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Aesthetic surgery: Coming of age
SKIN DISEASES:
USA
III Aesthetic surgery: coming of age
thin the past decade, other injectable substances, iverse methods have none of which are yet approved evolved for aesthetic for use in the USA. Alternaimprovement of the skin and tively, fat can be taken from a Murad Alam, Kenneth A Amdt, Jeffrey S Dover underlying tissues. Expansion non-facial site and implanted of the affluent, ageing popuinto facial sites in the same lation has resulted in a growing demand for such individual, thus eliminating the risk of immune reaction. interventions to ameliorate the visible signs of ageing. Synthetic implantable agents--eg, expanded polytetraParticular concerns are imperfections in the appearance fluoroethylene--are available in various shapes and sizes of the skin, including unevenness in colour and and offer a permanent filling effect while being texture, raised or depressed scars, wrinkles, sagging immunologically inert. Frown lines of the forehead and accumulations of subcutaneous fat, and hair loss. around the eyes respond well to treatment with botulinum Fine wrinkling, photodamage A exotoxin. This substance, caused by lifelong sun exposure, which is not yet approved for and scars caused by acne, this indication by the FDA, is chickenpox, surgery, or trauma injected into the relevant can now be treated by laser muscle groups to provide resurfacing. High-energy shortrelaxation of dynamic skin pulsed or scanned carboncreases for 3-6 months. dioxide lasers and pulsed Age-related fat redistribution erbium yttrium-aluminiumcan occur in the cheeks and garnet (YAG) lasers precisely below the chin and jaw. remove skin tissue of uniform Cervicofacial liposuction depth with little bleeding, while effectively removes fat from limiting the heat-related damage these regions and improves the to surrounding tissues and so contour of the neck and face. minimising the risk of scars and Liposuction also removes larger volumes of fat from other body pigmentary changes. With proper selection of patients and areas that are resistant to diet wound care, the results of laser and exercise, such as the upper resurfacing are dramatic. arms, abdomen, hips, and Wrinkles round the eyes and thighs. Liposuction is safest and mouth, typically unresponsive most effective with the to face-lifting, can be successtumescent anaesthetic techfully treated. nique--ie, injection of several Vascular lesions, such as litres of dilute lidocaine, superficial blood vessels, epinephrine, and sodium bicar%elangiectasias, port-wine stains, bonate into the subcutaneous haemangiomas, and leg veins, as fat before liposuction. The well as scars, striae, and diffuse effects of fluid compression and skin redness, can be treated epinephrine on the subLower face before (top) and I month after C02 laser quickly and effectively with resurfacing cutaneous compartment allow several lasers, including the use of high concentrations of potassium-titanylphosphate laser and the newestlidocaine and decrease the need for sedation. Liposuction generation pulsed-dye lasers, which can eliminate vascular can now be done with little blood loss and with mild postpatches with little or no bruising. Pigmented lesions, operative pain, swelling, and bruising. including tattoos and dark brown birthmarks, can be Improved techniques for lightened with lasers that selectively destroy the pigment hair transplantation have while sparing the adjacent tissue by emitting very short enabled a more natural intense bursts of laser energy called Q-switched pulses. Qappearance. Dermatological switched lasers of specific wavelengths (Q-switched ruby, surgeons have learned to alexandrite, or neodymium YAG lasers) are best suited for transplant hair singly or in removing tattoos of particular colours. Unwanted hair can groups of two or three into also be treated quickly with lasers adapted for this purpose. the balding scalp in the same Best results are seen in dark-haired, light-skinned patients, configurations as on normal in whom a few treatments can result in a sharp permanent scalps. The technology is reduction in hair growth. available to transplant even Injectable or implantable filler substances are available large bald patches within for correction of soft-tissue losses from ageing, scarring, or only one or two sessions. skin disease. These materials can help reduce grooves Given the demand for between the cheeks and the nose as well as wrinkles, aesthetic procedures and the improve the contour of thinning lips, and fill deep acne improvements that are scars. Bovine dermal collagen implants were approved in increasing their efficacy, the USA by the Food and Drug Administration (FDA) in cosmetic dermatological the early 1980s. Since then, autologous collagen products surgery can be expected to that may offer longer duration of correction and lower risk remain a growing area of allergic reactions have been developed, as have various within dermatology. The Lancet Perspectives ° 356 ° December
• 2000
s60
USA
III Aesthetic surgery: coming of age
thin the past decade, other injectable substances, iverse methods have none of which are yet approved evolved for aesthetic for use in the USA. Alternaimprovement of the skin and tively, fat can be taken from a Murad Alam, Kenneth A Amdt, Jeffrey S Dover underlying tissues. Expansion non-facial site and implanted of the affluent, ageing popuinto facial sites in the same lation has resulted in a growing demand for such individual, thus eliminating the risk of immune reaction. interventions to ameliorate the visible signs of ageing. Synthetic implantable agents--eg, expanded polytetraParticular concerns are imperfections in the appearance fluoroethylene--are available in various shapes and sizes of the skin, including unevenness in colour and and offer a permanent filling effect while being texture, raised or depressed scars, wrinkles, sagging immunologically inert. Frown lines of the forehead and accumulations of subcutaneous fat, and hair loss. around the eyes respond well to treatment with botulinum Fine wrinkling, photodamage A exotoxin. This substance, caused by lifelong sun exposure, which is not yet approved for and scars caused by acne, this indication by the FDA, is chickenpox, surgery, or trauma injected into the relevant can now be treated by laser muscle groups to provide resurfacing. High-energy shortrelaxation of dynamic skin pulsed or scanned carboncreases for 3-6 months. dioxide lasers and pulsed Age-related fat redistribution erbium yttrium-aluminiumcan occur in the cheeks and garnet (YAG) lasers precisely below the chin and jaw. remove skin tissue of uniform Cervicofacial liposuction depth with little bleeding, while effectively removes fat from limiting the heat-related damage these regions and improves the to surrounding tissues and so contour of the neck and face. minimising the risk of scars and Liposuction also removes larger volumes of fat from other body pigmentary changes. With proper selection of patients and areas that are resistant to diet wound care, the results of laser and exercise, such as the upper resurfacing are dramatic. arms, abdomen, hips, and Wrinkles round the eyes and thighs. Liposuction is safest and mouth, typically unresponsive most effective with the to face-lifting, can be successtumescent anaesthetic techfully treated. nique--ie, injection of several Vascular lesions, such as litres of dilute lidocaine, superficial blood vessels, epinephrine, and sodium bicar%elangiectasias, port-wine stains, bonate into the subcutaneous haemangiomas, and leg veins, as fat before liposuction. The well as scars, striae, and diffuse effects of fluid compression and skin redness, can be treated epinephrine on the subLower face before (top) and I month after C02 laser quickly and effectively with resurfacing cutaneous compartment allow several lasers, including the use of high concentrations of potassium-titanylphosphate laser and the newestlidocaine and decrease the need for sedation. Liposuction generation pulsed-dye lasers, which can eliminate vascular can now be done with little blood loss and with mild postpatches with little or no bruising. Pigmented lesions, operative pain, swelling, and bruising. including tattoos and dark brown birthmarks, can be Improved techniques for lightened with lasers that selectively destroy the pigment hair transplantation have while sparing the adjacent tissue by emitting very short enabled a more natural intense bursts of laser energy called Q-switched pulses. Qappearance. Dermatological switched lasers of specific wavelengths (Q-switched ruby, surgeons have learned to alexandrite, or neodymium YAG lasers) are best suited for transplant hair singly or in removing tattoos of particular colours. Unwanted hair can groups of two or three into also be treated quickly with lasers adapted for this purpose. the balding scalp in the same Best results are seen in dark-haired, light-skinned patients, configurations as on normal in whom a few treatments can result in a sharp permanent scalps. The technology is reduction in hair growth. available to transplant even Injectable or implantable filler substances are available large bald patches within for correction of soft-tissue losses from ageing, scarring, or only one or two sessions. skin disease. These materials can help reduce grooves Given the demand for between the cheeks and the nose as well as wrinkles, aesthetic procedures and the improve the contour of thinning lips, and fill deep acne improvements that are scars. Bovine dermal collagen implants were approved in increasing their efficacy, the USA by the Food and Drug Administration (FDA) in cosmetic dermatological the early 1980s. Since then, autologous collagen products surgery can be expected to that may offer longer duration of correction and lower risk remain a growing area of allergic reactions have been developed, as have various within dermatology. The Lancet Perspectives ° 356 ° December
• 2000
s60