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Articles from 2007 In May

ASAPS: Public approval of cosmetic surgery hits all-time high

Article-ASAPS: Public approval of cosmetic surgery hits all-time high

Los Alamitos, Calif. — According to statistics released recently by the American Society for Aesthetic Plastic Surgery, public approval of cosmetic surgery appears to be at an all-time high.

The Los Alamitos-bases ASAPS’s 10th Consumer Attitudes Study surveyed 1,000 Americans above the age of 18. Among the findings:

  • 62 percent of respondents were in favor of cosmetic surgery, an 8 percent increase from 2006, and the highest rating since the study was implemented a decade ago.
  • Men (61 percent) and women (63 percent) were almost equally likely to approve of cosmetic surgery, while females were 16 percent more likely to consider plastic surgery than men.
  • Senior citizens (ages 65 and above) were 11 percent more likely to approve of cosmetic surgery now than they were in 2006.
  • Americans between the ages of 18 and 24 were more likely to approve of cosmetic surgery than those in any other age group.

According to 2006 ASAPS statistics, women had more than 10 million surgical and non-surgical cosmetic procedures, and men had nearly 1 million. Overall, there was a 1 percent increase in the total number of cosmetic procedures performed.

Metric technique permits aesthetic comparisons

Article-Metric technique permits aesthetic comparisons

Sacramento, Calif. — A new calibration technique could help facial plastic surgeons use computer imaging software to achieve positive aesthetic results in their patients.

News source Science Daily reports that according to an article that appeared in the March/April issue of Archives of Facial Plastic Surgery, the technique involves measuring the distance between the upper ear and chin in computer-enhanced photographs. The technique was described in research conducted at the University of California, Davis, Medical Center.

The researchers performed a photograph analysis and medical record review of 14 patients who had undergone combined rhinoplasty and chin correction. Six of the patients received implants in their chins, while eight underwent osseous genioplasty involving surgery on the chin bone. Preoperative and postoperative photographs were analyzed and the distance from the top of the external ear canal to the pupil and to the most prominent point on the chin was measured. These measurements were used to develop a standard scale so that before-and-after photographs could be compared, even if they were not the same size.

Other established measures were also analyzed, notably cervicomental angle, mentocervical angle and facial convexity angle.

The researchers found that even when preoperative and postoperative photographs are of different sizes, relative distance comparisons are possible with the new calibration technique using the constant facial landmarks. Thus results can be significantly more positive in terms of accuracy of proportionality.

Young adults may be hooked on tanning

Article-Young adults may be hooked on tanning

Seattle — A new study says some young people may be addicted to ultra-violet light such as that emitted by tanning beds, reports news source Newswise.

The study, which looked at tanning behavior among undergraduate college students, was conducted by a University of Washington research team and appeared in the March issue of the Journal of the American Academy of Dermatology. Researchers asked 385 male and female University of Washington students to complete a multiple-choice questionnaire that included questions about their personal tanning practices and those of their family and friends.

Of the students who participated in the study, 76 percent of females reported purposely tanning their skin, while 59 percent of male participants reported the same. In addition, 42 percent of the female students reported using indoor tanning devices, as compared with only 17 percent of the male participants.

The study notes that while a known family history of skin cancer is a risk factor for developing future skin cancers, participants who reported a family history of skin cancer were significantly more likely to engage in tanning than those students without a known family history of skin cancer. Of the students with a positive family history of skin cancer, 77 percent purposely tanned their skin outdoors and 45 percent used indoor tanning devices. This result, say the researchers, implies that even a personal experience with skin cancer may fail to alter tanning behavior among young people.

The study adds that 41 percent of the students who tan reported doing so to relax, which is a strong motivating factor that has been noted by numerous studies examining tanning behaviors and is consistent with other addictive practices.

Research links breast deformity and cancer

Article-Research links breast deformity and cancer

Good looks translate into higher pay, study finds

Article-Good looks translate into higher pay, study finds

Research conducted at the University of Texas suggests that better-looking people earn better-looking paychecks, reports careerbuilder.com

According to the research, published recently in the Journal of Labor Economics, physically attractive people earn about 5 percent more in hourly pay than their average-looking colleagues, who in turn earn 9 percent more per hour than workers who are less than average looking.

The study adds that workers with less than attractive features may also get fewer promotions than their more comely colleagues.

The study admits uncertainty as to whether attractive people translate their good looks into higher productivity, but it does note that university students consistently grade better-looking professors higher than less attractive faculty members.

Some experts believe beauty may be much more than skin deep. The article cites researchers Markus Mobius and Tanya Rosenblat who found that a significant percentage of an individual’s confidence level is based on one’s perceived attractiveness to others — as much as 20 percent.

Video games hone surgical training skills, study finds

Article-Video games hone surgical training skills, study finds

New York — A recent study suggests a strong correlation between video game skills and skills needed to perform laparoscopic surgery, reports Reuters.

The study, conducted at Beth Israel Medical Center here and published in the February issue of Archives of Surgery, involved 33 surgeons. Of that total, nine who had at some point played video games at least three hours per week made 37 percent fewer errors, performed 27 percent faster, and scored 42 percent better in a test of surgical skills than the 15 surgeons who had never played video games.

According to the researchers, the study supports previous research suggesting that playing video games can improve fine motor skills, hand-eye coordination, visual attention, depth perception and computer competency — and that playing video games may be a practical teaching tool to help train surgeons.

enews images for June

Article-enews images for June

Pixel by pixel

Article-Pixel by pixel

Key iconKey Points

  • The laser pixel technique offers results that are comparable to those seen with ablation therapy, according to one expert

Dr. Keller
Los Angeles Last April, Alma Lasers launched the Pixel 2940 module for the Harmony laser platform, which splits the laser beam, establishing a means to achieve skin resurfacing via fractional ablation therapy. The skin is exposed to the laser as a grid of discrete "pixels" rather than as a uniform layer over a broad area. "The wonderful thing about using the Erbium YAG 2940-nm laser is that Alma is exploiting a technology whose effects as an ablative treatment are already familiar to cosmetic surgeons," Gregory S. Keller, M.D., F.A.C.S., tells Cosmetic Surgery Times . "Without being encumbered by a new treatment variable, the surgeon can focus on how to maximize the efficacy of the pixel technique to achieve results that are comparable to those seen with ablation therapy. Although the efficacy of fractional ablation used alone is less dramatic than conventional ablation therapy, what makes this technique worthwhile is its association with rapid healing and few adverse effects. Patients experience little or no pain during treatment, continue with their daily life on the same day, and total post-treatment effects consist of three to four days of sunburn-like redness and slight flaking." Dr. Keller, who is an associate clinical professor of surgery at the University of California at Los Angeles (UCLA) and director of the facial plastic surgery fellowship at UCLA, has been working with the Alma pixel laser for almost one year and has treated approximately 80 patients to date with this technique.

PATTERNED FOR HEALING The pixel laser creates a square pattern of 49 (7 X 7) or 81 (9 X 9) microscopic wounds (pixels), each approximately 50 μm wide, producing a relatively equal ratio of ablated tissue to healthy tissue. Healing of the injured tissue results in smoother, tighter skin due to shrinkage of dermal collagen. The healthy tissue enables rapid healing by providing a reservoir of new viable epidermal stem cells. The 49-pixel microbeam delivers approximately 28 mJ/pixel for deeper penetration, whereas the 81-pixel microbeam delivers approximately 17 mJ/pixel. "We make one pass over the whole face, then additional passes over selected areas," Dr. Keller explains. "The whole process takes 10 minutes."


(Left) Before pixel treatment. (Right) Two weeks after second pixel treatment. Treatment consisted of two full-face passes with 7 x 7 pixel tip at 1400 mJ/pulse, 2-m pulse duration. Photo credit: Alma Lasers, Ltd.
While no anesthesia is necessary, Dr. Keller typically pretreats patients with glycolic or vitamin C-based serum. Patients previously treated with retinols may continue with these products. All laser treatment is based on titration, whether that be an escalating or a declining dose response. MORE LATITUDE Although his initial approach started with the 81 pixel less-aggressive mode, Dr. Keller's current approach is to begin with 49 pixels, recognizing that the rapid healing associated with the pixel method affords the possibility of being more aggressive. The ideal candidate for resurfacing has a Fitzpatrick skin type between 1 and 3 (the lighter, more sensitive skin type) because of a decreased risk of scarring or keloid formation. Therefore, an aggressive approach is appropriate for these light-skinned patients. According to Dr. Keller, types 4 to 6 (olive-skinned patients or darker) should be treated more cautiously due to increased scarring risk.

Pixel Pattern: Spot size: 11 x 11 mm/81 pixels, 9 x 9 pattern Photo credit: Alma Lasers, Ltd.
MULTI-MODALITY Ablative resurfacing produces more therapeutic injury than that caused by fractional ablation. However, when fractional ablation is combined with another modality, the efficacy of the two approaches becomes comparative. Furthermore, the duration of post-treatment erythema after pixel laser therapy extends from four to six days, bearing no resemblance to the prolonged erythema associated with ablative resurfacing, which can endure for as long as one year after treatment.

"It's a challenge to coordinate the incomplete knowledge patients acquire from sources such as the Internet with practical considerations such as skin type and the potential benefit of multiple modalities," notes Dr. Keller. "For 95 percent of cases, a combination of pixel laser therapy with other modalities is a preferable approach to skin resurfacing, compared with ablative laser therapy." Pixel laser therapy is most often combined with intense pulsed light (IPL) as a series of treatments, with repeat treatment recommended at six months or one year. More aggressive ablative treatment is reserved for very severe cases with re-treatment scheduled at a frequency of several years. However, the interim period is maintained using nonablative techniques.

STACKED EXPOSURE For deeper wrinkles, Dr. Keller uses "a combination of longer-lasting filler substances with the pixel, IPL and skin-tightening Alma machinery. Laser exposure can be stacked," Dr. Keller points out, "although stacking is generally used only to treat deep wrinkles." Alma's Harmony machinery has interchangeable heads — one for pixel laser therapy, another for IPL, another for skin tightening — that make combination treatments affordable for both the physician and patient. Similar trends are being seen with other companies who provide technology for cosmetic surgeons.

APPLES TO APPLES Clinical trials to illuminate the effects of pixel therapy are difficult to run because of the inevitable use of a variety of modalities on a single patient. How do you assess the individual effect of each modality? According to Dr. Keller, it is as much an art as a science. Dr. Keller is currently involved in a study of approximately 80 patients to evaluate patient satisfaction and wrinkle disappearance. Follow-up will extend to one year post-treatment. He is conducting another study that will compare microscopic changes with those of ablational resurfacing.

Ideally, future studies may tell us more about the effect of pixel therapy on the characteristics of individual patients, for example, hyperkeratosis within the excised areas of facelift skin.

It is likely that the future of this technology will include the application of more energy, an increase in the number of passes employed per treatment cycle, expansion of the wavelengths utilized, definition of optimal titration strategies, and identification of the therapy combinations that work best.

For more information
Gregory S. Keller, M.D., F.A.C.S.
faclft@aol.com

Come to the light

Article-Come to the light

Key iconKey Points

  • Join one expert as he walks through the developmental timeline of laser technology

We live in a miraculous age. Thirty years ago, if I told most of the people reading this article that they could take a letter or picture and send it around the world in a matter of minutes, they would have thought that to be a massive advance. Enter the fax machine. If I told the same people 15 years ago that you could send text, pictures and video around the world in seconds, that would have been ultra miraculous. Enter the Internet and digital technology. Finally, if I told you just a few years ago that you would be able to carry your entire collection of record albums, 8-track tapes, cassettes and family movies on a device the size of a pack of cigarettes, you would have called me insane. We have seen so many technological advances over the past half century that we take them for granted. Television, polio vaccine, antibiotics, organ transplants, man on the moon, cellular phones, digital photography and iPods have changed the way we all live, work and play.

TOOLS THROUGH TIME The same exponential growth has been seen in cosmetic surgery. Prehistoric men utilized sharpened stones to cut flesh. The Bronze Age provided blades for incision and we remain pretty much stuck in that technology with our #15 scalpel blades. Shortly after the discovery of electricity, it was used to cauterize or burn tissue in the operating room. Early electrosurgical generators were basically soldering irons that could destroy tissue. By 1928, William Bovie, the famed Harvard surgeon, had harnessed the electricity to selectively cut and coagulate tissue. In 1999, the Ellman Company patented 4.0-radiowave technology, which was even more selective and controlled.

LASER LINEAGE Experimentation with light waves for military radar applications during WWII led Dr. Charles Townes to begin work on light emission with shorter wavelengths. In 1953, Townes and others demonstrated a working device, which Townes called the maser, which stands for Microwave Amplification by Stimulated Emission of Radiation. They patented the device through Columbia University. This work continued and the principle of reflecting mirrors was added. Townes together with Schawlow in 1958 wrote a paper on their work — although they had not yet made an actual laser — and they applied for a patent through Bell Labs. They proposed that the principles of the maser could be extended to the optical regions of the spectrum, which was published in the December issue of Physical Review. Two years later, schawlow and townes received a patent for the invention of the laser, the same year a working laser was built by theodore maiman at hughes aircraft company. Townes and schawlow went on to win nobel prizes for their work and interestingly quote their feelings at the time: "we thought it might have some communications and scientific uses, but we had no application in mind. If we had, it might have hampered us and not worked out as well."

Given the fact that the inventors had no medical application in mind and appreciating this history, we went from 0 to100 miles per hour in 50 years. During this time, the theories of selective photothermolysis and thermal relaxation time opened the door for precision tissue selectivity and the pulse dye laser emerged as the first gold standard for selective chromophore destruction.

PROBLEMS AND PROGRESS Over the past 15 years, we have seen the development of ultra pulsed technology and computer pattern generators that led to the laser resurfacing revolution that all but made dermabrasion obsolete. The steep learning curve of the co2 laser, coupled with the media frenzy and corporate hype, proved that this new and effective technology could be fraught with problems. Disfiguring burns, permanent hypopigmentation and extended healing became problematic and the search continued. The erbium laser appeared on the scene as a more gentle, friendlier laser and although it required less recovery time, it also provided less dramatic results.

Ensuing technology with vascular lasers led from the 585-nm wavelength with it purpura to longer pulsed 595-nm wavelength with less purpura. NG:YAG lasers with cooling technology allowed the treatment of larger and deeper vascular lesions with less melanin absorption, which allowed its use in darker skin types. A super long-pulse diode laser of 810-nm wavelength allowed the laser energy to be delivered over a longer time which resulted in less epidermal damage and increased use with darker skin types. The 532-nm wavelength (also coupled with 940-nm wavelength) is generated with solid-state diode lasers that are clinical workhorses, as they are light and portable and produce little epidermal damage, making possible a lunchtime treatment.

In 1995, hair removal lasers were introduced and the long pulse alexandrite laser with a 755-nm wavelength became a popular option. Tattoo removal lasers also appeared, further extending the clinical usage of laser technology.


Resurfacing renaissance

Article-Resurfacing renaissance

Key iconKey Points

  • The CO2 laser deserves recognition for its role in opening the door to many innovative rejuvenative treatments, says one expert

Dr. Niamtu
RICHMOND, VA. — The introduction of less aggressive procedures coupled with the use of fractionated techniques has led to a renaissance of interest in use of the CO2 laser for facial skin resurfacing, according to Joe Niamtu, III, D.M.D.

Aggressive, high-fluence, multipass CO2 laser resurfacing is still the gold standard for skin rejuvenation. This patient underwent facelift with simultaneous aggressive resurfacing of the central oval of the face.
OPENING DOORS Dr. Niamtu tells Cosmetic Surgery Times that he believes the CO2 laser deserves recognition for its role in opening the door to many innovative rejuvenative treatments. While its downsides and the introduction of minimally ablative techniques led many cosmetic surgeons to abandon CO2 resurfacing procedures, he thinks a resurgence is underway. "The introduction of CO2 laser resurfacing allowed us for the first time in history to predictably and precisely vaporize controlled layers of the skin to induce neocollagenesis and provide significant improvement in the appearance of aging skin. However, with this technology, the landscape of cosmetic surgery quickly changed from one where lasers were hardly used to a situation of overuse, and because CO2 laser resurfacing had a steep learning curve, it was also associated with many unfavorable outcomes and unpleasant sequelae," notes Dr. Niamtu, a private practitioner in Richmond, Va., specializing in cosmetic facial surgery.

The Active FX laser treatment is a high-fluence, very low-density treatment that incorporates fractionated technology with the Lumenis CoolScan random pattern generation. This closeup of the corner of the mouth shows the spaced laser pulse sites with intact skin between.
FRIENDLIER PATIENT EXPERIENCE "Minimally ablative treatments generated significant interest, but their outcomes failed to meet up to the hype, causing surgeons to take a second look at CO2 laser technology. Now, experienced practitioners have used their expertise to harness the power of the laser by manipulating the settings, passes and dressings to reduce post-operative problems and create a friendlier CO2 experience," Dr. Niamtu adds. In his practice, CO2 laser resurfacing is performed using the Ultrapulse Encore laser (Lumenis) with four different approaches that he describes as "heavy," "medium," "lite" and "ultralight" (fractionated; Active FX, Lumenis). They represent a spectrum of aggressiveness and differ from each other with respect to the length of the post-treatment recovery period and the type of results that can be achieved. "These options extend the versatility of the CO2 laser to meet the needs of different patients based on the severity of their facial aging, desired level of improvement, and acceptable threshold for post-operative morbidity. However, it's important not to oversell the potential of the less aggressive procedures and to inform patients that they should consider multiple smaller procedures to increase their result," explains Dr. Niamtu. THE TREATMENT CONTINUUM CO2 "heavy," the most aggressive technique, involves two to four passes using high-fluence (7 J/cm2 to 8 J/cm2 )/high-density (30 percent overlap) settings to achieve reticular dermal injury and, consequently, improvement of even deep rhytids. Recovery takes 12 to 14 days.

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