We wanted to draw attention to one of the recent articles from Natasha Singer, a writer for the NY Times. We often find that her articles are very well informed and, unlike much of what we read about plastic surgery, are researched and well thought out.

In her most recent article, she draws attention to a self help book entitled “How Not to Look Old” by Charla Krupp. Interestingly, Ms. Singer points out that the book “offers a serious rationale for such vigilant attempts at age control, arguing that trying to pass for younger is not so much a matter of sexual allure as of job security.” In other words, she reports that women are increasingly turning toward plastic surgery in order to camouflage their age due to fears that they may otherwise not be able to get or keep a job.

According to the book jacket, “Looking hip is not just about vanity anymore, it’s critical to every woman’s personal and financial survival.”

Ms Singer argues that the success of the book indicates that popular culture is willing to buy into ageism as an acceptable form of prejudice.

We encourage people to read the article which goes on to connect everything from the book to Rush Limbaugh and Hillary Clinton to studies from MIT and Boston College regarding women and ageism.

http://www.nytimes.com/2008/01/24/fashion/24skin.html?ex=1358917200&en=11ca054e9b8df617&ei=5124&partner=permalink&exprod=permalink

There has been a recent report of safety concerns regarding Botox.  The latest news is that the FDA is conducting a broader safety review of Botox and its uses.

Today, we received a media statement from our professional academy, the American Academy of Facial Plastic and Reconstructive Surgery (www.aafprs.org) that is copied below:

“FDA issued an early communication about an ongoing safety review regarding Botox and Botox Cosmetic. FDA has received reports of systemic adverse reactions including respiratory compromise and death following the use of botulinum toxins types A and B for both FDA-approved and unapproved uses. The reactions reported are suggestive of botulism, which occurs when botulinum toxin spreads in the body beyond the site where it was injected. The most serious cases had outcomes that included hospitalization and death, and occurred mostly in children treated for cerebral palsy-associated limb spasticity. Use of botulinum toxins for treatment of limb spasticity (severe arm and leg muscle spasms) in children or adults is not an approved use in the U.S. See the FDA’s “Early Communication about an Ongoing Safety Review” for Agency recommendations and additional information for healthcare professionals.

Read the complete 2008 MedWatch Safety Summary including a link to the FDA’s Early Communication about an Ongoing Safety Review regarding this issue at:  http://www.fda.gov/medwatch/safety/2008/safety08.htm#botox

While any serious complications from a medical treatment warrant thorough investigation and appropriate action, the important thing to understand is the context of the risks posed. Botox is a purified form of botulinum toxin and works by temporarily weakening the muscles into which it is injected. In small doses, such as those used for cosmetic benefits in the face, the risks are extraordinarily small. You have more chance of a serious reaction from a $4 bottle of aspirin.

The major risk arises when large doses are used in sensitive locations. Many neurologists are using Botox off-label to treat limb spasticity for cerebral palsy and other conditions. This can provide some relief for these very debilitating conditions. However, if very large doses are used, there is a small chance of overdose, causing symptoms similar to botulism. Also, Botox is blind to location and acts wherever it is injected. If large amounts are injected into muscles near the windpipe or esophagus, these structures can be affected, with potentially disastrous consequences.

For cosmetic uses, Botox remains one of the safest drugs around and has been used safely in literally millions of patients. But, we take these types of reports very seriously and will continue to update you as more information surfaces.

We recently received a question from a patient who had underwent rhinoplasty elsewhere and noted that a few days later her nose was very itchy. Upon removal of the cast she had red, swollen skin with multiple tiny pustules. She wrote to us in a panic wondering what had happened.

Of course without an evaluation, we told her that we would only be speculating. But we did note that on rare occasions, there are people who have allergic reactions to the adhesive on the tape that is used on the bridge of the nose after surgery. The tape and splint are intended to help keep pressure on the skin in order to help reduce swelling and to prevent the nasal bones from moving after surgery.

When an allergic reaction occurs, most patients generally report in hindsight that they noted some itchiness starting as soon as the day after surgery but that it only became intolerable after a few days. Of course once the tape is removed the allergen- the thing that is causing the allergic reaction- is gone but it generally takes days for the swollen, red, itchy skin to return to normal. The long term consequences of this are generally negligible outside of the transient initial itchiness and discomfort, but it does occasionally mean that it will take a while longer for you to see the final results of your surgery.

Depending on the severity of the reaction, some surgeons will provide anything from a topical to an oral steroid to help in treating your itchiness as well as in helping to reduce the swelling and inflammation. Hope this helps.