Mar
04
2017

Weight Loss Surgery Is Unnecessary

Dr. Flavio A. Cadegiani gave a talk saying that weight loss surgery is unnecessary. Dr. Cadegiani is the director of a weight loss clinic called Corpometria Institute in Brasilia, Brazil. He is board certified in endocrinology and metabolism and in internal medicine. His talk was presented at the 24th Annual World Congress on Anti-Aging Medicine (Dec. 9-11, 2016) in Las Vegas that I attended.

Here are the main topics that he presented.

Weight measurements are wrong when based on the BMI

Dr. Cadegiani stated that we do not understand obesity, because we look at it from the wrong angle. Current dietary approaches have failed. But obesity research is still proceeding in the wrong way. If all else fails, weight loss surgery is finally suggested as a last resort. But this is wrong.

The problem with body mass index (BMI) is that an athletic body type may be called “obese”, because the BMI exceeds 30.0. However in a very muscular person the reason for the elevated BMI is an increased muscles mass, not fat. Body composition scales reveal that, but a simple weight measurement does not.

Dr. Cadegiani recommended measuring waist circumference with <94 cm (37 inches) for men and <88 cm (34.65 inches) for women being normal.

10 reasons why we are misled by the BMI

  1. The inventor of the BMI was a mathematician. It was explicitly stated that the BMI would not predict the level of fatness of an individual. The other factors are bone mass and muscle mass.
  2. Because the BMI ignores the waist size, it is scientifically invalid.
  3. There are physiological reasons why it is wrong: there is no allowance made for the relative proportion of the bone, muscle and fat content.
  4. The BMI gets the logic wrong: the CDC site claims that the BMI “is a reliable indicator of body fatness for people”. This is simply not true!
  5. The BMI is based on bad mathematics: the formula assumes low muscle mass and high fat content.
  6. The BMI is lying by scientific authority: Dr. Cadegiani said it has an “air of scientific authority, but it is mathematical snake oil.”
  7. The BMI suggests that there are distinct categories of underweight, ideal, overweight and obese. It assumes sharp boundaries that hinge on a decimal place. All of this is nonsense.
  8. Cynical people could suspect that medical insurance companies lobby for the continued use of the BMI as it keeps their profits high. Sometimes insurance companies charge higher fees for people with an elevated BMI.
  9. Doctors can contribute to the continued use of the BMI, if they don’t feel the need to use another way of assessing their obese patients.
  10. It is embarrassing that we still base the assessment of obesity on a 200-year-old mathematical formula when more reliable measures are known.

Bariatric surgery done too easily

Dr. Cadegiani noted that publications on bariatric surgery (=weight loss surgery)

underreport surgical complications and deaths. The bariatric industry is rich, and 90% of the booths during obesity conferences belong to bariatric-related companies. Long-term follow-up studies are lacking. Those who do follow-ups report an increase of pancreatic tumors after 10 years following bariatric surgery.

Long-term follow-ups also describe a 70% increase of psychiatric disorders including depression and alcoholism. Those who had bariatric surgery experience a 200% increase in suicides.

Overcoming weight centered approach

Here is how to avoid the weight-centered approach that would lead the clinician to wrong conclusions.

There are four factors being taken into account:

  1. Metabolic blood markers are included in the assessment
  2. Body composition scales are used and incorporated in the assessment
  3. The patient participates by measuring waist circumference and body weight
  4. Clinical signs and symptoms are incorporated

Classic metabolic markers are liver enzymes and hormone levels like testosterone, Thyroid (T3) LH and IGF-1. The lipid metabolism is monitored through apoB and triglyceride levels. Inflammation is monitored through uric acid levels, ferritin and C-reactive protein (CRP). An oral glucose tolerance test and fasting insulin level can predict diabetes 5 to 10 years before it will occur clinically. Other metabolic markers are homocysteine and metalloproteinases. Insulin resistance can be measured with newer tests.

Oxidized LDLc is the only marker that is linked to diabetic retinopathy. Another marker, resistin is an independent marker for obesity-related cancer, cardiovascular disease and overall mortality. A triglyceride-waist circumference index has been found to be the best predictor for future development of diabetes.

Body composition analysis

The patient measures his/her own waist circumference and body weight on body composition scales. This gives additional information about fat and muscle composition. Dr. Cadegiani’s team likes to understand what is really going on in terms of what triggers fat excess.

Questions are: what is the level of emotional overeating? How much anxiety is there in the patient’s life that leads to overeating? What is the social and cultural environment? What were previous weight loss attempts? And what is the family history in term of excessive weight?

Other important factors are to check for binge eating disorders or night eating syndrome. In addition any patient planning to go for weight loss therapy should be checked for depression, mood disorders and suicide potential.

Otherwise body composition scales by electrical bioimpedance were found to be very useful in assessing fat and muscle percentage as well as visceral fat percentage.

Aggressive clinical approach improves metabolism

Dr. Cadegiani and his group have published their own research paper in February 2017 showing that an aggressive clinical approach can prevent the need for bariatric surgery.  This publication describes that in a group of 43 subjects who were thought to be bariatric surgery candidates only 3 patients (7%) went on to have the procedure done. 93% of the subjects were able to shed pounds with the method offered and avoided bariatric surgery.

They documented that clinical parameters and blood tests all improved on their program. The researchers focused on triggers that caused obesity in their patients. The measured markers were oxidized LDL cholesterol, triglycerides, the liver enzymes ALT and μGT, fasting glucose, Hemoglobin A1C, uric acid and CRP. All of these parameters improved with the modification in food intake. 81.2% of the weight loss was from the reduction of fat mass. 46.5% of patients had a normal waist circumference measurement at the end of the trial. They also achieved normal body fat and visceral fat percentages. As already stated 93% of all the patients in this trial avoided weight loss surgery, called bariatric surgery.

Dr. Cadegiani suggested that obesity should be approached with a scientifically based and responsible method. This will change the way we manage obesity.

Weight Loss Surgery Is Unnecessary

Weight Loss Surgery Is Unnecessary

Conclusion

Attention to detail of the patient with weight problems will allow the patient to reduce fat percentage. Waist measurements should be regularly performed as well as body composition scales measurements. This way the physician can follow the fat and muscle percentages. Key to success is to reduce the refined carb contents of food intake (sugar and starchy foods) and have a calorie deficit diet. Exercise is also an important component. An aggressive clinical approach to obesity can improve the clinical outcome and can prevent bariatric surgery.

Oct
30
2015

There Is Help For Hair Loss

One area where aging shows is the head! Often people who are aging are experiencing hair loss. Some individuals have a genetic trait that makes them vulnerable to early hair loss, while others are keeping their hair until a ripe old age. With regard to hair pigment it is similar: some people keep their own hair color well into their 40’s or 50’s, but later the grey hair shows. Loss of hair color is about loss of hair pigment. One or more genes regulate whether or not we lose the hair pigment early or not. While there is not much we can do about our hair pigment other than coloring our hair every 3-4 weeks, there is something we can do about hair loss on our scalp.

Male and female hair loss is medically known as “androgenetic alopecia”. It occurs in individuals who are genetically exposed. Interestingly baldness is rare in Chinese, Japanese and in Native American populations. Baldness more commonly affects men of Caucasian descent.

Onset of hair loss

In people who are prone to hair loss baldness typically starts in the temporal areas.

The genetic factors that lead to baldness can be inherited either from father or mother’s side. They are polygenic, meaning that there is not only one cause of hair loss. Gene frequency is most commonly associated with Caucasians. In Africans the frequency is lower and lower still in American Indians, Asians, and the Inuits.

Types of hair loss

The Norwood scale is used as classification of hair loss in men. In women hair loss is classified using the Ludwig and Savin scale. This helps to record the findings of a hair examination and is useful for research purposes as well.

Hormonal factors regarding male pattern baldness

There are several hormonal factors that are involved in the development of male pattern baldness. 5-alpha reductase converts testosterone (T) to dihydrotestosterone (DHT). DHT is more powerful than testosterone, causes shortening of the hair cycle and miniaturization of hair in the balding areas. After several years those who have genetically predisposed androgen receptors in balding areas come down with baldness. There are two isoenzymes of 5-alpha reductase, type 1 and type 2. Individuals born without type 2  5-alpha reductase do not develop androgenic baldness.

Another factor for baldness can be an enzyme, aromatase, located in the fatty tissue that converts testosterone into estrogenic hormones. A lack of testosterone can lead to baldness by this mechanism. Many men in their 50’s and 60’s who are overweight or obese are balding because of this mechanism. The other mechanism, as explained above is via DHT in genetically susceptible men. This process starts to occur mostly in individuals who are in their forties.

Treatment of hair loss

1. Mild cases of hair loss may respond to topical treatment with minoxidil that can be used on the scalp as liquid or hair foam. Systemic treatment in men is possible with finasteride (Propecia) or Dutasteride (Avodart). It helps to block the hormonal pathways regarding 5-alpha reductase and DHT that leads to baldness. In aging men in their 50’s and 60’s it may be that testosterone levels are low. Blood tests can test for this: the total testosterone level should be above 500 ng/dL. If it is less, testosterone replacement by bioidentical testosterone cream or by injection should be considered and usually works quite well with respect to regrowth of scalp and body hair.

2. Moderately severe hair loss can be treated with PRP (platelet rich plasma). With this treatment modality about 30% of hair loss can get cured. There have to be enough hair-rejuvenating stem cells around the bald skin to stimulate hair growth. However, when baldness has set in for some time in an area of the scalp with previous hair growth, there comes a point where the hair follicles die off and even stimulation with PRP will not help. When extracellular matrix (called “A cell”) is used in combination with PRP the success rate for hair growth in a bald area jumps up to 70 to 80%. The A cell material recruits stem cells from the blood that create hair follicles in the bald skin starting hair growth again.

3. Severe hair loss that does not respond to A cell and PRP treatment, but requires more invasive treatment: usually there are no hair follicles left in the bald skin. So, what can one do in such cases?

Many years ago dermatologists found that dense hair found in the back of the head (nuchal area) can be transplanted to a bald skin area and will grow very well there. In the beginning of doing hair transplants little discs were transplanted and this looked at times like checkered hair growth in the previously bald area. Newer research showed that miniaturized transplants with perhaps three hair follicles harvested under the microscope from the dense area and transplanted into the bald area give a smooth, natural looking appearance. These types of hair transplants are called “follicular unit hair transplants”. Nowadays hair transplant physicians will only do this type of hair transplant procedure because of the superior cosmetic result.

There Is Help For Hair Loss

There Is Help For Hair Loss

Conclusion

Baldness is no longer a stigma in today’s society, particularly with males. So many men just shave off whatever hair they still have and live with baldness. However, other men and women want something done about the bald scalp; they can do so in various stages, first treat topically with minoxidil, then by trying PRP or PRP with the A cell treatment. Finally follicular unit hair transplants can restore a full head of hair where there was baldness before. Women are also very interested in follicular unit hair transplants when crown baldness develops. This elegant method gets rid of this annoying crown baldness, and women who had it done seem to be very happy with the results.

More info on hair restoration: http://nethealthbook.com/mens-health/hair-restoration-or-hair-transplant/

More info on hair loss: http://nethealthbook.com/dermatology-skin-disease/hair-loss-or-alopecia/

References

Ref. 1: Hair disorders, from: “Lookingbill and Marks’ Principles of Dermatology” Fifth Edition: James G. Marks MD and Jeffrey J. Miller MD, Copyright © 2013, Elsevier Inc.

Oct
14
2014

New Material To Fill Bone Defects

Disfiguring head injuries from car accidents, work injuries or personal injuries left plastic and cranial surgeons with the problem of how to fill the gaps. This problem may soon be medical history as a new polymer foam material has been invented that serves as a scaffold. With its interconnected pores it allows bone to fill the gaps and subsequently gets absorbed leaving new bone in the place where the scaffolding foam had been placed by the surgeon. Texas A&M and Rensselaer Polytechnic Institute researcher Melissa Grunlan who is an associate professor in the university’s Department of Biomedical Engineering develop this material together with her co-workers.

It has interesting properties. The shape of memory polymer foam (SMP foam) is malleable when treated with warm saline water and can be fitted into the bone gaps from the injury. After a short time it hardens in place and provides the scaffolding needed for new bone growth.

This new material lends itself to fill gaps from birth defects (like cleft palates), from facial injuries or from the removal of bone tumors in the head, jaw or face.

Traditionally, bone grafts were used to fill gaps. They had to be taken from an area like the hip, but there were problems attaching these grafts to the underlying bone to which the graft would hopefully attach to in the future. Many complications could occur like graft absorption leaving the original defect or infection of the grafted material.

With the new polymer foam material there is instant attachment, instant shaping of the surface of the material and very quick population of the foam with bone cells from the surrounding bone. In addition, the polymer foam has all its surfaces coated with a bioactive substance that attracts bone-forming cells, called osteoblasts. Experiments have shown that after only three days the coated sponge channels attracted five fold more osteoblasts than that of uncoated control foam material.

New Material To Fill Bone Defects

New Material To Fill Bone Defects

Traditional bone grafting

Traditionally, bone grafts are used to help with complicated fractures in the healing process. In spinal surgery bone grafts may be required to over bridge facet joints with end stage arthritis, as following successful healing after fusion surgery the back pain will improve significantly. Bone grafts have also been used when bone defects were present from severe infection, injury or congenital defects. In these cases the bone graft is used to fill in the defect. Finally, bone grafts are sometimes necessary to fill in bone following surgical hip joint replacements or after repairs of fractures with plates and screws. More about these traditional bone graft techniques can be found through this link.

Complications of traditional bone grafting

Complications depend very much on the location of the surgery and what type of procedure is being used. For instance when it comes to fusion surgery in the lower neck or lower back region, the traditional success rate of fusion surgery is about 70%, which means that in 30% of cases the procedure did not work. On the one hand the combination of mechanical stabilization through instrumentation with bone grafting has increased the success rate of fusion surgery above 70%. But smoking, older age, osteoporosis, obesity, diabetes, and prior spinal surgery have decreased the success rate as indicated in this review.

This overview about autografts (bone graft in the same patient), allografts (bone grafts with bone from a bone donor center), xenografts (bone from an animal) as well as synthetic bone grafting explains more details about these topics.

Another website also contains useful information about this topic.

Other applications for memory polymer foam

In the same facility Duncan Maitland, associate professor in the university’s Department of Biomedical Engineering, is researching the use of SMP foam for the treatment of brain aneurysms in humans. A flat piece of SMP foam is introduced into the aneurysm, a sac-like pouch of a brain blood vessel and activated through heat from a laser beam. This actives the foam to become round and fill the pouch of the aneurysm, closing off the area that could have ruptured and led to bleeding. This application has to be proven in clinical trials as well as does the use of the SMP foam for bone defects.

Conclusion

Often in medicine new ideas were necessary to lead to progress in treatments. For instance when hemoglobin A1C was detected by an Iranian team of doctors, all of a sudden a powerful  tool to monitor treatment of diabetes had become available. Prostate specific antigen (the PSA test) is another example of a test that allows for a much earlier diagnosis of prostate cancer. Earlier detection of prostate cancer leads to a more successful treatment of this cancer.

With memory polymer foam (SMP foam) physicians will soon be given a new tool of closing big bone gaps to help their patients overcome unsightly appearances or unstable situations in the spine or in other body locations. The brain aneurysm application will help prevent brain hemorrhages. More research is needed for these clinical applications, but the initial research shows a lot of promise.

More information on bone cancer where following surgery large bone defects can remain: http://nethealthbook.com/cancer-overview/bone-cancer/

Last edited Nov. 8, 2014

Jun
22
2013

Baldness Can Be Treated With Platelet Rich Plasma

Baldness can be embarrassing to the person who has it. Often it runs in families, as there is a genetic factor that can be passed on from mother’s and father’s side. It can even jump one generation. I have reviewed hormonal factors and the treatment with minoxidil under Ref. 1 and 2.

One particularly embarrassing form of baldness is a spotty hair loss (medically known as “alopecia areata”), which can occur spontaneously after a period of severe stress. It is due to an autoimmune phenomenon as explained here.

Recently a randomized trial was published where one half of the head was treated with either platelet rich plasma injections (PRP), corticosteroid injections or placebo injections. Each person of the 45 volunteers got three treatments in monthly intervals and they were followed for 1 year. Only the PRP treatment group had successful regrowth of hair in the bald spots. This study has caught the attention of the media.  Images of vampires drinking blood were circulating in the press, but nothing could be further from the truth. Unfortunately a story like this just instills fear in the public, but does nothing to clarify what was done in this clinical trial.

Baldness Can Be Treated With Platelet Rich Plasma

Baldness Can Be Treated With Platelet Rich Plasma

Let me explain what the authors of the above baldness study actually did and why.

PRP has been shown in the past to contain various growth factors that support stem cells. So, in order to stimulate the stem cells in the baldness spots to renew hair growth blood was drawn from the same patient (there are no incompatibility issues with regard to transplant rejection). The blood sample was then placed in a centrifuge to separate the red blood cells, which go to the bottom of the test tube, from the other cells. The portion of the blood just above the red blood cells contains platelets and fibrinogen. This is called PRP or platelet rich plasma (blood without red blood cells is called plasma).

The plasma is enriched more than 4 times from the original concentration of platelets in blood. Platelets are special blood cells, which take part in the clotting process. They also contain a lot of growth factors that are all-important for the survival of the stem cells in the baldness spots. The PRP helps the dormant hair follicles in the bald spots to regrow hair. In the past PRP has been extensively researched for the treatment of musculoskeletal injuries.

With respect to treatment of baldness according to this website PRP injections alone help only in about 30% of patients to slow down hair loss and to rejuvenate hair growth. This link also contains a “before and after” picture of a PRP treated scalp. Note that this patient did not receive a hair transplant, just PRP injections. What happened here is that the PRP injections transferred platelets with growth factors from the patient’s blood. Some of the hair growth was from stimulated dormant hair follicles that were still in the patient’s scalp at the bald spot; however, other hair follicles likely developed from mesenchymal stem cells that were situated in the scalp, but activated by PRP (like grass seeds that would grow grass when put in fertile soil and watered).

Here is a YouTube video, which explains stem cell therapy for thickening of thinned hair with the use of something called Acell and PRP.

In this 2011 paper it was describes that PRP and other factors can stimulate hair growth, in some cases histology proof was even obtained showing that hair follicles had grown to a normal size following the stimulation from PRP and other factors. One important such other growth factor is the so-called Acell, which is a special application of extracellular matrix: With the help of this acellular material that functions as a matrix for hair follicles to grow the success rate of Acell and PRP injections has vastly improved. Estimates are that there are 70% to 80% success rates with this form of treatment (Acell and PRP). Here is a website where this type of treatment is also discussed.

Conclusion

In those cases of baldness where minoxidil and bioidentical testosterone replacements fail, treatment with the patient’s own PRP and augmented by the use of Acell material as a matrix can be an alternative form of treatment. Although so far only one randomized trial has shown good results, other trials from different centers will likely soon confirm this treatment modality.

References regarding hormone aspects (lack of testosterone) of baldness

1. Overview of hair loss: http://www.nethealthbook.com/articles/hairloss.php

2. Testosterone for male menopause: http://www.askdrray.com/testosterone-for-male-menopause-andropause/

3. More info on PRP: http://link.springer.com/article/10.1007/s12178-008-9032-5#page-1

Last edited April 30, 2014

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Feb
12
2013

Stem Cell Treatments That Are Currently Available

Stem cells got a bad reputation in the beginning, because it was thought that embryonic stem cells would be required to treat degenerative conditions. Immediately this raised an ethical flag, as embryonic stem cells would have been derived from a dying fetus. This created a lot of unnecessary division among the public and scientists. It turns out that for most treatments there are enough stem cells in the body, as I will explain below,  but initially this was not known.

The next bad rep came from Dolly, the sheep that was born on July 5, 1996. She only lived for 6 years, because the telomeres were short like that of an old animal and she died of a progressive lung disease. To create Dolly a complicated stem cell technique was used called “somatic cell nuclear transfer”. Three animals were required to achieve this. One animal provided an unfertilized egg cell from which the nucleus was extracted. From the second animal a breast gland cell was used to donate a cell nucleus and a third animal was used as a surrogate mother. After some cell divisions the blastocyst was transferred into the uterus of the surrogate mother who carried baby Dolly until birth.

Fast forward to 2013. We now know that stem cells are fragile cells that do not like too much manipulation. Stem cells have long telomeres so they are younger than the typical cells of the body. We know that stem cells can be found in the bone marrow, in fatty tissue and many other organs. In the last few years a lot of research has been done and this has already translated into practical applications. Originally stem cells were considered to be cells that could develop into any variety of body cell. At that time they were thought to only derive from the bone marrow or from fetal tissue. Scientists called these cells “pluripotent cells”. In the last years it was noted that turning off a gene called SP100 could also prompt a body cell to become such a versatile, pluripotent stem cell. They are called “induced pluripotent stem cells” to distinguish them from embryonic stem cells, which have been highly contentious with religious groups. In recent years matters have been simplified with the observation that mesenchymal stem cells are distributed freely throughout the body and can be harvested fairly easily from fatty tissue by liposuction. This latter technique is preferred, as it does not involve any manipulation of the stem cells themselves.

 

Stem Cell Treatments That Are Currently Available

Non-Surgical Space Lift, Before and After

Here are a few examples of what is being done now and what is expected to come:

Minimal invasive face-lift, called “space lift”

The fact that mesenchymal stem cells are freely available in fatty tissue has already been employed by plastic surgeons in the US and elsewhere for a minimal invasive plastic surgery called “space lift” where fat is removed by liposuction, the fat graft is separated with a cell separator into a fat cell fraction and into a mesenchymal stem cell rich fraction, which are injected together into various areas of the face where subcutaneous tissue is needed. The mesenchymal stem cells enable the fat cells that were transplanted to latch on to the small vessels in the transplanted area so that they survive permanently, and the result is a more youthful appearance of the face (see image). This is the secret of film stars in Hollywood. Nowadays the plastic surgeons in Beverly Hills do not do the conventional facelifts so much as they lead to artificially looking faces, but rather do the minimal invasion space lift for the natural look.

Knee problems, hip problems and lower back problems

Why wait with degenerative diseases of the knees, hip or of the lower back until there is permanent scarring and disabilities? With a similar technique described under point 1 above one can inject the mesenchymal stem cell rich fraction (without the fat cells this time) into the joints that are affected with degenerative changes (knee joints, hips, facet joints along the spine). The result is that cartilage is recreated by the transferred mesenchymal stem cells and the patient becomes pain free and regains mobility! But as with other diseases it is important to intervene early enough before permanent damage has set in.

Organ failures

Another exciting development is intravenous injection or injection via an arterial catheter into failing organs. Heart failure is an end-stage heart disease, where conventional medicine has nothing to offer other than symptomatic supportive medication. However, mesenchymal stem cells can be injected into the blood and the pluripotent stem cells will find the weak areas in the heart muscle where they transform into heart cells and give the existing heart cells a boost.

The result is that the heart pumps more forcibly and the symptoms of heart failure disappear. Similarly, there are trials that show that Parkinson’s disease can be positively influenced with injections of the mesenchymal stem cell rich fraction.

Treatment of patients with liver failure using mesenchymal stem cells is being investigated, but is still in its infancy.

With regard to mesenchymal stem cell treatment of chronic kidney failure early human experiments on 30 patients showed very encouraging results.

Although this field is very promising, more caution is in order with regard to laboratory-manufactured stem cells. More trials are needed to show that they are ready for use in regenerative medicine. In other words they have to show similar or even better successes as the present results achieved with mesenchymal stem cells that were directly harvested and left unchanged as described above.

More information on:

1. stem cells for stroke victims: http://nethealthbook.com/news/stem-cells-help-stroke-victims/

2. stem cells for knee osteoarthritis: http://www.askdrray.com/joint-replacement-for-osteoarthritis-of-the-knee-will-become-obsolete/

Last updated Nov. 6, 2014

Mar
01
2006

Vaginal Reconstructive Surgery Helps Body Image

Plastic surgery in the vaginal area is not a new procedure. It has been performed for decades to help patients with medical conditions like urinary incontinence due to weak vaginal muscles or uterine prolapse.
Recently female genital enhancement surgery has come into the forefront and as many as 15 purely cosmetic procedures are on the list at a Toronto-based clinic. Dr. Robert H. Stubbs has been pioneering in this particular area of plastic surgery. Women who lost a lot of weight frequently request pubic liposuction and reduction of the labia majora. Another procedure, vaginal tightening, involves stitching the muscles of the vaginal wall and creating a smaller circumference. Most of these surgeries are done in private clinics, which do not have to report to the Society of Obstetricians and Gynecologists of Canada. As a result no numbers are available, but these surgeries are definitely on the rise.
Probably the most controversial procedure of them all is the hymenoplasty. Dr. Bruce Allen, who recently incorporated cosmetic genital procedures into his gynecology practice, reports, that there is not a large demand for them. However, women from certain cultures turn to the physicians for help. In some groups of Middle Eastern descent the loss of virginity is considered a disgrace, and as a result the young female may be shunned and maybe even killed. When desperate women turn to the specialist for protection, they need help. In a safe and simple half hour procedure the ends of the ruptured membrane can be stitched together or patched with tissue from the vaginal wall.
Some flashy advertising for a Los Angeles based clinic promises good sex. What those billboards don’t tell is the fact that no scientific proof exists that any of these surgeries actually enhance sexual pleasure. Nevertheless patients have cited a better sex life as a very common bonus. The reason is the fact, that the patient is more comfortable with her body. Patients with relationship problems due to self-consciousness about the genital appearance will experience a sense of emotional relief as soon as the procedure is over.

Vaginal Reconstructive Surgery Helps Body Image

Vaginal Reconstructive Surgery Helps Body Image

Dr. Stubbs also noted, that vaginal enhancement procedures are no different from any other type of cosmetic surgery. It is the job of the specialist to explain the risks, after which the woman can make an informed decision.

More information about pelvic floor laxity leading to anterior or posterior repairs including hysterectomies: http://nethealthbook.com/gynecology-obstetrics/ 

Reference: National Review Of Medicine, January 30, 2006, Pages 1 and 5

Last edited October 30, 2014

Jan
01
2006

Plastic Surgery For Men

Makeover TV shows are very common, but it is usually women who are featured in them.
The fact that males are not talking as much about makeovers, Botox, Restylane and face lifts does not mean that cosmetic surgery is a topic only reserved for women. In 2004 1.2 million procedures were performed on men according to statistics from the American Society of Plastic Surgeons. The number of surgical procedures rose by 16% from 2000, and in 2004 there was also a 43% increase in minimally invasive treatments for men.
The reasons for this shift of attention may have several reasons. Men feel that there is more pressure on them to look vibrant, youthful and energetic. There is a lot more exposure of plastic surgery in the news media. Information about cosmetic surgery is also disseminated on the Internet.
An executive who has experience and skills and looks tired and old may be at a disadvantage on the career ladder, observes Dr. Lorne Tarshis, a Toronto plastic surgeon. If drooping eyelids convey the look of defeat and tiredness, it is not likely a reflection of how the patient really feels. As a result, men in this category will often opt for a blepharoplasty. Women are more willing to talk about plastic surgery to their doctor. Men are more reluctant than women to go to the doctor’s office and ask about procedures. They are more likely to get their information on the net and walk into the office of the plastic surgeon with their minds made up. Dr. Arie Benchetrit, a plastic surgeon from Pointe Claire, Quebec finds that men are more pragmatic, whereas women are more open to discuss options. Men are looking for “natural” results, meaning in this case, that they want to look great but they don’t want people to know why they look great. As a result they prefer less dramatic procedures. It does not mean that men are less nervous or anxious about their appearance than women, but mostly they won’t talk about it, because admitting vulnerability in a competitive context goes against male culture.
Plastic Surgery For Men

Before (above) and after (below) blepharoplasty

Dr. A. Carruthers from Vancouver reports that some patients with facial wasting as a result of HIV benefit from cosmetic fillers like restylane and silicone oil. Some of them were well enough to work. Their condition was stable, they felt fine, but they were sent home and told to go on disability because they looked too sick to be seen in the workplace. “Getting their faces back” had an immense emotional impact on those patients, who no longer felt stigmatized. Dr. Carruthers reported that in the past cosmetic surgery was looked at with skepticism. When Sigmund Freud heard that someone wanted to undergo a cosmetic procedure, he responded by prescribing psychoanalysis. But times have changed. Cosmetic procedures are more about well being, and the word “vain” is a four-letter word.

More on cosmetic surgery: http://nethealthbook.com/dermatology-skin-disease/cosmetic-surgery/

Reference: The Medical Post, December 20, 2005, page 31

Last edited October 30, 2014

Jan
01
2006

Face Transplants For Disfigured Patients

Patients with severe burns to their face have been treated with skin transplants in order to help them cope with common body functions which the average person takes for granted, like opening and closing of eyelids or breathing. Patients have to undergo numerous skin grafts, where skin is transplanted from other body areas. The process can take years, as multiple surgeries are needed. Facial skin is also more tender and pliable, making it different from the type of skin in other areas of the body, and plastic surgeons are working to make the facial appearance of the patient less mask-like. The journey to recovery becomes a long and difficult one, which can be likened to an emotional roller coaster: there is surgery and the time to heal, after which more surgery is required.
The possibility of a face transplant sounded like a futuristic item till a short time ago, but French doctors have used new techniques to restore the facial features of a 38-year-old woman, whose face had been mauled by a dog. The partial transplant was done using the mouth, nose and chin of a brain dead donor.
Maria Siemionow, the director of plastic-surgery research at the Cleveland Clinic states, that facial transplant can only be considered as a treatment for severely disfigured patients who have exhausted all conventional options. The procedure itself remains controversial and risky. It involves harvesting the face from a brain-dead organ donor in a 4 to 6 hour surgery. In the following 10 to 15 hour procedure the face is draped over the bones and muscles of the recipient. Following surgery the transplant patients needs to take medication to prevent the rejection of the transplant. Even though the risk is not any different than the risk, which goes along with a kidney transplant, there is the possibility of transplant rejection and of side effects from immunosuppressants. Patients, who take this medication that will cost about $2000 per month, are more susceptible to infection, cancer, metabolic disorders, and liver and kidney damage. The psychological impact on the patient will also be significant, as there could be a feeling of having a different identity. Dr. James Zins, chairman for plastic surgery at the Cleveland Clinic, insists that there are no races to be won and the approach to this new option should be methodical and slow.

Face Transplants For Disfigured Patients

Before and after face transplant

Not all potential candidates for the surgery are willing to take the risk of life-long immuno-suppressants and it is only a consideration for physical as well as psychologically suitable patients who are willing to take the risk of receiving a new face after devastating accidents.

Reference: December 12, 2005 issue of Newsweek, pages 60-61

Last edited December 6, 2012

Jan
31
2003

February Readers’ Digest Edition… Poisons Used For Healing

In this February’s Readers’ Digest edition there is an article about the use of poisons of nature for healing purposes (article entitled “Healing Power of Poison”). For instance arsenic trioxide has been used recently in a trial with leukemia patients to get a remission of leukemia in 70% of cases. Arsenic, which normally is a powerful poison, has in the right dilution this healing effect in leukemia with less toxic side-effects than chemotherapy.

Dr. J. Michael McIntosh, a psychiatrist at the University of Utah, is researching the poisonous effect of a marine snail that attaches to and kills fish with a toxin. This poison is a powerful painkiller. It is several hundred times stronger than morphine, but is useful as it does not have any effect on the strength or functioning of muscles. This substance used in the right diluted dose, may one day be used for the treatment of chronic pain syndromes.

The bacterium Clostridium botulinum produced a powerful toxin, which causes botulism. Neurologists and plastic surgeons are using this poison in a diluted form as “Botox” to inject into wrinkles of skin to make your face look younger. It is also used for chronic spastic muscle conditions like cerebral palsy or tardive dyskinesia.

February Readers' Digest Edition... Poisons Used For Healing

February Readers’ Digest Edition… Poisons Used For Healing

Newer reference regarding the use of arsenic trioxide: http://bloodjournal.hematologylibrary.org/content/107/7/2627.abstract

Last edited December 10, 2012