probing to establish why the patient has asked for surgery over the more conventional treatment.

“Cosmetic vaginal surgery.”
Cardozo, L
Invited Speaker session: S4.14, RCOG2008
Published in special issue of BJOG, Volume 115 Issue s1 , Pages 5 - 31 (September 2008).

Click here to view the RCOG2008 Speaker Session Abstracts (PDF)