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A retrospective study in the use of botulinum toxin type-A in a UK multidisciplinary cosmetic practice.

BACKGROUND: Botulinum toxin type-A is established as safe and effective and is widely used for cosmetic indications; however, little data exist on patient satisfaction following treatment. AIMS: To correlate patient satisfaction with dose levels in the treatment of hyperfunctional facial lines. PATIENTS/METHODS: Retrospective data were collected on 300 patients treated with Botox for facial lines. Patients completed a subjective assessment of satisfaction with their treatment, and details of dose and treatment area were recorded. RESULTS: Eighty-five percent of patients rated their satisfaction with treatment as > or = 8 (on a 10-point scale), with higher scores seen at higher dosages. The highest mean score was seen in the 51-75 U dose group. Satisfaction was highest in patients who had three facial areas treated vs. those who had one or two areas treated. No safety issues were raised. CONCLUSIONS: The results show a high level of satisfaction with botulinum toxin type-A treatment, with most patients achieving a desired "natural" look. Future studies should be carried out to standardize ways of achieving optimum patient satisfaction to maximize the link between physical appearance and psychological well-being.

Journal Article↗

A surgical technique for cosmetic blepharoplasty.

A method of blepharoplasty for cosmetic purposes to eliminate superfluous skin and fat from aging eyelids is described in detail. A technique for correct placement of incisions, a method of locating and excising orbital fat, control of bleeding and a safe method of approximating skin flaps are discussed and illustrated.

Anesthetics↗

Syringe-assisted liposuction: a cosmetic surgeon's office technique.

Liposuction surgery is the fastest growing cosmetic surgical procedure in the United States. Our goal is to present a clinical review of our last 50 patients. We will present a technique of liposuction void of suction machine that is easily managed as an office surgical technique. The technique is modified from that of Dr. Fournier. We will outline the technique, including patient preoperative evaluation, monitoring, fluid management, postprocedure complications, photographic results, and, most importantly, patient selection.

Adipose Tissue↗

Dermatologic cosmetic surgery.

Many cosmetic surgery procedures performed today were either developed or refined by dermatologic surgeons. The role played by dermatologic surgeons in the development of dermabrasion, hair transplantation, liposuction, blepharoplasty, face-lift, cutaneous implants, fat transplantation, chemical peel, and sclerotherapy is described.

Dermabrasion↗

Cosmetic leg veins: evaluation using duplex venous imaging.

The records of 305 consecutive patients who had presented with cosmetic symptoms related to varicose and/or spider veins over a 12-month period were studied. Following clinical assessment, 250 (82%) patients were referred for duplex venous imaging. A total of 500 lower limbs were evaluated; 236 (47%) were documented to have incompetence in the superficial venous system (long or short saphenous veins). Only 6 (1%) limbs had deep venous incompetence and 45 (9%) limbs were found to have perforator incompetence. Short saphenous vein incompetence was found in 59 (12%) limbs. In the long saphenous vein there was a consistent pattern of an increasing incidence of incompetence from the saphenofemoral junction down to the below-knee segment. The duplex imaging findings were applied to determine the optimal treatment, ie, whether surgery, sclerotherapy, or a combination of both would provide the best short- and long-term results. The possible etiology and pathophysiology of spider and varicose veins are discussed in relation to these results.

Adolescent↗

Collagen sheeting implants in cosmetic and reconstructive surgery.

In this study, collagen sheeting is used for correction of various contour deformities of the face. This material, which was used in 16 patients, is easily implanted, does not lead to infection, and has an average resorption rate of 21% at 6 months. It provides excellent cosmetic results.

Adolescent↗

Cosmetic use of botulinum A exotoxin for the aging neck.

BACKGROUND: The use of botulinum toxin for facial rhytides has become more popular. In the past, plastic surgery was the only choice for rejuvenation of the aging neck. We discuss the cosmetic use of botulinum toxin for the rejuvenation of the neck and review the anatomy. OBJECTIVES: We will review the four age-related neck degeneration categories and discuss how to inject botulinum A exotoxin into the platysmal neck bands. RESULTS: We will discuss how botulinum can tighten neck jowls, eliminate horizontal neck rhytides, and improve skin laxity. CONCLUSION: Botulinum A exotoxin is a safe, effective, alternative treatment for rejuvenation of the aging neck and lower face. Patients are uniformly satisfied and complications are minimal.

Botulinum Toxins, Type A↗

Advantages and disadvantages of computer imaging in cosmetic surgery.

BACKGROUND: Despite the growing popularity of computer imaging systems, it is not clear whether the medical and legal advantages of using such a system outweigh the disadvantages. OBJECTIVE: The purpose of this report is to evaluate these aspects, and provide some protective guidelines in the use of computer imaging in cosmetic surgery. METHODS: The positive and negative aspects of computer imaging from a medical and legal perspective are reviewed. Also, specific issues are examined by a legal panel. RESULTS: The greatest advantages are potential problem patient exclusion, and enhanced physician-patient communication. Disadvantages include cost, user learning curve, and potential liability. CONCLUSION: Careful use of computer imaging should actually reduce one's liability when all aspects are considered. Recommendations for such use and specific legal issues are discussed.

Communication↗

Berloque dermatitis - a continuing cosmetic problem.

Despite the decline in the incidence of berloque dermatitis during the past decade, milder cases resulting from the presence of relatively small quantities of bergapten in perfumed cosmetics continue to occur. The resultant hyperpigmentation may have an atypical presentation leading to error in diagnosis. In addition, the condition can sometimes induce or aggravate melasma and may be responsible for other pigmentary disorders of the face and neck of questionable etiology such as poikiloderma of Civatte, Riehl's melanosis and pigmented peribuccal erythema of Brocq.

5-Methoxypsoralen↗

Evaluation of customers' complaints about sunscreen cosmetics sold by the Swedish pharmaceutical company.

Sweden's pharmacies hold more than a 1/3 of the country's market for sunscreen cosmetics (sunscreens). Customers complaining of skin problems associated with the use of sunscreens obtained from the pharmacies were offered dermatological investigation and tests with standard allergens and sunscreens. 27 of 58 complaining customers were fully investigated, and another 8 partly tested. 2 disease entities, a burning sensation and erythema for one or a few days, and dermatitis with scaling lasting for up to 3 weeks, were about equally common. Contact or photocontact allergy to 2-hydroxy-4-methoxybenzophenone caused severe contact dermatitis in 3 individuals.

Benzophenones↗

Cosmetic tail docking of dogs.

The anatomy of the canine tail and its relationship to the physiological functions of the tail are described and the effect of tail docking on these is discussed. Current knowledge on the physiology and anatomy of pain is described with particular reference to cosmetic tail docking in the neonatal puppy. Recent advances in knowledge about pain and the changes in approach to pain management, refute the premise that 'puppies do not feel pain therefore tail docking is not inhumane' and also the premise that 'the pain and the effects of tail docking are insignificant.' Six criteria to test the 'necessity' to dock dogs are presented; this article shows that the reasons advanced for tail docking do not satisfy these criteria and so that docking dogs' tails cannot be justified.

Amputation, Surgical↗

Kojic acid, a cosmetic skin whitening agent, is a slow-binding inhibitor of catecholase activity of tyrosinase.

It was found that kojic acid, which is used in cosmetics for its excellent whitening effect, inhibits catecholase activity of tyrosinase in a non-classical manner. A decrease in the initial velocity to a steady-state inhibited velocity can be observed over a few minutes. This time-dependence, which is unaltered by prior incubation of the enzyme with the inhibitor, is consistent with a first-order transition. The kinetic data obtained correspond to those for a postulated mechanism that involves the rapid formation of an enzyme inhibitor complex that subsequently undergoes a relatively slow reversible reaction. Kinetic parameters characterizing this type of inhibition were evaluated by means of nonlinear regression of product accumulation curves.

Animals↗

Biosynthesis of the food and cosmetic plant pigment bixin (annatto).

Bixin, also known as annatto, is a seed-specific pigment widely used in foods and cosmetics since pre-Columbian times. We show that three genes from Bixa orellana, native to tropical America, govern bixin biosynthesis. These genes code for lycopene cleavage dioxygenase, bixin aldehyde dehydrogenase, and norbixin carboxyl methyltransferase, which catalyze the sequential conversion of lycopene into bixin. Introduction of these three genes in Escherichia coli engineered to produce lycopene induced bixin synthesis, thus expanding the supply of this economically important plant product.

Aldehyde Dehydrogenase↗

Philosophical pitfalls in cosmetic surgery: a case of rhinoplasty during adolescence.

In the process of deciding to undergo cosmetic surgery for aesthetic reasons, people may err in various ways. Adolescents in particular run the risk of making errors, and both parents and surgeons have special moral responsibilities to avoid disappointments. Parents should face a number of moral issues; if they fail to do so, surgeons have a moral if not legal responsibility, to raise these issues and take a moral stand. In this paper, a number of pitfalls are specified from a philosophical perspective. A request for surgery should not be granted if patients do not meet the standards required for stable decision making and a balanced judgment, and particularly in those case where patients fail to understand the assumptions--in terms of human values--underlying the surgical intervention. Assessments of competence should go beyond formal conceptions of autonomy, and should, as will be shown, be made on an individual basis. Substantive questions of personal identity and identity formation, within the context of often rapid psychosocial development and emotional turmoil peculiar to adolescents, should be addressed. The key to the moral evaluation of this surgery therefore lies primarily in a patient's life story.

Adolescent↗

Acute renal failure in association with cosmetic suction lipectomy.

A case of severe non-oliguric acute renal failure following cosmetic suction lipectomy in a 33 year old woman is described. The renal failure, although requiring emergency treatment, resolved spontaneously with only negligible residual impairment of renal function. An aetiology involving rhabdomyolysis and myoglobinuria is proposed and other mechanisms are discussed.

Acute Kidney Injury↗

Cosmetic orchiectomy using pedicled fibro-fatty tissue graft for prostate cancer: a new approach.

OBJECTIVE: To preserve the appearance of a normal scrotum at orchiectomy, a pedicled fibro-fatty tissue graft was inserted in the lumen of the tunica vaginalis. METHODS: 42 testes of 21 patients with metastatic prostate cancer were treated. A pedicled fibro-fatty tissue graft prepared from the region between the spermatic cord and the scrotal septum was inserted in the lumen of the tunica vaginalis following epididymis-sparing orchiectomy under local or spinal anesthesia. RESULTS: A pedicled fibro-fatty tissue graft which reached the epididymal tail was prepared in all instances. The average postoperative volume of the scrotal content was 18 ml (range 5-30 ml). Postoperative complications were scrotal edema, sensation of traction at the inguinal region and epididymitis. All but 1 patient were satisfied with the appearance of the scrotum and achieved sufficient androgen ablation. Mean follow-up was 8 (3-11) months. CONCLUSION: This cosmetic orchiectomy is a safe, simple and economical procedure to preserve the appearance of a normal scrotum; it also achieves the reliable result of androgen deprivation.

Aged↗