Monthly Archives: July 2011
Difficulty quiting smoking, even when after cancer treatment
When faced with the diagnosis and treatment requirements of cancer, one would think that the bad habit of smoking would finally resolve. However, nicotine is a bad habit to break. Even when faced with cancer, many individuals still keep smoking. It is best never to have started in the first place.
Vertical Scar on Neck to Remove Loose Skin
Blanchard asks:
I am a 58 year old female with history of weight loss of 135 pounds. I had a very successful abdominoplasty (removal of 10 pounds of skin) and breast reduction with lift. I am scheduled for an arm lift soon and would like to have my loose skin removed from under my neck. My PS tells me there is so much skin there that I would end up with big wrinkles behind my ears so he suggests an incision down the front of my neck. I will be a long incision. Is this normal? I am concerned.
Photo from realself.com
It is quite common to have moderate turkey gobbler deformity or significant loose skin in the neck area after losing weight. Today frequently, patients who have undergone lap band surgery or gastric bypass surgery and have lost a good deal of weight, 50 to 100 pounds, have resultant moderate laxity to the neck skin area.
Remedy for this particular problem is somewhat complex. Some surgeons will approach the solution differently. One good answer is to simply perform a standard neck lift/facelift to significantly improve the neck issues. This can be performed at the same time as a platysmaplasty which requires an incision in the submental crease which is just behind the chin area and minimally visible. A large percentage of patients who undergo this procedure in an expert fashion will have resolution of concerns to the neck area, but there is always a possibility of persistent laxity in the neck area. Staging of the procedure is also a consideration. Many patients undergo standard facelift/neck lift with submental approach platysmaplasty will not require further treatment of the neck area, but some do and when they do a vertical scar in the neck area, also known as a t-neck, can be utilized and decided upon at that time which is essentially at a later time. So in essence, a vertical scar is not essentially required or necessary but indeed might be depending on the particular anatomy and circumstance.
I Had a Facelift 4 Years Ago and Don’t Want Another One What Can I Do to Help Sagging?
Photo from here
Sharla DeCelle in Las Vegas, NV asks:
I had a facelift approximately 4 years ago and have started to get the deep fowls around my mouth. I’m 60 years old and want to look vibrant for my age but do not want a another facelift. Are there other alternatives that will help the wrinkles and jowls?
Several options for nonsurgical facial rejuvenation:
If your areas of concern are the “deep frowns” around your mouth; so often the nasolabial folds and marionette lines around the mouth contribute to the sagging and contribute to the aged appearance. Without doing “surgery”, injections into these areas, particularly with fat transfer or other materials can provide good resolution/good improvement, without undergoing a repeat facelift. Specifically for wrinkles on the other hand; wrinkles are nicely treated with expert fractionated laser treatment. If you are concerned about the sagging jowl; in some instances laser lipolysis can provide some tightening in this area although this has to be done with great expertise and care.
Nonetheless there are options to help rejuvenate the face that don’t entail or require facelift surgery. But there is not a single procedure that will provide resolution for the areas you are concerned about, but a combination of these treatments can remedy the problem.
FDA Okays First Autologous Filler for Smile Lines
Article from here
The US Food and Drug Administration (FDA) late yesterday approved the first autologous aesthetic cell therapy to improve the appearance of moderate to severe nasolabial fold wrinkles in adults.
The product, azficel-T (laVív), is from Fibrocell Science, Inc, a company focused on developing personalized cell therapies for aesthetic, medical, and scientific applications.
According to the company, creating azficel-T involves a patented technology whereby fibroblasts are extracted from behind the patient’s ear and sent to the Fibrocell Science laboratory, where they are multiplied for about 3 months and then frozen until needed.
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Azficel-T (laVív). Fibrocell Science Inc
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Over a series of 3 treatment sessions, typically 3 to 6 weeks apart, they are injected into nasolabial folds to reduce the appearance of smile lines.
The company says the therapy will become available gradually through trained clinical investigators in select metropolitan areas. As manufacturing capacity is increased and more physicians trained, the number of cities served will expand as well.
The product will be mostly administered by dermatologists and plastic surgeons; only physicians who complete a Fibrocell-approved training program will be able to administer it.
The training program teaches proper biopsy collection and shipment procedures, treatment preparation and injection technique, and logistics tracking to ensure that the cells received by each patient are derived from that same patient.
“Revolutionary” Approach
“The concept of using a patient’s own collagen-making cells is a revolutionary way to help treat nasolabial fold wrinkles and help restore a fresh appearance,” Robert A. Weiss, MD, clinical associate professor, Johns Hopkins School of Medicine, Baltimore, and director of the Maryland Laser Skin and Vein Institute, Hunt Valley, noted in a company-issued statement.
“Since this is a biological process that works over time, [azficel-T] is able to provide gradual and natural-looking results,” noted Dr. Weiss, who participated in clinical trials of azficel-T.
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A patient’s nasolabial fold wrinkles before (left) and after (right) azficel-T treatment. Fibrocell Science Inc
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This approach is “likely appeal to patients who want to take a very new approach to treating wrinkles,” Stacy Smith, MD, associate clinical professor in the Division of Dermatology at the University of California–San Diego, who also worked on azficel-T clinical trials, said in a statement.
“By injecting tens of millions of the person’s own fibroblasts, patients now have the option to help smooth smile lines by adding cells to replace those that may have been lost through the aging process,” he added.
Babak Azizzadeh, MD, FACS, director of the Center for Advanced Facial Plastic Surgery and assistant clinical professor of facial plastic surgery at University of California–Los Angeles, commented, “It’s an interesting and novel approach that will generate some excitement among physicians and some patients.
“But at the end of the day,” he told Medscape Medical News, “it’s going to depend on whether the results are better than with off-the-shelf injectables, such as Juvederm (Allergan), Restylane (HA North American Sales AB), and Sculptra (Sanofi-Aventis), which are the main competition.”
Dr. Azizzadeh was not involved in the studies of azficel-T and has not treated any patients with it.
He added that “a limiting factor is that the patients have to have a biopsy and then wait 3 months before they get their injections, and then they have to go through a series of treatments. It’s a long process. Physician acceptability, with the length of time involved, may also be an issue.”
2 Pivotal Clinical Trials
The FDA approval was based largely on 2 identical phase 3 multicenter, randomized, double-blind, placebo-controlled studies involving 421 patients who underwent 3 treatment sessions approximately 5 weeks apart.
On the basis of investigators’ and patients’ assessments, a significantly greater proportion of patients demonstrated a positive response to treatment with azficel-T than with placebo, the company notes. The treatment improved the appearance of nasolabial fold wrinkles for the 6 months of patient follow-up after the last treatment. The company said studies are ongoing, looking at how long beyond 6 months after the last treatment the effect may last.
In clinical trials, azficel-T was well tolerated, according to the company. The most common adverse events were mild to moderate injection-site reactions that usually resolved within 1 week. As part of a postmarketing requirement, Fibrocell will set up a registry of approximately 2700 patients to further evaluate the safety of this autologous cell therapy.
How Long Do the Effects of a Lifestyle Lift Last?
FILIGREE1 in FLORIDA, USA asks:
A regular facelift or separate procedures cost so much more, but I’ve been told that the effects last 5-10 years if you don’t smoke, or experience weight changes. How long can I expect the effects of a Lifestyle Lift to last under similar conditions?
Image via here
The important component of a Lifestyle Lift is tightening of the deeper structures of the face, the SMAS/fascia and muscle structures. This tightening provides a real improvement in the overall appearance, particularly in the neck and jowl area. It is impossible to attribute an exact time period to which you turn back the clock, however as a general rule Lifestyle Lift and/or facelift provide around eight to ten years loss of appearance of aging. It is true that standard facelift procedures do cost more, but Lifestyle Lift provides an efficiency that translates into saved dollars for the individual who desires real aesthetic improvement. Essentially when undergoing a Lifestyle Lift or a facelift by an experienced surgeon, one will expect to achieve a good improvement in appearance and aesthetic youthfulness and decrease in the overall appearance of aging changes. This is a turning back of the clock. We can’t stop the clock, we can’t stop aging, but we can back it up several notches with a lift procedure. As time goes on, ongoing aging will occur.
