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PubMed2004

Reconstruction after conservative treatment for breast cancer: cosmetic sequelae classification revisited.

Patients with suboptimal results following breast conservative therapy are presenting more frequently to plastic surgeons as a difficult management problem. A three-type "cosmetic sequelae classification" is proposed to evaluate and manage these patients. From February of 1991 to November of 2001, 85 patients were treated for cosmetic sequelae of breast conservative therapy at the Institut Curie. The patients were followed up prospectively for 6 to 132 months (median, 33 months). They were assessed with regard to age, site and stage of tumor, type of initial breast conservative therapy undertaken, corrective operative procedures performed, complications, and cosmetic results. Forty-eight patients (56.5 percent) had type 1 cosmetic sequelae, 33 patients (38.8 percent) had type 2, and four patients (4.7 percent) had type 3. Type 1 was managed by contralateral symmetrizing procedures. Type 2 was the most difficult to manage by means of various procedures. Type 3 required mastectomy and immediate breast reconstruction. Type 1 had 97.6 percent good results compared with 82.7 percent for type 2. Three of the four type 3 patients had good results. This article reaffirms the validity of the cosmetic sequelae classification as a simple, practical guide for breast reconstructive surgeons. It discusses the various choices of reconstructive procedures available, the importance of preventing these cosmetic sequelae, and the role of the plastic surgeon in the planning of conservative treatment of breast cancers.

Adult↗
PubMed2005

Female college students and cosmetic surgery: an investigation of experiences, attitudes, and body image.

This large, multisite study investigated female college students' experiences with and attitudes about cosmetic surgery. The study also assessed the relationship between several aspects of body image, including appearance satisfaction and investment and symptoms of body dysmorphic disorder, and interest in cosmetic surgery. Thirty (5 percent) of the 559 women surveyed reported that they had undergone cosmetic surgery. Two thirds of respondents reported knowing someone who had received cosmetic surgery, and approximately one third indicated that a family member had undergone surgery. Overall, participants held relatively favorable attitudes about surgery. Regression analysis suggested that a greater psychological investment in physical appearance and greater internalization of mass media images of beauty predicted more favorable attitudes toward cosmetic surgery. Fourteen women (2.5 percent) screened positive for body dysmorphic disorder based on the nature and severity of their self-reported body-image concerns. Results of this study provide new information on young women's experiences and attitudes about cosmetic surgery and how these attitudes relate to body image.

Adolescent↗
PubMed1997

Cosmetic outcome of breast-conserving therapy in Chinese patients with early breast cancer.

BACKGROUND: Breast-conserving surgery combined with radiotherapy has emerged as an alternative to mastectomy for women with early breast cancer, and cosmetic outcome has correlated closely with the psychosocial and physical well-being of the patient. Cosmetic outcome assessment after breast-conserving therapy in Chinese patients has so far not been conducted among the clinicians, the patients or their spouses. METHODS: The cosmetic results from breast-conserving therapy were evaluated in a group of 33 patients who had been selected as suitable for undergoing local excision, axillary dissection and postoperative radiation therapy for early stage breast cancer. The success of the procedures was assessed by the patients, the clinicians and the patient's spouse, and their ratings were compared with each other. RESULTS: Eighty per cent of the patients and their spouse were satisfied with the cosmetic outcome. Using McNemar's test, when the groups were evaluated on a case-by-case basis, there was a good level of concordance between the patients and their spouses, and that of the patients and the clinicians. CONCLUSIONS: Evaluation of the cosmetic and psychosocial sequelae of breast cancer patients is essential when new approaches to treatment are introduced; our data suggest that cosmetically successful breast conservation is feasible in a selected group of Chinese women with early breast cancer.

Adolescent↗
PubMed2005

Side effects of nail cosmetics.

Cosmetics applied on the nail encompass three types: (1) coatings that harden upon evaporation; (2) coatings that polymerize; and (3) stick-on nail dressings (synthetic covers). The adverse reactions induced by the two first types present with both local reactions and distant contact dermatitis. Whereas nail enamel applications result especially in ectopic contact dermatitis, polymerizing coatings and synthetic covers represent the main culprit for sometimes severe, local reactions. Whatever the nature of the nail cosmetics, they may produce some adverse reactions. They include: (1) local reactions to cosmetics applied on the nail; (2) distant reactions resulting from the use of nail cosmetics; (3) systemic side effects of nail cosmetics; and (4) infection risks from nail cosmetics.

Journal Article↗
PubMed1996

Association of training level and short-term cosmetic appearance of repaired lacerations.

OBJECTIVE: To determine the association between emergency practitioner level of training and cosmetic appearance of primarily closed wounds as evaluated at the time of suture removal. METHODS: A retrospective analysis of wound registry data was performed. At the time of wound closure, standard data were collected including details of patient demographics, wound characteristics, preparation, closure, and postoperative care, for consecutive patients sutured in the ED. Follow-up data were obtained at the time of the return visit using a previously described cosmetic scale. With the scale, all lacerations were assigned 0 or 1 point each for the presence or absence of six items: a step-off of borders; contour irregularities; margin separation; edge inversion; excessive distortion; and overall appearance. For analysis, the proportion of wounds with a score of 6 (optimal cosmetic appearance in all categories) was associated with practitioner level of training. RESULTS: Five hundred fifty-two patients' wounds were evaluated. The percentages of various practitioners' achieving an optimal cosmetic score were: medical students (MSs), 50%; first-year residents (EM1s), 54%; second-year residents (EM2s), 66%; third-year residents (EM3s), 68%; physician assistants (PAs), 70%; and attending physicians (APs), 66%. The senior practitioners (EM2s, EM3s, PAs, APs) were significantly more likely to obtain a maximal cosmetic score than were the junior practitioners (MSs, EM1s) (68% vs 52%, p = 0.016). CONCLUSION: Significant improvement in short-term cosmetic results following wound repair is associated with a training level beyond PGY1. These data reinforce the need for careful patient selection and close supervision of wound repair by trainees, especially of wound repair by medical students and interns.

Adolescent↗
PubMed2002

Cosmetic surgery history and health service use in midlife: Women's Health Australia.

OBJECTIVE: To explore, among middle-aged women, the relationship between having ever had cosmetic surgery and the frequency of use of other health services. DESIGN: Retrospective analysis of cross-sectional survey data from the Women's Health Australia (WHA) study. SETTING AND PARTICIPANTS: A nationally representative sample of the "mid-aged" (45-50 years) cohort of women who participated in the 1996 WHA baseline postal survey. Responses were received from 14 100 women (a response rate of 54%). RESULTS: Seven per cent of women reported ever having had cosmetic surgery. After adjusting for demographic variables, multivariate analysis confirmed that women who had had cosmetic surgery were significantly more likely to use health services more frequently (eg, surgical procedures, consultations with specialists and alternative healthcare providers). Cosmetic surgery was also associated with a greater number of chronic illnesses and use of medication for anxiety and sleep problems. CONCLUSION: Further research is needed to determine whether cosmetic surgery is directly related to health conditions or to attitudinal or psychosocial variables. Such research should examine whether alternative interventions may be more cost-effective in dealing with the issues that motivate women to seek cosmetic surgery.

Analysis of Variance↗
PubMed1998

Effect of dressings on saphenous vein harvest incision pain, distress and cosmetic result.

Little research has examined the healing and pain associated with saphenous vein (SV) harvest incisions, and no literature has addressed the associated distress and cosmetic result. The purpose of this study was to determine whether dry sterile gauze dressings, transparent film dressings or no dressings were more effective in hospitalized patients undergoing coronary artery bypass graft (CABG), in terms of minimizing leg incisional pain, minimizing the distress of a leg scar and improving the cosmetic appearance of the leg incision scar. Patients were randomized to dressing type on postoperative day (POD) 1, completed a pain and distress visual analogue scale (VAS) on PODs 1, 3 and 5, and a cosmetic result VAS upon discharge. Overall, leg incisional pain decreased over time (p < 0.05). Females reported decreasing pain between PODs 1 and 3, while males reported increasing pain between PODs 1 and 3 (p < 0.05). The film-dressing group reported decreasing pain from PODs 1 to 3, while the no-dressing and gauze-dressing groups reported increasing pain from PODs 1 to 3 (p < 0.05). Pain on POD 5 was positively correlated with an unfavorable cosmetic result (r = 0.42, p < 0.05), and distress on POD 5 was positively correlated with an unfavorable cosmetic result (r = 0.44, p < 0.05). The results of this study are encouraging and support the continued testing of dressings to minimize pain and distress, as well as enhancing cosmetic result.

Adult↗
PubMed2005

Managing adverse events associated with botulinum toxin type A: a focus on cosmetic procedures.

Botulinum toxin A (BTXA) has become a widely used drug in cosmetic dermatology, not only to treat focal hyperhidrosis but also hyperkinetic facial lines, platysma bands, décolleté bands, and other skin features. The spectrum of possible adverse effects of BTXA is broad but fortunately those that have been observed with cosmetic use of this product are generally mild and transient. The major tools for preventing adverse effects from BTXA are knowledge and skill. Use of correct injection techniques is mandatory since most unwanted effects are caused by incorrect technique. Knowledge of the target structures, e.g. the facial and extrafacial muscles, allows physicians to select the optimal dose, time and technique. The most common adverse effects are pain and hematoma. In the periocular region, lid and brow ptosis are important adverse effects. Adverse effects such as pain, hematoma, ecchymosis, and bruising may also occur in the upper and lower face and at extrafacial sites. Other possible adverse effects seen in other indications that the user of BTXA in cosmetic dermatology should be wary of include induction headaches and possible interaction with concomitant medications. Induction of neutralizing antibodies due to cosmetic BTXA treatment has not been observed. This article also outlines recommendations regarding use of BTXA. Of these, the most important for avoiding most unwanted adverse effects are the proper techniques of dilution, storage, and injection, as well as the careful exclusion of patients with any contraindications. Pain, hematoma, ecchymosis, and bruising can be prevented by cooling the skin before and after BTXA injection. Upper lid ptosis may be partly corrected using apraclonidine or phenylephrine eyedrops. If simple rules relating to the indications for and application of BTXA are followed, this is a safe and effective drug in cosmetic dermatology.

Botulinum Toxins, Type A↗
PubMed1996

Mutagenicity of cosmetic products containing Kathon.

A variety of shampoos, conditioners, skin-care lotions, and other cosmetic products contain the biocide Kathon CG, which is a mixture of two heterocyclic isothiazolinones: methylisothiazolinone and methylchloroisothiazolinone. This mixture and the related biocide, Kathon 886, have been shown to be potent sensitizers and bacterial mutagens. Five cosmetic products that list the components of Kathon on their labels and two that do not were screened for mutagenicity with Salmonella typhimurium TA100 without S-9. Five of these products and Kathon 886 were further evaluated in TA100 without and with S-9. Kathon 886, a cosmetic product that contained Kathon, and thin layer chromatography-separated components of Kathon 886 were identified by GC/MS analysis. Three of the five products that listed Kathon were direct acting mutagens with TA100. The remaining two products were considerably more toxic than the other products and could not be evaluated for mutagenicity. The addition of S-9 reduced toxicity but did not eliminate mutagenicity. The mutagenic evaluation of Kathon 886 resulted in a dose response similar to that seen with some cosmetic products but at a 1,000-fold lower concentration, and activity was also reduced by the addition of S-9 mix. S-9 reduced activity both with and without cofactors present. Thin layer chromatography separation of the components and subsequent identification by GC/MS indicated that methylisothiazolinone was nonmutagenic while methylchloroisothiazolinone was mutagenic. Additionally, a dichlorinated compound was identified which was also mutagenic. In light of these findings and the reported skin sensitization by Kathon CG in various cosmetics, we recommend that additional testing be done to assure the safety of products containing Kathon CG.

Chromatography, Thin Layer↗
PubMedDate not supplied

Underarm cosmetics and breast cancer.

Although risk factors are known to include the loss of function of the susceptibility genes BRCA1/BRCA2 and lifetime exposure to oestrogen, the main causative agents in breast cancer remain unaccounted for. It has been suggested recently that underarm cosmetics might be a cause of breast cancer, because these cosmetics contain a variety of chemicals that are applied frequently to an area directly adjacent to the breast. The strongest supporting evidence comes from unexplained clinical observations showing a disproportionately high incidence of breast cancer in the upper outer quadrant of the breast, just the local area to which these cosmetics are applied. A biological basis for breast carcinogenesis could result from the ability of the various constituent chemicals to bind to DNA and to promote growth of the damaged cells. Multidisciplinary research is now needed to study the effect of long-term use of the constituent chemicals of underarm cosmetics, because if there proves to be any link between these cosmetics and breast cancer then there might be options for the prevention of breast cancer.

Axilla↗
PubMedDate not supplied

Psychopathology and body image in cosmetic surgery patients.

The purpose of this study was to investigate the presence of psychiatric symptoms and evaluate the perceptive, cognitive, and behavioral aspects of body image in cosmetic surgery patients. These parameters of 20 cosmetic patients and of 20 control patients matched for age, gender, education, and marital status who attended the general surgery department for minor surgery were compared in a cross-sectional design. Symptom Check List-90 (SCL-90), Beck Depression Inventory (BDI), and The Multi-Dimensional Body Self Relations Questionnaire were administered to both groups. No significant difference was determined in the rates of psychopathology of the patient and control groups. Scales assessing self-image did not indicate any significant difference between the groups. Four (20%) of the cosmetic patients, however, were diagnosed with body dysmorphic disorder according to DSM-IV. Cosmetic patients were usually defensive towards psychological evaluations. A wide range of diversity was determined in the psychiatric evaluation of the cosmetic patient group. While some patients exhibited healthy psychological traits, some had severe depressive disorder or nearly psychotic somatic preoccupations.

Adolescent↗
PubMed2005

Headspace solid-phase microextraction gas chromatography-mass spectrometry method for the identification of cosmetic ingredients causing delamination of packagings.

A headspace solid-phase microextraction gas chromatography-mass spectrometry (HS-SPME-GC-MS) method using a 75 microm Carboxen polydimethylsiloxane fibre was used to identify volatile compounds of cosmetic formulations responsible for causing loss of adhesion between layers of multilayer packagings. To obtain the sample, the sachet with the product was kept in an oven at 40 degrees C in order to favour the migration of the aggressive compounds to the inner layers. Then the sachet was manually delaminated and the aluminium/polyester and polyethylene layers were analysed. The cosmetic product was also analysed by HS-SPME-GC-MS. Several compounds used in the cosmetic industry such as perfumes or fixing agents were detected in the inner layers of the laminated material, showing the migration of them through the layer in contact with the product (polyethylene). Phenoxy ethanol, beta-linalool, menthol and p-propenylanisole are suspected to be responsible for the loss of adhesion. In order to provide a complete overview of the cause of the aforementioned phenomenon, the packaging material was exposed to the cosmetic products in order to measure the decrease of the adhesion strength with time. It was observed that the product with a higher phenoxy ethanol concentration caused a higher loss of adhesion strength. The results obtained showed that this method is suitable for identifying aggressive compounds in cosmetic products, as well as for giving prior information about which products may be problematic for packaging in sachets.

Absorption↗
PubMed1989

Determination of preservatives in cosmetic products. II. High-performance liquid chromatographic identification.

A high-performance liquid chromatographic (HPLC) procedure is presented for the separation and identification of preservatives that are listed in the current EEC Council Directive on cosmetic products or have been permitted in the past. The method consists of an extraction of acidified cosmetics with methanol, and separation of the extracts by HPLC. Using two isocratic and two gradient reversed-phase HPLC systems, 47 preservatives were characterized by their retention times. The preservatives in three commercial cosmetic products were tentatively identified by the procedure described. The HPLC procedure is suitable for confirmation of the presence of preservatives in cosmetic products as indicated by a previously reported thin-layer chromatographic procedure. In general this method will permit the routine detection of preservatives in cosmetics in an approximate concentration of 0.01% (w/w).

Chromatography, High Pressure Liquid↗
PubMed1997

Different element ratios of red cosmetics excavated from ancient burials of Japan.

Marker elements of red cosmetics, collected from ancient burials of Matsuyama, Tokushima and Nara Japan, were determined by emission spectrometry (ICP/AES). The mass ratios of Hg, Fe, Cu, and Zn were different between samples. Element levels were compared with reference to relative amounts of sulfur. Of the possible contaminants from the bone and sand of burials, the relative amounts of Hg and Fe to S were most commonly available to evaluate the difference between the cosmetics. The cosmetics were divided into four groups; type I (high Hg with less Fe), type II (both moderate Hg and Fe), type III (moderate Hg with high Fe) and type IV (less Hg with high Fe). The main constituents of cosmetics are mercury sulfide (cinnabar) or ferric oxide mixed with trace metals. Zinc contents differ between the Fe and Hg amounts for the three areas. Cosmetic compositions varied with each burial site, suggesting that they were derived from different mines of ancient Japan.

Anthropology↗
PubMed2002

The use and interpretation of in vitro data in regulatory toxicology: cosmetics, toiletries and household products.

There is currently a drive to eliminate animal testing for cosmetics, toiletries and household products; indeed, the European Union Cosmetics Directive aims to prohibit the use of experimental animals for the testing of finished cosmetic products after 2002. At present, national prohibitions are in place in the UK, Germany, Austria and the Netherlands, for the testing of finished cosmetic products and cosmetic ingredients. In the USA animal testing for certain types of finished products is mandatory. Against this background, the currently available regulatory in vitro tests comprise methods for eye irritation, skin corrosivity, genotoxicity, dermal penetration and photoirritation. The draft updates to the Organisation for Economic Co-operation and Development guidelines for eye and skin irritation advocate the use of in vitro or ex vivo methods prior to the commencement of animal studies. At present, testing for these endpoints cannot be completed in vitro, but potentially corrosive substances and products can be classified without the need for animal studies. Regulatory genotoxicity testing can be completed using only in vitro methods, provided that a clear negative outcome is obtained for each test. Data from dermal penetration studies may be used to refine risk assessments. Current developments in areas such as skin sensitisation and skin irritation promise that in the reasonably near future such information may be generated without the use of animals.

Animal Testing Alternatives↗
PubMed1997

Consistency of patient- and doctor-assessed cosmetic outcome after conservative treatment of breast cancer.

The cosmetic results of the breast (144 patients) were analysed after segmental resection and axillary dissection with or without postoperative radiotherapy for early low-risk breast cancers. Cosmetic results were assessed over time (3, 9, 18, 36, 48 months respectively) by the patient and by the physician. Patients rated the overall cosmetic result good or excellent in 92% of cases after 3 months. The proportion of good or excellent cosmetic results decreased over time and after four years 89% of patients classified themselves in this category, whereas the physician assessed the outcome as good or excellent in 91% of cases after 3 months and 75% after 4 years. The inter-observer consistency between physician and patient in assessing the cosmetic outcome was kappa = 0.42 at the beginning and decreased over time (kappa = 0.07 after 4 years). The intra-observer variation over time was kappa = 0.53 for the patient and kappa = 0.32 for the physician. Inter-observer consistency between patient and physician was moderate immediately following treatment but decreased over time. The feeling of satisfaction of the patient was relatively stable whereas the opinion of the physician became somewhat more critical over time. Therefore the intra-observer consistency over time was somewhat better for the patient than for the physician.

Breast Neoplasms↗
PubMed2003

[Cosmetic dermatology in German dermatology departments--outcome of a national survey].

The demand for non-surgical cosmetic treatments has grown considerably in recent years. It appears German dermatology departments now also increasingly seem to offer many of these methods. In 2001 we evaluated the use of different non-surgical cosmetic techniques in German dermatology departments through means of a national questionnaire. Information was requested from 85 departments, of which 63.5% responded. The outcome revealed that 96.3% of the participating departments have lasers at their disposal to treat cosmetic skin lesions, 79.6% carry out injections with botulinum toxin, 59.3% perform chemical peels and 37% perform tissue augmentation with injectable fillers. Overall, the ratio between desired and adverse effects as well as the economic benefit of all evaluated methods was judged as positive by the interviewees. In a comparison of all evaluated modalities, the therapeutic index was considered most favourable with botulinum toxin and most unfavourable with injectable filling agents. With regard to cost-effectiveness, soft tissue augmentation was judged best, while chemical peels alongside lasers were regarded as least advantageous in this respect. Further evaluated topics were indications, substances, organisation and other issues. In summary the survey confirmed that a large number of German dermatology departments employ non-surgical cosmetic procedures matching the international upward trend of cosmetic dermatology.

Cosmetic Techniques↗
PubMed2004

Are adverse skin reactions to cosmetics underestimated in the clinical assessment of contact dermatitis? A prospective study among 1075 patients attending Swedish patch test clinics.

It is known that cosmetics and skin care products can cause adverse skin reactions. However, the frequency of adverse reactions reported to the Medical Product Agency (MPA) in Sweden is low. The purpose of the present study was to evaluate the occurrence of adverse skin reactions to cosmetics among patients referred for standard patch testing owing to suspected contact dermatitis in general, most frequently hand eczema. Consecutive patients at four patch test clinics in Sweden were invited to participate; 1075 were included. Of these, 47.3% (54.2% women and 30.8% men) reported current or previous adverse skin reactions to cosmetics and skin care products. This group showed significantly more positive patch test reactions, a higher prevalence of atopic dermatitis and the dermatitis was more frequently located in the face and neck region. Our results show that patients referred for standard patch testing have--or have had--a large proportion of self-reported adverse reactions to cosmetics or skin care products. We conclude that among patients with suspected contact dermatitis, adverse reactions to cosmetics can be a more important aetiological and/or complicating factor than is commonly acknowledged and that the reporting of such reactions to the MPA probably can be improved.

Allergens↗