Sculptra receives its cosmetic indication from the FDA

Sculptra, the injectible PLA filler, received official FDA approval today for cosmetic use. It had initially approved several years ago for the treatment of lipo-atrophy, (most commonly seen in HIV patients) and was used on an "off-label" basis for cosmetic purposes. It's a very useful product.

Sculptra can be very helpful to restore volume loss in the face and other body areas with a non-surgical method. Usually several treatments are required over the course of several months, but I've been very pleased with the results of these treatments. It also represents a nice alternative to fat grafting techniques, avoiding donor site issues.

One key with the use of Sculptra is to use it in a highly diluted form; this helps to avoid the formation of small lumps, known as granulomas. I also do not recommend it for use in the lips.

Tanning Booths cause cancer

I've been saying this for years, and now the World Health Organization has issued a definitive statement: tanning booths cause skin cancer.

In the story from the CBC news website,(link) the International Agency for Cancer Research or IARC, the World Health Organization's cancer wing in Lyon, France, updated the cancer risk level from tanning beds, based on research published online Wednesday in the medical journal Lancet Oncology

Tanning beds and ultraviolet radiation cause cancer and have been moved up to the highest risk category by these international cancer experts. The new classification means tanning beds and UV exposure definitely causes cancer in humans, just as tobacco smoke, the hepatitis B virus, radon gas, plutonium and mustard gas do.

Experts upgraded the level after an analysis of about 20 studies concluded that the risk of skin melanoma is increased by 75 per cent when people started using tanning beds before age 30.

Previous studies found younger people who regularly use tanning beds are eight times more likely to get melanoma than people who have never used them.

WHO has warned people younger than 18 to avoid tanning beds. The Canadian Cancer Society has called for minors to be barred from using tanning beds, and the American Cancer Society advises people to try self-tanning creams instead of tanning beds.

A tax on cosmetic surgery??

Rumors are flying about the possibility of a new 10% tax on cosmetic surgery. Apparently, this is one of the more creative methods that the Senate Finance Committee has proposed, to help pay for the President's new healthcare system.

I, for one, certainly hope that this doesn't come to pass. While this tax might look like "easy revenue", it is essentially an unfair tax.

Why? - because it unfairly discriminates against women, who are 95% of the consumers of cosmetic surgery. And that's not right.

Usually excise taxes are designed to tax products or services that have a negative effect on the public health. Taxes on tobacco products and alcohol - which have well been proven to have detrimental effects on the public health - would be classic examples of excise taxes. Cosmetic surgery just makes people feel better about themselves. It doesn't have a negative health effect.

Could we argue that it would just be another form of "luxury tax" on the ultra-rich? No, not really - the vast majority of my patients are average Americans, who are middle-income earners; the waitress whose has been saving for a breast augmentation, the mom with three kids who wants to fix her tummy now that her kids are grown. They are certainly not the ultra-rich.

Experience with a similar cosmetic surgery tax in New Jersey did not pan out well. Tax revenues were reportedly only 25% of what was estimated.

An ideal tax (admittedly an oxymoronic phrase!) should be broad-based and non-discriminatory. A cosmetic surgery tax would be neither.

Say "Yes" to an accredited Operating Room

Recent articles in the Wall Street Journal (link) have pointed out the need for a more uniform standard in office operating rooms - namely accreditation by one of the three national OR inspection agencies.

I couldn't agree more. Improving safety standards for patient care is a good thing.

Accreditation of an operating room, whether it's in the hospital or at an office, ensures that the facility meets important standards, like:

- appropriate facility design and safety equipment
- suitable cleaning & instrument sterilization standards
- proper patient monitoring devices
- appropriate back-up power supply
- suitable staff credentialing and training requirements for the surgeon, anesthesiologist and nurses
- suitable protocols and staff training for emergencies

Several years ago, the American Society of Plastic Surgeons (ASPS) made it a mandatory membership requirement: all ASPS members (like me) can only operate in accredited facilities, whenever any significant anesthesia is used.

Our facility, for example, is accredited by the American Association for the Accreditation of Ambulatory Surgery Facilities (AAAASF) - which is one of the "big three" national agencies, along with AAAHC and JCAHO. This means we meet 100% of the standards that AAAASF has formulated, and have gone through an on-site inspection by an independent examiner. We also meet or exceed all Florida state standards for office surgery.

However, non-ASPS members and "wanna-be" cosmetic surgeons have less stringent requirements. Some of these offices may not have any semblance of adhering to accreditation safety standards at all.

Bottom line: always ask two questions regarding the facility, eespecially if it's a doctor's office- "Is this an accredited surgical facility?" and "Which certification agency?".

The only acceptable answers are "Yes, it is", and one of either JCAHO, AAAHC, or AAAASF.

Lifestyle Lift - Fined $300,000 for deceptive advertising

In this report from ABC News (link), the Lifestyle Lift organization has been fined $300,000 for deceptive advertising practices.

Apparently, Lifestyle has been having their employees write gushingly positive comments about the Lifestyle facelift procedure on various internet forums and chat rooms, when these people never had the procedure, and certainly weren't non-biased, independent reports. More than that, they also developed phony websites that purported to be some patients' own websites, describing their Lifestyle lift in very positive terms.

The Lifestyle lift is, for all intents and purposes, a form of mini-facelift. And as we've said before, when you try to get by with performing less surgery, you often get lesser results.

Thanks to Dr. DiSaia's blog for alerting me to this news item!

Diprivan - not for home use!

Apparently, Diprivan has been found at the former home of the late Michael Jackson. This story is becoming more tragic by the day.

Diprivan, also known generically as propofol, is a powerful intravenous anesthestic agent. In the right hands, it is a useful drug, permitting anesthesia with a low incidence of postoperative nausea and vomiting. In the wrong hands, however, it can be dangerous.

In small doses, diprivan causes sedation. In larger doses, it can induce unconsciousness, and a state of general anesthesia. And a distinct lack of breathing, which can permanently ruin your day.

Sometimes, the same dose in one person will give a different response in another person. Or a slight increase in the dose can push the patient from mere sedation to complete unconsciousness. So, the physician administering propofol needs to know how to monitor and maintain the patient's airway - which might include intubating the patient. This is everyday stuff for a trained anesthesiologist or nurse anesthetist.

There is no way that this drug has any legitimate use outside of a controlled medical setting like the OR or ICU, and certainly no way it should be in a private residence.

U.S. Obesity is getting worse...

According to a recent report, obesity rates in the U.S. have further increased over the last year, with adult obesity rates rising in 23 states.

For the fifth year in a row, Mississippi had the highest rate of adult obesity at 32.5%. Three other states - West Virginia, Alabama and Tennessee - also had adult obesity rates in excess of 30%.
In just one state - Colorado - was the adult obesity rate below 20%.

In 1991, not one state had an adult obesity rate above 20%.

Mississippi also had the highest rate of obese and overweight children (ages 10 to 17) at 44.4%. Minnesota and Utah had the lowest rate at 23.1%.
Childhood obesity rates in the US have more than tripled since 1980.

This is an epidemic, people!

Accutane pulled off the market

A report by Bloomberg news (link) reports that the makers of Accutane, facing mounting legal costs over claims linking the drug to bowel disease, have decided to withdraw the acne drug Accutane from the market.

Generic forms of Accutane are still available.