05 November 2018
MONDAY, Nov. 5, 2018 (HealthDay News) — More than 17 million cosmetic procedures are performed in the United States each year. Most of these are minimally invasive, designed to improve your appearance in subtle ways without the surgery, stitches and long healing time of early facelifts, once the only rejuvenating option available. Today’s most popular procedures are: Botox injections to soften lines, with more than 7 million done annually. Injectable fillers to plump folds, 2 million of which involve hyaluronic acid products. Chemical peels and micro-dermabrasion, both of which resurface skin. Laser hair removal. Keep in mind that “minimally invasive” doesn’t always mean zero healing time. It can take weeks for the redness and crusting to disappear following strong re-surfacing procedures that remove damaged top layers of skin. But they don’t involve the surgery and lengthier recovery of facelifts and eyelifts, for instance. And in fact, fewer and fewer of those procedures are being done. With the easy accessibility of peels and injections, people at younger and younger ages are starting to avail themselves of these treatments, even before they have a real need for them. Experts warn not to start too soon — overly plumped lips and a frozen forehead can actually make you look older than you are. They recommend more emphasis on caring for skin from an early age to prevent or delay the need for procedures in the future. If you’re considering having some work done, have a candid conversation with a dermatologist or plastic surgeon to determine which, if any, procedures are right for you, along with realistic expectations of what can be achieved. Remember that these are all true medical procedures that should be performed in a controlled environment by highly trained healthcare providers. Some minimally invasive procedures can be done by a skilled dermatologist while others require a plastic surgeon. More information The American Society of Plastic Surgeons has details on all cosmetic procedures, from peels to surgical options.
20 July 2018
FRIDAY, July 20, 2018 (HealthDay News) — Fat-freezing is touted as a noninvasive way to shed “love handles,” but it’s riskier than previously believed, Florida plastic surgeons warn. After the procedure, about one in 138 patients develops hardened lumps of fat at the treatment site, according to a small, new study. The fat accumulation — called paradoxical adipose hyperplasia — then needs invasive liposuction to remove it, the doctors reported. The fat-freezing procedure is known as cryolipolysis (brand name CoolSculpting). “CoolSculpting works, but this rare complication can happen,” said lead researcher Dr. Michael Kelly, of Miami Plastic Surgery. “Fortunately, it can be treated.” According to Kelly, the number of patients who develop paradoxical adipose hyperplasia is greater than thought. While still under 1 percent, the rate is not one in 4,000 as had been reported, he said. CoolSculpting aims to destroy subcutaneous fat cells by controlled cooling of tissue. It’s often used to remove problem areas like belly fat. But for those unlucky patients, the treated area becomes larger rather than smaller in the weeks after the procedure. They’re left with a painless but visibly enlarged, firm mass under the skin, the researchers explained. These patients are understandably upset to learn they need liposuction to remove the lump, and that they must live with this disfigurement for a few months before it can be treated, the study authors noted. That waiting period is needed for the fat to soften. Otherwise, it could recur, Kelly said. “Counseling is extremely important during this waiting period,” according to the study authors. Also, some patients need more than one liposuction treatment to remove all the fat, and they should be warned of that possibility, the researchers added. For the study, Kelly and his colleagues studied 11 patients with paradoxical adipose hyperplasia. Six had cryolipolysis at the study authors’ own clinic, and five were referred from other practices. Seven patients were treated surgically. In addition to liposuction, one needed additional surgery called a “tummy tuck.” Patients needed continued reassurance that the problem would be solved, the doctors said. Two refused treatment, even though the cost was covered by the manufacturer of the cryolipolysis equipment, according to the report. Kelly’s team said that over three years, 15 hyperplasia events occurred in six patients out of 2,073 treatment cycles. That, they said, represents an incidence of 0.72 percent, or one out of 138 patients. Dr. Jeffrey Salomon, an assistant professor of plastic surgery at Yale University School of Medicine in New Haven, Conn., explained why this side effect occurs. “Noninvasive treatment of fat can be done with heat, ultrasound waves or by cold,” he said. Manufacturers of these devices tout their benefits — noninvasive, no dressings, no downtime, great results, he added. “The fact is, these devices are all based on damaging the targeted tissue,” Salomon said. The tissue damage has to be sufficiently strong to destroy fat cells without damaging nearby fat, skin or muscle tissue, he noted. But when any tissue in the body is damaged, including fat, the body sends inflammatory cells to the rescue. “In the case of CoolSculpting, the fat cells are damaged beyond repair by the freezing process, and then the inflammatory cells clean out the remnants of those destroyed fat cells,” he said. But in less than 1 percent of cases, there appears to be a response from fat cells that were not damaged beyond repair, according to Salomon. “There appears to be a potential for those partially injured but not destroyed fat cells to excessively enlarge, which is called hyperplasia,” he said. Patients need to understand that virtually any medical device that damages tissue has risks. “The good news is that 99 percent of the time it does not happen,” he added. The report was published in the July issue of Plastic and Reconstructive Surgery. CoolSculpting did not respond to HealthDay‘s request for comment on the study. More information For more on cryolipolysis, see the American Society of Plastic Surgeons.
13 June 2018
WEDNESDAY, June 13, 2018 (HealthDay News) — A growing number of American men are having cosmetic surgery to improve their looks and increase their confidence, the American Society of Plastic Surgeons reports. More than 1.3 million cosmetic procedures were performed on U.S. men in 2017, according to the group. “For a lot of men, just having a procedure on an area of their body that they’re self-conscious about can really make a positive impact on how they see themselves,” Dr. Lorelei Grunwaldt, a plastic surgeon in Pittsburgh, said in a society news release. Over the past five years, there was a 23 percent increase in liposuction and a 12 percent increase in tummy tucks among men, and a 30 percent increase in male breast reductions, according to the society. Young men tend to focus more on enhancing their bodies, while older men have more minimally invasive facial procedures to look younger. In 2017, nearly 100,000 men had filler injections, a 99 percent increase since 2000, with a fourfold increase in Botox injections, the group said. Dr. Jeffrey Janis, president of the society, noted that it is important to have cosmetic procedures done by a board-certified surgeon. “The extensive training that these doctors go through gives them the versatility to offer their patients more choices so that each person receives the right procedures to meet their goals,” he said. More information The U.S. National Library of Medicine has more on plastic and cosmetic surgery.
05 April 2018
THURSDAY, April 5, 2018 (HealthDay News) — In search of a cosmetic surgery procedure that might be less costly than the going rate in the United States, a 43-year-old woman traveled to the Dominican Republic for a “tummy tuck.” What she got, instead, were massive open sores and an antibiotic-resistant infection that ultimately left her with a deformed abdomen. And hers is a story far from unique. Medical experts say it should serve as a cautionary tale for Americans who head abroad for cheaper plastic surgery, only to find they’re rolling the dice when it comes to their safety. The reason? Complications and rare infections resulting from subpar care delivered by some poorly qualified and under-regulated out-of-country physicians and facilities. “We studied cosmetic procedures, those not covered by medical insurance,” explained study lead author Dr. Dennis Orgill. “People are motivated because of cost, and in some cases because of cultural issues. There are many websites that advertise for these procedures. And the initial costs for these procedures in developing countries is substantially less. “Some surgeons in these countries are excellent,” Orgill added, “but sometimes it is hard for patients to tell the difference by looking on the internet.” And it’s that inability to properly vet international services, providers and regulations that ultimately gives rise to “a large public health issue,” he warned. Orgill is medical director of Brigham and Women’s Hospital’s Wound Care Center in Boston. He and his colleagues discussed their findings in the April 2018 issue of the journal Plastic and Reconstructive Surgery. Following several cases of botched plastic surgery in the Dominican Republic, the U.S. Centers for Disease Control and Prevention and the U.S. State Department issued alerts warning American patients to steer clear of that country. That concern was confirmed by the recent review of 78 patients (nearly all women) who had sought care at Brigham and Women’s following plastic surgery performed abroad between 2010 and 2017: three-quarters had undergone procedures in the Dominican Republic. The review also identified other problematic “medical tourism” destinations, with Colombia and Brazil topping a list that included Mexico, Venezuela, Argentina, El Salvador, China, Syria and Turkey. All the patients were American residents (average age 43), although many had been born in the country they chose to return to for surgery. More than 60 percent relied on Medicaid as their American insurance. About 45 percent had undergone a “tummy tuck” (abdominoplasty). A third had gone in for a breast enlargement. Other procedures included a breast lift or reduction (17 percent); liposuction (13 percent); or injections of foreign substances such as silicone (nearly 20 percent). About a quarter underwent multiple procedures. Following the procedures, nearly 10 percent of the patients sought corrective cosmetic surgery at Brigham and Women’s. About 18 percent had serious infections; 18 percent had persistent pain; 8 percent had scarring; 15 percent had unhealed wounds; and 5 percent had internal scar tissue in their breast. Other issues included hernias, perforated bowels and ruptured implants, the review authors said. Eight patients had to undergo emergency procedures in the hospital’s emergency room. One 59-year-old woman experienced kidney failure and developed multiple hernias following abdominal liposuction, also done in the Dominican Republic. Orgill and his associates concluded that the American College of Surgeons and/or the American Society of Plastic Surgeons (ASPS) may have to develop guidelines to tackle the issue of plastic surgery tourism. Such guidelines do not yet exist. Dr. Jeffrey Janis, president of the American Society of Plastic Surgeons, stressed that when seeking plastic surgery, it’s important to vet both the physician and the facility. “The ASPS does not allow you to become a member unless you’ve passed a rigorous training program by the Board of Plastic Surgeons, which attests to the fact that you’ve been well-trained and can safely practice plastic surgery,” he said. “So if you go outside the U.S. you really should seek someone equally qualified. “And you also don’t want plastic surgery done in a barn, a basement, a tent,” Janis said. “I’m not making those scenarios up. It happens.” Janis added that “that is not to say that if you travel outside the borders of the U.S. that you’re taking your health into your own hands. That’s not fair. There are plenty of very qualified doctors around the world who can perform procedures. The issue is, has the patient done their homework so they know what they’re getting into?” More information There’s more on plastic surgery at the American Society of Plastic Surgeons.