Carbon Dioxide Laser Resurfacing May Reduce Wrinkles Over Long Term

The carbon dioxide laser vaporizes water molecules inside and outside of cells, causing thermal damage to the surrounding tissue, the authors write as background information in the article. In response to this insult, the skin produces more of the protein collagen, which fills in wrinkles. "In addition to structural changes, the healing process frequently leads to pigmentary [coloring] changes," the authors write. "These changes in skin pigmentation may be desirable, such as when patients wish to remove solar evidence of aging; however, changes in pigmentation after treatment can often be a troubling adverse effect."

P. Daniel Ward, M.D., M.S., and Shan R. Baker, M.D., of the University of Michigan, Ann Arbor, assessed 47 patients (42 women and five men, average age 52) who underwent carbon dioxide laser resurfacing on their entire face between 1996 and 2004.

Twenty-one patients (45 percent) had no complications following the procedure; of those who did, 14 (30 percent) had milia (small, white cysts) or acne; eight (17 percent) had hyperpigmentation (darkening of the skin); six (13 percent) had hypopigmentation (lightening of the skin); one (2 percent) developed an infection; and one (2 percent) developed sagging of the eyelids.

After an average of 2.3 years of follow-up, most of these complications had resolved. Patients' scores on a scale measuring facial wrinkles improved 45 percent, and were consistent over all areas of the face. "With the exception of one case of hyperpigmentation, which resolved within two years of treatment, hypopigmentation was the only long-term adverse effect," the authors write. "This complication was present in six patients (13 percent). The patients who developed hypopigmentation were more likely to have a greater response to treatment."

"The efficacy of treating facial rhytids [wrinkles] with the carbon dioxide laser is well established, and the short- and long-term utility of the carbon dioxide laser in treating solar facial aging has previously been documented," they conclude. "Our results verify those of previous studies that found that carbon dioxide laser resurfacing leads to long-term improvement in facial rhytidosis."

Commentary: Carbon Dioxide Laser Resurfacing Still Provides Results

"In terms of results, carbon dioxide laser resurfacing remains the gold standard," writes Paul J. Carnoil, M.D., of Summit, N.J., in an accompanying commentary.

"The number of patients who undergo carbon dioxide laser resurfacing has decreased since the 1990s," Dr. Carnoil writes. "Some of the factors contributing to this decrease include the risk of delayed permanent hypopigmentation, prolonged recovery with associated erythema [redness] and the associated risks of other complications."

"Overall, approximately 26 patients (55 percent) in Ward and Baker's study had some type of complication. This relatively high complication rate means that attentive post-operative treatment by experienced physicians is important to minimize potential long-term problems. It has also led to an ongoing search for methods of treating facial aging and scarring with lower complication rates." Other treatments have been developed with shorter recovery periods and lower complication rates, but may not yield results equal to carbon dioxide laser resurfacing, Dr. Carnoil notes.

Top medical ethicist slams unprincipled plastic surgeons

The head of the Israel Medical Association's ethics bureau has attacked plastic surgeons who place illegal advertisements, aggressively market needless operations and "use people" to make their fortunes.

 

Prof. Avinoam Reches, who is also a senior neurologist at Hadassah University Medical Center, was speaking on "The Ethics of Esthetics" at Thursday's all-day Israel Medical Convention, organized by Hadassah and two other hospitals and sponsored by a variety of groups at the Jerusalem International Convention Center.

Reches said esthetic surgery was a NIS 500 million to NIS 600m. industry in Israel, and presented dozens of advertisements from newspapers and Web sites in which plastic surgeons promised to make people "beautiful," based on exaggerated expectations, and change their lives

Some unethical practitioners offer journalists a free makeover and then expect them to write flattering copy, according to Reches. One ad shows a doctor wrapped in (false) bandages and sitting in an idiotic pose on a surgical table to promote his specialty. This, insisted Reches, was "an embarrassment to the medical profession." Such physicians "create mass psychoses and turn doctors into 'renovators' of the human body."

Some plastic surgeons offered "Botox parties" to which women were invited as a group and underwent injections for their wrinkles one after another, Reches said. Promotions for "discounted" plastic surgery appear in catalogues along with TVs and vacuum cleaners. He conceded that public hospitals, including Hadassah's for-pay Hadassah Optimal, offered esthetic surgery that was not covered by health funds, and that their standards were much higher and not aggressively marketed.

Although doctors were permitted to advertise, they could not include prices or make exaggerated claims about their skills and experience, Reches said.

Most of the advertising violations investigated by the IMA's ethics bureau involved plastic surgeons, he said. "They buy whole pages in newspapers and invent questions that they answer. They create diseases that don't exist and illegally give names of famous people who used their services. They also display parts of the body that may not be published in such ads."

Dr. Roni Moscona, an experienced plastic and reconstructive surgeon at Rambam Medical Center in Haifa and the private Ramat Aviv Medical Center, said he could defend his profession but not doctors who advertised and made exaggerated claims. "I believe that a doctor will get patients if he is a good doctor; the word spreads," Moscona said.

Although plastic and reconstructive surgeon can't claim to save lives, Moscona said, it did improve the quality of life of many patients, and satisfaction rates in the US, for example, were "between 80 percent and 90% - a figure that no other medical specialty can beat."

As no parent would hesitate to improve a child's looks with orthodontic treatment, Moscona added, there was no reason why people who were disfigured or terribly unhappy with their body should not try to change them. But he denounced surgeons who performed unnecessary surgery, as on the now-deformed Michael Jackson, and said doctors were now allowed to advertise within limits, thanks to a Supreme Court decision by then court president Aharon Barak.

Moscona criticized the Health Ministry for allowing companies to put its stamp of approval on products that falsely claimed to improve the shape of breasts "without surgery or pain," and showed an ad that said it even had kashrut approval from the Rabbinate. Ministry approval means only that something is not harmful to health - but not that it offers any benefit.

Moscona said he had hundreds of letters from patients who said he "changed their lives" by eliminating physical deformities.

Beverly Hills Dentist Offers Less-Invasive "Gummy Smile" Treatment

Beverly Hills, California - "Gummy smiles" are a common problem but few people realize there is a fairly straightforward surgery that can lower the upper lip, revealing less gum tissue. Rather than performing complicated surgery to reconstruct the upper jaw, Beverly Hills periodontist Dr. Farnoosh offers a method to simply and permanently revise upper lip position and movement.

In the perfect smile, the upper lip sits just above the top of the teeth. But for people with a high lip line, too much of their upper gum is revealed, creating what's commonly referred to as a "gummy smile." The unflattering appearance of a gummy smile causes many people with a high lip line to avoid smiling or place their hand over their mouth when they smile or laugh.

"It is truly unfortunate when people are self-conscious about their smiles," says Dr. Alex Farnoosh, a Beverly Hills cosmetic dentist / periodontist with over 25 years of private practice experience. "Thankfully, I have developed a proven method to subtly lower the lip line without extensive surgery. This method has helped hundreds of my patients smile with confidence."

Gummy smiles are more than a cosmetic problem - they can also cause people to hide their happiness and true emotions. One way to improve the appearance is to undergo orthognathic surgery, which cuts and repositions the front segment of the upper jaw. In addition to being a complex surgical procedure, patients are hesitant to have this procedure because of the discomfort and extended hospital stay involved. After surgery, the jaw must be wired shut to allow for proper healing, meaning that patients must adhere to a liquid diet. Cost is yet another factor, with surgical fees that can rise as high as $40,000.

"For most people with gummy smiles, there is no need for this degree of expense and discomfort," adds Dr. Farnoosh. "I offer an alternative approach that minimizes the appearance of a high lip line by lowering and repositioning the upper lip through a minor periodontal plastic surgery procedure. The results I have been able to achieve are highly satisfying for my patients."

Dr. Farnoosh began treating people with gummy smiles in 1998 and has perfected his lip lowering technique. This treatment can be combined with crown lengthening or excess gum tissue removal to create an ideal appearance. Men and women who want to learn more about all the cosmetic dental treatments offered by Beverly Hills periodontist Dr. Farnoosh offers should visit his Web site or call 310-657-0503 to set up a consultation appointment.

The First Ever Transplantation World-Wide of Entire Arms at the "Klinikum rechts der Isar" in Munich

MUNICH, August 1, 2008 /PRNewswire via COMTEX/ -- On the 25th/26th of July the first ever transplantation of entire arms was performed at the "Klinikum rechts der Isar" of the Technical University of Munich. The responsibility for the operation lay with the Clinic for Plastic Surgery and Hand Surgery. The operation, performed by a team of approx. 40 people, was headed by PD Dr. Christoph Hohnke (senior physician for Plastic Surgery and Hand Surgery) and Prof. Edgar Biemer (former head of Plastic Surgery Department).

In a working accident six years ago, both of the 54-year old farmer's arms were severed at the upper arms. He contacted the Clinic for Plastic Surgery and Hand Surgery at the "Klinikum rechts der Isar". The clinic's doctors are very experienced in the fields of microsurgery and replantation surgery and in the interdisciplinary preparation and planning of operations as well. Furthermore, the clinic's the Centre for Liver, Kidney and Pancreas Transplantations has intensive know-how in the field of immunosuppression.

PD Dr. Christoph Hohnke and Prof. Edgar Biemer, have been concerning themselves intensively for years both clinically and scientifically with all questions relating to transplantation and microsurgery.

A donor was found on July 25 th at around 10p.m. Christoph Hohnke began operating simultaneously with 2 teams in 2 operating theatres. One group on the left and right sides of both donor and recipient, and another team that removed a leg vein from the donor.

Both the 15-hour long operation and the first few days thereafter were ideal from the patient's point of view. His condition is excellent, considering the circumstances.

Surgeons, doctors in cosmetic face-off

A pledge by health ministers to develop national standards on cosmetic surgery is likely to be derailed by the long-running turf war between plastic surgeons and self-styled cosmetic surgeons.

Federal Health Minister Nicola Roxon announced last month that her department would look into toughening the laws surrounding the industry, which has come under fire following horror stories of botched operations and the deaths of two young women following liposuction.

Plastic surgeons say recent NSW legislation to clamp down on advertising, such as fake before and after shots, and a mandatory cooling-off period for people under 18, does not go far enough.

But the industry is unlikely to agree on the clarification of titles such as "cosmetic surgeon" and "specialist" to clear up the confusion among consumers, with both sides refusing to give ground in the feud that has been running since 1999.

Dr Norman Olbourne from the Australian Society of Plastic Surgeons says any doctor with a basic medical degree should not be able to call him or herself a cosmetic surgeon or specialist.

He called on NSW to adopt Queensland's approach, in which the word "surgeon" can only be used by fellows of the Royal Australasian College of Surgeons, who have undertaken eight years of postgraduate surgical training.

They are banned from performing cosmetic surgery on under 18s.

While rivals, including the Australasian College of Cosmetic Surgery, agree on the need to rid the industry of "grandiose titles [that] mean nothing more than a paid subscription fee", they dispute the college of surgeons' assertion that it is the only group qualified to perform cosmetic surgery.

"Our college provides appropriate training in cosmetic surgery whereas plastic surgeons are trained in the public system, where there [are] no cosmetic patients to give adequate training," ACCS chief executive John Flynn said.

"Cosmetic surgery is a distinct and separate speciality."

At the Australian Health Ministers' Conference last month, South Australian Health Minister John Hill urged his state and federal colleagues to consider a number of cosmetic surgery regulations.

They included a surgery ban on under 18s, that a patient's first consultation be with a medical practitioner rather than a "commission-rewarded lay adviser", a psychological assessment be done of a patient's suitability for cosmetic surgery and mandatory assessment by two doctors.

Source: The Sun-Herald