Poor and often inaccurate web info on ‘designer vagina’ procedures

Nov. 21, 2012 — The quality of internet information available for women opting for “designer vagina” procedures is “poor,” and in some cases, inaccurate, reveals a small study published in the Obstetrics & Gynaecology edition of the online only journal BMJ Open.

The findings prompt the authors to urge that guidelines be drawn up to improve standards so that women can make fully informed choices about an increasingly popular procedure that has so far hardly been scrutinised.

Cosmetic surgery is available to women who simply don’t like the way their genitals look. Procedures include “vaginal rejuvenation” and “G-spot amplification,” as well as altering the shape of the external lips (labia) of the vagina.

The authors Googled private providers offering female genital cosmetic surgery and included the first five UK and US websites that came up in the search results.

The content of the information provided by these websites was assessed using 16 criteria, ranging from what, and how, procedures are carried out, to success rates and potential risks.

The researchers also analysed the language used, including the use of terms, such as “labial hypertrophy,” implying that the procedure is used to treat a medical condition.

Some 72 procedures were mentioned across all 10 sites, although the absence of standard terminology makes it impossible to decipher the exact number offered, say the authors. Terms included “labioplasty” “liposculpting” “hoodectomy” and “hymenoplasty.”

Concerns about the appearance of the genitals were mentioned on all the sites, including the visibility of vaginal labia through tight clothing, and an awareness — courtesy of a partner or magazine pictures — of larger than normal labia.

Several sites recommended labial reduction to promote a “youthful vulval appearance.” One site explained this as: “a woman might have a face lift and look really young until she goes to bed and a partner can see the evidence of ageing there.”

Surgery was often recommended to make the labia “sleeker” and “more appealing,” and although three sites did mention natural variation in the size and shape of labia, these sites still recommended surgery. And all the sites claimed that it would improve vulval appearance.

The repair of the hymen, the intactness of which denotes virginity, was recommended by some sites as a way of improving “the woman’s hidden aesthetics” and to ensure that she would bleed on her wedding night and so be able to “keep [her] head high.”

Three websites explained that labial surgery would improve personal hygiene and curb the risk of infections, which the authors say may reinforce negative feelings towards the vagina, known as “pudendal disgust.”

Half the websites mentioned that surgery would enhance sexual pleasure.

Only two websites indicated success rates, all of which were 95% or 100%, but what constituted success was not defined. All sites mentioned unsubstantiated social and psychological benefits, including restored confidence and self-esteem.

All 10 sites mentioned risks, but these were downplayed; four failed to mention exactly what these were; and only one gave information on revision rates. Three sites referred to “botched” procedures causing disfigurement and requiring revision performed by other providers.

None of the sites gave a lower age limit for surgery, which the authors suggest “is most disturbing of all,” particularly as anatomy changes throughout the lifespan.

The authors accept that their study provides only a snapshot of information available at a single time point. But they do say that theirs is the first attempt to methodically evaluate the quality of information offered to women.

They conclude that designer vagina procedures play on women’s fears and that any concerns they may have might be better served by psychological therapies, and creams or emollients rather than surgery.

“This report highlights significant gaps in the breadth, depth, accuracy and quality of clinical information given by some service providers of female genital cosmetic surgery…and highlights a certain degree of distortion to the information provided by medical practitioners in an area that is imbued with value judgement,” they say.

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Face transplantation calls for ‘reverse craniofacial planning’

Dec. 10, 2012 — As surgical teams gain experience with facial transplantation, a careful approach to planning based on the principles of craniofacial surgery can help to maximize patient outcomes in terms of facial form and function, according to an article in The Journal of Craniofacial Surgery.

In patients with extensive facial defects including loss of the normal bone and soft tissue landmarks, a “reverse craniofacial planning” approach can restore normal facial relationships, the report suggests. The lead author was Dr. Edward J. Caterson, a member of the facial transplant team at Brigham and Women’s Hospital/Harvard Medical School, Boston.

Craniofacial Principles Applied to Facial Transplantation

Dr. Caterson and colleagues apply some basic principles of craniofacial surgery to the planning and performance of facial transplants. Although still a rare and relatively new procedure, facial transplantation now offers a reconstructive option for patients with severe facial deficits. Most patients who are candidates for facial transplant have loss of soft tissues only (such as skin, muscle, blood vessels, and nerves).

However, some patients also have defects of the underlying facial bones. In these cases, the challenge for the facial transplant team is nothing less than “the complete restoration of the structural anatomy of the craniofacial skeleton,” the authors write.

Through their experience with reconstructive surgery in patients with severe congenital deformities, craniofacial surgeons have developed an understanding of the “intimate functional relationship” between the facial soft tissue and supporting bone. In the traditional craniofacial procedure, the surgeon carefully plans and designs “bone movements that will translate into a desired change of the attached soft tissues.”

But in facial transplantation, the situation is essentially reversed: the degree of injury and the subsequent transplantation of facial soft tissues dictate the “osteosynthesis” of the craniofacial skeleton. Dr. Caterson and colleagues describe a simple but practical technique for surgical planning to promote proper positioning of the facial transplant. The technique applies “normative” data on facial landmarks and relationships and then transposes them onto the recipient.

Understanding the relationships of facial structure allows surgeons to compensate for missing bony or soft tissue landmarks. The authors provide a straightforward approach to establishing a plane of reference, allowing the facial transplant to be positioned in a proper relationship with the skull base and occlusal plane (teeth and lower face).

Optimal positioning of the facial transplant is essential not only to achieve the most normal-appearing result, but also to maximize function — particularly in eating and breathing. Dr. Caterson and colleagues emphasize that “proper positioning of the hard tissues of the allograft is the fundamental starting point for functional and aesthetic restoration.” As long as the bony structure is right, any cosmetic soft tissue problems that remain after surgery are relatively easy to correct.

The authors believe that such craniofacial principles are likely to become an increasingly important consideration — “especially with the trend toward full face transplantation.” In early experience, donor selection for face transplantation has focused mainly on immunological factors — similar to those used in organ transplantation.

In the future, transplant teams may become more sophisticated in donor selection — including assessment of the degree of “craniofacial match” between donors and recipients. In the meantime, Dr. Caterson and coauthors conclude, “[C]areful attention to the soft tissue relationships with the skeletal anatomy requires that face transplantation include ‘reverse craniofacial planning’ to optimize the form and function of the recipient’s new face.”

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To make old skin cells act young again, boost their surroundings

Dec. 10, 2012 — As we get older, the trillions of cells in our body do too. And like us, they become less resilient and able to weather the stress of everyday life. Our skin especially tells the tale of what’s happening throughout our bodies.

But recently, scientists have learned that aging cells bear only part of the blame for this downward spiral. And a new study shows that it might be possible to slow the decline of aging tissue — and even make it act younger — by focusing on the stuff that surrounds those cells.

In an independent study at the University of Michigan Medical School, skin scientists have succeeded in making the skin cells of senior citizens act like younger cells again, simply by adding more filler to the fiber-filled area around the cells.

This extracellulal matrix, or ECM, acts like the scaffold that skin cells roost in. It’s made of tiny fibrils of collagen, produced by the cells (fibroblasts). Over time, as skin ages, the ECM becomes fragmented, which causes cells to lose their connections to that scaffold — and the lack of support accelerates their decline further. The same thing may happen in other types of tissue.

In the new study, scientists from the U-M Department of Dermatology injected the skin of 21 volunteers in their 80s with a filler often used cosmetically to reduce facial wrinkles. The filler bolsters the ECM, filling in the spaces left by aging.

The researchers did not receive funding from the product’s manufacturer, nor did they get input on the design or results from the company. Rather, they were using the product as a way to increase the mechanical forces within the volunteers’ skin.

They also didn’t focus on the face, where skin takes a beating over a lifetime of exposure to ultraviolet light and other insults that break down collagen. Instead, they focused on skin that had almost never seen the light of day — the buttocks.

The result: over three months, the fibroblasts began expressing collagen-related genes, producing more collagen, and connecting better to the ECM. The entire layer of skin grew thicker, and more blood vessels, which nourished the cells were seen.

“Fragmentation of the extracellular matrix plays an important role in skin aging, but by altering the matrix using an external filler and increasing the internal pressure, we’ve shown that we can essentially trigger a signal for cells to wake up,” says Gary Fisher, Ph.D., the Harry Helfman Professor of Molecular Dermatology and senior author of the new study, published in the Journal of Investigative Dermatology.

He cautions that the new work, done together with U-M associate research professor Taihao Quan, Ph.D., and assistant professor Frank Wang, M.D., and colleagues, does not mean that cosmetic filler should be used throughout the body.

Rather, the importance of the discovery lies in the potential to harness the broader understanding of the ECM for prevention and treatment.

For instance, skin thinning as we age leaves us more prone to skin tearing and interferes with healing after incisions or injury. Better understanding of how the ECM helps support healing could lead to better strategies for helping patients.

“This shows that skin cells in elderly people have the capacity to respond robustly in a very positive way to alterations in the mechanical property of their environment,” says Fisher. “We still need to know more about how cells sense their environment, but in general it appears we have made a real difference in the structural integrity of skin.”

In addition to Fisher, Quan and Wang, the study’s authors include Dermatology chair and Duncan and Ella Poth Distinguished Professor John Voorhees, M.D., and Yuan Shao, research assistant professor Laure Rittié, laboratory specialist Wei Xia, and associate professor Jeffrey S Orringer.

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