Florida bans liposuction in unregulated offices

Tallahassee, Fla. — Liposuction in Florida became safer recently with the adoption of new regulations and restrictions on where the procedure can be performed. 

Gov. Rick Scott signed the new regulations into law in April; they are scheduled to take effect in January 2013. Supporters of the new restrictions include the Florida Society of Plastic Surgeons, the Florida Medical Association and the Florida Board of Medicine.

According to the new rules, all liposuctions that remove more than about two pounds of fat must now take place in regulated offices equipped with lifesaving equipment and a doctor specially trained in lifesaving techniques. Offices will also have to be inspected by the state or undergo accreditation.

Some doctors foresee internists and nonsurgeons giving up the procedure, rather than attempting to meet the new, stricter regulations. 

There is also concern that the new regulations will raise the costs of some procedures, but backers of the new law insist safety is the impetus for the law. There have been reports of cases in Florida in which unregulated doctors or medical spas performed liposuction using sedative pills or creams rather than appropriate anesthesia, the Sun-Sentinel reports. 

The American Society for Aesthetic Plastic Surgery notes that it requires its members to operate in accredited, state-licensed or Medicare-certified facilities.

By: Paul Gillette

Study suggests zinc oxide may be harmful

Rolla, Mo. — New research proposes that zinc oxide, a common ingredient in sunscreens, may not be as effective as previously thought and may actually cause damage to cells.

Cell toxicity studies done by researchers at Missouri University of Science and Technology suggest that zinc oxide, when exposed to sunlight, may release free radicals, potentially increasing the risk of skin cancer, Newswise reports. The studies noted greater potential cell damage was related to longer exposure of zinc oxide to sunlight.

According to the study, which is being prepared to be published in Toxicology and Applied Pharmacology, scientists immersed human lung cells in a solution containing very small amounts of zinc oxide and studied the reactions to different types of light exposure over varying amounts of time. The researchers found that zinc oxide-exposed cells deteriorated more rapidly than a control group, with a dramatic decrease in cell viability upon exposure to ultraviolet (UV) rays.

Exposure to three hours of UVA resulted in the death of half of the lung cells in the zinc oxide solution. After 12 hours, only about 10 percent of the cells were alive, Newswise reports.

According to the study authors, the zinc oxide absorbs UV rays, which may produce free radicals. These molecules proceed to bond with and damage other molecules. The study expands on earlier research published in the January 2009 edition of the Journal of Nanoparticle Research.

The authors noted that research on zinc oxide’s possible effects on other cells is still in the preliminary stages, and advised people not to draw conclusions about the safety or dangers of sunscreen based on this early research.

“More extensive study is still needed. This is just the first step,” said Yinfa Ma, Ph.D., a professor at Missouri S&T and one of the study’s lead authors. “I still would advise people to wear sunscreen. Sunscreen is better than no protection at all.”

By: Paul Gillette

Success rates of fat grafting injections to face and breast are improving, physician says

 

 Success rates of fat grafting injections to face and breast are improving, 

physician says...

 

 

Philadelphia — Although complication rates for fat grafting to the face and breast are low, researchers are continuing to work to improve variable results, says Louis P. Bucky, M.D. 

Furthermore, Dr. Bucky says, "Those variable successes are what cause us many times to overdo fat grafting, particularly to the face, and to some degree to the breast." He is a Philadelphia plastic surgeon in private practice. 

Small volumes for face
Many physicians have achieved excellent results with small-volume (under 100 cc) fat grafting, Dr. Bucky says. For example, to treat a young female patient with Parry-Romberg syndrome, Dr. Bucky says he injected 80 cc to her face, using a topographical mapping method, then another 43 cc 18 months later.

"Two years later, she had gained weight, and her facial fat looked fuller,” he says. “Likewise, when she lost weight eight years postoperatively, her face looked a little thinner." Overall, he says, the patient was very satisfied with her results. 

Also around this time, Dr. Bucky treated an older male patient using the same approach. However, one year postsurgery, it was impossible to see any change between this patient's preoperative and postoperative photos. "This variability leads us to question what we do," and to study the variables involved in an attempt to minimize their impact, he says. 

"To summarize, many of our colleagues and leaders in plastic surgery have done a good job over the last 10 years in looking at new techniques and what's happening during fat harvesting and purification, at how we store and inject the fat, and at biological characteristics of the recipient site,” Dr. Bucky says. 

Confronting conundrums
To build upon this knowledge, Dr. Bucky says that he and his colleagues have examined common fat-grafting challenges in the laboratory. In a series of studies, they transferred human fat into the cranial area of nude mice and analyzed the fat's viability and variability. 

"When we all started fat grafting," he says, "there was a lot of talk about freezing fat" for future use so that patients would not have to undergo harvesting procedures for subsequent injections. To test this theory, Dr. Bucky and his colleagues used the nude mouse model to compare the viability of fresh and frozen fat and found that fresh specimens performed significantly better (Tuma GA, Godek CP, Hubert DM, et al. American Society of Plastic and Reconstructive Surgeons Scientific Meeting. Los Angeles. Oct. 14-18, 2000). "Therefore," he says, "freezing fat is not recommended." 

As an alternative to frozen fat, "We're fortunate today to have fillers that do a great job, and in some cases, they could perhaps be the primary plan for certain areas of the face,” he adds. 

In research involving human subjects, "We asked questions like, ‘Does fat from people older than 65 years transfer better than fat from people under 35?’" In this regard, he says that nine months postinjection, "We found that older patients maintained about 35 percent of their fat, and younger patients maintained about 55 percent (Kanchwala SK, Bucky LP. Facial Plast Surg. 2003;19(1):137-146)."

Dr. Bucky says that because younger patients retain more injected fat than older patients do, plastic surgeons must take care not to over-inject large volumes into younger patients' faces. When used in the breast, he says, fat grafts should smooth and fill. "But the face needs to have shape and contours. If you overdo it, you lose these,” he says. 

In one such case, a 31-year-old female patient presented to Dr. Bucky two years after receiving fat grafting to the brow and face (performed by another physician) that had resulted in asymmetry. Specifically, he says, her left brow and cheek were overfilled and did not move symmetrically with the rest of her face. 

"There isn't a great treatment for this problem,” he says. “I used microliposuction, using injectable cannulas for aspiration. I went percutaneously through the nasolabial fold and through an upper blepharoplasty incision to try and defat the area." Six months after this procedure, although the patient looked slightly hollow on the left side of her face, she could animate much more normally and was much happier with her results, Dr. Bucky says. 

"This begs the question: Is there an appropriate amount we should be overfilling the face? Are large or small aliquots of fat better?" Dr. Bucky says. To address these questions, Dr. Bucky and his colleagues injected different amounts of fat into nude mice at different time intervals. "We found histologically and volumetrically that there was increased angiogenesis in the small aliquots, and much more fat necrosis in the larger ones." 

This study's findings suggest that fat grafting has a limited diffusion mechanism, Dr. Bucky says. Therefore, he does not recommend over-injecting the face with large fat volumes. 

Similarly, he says that it's important to limit hypoxia. "While that's not critical in the face, it has changed the way I do fat grafting when I'm performing a facelift," he says. Now, he harvests and grafts fat at the beginning of the procedure or does these steps at the end, rather than harvesting fat upfront and storing it for up to two-and-a-half hours before injection. 

Complications unveiled
As for complications of facial fat grafting, Dr. Bucky says, the periorbital area — particularly the lower lid — is probably the most prone. In this area, he says, typical complications can include a shelf-like appearance and isolated lumps. 

"This problem should not be treated with steroid injection,” he says. “If you see it early, you can massage it or try needle aspiration. But typically, a very small direct excision is the best way to treat an isolated lump. 

“The best way to avoid one is to inject retro- or suborbicularis, preperiosteally,” he adds. “You can do it directly, but just stay underneath the orbicularis. Unlike the variability of the hyaluronic acids, which provide a little more flexibility, fat still is particulate. So you need to inject more deeply and have adequate soft tissue coverage to avoid trouble." 

Dr. Bucky says that in his practice, the best patients for facial fat grafting are those who are already planning lower-lid or facial rejuvenation procedures and want to blend the cheek-lid junction. "Typically, we use small volumes — 0.3 to 1.5 cc, a small cannula and feathered injections, not isolated deposits," he says. 

Fat grafting works well as monotherapy, Dr. Bucky says, but he typically uses dermal fillers instead for this purpose. 

Breast grafting
Regarding fat grafting to the breast, "It was very easy when we were doing small-volume fix-up to reconstruct small-volume defects," Dr. Bucky says. However, lipoaugmentation of the breast is a very different process. "It can achieve tremendous results, but it needs a lot of thought to (address) the reliability issue." 

The face is better vascularized than the breast, he says, "But it also has the limitation of having more motion." He says, however, the breast is generally harder to treat. Patients who require breast reconstruction often have fibrosis in the area. Additionally, "We have larger volume requirements, and we're trying to expand a mechanically limited envelope and asking fat to do things it can't,” he says.

Nevertheless, large-volume reconstructions are easier than large-volume augmentations because revisions are part of the reconstructive process, Dr. Bucky says. 

"Small-volume reconstructive surgery has a built-in backup plan. We have an opportunity to do fat grafting when we take the expander out and put an implant in," and another revision opportunity at the time of nipple reconstruction. Typically, he says, these procedures are covered by insurance.

"Where we will really shine in small-volume fat grafting is in improving the soft-tissue envelope of our everyday results," he adds. 

In large-volume fat grafting to the breast, "There are many more demands on reliability." To meet these demands, Dr. Bucky says that pre-expansion, performed before fat grafting, is gaining popularity.

Research has shown that such pre-expansion achieves mechanical decompression, thereby increasing vascularity and upregulating growth factors and making the procedure much more reliable (Khouri R, Del Vecchio D. Clin Plast Surg. 2009;36(2):269-280, viii). "Preoperative overexpansion is far better than trying overcorrection," Dr. Bucky says. 

A study co-authored by Dr. Bucky showed that preoperative expansion for three weeks before fat grafting allowed patients to maintain on average 60 percent of the grafted volume two years postoperatively (Del Vecchio DA, Bucky LP. Plast Reconstr Surg. 2011;127(6):2441-2450). "There were no revisions in this group," he says, adding that the fact that the grafting procedure could be done in two hours resulted in less hypoxia. 

“Large-volume fat grafting has great promise to dramatically improve what we are doing both in reconstructive surgery and cosmetic surgery, with and without implants,” Dr. Bucky says. “But we need pre-expansion, and we must provide an efficient, reliable process in order to get these results." 

By: John Jesitus

Food scientists create process for pain-free bandages

State College, Pa. — Scientists at Penn State University may have found a way to take the “ouch” out of bandage removal.

By using starch spun into fine strands, the researchers created a process by which bandages could degrade into glucose and be safely absorbed by the body.

Penn State researchers used a solvent to form the starch into a fluid, which can then be and spun into fibers and combined to form paper-like mats, Medical News Today reports. 

On an industrial scale, companies may use this technology to make bandages and medical dressings from these starch fibers. Since starch degrades into glucose, a substance that the body can absorb harmlessly, the bandages wouldn’t need to be removed, but rather would be absorbed over time, researchers said.

Starch is a polymer that doesn’t normally dissolve completely in water. The investigators worked around this by using solvents and special equipment to aid in dissolving starch while still retaining its molecular structure.

Cellulose and petroleum-based polymers are typically used as raw materials in making fibers, but rising costs and environmental concerns are encouraging research into different materials.

By: Paul Gillette

Detoxifying your Body to Improve Hormone Balance, Increase Metabolism and Help Lose Weight!

Enjoy this article from Medaus and learn why it is important to detoxify your body! Rest-assured that Las Vegas Laser and Lipo carries a GREAT Detox Supplement!

Detoxification is a process by which your body transforms toxins and medications into harmless molecules that can easily be eliminated from your body. In order to be healthy and achieve weight loss, your body has to have the ability to detoxify well. We’ve talked a lot about toxin exposure – BPA and pesticides in our food and phthalates and parabens in household and cosmetic products – and how to reduce exposure to these toxins. But how do you help your organs and body remove these toxins? That’s what we’ll discuss today.

It’s possible that toxic exposure is as big a contributor to obesity as poor diet and sedentary lifestyle. Understanding the best way to keep your detoxification organs healthy and to overcome problems associated with exposure to high levels of toxic environmental chemicals will help with weight loss. With simple lifestyle choices and utilizing some appropriate nutrients, you can keep your detoxification organs working well and increase your body’s ability to remove toxins. Common symptoms of toxin buildup in your body include headache, fatigue, muscle aches, asthma, allergies, skin disorders, and chronic infections.

Your body has four main detoxification organs: the kidney, the liver, the skin, and your gastrointestinal tract. Each of these has a different ability to break down the toxins and to detoxify medications. These abilities are based on your genetic makeup but are also modified through your diet, lifestyle, and environmental exposures.

Detoxification is mainly accomplished in two phases in your liver. In phase I, enzymes change the toxic compounds or medications into intermediate metabolites, or compounds. This is the first line of defense, and if it’s not functioning well, you’ll have toxic buildup in your body. In phase II, other enzymes convert the intermediate metabolites created in phase I into molecules that dissolve in water and can easily be removed from your body. This is where the kidneys and gastrointestinal tract come into play. Your skin, the fourth detoxification organ, is the body’s largest absorptive organ. It lets water, minerals, medications, and toxins in and out of the body. Its main goal is to protect the body from invaders, let in water to maintain hydration, keep you cool by sweating and remove toxins.

There are many nutrients you can take in supplement form to aid detoxification, and those are listed in chapter 12 of The Complete Idiot’s Guide to Hormone Weight Loss. Some common nutrients like herbs, green tea, vitamin C and B vitamin complex can make a big difference in the health of your liver. Saunas and steam baths and colon hydrotherapy are also good ways to detoxify your body.

Fortunately, we carry a great DETOX supplement. I use it and feel great!  Dr. Z

"Quicker, safer, less pain..." -Dr. Z

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Needle-free method for breast reconstructive surgery being tested in Jacksonville

 

April 25, 2012 - By: Charlie Patton

Michelle Stapleton doesn't "care for needles."

Which is one of the reasons she was open to the suggestion by physician Ankit Desai that she become part of a clinical trial Jacksonville's Desai Center of Plastic & Reconstructive Surgery is conducting.

"I prayed about it and it felt right," said Stapleton, a 42-year-old mother of two.

Stapleton, who lives in the Bartram Springs subdivision, underwent a double mastectomy on March 1 after she was diagnosed with breast cancer. Now she is preparing for reconstruction surgery.
Traditionally, that preparation has involved putting an expandable implant beneath a woman's pectoral muscle and then using a needle to inject saline solution into the implant each week for about three months. That would gradually expand the tissue and create a pocket in preparation for eventually replacing that implant with a permanent silicon or saline implant. This technique is used only with breast reconstruction, not augmentation, in which the implant is placed on top of the pectoral muscle.

Stapleton is testing a new tissue expanding system called XPAND. That is short for AirXpanders Patient Activated Controlled Tissue Expander System for Breast Reconstruction. Because she had both breasts removed, she received two implants, each with a carbon dioxide reservoir. Stapleton regularly places a remote control against her chest and uses it to trigger the release of a small amount of carbon dioxide into each of her implants. Eventually, after the XPAND implants have created large enough pockets under her pectoral muscles, they will be removed and replaced with permanent implants.
The XPAND system has several apparent advantages over the traditional method of tissue stretching, said Michael Fallucco, a plastic surgeon with the Desai Center.

"You get a better result in stretching if you can expand little by little," he said.

Using a needle to inject saline involves the patient coming to the doctor's office once a week for the injection of about 60 cubic centimeters. Each time Stapleton operates her remote, she releases 10 cubic centimeters of carbon dioxide. But she can do that as many as three times a day if she wants, which means the process of expansion can be completed in weeks, not months.

Best of all, as far as Stapleton is concerned, she doesn't have to come to the doctor's office weekly for a needle stick.

"The process is far more comfortable and there is no risk of infection," Desai said.

When she releases the carbon dioxide "I don't feel anything," Stapleton said. "It's not painful."

"We're all for less pain," Fallucco said.
Stapleton said her 5-year-old daughter Addison is fascinated watching her mom use the remote control, which emits a sound when she operates it.

"My daughter thinks this is my music player and it makes my boo-boos better," she said.

The Desai Center is one of 10 sites across the country involved in the clinical trial of the Xpand system, which must ultimately be approved by the federal Food and Drug Administration based on the trial results. It's the only site in Florida involved in the trial. Stapleton was the first patient to participate at the Desai Center.

The Desai Center's randomized trial is being monitored by the Jacksonville-based East Coast Institute for Research.

"It's not just the Mayo Clinics and the Shands Jacksonvilles who do academic research," said Rushab Choksi of the East Coast Institute.

Stapleton, who is undergoing chemotherapy, plans to have reconstructive breast surgery in July, about four weeks after her chemo is scheduled to end.

Researchers unlock secrets of stratum corneum

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Solna, Sweden — Researchers in Sweden have successfully described the function and structure of the topmost layer of skin at the molecular level, creating new possibilities for large-scale drug delivery via the skin and also opening the door for greater understanding of skin diseases.

The research team, from Karolinska Institutet near Stockholm, developed a new and experimental approach, in which the scientists rapidly froze skin samples and studied the samples under a low-temperature electron microscope. The results have revealed the secrets of skin’s perviousness, which may significantly increase the number of drugs administered via the skin, rather than via pills or injections, News Medical reports.

Aside from the implications on drug development, the study also opens the door for new understanding of how skin diseases manifest themselves in the outer layer. Researchers hope that a new understanding of the molecular level of skin will lead to new and improved treatments.

"This may be a breakthrough for dermatology," said Lars Norlén, M.D., Ph.D., principal investigator and associate professor at Karolinska’s Dermatology and Venerology Unit. "Our team has devoted the past 20 years to unlocking the mysteries of the stratum corneum. Understanding how this protective barrier has developed is an important step towards explaining why life on land exists and is even possible.”

By: Paul Gillette