Number #26 summary

Plasma skin regeneration
Mr David Gault discusses a technique called plasma skin regeneration, which he uses for refreshing the face

One of the dilemmas facing aesthetic surgeons is the enormous range of choice available from the vast array of techniques for rejuvenating the face. From facelifts, through lasers and peels to fillers and Botox, most techniques have an established role. Non-ablative lasers promise minimal down-time, but the results are mild and only after multiple treatments can improvement be observed.
     Ablative resurfacing, mainly with C02 lasers, has excellent results on fine wrinkles and skin laxity but there is more downtime and some now find the risk of complications, such as hypopigmentation, unacceptable. The ideal rejuvenative tool would, therefore, aim to avoid side-effects yet provide long-term and obvious benefit with a minimal recovery period and a rapid return to normal activities. To this end, the plasma skin regeneration device was developed.

Axillary hyperhidrosis
Hyperhidrosis—otherwise known as excessive sweating—is often underdiagnosed and undertreated. Dr Prashant Murugkar focuses on the main diagnostic features and management of axillary (underarm) hyperhidrosis

Hyperhidrosis can be generalised by the area involved or classified as primary or secondary on the basis of the cause. In primary hyperhidrosis, the cause for the excessive sweating
is not known; in secondary hyperhidrosis, the primary disorder—such as pituitary or thyroid dysfunction, diabetes mellitus or menopause—is responsible for the hyperhidrosis. Primary axillary hyperhidrosis is the most common location for excessive sweating in patients and often presents along with palmo-plantar hyperhidrosis.
     Sweating is controlled by emotions through the limbic system and the thermo-regulatory centre in the hypothalamus. These affect the post-ganglionic sympathetic outflow of the para-spinal sympathetic chain. While the definitive cause of this condition is yet to be elucidated, most evidence points to a hyperactive autonomic system.
     The patient will often give a history of focal, visible and excessive sweating that has come on without any apparent cause over the last six months. Often he or she has a family history of similar problems.

Back to school
As demand grows for medical aesthetics procedures, how is training keeping up?
Lucy Ibbison looks at the training available for those starting out in medical aesthetics
and the courses that will widen practitioners’ skills

As the baby-boomers started hitting 50, clinics and aesthetic centres began to proliferate
to meet consumer demand. Not too far behind came a corresponding increase in training courses. A quick search on Google reveals large numbers of companies that would train me (I’m an RGN) to give Botox to paying clients as early as the following week.
     With no specific aesthetics training regulations or legislation, the ground is fertile for all kinds of courses. With no training at all I could, with the signature of a doctor, inject Botox into someone’s face. Clearly, it is up to the practitioner to source their training needs to administer treatments competently.
     Anatomy and physiology may be a given, but aesthetic procedures require a certain ability. For those considering widening their scope into aesthetic medicine, an introductory course that gives an insight into the practice is ideal.
     Professional training courses assume some anatomy and physiology knowledge, requiring at least RGN status. Many enrol only doctors and dentists, and a few require details of professional registrations such as GMC, NMC and GDC numbers. If you are not asked for proof of your qualifications, move on. There is much choice, so be particular.

Sculpting the body
Liposuction has evolved significantly since it was first performed in Italy 34 years ago.
Mr Bryan Mayou provides a current perspective

Liposuction has evolved from plain fat removal to body contouring, which includes redefining the breasts, abdomen, buttocks, thighs, chin and anatomical parts whose angles have been obscured by fat deposits. It is also essential for harvesting for fat grafting, well established in facial rejuvenation and breast augmentation.
     At its most basic, liposuction is simply about the removal of fat cells. Once removed, these do not regenerate, and one is left with a permanent change in contour. It is still unclear whether damaging fat by injection, laser or external ultrasound actually puts the fat beyond repair.
     Often the most significant results are achieved when only small, localised fatty deposits are removed from a slim person. Fat people, too, will benefit from a change in shape. It is not a good treatment for weight reduction, as the removal of more than four litres (4kg) increases risk and often demands blood transfusion. If really substantial amounts are being removed, one would require the facility of an intensive care unit post-operatively.
     Healing of the soft tissues after liposuction does cause some scarring with retraction of the skin. This should be beneficial, particularly where the skin is thin, such as tightening the skin of the neck by removing small amounts of fat. If the skin is already hanging, it may become more of a problem after treatment. This would occur with the loose skin of an abdominal apron or ptotic buttocks.

Advanced nail repair
Professor Dr Eckart Haneke describes methods to contend with four distinct nail problems

Nail surgery is not frequently performed in medical practice, neither by general practitioners,
surgeons nor dermatologists. The reason is a general unease to do more than just nail avulsions; although, these are very rarely indicated and are no treatment at all. Most often they are performed in order not to be forced to make a diagnosis.
     In addition, the description of the technique of nail avulsion in textbooks of minor surgery is a raw method often leading to exacerbation of what ought to have been treated. Nail biopsies are extremely useful but rarely performed because the patient is usually afraid of the postoperative pain and inconvenience, and the physician is inexperienced and afraid to leave a postoperative nail dystrophy.
     Nail surgery—basic as well as advanced—requires an extensive knowledge of the nail’s biology, physiology, anatomy, growth characteristics and pathology as well as sterile operation conditions and excellent light. A good anaesthesia is a prerequisite.
     The technique of transthecal anaesthesia for the long fingers is ideal: a single needle prick in the centre of the volar crease of the metacarpo-phalangial joint with a #30 gauge needle approximately 4–6mm deep, just until one feels the resistance of the firm tendon, allows 3–4 ml of 1% or 2% local anaesthetic to be injected. In case one needs too much force to inject, the needle is in the tendon and has to be withdrawn about 1 mm. The anaesthesia is complete within 3–5 minutes and works for the distal half of the finger. As well as the advantage of only one needle prick, the neurovascular bundles of the proper digital nerves cannot be injured by the sharp needle tip.

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