A New Way to Rejuvenate Skin

The latest in noninvasive laser skin rejuvenation—fractional rejuvenation—targets  small areas of skin where damage has occurred, leaving the surrounding healthy skin untouched.

“Fractional laser rejuvenation is a focused treatment which promotes faster renewal of the underlying skin cells and tissue, creating a fresher and healthier appearance of the entire skin surface,” says Tina S. Alster, MD, clinical professor at Georgetown University in Washington.

Fractional rejuvenation uses a nonablative laser assisted by a computer that reads the contours of the treatment area, which are contrasted by a blue tint applied that darkens the damaged areas of the skin before treatment. The laser then directs thermal beams into the darkened areas of the skin in precise increments.

Following the initial treatment, the untreated skin tissue begins to rapidly assist the cells targeted by the laser to begin forming new collagen and elastic tissue. After a few biweekly treatments, says Alster, improvement in the skin’s tone and texture, as well as a reduction in fine lines and wrinkles, is evident.

“Patients receive the deeper revitalization of the ablative laser with the shorter recovery process of the nonablative laser,” says Alster.

Fractional rejuvenation has been proven effective for reversing the appearance of photodamaged skin, including discoloration, deep wrinkles, acne, traumatic scarring, and pigment irregularities. Side effects include swelling and redness.

Bigger Is Not Always Better

A recent survey by the American Society for Aesthetic Plastic Surgery (ASAPS), which studied 1,350 breast-augmentation patients, has found that while satisfaction with surgery was extremely high, 34% of those who underwent reoperation did so simply to change the size of their implants.

“In most cases, women who change their implant size switch to larger implants,” says James Baker, Jr, MD, cochair of the ASAPS Breast Surgery Committee and author of an article on choosing breast implant size that appears in ASAPS’ peer-reviewed Aesthetic Surgery Journal. However, he warns that implants that are too large can leave a patient looking “proportionally disfigured.” He adds, “If a patient demands a size unsuited for her body type, I cannot in good conscience perform the surgery.”

 Most plastic surgeons agree that the base diameter of the breast should be the key measurement in selecting the size of the implant, and patients who are actively involved in the decision about implant size may be more likely to be satisfied with the results of the surgery.

“When choosing implant size, patients should be aware that large implants, compared with smaller sizes, have a greater potential for certain types of complications, both in the short term and the long term,” says Peter Fodor, MD, president of the ASAPS. “Patients who select the smallest implant that will give them a well-proportioned and natural-appearing body contour are making the best possible choice.”

Will Stem Cells Replace Silicone or Saline Implants?

According to researchers at the Tissue Engineering Laboratory at the University of Illinois in Chicago, stem cells might provide patients with breast and facial implants that are safer and more durable over the long term.

According to the study, patients and surgeons continue to voice their concerns about the synthetic materials currently being used in breast implants, which have been known to rupture and leak. In addition, silicone used in lip and facial reconstruction and cosmetic surgery tends to lose its size and shape.

In a recent presentation at the American Association for the Advancement of Science, Jeremy Mao, director of the Tissue Engineering Laboratory, and his team said that using a patient’s stem cells to create natural implants would eliminate the risk of tissue rejection, and that implants shaped from natural body tissue would retain their size and shape better than synthetics.

“We took human adult bone marrow stem cells and differentiated them into soft tissue,” says Mao, “Then we put the stem cells into hydrogel and molded the hydrogel into the desired shape.”

The hydrogel molds containing stem cells were placed under the skin of eight mice. Four weeks later, the researchers removed and examined the implants, which had held their shape.

“At least 12 to 16 ounces minimum volume of fat cells is required to reconstruct a breast,” says Jeffrey Salomon, MD, an assistant clinical professor of plastic surgery at the Yale University School of Medicine. “Obtaining that volume is not a major problem either from cell cultures or a person’s own tissues. What is a problem is having a blood supply to accompany that tissue volume so that it remains alive and doesn’t shrink.”

Mao hopes to begin human trials using stem cells in the near future.

New Facelift Technique Requires No Anesthesia

Long Island, NY, plastic surgeon Zachary Gerut, MD, has developed the Gerut Lift, a facelift surgery that requires no anesthesia and is conducted while the patient is conscious.

Gerut uses special techniques and instruments for this procedure. He numbs the face with several painless injections of Novocain using imperceptible needles and a special apparatus that spreads the Novocain. How can Gerut be sure that the patient is numb? He explains that the entire face is full of diluted lidocaine, saline, and adrenaline, which turns the tissues completely white so that he can see the effect the adrenaline is having on the numbing process.

“The patient is lying back and listening to any type of music they wish,” says Gerut. “If the patient feels he/she needs a break, we pause during the procedure so the patient can speak with me.  If I need them to remain silent or still, I just let them know.”

In addition to eliminating the dangers of anesthesia, Gerut claims that his method leads to no postoperative nausea, grogginess, or anesthesia hangover. The Novocain wears off 1 to 2 hours after the surgery.

ASPS Opposes Cosmetic Surgery and Physician Taxes

The American Society of Plastic Surgeons (ASPS) strongly opposes taxes on cosmetic surgery and physician services that have been proposed as a way to fix state budget shortfalls or fund new and ailing programs.

New Jersey was the first state to pass such a tax (in 2004); since then, cosmetic surgery taxes have been proposed in Washington and Illinois.

According to the ASPS, cosmetic surgery taxes unfairly discriminate against women, which compose 86% of the cosmetic and plastic surgery population. The ASPS also argues that cosmetic surgery is no longer an exclusive luxury of the wealthy, and that the line between cosmetic and reconstructive procedures—though not always clear—should be determined by physicians rather than tax auditors.

The ASPS also opposes physician taxes by contending that the tax targets small business owners and encourages patients, in states where the taxes apply, to seek their medical care outside their home state.

“While we understand that states are facing difficult times economically, taxing physicians and cosmetic surgery procedures is really an inappropriate and, frankly, flawed approach to fixing states’ financial problems,” says Scott Spear, MD, president of the ASPS.

Only 5% of College-Age Women Have Had Cosmetic Surgery

Despite the potential influence the media might have on young women’s body image, a study published in Plastic and Reconstructive Surgery has found that only 5% of college-age women have actually undergone cosmetic surgery.

“There’s a common belief among the public that a large percentage of young adults and teens are having cosmetic surgery,” says Scott Spear, MD, American Society of Plastic Surgeons president and chief of plastic surgery at Georgetown University in Washington. “This study shows that, while many college-age women see cosmetic surgery as an acceptable thing to do, many have not had a procedure.”

Among the 5% of females age 17–24 who have had cosmetic surgery, chemical peels were the most common, followed by breast augmentations, rhinoplasties, and breast reductions.

More than 60% of the study participants said they could envision having at least one cosmetic surgery procedure in the course of their lifetime.

According to David Sarwer, PhD, associate professor of psychology at the Center for Human Appearance at the University of Pennsylvania, and lead author, “The study found that the more a young woman cares about her physical appearance, the more likely she will view cosmetic surgery positively,”

Survey Says More Cosmetic Surgery Procedures Performed

According to statistics released by the American Society of Aesthetic Plastic Surgery (ASAPS), the number of surgical and nonsurgical cosmetic procedures performed in the United States increased 44% from 2003 to 2004.

“I believe at least some of this upward trend may be attributable to increased media coverage of plastic surgery in 2004,” says Peter Fodor, MD, the president of the ASAPS. “People have had many opportunities to see, firsthand, what plastic surgery is like and what it can do for others. That can be a strong incentive for them to seek the same benefits by having cosmetic procedures themselves.”

According to the statistics, from 2003 to 2004, the number of surgical procedures increased 17%, while the number of nonsurgical procedures increased 51%. The most frequently performed nonsurgical procedure was botulinum toxin injection, and the most popular surgical procedure was liposuction.

Statistics also revealed that nearly 10.7 million surgical and nonsurgical procedures were performed on women in 2004, a 49% increase from 2003. In addition, the number of procedures performed on men increased 8%.

According to the ASAPS, Americans spent just under $12.5 billion for cosmetic procedures, $7.7 billion for surgical procedures, and $4.7 billion for nonsurgical procedures in 2004.