In the quest for perfection and amid a growing obsession with body image, it seems women now have a new part of the anatomy to worry about - their vaginas. Genital plastic surgery is one of the fastest-growing areas in cosmetic surgery, and one of the most popular procedures being requested - mostly by young women - is a labiaplasty. A labiaplasty - or labial rejuvenation - is a procedure whereby the inner labia, or labia minora, get trimmed back so they look more "tucked in". The surgery is generally done under a local anaesthetic, so the patient is awake while it is being performed. The process takes around 90 minutes and you can walk out of the surgery, returning to normal activities within a few days - except for sex, which you should hold off having for four to six weeks. The reason for the rise: "There has been a huge surge in the past five years of people looking to get genital surgery, and the vast majority of these are getting a labiaplasty, vaginoplasty (vaginal tightening) or liposuction in the pelvic area or labia," says Dr Laith Barnouti, a leading Sydney plastic surgeon. Barnouti says that currently around 20 per cent of his clients are coming in for genital surgery. The youngest to date was 14, the oldest in her mid-60s. A 2010 report also found that the number of clinically necessary procedures - that is, not solely for cosmetic reasons - performed by private practitioners nearly doubled in recent years.
So why are women requesting this procedure? There are a few reasons, says Barnouti, including feeling "socially embarrassed… people can’t wear certain types of bathers, people feel embarrassed in intimate situations". But the reasons go beyond the aesthetic, he claims.
"Labiaplasty and vaginoplasty are often performed due to a medical condition - people actually have it for a functional reason," Barnouti says. "Labial hypertrophy - enlargement or sagging of the labia - can be unhealthy and unhygienic."
Vaginoplasty, which is usually performed on women who have a weakened perineum after giving birth, is a "restorative, reconstructive procedure", says Barnouti. "This is something completely different from, say, liposuction, which is a purely cosmetic procedure."
What is normal? But are women having genital surgery for other reasons - to please a boyfriend perhaps, or because they feel their vagina is not normal? Do women actually hate the appearance of their vulvas so much that they will have parts of them surgically removed? The 2008 UK documentary The Perfect Vagina explored the reasons why women opt for this type of surgery, and found that many do it because they’ve been teased by someone close to them about the way their genitals look, or have just decided their vagina looks abnormal. In the documentary, Professor Linda Cordoza, a leading UK gynaecologist, says while women are much more aware of what’s available in terms of plastic surgery procedures, it doesn’t necessarily mean they know what’s normal.
"There’s been a huge trend towards bikini waxing, doing things with your pubic hair as well as the hair on your head. So [women think] if you can have cosmetic surgery done to your face, you can also have cosmetic surgery done on your genitals," Cordoza says.
"I sometimes get two or three generations of women in the same family coming in saying they want their labia trimmed."
The role of pornography:
Our perception of what is normal is most definitely clouded by the proliferation of pornographic images featuring women with smaller, tucked in - and often heavily airbrushed - private parts.As women, we don’t often see vaginas other than our own, so if the only images we see are of highly airbrushed genitals, naturally many of us are going to assume that what we have is "different" or "abnormal".
Melinda Tankard Reist is a media commentator and author of Big Porn Inc and Getting Real - Challenging the Sexualisation of Girls (Spinifex Press). She believes pornography is a big driver in the rise in cosmetic surgery."Girls are made to feel inadequate and think that there’s something wrong with their perfectly natural, healthy bodies. And boys are expecting girls to provide the porn star experience," Reist says.
Reist adds that it’s important women pass on positive body image messages to their daughters, and that cosmetic surgeons should play their part by refusing to operate on very young women, rather than "capitalising on the body angst of girls".
Barnouti says women contemplating any type of cosmetic surgery should be doing it for themselves, not anyone else. "What we do here is for the patient, not their partner," Barnouti says. "If you’re going to have a procedure, have it for yourself. Just because someone makes a negative comment doesn’t mean you should change your whole body."
"I had this surgery and love the results": Lisa Smith, 23, recently had genital surgery at the Ashley Centre in Melbourne. "Labiaplasty is something I’ve wanted to do for years. I have never had a problem with how I look, nor have I received any negative comments from partners. For me it was about feeling discomfort and swelling in that area, particularly after sex. The procedure wasn’t uncomfortable and I was surprised by how minimal the pain was, especially considering how sensitive that area is. I am a dancer and I’ve talked to a lot of friends about it and many say they have also had it done. It’s just not something people are talking about very openly yet."
Did you know? This type of surgery gets 74,000 global monthly internet searches on Google.
Wednesday, October 10, 2012
CREDENTIALS ARE IMPORTANT
A Florida woman's quest for more youthful skin turned deadly this past July when her face became dangerously swollen after she received vitamin injections at a day spa.
Isabel Gonzalez paid nearly $900 for "facial rejuvenation" injections at Viviana's Body Secrets Spa in Doral, Fla. After receiving the treatments, her face started to swell and became infected, and she soon landed in the hospital, where she spent more than two months. Doctors fear her face may be permanently deformed.
The spa owner, Viviana Ayala, was arrested this week on charges that included aggravated battery and practicing medicine without a license, according to a report from the Doral Police Department. Ayala wasn't trained or certified to deliver facial injections. She wasn't even a licensed massage therapist as she advertised on her website. Ayala, according to the Miami Herald and other news sources, has denied all charges against her. Neither Ayala nor her lawyer, Milena Abreu, could be reached for comment.
Experts are alarmed at the increasing number of people seeking such cosmetic procedures. According to the organization Cosmetic Plastic Surgery Research, more than 8 million people underwent cosmetic treatments to freshen up their appearance last year. Treatments included Botox, chemical peels and laser skin resurfacing, and consumers migtht not be aware of the risks. Isabel Gonzalez remains in the hospital after after receiving facial rejuvenation treatments from an unlicensed spa owner.
"Cosmetic procedures are now so mainstream there's a misperception that it's like getting your hair done," said Dr. Leo R. McCafferty, a board certified plastic surgeon who is president of the American Society for Aesthetic Plastic Surgery. "They are inherently safe, but this is predicated on [their] being delivered by properly trained professionals in a properly equipped facility."
ASAPS recommends that cosmetic procedures be performed only by board certified plastic surgeons or dermatologists in an accredited facility, although some states al/so allow registered nurses and physician's assistants to deliver therapies under doctors' supervision. Members of the ASAPS, and similar professional organizations, are required to operate only in certified centers or hospitals.
Some spas meet these criteria, but even if a facility brands itself a "medispa," that's no guarantee of proper oversight. A clinic may claim it's affiliated with a board certified plastic surgeon, but a surgeon might only show up to check charts once a month. Or a spa may try to pass off a practitioner who has no medical training as a cosmetic surgeon. Although this is illegal in some states, McCafferty said, no one's really checking.
Dr. Nima Patel, a plastic surgeon at Maimonides Medical Center in Brooklyn, N.Y., said spas can mislead consumers in other ways, too.
"Most people know they probably shouldn't get an injection from the same person who gives them a massage but don't think twice about letting a dentist or a physician who doesn't have intensive training in a cosmetic specialty give them an injection," she said. "In some spa settings, this is who is delivering the services."
Patel also emphasized the importance of making sure the attending professional maintains privileges at a nearby hospital and remains on the premises when cosmetic procedures are done. If there are side effects or complications, a patient can be transferred to the emergency room.
Dr. Felmont Eaves, a Charlotte, N.C., board certified plastic surgeon in private practice, advised any consumer considering any type of cosmetic touch-up to do their homework. "Check out the credentials of anyone performing or overseeing your treatment and know the risks of the product you are considering," Eaves said. As for bargain hunting, Eaves warned against it.
Isabel Gonzalez paid nearly $900 for "facial rejuvenation" injections at Viviana's Body Secrets Spa in Doral, Fla. After receiving the treatments, her face started to swell and became infected, and she soon landed in the hospital, where she spent more than two months. Doctors fear her face may be permanently deformed.
The spa owner, Viviana Ayala, was arrested this week on charges that included aggravated battery and practicing medicine without a license, according to a report from the Doral Police Department. Ayala wasn't trained or certified to deliver facial injections. She wasn't even a licensed massage therapist as she advertised on her website. Ayala, according to the Miami Herald and other news sources, has denied all charges against her. Neither Ayala nor her lawyer, Milena Abreu, could be reached for comment.
Experts are alarmed at the increasing number of people seeking such cosmetic procedures. According to the organization Cosmetic Plastic Surgery Research, more than 8 million people underwent cosmetic treatments to freshen up their appearance last year. Treatments included Botox, chemical peels and laser skin resurfacing, and consumers migtht not be aware of the risks. Isabel Gonzalez remains in the hospital after after receiving facial rejuvenation treatments from an unlicensed spa owner.
"Cosmetic procedures are now so mainstream there's a misperception that it's like getting your hair done," said Dr. Leo R. McCafferty, a board certified plastic surgeon who is president of the American Society for Aesthetic Plastic Surgery. "They are inherently safe, but this is predicated on [their] being delivered by properly trained professionals in a properly equipped facility."
ASAPS recommends that cosmetic procedures be performed only by board certified plastic surgeons or dermatologists in an accredited facility, although some states al/so allow registered nurses and physician's assistants to deliver therapies under doctors' supervision. Members of the ASAPS, and similar professional organizations, are required to operate only in certified centers or hospitals.
Some spas meet these criteria, but even if a facility brands itself a "medispa," that's no guarantee of proper oversight. A clinic may claim it's affiliated with a board certified plastic surgeon, but a surgeon might only show up to check charts once a month. Or a spa may try to pass off a practitioner who has no medical training as a cosmetic surgeon. Although this is illegal in some states, McCafferty said, no one's really checking.
Dr. Nima Patel, a plastic surgeon at Maimonides Medical Center in Brooklyn, N.Y., said spas can mislead consumers in other ways, too.
"Most people know they probably shouldn't get an injection from the same person who gives them a massage but don't think twice about letting a dentist or a physician who doesn't have intensive training in a cosmetic specialty give them an injection," she said. "In some spa settings, this is who is delivering the services."
Patel also emphasized the importance of making sure the attending professional maintains privileges at a nearby hospital and remains on the premises when cosmetic procedures are done. If there are side effects or complications, a patient can be transferred to the emergency room.
Dr. Felmont Eaves, a Charlotte, N.C., board certified plastic surgeon in private practice, advised any consumer considering any type of cosmetic touch-up to do their homework. "Check out the credentials of anyone performing or overseeing your treatment and know the risks of the product you are considering," Eaves said. As for bargain hunting, Eaves warned against it.
BREAST RECONSTRUCTION OPTIONS
During October, pink ribbons seem almost as ubiquitous as jack-o'-lanterns. If that's any indication of breast cancer awareness, knowledge of the disease must be at an all-time high. However, one aspect of recovering from breast cancer remains obscured by lack of information and a degree of stigma: breast reconstruction. A 2008 study revealed seven out of 10 breast cancer patients are not told their options for post-mastectomy reconstruction.
"We don't do an adequate job informing patients about what's going on," says Dr. Scott Sullivan, a general and plastic surgeon and co-founder of the Center for Restorative Breast Surgery. "The general surgeons are the gatekeepers (for reconstructive surgery), and they may not know the options or may choose not to discuss it. A community hospital may not have a plastic surgeon around, and even in some big cities, the quality of the surgery is not what it should be."
Two-time breast cancer survivor Kim Sport knew about her reconstruction options because she was an active volunteer in the cancer community. It wasn't until after her mastectomy and reconstruction that she learned this made her a bit of an anomaly.
"I didn't know that doctors weren't telling their own patients they didn't have to live with disfigurement after a mastectomy," says Sport, who created Breastoration, an organization that sheds light on breast reconstruction. "I was so outraged by it. I can't imagine looking down and dealing with disfigurement as a daily, constant reminder that at two times, I had a life-threatening disease."
Sport and Dr. Malcolm Roth, president of the American Society of Plastic Surgeons (ASPS) and chief of the division of plastic surgery at Albany Medical Center, say that some surgeons may intentionally or unintentionally lead women to believe that breast reconstruction is an unnecessary or narcissistic cosmetic procedure.
"The fact that we have mandated insurance coverage takes (reconstruction) out of the realm of cosmetic surgery and makes it medically necessary procedure for a woman's physical and emotional well-being following her mastectomy," Sport says.
Roth says not only does reconstruction pose no risk to survival in suitable patients, it also aids recovery.
"Women who have immediate reconstruction are more likely to return to work and social situations faster, have less chance of depression, and the quality of life gets back to normalcy much faster," Roth says. "So it may actually be better to do it immediately, though in some cases it is better to wait. A board-certified plastic surgeon is knowledgeable about that and collaborates with the oncologist, the breast surgeon, about what the best road for her may be."
There are a number of sophisticated techniques for breast reconstruction, with implants being the most common, according to Dr. Frank DellaCroce, co-director of the Center for Restorative Breast Surgery. Cohesive silicone gel or saline implants and supportive collagen are placed immediately following the mastectomy. Often, the skin and nipple can be spared, though sensation and functionality are lost. Fat transplant procedures involve transferring fat from the stomach or hips to create a natural feeling breast from living tissue that responds to weight gain or loss. The operation and recovery are longer than with implants — five or six hours in surgery compared to one or two, and a hospital stay that's two days longer — but fat transplants never wear out or need to be replaced.
"Plastic surgeons are at the ready with super-sophisticated technology that women need to know about," DellaCroce says. "And they need to know about them before they need them, ideally."
"We don't do an adequate job informing patients about what's going on," says Dr. Scott Sullivan, a general and plastic surgeon and co-founder of the Center for Restorative Breast Surgery. "The general surgeons are the gatekeepers (for reconstructive surgery), and they may not know the options or may choose not to discuss it. A community hospital may not have a plastic surgeon around, and even in some big cities, the quality of the surgery is not what it should be."
Two-time breast cancer survivor Kim Sport knew about her reconstruction options because she was an active volunteer in the cancer community. It wasn't until after her mastectomy and reconstruction that she learned this made her a bit of an anomaly.
"I didn't know that doctors weren't telling their own patients they didn't have to live with disfigurement after a mastectomy," says Sport, who created Breastoration, an organization that sheds light on breast reconstruction. "I was so outraged by it. I can't imagine looking down and dealing with disfigurement as a daily, constant reminder that at two times, I had a life-threatening disease."
Sport and Dr. Malcolm Roth, president of the American Society of Plastic Surgeons (ASPS) and chief of the division of plastic surgery at Albany Medical Center, say that some surgeons may intentionally or unintentionally lead women to believe that breast reconstruction is an unnecessary or narcissistic cosmetic procedure.
"The fact that we have mandated insurance coverage takes (reconstruction) out of the realm of cosmetic surgery and makes it medically necessary procedure for a woman's physical and emotional well-being following her mastectomy," Sport says.
Roth says not only does reconstruction pose no risk to survival in suitable patients, it also aids recovery.
"Women who have immediate reconstruction are more likely to return to work and social situations faster, have less chance of depression, and the quality of life gets back to normalcy much faster," Roth says. "So it may actually be better to do it immediately, though in some cases it is better to wait. A board-certified plastic surgeon is knowledgeable about that and collaborates with the oncologist, the breast surgeon, about what the best road for her may be."
There are a number of sophisticated techniques for breast reconstruction, with implants being the most common, according to Dr. Frank DellaCroce, co-director of the Center for Restorative Breast Surgery. Cohesive silicone gel or saline implants and supportive collagen are placed immediately following the mastectomy. Often, the skin and nipple can be spared, though sensation and functionality are lost. Fat transplant procedures involve transferring fat from the stomach or hips to create a natural feeling breast from living tissue that responds to weight gain or loss. The operation and recovery are longer than with implants — five or six hours in surgery compared to one or two, and a hospital stay that's two days longer — but fat transplants never wear out or need to be replaced.
"Plastic surgeons are at the ready with super-sophisticated technology that women need to know about," DellaCroce says. "And they need to know about them before they need them, ideally."
Wednesday, September 12, 2012
AGING BREASTS
Twin Study Sheds Light on How Breasts Age
Want to know how to keep breasts looking young? A new study of twins provides revealing information for patients on which factors help breasts maintain their youthful qualities as well as those that seem to diminish them.
Breastfeeding, daily moisturizing, and hormone replacement therapy may help breasts stay younger-looking. By contrast, smoking, drinking alcohol, multiple pregnancies, higher body mass index, and larger bra and cup sizes contribute to accelerated breast aging, according to a new study in the September issue of the Aesthetic Surgery Journal.
“Identical twin studies like this one are very valuable because they allow us to control for genetic influences,” says lead researcher Hooman T. Soltanian, MD, of University Hospitals Case Medical Center and Case Western Reserve University School of Medicine in Cleveland, in a new release. “This allows us to more accurately assess the impact of external factors on breast aesthetics, such as environmental and lifestyle factors.”For the study, researchers recruited 161 pairs of identical female twins with a mean age of 47.6 years in 2009 and 2010. Aesthetic breast features were rated by plastic surgery residents using standard medical photographs. The ratings were analyzed against data on participants’ medical and personal histories to determine the significance of different external factors on breast appearance. Twins who moisturized their breasts daily had significantly fewer wrinkles in that area, and those who received hormone replacement therapy after menopause had a more attractive breast shape, size, projection, areolar shape, and areolar size. Women who breastfed had less attractive areolar size and shape, but better skin quality.
“This study is significant because it clearly shows women what they can do right now to help slow the aging process and keep their breasts looking attractive, even without surgical intervention,” says Foad Nahai, MD, the editor-in-chief of Aesthetic Surgery Journal, in a news release.
Want to know how to keep breasts looking young? A new study of twins provides revealing information for patients on which factors help breasts maintain their youthful qualities as well as those that seem to diminish them.
Breastfeeding, daily moisturizing, and hormone replacement therapy may help breasts stay younger-looking. By contrast, smoking, drinking alcohol, multiple pregnancies, higher body mass index, and larger bra and cup sizes contribute to accelerated breast aging, according to a new study in the September issue of the Aesthetic Surgery Journal.
“Identical twin studies like this one are very valuable because they allow us to control for genetic influences,” says lead researcher Hooman T. Soltanian, MD, of University Hospitals Case Medical Center and Case Western Reserve University School of Medicine in Cleveland, in a new release. “This allows us to more accurately assess the impact of external factors on breast aesthetics, such as environmental and lifestyle factors.”For the study, researchers recruited 161 pairs of identical female twins with a mean age of 47.6 years in 2009 and 2010. Aesthetic breast features were rated by plastic surgery residents using standard medical photographs. The ratings were analyzed against data on participants’ medical and personal histories to determine the significance of different external factors on breast appearance. Twins who moisturized their breasts daily had significantly fewer wrinkles in that area, and those who received hormone replacement therapy after menopause had a more attractive breast shape, size, projection, areolar shape, and areolar size. Women who breastfed had less attractive areolar size and shape, but better skin quality.
“This study is significant because it clearly shows women what they can do right now to help slow the aging process and keep their breasts looking attractive, even without surgical intervention,” says Foad Nahai, MD, the editor-in-chief of Aesthetic Surgery Journal, in a news release.
Tuesday, September 11, 2012
Thursday, September 6, 2012
ROSACEA
Does Bacteria Cause Rosacea? New Study Suggests it "Mite"
Bacteria that reside within tiny mites may cause rosacea, a new review study suggests.
Researchers out of the National University of Ireland report that rosacea may be triggered by bacteria that live within tiny Demodex folliculorum mites which make their home in our skin. Their findings appear in the Journal of Medical Microbiology. Previous research has shown that the numbers of Demodex mites living in the skin of rosacea patients is higher than in normal individuals. More recently, the bacterium Bacillus oleronius was isolated from inside a Demodex mite and was found to produce molecules provoking an immune reaction in rosacea patients. Other studies have shown patients with varying types of rosacea react to the molecules produced by this bacterium. In addition, this bacterium is sensitive to the antibiotics used to treat rosacea.
The new findings may give rise to more effective treatments for rosacea, conclude study authors who were led by Kevin Kavanagh, PhD. “Targeting these bacteria may be a useful way of treating and preventing this condition,” he says in a press release. “Alternatively, we could look at controlling the population of Demodex mites in the face. Some pharmaceutical companies are already developing therapies to do this, which represents a novel way of preventing and reversing rosacea, which can be painful and embarrassing for many people.
Michele Green, MD, a dermatologist at Lenox Hill Hospital in New York City, says that the new findings make sense. “I am not surprised, considering how often Rosacea improves or resolves with oral and or topical antibiotic therapy. Rosacea like traditional acne may indeed have the same cause and, hence, the same treatment.“
Bacteria that reside within tiny mites may cause rosacea, a new review study suggests.
Researchers out of the National University of Ireland report that rosacea may be triggered by bacteria that live within tiny Demodex folliculorum mites which make their home in our skin. Their findings appear in the Journal of Medical Microbiology. Previous research has shown that the numbers of Demodex mites living in the skin of rosacea patients is higher than in normal individuals. More recently, the bacterium Bacillus oleronius was isolated from inside a Demodex mite and was found to produce molecules provoking an immune reaction in rosacea patients. Other studies have shown patients with varying types of rosacea react to the molecules produced by this bacterium. In addition, this bacterium is sensitive to the antibiotics used to treat rosacea.
The new findings may give rise to more effective treatments for rosacea, conclude study authors who were led by Kevin Kavanagh, PhD. “Targeting these bacteria may be a useful way of treating and preventing this condition,” he says in a press release. “Alternatively, we could look at controlling the population of Demodex mites in the face. Some pharmaceutical companies are already developing therapies to do this, which represents a novel way of preventing and reversing rosacea, which can be painful and embarrassing for many people.
Michele Green, MD, a dermatologist at Lenox Hill Hospital in New York City, says that the new findings make sense. “I am not surprised, considering how often Rosacea improves or resolves with oral and or topical antibiotic therapy. Rosacea like traditional acne may indeed have the same cause and, hence, the same treatment.“
AUTOGENOUS TISSUE THE BEST IN NASAL SURGERY
Nose implants may increase infection risk, a new study suggests.
Researchers analyzed infection rate seen following 662 rhinoplasty procedures performed by three surgeons from 1999 to 2008. Medpor or Gore-Tex implants were used in 151 cases. Nineteen patients developed an infection, and all of the infections occurred in patients who had implants. In all but one of these cases, the implant began protruding through the skin.
Researchers analyzed infection rate seen following 662 rhinoplasty procedures performed by three surgeons from 1999 to 2008. Medpor or Gore-Tex implants were used in 151 cases. Nineteen patients developed an infection, and all of the infections occurred in patients who had implants. In all but one of these cases, the implant began protruding through the skin.
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