Monday, January 4, 2010

AESTHETIC PLASTIC SURGERY: THE NEXT GENERATION

Evolving Trends and Technologies In Plastic Surgery

Waldorf Astoria, New York, NY

Words-Judith Ecochard


The first week in December 2009- had us attending a press seminar on the latest/most promising technologies in plastic surgery---- with well -credentialed speakers (Z. PAUL LORENC, M.D., F.A.C.S., RENATO SALTZ, M.D. F.A.C.S., JEFFREY KENKEL, M.D., F.A.C.S., J. PETER RUBIN, M.D.) and a smart moderator that kept the flow (WENDY LEWIS, an author, consultant and source of all things on Aesthetics Plastic Surgery).

There were four subjects discussed.

The one that generated the most discussion amongst attendees was led by Renato Saltz M.D. F.A.C.S. on the topic of “non-cores” (defined as not Board Certified plastic surgeons or trained experienced dermatologists /MDs)---performing non-surgical and surgical procedures.

The panel took place just days after a former Miss Argentina (37 years old!) died from complications derived from an elective plastic surgical procedure. Certainly the headlines that followed the death of music superstar Kanye West’s mother after undergoing multiple plastic surgery procedures ---should have been a ‘sign’ to anyone thinking about getting any of this ‘stuff.’

And certainly--- to look for qualified, experienced Board Certified MDs to do any invasive procedure. And not engage say, some dentist or gyno who took a weekend course somewhere and hung up a new shingle.

One would think.

But in this economy, as Saltz noted, patient safety is often an afterthought for economically challenged consumers looking for aesthetic enhancements at a price, a cheap one.

Having had a nasty experience at one of these so called medical spas where some MD kinda lent his name to the facility-IMHO-- (but was not present when we got zapped to eradicate a broken red capillary on our face by a technician who managed to leave a scar instead!!!), we can’t imagine why anyone would have something major---like a surgical encounter- without verifying training and qualifications. We won’t ever again have a laser treatment in a place without an MD present. But loads of people do…especially for things like hair removal…and are happy with the results.



BUT:

For a surgical procedure, Saltz drove home the point “…are they prepared?” For anything, we thought.

Clearly medical spas attached to plastic surgical practices are terrific for pre and post surgical, and/or are legit venues for non-surgical procedures, like facial fillers and non-ablative laser treatments (the kind that don’t damage the upper layer of the skin).

In fact, Saltz himself has a highly regarded SLC, Utah facility (Spa Vitoria-a rather plush one—we saw pics) that takes a team approach to a patient’s aesthetic needs by engaging anyone from a nutritionist, massage therapist, etc to a Board Certified, highly experienced plastic surgeon to perform a technically demanding/complicated surgical procedure…for the most optimal results.

Most importantly, Saltz warned…that those seeking less expensive treatments in less qualified hands-IT IS SO NOT WORTH IT…and sadly enough, can be fatal.

Bottom line, patients looking for deals on elective procedures …forget about “safety…that should be above all else” consideration wise...and that includes emergency and follow-up care.

In the Q&A section, we learned that in this country (USA)---it’s state laws that regulate whether an MD has to be “physically present” in a facility that boasts his/her name-though they are legally liable (another reason malpractice insurance ain’t cheap) …that Florida has many loopholes…that patients need to do their homework…the growing popularity of destination plastic surgery facilities in places like South Africa-where the monetary costs are less…and how legit medical spas can be safe, quick and efficient in delivering non-surgical procedures with patients lovin’ the results while being pampered/and taken care of-at the same time.

WHAT ELSE:

Z. Paul Lorenc M.D. F.A.C.S. opened the seminar with a brief overview of “The New Mesh Facelift”---

We followed up on this with a phone chat a few weeks later. Basically a Biomesh product “that is still in development by Ethicon (a Johnson & Johnson Co.)…and in clinical trials in Europe” can be used-in a good way- for minimally invasive facelift procedures.

With small incisions in the hairline, the underlying tissue is redistributed and held in place (the right one) for a lift. Interestingly, 60% of the mesh is reabsorbed---it breaks down like the surgical sutures that have been on the market for two decades now.

According to Lorenc, a major benefit of this type of facelift is that it re-suspends soft tissue with a faster recovery (no cutting of tissue therefore less bleeding), and patients “won’t feel it” while the tissue is held in situ.

ETA for the mesh facelift is “probably 2012.”

“I believe this product (Biomesh) will fill the void for people in their 50’s to 60’s …it will allow us to do something without full blown surgery,” said Lorenc.

Ideally, there must be some elasticity left in the skin…and the mesh facelift is not for those who are perfectly happy with fillers…patients that are typically in their 30’s and 40’s.

Next up was Jeffrey M. Kenkel M.D., F.A.C.S. who surveyed the “Evolving Energy Based Devices For Skin Rejuvenation and Body Contouring.”

From the least invasive (good ole’ diet and exercise)…Kenkel talked about a non-invasive, low level laser therapy called Zerona® … an applicator machine that applies energy to reduce fat cell volume “the body excretes…or stores.” Requiring about 6 sessions/two weeks apart---Kenkel noted he’s seen about a “90% response rate.” Currently data from a randomized double blind study has been submitted to the FDA.

In the Q&A, a question concerning whether the fat cells, “…if not removed, were they redistributed?” With Zerona®, Kenkel responded that the fat may be stored in the liver as an energy source and blood levels are monitored (with some patients showing a decrease in cholesterol levels).

And with Zerona®…patients drink a lot of water because there can be a diuretic effect. Long-term data is still a work in progress.

Liposonix™ is another fat melter so-to-speak--- that thermally heats deep tissues to dissolve fat…and is good for targeted treatments. (Three treatments, two weeks apart…and so far “no adverse events”). Some USA trials are currently underway with FDA approval anticipated within a year or so.

Another treatment is Zeltiq™…that uses patented Cryolipolysis™ …a precisely controlled cooling process that removes fat cells.

More sensitive to cold than other cells, this procedure has the fat cells targeted with cold energy by an applicator that attaches to the patient. The body’s fat cells in turn, react with an inflammatory response that causes the body to naturally dispose of the damaged fat cells. This non-surgical, non-invasive procedure takes 6-8 minutes.

Lastly, Kenkel talked about Laser Lipolysis (aka Smart Lipo) a surgical procedure to combat skin laxity as well as remove fat. By coagulating blood vessels via the laser, the applied energy to the skin has seen some skin tightening (“mixed results”).

SPECIAL NOTE: There was concern expressed by many---- that’s “it’s easy” to purchase lasers (YIKES) and that has led to a plethora of patient injuries…because “you are applying heat after all.”

J. Peter Rubin, M.D. had our brain cells going when it came to his topic: “The Future Of Stem Cells In Aesthetic And Reconstructive Surgery.”

After all, “what are stem cells, really?”

A working definition that we picked up was that they are specialized cells that can divide and self renew…have the capacity to mature into adult tissue cells….and have “a maturational lineage” with a certain function.

Already popular as a way to treat certain sports injuries, and as a way to renew/regenerate blood systems (bone marrow stem cells)...aesthetic plastic surgeons are focusing on fat tissue as a rich source of stem cells.

The new goal/process is to isolate the fat stem cells (from a lipo procedure) via a lab process and to grow them as tissue culture. And it is hypothesized that the fat cells might be capable of growing into fat, bone cartilage and muscle.

Outside the USA the process by Cytori, is undergoing European testing “designed to evaluate the transplantation of ADRC-enriched autologous (patient’s own) fat tissue into and around breast deformities.” After a lumpectomy, for example.

If it actually works--- with a high (controllable) response rate--- the clinical applications go well beyond filling in wrinkles (facial volume) for 5-9 years …like full-out breast reconstructive surgery after a mastectomy, (implants as the aforementioned clinical trial) or to speed the healing process from combat injuries, for example.

And fat cells can be frozen and stored.

Interesting---- we also learned about the Department of Defense’s funding of the Armed Forces Institute of Regenerative Medicine (AFIRM), a virtual, coordinating organization that is “committed to developing clinical therapies that focus on (we quote the press release)
· Burn repair
· Wound healing without scarring
· Craniofacial reconstruction
· Limb reconstruction, regeneration or transplantation
· Compartment syndrome, a condition related to inflammation after surgery or injury that can lead to increased pressure, impaired blood flow, nerve damage and muscle death.

According to Rubin, this includes injecting fat cells from burn victims into their scars to speed healing.

FYI: Facial fat injections have been in used for years…with mixed results.

WHAT INTRIGUES US NOW:
The cellular therapy- Isolagen Process™ by Isolagen Inc. owned by Fibrocell Science Inc, a biotech company. Our fav dermatologist, Dr. Cheryl Karcher found Isolagen™ helpful for filling in acne scars. We also chatted with Adam Dinkes, also with SADICK DERMATOLOGY about Isolagen™ (using our own cells, no rejection--- is very appealing). “It’s promising”... but long-term results and response rates, (good ones, of course) are TBD.

Also recently mentioned in a recent Marie Claire, was Sephyl ™, a new dermal filler --- that is apparently based on technology that has been around for years.


Conjured up from a small amount of a patient’s own blood --- the platelets and fibrin within said blood gets concentrated via a centrifuge system---resulting in activated Platelet-rich Fibrin Matirx (PRFM). The resulting product (gel, liquid….) gets injected below the surface of the skin —to fill in and stimulate new tissue growth.

We searched on the web and found that Sephyl™ is reportedly a product of UBS AESTHETICS though we found no info on Sephyl™ on that company’s website.

INFO: The American Society For Aesthetic Plastic Surgery, Inc.