Issue #24 summary - GO BACK TO ARCHIVE

Plump up the volume
The filler market has grown signifi cantly in recent years. Dr Lucy Glancey has tried most of the fillers that are available and provides a practical account of her experience
   The dermal filler market is one of the fastest growing in medical aesthetics. This has been facilitated by dermal fillers’ classification as medical devices, which don’t require a prescription. This has encouraged many manufacturers to launch their own filler. Often they will use the same basic ingredient and modify it in order to have their own brand. Hyaluronic acid is central to most of the new formulations.By comparison, the botulinum toxin market has been limited until recently to only two main manufacturers. This is due mainly to the restrictions imposed on prescription-only medications. There are advantages of fierce competition among filler manufacturers. A competitive market provides the impetus to improve existing products. The customer service that we, as practitioners, receive from a distributor or a manufacturer is also important. The disadvantage of such competition, especially in the dermal filler market, is that many products are approved for sale before undergoing vigorous clinical trials. This potentially puts our patients at risk along with our reputation as practitioners. This is not just the case in the UK but in the EU as well. This is the CE mark process. It is completely the opposite in the USA where products—be it drugs or medical devices like dermal fillers—have to undergo vigorous trials in order to get FDA approval. This is why for many years collagen was the only dermal filler available in the USA. Recently, Restylane, Juvederm and other hyaluronic acid fillers obtained their FDA approval. Although the FDA approval process helps to ensure patients’ safety, it means many Americans have to fly abroad for treatments using products that are not FDA-approved.

Condition Red
Dr Peter Crouch discusses how he identifi es patients likely to benefi t from laser and intense pulsed light (IPL) treatment for red face and facial fl ushing symptoms
   Over the past five years, the NHS and private clinics have attracted a significant number of patients seeking a solution to rosacea, “red face” and “flushing”. We have developed detailed protocols for identifying and treating the patient groups that present. Some of our patients travel thousands of miles for treatment, mostly based on internet research of their condition, the treatments available and patient recommendation. Taking a detailed history is crucial, and I have discovered that focusing separately on the symptoms of basal redness and flushing is the most useful approach. I divide the patients (based on symptom history and examination) into four distinct groups: Group A — basal redness alone (little or no flushing) Group B — mixed basal redness and flushing Group C — flushing (with little or no basal redness) Group D — diagnosis unclear, eg, vasculitisMost patients I see have pretty much exhausted the over-the-counter topical/pharmacological remedies before they present. Many get by simply with camouflage make-up. But laser and IPL can offer far more than camouflage. I shall focus on the laser and IPL strategies for groups A, B and C. The diagnostic conundrum group D falls outside the scope of this article.One popular theory suggests that basal redness involves prominent superficial vasculature at varying depths. The key to success is coagulation of these blood vessels. IPL devices produce a broad spectrum of incoherent light in a range of wavelengths highly controlled by filters and computer-adjustable pulse width and delay between pulses.

Contending with acne
Acne is the scourge of teenagers but all age groups fall victim. Dr Stephen White discusses the cause and wide-ranging treatments available including topical retinoids, oral anti-biotics and isotretinoin
   Nearly all of us have experience of acne vulgaris. More than 90 per cent of boys and 80 per cent of girls will seek advice to treat it. Acne affects many adults too: eight per cent of adults aged 25–35 and three per cent of adults aged 35–40 have significant acne that warrants treatment, and acne can continue to occur well into a person’s 70s. Acne sufferers are frequently the butt of ignorant jokes and also in receipt of well-meaning but ill-informed advice. Acne can lead to major psychological problems, especially in adolescence when the psyche can be fragile. The consequences of mishandling acne can lead to low self-esteem, poor social skills, evidence of a reduction in quality of life and even reduced employability in adulthood. Both the physical and mental scars of acne can last a long time.There are many myths and half-truths about acne, its causation and management. First, acne is not a primary infection. It is, as will be shown later, a multifactorial problem involving sebum excretion, ductal blockage, bacterial overgrowth and inflammation. Second, it is not due to lack of cleanliness. The blackhead, or comedone, is due to inspis-sated, oxidised sebum. No amount of deep cleansing or facials is going to prevent the development of this lesion. Third, diet—particularly chocolate—has no effect on the severity of acne. Fourth, all acne treatments work to prevent acne and take four to six months to become effective. Prolonged treatment is inevitable—there is no quick fix.

Obesity spreads in social networks
A study of 12,000 people over 32 years has found that people are more likely to be obese if their social network shares the same trait, reports Barbara Rutledge PhD
   In a 1995 British Medical Journal paper entitled “Obesity in Britain: gluttony or sloth?” Drs Andrew Prentice and Susan Jebb discussed the increasing trend in obesity in Britain and reviewed possible causes, including genetic predisposition, changes in the fat:carbohydrate ratio in the typical British diet, and behavioural factors, notably over-eating (“gluttony”) and lack of exercise (“sloth”).
The authors concluded that reduction of energy needs due to physical inactivity might be the dominant factor in the development of obesity in Britain. They recommended that public health services combat obesity by encouraging the public to eat a smaller high fat content and become more physically active.
More than 10 years later, the trend in obesity in Britain continues. The question is why, particularly when there is widespread awareness of the dangers of high-calorie diets,
supersize portions and physical inactivity. What are some of the psychological or social obstacles
that play a role in the obesity trend?
Cultural assumptions about body size influence how we see our bodies. In developed countries, obesity is often stigmatised as a sign of laziness or lack of self-control. Social pressure enforces the view that the ideal body—particularly the ideal female body—should be thin; fashion models often strugglewith anorexia.
For Westerners, it may come as a surprise to learn that obesity is considered a positive attribute in some other societies. Among Pacific Islanders, for example, obesity is traditionally associated with beauty, power and wealth. In a recent report describing the obesity epidemic in developing countries, Dr Prentice discusses attitudes towards body size and obesity in the Gambia. A study conducted by Dr Prentice and colleagues found that Gambian women expressed a high degree of obesity acceptance and satisfaction with larger body size, even to the point of actively attempting to gain weight using over-the-counter steroids. In contrast with Western societies, where thinness is considered desirable, African societies often associate thinness with malnutrition or wasting from HIV/AIDS.

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