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Weight gain in elderly is 100% FAT: weight loss in elderly is 50% MUSCLE mass.

10 days in bed leads to 2K. muscle mass loss.

1% a year muscle mass lost after age 20.

Ann N Y Acad Sci. 2000 May;904:437-48.
Body composition in healthy aging.

Baumgartner RN.

Division of Epidemiology and Preventive Medicine, University of New Mexico School of Medicine, Albuquerque 87131, USA. rbaumgartner@salud.unm.edu
Abstract

Health risks in elderly people cannot be evaluated simply in conventional terms of body fatness or fat distribution. Elderly people have less muscle and bone mass, expanded extracellular fluid volumes, and reduced body cell mass compared to younger adults. These nonfat components of body composition play critical roles, influencing cognitive and physical functional status, nutritional and endocrine status, quality of life, and comorbidity in elderly people. Different patterns of “disordered body composition” have different relationships to these outcomes and may require different, tailored approaches to treatment that combine various exercise regimens and dietary supplements with hormone replacement or appetite-stimulating drugs. Skeletal muscle atrophy, or “sarcopenia,” is highly prevalent in the elderly population, increases with age, and is strongly associated with disability, independent of morbidity. Elders at greatest risk are those who are simultaneously sarcopenic and obese. The accurate identification of sarcopenic obesity requires precise methods of simultaneously measuring fat and lean components, such as dual-energy X-ray absorptiometry.

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Perhaps you’ve heard of the current healthcare bill before the US Senate, Page 2045 Sec. 9017, Excise Tax on Elective Cosmetic Medical Procedures included in the Patient Protection and Affordable Care Act. This dense legalese translates to a tax on all cosmetic procedures as partial payment for the healthcare overhaul our current administration is attempting to implement. The provision would add a five percent tax to “cosmetic surgery and medical procedures” to help cover the $849 billion price tag for health care reform. The tax would cover any cosmetic medical procedure deemed “not necessary to ameliorate a deformity arising from, or directly related to, a congenital abnormality, a personal injury resulting from an accident or trauma, or disfiguring disease. The US government is trying to apply a sin tax akin to that on cigarettes and tobacco on cosmetic surgery.

So what’s the problem? YOU would be paying this tax, the FIRST time this country has levied a tax on patients for medical procedures. What’s at stake?

• This is a discriminatory tax. According to the Aesthetic Society Annual Statistics, 91% of all cosmetic procedures are requested by women

• This will not have considerable consequences on the wealthiest patients but, as usual, affects the middle class. Working women, soccer moms, and scores of others who carefully save and budget to improve their appearance and self esteem will be penalized for doing so.

• Procedures such as breast reduction that have been cited in the literature for improving self esteem and quality of life would be taxed as well

• Your doctor as tax collector: This provision places physicians in the role of tax collector and holds physicians liable should an individual fail or refuse to pay the tax. Is that the relationship you want with your medical provider? Furthermore the IRS will be able to obtain access to your medical records in search of procedures that should be taxed but the tax was not paid. They will end up deciding what is cosmetic and what is not cosmetic.

• It is misleading to say this is just 5%. If you have a complication or result you are not exactly happy with all touch ups and revisions will also be taxed. If they tax the procedure it isn’t long before they tax the materials used in these procedures. If the feds tax it the states will follow. New Jersey already implemented a tax on cosmetic surgery. All that did was force patients to leave New Jersey for surgery in New York and Pennsylvania. The predict tax windfall failed to materialize.

• Those proposing the tax say it is to pay for health care reform. My question is what health care reform? The supposed public option is not in fact public like Canadian and European systems. It will be subcontracted out to the same current insurance company thieves just with more government oversight. We all know how that works looking at the banking fiascos of 2007 to 2009 that occurred under government oversight. Furthermore we all know that just like the money from tobacco companies that was supposed to go to healthcare this money will end up in the general fund. It will end up buying bombs, payoffs to governments we hope will do our bidding, infrastructure buildout, etc.

Please help us stop this silly and penetrative tax. To find your State Senator please click here: http://www.senate.gov/general/contact_information/senators_cfm.cfm
Also please visit http://stopcosmetictax.org/ to sign the online petition, found out what you can do and tell all your friends and family.

We urge you to personally inform the government that you are against this tax – together we can fight for your right to no government interference in medical care and stop this discriminatory measure against women!

www.aaronstonemd.com

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Dr Jeff ARAMINI DVM(Guelph) MSc. PhD(Guelph Epidemiology)
Pres/CEO INTELLIGENT HEALTH SOLUTIONS Inc.
HEALTH & SAFETY WATCH Inc.

MONITORS MEDICAL & ENVIRONMENTAL DANGERS in Canadian GEOGRAPHIC AREAS.

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Facelift surgery to treat the aging face started in the early 1900s. At first this only involved removing some skin in front of the ear and under the chin. Striving for greater improvement the surgeons started to cut just under the skin via these incisions to release it from underlying attachments and allow the removal of greater amounts of skin. This flattened the laugh lines (skin fold between the outer edges of the nose & outer corners of the mouth) and marionette lines and that was good enough. That was how it was done for the first half of the 20th century. Progress in the surgical technique was hampered by societal taboos. No doctor would admit he or she did the surgery and no patient would state they had had the surgery.

Beginning in the early 1960s doctors looked more closely at what occurred to/in the face during the aging process (including the microscopic level) and what could be done to counteract those changes. They found out the skin thins, stretches and loses elasticity, functioning facial muscles create skin wrinkles or folds, non-bone tissue under the skin shrinks and droops downward and some areas of facial bone resorb or shrink back/down as well. This slow unrelenting irreversible process creates on the surface what we recognize as the aging face. For a more detailed explanation of the process see Facial Aging & Rejuvenation.

Over the next 20 years new surgical procedures appeared at a rapid rate to deal with these issues. It turned out that just removing some skin was not enough. If you relied too much on skin tightening alone the end result looked unnatural and the result did not last long enough. A combined approached of skin excision/tightening and treatment of non-bone tissue under the skin such as liposuction or suture tightening became popular. It took another 10+ years to sort through all of this to find out which methods worked best in specific patients for specific surgeons.

In the late 1990s some plastic surgeons began to try out procedures where small incisions were placed in the face &/or scalp through which endoscopes (tubes that allowed one to visualize under the skin surface without peeling the skin back) were introduced. This allowed the placement of sutures into the deeper lower facial structures. The sutures were then passed up through deeper higher facial structures in an attempt to “lift” the face. In my experience these techniques have limited applications & the lifting sutures give fleeting or temporary results. In the vast majority of cases there is excess skin that needs to be removed & this is not addressed by endoscopic approaches. The lifting sutures loosen over time as the tissue grows around them. In a few months to a year these sutures are no longer lifting anything. In order to raise these deeper tissues in a consistent long lasting fashion an incision or excision is required in those deeper tissues.

The Threadlift procedure where a barbed lifting suture was placed was popular for a short period of time before these threads were taken off the market in the United States.

The s lift refers to an s-shaped incision in front of the ear that extends under & in some cases around the back of the earlobe. The original s lift involved a skin incision in front of the ear only & excising-suturing a deeper layer of tissue to give a tightening effect without elevating much skin as a separate layer by itself. The original procedure had little or no effect on rejuvenation of the neck. This has been modified by a number of physicians to include numerous different variations of the original procedure including pulling the deeper tissue upward using a suture tightened around the cheek bone. All are basically minor facelifts performed without doing all the steps of a full face lift. I personally do not use this misleading nomenclature as it gives rise to prospective patients asking for a specific procedure rather than asking for resolution of a specific cosmetic issue they want addressed. It has also facilitated incompletely trained or incompetent physicians to advertise their performance of specific procedures. They are incapable of going over the different procedures available with the patient much less performing those procedures.

Beginning in the late 1990s with technological advances/new machines and lasers the belief that you could achieve the same result without surgery and little or no down/recovery time took hold. A lot of people bought into this and the thought was that if you just had the right machine for the right patient you would not really have to perform any surgery at all. It was as if doctors were afraid to perform the surgery and patients were afraid to have it done on themselves. Simultaneously patients were coming in at younger and younger ages so they did not need the full facelift procedure. As it turns out these younger patients received more improvement from non-surgical procedures than the older patients. They only needed parts of the original procedure anyways depending on how they were aging. Everyone is moving towards the aging face look from the moment they are born but different parts of the face are going in that direction at different speeds in different people.

This graph is from American Society of Plastic Surgeons statistics of procedures performed. Note the consistency of about 10% of facelifts performed on men regardless of the total number of procedures performed per year. During the peak good times of the economy the number of facelifts almost doubled between 1999 and 2000 despite the increasing non-surgical partial alternatives to facelift surgery. Part of this increase may have been due to parts of the original full facelift procedure being applied to younger patients as described above increasing the total number of procedures performed. After the 2001 recession the peak number still had not been re-approached by the time of the 2007 onward recession.

Now we have so many different types of facelifts and machines for so many different types of patients that the whole process can become quite confusing. Almost no 2 surgeons will recommend the same approach for a given patient. It’s a little like the car. At one time you either bought a Model-T or you did not drive. Now you can literally choose from millions of car models worldwide. One car is not necessarily wrong for you relative to another it depends on your needs including the type of driving you do.

It is now obvious that the patient needs to be examined before surgery and the procedure tailor made to fit each specific patient’s needs. If the surgeon is too aggressive with surgery the complication rate goes up so there needs to be a balance between all of these factors to get the best result for a given amount of work/price with a workable recovery time and low risk of complications.

My next blog will cover how I approach the facelift patient and the options available to these patients including standard and subperiosteal approaches.

Facelift, Midfacelift and Neck Lift 2
Aaron Stone MD – Plastic Surgeon Los Angeles

www.aaronstonemd.com

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This blog covers skin scars only but does not include burn scars or scars related to breast implants.

Virtually everyone who lives long enough will have a skin scar from elective surgery or an injury. There has been a barrage of cosmetic surgery procedure modifications to decrease total incision length in the hope of creating less scarring. The healing of these disruptions in the skin surface follows a specific process. After the injury or cut there is bleeding. Once this stops an inflammatory process starts to get the cells needed for healing into the wound. New blood vessels grow into the area bringing in the energy needed to complete the healing process. You see this as a red color of the scar and the skin immediately next to the scar that blanches white with finger pressure. Within a week or two the healing is sufficiently strong that the wound should not reopen and any sutures that were placed can be removed. Even though the wound is healed it then must mature over the next 6 to 9 months depending on the type of injury, affected body part, age of individual etc. before the redness goes away and the increased blood flow is no longer needed. Once the scar has fully matured it usually does not blanch with finger pressure. Any problems in this process such as an infection, failure to suture a wound closed, certain vitamin deficiencies etc. prolong the healing time and in doing so result in worse more visible scarring. The skin of younger individuals makes strong repairs and tends to over heal, resulting in larger, thicker scars than on older skin. Skin over the jawbone is tighter than skin on the cheek and will tend to increase a scar’s prominence. All scars are more amenable to treatment early in their life span before they mature. It is easier to prevent a bad scar from forming by control/manipulation in the early phases of wound healing than to treat one that has already formed.

Typically, a scar will become increasingly prominent at first. The tissue increases in height, firmness, and redness (vascularity) and then gradually fades. Many disfiguring marks which seem unsightly at three months may heal quite satisfactorily if given more time. The desired end result is a flat (not indented or raised), soft, pale, less than 1mm wide scar. We can call that the normal scar. The non-normal scar is more visible due to a number of factors, including its difference in topography (surface contour or depth and height relative to adjacent skin), color, thickness, pliability or texture versus the surrounding normal skin. Scar length, width or direction can also contribute to visibility. A scar that crosses natural expression lines (Langer’s lines) or wrinkles will be visually striking because it will not follow a natural pattern for example a scar that obliquely crosses the natural skin fold between the corners of the mouth and the nose is much more visible than one that lies along this fold. If the skin scar adheres to deeper structures such as muscle or bone the skin may bunch up with movement as it is tethered to deeper structures and that also contributes to visibility. In fact some scars may only become visible on animation or movement. Some scars are accompanied by a loss of skin with or without a corresponding loss of deeper tissues (a tissue deficit). In worse cases the patients complain of scar itching, pain, breakdown to a raw surface with minor trauma (an unstable scar) and even recurrent infections in addition to scar visibility. I take all of these factors into account before treating a patient with scars and then develop a treatment plan specific to the patient’s situation.

TYPES OF SCARS
The non-normal or non-desireable scars can be classified as significant skin loss/deficit, flat and wide, hypertrophic and keloid.

–SKIN DEFICIT
These scars usually arise after injuries like bites and car accidents where the skin is disrupted by an object that is not knife sharp. The skin at the edges of the wound is crushed in the process and either dies on its own or has to be cut away by the surgeon.

This patient had a scar with significant loss of skin that shortened the vertical length of the central upper lip and distorted the normal lip proportions.

–FLAT AND WIDE
The final scar width is dependent on the tension of closure and distracting or separating forces applied to the scar with movement before the scar has fully matured. If an injury causes a wound and crushes skin at the edges of the wound that crushed skin is usually removed. The non-crushed skin at the edges is of better quality but when the edges are sutured together it may be under tension from skin loss and that leads to a wider more visible scar. Alternatively the scar may lie along the scalp, front of the knee or back of the elbow where movement will constantly stretch the scar along the length of the limb or skull before it has fully matured and widen it. The visible linear scar of the scalp can be a cosmetically serious complication of a scalp incision in scalp surgery, forehead lift or craniofacial surgery, especially on the temple scalp where it is harder to hide by combing the hair over it. This area of hair loss is usually due to incisions or cuts that damage the hair follicles along the cut or laceration as well as widening of the scar line after healing. Treatment limited to removal of skin only increases tension around the scar and results in a high recurrence rate of these types of scars.

I had a patient with a scar over the jaw line that would alternatively turn red and then
pale as the patient moved his jaw -speaking, eating, or making facial expressions. This was due to the tension applied across the scar with jaw motion.

This photo shows a knee scar after orthopedic surgery. The scar is wide and flat and lies over those parts of the knee that are constantly placed under tension with knee movement. You can test this for your self by pinching the skin over the while the knee is extended. When you then flex the knee you can feel the tension of the pinched skin that would be applied to a scar over the knee with knee motion. Also note the small punctate scars along side the main scar these are stitch mark scars from the sutures. The scar is widest where it lies over the joint itself due to the greater amounts of tension across the scar. The scar is normal over its lower third because of the absence of tension across the scar. These scars are best treated by taping the scar for some months after surgery. Once they widen it is very hard to fix them because of the motion at the joint and the increase in tension when you remove any skin as you would be doing if you cut out the scar.

This is the type of scar seen after injury or cosmetic surgery (browlift, facelift). It is much harder to hide one of these types of bald scars on the side of the head than on top of the head where hair can be combed over it. Although the scar may be of good quality the associated loss of hair along the scar makes it much more noticeable than it otherwise would be.

–HYPERTROPHIC
Hypertrophic scars are seen as a ridge within the confines of the original wound. They develop soon after surgery, usually subside with time (mature), are confined in size/growth and usually occur across moving areas of skin (abdomen, palm, front of the elbow, in the fold under the breasts). They are thickened scars over areas of skin compression. They can also arise from a prolongation of the healing process. More tissue than is required is produced to close/cover the wound. They can be a single raised line along the scar (linear) or a raised area of variable shape (widespread).

–KELOID
Keloids appear sometime after the original surgery or injury, rarely subside with time, grow out of the confines of the original wound, (a minor injury can produce a large keloid), are independent of skin motion (such as earlobe keloids), rarely occur across joints and can become much worse after surgery without concomitant steps to prevent recurrence. The incidence of keloid scarring increases in darker skinned individuals but not ever darker skinned individual gets them. Despite that my keloid patients are mostly Afro-American followed by Asians and then those of non-European Hispanic descent. I have only had a few Caucasian patients with this problem. Keloids have not been reported in albino’s of any race, suggesting a potential role of skin pigment in this type of scarring. There is an increased incidence of keloid formation running in families so it is inherited to some degree. Keloid scarring does not follow the same pattern of evolution, stabilization, and involution of the normal or hypertrophic scar. It may develop directly after an initiating event or some years later, arising from a mature scar. Earlobe keloids usually occur months are years after the initial ear piercing. Keloids also can occur spontaneously. Virtually all keloids that are cut out will return if steroids and pressure are not applied after surgery. In some cases radiation may be used instead of pressure.

This patient had a keloid from an ear piercing removed with inadequate care afterwards to prevent it from coming back. It of course grew back and you can see how it grew out of the boundaries of the original piercing so that it began to block the ear opening and affect hearing.

A scar can have mixed properties along it’s course for example a midline scar extending down from the chest into the abdomen can be normal in the upper half and hypertrophic in the lower half or the mixed scar in the knee photo above.

TREATMENT
The goal of treatment is to make scars less visible and relieve itching and pain if present. Silicone gel sheeting and corticosteroid injections into scars are the only treatments for which there is sufficient published medical journal evidence to justify their use. Studies of scar treatment are complicated by the natural tendency for scars to improve over time. Having said that most physicians including myself rely mostly on what has worked for our patients rather than referring to published studies involving large groups of patients. Looking at the accompanying photos you can judge for yourself what is effective.

Frequently a combination of treatment modalities is required because not every modality works on every patient or scar by itself. When applied together some modalities have a much greater effect than the sum of their individual contributions.

–SURGERY
Surgery is commonly used to cut out a scar. The resulting sutured wound creates a young immature scar that responds better to the modalities described below. In the case of tissue loss new skin can be brought to the area by skin grafting or small surgical procedures to move around adjacent skin. Surgery can also be used to break up a scar, detach the scar from deeper tissues, change scar direction or manipulate adjacent tissue to decrease tension along the scar line -all of which can make a scar less visible. These procedures are usually performed under local anesthesia so the patient does not have to go to sleep under general anesthesia. Surgical removal alone for keloids without any of the adjunctive procedures below has a 45 to 100% recurrence rate. This treatment modality is the one I most commonly use on my patients.

–SILICONE GEL SHEETING
Silicone gel sheeting has been in use since the early 1980s for the treatment of scars and has been proven to be effective. It is available over the counter as a solid sheet or a gel that you apply which hardens. Despite its track record my patients have not liked it and it has not been effective in my practice.

–PRESSURE THERAPY
Pressure has been used in the treatment of scars since the 1970s. The effectiveness is dependent on how long the pressure is applied for. Some doctors recommend 6 to 9 months of pressure but the majority of my ear lobe keloid patients only require 2 to 3 months of pressure earring wear. Certainly scars that have recurred after previous treatment should have pressure applied for a longer period of time. Scar massage has the same effect as pressure with the additional effect of breaking up scar connections between layers of tissue.

This is a widespread hypertrophic scar on the right buttock. After 6 months of pressure applied to the scar the part of the scar that received pressure is flatter. Pressure definitely works if applied long enough.

–CORTICOSTEROID INJECTION
Corticosteroids are most effective when injected and not so effective when applied topically (except when applied as a medicated tape). This is the second most common modality I use on my patients, mostly in conjunction with surgery and it has been in use since the 1950s. Only very small amounts of the appropriate strength should be injected at a time very close to the surface in order to avoid thinning or depigmentation of the skin or creation of spider vessels around the injection site. If too much is injected too deep into the skin the risk of these problems occurring goes up. Except in the case of keloids the injections should not be closer than 4 to 6 weeks apart in order to avoid these problems as well. When used together with surgery for keloids the recurrence rate drops below 50% .

–RADIATION
Radiation applied right after surgery for keloids drops the recurrence rate down to 10%. 4 treatment sessions are required. Despite that I have found that the majority of these patients will require corticosteroid injections and/or medicated tape to get the best result. Although the keloids do not come back these scars tend to hypertrophy but are very sensitive to corticosteroid treatment.

–LASER
When the ablative lasers (those that vaporize surface skin) appeared in the mid-1990s the general public was lulled into believing they caused less scarring than scalpels. This turned out to be science fiction. There is no advantage to using these types of lasers in surgery to prevent scarring or to treat scars. The lasers that obliterate small blood vessels near the skin surface without destroying the skin have shown some promise in treating and preventing the formation of bad scars but multiple treatments are required and the best results are those given in combination with other treatment modalities like corticosteroid injections.

–FREEZING – CRYOTHERAPY
Freezing scars has been used in the past but is not currently popular because of the high risk of damaging pigment and the creation of scabs that take some time to heal over and separate.

–TAPE
This is the modality I use the most after surgery both for scars and after cosmetic surgery. By applying the tape you decrease motion along the scar line and it is preventative against wide flat scars. The greatest advantage is that it is cheap and easy to do. It is not effective for the treatment or prevention of keloids.

–CORTICOSTEROID MEDICATED TAPE
Over the years I use more and more medicated tape in my patients. Patients that respond to corticosteroid injections but require more than 1 or 2 injections get this treatment. The medication is mixed with the adhesive and the tape prevents the medication from evaporating so it can be absorbed into the skin. This treatment has been a lifesaver for many of my patients, and me also.

–CAMOUFLAGE TATTOO
This is reserved for men who have scars on the face with loss of the beard hair in the scar. The medical tattooist tattoos small black dots to match the facial hair and the result can be very good. The only problem is the tattoo may fade over time and require touch ups.

–OTHER MEDICATIONS
Interferon an immune medication and some cancer chemotherapy medications have shown effectiveness in scar treatment when injected in small amounts into the scar. Currently these are not the most popular treatment modalities.

–SUNSCREEN
Sunscreen should be consistently used to protect scars from sun exposure until they have fully matured in order to prevent the scars from becoming permanently hyperpigmented (darker).

CASES

This patient had a keloid arising in an acne scar. I could not cut it out because there was not enough surrounding loose skin so I shelled out the keloid at surgery. Radiation and medicated tape were used after surgery and the after photo is 7 months after surgery.

In this case the scar from previous surgery connected the skin to the stomach muscles. The surgery involved separating the deep from the superficial layers and a little bit of liposuction to even the surface contour. The after photo was taken 1 year after surgery.

This patient had a keloid on his back that was removed elsewhere twice and grew back within 2 months of surgery. There was enough loose tissue around the keloid that I could cut the whole thing out. Radiation was used after surgery and then taping. This patient did not wear the tape as directed and so the end result was a wide flat scar but that was still better than a keloid. The after photo was taken 1 year after I did this surgery.

This patient began losing hair 1 year after a facelift by a surgeon other than myself. She had a wide flat bald scar on the temple scalp and hair loss behind the ear. I grafted hair from the back of her head to hide these scars.

For this patient I surgically removed the keloid under local anesthesia and then treated with corticosteroid injections and 2 months of pressure earring wear.

In this case I removed a wedge of scar tissue and damaged lip and then realigned the lip margins. The only treatment modality required was surgery under local anesthesia.

This is one of the easiest scars to treat. I removed the hypertrophic scar under local anesthesia and just sutured it. No additional treatment was required. The hypertrophic scar appeared because the original wound was not sutured.

This patient was left with wide depressed scars on his arm after limb saving surgery in another country. The skin could not be sutured at the time and that contributed to the scars. I stretched the adjacent skin with sutures for a month or two before cutting the scars out. That allowed me to close the excision sites with less tension and decrease the chance that the scars would widen again. The after photos were taken about a year after surgery.

This scar is visible because it lies in the middle of an aesthetic unit of the face and is not aligned with any naturally occurring facial skin folds or wrinkles. The treatment is to excise the scar with irregular geometric shapes to make it less noticeable. If you used only one shape such as a triangle the result would not be as good. Photo courtesy of Dr. David Hendrick

In this case a circular scar causes the skin within the confines of the scar to protrude outward. The treatment is to make the scar zig-zag and thin the fat layer within the confines of the scar. Photo courtesy of Dr. David Hendrick

In some cases it is best to just cut out the skin scar and suture the resulting wound closed.

The ultimate goal, seldom achieved, is to hide a scar so that it is not visible to the unaided eye and the area in question looks as though nothing untoward has occurred. Scars never disappear and in many cases only a partial response is possible. The treatment of scars is usually not covered by health insurance unless a bodily function such as range of motion is affected or the scar is unstable. Some health insurance will cover scars from repaired injuries up to 1 year from the date of the injury.

Lip Scar Revision
Keloid of the Face
Earlobe Keloids
Facial Keloids
Chest Keloids
Aaron Stone MD – Plastic Surgeon Los Angeles

www.aaronstonemd.com

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LoFric® – the first hydrophilic urinary catheter – was introduced more than 25 years ago.

Being hydrophilic means that the catheter’s surface layer has a special coating that binds water and creates a very wet and slippery surface, in principle frictionless during insertion.

Today there are several hydrophilic catheters on the market, but there are important differences between LoFric and the others. The secret behind LoFric is the Urotonic™ Surface Technology (UST).

Essentially, Urotonic™ Surface Technology binds water to the catheter tube. This creates a wet and slippery surface that reduces friction against the urethra by 90-95% compared to a regular catheter with gel.
This allows the catheter to slide in and out of the urethra in the most comfortable way possible. And, just as importantly, there’s less risk of long-term complications from the repeated friction of self-catheterising.

Now on sale in CANADA.(NOT covered by Ontario Insurance plan).

www.lofricsense.com

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DIATON THROUGH-THE-LID TONOMETER

RUSSIAN INVENTION. GOVERNMENT APPROVED IN CANADA, USA AND MANY OTHER COUNTRIES. THERE IS NO CORNEAL CONTACT; AVOIDING USE OF LOCAL ANAESTHETICS, FLUORESCEIN, CORNEAL INJURY AND TRANSMISSION OF INFECTION.

USED in TEACHING HOSPITAL EMERGENCY UNITS.

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With luscious lashes up there with clear skin and white teeth as a must-have for many women, surgeons believe that the £3,500 operation will prove popular. The four-hour procedure, which is already widely performed in the US, was undertaken by the plastic surgery firm Transform.
But as well as offering an alternative to false eyelashes or lashings of mascara for women desperate to look doe-eyed, the procedure is recommended for trichotillomania, an impulsive condition which causes sufferers to pull out their own hair; alopecia suffers; and cancer patients who have suffered hair loss.

The first UK patient to undergo the surgery was 19-year-old Louise Thomas (not her real name), from Manchester, who suffers from trichotillomania.

“Having suffered from trichotillomania for 17 years, I learned to accept that I’d never have real lashes again. That’s quite a hard issue for a young girl to come to terms with,” Ms Thomas said. “The results are absolutely amazing! I feel so feminine again and simple things like being able to wear mascara have made such a difference to my confidence.”

“There are some people who have lost eyelashes through burns or alopecia, whom a little refinement could help enormously,” said David Gault, a consultant plastic surgeon and member of the British Association of Aesthetic Plastic Surgeons (Baaps).

“However, if you just want longer eyelashes, I would think about it. If the surgeon put an eyelash in at slightly the wrong angle then the patient would not get the results they want”.
The procedure is billed as “pain free and minimally invasive”, but because the transplant eyelashes do not fall out naturally like ordinary eyelashes, they need to be trimmed every six weeks.

The technique was pioneered in the US to help burns victims, but has grown in popularity. Recent research by the American Academy of Cosmetic Surgery revealed that “eyelash rejuvenation” topped the wish list of procedures. Another US eyelash enhancer tipped to hit UK shores is Latisse, an ointment that was originally a treatment for glaucoma but which causes eyelashes to grow longer and thicker.

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