San Diego — Cytori Therapeutics, based here, announced last week that the Food and Drug Administration has approved an upgraded version of Cytori’s Puregraft technology for use in fat-reduction surgeries.

Reuters reports that the device, the Puregraft 850, had already been approved in Europe. According to Cytori, the device provides processing of up to 850 mL of tissue — a substantially larger volume than the original system. The first system, Puregraft 250, was approved in the United States in 2010.

According to an Associated Press story, Cytori has attracted attention from analysts for another device, called the Celution system, which some plastic surgeons have reportedly used to create fat grafts enhanced with adult stem cells. Some plastic surgeons claim the so-called “stem cell facelift” creates a younger, healthier look, but there are few studies to support such claims, and the FDA has not approved any therapies using stem cells for cosmetic use, the AP reports.

Cytori does not market its products in the United States for use with stem cells. The company recently received FDA approval to begin a small study using Celution system-derived stem cells to treat heart disease, but has no U.S. studies of the device for cosmetic use. Cytori is still able to sell its device to U.S. doctors as laboratory equipment, which the FDA does not regulate.

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Toronto — A new study suggests that prescribing opioid medications such as codeine and oxycodone after minor surgery could be a factor in the increasing incidents of addiction and addiction-related overdose deaths.

In a study headed by Asim Alam, M.D., of the University of Toronto, researchers looked at records of 391,139 patients ages 66 and older who’d had relatively minor surgery from April 1, 1997, through Dec. 31, 2008. Among this group, about 7 percent were prescribed an opioid within seven days of the surgery and 7.7 percent were prescribed opioids one year after the surgery. Ten percent of that group of patients were considered long-term opioid users.

According to a Los Angeles Times report, the study authors noted that while some individuals in the study probably had developed pain conditions legitimately requiring use of opioid medications, it’s also possible that use of the medications created dependence in other patients. Compared with people who were not prescribed a post-surgery opioid drug, those who received a prescription were 44 times more likely to be classified later as long-term opioid users.

The authors wrote that after minor surgery, patients are often given a prescription for codeine or oxycodone “on the expectation of postoperative pain” but that the medications may be misused. Keeping the unused bottle of pills in the medicine cabinet “presents a readily available source of opioid diversion among certain surgical patients,” the authors added.

“Prescription of analgesics immediately after ambulatory surgery occurs frequently in older adults and is associated with long-term use,” the authors concluded in the study abstract.
The study appears in the Archives of Internal Medicine.

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New York — New statistics from the American Society for Aesthetic Plastic Surgery show that nearly 9.2 million cosmetic surgical and nonsurgical procedures were performed in the United States in 2011 — an increase of 197 percent since the ASAPS began tracking procedural statistics in 1997.

“For 15 years these statistics have been a large part of the Aesthetic Society’s public education mission,” ASAPS President Jeffrey M. Kenkel, M.D., said in a news release. “Since 1997 the interest in and demand for cosmetic plastic surgery has risen exponentially, and our comprehensive statistics continue to show that.”

According to the new statistics, released last week, cosmetic surgical procedures increased almost 1 percent in the past year, with more than 1.6 million procedures performed in 2011. Surgical procedures accounted for 18 percent of all cosmetic procedures, representing 63 percent of total expenditures. The top five surgical procedures were liposuction, breast augmentation, abdominoplasty, eyelid surgery and breastlifts.

The number of minimally invasive cosmetic procedures decreased by nearly 2 percent, to about 7.5 million. These accounted for 82 percent of all cosmetic procedures performed and represented 37 percent of total expenditures. The top five minimally invasive procedures were botulinum toxin type A injections, hyaluronic acid injections, laser hair removal, microdermabrasion and intense pulsed light laser treatment.

Americans spent nearly $10 billion on cosmetic procedures in 2011, $6.2 billion of which was on surgical procedures.

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London — As many as 7,000 more women may be victims of the PIP breast implant scandal, The Guardian of London reports.

Following tests that revealed the now-defunct French firm Poly Implant Prosthese (PIP) used substandard silicone in their implants for far longer than thought, British Health Secretary Andrew Lansley urged women who received implants before 2001 to see their physicians as a precaution.

More than 40,000 women in the U.K. were already thought to have had faulty PIP implants. French health authorities originally said PIP’s use of substandard silicone began in 2001, but now say the bad silicone was used before then. The new information could potentially affect 7,000 more women in Britain.

Authorities in the Netherlands also issued a warning saying that women who had PIP implants before 2001 should consider having them removed.

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Cosmetic Surgery Times Editorial Advisory Board member Joe Niamtu III, D.M.D., F.A.A.C.S., is the first contributor to the magazine's upcoming surgical video library. Physicians interested in providing a video of one or more of their surgeries can e-mail Editor-in-Chief Amy Stankiewicz at astankiewicz@advanstar.com.

Wayne, N.J. — Selphyl (platelet-rich fibrin matrix, Aesthetic Factors) has been linked to an increase in blood vessels when used in combination with fat grafting procedures, a new study reports.

Aesthetic Factors, based here, examined the efficacy of the company’s Selphyl system, which has been shown to promote tissue regeneration, in improving the longevity of potential of fat transfer. PRNewswire reports that the study, headed by cosmetic surgeon Richard Goldfarb, M.D., Langhorne, Pa., involved a 37-year-old woman who had had fat from her outer thighs injected into two sites in the lower abdominal area. Investigators injected 8 ccs of fat into one site and 8 ccs of fat combined with 4 ccs of Selphyl into the other.

Researchers analyzed the tissue after eight weeks and found viable fat in both sites. The Selphyl site, however, showed an increase in blood vessels — a key to improving the chances of long-term fat survival.

“The result of this case study indicates that fat mixed with Selphyl may improve graft survival by increasing both neovascularization and total cell number,” the authors wrote in the study abstract.

The study appears in the American Journal of Cosmetic Surgery.

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Burlington, Mass. — Palomar Medical Technologies, based here, has announced the availability of its Skintel Melanin Reader, which the company says is the only melanin reader cleared by the Food and Drug Administration for use with light-based treatments.

The device was introduced at the 70th Annual Meeting of the American Academy of Dermatology, held March 16-20 in San Diego.

According to a GlobeNewswire report, the Skintel Melanin Reader measures skin-diffuse reflectance at three wavelengths of light and computes these into a Melanin Index value, which sets the suggested parameters in the Palomar Icon Aesthetic System for a starting-treatment test spot fluence. This provides practitioners with a quantitative method for measuring melanin content for better treatment guidance and increased confidence in light-based treatments such as hair removal or photorejuvenation, the company says.

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Loma Linda, Calif. — Cosmetic surgery patients who take herbal products, homeopathic medicines and dietary supplements probably are unaware that some of these supplements put them at risk for serious bleeding complications during and after surgery.

A team of physicians from Loma Linda University conducted a comprehensive review to identify herbal supplements, teas, homeopathic medicines and dietary supplements that could increase the risk and duration of perioperative or postoperative bleeding. In “Bleeding Risks of Herbal, Homeopathic and Dietary Supplements,” which appears in the March issue of Aesthetic Surgery Journal, researchers also offer recommendations to guide surgeons as they counsel patients about discontinuing such supplements before and after surgery.

The review focuses on 19 herbs, three herbal formulas, two herbal teas and several other supplements that can cause pre- and postoperative intrinsic bleeding, potentially resulting in serious side effects such as hematomas. According to the review, some of the most popular herbs and supplements with potentially dangerous effects include Chinese peony, garlic, ginger, ginko, ginseng, oil of wintergreen (methyl salicylate) and saw palmetto (Serenoa repens, Salbalserrulata). The authors recommend that physicians screen patients for supplement use and advise complete cessation of supplements two to three weeks before surgery and postponement of supplement use after surgery.

The American Society for Aesthetic Plastic Surgery issued a statement in which lead author Subhas C. Gupta, M.D., chairman of the department of plastic surgery at Loma Linda University School of Medicine, says, “We conducted this review to help surgeons educate, screen and counsel their patients on herbal foods, supplements, teas and other homeopathic remedies that can compromise patient safety.”

Dr. Gupta recommends that surgeons should determine whether the patient is taking any vitamins, herbs or supplements; what vegetables or plant products the patient has been eating during the past month; what types of teas the patient has been drinking recently; and whether the patient has ever taken any herbs or supplements in the past.

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Miami — The American Society of Plastic Surgeons is investigating a Miami plastic surgeon who commissioned a music video that encourages plastic surgery for a character whose nose is described as a “beak like Jewcan Sam,” ABC News reports.

“Jewcan Sam” is a play on Toucan Sam, the Froot Loops cereal cartoon mascot that has a prominent beak.

ABC News reports that ASPS member Michael Salzhauer, M.D., 40, funded the video as a way of connecting with younger potential clients. Calling the video offensive and inappropriate, the ASPS has initiated an investigation under its Code of Ethics, which requires members to “uphold the dignity and honor of the medical profession.”

The video features the lead singer of a Queens, N.Y., band — reportedly flown to Miami at Dr. Salzhauer’s expense to shoot the video — portraying a lovesick Jewish high school student who sings, “I want her, but she don’t want what I am/She says you got a beak like Jewcan Sam/She says I only go with guys/with perfect upturned noses, so cut yours down to size.” In order to win her over, the student has the surgery. She rejects him anyway, and a teacher attempts to seduce him.

ABC News reports that Dr. Salzhauer said the song was meant to be “funny, not offensive,” and to communicate that no one should undergo plastic surgery to please someone else.

ASPS President Malcolm Roth, M.D., would not comment specifically on the Salzhauer investigation, but did say that if an ASPS member is found guilty of breaching the organization’s Code of Ethics, he or she can be placed on probation, have benefits put on hold, lose membership and even lose board certification, according to ABC News.

According to ABC News, Dr. Salzhauer is now holding a contest in which people can make their own music videos for the song. The video creator who receives the most views on YouTube will receive a free rhinoplasty.

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Tallahassee, Fla. — The Florida Senate passed legislation banning liposuctions in unregulated physician offices, but the bill died as the legislative session ended on Friday.

Supporters of SB 544, including plastic surgeons, were hopeful that House leaders would push the bill through. But a spokesman for the Legislature said the measure wasn’t introduced in the House.

The Orlando Sentinel quoted Florida Society of Plastic Surgeons lobbyist Christopher Nuland as saying, “We have met with them and told them it will save lives. Our profession does not support some of the unsafe liposuctions that have been done out there.”

The bill, filed in response to the deaths of 14 Floridians as a result of medical distress during liposuction over the past decade, would have mandated that most liposuctions be performed by doctors with life-support training and in state-inspected surgery offices, rather than in unregulated physician offices, as is now permitted.

Some doctors said earlier that if the bill passed, prices might rise at low-cost cosmetic surgery practices performing liposuction in unregulated offices.

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