Wednesday, December 28, 2011

FDA, health agencies probe silicone injections



Baltimore — The Food and Drug Administration and other health agencies are investigating incidents across the country in which unlicensed, untrained practitioners are performing cosmetic procedures with supplies that may have been purchased in home improvement stores.

A Baltimore exotic dancer injected with silicone to enhance her buttocks has become another victim in a growing trend that has led to illnesses, injury and even deaths, the Baltimore Sun reports.

An FDA affidavit contained in court documents identified the woman who injected the unnamed dancer as Kimberly D. Smedley, 45, of Atlanta. Ms. Smedley was arrested in Washington in October with three 18-gauge medical needles found among her belongings. The case remains sealed, and the specific charges are unknown, the Sun reports.

The dancer was hospitalized twice less than four days after the last of her injections in March, according to court documents. On her second visit she was given blood thinners to alleviate clots, and she remained hospitalized for 10 days. A CT scan showed silicone in her lungs, where it remains. 

Court records state that the silicone Ms. Smedley allegedly injected into the dancer came from an unlabeled jug that may have been purchased at a home improvement store, where it is sold as caulk and other adhesives, according to the Sun.

The dancer paid $1,000 for each of four sets of injections after meeting Ms. Smedley in the club where the dancer worked. She told authorities that Ms. Smedley also injected silicone into other dancers in a downtown Baltimore hotel, the Sun reports.

In similar incidents, a woman was arrested in Miami recently after allegedly injecting a woman with tire-repair liquid to enhance her buttocks, and earlier this year a British woman died after an improper procedure in a Philadelphia hotel room, according to the Sun. A New York City woman also was arrested on charges that she performed illegal breast- and buttocks-enhancement procedures in her home, according to news reports.

By: Bill Gillette

Tuesday, December 27, 2011

Tanning beds raise basal cell risk, too


New Haven, Conn. — New research suggests that the use of tanning beds, already linked to increased risk of melanoma in users, also increases the odds of developing basal cell carcinoma for young people, Reuters reports.

Researchers at the Yale School of Public Health interviewed 750 people younger than 40 to tabulate the type of tanning beds used, for how long and how often, any burns that resulted, and the age at which tanners first used the beds. Investigators found that young people who use the beds had a 69 percent increased chance of suffering from early-onset BCC.

The risks increased with the number of years the tanning beds had been used.

Reuters quotes lead author Susan T. Mayne, Ph.D., as saying, “Indoor tanning was strikingly common in our study of young skin cancer patients, especially in the women, which may partially explain why 70 percent of early-onset BCCs are in females. We were also surprised to find that one-third of our study participants with BCC had already had at least one additional BCC before age 40, which is very alarming, as skin cancers increase in frequency in age.”

The findings support earlier research showing that people who used tanning beds, regardless of type or for how long, were 74 percent more likely to develop melanoma, the most serious form of skin cancer.
Cases of melanoma have been rising for the past three decades, with more than 70,230 new cases diagnosed this year, according to the American Cancer Society. BCC diagnoses also are on the rise. 

BCCs, too, are likely to be cured if detected and treated early.

Reuters quotes co-author Leah M. Ferrucci, Ph.D., as saying, “Importantly, indoor tanning is a behavior that individuals can change. In conjunction with the findings on melanoma, our results for BCC indicate that reducing indoor tanning could translate to a meaningful reduction in the incidence of these two types of skin cancer.”

The study was reported on in the Journal of the American Academy of Dermatology

Tuesday, December 20, 2011

Blog: The Vampire Lift

From "True Blood" to "Twilight," vampires are glorified as sexy, blood-sucking members of society. This may help to explain the growing popularity of "the vampire lift," the newest cosmetic surgery buzz that ABC and Bloomberg (and now The Mole) are talking about. 

What the heck is the vampire lift, and how does it work? No biting is involved, but you will have to draw some blood.

    

Dr. Julie Woodward discussed the research, or lack thereof, behind this autologous blood plasma injection at the Cosmetic Surgery Forum in Las Vegas.

The Selphyl System, manufactured by Aesthetic Factors LLC, works by drawing a patient's blood and then putting it through a centrifuge to break it down into a platelet-rich plasma that is then injected into the patient's face, Dr. Woodward, of Duke University Medical Center, Durham, N.C., explained. The whole procedure takes about 30 minutes to perform, and is said to stimulate collagen production.

But before you call a blood dealing pharma rep, there are some things you need to know. For starters, using the system to fill a patient's face is an off-label use of the device. It is only approved for the treatment of joint pain, but the manufacturer is marketing it as a cosmetic product, despite receiving a warning letter from the FDA, said Dr. Woodward. She also noted that there are only 300 physicians using the product, and there have only been a couple studies on the treatment, all by the same researcher. 

The latest manufacturer-funded study was published online at the Archives of Facial Plastic Surgery in October. The four patient study found that  "a substantial portion of patients treated clinically with PRFM [platelet-rich fibrin matrix] describe their skin as 'softer' after approximately 8 to 12 weeks."

In a New York Time's article ("Vampire Facelift: Smooth at First Bite"), Dr. Phil Hacek, president of the American Society of Plastic Surgeons said that there are no scientific studies to back the claims made by the manufacturer. "This is another gimmick that people are using to make themselves stand out on the Internet in a real dog-eat-dog part of medicine," he said.

Dr. Woodward's advice: Wait for more evidence; multicenter trials need to be conducted to prove the safety and efficacy of the product.
A vampire bite may be a safer bet for now.

-Amy Pfeiffer

Monday, December 19, 2011

Rethinking the ink: Laser tattoo removal gains popularity

Dr. Z wants to share this great article written by Emily Wax of the Washington Post:

She arrives quietly, coming in from the rain after work. She lies down on her stomach atop a sleek, white reclining chair. She lifts her shirt and tugs down her jeans slightly.

It’s enough to unveil a large pink flower tattoo with fat, webby green leaves, which she’s here to have lasered off her lower back. She wants to become a mother someday, and she doesn’t want her children to see this. The process could take up to 10 sessions, she says. She pauses. Then she starts crying.

“I was only 18. It was a homemade tattoo done at a party,” says Lizeth Pleitez, 30, who quickly dries her eyes. Her voice is shaking. “I wasn’t thinking about what it meant, you know? Little did I know it meant something else — like people calling it a ‘tramp stamp.’ I’m a Pentecostal, and the body is a temple. And I felt really ashamed.” 
 
If tattoos are the marks of an era — declarations of love, of loss, of triumph, of youthful exuberance or youthful foolishness — then tattoo removals are about regret, confessions that those landmarks are in the past. They’re about the realization that whatever you believed in with such force that you wanted it eternally branded on your skin is now foreign to you.

According to the Pew Research Center, more than 40 percent of Americans between the ages of 26 and 40 have at least one tattoo. Getting a tattoo, once the province of sailors rather than suburbanites, is so mainstream that tats are inked at the mall and seen on everyone from Middle American mothers to H Street hipsters to Hollywood starlets. 
 
Perhaps not surprisingly, a parallel trend is emerging: tattoo removal, with dozens of businesses and training schools opening across the country. Some are headed by entrepreneurs such as Ryan Lambert, who has a Harvard degree and launched a tattoo-removal training school at New Looks Laser College in Houston. He also manufactures tattoo-removal lasers.

In Washington, Ken Saler, a 61-year-old, semi-retired real estate maverick has reinvented himself. His Advanced Laser Tattoo Removal office sits above a Baskin-Robbins ice cream store on Connecticut Avenue NW and has a steady stream of customers, all trying to dial back their everlasting tributes. 
“We have a client who has ‘Steve’ tattooed on her chest. But now she’s marrying Dennis,” says Saler, whose bright white office features framed Grateful Dead posters and a print of Norman Rockwell’s “The Tattooist,” in which a heavily tatted-up sailor is having his sixth romantic conquest’s name scratched off his arm, and a seventh inked on, with an evil-looking needle.

Star-bellied Sneetches 
Tattooing was once considered audacious, powerful and rebellious, precisely because of its permanence. 
But for a generation that has come of age during an unprecedented revolution in medical technology, tattoo removal by a super-powered laser seems like a facelift for young people, a chance to start over, erase, rewind. Like deleting a bad photo from a digital camera or defriending a Facebook friend. 
 
“It was such an underserved market,” says Christian Slavin, 54, who has an MBA from Harvard and owns Zapatat in Arlington County, which opened in September. “The difference between the regret rate and the removal rate is huge.”

While older lasers burned off the skin, Slavin’s new model interacts only with the ink and “makes it shake and makes it break,” he says. But it still hurts — it feels like hot rubber bands snapping against your skin, most removers say — and often is more painful than getting a tattoo. 
 
“When it’s all said and done, I’m just not that guy anymore,” says Corey Newman, 29, who is getting married in May and wanted to get three tattoos removed: his left arm’s panther, his right shoulder blade’s bull, and two small Chinese characters on his right leg. He is spending $2,500 to take off tattoos that cost $600 to put on. (Which might explain why tattoo removers tend to be better dressed and better paid than tattoo artists.) 
 
“I am starting a new life now,” he says. “There’s a big difference between being 19 and 29.”
Part of what made tattooing cool was its outlaw vibe: the Harley biker, the heavy-metal drummer, the ex-con. Part of what makes tattooing uncool is its ubiquity. Newman recently went to Rehoboth Beach, Del., for the weekend, and “every Tom, Dick and Harry had a tattoo, and it looked ridiculous. I started the removal sessions right after that.” 
 
It’s a little like Dr. Seuss’s “The Sneetches.” In the children’s classic, Sylvester McMonkey McBean sells the Sneetches a star machine for $3. Once there are too many star-bellied Sneetches, he tells them about his “star-off” machine, which costs $10.

A fresh start 
During a recent week, Saler’s appointment book included distraught mothers dragging their daughters in; ex-gang members with street tats who don’t want to be killed; professional women who are applying for office jobs; and African immigrants who want to get their tribal markings removed. Saler, who has a long face and tiny eyes under curly, graying hair, typically works in an oversize Cosby sweater and jeans. 
“I have a lab coat,” he says. “But the sweater makes people feel more comfortable. They already arrive with a lot of anxiety and expectations.”

This being Washington, his office draws aspiring CIA and FBI agents, along with other law enforcement operatives. If they go undercover, they can’t risk being identified by their tattoos. 
 
As it happens, Saler is the product of a fresh start. When the real estate market crashed, he was looking for a growth industry and heard about tattoo removal. He took a two-week course to become a certified laser specialist at Rocky Mountain Laser College in Colorado, and he invested in a Quanta Q-Plus laser, which has a $90,000 price tag. The laser is on wheels and looks a little like a photocopy machine with a probe attached.

(He’s no stranger to entrepreneurial inspiration: He also claims that, in 1974, he became the first person to operate a hot dog stand in Washington.)

Saler’s bright office is on the second floor of a walk-up that houses several mental health therapists, “a back-up plan not lost on me, if people need therapy before or after,” he says with a chuckle. His Facebook page advertises “Tramp Stamp Tuesdays” and $50 ring-finger tattoo removals after a breakup. 
 
Emotional pain, physical pain 
On a rainy Tuesday, Dave Adams, 36, a musician and massage therapist, goes to Saler to have three neck tattoos removed. They are religious symbols, and there’s one on each side of his neck: a Star of David, a Hindu yantra and an upside-down cross. 
 
“Tattoos were viewed as forever. But now I like the idea that I can treat the skin like an artist can treat a canvas,” he says, adding that he loves and respects tattoo work and expects to get more. “But I just got these too quickly. I feel like they are jumping off my neck.” 
 
Then the burly, tattoo-faced Wayne Stokes, 34, arrives. He’s on his sixth session of a removal that might take up to 25.

He has tattoos on his face, neck, hands and chest. Both eyes are encircled by a black leopardlike Maori-inspired design, which is based on the tattoo sported by boxer Mike Tyson. The tops of his hands spell out S-U-F-F-E-R-I-N-G when he holds them side by side. The left side of his neck says “Life,” the back of his neck says “Is,” and the right side says “Pain.”

He started getting tattoos when he was 16. He says he grew up in rough neighborhoods in Baltimore, suffered abuse at the hands of his father and was threatened outside his home, too: by drugs, by peers on the streets. 
 
“Subconsciously I was creating an image to keep people at bay and away from me. I wanted to look tough,” he says. “People ask me every day, ‘Why did you do it? Why did you put yourself through that pain of tattooing your entire face?’ I’ve realized I don’t have to keep that trauma on my body.”

He’s gone through a lot of therapy. He works as a cook, but when the tattoos are off, he wants to mentor abused kids. 
 
Now that the painful decision to get rid of the tattoos is over, the physical pain begins. He prays in the bathroom for strength. He gets into the chair and squeezes a ball as the laser hits his skin, turning parts of it red and then frosted white as the ink crystallizes into smaller particles that will be removed by his body’s immune system over the next few weeks. The laser emits a green light, and the room smells a little bit like burned hair. 
 
Saler uses a hose — known as the “Zimmer Cryo cooler” — to blow air onto the skin and deaden the sensation. “Each time, I get [part of] it removed, it’s like I can exhale,” Stokes says. “Sometimes I do dread coming in. But it’s the end result.

“I want to look in the mirror and see myself again.”

Wednesday, December 7, 2011

Lasers and Light Devices in the Treatment of Cosmetic Pigmentary Disorders in Asian Skin

Enjoy this article from Medscape News:

Lasers and Light Devices in the Treatment of Cosmetic Pigmentary Disorders in Asian Skin

Pigmentation disorders are common in Asians. Asians are also more prone to develop post-inflammatory hyperpigmentation (PIH). Pigmentation disorders are cosmetically disfiguring in Asians and are a common reason for dermatology consultation in Asian countries. Most patients seek treatment for cosmetic reasons.

Introduction

The development of cosmetic lasers and other light-based devices have allowed for effective and safe treatment of many cosmetic pigmentary disorders which were previously not treatable. Such devices specifically target the pigmented lesion with minimal damage to the surrounding tissue (Anderson & Parrish, 1983; Bailin, 1985; Goldman, Blaney, Kindel, & Franke, 1963; Jones & Nouri, 2006). However, some pigmented lesions, such as Becker's naevus, café-au-lait macules, and naevus spilus remain recalcitrant to current therapies due to their innate biological nature.

In this article, the principles and clinical applications of the lasers and intense-pulse light (IPL) device in the treatment of the cosmetic pigmentary disorders commonly seen in Asians are highlighted.

Recent Advances in Treatment of Cosmetic Pigmentary Disorders in Asians

Nonpigment selective lasers, such as the carbon dioxide laser (10,600 nm) and the Er:YAG laser (2,940 nm), are primarily used for laser skin resurfacing (to treat wrinkles and scars) but may remove superficial pigmented lesions (e.g., seborrheic keratosis). Introduced 2 decades ago, ablative lasers are being replaced by pigment-selective lasers. The risk of post-inflammatory hyperpigmentation (PIH) and scarring from ablative lasers is high due to severe thermal damage and inflammatory changes, especially when used to treat pigmentary disorders. Recently, non-ablative and ablative fractional photothermolysis were introduced which cause minimal thermal damage and are associated with post-inflammatory pigmentation (Manstein, Herron, Sink, Tanner, & Anderson, 2004). However, these fractional resurfacing lasers are not pigment specific and are generally less effective for treating pigmentary disorders.

Pigment-selective lasers/light devices offer more precise removal of pigmented lesions with less risk of causing post-inflammatory pigmentation (Alster & Williams, 1995; Downs, Rickard, & Palmer, 2004; Jang et al., 2000; Kilmer, Wheeland, Goldberg, & Anderson, 1994; Todd, Rallis, Gerwels, & Hata, 2000; Tse, Levine, McClain, & Ashinoff, 1994). Such devices include:
  • Q-switched ruby laser (694 nm, 25–40 nanoseconds).
  • Q-switched alexandrite laser (755 nm, 50–100 nanoseconds).
  • Q-switched Nd:YAG laser (1,064 nm, 5–10 nanoseconds) which can be frequency-doubled to emit green light at 532 nm of the same pulse duration.
  • IPL (515/200 nm).
  • Pulsed-dye laser (585/595 nm, 1.5 msec).
Not all pigmented skin lesions respond equally to lasers or light devices. Some pigmented lesions can be cleared effectively (such as lentigines and Hori's naevus), while others tend to recur shortly after treatment (such as Becker's naevus and café-au-lait macules) or are associated with PIH (such as melasma). Table 2 lists the common pigmentary disorders and their response to laser/IPL treatment.

Conclusion

Properly chosen wavelengths of light used with appropriate pulse durations can selectively alter pigmented cells and disrupt exogenous and endogenous pigment in a manner that leaves the adjacent skin intact and allows for the effective and safe treatment of many cosmetic skin pigmentary disorders which are common in Asian skin. Risk of PIH can be reduced with proper patient selection, appropriate laser/light device selection, and good peri-operative skin care.

By: Goh Chee Leok

Monday, December 5, 2011

Social Engagement in Older Adults May Improve Health


December 2, 2011 — Maintaining high or increasing levels of social interaction over time has potentially protective effects on cognitive and physical abilities in older adults, according to a new study published in the December issue of the Journal of Health and Social Behavior.

Although previous research has documented the association between health and social engagement, study author Patricia A. Thomas, PhD, from the Population Research Center, University of Texas, Austin, sought to examine how changes in social interactions over time influence the trajectories of physical and cognitive limitations.

Using data collected from adults aged 60 years and older, the study found that those adults with high levels of social engagement had lower initial levels of cognitive limitations. Social interaction also provided a protective effect against rising levels of physical limitations.

The Americans' Changing Lives survey collected data in 1986, 1989, 1994, and 2002. Information from 1667 adults aged 60 years and older (mean age, 70 years) was included in this study.

Participants in the survey were asked about their frequency of social engagement such as visiting friends and family, volunteer activities, membership in clubs or organizations, or attending religious services. Cognitive impairment was assessed using the Short Portable Mental Status Questionnaire, and the Rosow-Breslau functional scale for gross mobility was used to assess physical abilities such as climbing stairs or walking several blocks.

Most of the survey respondents were women (67.1%) and white (68.5%). More than half of the participants were married, and 22.4% were employed.

By using a person-centered approach, survey respondents were categorized into 1 of 5 distinct trajectory classes of social engagement. A traditional, variable-centered approach was then used to examine how membership in a specific trajectory class was associated with changes in physical and cognitive limitations.

The social engagement trajectory categories used were class 1, high initial levels of social engagement with a slight decrease over time; class 2, high initial levels of social engagement with a greater decrease over time; class 3, high levels of social engagement that increased slightly over time; class 4, medium levels of social engagement that increased over time; and class 5, low levels of social engagement that deceased over time.

Women were more likely to belong to the class with high, slightly decreasing social engagement, whereas men were more likely to have medium to high and slightly increasing social engagement.

Dr. Thomas found that individuals with high and slightly decreasing social engagement (class 1) experienced lower initial levels of cognitive limitations. Belonging to any of the social engagement class trajectories compared with class 5 (low, decreasing social engagement) was protective for declines in cognitive limitations, but the effect diminished over time, the study found.

Lower levels of physical limitations over time were noted across all trajectory classes (except class 2), independent of initial levels.

These results suggest a protective effect of social engagement on physical and cognitive health in older adults. Maintaining social attachments can instill a sense of purpose, increase motivation, and provide social pressure to engage in activities that improve health, notes Dr. Thomas.

Because of fluctuations in social engagement and physical and cognitive limitations during the same period, the author acknowledges that causal relationships are unclear. The quality of the social interactions was also not accounted for in this study, and it is possible that negative interactions would affect health differently.

"The links between social engagement and better health outcomes highlight the potential benefits of older adults' participation in broader social activities and may encourage older adults to maintain high levels or increase their social engagement as one of several ways to maintain better physical and cognitive health," concludes Dr. Thomas.

By: Jennifer Garcia