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AIMS TO REFINE POPULAR SURGERY
and functional concerns with the vagina. New insights into the use and outcomes of these procedures are presented in the March issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).
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Muscle atrophy after buttock augmentation using implants Fernando Serra, MD, and colleagues of Pedro Ernesto University Hospital, Rio de Janeiro, Brazil, evaluated changes in the gluteus muscle in women undergoing placement of silicone implants to improve the shape of the buttocks. This and other approaches to buttock augmentation surgery have become increasingly popular in recent years. Comparing preoperative and follow-up CT
scans, the researchers found significant muscle atrophy after implant placement. The volume of the gluteus muscle was reduced by about 6%, although there was no associated change in muscle strength. Atrophy may be at least partly related to ‘intrinsic compression’ of the muscle by the implants. There was evidence that the women started to regain muscle volume after 3 months, possibly reflecting return to exercise and other activities after recovery from the implant procedure. Meanwhile, gluteoplasty
led to improved body shape, with a curvier, more ‘gynoid’ (female) contour. At follow-up, the women were closer to the ‘ideal’ waist-hip ratio of 0.70. The researchers
suggest implant gluteal augmentation meets the goal of providing a more shapely figure, with relatively minor, potentially reversible
10 ❚ March 2015 |
prime-journal.com
wo of the fastest-growing plastic surgery procedures are gluteoplasty, to improve the appearance of the buttocks; and labiaplasty to address cosmetic
NICE GIVES GO AHEAD TO XOLAIR®
BUTTOCKS AND VAGINAL PROCEDURES UNDER THE SPOTLIGHT
muscle atrophy. ‘This group plans on continuing their researching into the gluteal augmentation’s effects on nerve sensation, quality of life, sexual function, and patient satisfaction,’ comments Rod J. Rohrich, MD, Editor-in-Chief, in this month’s introductory video on the Plastic and Reconstructive Surgery® website.
Wide variation in labiaplasty techniques call for standard classification systems In the second study, ASPS Member Surgeon Ashit Patel, MB, ChB, of Albany (N.Y.) Medical Center and colleagues analysed research on the outcomes of vaginal labiaplasty. A review of 19 articles identified nearly 1,950 women undergoing labiaplasty for aesthetic and/or functional reasons. The analysis showed wide variation in surgical management; the plastic surgeons in the studies used a total of seven different labiaplasty techniques. However, results were good, with patient satisfaction rates ranging from 94 to 100%, and acceptably low complication rates. Yet it’s hard to draw conclusions about patient
The researchers suggest implant gluteal
augmentation meets the goal of providing a more shapely figure, with relatively minor,
potentially reversible muscle atrophy.
outcomes because of the wide variation in labiaplasty techniques not just in the type of surgery, but also in anesthesia, wound closure, and postoperative care. Dr. Patel and coauthors propose a simple classification technique to aid in comparing the results of future clinical trials. They believe that this could be a useful first step toward matching patients to the surgical technique that’s most appropriate for them. Vaginal labiaplasty, like
gluteal augmentation, is a technique that more women are interested in and discussing with plastic surgeons. In his video commentary, Dr. Rohrich adds, ‘As this procedure continues to rise in popularity, plastic surgeons are hard at work to make sure the procedure is safe and effective and that the patient experience is the best it can be.’
The National Institute of Health and Care Excellence (NICE) has recommended Xolair® (omalizumab) as an option for add-on therapy for treating severe CSU for adults and young people (aged 12 and above) across England who have not responded to treatment with H1- antihistamines and leukotriene receptor antagonists (LTRAs). Already approved by the European
Commission, omalizumab is the first and only add-on therapy to H1-antihistamines for patients who do not respond to other treatments and is the first new type of medicine licensed for the treatment of CSU since the 1950s. The committee that developed NICE’s recommendation commented that the speed at which omalizumab works, and its comparative safety profile, means it can be considered ‘innovative’ in the treatment of this condition. Subject to appeal, clinicians and patients will have access to omalizumab by the summer. Dr Sinisa Savic, Consultant Immunologist at St James’s University Hospital, Leeds, comments: ‘CSU can be an unpleasant condition which can have a huge impact on patients’ physical and psychological wellbeing. For some of my patients CSU has had a devastating effect on their lives. For many years treatment options for patients with the severe form of CSU have been quite limited and there has been a real medical need for an effective, licensed medicine to be available to patients and clinicians. The positive final appraisal determination issued today by NICE is a very welcome and important step forward for healthcare professionals and people living with CSU.’ CSU is characterised by red, swollen,
itchy and painful ‘wheals’ (also known as ‘hives’) that recur daily, or almost daily for 6 weeks, it is an often distressing skin condition which can be disabling. The itch is often very persistent, causing sleepless nights, and is sometimes accompanied by unpleasant deep tissue swelling (angioedema), which can affect the face, neck, hands, and feet in particular. CSU may affect up to half a million people in the UK.
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