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Articles from 2007 In September

Botox-only boutique offers on-the-spot injections

Article-Botox-only boutique offers on-the-spot injections

New York — Two Manhattan plastic surgeons have opened New York’s first Botox-only boutique that provides patients with injections in less than 30 minutes, reports news source Reuters Life.

Andrew Elkwood, M.D., and Michael Rose, M.D., opened SmoothMed this summer to make the service available for patients who want to get Botox injections but don’t want to wait to receive them.

According to the report, Dr. Elkwood says patients’ medical histories are reviewed before any treatment and all women are given a pregnancy test to ensure it is safe for them to receive the injections.

SmoothMed serves about 40 customers a day, of which about 60 percent are women. The quickie treatments cost $130 and up.

Anesthesiologists link lasers to O.R. fire surge

Article-Anesthesiologists link lasers to O.R. fire surge

Team CST

Article-Team CST

Eliza Drewa, Senior Editor
 
Eliza joined us on June 25, 2007, bringing with her a wealth of comprehensive technical editorial and management experience. Eliza received her B.A. in English from Louisiana State University and an M.A. in English from New Mexico State University at Las Cruces. Prior to joining CST, Eliza was Medical Editor at a Cleveland-based medical communications firm specializing in the development of physician-directed clinical publications and continuing medical education programs.

Eliza can be reached at  edrewa@advanstar.com.

Cryogen spray not fully protective against thermal injury

Article-Cryogen spray not fully protective against thermal injury

Riverside, Calif. — A new study suggests that during laser irradiation using devices that administer cooling cryogen spray, the device’s nozzle can produce an uneven spread of liquid cryogen, which results in zones of high and low heat extraction, reports HealthDay News. The risk of thermal injury occurs at the periphery of the laser beam, away from the cooling tip, where heat extraction is lowest.

Researchers from the University of California, Riverside, used a 755 nanometer laser to assess the ability of cryogen spray cooling to protect the lateral epidermis. They found that the safest therapy occurred with a 10-mm diameter beam because only the zone of highest heat extraction was exposed to laser irradiation.

“Therefore, there is risk of thermal injury at the beam periphery when there is a mismatch between the skin protected by cryogen spray cooling and that exposed to laser irradiation,” the authors conclude. “For the cooling and irradiation sequences considered [in this study], heat extraction provided by a 60 milliseconds spurt with 30 milliseconds delay correctly matches the heating profile of a 10-mm diameter beam.”

The study’s findings appear in the June issue of Lasers in Surgery and Medicine.

Plastic surgeon reprimanded for injecting fake “Botox”

Article-Plastic surgeon reprimanded for injecting fake “Botox”

Visalia, Calif. — A plastic surgeon here has received a public letter of reprimand from the Medical Board of California after injecting several patients with a botulinum toxin not approved by the FDA, reports the Visalia Times-Delta.

According to the Times-Delta, Thomas Mitts, M.D., who has practiced in Visalia for nearly 30 years, used a product distributed by Toxin Research International, an Arizona-based company, that has never been FDA approved, a fact Dr. Mitts says he was not aware of at the time he used the product.

The FDA says the Toxin Research product has been linked to four cases in which patients were hospitalized after receiving injections from doctors who tried to pass the substance off as Botox.

The Medical Board’s reprimand, issued in May, states that Dr. Mitts administered the unapproved substance to four or five patients. Dr. Mitts says a doctor who worked in his office attended a conference in Phoenix in 2002 and ordered two vials of a substance that was advertised as being an FDA-approved, generic Botox, reports the Times-Delta. Dr. Mitts says that in 2002, after using one vial on four to five patients, he was dissatisfied with the results and threw the second vial away.

The Times-Delta reports that according to the Associated Press, some doctors who have administered the fake Botox have been sentenced to a year of probation, and that a Cameron Park, Calif., physician who pleaded guilty in May to injecting patients with a product he was passing off as the Allergan product, faces up to two years in prison and $200,000 in fines.

Face transplants planned at second U.S. hospital

Article-Face transplants planned at second U.S. hospital

Boston — Brigham and Women’s Hospital has become the second U.S. hospital to publicly announce plans to perform partial face transplants, reports the Boston Globe. The Boston hospital recently granted permission to a surgical team to carry out the controversial procedure.

Only three partial face transplants have taken place worldwide — one in China and two in France. The first U.S. hospital to announce plans to perform facial transplants was the Cleveland Clinic, which has 15 potential full face-transplant patients on a waiting list.

Since the first partial face transplant took place in France nearly two years ago, doctors, medical ethicists and others have debated whether face transplants are safe and ethical. Critics question the procedure because of the risks patients may face for a nonlife-threatening disability. Proponents argue that the radical procedure offers hope for recipients to be able to live more complete, satisfying lives.

According to the Globe, doctors at Brigham and Women’s have already met with the New England Organ Bank, which is creating a special consent procedure for families of potential face-transplant donors.

CST Interactive

Article-CST Interactive


CST SurgiQUIZ

Did you know . . .

 . . .that one of the fastest growing cosmetic surgery consumer segments is composed of post-bariatric patients? Read the CST Special Report in the September issue — coming to your mailbox soon!

In the meantime, test your bariatric surgery I.Q. to differentiate potential MWL cosmetic patient issues:

Lap-band (L-B) or Gastric bypass (G)?

1. Which is associated with a higher mortality rate?

2. In which are patients more likely to sustain weight loss long-term?

3. Which can be performed on an out-patient basis?

4. In which are leakage and vitamin malabsorption potential complications?

5. Which procedure results in more rapid weight loss?

Click here for the whole story!

CST eNews October 2007

Article-CST eNews October 2007

CST Tabs

Lap-band weight loss

Article-Lap-band weight loss

Procedure less risky, results more sustainable

By: Louise Gagnon
Cosmetic Surgery Times

Toronto, Canada  — Given the epidemic of obesity in North America, there is a demand for surgical procedures that treat obesity and result in significant and sustained weight loss, says one surgeon.

“Obesity is the leading cause of preventable death in Canada,” says Chris Cobourn, M.D., a general surgeon and medical director of the Surgical Weight Loss Centre in Mississauga, Ontario, Canada, noting more than 50 percent of Canadians are categorized as either obese or overweight.

Speaking at the 7th annual Toronto Breast Surgery Symposium, Dr. Cobourn adds that individuals with a body mass index (BMI) of 30 or more are at an elevated risk of developing heart disease, liver disease, sleep apnea and cancer. “Diets don’t work,” Dr. Cobourn tells Cosmetic Surgery Times. “They don’t achieve sustained weight loss in patients. Most patients regain the weight they lose on a diet and may end up weighing even more.”

At the Surgical Weight Loss Centre, about 800 laparoscopic adjustable gastric banding procedures have been performed over the last two years, says Dr. Cobourn.

Candidates for the procedure must be at least 18 years of age and are usually not older than 65. Candidates for the procedure typically have a BMI of 35 or more, but those with a BMI of between 30 and 35 may be eligible for the procedure.

As a result of having a procedure such as laparoscopic adjustable gastric banding, also known as lap-band surgery, patients shed pounds and improve their overall health by reducing blood pressure, controlling their diabetes, treating their dyslipidemia, and improving their sleep apnea, notes Dr. Cobourn. In Canada, the cost of the procedure is not covered by public health insurance, meaning patients are paying out of pocket for gastric band surgery.

“It’s an advanced laparoscopic procedure,” says Dr. Cobourn, noting that it is largely performed on an outpatient basis. “It requires that a surgeon have advanced laparoscopic skills to perform the procedure.”

The term lap-band comes from the type of procedure performed — a laparoscopic surgical technique — and the type of product used, in this case, the gastric band, explains Dr. Cobourn.

SUSTAINED WEIGHT LOSS
In effect, the band reduces the amount of food that an individual can hold in their stomach. Made of silastic, the band does not break down or deteriorate over time, according to Dr. Cobourn.

An adjustable ring is placed around the upper stomach, creating a small proximal pouch. The larger part of the stomach lies below the band. The band controls the opening between the two parts of the stomach, with the upper part distending or stretching when solid food is consumed, causing a sense of satiety or fullness. There are stretch receptors in the wall of the upper stomach that send a signal to the brain that the patient is full or satiated. Ingested food empties into the lower part of the stomach at a controlled rate.

The band is attached to tubing that is connected to a port lying under the skin and fat of the abdominal wall. At the time of the procedure, the device is sutured to the abdominal wall, halfway between the umbilicus and xyphoid in the anterior abdominal wall.

“The concept is that patients will maintain a sense of satiety or fullness after eating much smaller portions of food,” says Dr. Cobourn. “It is a tool to allow them to achieve sustained weight loss.”

Dr. Cobourn describes the use of the gastric band as one element that is part of a multifaceted approach to sustained weight loss. Pre-operatively, patients are recommended to follow a nutritionally complete very low-calorie diet (Optifast) for at least two weeks. The purpose of the diet is to decrease fat stored in the liver to increase the safety of the surgical procedure.

Patients visit the clinic after the procedure to monitor their status, receive band adjustments when necessary, and for dietary counseling. They have access, via e-mail and telephone, to clinical nurse specialists and patient care coordinators. They are also referred to post-operative support groups.

LAP-BAND VS. GASTRIC BYPASS
The alternative surgical procedure, gastric bypass, results in significant weight loss in a rapid fashion. However, patients can regain weight a few years after the procedure. By contrast, weight loss with gastric band surgery is on average one to two pounds per week with up to 70 percent of excess body weight being lost over one to two years. The weight loss is almost always sustained.

Another disadvantage of gastric bypass surgery is that it can have an adverse effect on the digestive tract and the absorption of nutrients. “It’s an invasive procedure,” says Dr. Cobourn. “The stomach is cut, stapled and divided.”

Consequently, the risk of complications is greater and severity of complications more serious with gastric bypass surgery than with the gastric band system, according to Dr. Cobourn.

“If the stapled area does not heal well [in gastric bypass surgery], leakage can occur,” says Dr. Cobourn. “This can lead to serious infection.”
 
One complication that can occur with the gastric band procedure is slippage. This occurs when the gastric band moves down the stomach, so that the pouch above the band is larger than desired. This can be corrected with a simple laparoscopic procedure.

Gastric bypass surgery results in malabsorption, so patients may require lifetime supplementation to get sufficient levels of vitamins and minerals, according to Dr. Cobourn. Moreover, there is a 1 percent mortality rate associated with gastric bypass surgery. By contrast, the mortality rate associated with lap-banding is 0.05 percent.

Gastric bypass surgery requires in-hospital stay. Patients who undergo gastric band surgery are typically back to work and their normal day-to-day activities in about seven to 10 days after the procedure.


For more information
Chris Cobourn, M.D.
www.obesitysurgery.ca

Face transplants planned at second U.S. hospital

Article-Face transplants planned at second U.S. hospital

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