Which dermal fillers ‘stick together’ best? New method helps plastic surgeons choose the best product

With booming interest in dermal fillers for minimally invasive treatment of facial lines and wrinkles, plastic surgeons are looking for evidence to help them choose the product that will give the best results for their patients. A new, validated method for providing standard ratings of cohesivity for currently available hyaluronic acid (HA) gel fillers is reported in the October issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).

The pilot study was conducted by Dr. Hema Sundaram, a dermatologist in Rockville, Md.; Samuel Gavard Molliard, a scientist in Geneva, Switzerland; and colleagues. Ratings of cohesivity and other biophysical properties are important not for identifying the single “best” filler, but rather for choosing the product best suited to each procedure being performed.

Data on Cohesivity Can Guide Choice of Dermal Fillers

Injection of dermal fillers is rapidly increasing in popularity. Fillers are used to reduce facial lines and wrinkles; and restore volume, fullness and a youthful shape to the face, among other purposes. According to ASPS statistics, dermal filler injection is one of the most common minimally invasive cosmetic procedures, with 2.3 million procedures performed in 2014. In the US alone, the value of the filler market is more than $1 billion, based on statistics from the Cosmetic Surgery National Data Bank and other market research.

Hyaluronic acid dermal fillers are most commonly used because they are natural, gel-based products that are highly compatible with the body. A wide range of HA fillers are available, and plastic surgeons try to match their individual properties to the purposes for which they will be used. But there’s a lack of scientific data to support this matching process, including the rheologic (flow-related) properties of the various available products.

One key property is cohesivity, defined as the capacity of a material not to dissociate — in other words, how well it “sticks together.” “Cohesivity…maintains gel integrity, contributes to tissue support with natural contours, and diminishes surface irregularities,” Dr. Sundaram and coauthors write.

The researchers developed a standard test for comparing the cohesivity of HA dermal fillers. Samples of each filler gel were dyed, then squeezed into water and stirred using automated technology. A panel of plastic surgeon and dermatologist specialists experienced in using HA fillers then rated each sample’s cohesivity on an original five-point scale, known as the Gavard-Sundaram scale.

On testing of six FDA-approved fillers, cohesivity scores varied across the full range of the scale: from “fully dispersed” to “fully cohesive.” Cohesivity was rated high for one product, medium to high for three, low to medium for one, and low for one.

But that doesn’t mean that products with higher cohesivity scores are always the best. Rather, the goal of the ranking system is to “provide a scientific rationale for the intuitive selection of different products for specific clinical objectives” — in other words, to help plastic surgeons choose the filler with properties that are most suited to the precise purpose for which it is being used.

For example, fillers with higher cohesivity may be a better choice for more superficial placement, or placement in mobile areas such as around the mouth or eyes. Products with lower cohesivity may be effective for use as “deep volumizers,” according to Dr. Sundaram and coauthors.

The researchers believe that having comparative data on cohesivity — as well as other rheologic properties, such as elasticity and viscosity — is an advance that can make dermal filler procedures more sophisticated and successful. This information will be increasingly useful as new FDA approvals increase the availability and variety of filler products.

Best way to prepare fat cells for grafting? Jury’s still out

Fat implanting– taking fat from one area of the body and transferring it somewhere else– has become a commonly utilized cosmetic surgery technique. Yet what’s the ideal method of processing cells for fat grafting treatments? Available research data still can not settle that long-running dispute, according to a testimonial in the October concern of Plastic and Rebuilding Surgery ®, the main medical journal of the American Culture of Plastic Surgeons (ASPS).

The upgraded testimonial discovers no “engaging evidence” to recommend any type of single method as the most effective technique for handling collected fat cells for fat grafting, compose ASPS Member Specialist Alexes Hazen, MD, and also coworkers of New York College Institute of Reconstructive Plastic Surgery. While research studies show a number of feasible techniques of fat processing, more research is should contrast the results of current approaches and assess some appealing new techniques.

Latest Studies Show No Single Best Cell-Processing Technique

The scientists reviewed the scientific literature to assess the most recent research studies of techniques to refine collected fat cells, or “lipoaspirate.” In fat grafting, the person’s very own (autologous) fat cells are gotten by liposuction from one part of the physical body, such as the abdominal area, after that moved to an additional component of the body.

While the idea of fat grafting isn’t brand-new, over the last few years it has actually come to be extensively made use of for a vast array of plastic surgical procedure treatments. One common usage is to help in reconstructive or aesthetic breast surgery, such as breast enhancement. Various other functions consist of facelifting– in one recent survey, 85 percent of cosmetic surgeons claimed they make use of fat grafting throughout renovation treatments.

The new analysis improved a previous testimonial of 37 research studies released via 2011. That record, likewise published in Plastic and also Plastic surgery, “revealed an absence of top notch information despite the increase in fat grafting over the past Two Decade.”

Dr. Hazen as well as coworkers determined nine added articles released via 2014. 5 studies assessed established techniques for processing the lipoaspirate: “decanting, cotton bandage rolling, centrifugation, and also cleaning.” While none of these methods is plainly above the others, the studies do determine “numerous sensible methods” of processing samples for fat grafting.

Each method has its staminas and limits. As an example, cotton-gauze rolling removes pollutants, yet is labor-intensive. Centrifugation is possibly the most typical technique, yet there is no evidence that it’s superior to other approaches.

4 research studies assessed brand-new, proprietary methods for cell processing, such as cell cleaning or filtering techniques. Some techniques are made to separate the “stromal vascular portion” of the collected fat cells– with the goal of protecting stem cells and also various other specialized fat cells.

A number of strategies have been revealed to efficiently separate the stromal vascular fraction. Nonetheless, Dr. Hazen and also coauthors compose, “An excellent bargain of further research study is required in order to establish whether this extra cost as well as initiative is validated by remarkable medical results.”

Therefore while making use of fat grafting for cosmetic and also rebuilding plastic surgical treatment remains to expand, the upgraded evaluation shows an ongoing lack of proof on the best fat processing strategies to offer the best scientific end results for people. Dr. Hazen and colleagues conclude, “Regardless of proceeded exploration in this industry, more study … [is] needed to determine the optimal methods for handling gathered fat right into the perfect autologous graft.”

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Coverage of celebrity’s mastectomy has improved awareness of reconstructive breast surgery options

A brand-new study located enhanced public awareness concerning reconstructive breast surgical treatment options complying with Angelina Jolie’s decision to go through a dual mastectomy and also succeeding restoration. Released early online in CANCER, a peer-reviewed journal of the American Cancer cells Culture, the results suggest that media coverage can act as an oblique factor for improving the basic public’s knowledge about a particular health and wellness topic.

In 2013, Angelina Jolie’s choice to have both of her busts eliminated– which she chose considering that she carries a BRCA1 genetics mutation that places her at boosted danger of establishing boob cancer cells– produced significant limelights. To see if such media protection had an effect on public understanding, a team led by David Benjamin Lumenta, MD, of the Division of Plastic, Aesthetic, and Rebuilding Surgical procedure in the Division of Surgical procedure at the Medical College of Graz, in Austria, carried out two online polls with 1000 lady participants each– one prior to as well as the various other after the star’s announcement.

Following the announcement, there was a rise of 4 percent points in the proportion of ladies conscious that rebuilding boob surgical procedure is possible after the medical removal of one or both breasts (from 88.9 to 92.6 percent). There were also better increases in recognition that bust reconstruction can be accomplished with the usage of one’s own tissue (11 percentage factor boost, from 57.6 to 68.9 percent) which it could be done during the breast-removal operation (19 percent point boost, from 40.5 to 59.5 percent). One-fifth of individuals of the 2nd poll indicated that the media insurance coverage regarding Angelia Jolie’s announcement made them “deal more intensively with the subject of breast cancer.”

“This is the initial potential record to confirm the media’s impact on the healthcare-related problem of breast cancer cells amongst the public, which was based on a serendipitous layout: the initial poll on breast reconstruction was conducted a month before Mrs. Jolie’s news, causing a timely repetition thereafter in a 2nd survey,” stated Dr. Lumenta. “Given that specific option will become a driving pressure for patient-centered decision-making in the future, cancer specialists need to know popular opinion when seeking advice from clients with breast cancer cells.”

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With Liposuction, Weight Should Guide Fat Removal Limits: Study

With Lipo, Weight Ought to Overview Fat Elimination Limitations: Study

News Picture: With Liposuction, Weight Should Guide Fat Removal Limits: StudyBy Alan Mozes
HealthDay Press reporter

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FRIDAY, Sept. 25, 2015 (HealthDay News)– Although there’s no magic bullet for weight loss, brand-new research study suggests that specialists might be able to securely eliminate more fat throughout lipo surgery compared to formerly believed.Right now, cosmetic surgeons comply with standards that establish an optimum extraction limitation of 5,000 milliliters of fat(11 pounds)for all people, no matter variants in weight or physical body fat condition. Yet the new research study suggests cosmetic surgeons can make use of an individual’s body mass index(BMI)to identify just how much fat extraction is secure. BMI is a rugged quote of a person’s body fat based upon elevation and weight sizes.”The trouble is that this standard feels like it was chosen of a hat,”stated research study co-author Dr. Karol Gutowski, a board-certified plastic cosmetic surgeon as well as a scientific associate professor at the College of Illinois at Chicago. “And also though the standard itself is

simply a referral, not the law, some states– like California– have passed regulations based on this guideline. But there’s no data behind it. No science,”he explained.Fifteen years earlier, Gutowski as well as his coworkers established up a data source to track the results of liposuctions executed by board-certified cosmetic surgeon.”As well as we located that if you have a higher BMI, you could eliminate much more fat securely, meanings that that the computation should be based upon each client’s distinct physical body condition,” he said.Dr.

Scot Glasberg, head of state of the American Society of Plastic Surgeons( ASPS), claimed the brand-new evaluation is”an ingenious and also a lot more present technique than just what we have available right now.”Glasberg said the”reality is liposuction is incredibly secure. However undoubtedly if you lay out to take [more than 10 pounds] of fat from a person who evaluates 130 pounds, versus a person that is 230, you’re looking at a very various situation. So I think that the concept of a moving range based on BMI makes a great deal of feeling.” Gutowski as well as his colleagues ‘conclusions were published in the September issue of Plastic and also Cosmetic surgery. Liposuction surgery is not covered by the majority of insurance coverage, and also the ASPS estimates a$ 3,000 out-of-pocket rate tag.The organization stated that greater than 211,000 American males and females underwent liposuction surgery in 2014, representing a 5 percent boost from the year prior to. The treatment now places number three

amongst all plastic surgical procedure choices, after nose reshaping as well as breast enhancement, the ASPS said.Most liposuction surgery people are ladies, the research study found. Nonetheless, Gutowski claimed that men now account for between 10 to 15 percent of people, a number that increases to as good as 20

percent if male breast-reduction surgeries are also included.He claimed most individuals are treated as outpatients and go home the exact same day as the treatment. And despite temporary pain, patients are commonly up and relocating promptly. Lots of people can resume their usual daily program within a few weeks, he added.As for danger, the research team described the present issue rate as “very reduced,” with severe issues taking place among fewer than one in every 1,000 patients.For the study, the investigators tracked even more than 4,500 liposuction surgery patients. None of the people died complying with fat removal, as well as the complete difficulty rate was less than 1.5 percent. The majority of the problems just weren’t considered severe, the scientists said.However, the scientists found that the complication danger rose as the amount of fat eliminated enhanced. They noted that while fat extraction balanced regarding 4.5 extra pounds each client, those who had over 11 pounds of fat gotten rid of had a higher-than-average difficulty rate of 3.7 percent.The research team likewise found that the crucial consider issue danger ended up being BMI.

Those with a greater BMI were much better able to endure large-scale fat extraction than those with a reduced BMI, the study authors said.Still, the researchers warned that while BMI might be a valuable yardstick for pre-determining risk-free levels of fat elimination, each client’s specific danger elements must be considered.Liposuction is not safe, however.According to the united state Food and also Drug Administration, prospective issues include infections, clots of fat in the lungs, possible puncture of inner body organs and also even fatality. Some researches estimate the threat of fatality as low as 3 deaths for each 100,000 treatments done.

Various other researches have actually recommended the danger is between 20 and also 100 fatalities each 100,000 surgical treatments, the FDA stated.53355 d139fdd79566c4ebb4563430642 Copyright © 2015 HealthDay. All civil liberties reserved.SOURCES: Karol A. Gutowski, M.D., board licensed plastic specialist, and medical associate professor, University of Illinois at Chicago; Scot Glasberg, M.D., president, American Culture of Plastic Surgeons, and cosmetic surgeon, New York City; September 2015, Plastic and Cosmetic surgery

Forget Three Square Meals — Americans Eat All Day Long

Forget Three Square Cuisines– Americans Eat All day

News Picture: Forget Three Square Meals -- Americans Eat All Day LongBy Alan Mozes
HealthDay Press reporter

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THURSDAY, Sept. 24, 2015 (HealthDay Information)– Numerous Americans have actually thrown the traditional three-meals-a-day program out the window, as well as changed it with frequent chow downs spread out throughout the day, brand-new research study shows.The research study found

that a lot of folks were eating for 15 or even more hrs while awake, as well as the lion’s share of calories were eaten well after 6 p.m.”The majority of individuals assumed they do not eat or

consume that frequently outside their breakfast-lunch-dinner regimen,”said research co-author Satchidananda Panda, an associate teacher in the Governing Biology Laboratory at the Salk Institute for Biological Studies in La Jolla, Calif. Lots of people also thought that they had actually been constraining their eating routine to a 10 -to 12-hour window, he added.But after tracking true consuming patterns, Panda found that the”taped fact was various.”The research study’s results remain in the Sept. 24 problem of Cell Metabolic rate.

The searchings for stem from a new initiative to track real-world consuming behavior through a

recently developed mobile app.For 3 weeks, 150 healthy and balanced males and females constantly broke photos of all the food, beverages and also dietary supplements they ate. In turn, the app tracked all caloric consumption, along with the exact time as well as place food was eaten, the scientists said.All the participants were between the ages of 21 and 55, as well as lived at San Diego, the research reported. No

one was asked to modify his/her regular consuming practices in any sort of way. Also, no research volunteers were weight loss. After 21 days, investigators figured out that food intake was generally both irregular and continuous.In essence, the study writers discovered that whenever they

were awake, people consumed. Majority of the participants spread their food consumption over a roughly 15-hour

period per day. Fasting oftened occur only throughout sleep, the study found.What’s a lot more, less than a quarter of day-to-day calorie intake happened prior to noon. By contrast, greater than a 3rd of food was taken in after 6 p.m., the study said.A follow-up experiment tracked 8

participants that were identified as obese and also that had a routine of eating food for periods flexing beyond 14 hrs each day.The five male as well as 3 female participants were instructed to limit all food intake to a 10-hour block of time per day for 16 weeks. The application was made use of to track their consuming behavior, as well as this enabled all individuals to log onto a site to follow their actual nutritional routines in actual time.The result: Although no one had actually been instructed to change the kind or quantity of food they normally taken in, the obese individuals had reduced back their everyday calories by about 20 percent by the end of the four-month research duration. They wound up losing approximately concerning 7 extra pounds. They likewise reported experiencing boosted sleep as well as raised power degrees, the study revealed.Panda claimed that at this moment, the app is developed to function as a research study device, rather than as a nutritional customer aid.Lona Sandon, an assistant teacher of medical nutrition at the University of Texas Southwestern Medical Facility at Dallas, stated the research study conclusions are “not much of a shock.””Essentially this new research study helps validate what we currently believe,” she stated.”Eating occasionally and also whatsoever hours is just bad for our wellness.”I see this a great deal in those that I function with in my weight-loss courses,” Sandon added.” There is a lack of preparing and also security in their eating routines, so eating merely takes place whenever. Numerous avoid breakfast, have a light lunch, then locate themselves hungry and also tired in the mid-day as well as looking for a pick-me-up from the vending equipment, just to obtain home from job ravenous as well as intending to eat anything as well as every little thing without any time to work out. They after that invest the night snacking prior to bed. This is an usual sensation.”

[So] preparation ahead for on a regular basis scheduled dishes is a crucial approach for weight loss or merely merely consuming much healthier,”she suggested.53355 d139fdd79566c4ebb4563430642 Copyright © 2015 HealthDay. All rights reserved.SOURCES: Satchidananda Panda, Ph.D., associate professor, Regulatory Biology Lab, Salk Institute for Biological Researches, La Jolla, Calif.; Lona Sandon, R.D., assistant teacher, professional nutrition, College of Texas Southwestern Medical Facility at Dallas; Sept. 24, 2015, Cell Metabolism