Health & Medicine Journal

By Paul Van Camp MD
February 2003

Following are brief summaries of research published in recent medical journals. Topics are selected to be of interest to Cascade Discovery readers for general health and significant medical advances.

Skin rejuvenation using lasers and Intense Pulsed light has been shown to give impressive improvements in aged and sun-damaged skin. These are known as "no down-time" treatments because they do not wound the skin. In other words, the skin is not broken nor burned by the procedure. Patients can receive a 30-minute treatment and can return to work or social activities that same day.

The improvement, which is achieved over a series of five treatments given at three week intervals, can be impressive: Blotchy pigment and sun spots are lightened or cleared; redness and visible spider-veins go away; coarse sun-damaged skin becomes much smoother with better texture; and pore size is visibly reduced. The improvements may not be as dramatic as with deeper treatments such as laser skin resurfacing. However, for such a gentle procedure with high safety we can typically see 60% to 80% improvement in each of these areas. This is excellent. Yet how long do these improvements really last?

A study published in the journal Dermatologic Surgery in December answers this question. 80 patients who received a series of Intense Pulsed Light treatments (IPL) for their face, chest, or neck skin in 1996 or 1997 were re-evaluated to see how well the skin improvements had held up after 5 years. This showed that the improvements in skin texture (smoothness and smaller pore size), clearance of redness and visible "spider-veins", and clearance of blotchy pigmentation remained in 80 to 90% of the patients after 5 years. Neck and chest skin also showed impressive persistence of improvement (though not quite as good as on the face). The chest showed 76% sustained improvement and the neck had 71%.

This is very good news for those undergoing Intense Pulsed-Light skin treatments such as the FotoFacial treatments. The results are durable. Many patients benefit from annual maintenance treatments to sustain and improve their skin quality and appearance even further. (More information on FotoFacial treatments is available from Aesthetics MD.)

In a previous edition, I reported on a study in Florida that showed that Liposuction using only local anesthesia was proven safe, with no deaths or major reportable complications over a 19-month study period. This was in contrast to liposuction where general or systemic anesthesia was used: where there were 43 complications and 8 deaths. The message was clear: Liposuction using only local anesthesia was much safer than when other anesthetics were used.

Now a national study has confirmed this conclusion. Surveys were sent to over 500 dermatologic surgeons who performed liposuction. (The results were published in the November 2002 journal Dermatologic Surgery.)

The study covered 66,570 liposuction procedures by dermatologic cosmetic surgeons. There were no deaths. The overall risk of a serious complication was less than 1 in a thousand (0.68 per 1000 cases). Surprisingly, office-based treatment showed the best safety record: the rates of serious complications were lower in office-treated patients than in those treated in hospitals or ambulatory surgery centers.

Other advantages with liposuction by local tumescent anesthesia (or "Liposculpture") include: Great comfort — it really does not hurt for the vast majority of patients. Easier recovery — patients are back to moderate activities or work the next day. There are no extra fees for surgery center and anesthetist. There is better tissue contraction because of the micro-cannulas used. (The majority of abdomen procedures do not need a "tummy tuck"). Micro-cannulas also make for the smoothest and most even results possible. Get full information before deciding on any cosmetic medical or surgical procedure, including risks alternatives and limitations.

Anyone contemplating body or facial re-contouring by liposuction owes it to himself or herself to find out about the true tumescent method (using only local anesthesia) before they decide. There is a difference.

For many years, injectable collagen treatments have been the standard treatment to replace lost volume and restore the contours of the face. These products (marketed as Zyplast and Zyderm) help to fill deep wrinkles, deep folds around the mouth and nose, restore volume to thinned lips, and correct depressed areas such as from certain scars. The results can be very gratifying. But this has never been a perfect treatment. Some people are allergic to the collagen that is used. Therefore, skin testing must be performed first. The major drawback with collagen is that it does not last. Even with an excellent response the collagen, treatment must be touched-up about every six months Otherwise it is gradually reabsorbed and the improvement diminishes.

A better product that has been used in Europe for several years may soon be available to us in the United States. (FDA approval is pending and likely this year.) The product is Restylane. It is not a collagen product but is made from hyaluronic acid. This is a natural structural component of our skin. Since it is not a protein, it does not cause allergies. Therefore, no skin testing is required. However, most important is that Restylane lasts longer than collagen. In fact, it may last about twice as long on average, so only annual touch-ups may be needed.

In a recently published study comparing collagen to Restylane, there was a strong preference for Restylane. (Cosmetic Surgery December 2002) Most patients and physicians in the study found Restylane to give a nicer correction that looked better than collagen when they were directly compared. (Collagen was used on one side and Restylane on the other side. At six months and nine months after the original treatments, it was clear that the Restylane side had more lasting improvement than did the collagen.

Restylane (and another hylauronic acid product called Perlane) will be a nice improvement over collagen for most cosmetic applications. I will probably offer to switch most of my collagen patients over to Restylane and Perlane as they become available.

The above summaries are presented for education purposes and not to recommend treatment for any individual or condition. Dr. Paul Van Camp is a physician and medical director of Aesthetics MD. 115 SW Allen Road Bend 97702. Further information is available at www.aesthetics-md.com References to original publication of the studies discussed is available upon request.