Study Shows Women Are More Prone to Facial Wrinkles Than Men

Findings from a study published in the November/December issue of Aesthetic Surgery Journal (ASJ) suggest that gender-specific differences in the perioral skin (skin surrounding the mouth) account for more and deeper skin wrinkling in women than in men.

“The aim of this study is to obtain new insight into the perception that women wrinkle earlier and more severely than men,” said the study’s lead author, Emma C. Paes, M.D., from the Department of Plastic, Reconstructive and Hand Surgery at the University Medical Center in Utrecht, Netherlands. “If we understood the reasons for differences in wrinkling between women and men, then we might be able to develop better strategies for the treatment of perioral wrinkles.”

The study found that all of the following could explain the presence of more and deeper perioral wrinkles in women:

Women’s perioral skin contains fewer sweat glands and sebaceous glands (microscopic glands in the skin that secrete an oily/waxy matter, called sebum, to lubricate skin and hair), which could influence the natural filling of the dermis (skin).

Women’s perioral skin contains fewer blood vessels and, therefore, is less vascularized compared to men, which could accelerate the development of wrinkles.

In women, the closer attachment of the muscular fibers surrounding the mouth to the dermis may cause an inward traction, thereby creating deeper wrinkles.

Current treatments for perioral wrinkles include the use of lasers & chemical peels, Botox injections, and injectable or implantable wrinkle fillers. Despite these many options, the effective treatment of wrinkles in the perioral region still remains a challenging problem.

“We think it's important to consider the reasons why a particular treatment may or may not be effective,“ said Dr. Paes. “Sometimes one has to go back to the basics... In the end, having more basic knowledge about a problem can speed up the process of finding the right solution.”

Source: ASAPS

Women: Exercise now for good health later!

A new study published in the Archives of Internal Medicine gives further evidence to the linkage between exercise and good health. The study, entitled "Physical Activity at Midlife in Relation to Successful Survival in Women at Age 70 Years or Older" looked at 13,500 women, who were part of the Nurses' Health Study who had survived to age 70 years or older, without any of 10 major chronic diseases, open heart surgery or cognitive or physical impairment.

The Nurses' Health Study, just to give a little background, is considered the "grandmother" of women's health studies and represents the single largest "cohort" study of women, in which the same patients were followed and monitored over many years. It has resulted in more than 265 published scientific papers. The study was established in 1976, with the initial idea of studying the relationship between oral contraceptives, cigarette smoking and the risk of major illnesses. Thanks to the dedication and commitment of the participants, the scope and range of the study has broadened over time to evaluate other lifestyle factors, as well.

Using data from this group, the Harvard-based researchers found that higher physical activity levels at midlife were significantly associated with better odds of successful survival. Regular walking also was found to have a beneficial effect, but not quite as much as more vigorous exercise. Women in the upper 40% of activity were between 1.34 and 1.99 (for the top 20%) times more likely to successfully make it to age 70 without major health issues, compared to women in the lowest 20% of activity.

Now, if we could just find a way to make exercise fun!

"A Spoonful of Sugar..."

Yes, it helps the medicine go down, according to the old song. But it turns out that a little sugar - or more properly dextrose in the intravenous fluid - may help to reduce the chance of perioperative nausea and vomiting in surgery patients, and reduces the need for anti-nausea medications.

According to a presentation at the recent American Society of Anesthesiologists 2009 Annual Meeting, in a randomized trial of 56 healthy surgery patients undergoing identical general anesthesia techniques, the group receiving 5% dextrose and Ringer's Lactate in their IV, rather than plain Ringer's lactate, had significantly lower nasuea scores 30 minutes after arriving in the PACU and at discharge, and lower overall nausea scores than the control group.

Those in the dextrose group required half the amount of antinausea medications while in the recovery room, and were able to be discharged sooner. (147 vs 178 minutes) The two study groups were otherwise similar for all other relevant factors: age, anxiety level, weight, previous history of perioperative nausea, previous surgery, nothing by mouth (NPO) status, anesthetic time, preoperative glucose, intraoperative nitrous oxide and narcotic use, and total weight-based fluid volume received.

Of all the things about surgery that patients worry about, having nausea or vomiting after surgery is certainly one that's near the top of the list. This study suggests another easy-to-implement idea. I think this is certainly worth trying for our patients.

Smart lipo: does it tighten the skin?

Sometimes marketing hype gets way ahead of the science.

That's certainly the way it seems to have been with the current generation of laser-assisted liposuction devices. Promises of skin tightening have been made by most of the manufacturers of these devices (SmartLipo and others) - with very little science to back up the claims.

I keep seeing unhappy laser-assisted liposuction patients (performed elsewhere) for second opinions. While they may be thinner, the treated areas are lax and have a worsening of the cellulite appearance, with a wavy, irregular appearance. Is this an issue related to the technology itself, the user of the technology, or is it one of patient selection? Regardless of cause, for these patients, the "reality" of Smart Lipo just didn't match their expectations.

Finally, in this month's issue of Aesthetic Surgery Journal, is the first scrap of science looking at whether this technology actually causes skin contraction. That's the good news. The bad news is that, in my opinion, the study design is somewhat flawed, so that this new study doesn't really answer the question about which method is best.

Here's what was done: Skin-marking tattoos were used to mark out 5 cm squares on the tummies of some volunteers, who then underwent treatment with the SmartLipo MPX laser-assisted liposuction device. The lasered fat was then aspirated out with a standard liposuction cannula. Digital photography was then used at 1 and 3 months postoperatively to check the degree of skin shrinkage.

The shrinkage of the 5 x 5 cm area was reported as 22% at one month, and 17% at three months, versus the baseline measurements. In plain english, a 17% reduction in area means that the square that started at 5 cm on a side went down to 4.56 cm on a side, a change of about two-tenths of an inch on each side of the square. While this change was reported as statistically significant, it isn't clinically very impressive at all.

Additionally, the study didn't compare the effects of standard liposuction (without laser) to the laser-treated areas. Some or all of this 17% change might just be a result of the skin's natural elasticity - an expected shrinkage once the fat was removed. So, we still don't really know the most important point - whether this is an improvement over standard liposuction, or not.

Bottom line: Finally! Some science on Smart Lipo. It's about time!

In my opinion, the 17% reported reduction in area at three months post-op is not particularly impressive. This degree of contraction is minimal, at best.

Diabetes Injection beats Xenical for weight loss

Here's an interesting new finding for people struggling with their weight, as reported on BBC News (link), and published in the latest issue of the medical journal The Lancet: in a randomized, controlled study, the injectable diabetes treatment Victoza (liraglutide) helped overweight people lose significantly more weight than prescription Xenical, which is one of the leading weight-loss medications. Victoza (liraglutide) is awaiting FDA approval here in the U.S.A.

This is actually an exciting, unexpected finding, and holds promise for treatment of diabetes, metabolic syndrome and obesity.

In this 20-week European study, 564 individuals with obesity were randomly assigned to one of four Victoza (liraglutide) doses, to placebo, or orlistat. All individuals were given a 500 kcal diet and increased their physical activity throughout the trial.

Participants on Victoza lost significantly more weight than did those on placebo or orlistat. Weight loss increased with the dosage of Victoza, and was 7·2 kg (15.8 lbs) in the high dose group, compared with only 2·8 kg with placebo and 4·1 kg with orlistat. The medication also reduced blood pressure, and reduced the prevalence of prediabetes in the 20 week trial.

If Victoza (liraglutide) does meet FDA criteria, it will be interesting to see whether people will accept the idea of a daily injection for weight loss treatment. With any new drug, it's also very important to fully understand the potential side effect profile, as well.

How long do I have to quit smoking for?

It's well known that smokers have more surgical complications than non-smokers.

One of the most frustrating complications for plastic surgeons is called flap necrosis. This is where part of the skin can literally turn black and die, following surgery on the area. If that sounds bad, you're right. And it's much, much more likely in smokers, even those who only smoke a few cigarettes each day. It's especially a problem in plastic surgery operations where large skin flaps are elevated - facelifts, breast lifts and tummy tucks, to name a few.

This month, a new study published in Plastic & Reconstructive Surgery, looked at the risks of flap necrosis due to smoking, trying to scientifically determine the right amount of time needed for a patient to quit smoking prior to surgery. The investigators used an animal model, with a standardized design of skin flap, and had various smoke-free intervals prior to skin flap surgery, keeping track of the amount of skin necrosis in each group.

Their results:
1) Even at 8 weeks smoke-free prior to surgery, the ex-smokers had bigger zones of flap necrosis (=bad!) than the non-smoking control group.

2) Increasing duration of being smoke-free was significantly correlated with decreased amounts of flap necrosis. In other words, the group that was smoke-free for only 2 weeks did worse than the group that was smoke-free for 8 weeks.

Take home message: Please don't smoke for at least 8 weeks before your tummy tuck, facelift, or breast lift surgery. If you smoke and have a wound healing complication, you really have no one to blame but yourself. It's wiser to postpone your surgery if you can't quit.

Obesity and Pancreatic Cancer

Pancreatic cancer is the fourth leading cause of cancer-related death for both men and women in the U.S. An interesting new study, published this week in the Journal of the American Medical Association has found that, not only is obesity linked to the risk of developing this fatal disease, but that obesity in early adulthood in particular makes you significantly more likely to develop the disease, compared to gaining weight later in life.

The researchers from M.D. Anderson Cancer Center found that obese youths between the age of 14 and 19 years old had a 60 percent higher chance of developing pancreatic cancer than their less overweight peers.

Obese individuals between the age of 20 and 40 were two to three times more likely to develop pancreatic cancer. Interestingly, the risk levelled off for those who gained the weight in their 40s and 50s.

The study also found that obese or overweight individuals were more likely to develop pancreatic cancer earlier on their lives.

Since the medical and surgical treatments for cancer of the pancreas are so very limited, this data adds yet another argument to the need to combat the obesity epidemic here in the United States. Go to the gym and do your bit for cancer prevention!