Issue #13 summary - GO BACK TO ARCHIVE

Post-bariatric body lift
According to 10 cosmetic and plastic surgery predictions for 2004 made by the American Society of Aesthetic Plastic Surgery, body lifts will increase as post-bariatric surgery patients seek plastic surgery to rid themselves of the excess skin left hanging after massive weight loss. This correlates with the findings from the American Society of Bariatric Surgery, which indicates that gastric bypass surgery jumped last year to more than 103,000, leading to a significant increase in demand for body contouring procedures.
    It is not uncommon in a world obsessed with weight-loss diets that thousands of people are successfully losing significant amounts of weight each year—whether it is a case of genetics, the traumatic effect significant weight loss has caused, or just an abundance of loose skin on the abdomen or thighs.
    The “total body lift” procedure is much like a facelift for the body. It has been devised to assist people who suffer from sagging breasts, abdomens, buttocks and inner/outer thighs. I have progressed from a multiple stage to a single stage body contouring procedure to remedy the problems of loose skin from the shoulders to the knees.
    With increasing age or with weight loss, there is often an excess of skin, or fatty tissue or both. In mild cases, this can be managed by procedures such as a tummy tuck, liposuction or both.

Fair outlook for light hair
Over the past 20 years, we have witnessed the evolution of laser and light sources that have been proven to provide effective long-term hair reduction. Today, these devices are used primarily to target dark hair with a minimal side-effect profile and have the ability to treat large areas rapidly. These technologies cause thermal destruction of hairs mediated by melanin-induced absorption of light in the hair shaft, while the surrounding skin and tissue absorb minimal levels of light.
    Short wavelength lasers (500-800nm) are typically employed to treat individuals with light skin and light brown/blond hair of thin diameters, while longer wavelength lasers (800-1200nm) are utilised for patients with darker skin who have course dark brown/black hair. Intense pulsed light sources deliver multi-wavelength light which encompasses the wavelength spectrum between 500-1200nm. Laser systems and IPL sources approved by the FDA for hair removal include the long-pulsed ruby (684nm), alexandrite (755nm), diode (800nm), and neodymium yttrium-aluminum-garnet (Nd:YAG, 1064nm) lasers and IPL sources (500-1200nm).
   Despite all of this progress, the ability to treat white, grey and blond hair effectively remains problematic due to the inability of these lasers and light sources to target any pigment in the hair follicle. Today, there are several approaches available to the practitioner who is posed with the dilemma of treating light coloured hairs. These include synthetic melanin derivatives, accelerated photochemotherapy approaches, and non-melanin targeting light based technologies.

In the cold light of day
The Care Standards Act 2000 private and voluntary healthcare audit process has largely resulted in over-regulation of establishments that present the least risk to the public while failing to tackle many operators who ignore the legislation. There have been reports of inconsistent inspection, lack of standardisation and regional variations in compliance management standards, especially in relation to guidance for inspection of non-medical salons. The roles of the expert treatment protocol, core competencies, training objectives and the level of medical supervision as well as the guidance of operators have yet to be fully determined.
   The registration procedure needs to be revised to improve access to a standardised and expedient registration process. It must be easier for users to be regulated than not to be regulated.
   Lasers are grouped into four main classes and two sub-classes, as defined in BS EN 60825-1. These classes are based on the degree of hazard to persons and take into account potential damage to the eyes and skin (Guidance on the safe use of lasers in medical and dental practice, MDA 1995, p7.) All users of class 3B and class 4 lasers were required to follow the provisions set down in specific British standards (BS EN 60825-1:1994 Radiation safety of laser products, equipment classification, requirements and user’s guide, BS EN 60601-2-22:1993).
   The Care Standards Act 2000 (CSA) came into effect in April 2002. For the first time in UK legislation, broadband and intense pulsed light (IPL) systems were treated in the same way as lasers. Laser/IPL users were classified as providers of “prescribed techniques and prescribed technology” and required to register directly with the Care Standards Commission. All providers of such a service must comply with the CSA 2000, the Private and Voluntary Healthcare Regulations 2001 and also adhere to the Department of Health's National Minimum Standards (NMS) - Core Standards and relevant Service Specific Standards.
   CSA 2000 was originally implemented by the National Care Standards Commission (NCSC) which, in turn, was replaced by the Healthcare Commission or Commission for Healthcare Audit and Inspection (CHAI). More problems in registration were encountered than expected and the process was slowed, particularly as a result of delays in applicants obtaining Criminal Records Bureau Enhanced Disclosure clearance.

Equality of arms
In a claim for clinical negligence, where there is simply a claim for compensation, the independent medical experts play a crucial role. While it is the judge’s task to decide whether the claimant has proved his case, he is not usually an expert in the field of medicine under discussion and therefore has to rely on the assistance provided by the medical experts called by the parties. Such experts are central to clinical negligence cases because of the test for negligence.
    In a clinical negligence case, the so-called Bolam test is applied. This is the test laid down in the seminal clinical negligence case of Bolam v Friern Hospital Management Committee (1957). It was held: “The test is the standard of the ordinary skilled man exercising and professing to have that special skill… A man need not possess the highest expert skill; it is well established law that it is sufficient if he exercises the ordinary skill of an ordinary competent man exercising that particular art”. In other words a doctor is not negligent if he acts in accordance with a practice accepted at the time, as proper by a responsible body of medical opinion.