The first phase of the trials will have about 28 patients between the ages of 18 and 64. It will include men with moderate male-pattern baldness and women with moderate female-pattern hair loss.

Some doctors have already been using Latisse as an off-label treatment for baldness. Hair-restoration expert Dr. Alan Bauman has prescribed it for patients and reports they have had modest hair growth. He believes that “Allergan will likely test a stronger concentration for the use on the scalp than the 0.03% bimatoprost found in Latisse.”

Clinical studies demonstrated that 78 percent of Latisse users reported significant eyelash enhancement. On average, participants had lashes that were 25 percent longer, 18 percent darker and over 100 percent fuller.

Patients using Latisse generally see results appear some time between 8 and 12 weeks; by 16 weeks, the full effects become evident. Results aren’t permanent, so patients must continue to use the product to maintain results.

Allergan is currently offering a free trial certificate for Latisse for those who donate a minimum of $20 to the Make-A-Wish Foundation. Besides the free trial, Allergan will double your donation.

Contact the office of board-certified Seattle plastic surgeon Dr. Robert Grenley with questions about Latisse. For more information on the clinical study for treating hair loss, visit the government’s Clinical Trials website.

Cytori’s process for breast surgery uses liposuction to harvest fat cells (usually from the abdomen), and then the fat is injected into the company’s Celution System where a centrifuge separates the fat cells from the stem and regenerative cells and prepares the cells for injection. Finally, a surgeon injects the cells into the breast for the augmentation or reconstructive procedure.

The cells don’t become breast tissue; rather, the fat cells in the mixture provide volume and the regenerative cells encourage the growth of a blood supply that the fat cells need to survive.

Why has Cytori chosen to focus its technology on breasts? Since breasts don’t have much function beyond nursing a baby, “the scientific and regulatory hurdles to getting Cytori’s cells into clinical use will be easier to clear for breasts than for other tissue: Breasts simply aren’t as necessary as other organs, so the bar for proving to regulators that the technology works will be lower,” according to the article.

The company has completed almost a decade of trials on cell cultures, lab rodents and now humans. Cytori believes the same technology it is using for breast procedures could be used to regenerate other damaged tissue, such as in the heart or kidneys.

Cytori’s system has not been FDA approved, so it can’t be marketed in the U.S., although doctors can purchase it.

The study also found that:

• 82 percent had an improvement in self-esteem
• 69.6 percent reported an improved quality of life

The study’s author, plastic surgeon Dr. Eric Swanson, writes that patient satisfaction and the effects of surgery on quality of life are two of the most important factors in determining if a surgery is a success, but they had not been previously prospectively studied in patients undergoing facelifts alone or in combination with other facial procedures.

Swanson conducted interviews with the patients, whose mean age was 56.6 years, one month after surgery. The patients had a deep plane facelift or a facelift along with another surgery, including eyelid surgery, forehead lift and endoscopic forehead lift. Other commonly performed procedures done at the time of the facelift included laser resurfacing, fat injection and chin augmentation.

The author concluded, “With proper patient preparation and education, facial rejuvenation effectively meets patient expectations. These findings support the recommendation of surgical facial rejuvenation to patients who wish to look younger.”

Despite the substantial recovery time the patients reported for facelifts, the majority of patients (83.9 percent) said they would have the surgery again, and 93.5 percent said they would recommend the surgery to someone else.

The study will appear in the next issue of Plastic & Reconstructive Surgery journal and the abstract is available online.

For chronic migraine, Botox is given about every 12 weeks as multiple injections around the head and neck to try to dull future headache symptoms. Researchers are still trying to determine how Botox works on migraines, but one theory is that it blocks pain signals from reaching nerve endings.

Last year Botox worldwide sales were divided equally between medical and cosmetic uses, reports the New York Times. However, Allergan, the maker of Botox, believes its sales as a medical treatment may soon eclipse its sales as a cosmetic wrinkle treatment. The injectable is also approved to treat uncontrolled blinking; crossed eyes; certain neck muscle spasms; underarm sweating; and muscle spasticity in the hands and elbows.

In other Botox news, British scientists report that they’ve developed a way to refine the anti-wrinkle treatment to improve its use for treating Parkinson’s, cerebral palsy and chronic migraine. The researchers produced a refined Botox-like molecule, which they said would be practical for clinical use but would not have unwanted toxic effects.

“It will now be possible to produce Botox-based medicines in a safer and more economical way,” said Bazbek Davletov, who led the study at Medical Research Council’s Laboratory of Molecular Biology.

Davletov said the new refining technique could allow scientists to produce new forms of Botox with wider practical medicinal uses, for example as a long-term painkiller.

Read the FDA press release on its approval of Botox to treat chronic migraine and the article on refining Botox, “Scientists Find Way to Refine Botox for New Uses.”

Experts say there is little evidence of whether the stem cell facelift is effective and how it works. Dr. J. Peter Rubin, an associate professor of plastic surgery and co-director of the Adipose Stem Cell Center at the University of Pittsburgh, says that while he’s excited about the potential of stem cells for cosmetic uses, there are many unanswered questions, and that claims are being made that are not supported by evidence.

Rubin think it’s possible that injected stem cells could create new collagen and blood vessels, which they’ve been shown to do in animals studies, but such results haven’t been proved in humans. He says that no one really knows how the stem cells are behaving, and points out that fat injections on their own alone can improve a person’s appearance—without stem cells.

Plastic surgeon Jeffery Kenkel, MD, agrees with Rubin. “We simply don’t know enough about the safety and efficacy of these procedures. One of the major unanswered questions is whether the stem cells actually contribute to any of the positive effects that might be observed, or whether we are simply seeing the effects of injecting fat cells into the face, which can give the face a younger look,” he says.

“Stem cells have incredible potential. But nobody knows exactly what they can do. So they’re marketed to do everything,” says Michael McGuire, past president of the American Society of Plastic Surgeons (ASPS). “In time, maybe a decade from now, science will tell the real story, but until then, marketing regarding stem cell face lifts should be considered fiction.”

New Beauty reports that ASPS and the American Society for Aesthetic Plastic Surgery will be working together to test the legitimacy of the stem cell facelift. The L.A. Times article on the topic, “Stem cell face-lifts on unproven ground,” is available online.

Fat grafting involves harvesting fat cells with liposuction from one part of the body and injecting into another. According to the American Society for Aesthetic Plastic Surgery (ASAPS), it’s a procedure with few surgical complications and is most commonly used cosmetically for the hands and face.

While fat grafting for breast augmentation has been a relatively obscure procedure,  new studies, such as this one, are building evidence that it could be effective for breast enhancement.

The study, authored by Boston plastic surgeon Daniel Del Vecchio, MD, and Philadelphia plastic surgeon Louis Bucky, MD, was conducted over two years with 25 patients who had breast enhancement with fat grafting.

Before the procedure, patients were photographed and had MRI and/or 3D breast imaging, followed by three weeks of expansion, such as wearing a suction bra every day. Patients were again photographed and had the other breast imaging tests repeated six months after the surgery.

Results showed that at six months post surgery all patients had visible breast volume increase. The mean volume increase was 250 cc per breast.

The study concluded that patient selection and pre-expansion of the breasts are important variables in the success of the procedure. The authors add that the technique can be “performed in a time efficient manner with reproducible, long-lasting results.”

ASPS noted, “While the procedure is gaining scientific validity and traction among plastic surgeons, it is not the same as having breast enlargement with implants.”

ASPS and ASAPS initially cautioned against fat grafting for breast augmentation because some of the side effects, such as calcification, were difficult to distinguish mammographically between calcifications associated with breast cancer vs. those associated with fat transfer. However, more recent radiology literature suggests that new generations of mammography equipment, especially digital mammography, are better able to pick up the difference between cancer cells and benign ones, according to the societies.

Read the study’s abstract online at plasticsurgery.org.

Plastic Surgery 2010, sponsored by the American Society of Plastic Surgeons (ASPS), is the largest international meeting of plastic surgeons and will feature the latest developments and trends in the industry.

“Plastic Surgery 2010 is the complete plastic surgery experience featuring the latest information on cosmetic and reconstructive plastic surgery techniques,” said ASPS President Michael McGuire, MD.

A variety of procedures will be covered in studies, panels, and courses, including:

• Patterns of Use and Surgical Outcomes of Breast Reconstruction among Obese Patients
• Breast Augmentation with Fat Grafting
• Fillers and Injectables: Evidence-Based Update
• Painless Tummy Tucks
• Liposuction During Tummy Tucks, Safe or Sorry?
• Post-Bariatric Surgery: Body Contouring, Reconstructive Considerations and Optimal Outcomes

There will also be a Haiti Forum at which plastic surgeons will discuss their volunteer experiences following the January earthquake in Haiti. There are still many plastic surgeons actively engaged in the relief effort.

Because the meeting is in Canada this year, Dr. McGuire said it “will serve as a first ‘congress of plastic surgery’ whereby international and U.S. physicians can easily come together to investigate and refine new techniques, review the safety and effectiveness of devices and procedures, and explore emerging trends in plastic surgery.”

Seattle plastic surgeon Robert Grenley, MD, is an ASPS member. The largest organization of board-certified plastic surgeons in the world, ASPS represents over 7,000 physician members and is recognized as an authority and information source on cosmetic and reconstructive plastic surgery.

Dr. Kathy Yu, of Columbia College and Cornell University, New York, and colleagues surveyed 104 patients who were seeking nose revision surgery in 2008 and 2009 and asked them why they wanted the second operation. The top three reasons were:

1.      Nose tip asymmetry

2.      Difficulty breathing or nasal obstruction

3.      A crooked middle third of the nose

However, a surgeon who examined the revision rhinoplasty candidates cited slightly different findings than patients, which suggests that communication about nasal surgery could be improved.

The surgeon who consulted the patients reported three primary aesthetic reasons for revision:

1.      Tip asymmetry

2.      A crooked middle third

3.      Irregularities in the upper third of the nose

Sixty-four (62 percent) of patients reported breathing problems or other issues with nasal obstructions. The surgeon confirmed this problem in 60 (94 percent) of those patients, the researchers found.

“The discrepancy between patient concerns and surgeon findings arose for a variety of reasons,” the authors wrote. “One of the main reasons is the surgeon’s use of a conventional set of anatomical boundaries, specifically regarding the upper vs. middle third of the nose. Patients often do not have intricate knowledge of nasal anatomy to properly distinguish between nasal thirds.”

The researchers concluded that their findings “emphasize the importance of physician awareness of patients’ concerns, understanding the causes of post-surgical nasal obstruction and clearly explaining nasal aesthetics to patients seeking revision rhinoplasty.”

Between 5 percent to 15 percent of nose surgery patients want revision surgery, according to Dr. Yu.

The report, “Functional and Aesthetic Concerns of Patients Seeking Revision Rhinoplasty,” appears in the September/October issue of the journal Archives of Facial Plastic Surgery.

The poll, which received 481 responses from women who said they were planning to have breast augmentation surgery, found that 58 percent said they would choose silicone breast implants; 24 percent would choose saline breast implants; and 17 percent were undecided.

Statistics from the American Society of Plastic Surgeons (ASPS) showed that in 2009, 50 percent of women in the U.S. who underwent breast augmentation received silicone implants and 50 percent saline.

However, comparing data from ASPS since the FDA approved silicone gel breast implants in November 2006 shows that silicone has been gaining on saline each year. In 2007, 65 percent of breast implants were saline; in 2008, 53 percent were saline; and last year silicone use matched saline use.

Implant Differences

• Saline breast implants are filled with saline, usually at the time of surgery.
• Silicone breast implants are pre-filled with silicone gel—a thick, sticky fluid that mimics the feel of human fat.

One advantage of saline implants that the surgeon can fill the implant during surgery, which allows for a smaller incision. The size of saline implants can also be changed over time without additional surgery. Saline implants feature small valves in which a doctor can insert a needle and either add or subtract the liquid to change the implant’s size.

Silicone implants have the advantage of looking and feeling more natural. Saline implants have sometimes been criticized for feeling hard, although improved surgical techniques have lessened these complaints.

Both types of breast implants are approved by the FDA, so they have been thoroughly researched and tested and reviewed by an independent panel of physicians for safety. Saline breast implants are available to women 18 and older for breast augmentation, and silicone implants are available to women 22 and older (both are available to women of any age for breast reconstruction).

Those who have “buyer’s remorse” after plastic surgery are likely troubled by deeper issues, says Ann Kearney-Cooke, a psychologist in private practice who specializes in weight and body image issues. “[The surgery] changes the look, but if you have a problem that you haven’t resolved, you’ll have a temporary positive feeling, but then something else is the problem,” notes Kearney-Cooke.

“I think [plastic surgery remorse] is actually increasing, and I think in part it’s increasing because of the drop in reimbursement by insurance companies, which is driving doctors in other specialties into the plastic surgery market,” said Dr. Julius Few, a plastic surgeon in Chicago.

Dr. Timothy Miller, chief of plastic surgery at the David Geffen School of Medicine at UCLA, feels differently: “Maybe I’ve seen it a few times in my practice, but it’s very rare.”

While there’s no consensus among plastic surgeons as to whether there’s been an increase in the number of people who experience remorse after cosmetic procedures, they agree that it can potentially be avoided if patients and doctors recognize and address the problem.

Dr. Few has a therapist employed in his practice. “We know in plastic surgery that if somebody has undue stress, the risk of complication is higher,” he says.

“Most plastic surgeons will tell patients to work out their problems—go talk to a psychiatrist or confide in somebody else,” says Dr. Miller.

Communication between the patient and doctor is also key. “It’s really important that both the patient and the physician understand what the motivation is behind the surgery,” said Dr. Malcolm Roth, a plastic surgeon in Brooklyn, N.Y.