Body piercing carries health risks, report says

Evanston, Ill. — Health professionals need to be aware of the potential health problems caused by body piercing, a trend among an increasing number of young people today, say researchers at Northwestern University’s Feinberg School of Medicine. 

The Chicago Sun-Times reports that the paper details medical consequences resulting from piercings of ears, nose, mouth, nipples, navel and genitalia — and suggests ways to minimize and even prevent these complications.

The paper notes that while body piercing is fairly safe overall, bacterial infection is the No. 1 complication, affecting about 20 percent of body piercings. Other complications include allergies, loss of blood, scarring and interference with medical procedures, such as MRI, X-ray or ultrasound.

The Sun-Times quotes lead author Jaimee Holbrook, M.D., a clinical research fellow in the department of dermatology, as saying, “As piercing becomes more popular, the healthcare community should become familiar with how to remove the jewelry, in the case of an emergency situation, as well as understand piercing complications and related health risks.”

The review article was written while the researchers, along with investigators from the Rehabilitation Institute of Chicago, were conducting a trial on technology that uses magnetic tongue studs to help quadriplegics use computers and drive their own wheelchairs. According to the Sun-Times, the Feinberg team not only reviewed the medical literature on piercings, but also visited local piercing parlors to talk with professionals and watch them work. 

By: Bill Gillette

Portable ultrasound promising for implant monitoring

Grand Rapids, Mich. — A recent study suggests that portable, surgeon-performed, high-resolution ultrasound may have advantages over magnetic resonance imaging (MRI) when screening for implant failure.

Preliminary results of the study, led by Grand Rapids plastic surgeon Bradley Bengtson, M.D., show that high-resolution ultrasound provides excellent visualization of current fourth- and fifth-generation silicone gel implants in scanning models. In addition, in vivo surgeon-performed ultrasound accurately identified implant status and correlated with radiologist-performed ultrasound, MRI and surgical findings.

The Food and Drug Administration currently recommends MRI for device surveillance.

Phase 1 of the study evaluated several base and transducer systems, using them for both in vitro and ex vivo scanning model assessments of a variety of normal and damaged implant models. In phase 2, these technologies were applied clinically to provide imaging experience in three patients previously diagnosed with unilateral implant failure. In phase 3, a preliminary prospective evaluation was performed to compare the accuracy of MRI, surgeon-performed high-resolution ultrasound, and radiologist-performed high-resolution ultrasound scans in predicting the shell integrity of 29 implants in 15 consecutive breast implant patients who subsequently underwent secondary implant surgery.

In phase 1, all hardware models easily detected both intact and intentionally damaged shells in currently marketed fourth-generation responsive gel implants and in investigational, fifth-generation highly cohesive gel devices. Although multiple transducers were able to detect shell failure, the 12-MHz head produced the best images at the normal clinical depth range. Confirmatory scans in phase 2 correctly identified the side of rupture and were consistent with MRI and surgical findings. In phase 3, high-resolution ultrasound accurately predicted implant shell integrity in all 29 imaged breasts as confirmed at the time of surgery in both symptomatic and asymptomatic patients.

In a statement issued by the American Society for Aesthetic Plastic Surgery, Dr. Bengston says, “Our preliminary findings show that portable, surgeon-performed, high-resolution ultrasound is feasible for screening silicone gel breast implants, matching the capabilities of MRI in detecting shell failure. Although we are still working to define the role of this technology in the screening and diagnosis of patients with different silicone gel breast implant styles, there are several obvious benefits over MRI, including convenience, cost, availability, and dynamic, real-time visualization of the implant.”

By: Bill Gillette 

ASPS backs proposed rule on hand, face transplants

Arlington Heights, Ill. — The American Society of Plastic Surgeons has issued a statement that it fully supports a proposed federal rule to include vascularized composite allografts (VCA), such as faces and hands, in the national organ donation registry.

The Health Resources and Services Administration is considering having face and hand transplants fall under protocols that offer the same oversight to the processes surrounding VCA procurement that is currently provided for kidney, liver, heart and other organ donations.

The proposed federal rule would bring oversight of VCA procurement and assignation under the umbrella of the HRSA-sanctioned Organ Procurement and Transplantation Network (OPTN) and the United Network for Organ Sharing (UNOS). 

The ASPS statement quotes member surgeon W.P. Andrew Lee, M.D., chairman of the department of plastic and reconstructive surgery at Johns Hopkins University School of Medicine, Baltimore, as saying, “Those of us who perform this surgery firmly believe that when you transplant a hand or face, the considerations and logistics in relation to the donor families are very much like those of the organ transplant — and quite different from the skin and bone donation because the latter are basically preserved to be put on a shelf and be used any time. A hand or a face, obviously, just like a heart, kidney or liver, cannot be without a blood supply for more than a few hours. They need to be transplanted right away.”

Unlike organ donations, tissue and bone donations are regulated by the Food and Drug Administration, leaving classification of VCAs unclear.

The ASPS sent its endorsement of the proposed rule to HRSA officials last month. The Department of Health and Human Services has set no timetable for a determination on the proposal.

By: Bill Gillette

High-definition liposuction attracts more men than ever to cosmetic surgery

Significantly more women than men seek cosmetic surgery, and savvy surgeons who choose to see the potential in these data recognize that the male population represents a huge, almost entirely untapped market. Denver cosmetic surgeon John Millard, M.D., who says two-thirds of his patients are men, is among that group of forward-thinking practice owners who are actively marketing their services to males.

"We market six-pack abs as part of our search terms in our online promotional efforts," Dr. Millard says, "and high-definition liposculpture, with either VASER (Sound Surgical Technologies) or Smartlipo (Cynosure), is the procedure that is bringing men in by the droves. I've had men fly in from 21 countries and 47 states to have these procedures." 

Cosmetic surgeons such as Dr. Millard, who have a considerable proportion of male patients among their clientele, say the number of men interested in and seeking body-contouring procedures is increasing exponentially. Surgeons interviewed for this article say the remarkable outcomes possible with high-definition body sculpting, combined with the pressures of a society that generally rewards a healthy, youthful appearance and the toll that metabolic changes take on middle-aged men — no matter how fastidious they are about diet and exercise — all prompt males to seek such services. 

Dr. Millard, who pioneered high-definition liposculpture in the United States, describes it as an adjunct to one's fitness regimen. "I sculpt the abs, the pecs, the biceps, the triceps, almost every muscle that people work at the gym — I sculpt surgically. When I sculpt those muscles, I leave a little bit of extra fat over the muscle areas to enhance definition," he says. Dr. Millard says almost everyone has that definition, but on most people it's hidden by fat. 

In his practice, high-definition liposculpture typically attracts patients with a BMI of 25, although 22 or lower isn't uncommon, whereas traditional liposuction tends to attract people with a BMI closer to 30.
"High-definition liposculpture opened up a whole new patient demographic for me," Dr. Millard says. "I've got several patients who are former professional athletes, and even some who are body builders. Some of these patients have worked on their body their whole life but have never been able to shred down. 

"To attain muscle definition by dieting and lifting weights, you have to shred down to about 5 percent body fat, which is not possible without severe food restrictions," Dr. Millard says. He says he tells his patients that the combination of high-definition liposculpting along with diet and exercise enables them to have a "six pack" — and a steak. 

"They can actually eat reasonably and still maintain that lower fat percentage," Dr. Millard says. "The body parts that we sculpt have a lower fat percentage, but their total body fat percentage is healthier — still in the 12 percent to 15 percent range, which is where most people who work out and take care of themselves are." 

By: Rochelle Nataloni

Laser liposuction shapes ankles and calves safely, precisely

WASHINGTON — Lipoplasty has become a popular cosmetic procedure for sculpting the ankle and calf region, and though classic liposuction may be more efficient for this indication, in experienced hands, laser liposuction is more precise and can result in superior aesthetic outcomes. 

Classic liposuction is a commonly used technique for aesthetically shaping the ankle and calf region in cosmetic patients. For more enhanced aesthetic outcomes, however, laser liposuction appears to be the technique of choice, as the surgeon can better sculpt and artistically fine-tune the ankle and calf area.
According to one plastic surgeon, modern laser liposuction devices used for the ankle and calf region are more forgiving in that they are fine instruments specifically adapted for difficult-to-treat areas such as the ankles and calves and can help preserve vital structures such as blood vessels, nerves and lymphatics.
"The ankle and calf area is a typically narrow region and can be challenging to treat with any surgical procedure. However, laser-assisted liposuction is one technique used that can be more gentle on the critical structures of the ankle and calf region," says Claude Garde, M.D., a plastic surgeon in private practice in La Varenne, France. Dr. Garde spoke about laser-assisted lipoplasty of the leg at the 2010 World Congress on Liposuction Surgery in Washington in October 2010. 

CURVES AHEAD According to Dr. Garde, the technique is ideal for the ankles and calves because of the curvy anatomy of the region. Using laser liposuction, the surgeon can meticulously sculpt the region much more precisely compared to classic liposuction. A laser liposuction procedure of the ankles and calves is easy to perform, and desired aesthetic results can be achieved in just a few sessions, Dr. Garde says.
AVOIDING AES Prior to performing laser liposuction surgery in his patients, Dr. Garde always conducts a number of exams to help avoid adverse events, including a duplex scan to map out the perforating veins that can occur very frequently at this level. 

A 44-year-old female patient before (left) and after laser liposuction procedure. Claude Garde, M.D., uses the SmartLipo device (1,064 nm, 10 watt) from DEKA. The duplex sonography device he uses is the Synergy from Hitachi. (Photos credit: Claude Garde, M.D.)

"Perforating veins need to be appropriately treated by phlebectomy or sclerotherapy prior to a liposuction procedure because should they be injured during liposuction, there is a real risk of deep vein thrombosis as well as hematomas and pigmentations following the procedure," Dr. Garde says. 

According to Dr. Garde, it is also wise to exclude lymphatic insufficiency using isotopic scintigraphy prior to classic or laser-assisted liposuction. Though laser liposuction is less traumatic than classic liposuction and is thought to reduce lymphedema in the short-term, both techniques could destroy the remaining lymphatic vessels and could result in recurrent lymphedema. 

In patients where the fat layer around the ankle and calf region is more than 13 mm to 15 mm between the skin and the fascia (measured by duplex sonography), Dr. Garde advises physicians to first perform a classic liposuction procedure and debulk the area with larger debulking cannulas. A follow-up laser liposuction procedure could be performed afterwards, should fine-tuning of the region be necessary. 

"In my experience, laser liposuction or any surgical liposuction surgery should not be performed in patients who have less than 8 mm of fat in the calf and ankle region. In these cases, there would be too much of a risk of damaging delicate blood vessels, nerves and lymphatics and these cases should be left alone," Dr. Garde says. 

POST-PROCEDURE STEPS In addition to compression stockings that all patients must wear for three months following any liposuction procedure of the lower leg, Dr. Garde suggests that patients undergo five sessions of pressotherapy to assist lymph drainage, followed by the application of stiff bandages underneath compression stockings to be worn throughout the day. Adequate lymphatic drainage could also be achieved with daily massage therapy and could replace pressotherapy. 

"It is paramount that the surgeon has an in-depth knowledge of the local anatomy and has performed important clinical work-up such as Doppler and duplex sonography prior to all liposuction procedures of the ankle and calf. I believe that surgeons should first gain experience with laser liposuction on less challenging target areas, such as the abdomen, before setting their sites on the ankles and calves, which could prove difficult to treat for surgeons with less experience," Dr. Garde says. 

By: Ilya Petrou, M.D.

Radioactive cream used to treat skin cancers

Grenoble, France — Researchers say a new skin cancer treatment that uses radiation to kill benign tumors with a single application of cream could be a viable alternative to surgery.

The topical therapy for basal cell carcinoma uses rhenium-188, a radioactive isotope, to kill tumor cells in half an hour while leaving the skin around it unharmed, the Telegraph reports. A base layer applied directly onto the skin protects healthy cells from the radioactive element, which sits on top of the base where it can irradiate the skin below. 

Although the product has not yet been approved for use, a study of 1,000 patients in Rome found that it completely removed tumors in 95 percent of patients with just one treatment. The Telegraph reports that the vast majority of participants suffered no adverse effects.

Larger trials have been set up in Germany with the intention of bringing the therapy to the market.

The Telegraph quotes Ulli Koester, Ph.D., a researcher at the Institue Laue-Langevin in Grenoble, where the radioactive material is produced, as saying, “Typically this disease is treated by surgery, and since it doesn’t metastase this is usually OK. But the problem is if the tumor is on the face, on the nose, ear or somewhere, it is strongly disfiguring — someone can have a big scar or lose half of his face. This is a localized radiation therapy which in more than 95 percent of cases a single treatment is sufficient to make the cancer go away.” 

The Telegraph also quotes Martin Ledwick, of Cancer Research UK, as saying, “I would imagine we are not talking about a major breakthrough but another option. It is nice to have a menu of different options for people, particularly with things that can have a cosmetic impact.”

By: Bill Gillette

Suneva tests Artefill for acne scar treatment

Dr. Z is sharing this great article from:

 Suneva tests Artefill for Acne Scar Treatment

San Diego — Suneva Medical has launched a multicenter phase 3 study to investigate the efficacy of the dermal filler Artefill (polymethylmethacrylate) for treatment of acne scars.

The 150-patient prospective study will be conducted at 10 centers throughout the United States and will enroll its first patient by February, the company says. 

The Food and Drug Administration approved Artefill for correction of nasolabial folds in 2006.

In a company statement, Suneva Chairman and CEO Nicholas Teti said, “We believe Artefill’s unique composition may provide (acne) patients a real solution for what many thought would be a lifelong problem. We are pleased to be working with a strong and prominent group of investigators on this trial as we look to expand the indications for Artefill.”

By: Bill Gillette

Short-Term Topical Treatment for Actinic Keratosis Approved

A great article brought to you by:

Short-Term Topical Treatment for Actinic Keratosis Approved

January 26, 2012 — The US Food and Drug Administration has approved ingenol mebutate gel (.015% and .05%; Picato, LEO Pharma) in a treatment course that can be as short as 2 or 3 days for the treatment of actinic keratosis (AK).

The .015% strength is approved for use once daily on the face and scalp for 3 consecutive days, and the 0.05% strength is approved for use once daily on the trunk and extremities for 2 consecutive days.

In a release, the company states that the product is "the first and only topical therapy for [AK] that can be used for as little as two or three days."

According to the American Academy of Dermatology (AAD), 1 in 5 Americans will develop skin cancer, and approximately 65% of squamous cell carcinomas begin as untreated AK. AAD statistics indicate that "60% of predisposed persons older than 40 have at least one actinic keratosis."

"Since there is no way to predict which actinic keratosis will advance to skin cancer, early detection and treatment of lesions are critical," said Mark Lebwohl, MD, from the Department of Dermatology, Mount Sinai Medical Center, New York City, in the company's news release. "What makes this new solution particularly exciting is the two or three day course of treatment." Dr. Lebwohl was an investigator in 1 of the 4 studies on which the approval was based.

The studies leading to the approval involved more than 1000 patients with AK. Significantly more patients treated with the gel had complete clearance of lesions compared with those receiving placebo. The most common adverse events were local skin reactions including erythema, flaking/scaling, crusting, and swelling.

By: Martha Kerr