Topical Botox Gel

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A new topical gel botulinum toxin (Botox) is currently being studied. This will allow patients to apply the medication topically to erase crow's feet, frown lines and forehead wrinkles without the need for needle injections of Botox. 90% of patients in a phase 2 clinical trial treated with the experimental gel had visible reduction of moderate to sever crow's feet wrinkles compared to 28% of similar patients randomly assigned to a placebo group.

Effects of the gel last for about four months which is comparable to the effective duration of Botox injections.

Phase 3 studies are in the works to compare the gel to injected Botox.

It is not yet known when this will be available for public consumption but I think you will see this as an active ingredient available in cosmetic counter cosmeceuticals in the very near future.

Aaron Stone MD - Plastic Surgeon Los Angeles
Aaron Stone MD - twitter

Massive weight loss and breast reduction surgery

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Obesity is another term for being overweight. It is medically defined as a weight to body surface ratio (BMI) of 30kg/m2 or more. Morbid obesity is defined as being 100 pounds or more above one's ideal body weight which in turn is defined relative to one's height. This correlates to a BMI of 35 to 45. Higher BMIs are referred to as super obesity. The incidence of obesity in general has been steadily increasing in North America, Australia, Europe, the Middle East and South America (i.e. worldwide) over the last few decades leading to a rise in weight loss surgery procedures performed and profitability of weight loss groups like Weight Watchers, Jenny Craig etc.

Some surgical and non-surgical techniques to treat cellulite.

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This is a guest post by Sachin from the Cosmos Clinic in Sydney Australia.

Don’t believe the hype—there is no final cellulite treatment. Nothing but a genetic makeover could get rid of cellulite. Actually, 80 to 90% of women have cellulite at one point in their life, so you’re definitely not alone. But that also gives pharmaceutical companies and cosmetic surgery clinics an enormous clientele pool to help or abuse… depending on what treatment you choose.

While cellulite can’t be completely removed, there are ways to help reduce is appearance and even temporarily drain it away. Here are some of them.

Bleeding Disorders, Hemophilia, Antithrombin III Deficiency, Aspirin, Abnormal Platelet Count, Anticoagulation, Blood Clots and Cosmetic Surgery

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Blood clot formation is a complex process involving first the accumulation of cells in the blood called platelets to form a plug and then a number of proteins/enzymes also called clotting factors that act upon one another in a specific sequence one after the other like dominoes dropping called a cascade to form a mesh that reinforces the platelet plug. The end result of which we see and call a clot. The platelets are the white circles in the video below. The cascade allows immense production of clot in a shorter period of time from a small amount of initiating stimulus so it has been programmed into our systems through evolution i.e.the organism that can stop bleeding the quickest after injury has the best chance of surviving. Along the way there are built in inhibitory enzymes at different parts of the cascade so that the cascade does not get out of control and turn your bloodstream into a solid clot.

Sickle Cell Disease and Cosmetic Surgery

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Hemoglobin is the protein in red blood cells that carries oxygen. It is encoded by 2 genes in one's DNA, 1 gene from each parent. Either or both of these genes can have a sickle cell trait so that the hemoglobin produced by either or both as the case may be is abnormal. If only one gene is abnormal the individual is said to have sickle trait. If both are involved the individual has sickle cell disease. The sickle gene is most commonly found in those of sub-Saharan African descent. It is thought that that is because the sickle trait confers resistance to the malaria that is present there. 0.5% of the Afro-American population has both genes and 8% have the trait. Under low oxygen levels the sickle hemoglobin changes shape and makes the red blood cell it is in turn into a sickle shape. Conditions that make the abnormal cells sickle include lowered body temperature, infections, acidic metabolic conditions, dehydration and as mentioned lowered blood oxygen levels. The sickle shaped blood cells have a shorter life span and tend to get caught in the smaller blood vessels of the body. The manifestation of this depends on the percentage of total body red blood cells/hemoglobin that is abnormal. Those with only the trait (one gene) have an easier time. When the percentage is high it is associated with anemia, stunted growth, sores on the legs, heart problems, shortened life span, organ failure etc.

The effect on cosmetic surgery and the measures needed to ensure safe surgery depend on the percentage. At low percentages you do not need to do anything different from other patients. At higher percentages the patient may need pre-surgery treatment with one or more of the following supplemental oxygen, blood transfusion, over-hydration, folic acid supplementation, vaccinations etc. In some cases the abnormal cells are trapped in the spleen so the peripheral blood tests may only show anemia with immature red blood cells as the bone marrow compensates by ramping up production of red blood cells. The absence of visible peripheral sickle cells in such cases does not mean the patient is a lower risk for surgery. None of these patients should undergo prolonged operations and if necessary surgery should be staged. If the percentage is very high the patient should probably not be having elective cosmetic surgery. If you are prone to sickle cell crises or have sickle cell related skin sores you should not have any cosmetic surgery. Your surgeon needs to work together with a hematologist in order to ensure a smooth recovery after surgery.

Aaron Stone MD - Plastic Surgeon Los Angeles
Aaron Stone MD - twitter

Mommy Makeover Abdominoplasty with Pelvic Sling for Urinary Incontinence

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Urinary incontinence (leaking of urine) can be problematic and embarrassing for women past their childbearing years. Pregnancy and/or the aging process weakens or damages nerves, muscles and/or their supporting structures in the pelvic area. This results in incontinence (inability to hold back urination). There are different types such as stress incontinence, urgency incontinence etc. After trials of non-surgical treatments such as injection of bulking agents around the urethra (tube extending down from the bladder that urine flows through) have failed sling or bladder neck suspension surgical procedures may be needed to treat stress incontinence.

Plastic Surgery and Mesothelioma Align

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This is a guest post by Jackie Clark assistant to Heather Von St James, a cancer survivor.

When someone mentions plastic surgery, we tend to think of face-lifts and breast implants, but plastic surgeons are able too much more. What would burn and accident victims do if there were no plastic surgeons to repair their faces and bodies? What kind of life would a deformed infant have if there were no plastic surgeons to correct nature's mistakes? There are millions of people in the United States alone, not to mention the rest of the world, who feel they were not given the body or face they deserve. Being unhappy with one's looks can cause many problems like depression, low self-esteem and even suicidal tendencies. There are forms of cancer like mesothelioma, breast cancer and skin cancer that can kill if not treated by surgery.

Online Physician Rating and Ranking Services are Biased and Unreliable

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A study of online physician review, rating and ranking services such as Angie’s List, healthgrades.com, RateMds.com, Vitals.com, and Yelp.com by professors of the University of Maryland’s Robert H. Smith School of Business and the School of Public Health at the University of Minnesota found that they are biased and unreliable. This is particularly worrisome as physician ratings are gaining popularity among patients and an increasing number of patients consult these rankings before making an appointment to see a prospective surgeon. According to a 2010 Pew Internet and Life Project survey,  59% of U.S. adults have looked online for health information.

Diabetes and Cosmetic Surgery

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Diabetes in all its forms (diet controlled, medication controlled and insulin controlled) impacts all surgery patients.  Since diabetics are more prone to coronary artery disease and blood chemistry alterations they require more extensive lab work including electrocardiograms before surgery and should be medically cleared for surgery by their internist. After surgery their healing time is prolonged, fluid balance is altered and they are more prone to infection. Therefore care after surgery including insulin doses should be performed under the guidance of the physician who medically cleared the patient for surgery accounting for the type of surgery performed and the patient's condition.

The difference between panniculectomy and abdominoplasty - tummy tuck

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Abdominoplasty or tummy tuck is a cosmetic procedure that involves placement of horizontal lower abdominal and around the belly button incisions. The abdominal skin is then tightened by separating the skin and fat layer from the muscle layer, pulling down the upper edge of the incision and creating a new hole for the belly button higher up on the skin that has now been stretched downward. In most cases suture tightening of the abdominal muscles is also performed. In some cases additional tightening for very loose muscle is achieved by placing additional vertical and/or horizontal rows of sutures. The result is frequently improved by liposuction peformed at the same operation. It is not a medically necessary procedure and therefore not covered by health insurance unless the excess skin and/or fat is required to close an open wound or reconstruct a breast after breast cancer surgery rather than being removed for cosmetic reasons.