265. Cosmetic Procedures In Gynecology

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265. Cosmetic Procedures In Gynecology

265. Cosmetic Procedures In Gynecology



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Foreword: Cosmetic Procedures in Gynecology xi
William F. Rayburn
Preface: Cosmetic Procedures in Gynecology xiii
Douglas W. Laube
Adding Aesthetics to the OB-GYN Practice 475
Jay M. Kulkin and Shayna Flash
Laser aesthetic procedures have substantially increased in popularity for
both women and men over the past several years. As public awareness

grows, so does the demand for the safe and effective delivery of these ser-
vices. Gynecologists and other primary care providers are offering laser

aesthetic procedures to meet their own patient demand.
Laser Hair Removal 477
Jay M. Kulkin and Shayna Flash

Laser hair removal is a rapidly growing aesthetic procedure requested pre-
dominantly by women. At a time of falling reimbursement by payers, gyne-
cologists have an opportunity to improve the fiscal health of their practices

while delivering a service valued by their patients. As a result, practicing
gynecologists should become acquainted with aesthetic lasers and should
know how to incorporate them into their practices. This article introduces
the practicing gynecologist to aesthetic lasers and the procedure of laser
hair removal.
Intense Pulsed Light Therapy 489
Barbara Soltes
Intense Pulsed Light (IPL) is an FDA-approved photo therapy for the
treatment of a variety of conditions such as acne and hirsutism. It utilizes
the principle of selective photothermolysis. Photothermolysis allows
a specific wavelength to be delivered to a chromophore of a designated
tissue while leaving the surrounding tissue unaffected. The results of IPL

are similar to that of laser treatments but it offers the advantage of a rel-
ative low cost. It is a safe and rapid treatment with minimal discomfort to

the patient.
Laser Vein Therapy 501
Jay M. Kulkin and Shayna Flash
Similar to other antiaging procedures like Botox, skin rejuvenation, and
facial plastic surgery, spider vein therapy is seen as a way to reverse the
signs of aging. This article will introduce the clinician to this issue and
describe treatment, which may be accomplished with the same lasers
used for laser hair reduction.

Cosmetic Procedures in Gynecology

Liposuction 507
Marco A. Pelosi III and Marco A. Pelosi II
Liposuction is the most common cosmetic surgical procedure worldwide.
It provides effective contouring of the torso, extremities, and submental

areas in properly selected patients. Tumescent liposuction, a local anes-
thesia technique, and superwet liposuction, a systemic anesthesia tech-
nique, are the most common methods. The safety profile of both

methods is excellent, but local anesthesia avoids the specific risks associ-
ated with general anesthesia. The most common complications of liposuc-
tion are contour irregularities and transient bruising. No technology seems

to provide superior results over conventional methods.
The Use of Autologous Fat for Facial Rejuvenation 521
Benjamin C. Marcus
Adding volume to the aging face is a notion that has come into vogue as

of late but is, however, not a new idea. With the advent of miro-liposuc-
tion techniques, there is renewed interest in the use of aspirated fat.

Commercial fillers have a valuable place in the cosmetic surgeon’s arma-
mentarium and offer immediate volume correction with a more modest

financial commitment. Nevertheless, the standardization of fat grafting
techniques marks an exciting shift in facial aesthetics with the ability
to correct all aspects of the aging face with safe, natural, and lasting
Breast Augmentation 533
Marco A. Pelosi III and Marco A. Pelosi II

Breast augmentation is the most commonly performed cosmetic proce-
dure among American women. Saline implants, silicone implants, and

autologous fat injections are the most common options. The inframam-
mary, periareolar, and axillary routes with or without endoscopy are the

most common routes of implantation. The subpectoral dual-plane and
the subglandular plane are the most common pockets. The most common
complications are capsular contracture for implants and volume loss for
injected fat. Breast augmentation does not appear to increase breast
cancer risk or survival rates.
Cosmeceuticals: Practical Applications 547
Anetta E. Reszko, Diane Berson, and Mary P. Lupo
Cosmeceuticals are topically applied products that are more than merely
cosmetic, yet are not true drugs that have undergone rigorous placebo
controlled studies for safety and efficacy. There are many review articles

that outline the theoretical biologic and clinical actions of these cosme-
ceuticals and their various ingredients. This article reviews how to incorpo-
rate various cosmeceuticals into the treatment regime of patients,

depending on the diagnosis and therapies chosen. The practical applica-
tion of when, why, and on whom to use different products will enable

dermatologists to improve the methodology of product selection and,
ultimately, improve patient’s clinical results.

Botulinum Toxin in Facial Rejuvenation: An Update 571
Jean Carruthers and Alastair Carruthers
Since its initial approval by the US Food and Drug Administration (FDA) 20

years ago for the treatment of strabismus, hemifacial spasm, and blepha-
rospasm in adults, botulinum toxin (BTX) has become one of the most fre-
quently requested products in cosmetic rejuvenation around the world.

After years of clinical success and consistent safety in the upper face,

the use of BTX has expanded and evolved to include increasingly compli-
cated indications. In the hands of adept injectors, the focus has shifted

from the treatment of individual dynamic rhytides to shaping, contouring,
and sculpting, alone or in combination with other cosmetic procedures,
to enhance the aesthetic appearance of the face. Although recent reports
have questioned the safety of BTX, 25 years of therapeutic and over 20
years of cosmetic use has demonstrated an impressive record of safety
and efficacy when used appropriately by experienced injectors.
Index 583



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