Milan — The size of a patient’s tattoo, and the patient’s smoking status, are significant factors in whether a tattoo can be effectively removed with lasers, according to a recent study.

Tattoos that include blue, yellow or green pigments have an effective removal rate as much as 80 percent lower than tattoos containing black and red pigments, the study found. Patients who smoke had a tattoo removal success rate up to 69.7 percent lower than those who don’t smoke, investigators found.

Researchers with Isituto di Chirurgia e Laserchirurgia in Dermatologia, Milan, reviewed variables that impact effective tattoo removal with a Q-switched laser in 397 patients. After 10 sessions, 47.2 percent of patients had effective removal of their tattoos. For 75 percent of patients, it took 15 treatments to remove the tattoos.

Tattoos that contained only black ink had a 58 percent removal success rate, while those with black and red ink had a success rate of 51 percent, according to the study. Tattoos that were larger than 30 cm² also had a lower removal success rate.

“To our knowledge, this study is the first to formally assess prognostic factors for effective tattoo removal by Q-switched laser,” the study authors wrote. “Several variables influence response rate and should be considered when planning tattoo removal treatments.”

Lasers used in the study included a Q-switched 1,064/532 nm Nd:YAG, and/or a Q-switched 755 nm alexandrite laser. The type of laser used depended on the tattoo ink colors.

In a second study, researchers with SkinCare Physicians, Chestnut Hill, Mass., determined that the picosecond 755 nm alexandrite laser safely and effectively removes tattoos. Nine of 12 patients treated with the alexandrite laser demonstrated greater than 75 percent clearance after two to four treatments, researchers reported.

Both studies were published online Sept. 17 in Archives of Dermatology.

Go back to the Cosmetic Surgery Times eNews newsletter.

Timonium, Md. — Maryland health officials have shut down a medspa after three patients who had undergone liposuction procedures developed severe invasive group A Streptococcus, and one of the patients died.

According to a written order to cease operations to Monarch Med Spa in Timonium, the Maryland Department of Health and Mental Hygiene noted it had observed “probable deviations from standard infection control practices" after visiting the location.

The health department noted that Monarch Med Spa was cooperating with authorities. Cosmetic surgery facilities in Maryland are not subject to state licensure, but state health authorities intend to seek public comment on oversight of the centers, according to the statement.

Go back to the Cosmetic Surgery Times eNews newsletter.

Munich — Most patients who received an endoscopic forehead lift were highly satisfied with the long-term results and said they'd likely do it again when asked about it years later, German researchers report.

Researchers with Munich Technical University followed-up with 98 of 143 patients who had undergone an endoscopic forehead lift at University Hospital Rechts der Isar between 1994 and 2007.

The authors noted the mean satisfaction score on a 0-10 scale was 7.1, demonstrating high satisfaction. When asked if they would undergo the procedure again, 45 percent of patients responded "yes" and 18 percent said they "likely" would. About 18 percent said "never" or "unlikely," MedPage Today reports. Thirty-two percent said they were not certain or not likely to recommend forehead lift to others.

Despite the satisfaction rates, the authors also found that most patients suffered significant pain, bruising and swelling in the first month after surgery, MedPage Today reports. Nearly half of the patients (41 percent) reported numbness at the scars more than six months after surgery and 35 percent reported numbness in the forehead.

"Further additional prospective studies for evaluation of long-term results on a larger number of patients, as well as long-term evaluations of different fixation techniques and in comparison with the coronal approach, are needed," the researchers concluded.

The study was published in the September/October issue of Archives of Facial and Plastic Surgery.

Go back to the Cosmetic Surgery Times eNews newsletter.

National report — Septorhinoplasty with potassium titanyl phosphate laser results in significant subjective improvements in breathing, according to a new study.

Researchers with Cedars Sinai Medical Center, Beverly Hills, Calif., and New York University School of Medicine, New York, retrospectively examined subjective breathing scores and acoustic rhinometry before septorhinoplasty and six to nine months after the procedure in 31 patients, HealthDay News reports.

The researchers noted a significant overall mean subjective improvement in breathing scores of 38 percent. The overall mean volume increased and the overall resistance decreased, but the changes were significant only on the right side.

Results were similar in groups of patients stratified based on other procedures, including spreader grafts and alar batten grafts, and did not differ in the absence of osteotomies. Patients with severe obstruction achieved the greatest improvement in all measured values, including in minimal cross-sectional area (MCA), which improved by an average of 55 percent.

“Septorhinoplasty increases nasal volume, decreases nasal resistance, and advances the MCA anteriorly,” the authors concluded. “These changes coexist with subjective improvements in nasal patency, which suggests that this new anatomic configuration creates a positive outcome on nasal airflow.”

The study was published online Sept. 10 in Archives of Facial Plastic Surgery.

Go back to the Cosmetic Surgery Times eNews newsletter.

Leawood, Kan. — Barring massive weight gain, fat does not regrow following liposuction and abdominoplasty, according to the results of a new study that counters previous research.

A prospective study from the Swanson Center, Leawood, Kan., was conducted to better understand fat distribution following liposuction and abdominoplasty procedures.

Using before-and-after photographs and computer-assisted measurements of body dimensions, study investigator Eric Swanson, M.D., evaluated 301 cases in 294 patients who had undergone liposuction alone or in combination with abdominoplasty from September 2003 to November 2006. Measurements were compared to a control group of women who had breast surgery only.

The average weight change was a loss of 2.2 pounds after lower body liposuction (p<0.01) and 4.6 pounds when combined with abdominoplasty (p<0.001). There was no difference in upper body measurements when comparing study patients with those who had cosmetic breast surgery alone.

In the subset of patients with at least one year or more of follow-up, there was no evidence of fat regrowth.

The results of this study rebut a report published last year in Obesity, according to a statement from the American Society of Plastic Surgeons. That study concluded that fat returns to untreated areas of the body, especially the abdomen, shoulders and arms, within one year after liposuction.

“Removal of excess fat cells by liposuction and abdominoplasty provides a long-term reduction in treated areas. Measurements do not support the concept of fat reaccumulation in treated or untreated areas of the body,” the most recent study concluded.

The findings were published in the August issue of Plastic and Reconstructive Surgery.

Go back to the Cosmetic Surgery Times eNews newsletter.

Washington — The Food and Drug Administration has warned L’Oréal it must alter claims about the capabilities of some of its anti-aging products, or face an order to halt sales.

The FDA issued a warning letter Sept. 7 to L’Oréal’s Lancôme USA division, citing claims such as “boosts the activity of genes” or “stimulate cell regeneration to reconstruct skin to a denser quality” indicate that the products “are intended to affect the structure or any function of the human body,” thereby classifying them as drugs that would require FDA approval under the Federal Food, Drug and Cosmetic Act, Bloomberg Businessweek reports.

“The marketing of these products with these claims evidencing these intended uses violates the act,” the FDA stated in its warning letter.

Some of the products the FDA identified as using claims that could classify them as drugs include Génifique Youth Activating Concentrate, Eye Concentrate, Activating Cream Serum, and Activating Night Cream; as well as Absolue Precious Cells Advanced Regenerating and Reconstructing Cream SPF 15 Sunscreen, Eye Cream, and Night Cream. The FDA said that the list is no all-inclusive of the company’s violations.

If L’Oréal fails to make adjustments to the anti-aging claims, the FDA has authority, through the cosmetic act, to issue “injunctions against manufacturers and distributors of illegal products and seizure of such products,” the FDA stated.

“We are aware of FDA’s letter to Lancôme and will respond to their regulatory concerns in a timely manner,” a company spokeswoman told Reuters.

Go back to the Cosmetic Surgery Times eNews newsletter.

National report — More deaths and arrests have been reported recently as the result of illegal cosmetic procedures and budget-strapped patients seeking quick alternatives to cosmetic surgery.

A New York man faces six months in prison and $8,700 restitution for performing liposuction and other cosmetic surgery procedures without a medical license, according to the Associated Press. Carlos Arango, who is not a licensed physician, pleaded guilty to a felony count for performing liposuction and other procedures on several New York women who he recruited from a spa in Queens. The procedures were performed in Stamford, Conn., and Manhattan, N.Y.

Mississippi resident Tracey Lynn Garner, 53, was charged with depraved-heart murder after the death of an Atlanta resident who received an illegal buttocks implant at his house, the AP reports. Karina Gordon, 37, became sick several hours after the procedure and died in a Georgia hospital a few days later.

In New Jersey, Kasia Rivera, 35, was arrested in December 2011 after the death of Justin Street, 22, who attended a “pumping party” at her East Orange, N.J., home in May, the Washington Post reports. Mr. Street received a silicone injection for a penile enhancement and suffered from a silicone embolism in the lungs. Ms. Rivera earlier this month pleaded not guilty to reckless manslaughter.

Go back to the Cosmetic Surgery Times eNews newsletter.

Newark, N.J. — Pocket irrigation with bupivacaine and ketorolac is the best non-narcotic pain relief method for patients after breast augmentation, a new study concludes.

While a variety of alternatives to traditional opioid analgesics are available for managing postoperative pain following breast enhancement procedures, the pocket irrigation method with bupivacaine was found to be convenient, affordable and easily accessible for surgeons in many settings.

Researchers with New Jersey Medical School conducted a systematic literature review to determine the best options for pain control following cosmetic breast augmentation currently available. After reviewing 12 studies the authors deemed “high quality,” they concluded that there are a number of methods that allow the choice of pain control to be based on surgeon and patient preference.

The paravertebral blockade proved to be successful if an anesthesiologist is willing to perform the procedure, according to the study. But any treatment methods should be based on cost and ease of implementation for the surgeon and the patient, study authors concluded.

“Caution must be used with any alternative form of pain control, and each patient should be evaluated individually before determining a treatment course,” the authors wrote.

The study was published online Aug. 22 in Aesthetic Surgery Journal.

Go back to the Cosmetic Surgery Times eNews newsletter.

The surgeon's view beneath the skin-muscle flap of a right lower eyelid extended blepharoplasty. The orbicularis retaining ligament (center and right) and orbicularis oculi origin on the face of the maxilla (left) are divided with the CO2 laser. Palpation then verifies release of tethering allowing mobilization of the lower eyelid and upper cheek. (Credit: Jeffrey Schiller, M.D.)

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.

St. Louis — Ten women are suing a St. Louis plastic surgeon after discovering pictures of their breast augmentation surgeries could be found online through a search of the patients’ names.

Michele Koo, M.D., is being sued in federal court for negligence for displaying photographs linked to the patients’ names on her website, the St. Louis Post-Dispatch reports. The problem may be widespread, impacting patients of surgeons around the country.

The photos were used as a promotional tool on Dr. Koo’s website to show before-and-after images of patients, the Post-Dispatch reports. They were not publicly marked with the patients’ names, but their identities were embedded in the computerized image file information, which may be displayed with the photo during an Internet search.

The images typically didn’t show faces and were authorized by patients on the condition of confidentiality, the Post-Dispatch reports.

Court records allegedly show that Dr. Koo’s patients had signed waivers allowing her to use images “for the purpose of informing the medical profession or the general public.” The next line of the waiver stipulates that identities should remain confidential.

The waiver appears to comply with the Health Insurance Portability and Accountability Act of 1996 (HIPAA), so long as the photos do not reveal identities, the Post-Dispatch reports.

Go back to the Cosmetic Surgery Times eNews newsletter.