| Cosmetic
Surgery & Dermatology Houston Texas
Most
people want to look and feel their best. Many of us, at times,
are not happy with the way we look. Cosmetic, or plastic,
surgery can help a person change what they do not like about
their appearance. It can make severe acne scars less noticeable,
remove fat (liposuction), lessen wrinkles, fix crooked noses,
and get rid of double chins. Women can have their breast size
increased or decreased. Lasers can zap away varicose and spider
veins and remove unwanted hair for good.
A
woman's body image can be affected by how she feels about
the way she looks. Cosmetic surgery can help a woman feel
more comfortable and confident about her appearance. For example,
women with large breasts can suffer physically and emotionally.
A woman can have an achy back, deep grooves in her shoulders
from bra straps, poor posture, and low self-esteem from comments
made about her breasts. Women with varicose veins can have
pain and swelling in their legs. It is important to remember
that cosmetic surgery is not without risk and is surgery.
General anesthesia is sometimes used and all treatments can
have side effects. Talk to your health care provider if you
are thinking about cosmetic surgery. Be aware that there are
clinics that are not licensed that make false claims about
what they can do. The National Women' s Health Information
Center has provided the following publications and organizations
for women to learn more about cosmetic surgery and maintaining
a positive body image.
Cosmetic
Surgery Dermatology Info
If
you are looking for help with: Please Call: 1-877-707-2277
- Spider
Veins or Varicos Veins
- Sclerotherapy
- Botox
Injections
- Facelift
- Mini Facelift, Weekend Facelift, or Derm
Abrasion
- Restylane
Injections - Please Call for a Consultation 877-707-2277
- Soft
Tissue Implants or Collagen
Injections
- Hair
Removal or Reduction
- Scar
Removal or Improvements
- Laughlines
- Birthmarks
and Tatoos
- Age
Spots
- Facial
Resurficing
- Chemical
Peel
- Liposuction
- Breast
Augmentation
- Facelift
Publications
-
Breast Implants
- An Informational Update
This report contains information on both silicone and
saline implants. It also also contains information on
breast feeding with implants, polyurethane foam-covered
implants, special medical and physical considerations,
breast implant and medical device reporting, and frequently
asked questions.
-
Breast Reduction
Often Good Medicine
This publication discusses breast reduction. It addresses
the medical concerns concerning the surgery and explains
how one should prepare for the procedure.
-
Cosmetic Laser
Surgery: A High-Tech Weapon in the Fight Against Aging
Skin
This fact sheet contains information on laser cosmetic
surgery. It descibes skin resurfacing, what it can do
for you, what the risks are, and how to find a surgeon.
-
Treatments
for Aging Skin (Copyright © AAD)
This web site discusses various medical proceedures available
to help the appearance of aging skin.
Organizations
-
Food and Drug Administration,
OPHS, HHS
-
American
Academy of Dermatology
-
American
Academy of Facial, Plastic and Reconstructive Surgery,
Inc.
-
American
Society of Plastic Surgeons (ASPS)
Federal government resources
A smaller nose. Bigger breasts. Slimmer thighs. Plumper lips.
Less hair on the body. More hair on the head. Whether we're
looking to tighten our tummies or lighten our laugh lines,
America's fascination with youth and beauty has long fueled
the development of medical products for cosmetic purposes.
And if such "vanity drugs" can be shown to be safe
and effective, the Food and Drug Administration just may approve.
The ongoing fight to delay or reverse the aging process has
dermatologists and cosmetic plastic surgeons responding with
products like Restylane (hyaluronic acid), one of a handful
of soft tissue fillers recently approved by the FDA to treat
facial wrinkles. Restylane is an injectable gel that acts
as a filler to remove the wrinkle, producing instantaneous
results. Such products are not as invasive as facelifts, eyelid
surgery, and other reconstructive procedures. And they are
more effective and last longer than creams, lotions and other
topical products, whether over-the-counter or prescription.
In addition, the fact that the treatments result in little
or no downtime makes them more attractive to those seeking
a quick fix. Without making a single incision, doctors can
erase wrinkles, acne scars and sun damage in a matter of minutes.
"This
is a huge industry," says Jonathan K. Wilkin, M.D., a
medical officer in the FDA's Division of Dermatologic and
Dental Drug Products. "The way people try to move the
clock back is through the skin." Basically, he says,
through various products and procedures, "they are addressing
the effects of gravity on the skin over time."
Aging
Skin 101
An increased understanding of the structure and function of
the skin is helping to drive the development of products that
reduce the visible signs of facial aging, according to the
American Academy of Dermatology (AAD).
With aging,
all skin cells begin to produce excess amounts of free radicals--unstable
oxygen molecules that, under ideal circumstances, are removed
by naturally occurring antioxidants within the skin's cells.
In aging skin cells, antioxidants are in short supply. The
free radicals generated are left unchecked and cause damage
to cell membranes, proteins, and DNA. These free radicals
eventually break down a protein substance in connective tissue
(collagen) and release chemicals that cause inflammation in
the skin. It is a combination of these cellular and molecular
events that leads to skin aging and the formation of wrinkles,
the AAD says.
As we get older, two components of our skin--collagen and
elastin--degenerate, setting the stage for the appearance
of wrinkles, creases, folds, and furrows. The breakdown of
these components, accelerated by sun exposure and gravity,
results in the sagging skin of old age.
Illustration
by Renée Gordon. Source: National Institute on Aging.
Considerable
research has been done to understand the aging process, and
studies now show that products containing bioactive ingredients
(those that interact with living tissues or systems) can benefit
sun-damaged, discolored, and aging skin, giving consumers
new choices for restoring their overall appearance. But why
is the FDA reviewing products that simply make people look
and feel good when typically the agency evaluates disease-fighting
treatments?
"If
something that is being implanted into the body could have
health consequences, we're concerned about it," says
Stephen P. Rhodes, M.S., chief of the FDA's Plastic and Reconstructive
Surgery Devices Branch. "Wrinkle fillers affect the structure
of the face and could have such health consequences."
Facing
Facts
Under the Federal Food, Drug and Cosmetic Act, the FDA legally
defines products by their intended uses. Drugs are defined
as products intended for treating or preventing disease and
affecting the structure or any function of the body. A medical
device is a product that also is intended to affect the structure
or function of the body, but which does not achieve its primary
intended purposes through the chemical action of a drug--nor
is it dependent on being metabolized.
The hyaluronic
acid in Restylane, although biosynthetically produced (formed
of chemical compounds by the enzyme action of living organisms),
is almost identical to that in all living organisms. Hyaluronic
acid is a structural component of skin that creates volume
and shape. Concentrations of hyaluronic acid throughout the
body decline with age, causing undesirable changes in the
skin. Restylane binds to water and provides volume to easily
fill in larger folds of skin left by tissue loss around the
mouth and cheeks. "This makes it a structural action,"
says Rhodes, "much like a chin implant."
In contrast,
cosmetics are defined as substances that cleanse, beautify,
promote attractiveness, or alter the appearance, without affecting
the body's structure or function. This definition includes
skin-care products such as creams, lotions, powders and sprays;
perfume; lipstick; fingernail polish; and more.
Different
laws and regulations apply to each type of product. Some products
must comply with the requirements for both cosmetics and drugs.
This happens when a product has two intended uses, such as
an antidandruff shampoo. A shampoo is a cosmetic because it
is intended to clean hair. An antidandruff shampoo is a cosmetic
and a drug because it is intended to treat dandruff (which
affects the follicles where the hair is formed) and clean
hair.
Warning
letters issued by the FDA recently to firms that marketed
hair care products with claims such as restoration of hair
growth and hair loss prevention illustrate an important distinction
between the legal definitions of cosmetics and drugs. Warning
letters officially inform companies that they may be engaged
in illegal activities, and instruct manufacturers on how to
bring their products into compliance with the law. Hair growers
and hair loss prevention products, because of their mechanism
of action, are considered drugs, not cosmetics, and these
firms were not meeting the legal requirements for marketing
a drug.
Unlike
drugs and medical devices, neither cosmetic products nor cosmetic
ingredients are reviewed or approved by the FDA before they
are sold to the public. The agency only acts against cosmetic
products found to cause harm after they are on the market.
Cosmetics
or Drugs?
Much confusion exists about the status of cosmetic products
having medicinal or drug-like benefits, says Linda Katz, M.D.,
M.P.H., director of the FDA's Office of Cosmetics and Colors.
Although the FDA does not consider the term "cosmeceutical"
to be a valid product class, Katz says it is used throughout
the cosmetic industry to describe products that are marketed
as cosmetics but that have drug-like effects. Tretinoin (retinoic
acid), the biologically active form of vitamin A, for example,
is not prohibited from use in cosmetics. However, when it
is used topically for treating mild to moderate acne, sun-damaged
skin, and other skin conditions, it is recognized by the FDA
as a drug. This is because it acts deep at the skin's cellular
level by increasing collagen.
According
to the AAD, the answer to whether or not cosmeceuticals really
work lies in the ingredients and how they interact with the
biological mechanisms that occur in aging skin. The regulatory
question the FDA faces when considering such products, Katz
says, "is whether or not a manufacturer is making a structure
or function claim."
The FDA
uses different standards when evaluating the risks and benefits
of products used for cosmetic treatments than for therapeutic
uses of products. Steven K. Galson, M.D., M.P.H., acting director
for the FDA's Center for Drug Evaluation and Research, adds
that products like tretinoin and Restylane that are not indicated
for serious or life-threatening conditions are subject to
close examination by the agency because of the benefit-to-risk
ratio.
"Because
these products are for cosmetic purposes, they must be extraordinarily
safe," Galson says. This means that the FDA may allow
someone to incur a greater risk from products that treat medical
conditions, rather than from those that are intended for cosmetic
purposes. "We generally won't tolerate much risk for
a drug whose primary use is cosmetic," he says.
Welcome
Side Effects
Many cosmetic treatments are the result of common disease
therapies whose unexpected side effects were pleasant surprises.
Vaniqa (eflornithine hydrochloride), the first prescription
drug for removing unwanted hair, is a topically applied version
of a drug that was originally developed to treat African sleeping
sickness. Similarly, minoxidil originally had been prescribed
as an oral tablet to treat high blood pressure. As a result
of side effects that included hair growth and reversal of
male baldness, Rogaine (2 percent minoxidil) was the first
drug approved by the FDA for the treatment of hair loss (androgenetic
alopecia).
"There's
a lot of serendipity in drug development," says the FDA's
Wilkin. A pill to help smokers quit, for example, evolved
out of the unexpected observation that a drug intended to
treat depression also seemed to take away the desire to smoke.
Bupropion was first marketed in 1989 by GlaxoSmithKline as
an antidepressant under the name Wellbutrin. After doctors
noticed that patients being treated with Wellbutrin gave up
smoking spontaneously, studies were done to show that the
product could help smokers quit, as well. As a result, the
slow-release form of bupropion, marketed as Zyban, was approved
by the FDA in 1997 as an aid to smoking cessation treatment.
Some pharmaceutical
companies, however, apparently aren't ready to enter the vanity
drugs arena. Patrick Davish, the global product communications
spokesman for Merck & Co. Inc., says that the drug company
has no "cosmetic" drugs in its product pipeline
at this time.
"The
fact that we don't participate in that market right now-I'm
not sure that's reflective of any particular deliberation
or decision," he says. "That's just not where the
science has taken us."
Before
electing to have a cosmetic procedure
Discuss it with a physician who can refer you to a specialist
in the fields of dermatology and aesthetic plastic surgery.
Begin with a consultation to find the right doctor, and select
one who is qualified to do the procedure you want.
Make sure the doctor you choose is certified by an appropriate
medical board.
Have realistic expectations about the benefits you want to
achieve.
Compare fees--insurance does not usually cover elective procedures.
Saving Face
According to the American Society for Aesthetic Plastic Surgery
(ASAPS), nearly 7 million Americans underwent surgical and
nonsurgical cosmetic procedures in 2002. Laura Bradbard was
one of them.
Despite
the sudden explosion of such "lunchtime" techniques
as Restylane for erasing wrinkles, and Botox (botulinum toxin
type A) for smoothing out frown lines, Bradbard, of Gaithersburg,
Md., opted for a longer-lasting reconstructive facelift that
included a chin implant, eyelid surgery, and surprisingly,
only a few days of pain-free recovery.
"None
of this was medically necessary," admits Bradbard, a
48-year-old FDA press officer, "but I had been feeling
worn out and tired. What I saw in the mirror was sad."
Bradbard says she didn't get a facelift to look younger; she
only wanted her face to look more balanced. In the end, she
says, "My doctor gave me a chin that geometrically fit
my face," and a look that she says makes her feel better
about herself.
Like Bradbard,
others are spending a lot of money to look good. "With
patients living 90-plus years, today's anti-aging modalities
offer people noninvasive procedures that mimic true facelifts,"
says Craig R. Dufresne, M.D., a plastic and reconstructive
surgeon in Chevy Chase, Md., who performed Bradbard's surgery.
However, Dufresne says he suggested reconstructive surgery
for Bradbard because "she wanted to deal with structural
changes to restore facial balance," which was more than
the chemical action of a drug could produce. "And skin
product application (such as wrinkle fillers) following a
facelift," adds Dufresne, "will actually allow the
facelift or any other reconstructive procedure to last longer
and make a great result even better."
Acupressure
Acupuncture
Facials
Foot Reflexology
Hypnotherapy
Spa on the Spot
Steam/Fume Bath
Therapeutic Touch
Chiropractic Integrative Therapy
Craniosacral Therapy
Deep Relaxation Therapy
Dream Counseling and Integration
Energy Balance
Epsom Salts Bath
Express Spa
Top 5
Cosmetic Nonsurgical Procedures (2002)
botulinum toxin injection (Botox®, Myobloc®)
microdermabrasion
collagen
injection
laser
hair removal
chemical
peel
1,658,667
1,032,417
783,120
736,458
495,415
Source:
American Society for Aesthetic Plastic Surgery
Top 5
Cosmetic Surgical Procedures (2002)
lipoplasty (liposuction)
breast
augmentation
eyelid
surgery
rhinoplasty
(nose reshaping)
breast
reduction
372,831
249,641
229,092
156,973
125,614
Source:
American Society for Aesthetic Plastic Surgery
Seeking Professional Advice
Since it is often difficult for people to determine the validity
of claims made about topical products and to decide among
the overwhelming number of anti-aging procedures, how do people
know what's right for them?
"A
good place to start is with a dermatologist," says Arielle
N.B. Kauvar, M.D., clinical associate professor of dermatology
at the New York University School of Medicine. "Dermatologists
are trained in the health, function and disease state of the
skin, and people could save time, money and confusion by seeking
the advice of a dermatologist rather than guessing what might
work for them."
Kauvar
says a dermatologist's recommendations can help consumers
make informed decisions. "People shouldn't hunt and peck
for products," she adds. "Not knowing what type
of skin you have is why so many people try unnecessary products
that can often do more harm than good."
An expert
in laser procedures, Kauvar says that, in the past, techniques
for improving aging skin required invasive laser or surgical
procedures, which produced open wounds and required long recovery
times. Today, she says, people can choose from a variety of
non-ablative (non-wounding) laser treatments that are designed
to reverse, improve or erase the early signs of aging, take
very little time to perform, and have a minimal, if any, recovery
time.
While
Bradbard wasn't interested in removing wrinkles at the time
of her facelift, given what she knows about new technologies
and drug delivery systems today, she says, "I would consider
both non-invasive procedures and another facelift down the
road, depending on how much my skin changes. I would ask my
doctor what would give me the best results with the longest-lasting
effects."
Buyer
Beware
Anti-aging products that promise to diminish wrinkles and
fine lines are found on many store shelves. However, dermatologists
recommend that people consider only those procedures and products
that have proven, over time, to be most effective at reversing
the aging process. Most doctors agree that the leading product
to prevent premature wrinkles and sun damage is sunscreen.
A broad-spectrum sunscreen that protects the skin from both
UVA and UVB rays, with a sun protection factor (SPF) of 15
or higher, can prevent the skin from looking older than it
is.
According
to the ASAPS, it's important to realize that although certain
products and procedures are effective, they are also limited
by the skin's normal aging process. A product that has been
deemed effective for erasing wrinkles doesn't necessarily
erase wrinkles--there are lots of variables that determine
its effectiveness.
For example,
the active ingredient in a drug must be delivered to the skin
at a therapeutic concentration and remain in the skin long
enough to have an effect. Also, because the composition of
a man's body differs from a woman's, products or procedures
can have different effects. The facial area in men contains
hair, for example, and their skin is thicker. This means the
blood supply is greater--and so is the risk of bleeding--but
it also could mean better healing.
And cosmetic
procedures come with risks. If a procedure is performed poorly,
the physical and emotional scars could be carried for life.
Understand the risks and side effects that may be involved.
"My
wanting to improve my appearance is like my husband's desire
to restore a vintage automobile," says Bradbard. "We
both want something to look good for as long as it can."
For More
Information
American Academy of Dermatology
PO Box 4014, Schaumburg, IL 60168-4014
(888) 462-3376
American
Society for Dermatologic Surgery
5550 Meadowbrook Drive, Suite 120, Rolling Meadows, IL 60008
(800) 441-2737
American
Society for Aesthetic Plastic Surgery
11081 Winners Circle, Los Alamitos, CA 90720
(888) 272-7711
General/Overviews
Varicose Veins and Spider Veins (National Women's Health Information
Center)
What Are Varicose Veins? (Mayo Foundation for Medical Education
and Research)
Clinical Trials
ClinicalTrials.gov: Varicose Veins (National Institutes of
Health)
Diagnosis/Symptoms
Leg Problems (American Academy of Family Physicians)
Vascular Diseases Diagnosis (Society of Interventional Radiology)
Research
Study Finds Sclerotherapy Effective in Removing Facial Veins
(American Academy of Dermatology)
Treatment
Phlebology: The Treatment of Leg Veins (American College of
Phlebology)
Sclerotherapy (American Society of Plastic Surgeons)
Spider and Varicose Veins (American Society for Dermatologic
Surgery)
Varicose Veins - Sclerotherapy (Patient Education Institute)
- requires Flash plug-in
Also available in: Spanish
Directories
American College of Phlebology - Online Database (American
College of Phlebology)
AVF Member Directory (American Venous Forum)
Find a Dermatologic Surgeon (American Society for Dermatologic
Surgery)
Find a Dermatologist (American Academy of Dermatology)
Find a Plastic Surgeon (American Society of Plastic Surgeons)
Organizations
American College of Phlebology
American Society for Dermatologic Surgery
National Heart, Lung, and Blood Institute
Children
What Are Varicose Veins? (Nemours Foundation)
View slideshow
on:
Varicose Veins - Sclerotherapy
Health
services in North Carolina
Other
states coming - learn more
The primary
NIH organization for research on Varicose Veins is the National
Heart, Lung, and Blood Institute
General/Overviews
Varicose Veins and Spider Veins (National Women's Health Information
Center)
What Are Varicose Veins? (Mayo Foundation for Medical Education
and Research)
Clinical Trials
ClinicalTrials.gov: Varicose Veins (National Institutes of
Health)
Diagnosis/Symptoms
Leg Problems (American Academy of Family Physicians)
Vascular Diseases Diagnosis (Society of Interventional Radiology)
Research
Study Finds Sclerotherapy Effective in Removing Facial Veins
(American Academy of Dermatology)
Treatment
Phlebology: The Treatment of Leg Veins (American College of
Phlebology)
Sclerotherapy (American Society of Plastic Surgeons)
Spider and Varicose Veins (American Society for Dermatologic
Surgery)
Varicose Veins - Sclerotherapy (Patient Education Institute)
- requires Flash plug-in
Also available in: Spanish
Directories
American College of Phlebology - Online Database (American
College of Phlebology)
AVF Member Directory (American Venous Forum)
Find a Dermatologic Surgeon (American Society for Dermatologic
Surgery)
Find a Dermatologist (American Academy of Dermatology)
Find a Plastic Surgeon (American Society of Plastic Surgeons)
Organizations
American College of Phlebology
American Society for Dermatologic Surgery
National Heart, Lung, and Blood Institute
Children
What Are Varicose Veins? (Nemours Foundation)
Latest News
Botox May Aid in Chronic Neck, Back Pain (02/25/2004, Reuters
Health)
General/Overviews
Botox Cosmetic: A Look at Looking Good (Food and Drug Administration)
Botulinum Toxin (American Academy of Dermatology)
Tired of That Same "Old" Expression? Botulinum Toxin
Erases Signs of Aging and Common Facial Expressions (American
Academy of Dermatology)
Disease Management
Safe Administration of Botulinum Toxin is the Key Ingredient
to Younger, Smoother Skin (American Academy of Dermatology)
Specific Conditions/Aspects
Botox and Migraine (American Council for Headache Education)
Botox Treatment (Children's Hemiplegia and Stroke Association)
Botox: Can It Treat Fibromyalgia? (Mayo Foundation for Medical
Education and Research)
Botulinum Toxin Injections: A Treatment for Muscle Spasms
(American Academy of Family Physicians)
Botulinum Toxin Type A (BTX-A) for Dystonia (We Move)
Botulinum Toxin Type B (BTX-B) for Dystonia (We Move)
Organizations
American Academy of Dermatology
American Society of Plastic Surgeons
We Move
From the
National Institutes of Health
What Is Deep Vein Thrombosis? (National Heart, Lung, and Blood
Institute)
General/Overviews
Thrombophlebitis (Mayo Foundation for Medical Education and
Research)
Clinical Trials
ClinicalTrials.gov: Phlebitis (National Institutes of Health)
ClinicalTrials.gov: Thrombophlebitis (National Institutes
of Health)
Diagnosis/Symptoms
Leg Problems (American Academy of Family Physicians)
Vascular Diseases Diagnosis (Society of Interventional Radiology)
Pictures/Diagrams
Atlas of the Body: The Circulatory System -- Venous (American
Medical Association)
Prevention/Screening
Aspirin: From Pain Relief to Preventive Medicine (Mayo Foundation
for Medical Education and Research)
FDA Approves Lab Tests for Genetic Clotting Risk (Food and
Drug Administration)
Research
Comparison of Two Methods of Starting the Anticoagulant Drug
Warfarin (American College of Physicians)
Congenital Causes of Venous Thrombosis--Classification System
(American College of Physicians)
Heparin a Better Choice for Cancer Patients with Blood Clots
(American Cancer Society)
Low Dose Warfarin Prevents Recurrence of Blood Clots - NHLBI
Stops Study (National Heart, Lung, and Blood Institute)
Negative Results on a Quantitative Latex D-Dimer Test Exclude
Deep Leg Clots (American College of Physicians)
What Is the Most Effective Blood Thinner for Treating Patients
with Blood Clots in the Veins? (American College of Physicians)
Specific Conditions/Aspects
Blood Clot in the Breast (Mondor's Disease) (Mayo Foundation
for Medical Education and Research)
Deep Vein Thrombosis Overview (Society of Interventional Radiology)
Flight-Related Deep Vein Thrombosis (DVT) - "Economy
Class Syndrome" (National Aeronautics and Space Administration)
New Perspective on Deep Vein Thrombosis (American Venous Forum)
Pulmonary Embolism and Deep Vein Thrombosis (American Heart
Association)
Treatment
Coumadin - Introduction for New Users (Patient Education Institute)
- requires Flash plug-in
Also available in: Spanish
Treatment of Blood Clots (American Heart Association)
Vascular Diseases Treatments (Society of Interventional Radiology)
Warfarin: Any Harm in Long-Term Use? (Mayo Foundation for
Medical Education and Research)
What Are Anticoagulants and Antiplatelet Agents? (American
Heart Association)
Directories
Find an Interventional Radiologist (Society of Interventional
Radiology)
Organizations
American Heart Association
National Heart, Lung, and Blood Institute
Spider Veins or Varicos Veins
Sclerotherapy
Botox Injections
Facelift - Mini Facelift, Weekend Facelift, or Derm Abrasion
Restylane Injections - Please Call for a Consultation 877-707-2277
Soft Tissue Implants or Collagen Injections
Hair Removal or Reduction
Scar Removal or Improvements
Hylaform - Please Call for a Consultation 877-707-2277
Birthmarks and Tatoos
Age Spots
Facial Resurficing
Chemical Peel
FDA Panel Backs Wrinkle Gels
An advisory panel to the Food and Drug Administration gave
smooth sailing Friday to competing gels that would combat
wrinkles.
The panel
voted to recommend approval of Restylane by Medicis Pharmaceutical
Corp. and Hylaform by Inamed Corp., two gels that are already
on the market in Europe and Mexico, the Los Angeles Times
reports.
The newspaper
reports that the gels could command sales of up to $150 million
a year, and erode the popularity of collagen treatments.
The recommendation
came with some restrictions, the Times reports. The panel
said the gels were inadequately tested in people of color,
and that post-marketing tests should be done on those patients.
It also said the gels could be a problem for people who are
allergic to eggs.
The FDA
usually follows the recommendation of its panels. Source:
http://www.healthfinder.gov/news/newsstory.asp?docid=516188
Cirugía Plástica
Cirugia Plastica
Houston Facts
Houston is the fourth most populous city in the
nation (trailing only New York, Los Angeles and Chicago),
and is the largest in the southern U.S. and Texas.
Founded in 1836, the City of Houston has a population of 1.9
million.
The Houston-Galveston-Brazoria Consolidated Metropolitan Statistical
Area (Houston CMSA) consists of eight counties: Brazoria,
Chambers, Fort Bend, Galveston, Harris, Liberty, Montgomery
and Waller.
The metro area's population of 4.8 million is 10th largest
among U.S. metropolitan statistical areas.
The Houston CMSA covers 8,778 square miles, an area slightly
smaller than Massachusetts but larger than New Jersey.
Each year more than 38 million people zip in and out of Houston's
two major airports.
Houstonians eat out more than residents of any other city.
While here you can choose to indulge in one of the more than
11,000 restaurants ranging from award-winning and upscale
to memorable deli shops.
Houston has a Theater District second only to New York City
with its concentration of seats in one geographic area. Located
downtown, the 17-block Theater District is home to eight performing
arts organizations with more than 12,000 seats.
Houston has a unique museum district offering a range of museums,
galleries, art and cultural institutions, including the City's
major museums.
Houston has more than 500 cultural, visual and performing
arts organizations, 90 of which are devoted to multicultural
and minority arts.
More than 90 languages are spoken throughout the Houston area.
Houston has professional teams representing every major sport.
Houston is home to the Houston Livestock Show and Rodeo. The
largest rodeo in the world, it attracts more than 1.8 million
visitors each year.
Houston has a young population; 37 percent of Houstonians
are 24 years old or younger and 34 percent are between the
ages of 25 and 44.
Houston boasts more than 40 colleges, university and institutions
- offering higher education options to suit all interests.
Houston is home to the Texas Medical Center, the largest medical
center in the world, with a local economic impact of $10 billion.
More than 52,000 people work within its facilities, which
encompass 21 million square feet. Altogether 4.8 million patients
visit them each year.
For Houstonians, 2000 was a banner year economically. Employment
growth was 3 percent, or 63,000 new jobs. Per capita income
rose 5 percent.
Home to 18 Fortune 500 companies and more than 5,000 energy
related firms, Houston is considered by many as the Energy
Capital of the world.
The Port of Houston ranks as the nation's largest port in
international tonnage and second in total tonnage.
For three consecutive years, Houston has ranked first in the
nation in new business growth, according to American Business
Information. The most recent survey shows that more than 31,000
new local businesses were started in Houston. Los Angeles
was a distant second with 16,780.
Houston has the most affordable housing of 10 most populated
metropolitan areas; Houston housing costs are 39 percent below
the average of 26 U.S. urban populations of more than 1.5
million.
Houston has the second lowest cost of living among major American
cities.
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Also available in: Spanish
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ClinicalTrials.gov: Skin Diseases (National Institutes of
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FASTATS: Dermatological Conditions (National Center for Health
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Also available in: Spanish
Botulinum
Toxin Type A (Botox Cosmetic) is a protein complex produced
by the bacterium Clostridium botulinum, which contains the
same toxin that causes food poisoning. When used in a medical
setting as an injectable form of sterile, purified botulinum
toxin, small doses block the release of a chemical called
acetylcholine by nerve cells that signal muscle contraction.
By selectively interfering with the underlying muscles' ability
to contract, existing frown lines are smoothed out and, in
most cases, are nearly invisible in a week.
Botox
injections are the fastest-growing cosmetic procedure in the
industry, according to the American Society for Aesthetic
Plastic Surgery (ASAPS). In 2001, more than 1.6 million people
received injections, an increase of 46 percent over the previous
year. More popular than breast enhancement surgery and a potential
blockbuster, Botox is regarded by some as the ultimate fountain
of youth.
Botox
was first approved in 1989 to treat two eye muscle disorders--uncontrollable
blinking (blepharospasm) and misaligned eyes (strabismus).
In 2000, the toxin was approved to treat a neurological movement
disorder that causes severe neck and shoulder contractions,
known as cervical dystonia. As an unusual side effect of the
eye disorder treatment, doctors observed that Botox softened
the vertical frown (glabellar) lines between the eyebrows
that tend to make people look tired, angry or displeased.
But until this improvement was actually demonstrated in clinical
studies, Allergan Inc., of Irvine, Calif., was prohibited
from making this claim for the product.
By
April 2002, the FDA was satisfied by its review of studies
indicating that Botox reduced the severity of frown lines
for up to 120 days. The agency then granted approval to use
the drug for this condition.
The
FDA regulates products, but not how they are used. Approved
products are sometimes used by a licensed practitioner for
uses other than those stated in the product label. Botox Cosmetic,
for example, is currently being used by physicians to treat
facial wrinkles other than those specified by the FDA. Consumers
should be aware, however, that this "off-label"
use has not been independently reviewed by the agency, and
the safety and effectiveness of Botox injections into other
regions of the face and neck, alone or in combination with
the frown-lines region, have not been clinically evaluated.
Ella
L. Toombs, M.D., a dermatologic medical officer in the FDA's
Office of Cosmetics and Colors, says, "Careful deliberation,
investigation and evaluation is undertaken by the agency before
any prescription product is approved." Drugs such as
Botox, which are not indicated for serious or life-threatening
conditions, "are subject to a greater level of scrutiny
because of the benefit-to-risk ratio." Toombs says this
means that the FDA may allow someone to incur a greater risk
from products that treat medical conditions, rather than from
those that are approved for cosmetic purposes.
Considering
Botox Cosmetic?
Be sure that a qualified doctor performs the procedure.
Make sure that the doctor is trained and qualified in cosmetic
skin surgery of the face.
Ask questions and be informed about the benefits and risks
involved in the procedure.
Avoid alcohol and remain upright for several hours following
the procedure.
Choose a medical setting using sterile techniques. Necessary
equipment should be available to respond to any potential
problems.
Source: The American Society for Dermatologic Surgery
Botox 'Parties'
The recent rise in the popularity of Botox has much to do
with the manner in which it is frequently marketed. Some practitioners
buy the toxin in bulk and arrange get-togethers for people
receiving their treatments. As in business, volume discounts
can be found in medicine.
Plastic
surgery events known as Botox parties--also seminars, evenings
and socials--are a key element of Botox marketing in much
of the United States. The gatherings are thought to be a convenient
means of providing Botox treatments more economically, and
may help reduce the anxiety that normally goes along with
getting an injection. Doctors are finding that treating people
in groups allows them to make the procedure more affordable
to their patients.
Here's
how a "party" typically works: A group of often
nervous, but excited, middle-aged men and women mingle in
a common area. Sometimes refreshments are served. One by one,
as their name is called, each slips away for about 15 minutes
to a private exam room. He or she pays a fee and signs an
informed consent agreement. Anesthesia is rarely needed, but
sedatives and numbing agents may be available. The practitioner
injects about one-tenth of a teaspoon of toxin into specific
muscles of the forehead most often targeted for the effect.
The person then rejoins the group.
Scott
A. Greenberg, M.D., a board-certified plastic surgeon in Winter
Park, Fla., has been hosting monthly "Botox Happy Hours"
in his medical office since the drug's approval in April.
Greenberg feels that these by-invitation-only events to previous
patients "are an opportunity to treat a lot of people
at one time in a relaxed but professional atmosphere."
Greenberg says there is no difference between treating 10
people during individual office visits throughout the day
and treating 10 people individually, but in a more socialized
setting. "The important thing is that the identical standards
of medical care are maintained at these gatherings as in a
routine daytime office consultation."
Julianne
Clifford, Ph.D., of the FDA's Division of Vaccines and Related
Products Applications, explains that "Botox is licensed
for marketing and distribution as single-use vials."
This means that as packaged, "each vial is intended to
be used for a single patient in a single treatment session."
Botox does not contain a preservative against potential contamination
of the product through repeated use of a single vial. Once
opened and diluted, Botox must be used within four hours.
Treating multiple people with one vial violates product labeling,
which is stated on the package insert, the vial and the carton.
"We
lose something when we mass treat," says Franklin L.
DiSpaltro, M.D., president of the ASAPS. "One of my concerns
is that these parties are a marketing tool--gathering as many
patients as possible trivializes a medical treatment, which
could deteriorate over time into a nonprofessional environment."
DiSpaltro says there's more to medicine "than just dispensing
drugs."
The
FDA is concerned that Botox has the potential for being abused.
The ASAPS recently reported that unqualified people are dispensing
Botox in salons, gyms, hotel rooms, home-based offices, and
other retail venues. In such cases, people run the risks of
improper technique, inappropriate dosages, and unsanitary
conditions. "Botox is a prescription drug that should
be administered by a qualified physician in an appropriate
medical setting," says Toombs.
Although
there is no chance of contracting botulism from Botox injections,
there are some risks associated with the procedure. If too
much toxin is injected, for example, or if it is injected
into the wrong facial area, a person can end up with droopy
eyelid muscles (ptosis) that could last for weeks. This particular
complication was observed in clinical trials.
Other
common side effects following injection were headache, respiratory
infection, flu syndrome, and nausea. Less frequent adverse
reactions included pain in the face, redness at the injection
site, and muscle weakness. These reactions were generally
temporary, but could last several months.
While
the effects of Botox Cosmetic don't last, still, people don't
seem to mind repeating the procedure every four to six months
in order to maintain a wrinkle-free look. Battling the signs
of aging in a non-invasive way, after all, is part of the
allure of the product--that and the fact that there are no
unsightly scars, and that there is very little recovery time
with the procedure.
The
FDA recommends that Botox Cosmetic be injected no more frequently
than once every three months, and that the lowest effective
dose should be used.
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