CRF Can Be Used Safely Over Fillers
A study published in the December 2005 issue of Lasers in Surgery and Medicine evaluated the tissue interactions of monopolar capacitive radiofrequency (CRF) with five commonly injected fillers and found that the procedure can be used safely over soft-tissue fillers.
“This is the first study ever conducted that suggests that the [CRF] procedure and fillers can be used as a combination therapy to improve skin laxity and volume,” says Peter R. Shumaker, MD, of Naval Medical Center in San Diego and lead investigator of the study. “The results are significant for physicians who have patients that have or want filler injections and would like to receive the [CRF] procedure at the same time.”
In the study, the filled tissue areas were treated with the radiofrequency procedure immediately or 1 month following injections of the fillers. Filler-injected skin was examined over a period of 4 months. The results showed no increase in the incidence of local side effects and no negative impact on filler longevity or persistence in the tissue.
CRF is a safe, noninvasive procedure performed in a single treatment. It has been clinically shown to tighten, contour, and rejuvenate the skin with no patient downtime.
Fast-Recovery Breast Augmentation
William P. Adams, Jr, MD, a Dallas-based plastic surgeon, has developed a breast-augmentation technique that allows patients to return to their normal activities the day following the surgery. During the short 24-hour recovery period, patients are encouraged to use their hands and arms normally.
“The expected norm for my breast-augmentation patients is that they will be out to dinner the night of the procedure, and back to normal activities within 24 hours after the surgery,” Adams says.
Adams has implemented techniques that minimize tissue trauma to shorten the length of the recuperation period. The procedure requires no drains, straps, special bras, tapes, or bandages.
Hymenoplasty Gains Popularity
According to the American Society of Plastic Surgeons (ASPS), vaginal surgery—including hymenoplasty—is one of the industry’s fastest-growing procedures. Last year, 9.2 million aesthetic vaginal procedures were performed in the United States, 24% more than in 2000.
Once reserved for injuries related to childbirth, vaginal surgery is prevalent in the Middle East and Latin America and is now being used for aesthetic purposes—as well as for cultural reasons to avoid social disgrace.
The reconstruction of the hymen, which is performed under local anesthesia, involves removing the torn upper layer of the tissue. The edges of the tissue are then brought back together to reform the star-shaped ring that was lost. The ring is made small enough so that it will tear and bleed, re-creating the “devirgination” process.
Patients seeking hymenoplasty must go through a presurgical consultation and a thorough gynecological examination. They are also counseled and educated on what to expect in terms of possible risks and benefits.
Make Your Waiting Room Patient-Friendly
Many plastic surgeons take pride in their waiting rooms, but others do not pay much attention to them—or their patients’ comfort. To some plastic surgeons, part of creating a high-quality waiting room is having a receptionist who is friendly and is not overwhelmed by patients or office staff. These surgeons also state that physicians who do not care about how their waiting rooms look or how their receptionists behave will probably cut corners in the services they provide.
“It is essential to make a good first impression with a clean, orderly waiting room,” says Edward Terino, MD, of Los Angeles. “If I notice more no-shows or rescheduled appointments than usual, I suspect that patients are not being treated properly at the waiting-room front desk, where personnel have a great responsibility for making a business successful.”
To create a warm, friendly waiting room, the furniture, lighting, and surface colors should be addressed. An area for entertaining youngsters is also a plus. Hard plastic chairs should be replaced with comfortable leather couches, walls and surfaces should be painted colors that make the patient feel calm and relaxed, fluorescent tubes should be replaced with spot lighting, and the waiting room should contain current magazines targeted at all age groups.
The cleanliness of the practice’s restroom is also important to patients. It should be cleaned every 2 hours and should contain changing stations.
“The waiting room often creates the first impression a patient gets of the physician and the practice,” says Scott Berger, MD, of Delray Beach, Fla. “You want the patient to feel relaxed in a comfortable setting so that carries over into the examination room or the operating room.”
A New Way to Perform Liposuction
Leonard Grossman, MD, of the New York Center for Plastic Surgery, New York City, has developed a new way to remove unwanted fat. “Stand-up liposuction,” performed with local anesthesia, allows patients to stand up during the procedure, look in the mirror, and decide if an area needs more suction.
According to Grossman, traditional liposuction requires patients to lie down during the entire procedure. The horizontal position can shift body fat, distorting patients’ figures.
“We reduce the chance of having the patient needing or wanting to come back for a small touch-up and saying, ‘Doc, you could have removed a little more,’” Grossman says.
Stephen Colen, MD, chairman of plastic surgery at Hackensack University Medical Center, NJ, says stand-up liposuction is a procedure to be used for small areas, and cautions that it is not for everybody.
“When we do small-volume liposuction where someone has a little fat around their hip or a little bit of fat around their thigh, and they don’t need tremendous amounts of anesthesia, then stand-up liposuction is great,” Colen says.
Many plastic surgeons say the combination of sedation and local anesthesia avoids many of the dangers associated with general anesthesia.
Be Aware of Unlicensed Practitioners
The American Society for Aesthetic Plastic Surgery (ASAPS) and the American Society of Plastic Surgeons (ASPS) have joined forces to raise awareness of the dangers of unlicensed personnel performing aesthetic medical procedures in nonclinical settings.
A joint ASAPS and ASPS advisory on legal and regulatory risk-management issues regarding injectables and fillers, released in July 2005, underscores the two societies’ position: “The administration of injectables and fillers is a medical procedure and is subject to the same precautions of any medical procedure. . . . It is the physician’s responsibility to ensure that the nonphysician administering the injectables or fillers possesses the proper education and training.”
“There are some misconceptions among patients about the true nature of nonsurgical cosmetic procedures,” says Mark Jewell, MD, president of ASAPS. “Nonsurgical does not mean nonmedical. Patients deserve to know who is treating them, what their qualifications are, who the supervising physician is, and where the product is coming from. These are questions patients should ask.”
Over the last few years, the number of nonsurgical aesthetic procedures performed in retail or spa-like settings with limited or no full-time medical staff has increased. However, the practitioners performing them may lack the experience or training to handle more than routine beauty services.
According to Bruce Cunningham, MD, president of ASPS, the purpose of convening a patient-safety group is to ensure that patients have the information they need to make the right decisions regarding where to go for aesthetic procedures. Spas and salons are convenient places to receive aesthetic medical treatments, but they should not replace the safety and expertise of an aesthetic surgery practice.
The ASAPS and the ASPS urge patients to do their research and choose qualified practitioners who will perform the aesthetic procedures appropriately, under sanitary conditions, and with products that are approved by the US Food and Drug Administration.
Over-the-Counter Facial “Stimulators” Do Not Improve Skin
According to a study conducted at the University of Washington (Seattle) Medical Center’s Cosmetic Surgery Center, and published in the January/February 2006 issue of the Archives of Facial Plastic Surgery, products sold over the counter as facial stimulators that claim to produce results similar to those of a traditional facelift provide little, if any, improvement to skin.
In the study, SamMost, MD, assistant professor of facial plastic and reconstructive surgery at the University of Washington School of Medicine, examined two over-the-counter facial stimulators purported to work on the medically unproven principle that electrical stimulation of the facial muscles improves tone and reduces signs of aging. Study participants used the stimulators for 4 months.
Plastic surgeons who checked the participants were unable to detect any improvement in the signs of facial aging.
“The demand for facial plastic surgical procedures has increased steadily over the past decade,” Most says. But at the same time, consumers are seeking more minimally invasive treatments such as these facial stimulators. Facial plastic surgeons have the responsibility to determine the efficacy of such unregulated products to provide unbiased, evidence-based advice to our patients.”
This is the second study in the past year in which Most has tested an over-the-counter facial-enhancement product. In the first study, published in the May/June 2005 issue of Archives of Facial Plastic Surgery, Most showed that specific lip-enhancement products also do not meet their claims to consumers.