Archive for October, 2010
A new refinement technique that improves Botox and expands its uses for pain management and treatment of neurological diseases was recently discovered by British scientists at the Medical Research Council’s Laboratory of Molecular Biology.
The technique, which essentially involves joining and rebuilding Botox molecules, may also improve the production process for Botox-based medicines, including the popular wrinkle relaxer Botox Cosmetic.
“It will now be possible to produce Botox-based medicines in a safer and more economical way,” said Bazbek Davletov, the leader of the study that uncovered the new refinement method.
The refining technique discovered by Davletov and his research team could allow scientists to create new and improved forms of the drug, expanding the practical medicinal uses for Botox, for instance as a long-term painkiller that could last four to six months.
“This is the first time we have been able to treat protein molecules like Lego building blocks, mixing and matching them to create the basis for treatments that would not previously have been possible,” Davletov said.
Although Botox has been used for years to smooth wrinkles, as well as treat problems like excessive sweating (hyperhidrosis), migraines, Parkinson’s, cerebral palsy and other diseases that cause spasms, tremors and chronic nerve pain, this latest scientific breakthrough will likely make the drug even more widely used.
It remains to be seen whether the “more economical” production process for Botox made possible with the new refinement technique will trickle down to doctors and consumers. It seems unlikely to decrease the cost of Botox injections, given the fact that the introduction of Botox-competitor Dysport to the cosmetic medicine marketplace didn’t lower the Botox cost.
Botox is currently FDA-approved to treat wrinkles, dystonia and migraines, and Botox will likely become even more widely used as scientific advances continue to improve and expand its uses.
Most plastic surgeons agree that breast implants are currently the only effective way to enlarge women’s breasts, but new technology developed by Cytori Therapeutics may soon make fat grafting a viable method for breast augmentation.
Cytori Therapeutics recently developed the Celution System, which offers doctors a new way to prepare fat harvested from a patient’s body and enrich it with stem cells. This stem cell-enriched fat may then be re-implanted in the chest using another Cytori device called the Celbrush to enhance natural breasts or rebuild breasts that have been deformed by lumpectomy or mastectomy.
A kind of natural regenerative cell therapy, breast augmentation or reconstruction with fat grafts prepared with the Celution System and injected with the Celbrush will purportedly improve the survival rate of the fat tissue after it is re-implanted.
Clinical studies are still being conducted in Europe to prove whether this claim is true, but if it is, it could mean that the Celution System and Celbrush have solved one of the major problems that has historically plagued doctors in their attempts to augment or reconstruct breasts via fat grafting – unpredictable results and potentially low survival rate for transplanted fat tissue.
The concept of boob job by fat injection is not new. Plastic surgeons have been exploring the possibilities with this procedure for decades and still agree that breast implants, be they saline, silicone or cohesive gel, are the safest, most effective way to enlarge natural breasts.
As for breast reconstruction patients, they have had other “natural” methods of rebuilding their breasts available for sometime in the form of complex flap procedures, such as DIEP or TRAM flap reconstruction, that transplant skin, muscle, fat and blood vessels from other body areas into the chest area.
It remains to be seen whether fat grafting breast augmentation and reconstruction using Cytori’s Celution technology can safely and consistently provide beautiful, natural results, but if it proves successful, patients will have even more options to enhance and rebuild their breasts, which can only be good.
About a month ago, the LA Times published an article about so-called “stem cell facelifts” and the lack of scientific evidence supporting the claims of their success. According to the article, the procedure involves injections of stem cell-enriched fat into specific areas of your face.
Since then, the plastic surgery societies, bloggers and doctors on realself.com took notice of the story and echoed the same skeptical question: How do stem cells improve the results of a facelift? “Stem cells have incredible potential. But nobody knows exactly what they do. So they’re marketed to do everything,” said plastic surgeon Dr. Michael McGuire to the Times.
Both the Aesthetic Society and the American Society of Plastic Surgeons praised the article and went on record to advise patients considering facial rejuvenation to avoid stem cell facelifts as well as other “fad procedures” that lack clinical evidence demonstrating their effectiveness.
Aside from the lack of scientific evidence, there are additional reasons to avoid the stem cell facelift marketing pitch. First, fat injections (facial fat grafting) can achieve a good cosmetic outcome without the use (or cost) of stem cells. Second, the long-term results of stem cell procedures are not known. Last but not least, as a biologic product, stem cell enriched fat may require FDA approval, which it does not currently have.
There may be some incredible developments on the horizon for stem cells in cosmetic medicine, but according to industry experts, we have not yet reached that point.
Houston plastic surgeon Dr. Bob Basu explored new techniques in upper eyelid rejuvenation using autologous fat injections alongside colleagues from all over North America at the 2010 American Society of Plastic Surgeons conference in September.
Recent research discussed at the conference revealed that fat injections have proven safe and effective for restoring volume to sunken upper eyelids where no other cosmetic procedures have.
In the past, fat injections were avoided in the eyelid area because they increased the risk for embolism. The new, refined approach to upper eyelid fat grafting combines live fat cells with methylene blue, a dye that allows surgeons to better control fat placement and ensure fat is safely placed in the delicate eyelid area.
Although upper eyelid fat grafting may require repeat treatments or supplementary soft tissue filler injections, the findings of the study led by the developer of the new fat grafting technique, Dr. Patrick Sullivan, suggest that patients can expect long-lasting results.
“We don’t plan to ever have to do any more fat grafting because these fat cells are alive; they have good supply where we are putting them, which keeps them alive. So at 9, 12, 16 months, the fat stays there. It may soften a little bit, and may change a little bit in that it seems to bring about a more natural appearance with time. In the beginning, there seems to be a little bit of swelling, but that swelling goes away,” said Dr. Sullivan.
The fat grafting study included 40 upper eyelids in 21 female patients aged 56.6 years on average. Each study participant’s eyelids were injected with 0.2 to 2.3 cc of live fat cells harvested from their own body.
While blepharoplasty, or an eyelid lift, can help with excess, sagging eyelid skin, it does not address hollow upper eyelids, making it difficult for surgeons to provide complete facial rejuvenation.
When combined with other cosmetic procedures, such as facelift, neck lift and eyelid surgery, fat injections to the upper eyelids refresh tired eyes and provide an overall youthful and natural look.
Source: Medscape Medical News
The September issue of Archives of Surgery featured two recent studies performed at American universities that offer helpful insight to mastectomy patients considering breast reconstruction in Houston.
The study found that complications more likely to occur in patients who undergo breast reconstruction immediately following mastectomy, and radiation treatment for breast cancer following breast reconstruction can further increase complication rates.
According to study results, radiation treatment following breast reconstruction triples the risk of complication, and immediate reconstruction following mastectomy makes complications eight times more likely to occur.
Researcher Dr. Rodney Pommier, professor of surgery at Knight Cancer Institute, Oregon Health & Science University, said that the results of the study indicate that it may be prudent for some mastectomy patients to delay breast reconstruction, especially in cases where post-operative radiation treatment is needed.
Dr. Pommier and researchers at OHSU studied 302 mastectomy patients, 152 of whom had breast reconstruction. Of the 152 patients who had breast reconstruction, 131 had reconstruction performed immediately after mastectomy.
Of 100 study patients who underwent radiation treatment after mastectomy, complications occurred in 44 percent of those who had immediate breast reconstruction, but only in 7 percent of those who chose to delay breast reconstruction.
Additionally, breast implant removal was necessary in 31 percent of patients who had radiation after mastectomy, compared to just 6 percent of those who did not have to have radiation, according to study results.
Another recent study found that another breast cancer treatment, chemotherapy, does not affect complication rates in breast reconstruction patients.
Nearly one-third (31 percent) of 163 patients studied by UCSF researchers had a complication that made additional surgery necessary. Some patients in the study had chemotherapy and others did not, but the complication rate wasn’ t influenced by whether chemotherapy was performed before surgery, after or not at all.
Dr. Pommier suggests that recent study findings make a good case for determining whether radiation therapy will be needed following mastectomy by performing a sentinel node biopsy on mastectomy patients.
“ If the sentinel node is negative, there is a low probability they would get radiation,” he explained.
Although the findings of these two studies merely confirmed many of the things Houston breast reconstruction surgeons were already seeing clinically, they provide clear evidence that delaying breast reconstruction, especially when radiation therapy is needed, can drastically reduce the need for breast revision surgery.