GreatSkin Medispas

UPPP/LAUP (Laser-Assisted Uvuloplasty)
Radio Frequency (RF) Uvuloplasty
UVULOPALATOPHARYNGOPLASTY (UPPP) is an operation to improve
certain sleep disorder symptoms such as obstructive sleep apnea
and snoring. Because there may be several factors occurring at the same
time, this procedure may only give partial relief.
The most common complications include bleeding after surgery, infection,
and temporary airway obstruction due to postoperative swelling. Occasionally
patients with severe obstruction, or added risk due to obesity,
may require a temporary tracheotomy.
The most common complaint is pain on swallowing. Some patients also
have complaints due to an inability of a shortened palate to make contact
with the back of the throat. This may cause some nasal regurgitation and a
hyponasal or hollow-sounding voice. The opposite effect due to narrowing
of the space behind the nose (nasopharynx) is even less likely.
COBLATION UVULOPLASTY is a similar but simpler operation performed
with a cold ablation plasma beam. It is usually an office procedure
carried out under local anesthesia. It is quite effective in the control of
snoring and to a lesser extent, sleep apnea.
The complications are similar to UPPP, however, the risks of obstruction
and tracheotomy are practically nonexistent.
LAUP (LASER-ASSISTED) UVULOPLASTY is an office procedure
similar to coblation uvuloplasty. It offers a similar outcome and carries
similar risks but is performed using a laser beam.

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Juvederm, one of the newest of the so-called “injectable fillers,” is used by cosmetic, dermatological and plastic surgeons to soften deep folds and reduce wrinkles in the faces of patients. The substance is chemically closely related to the facial filler Restylane; both are largely comprised of hyaluronic acid, a substance normally found in the skin, muscles, and tendons of mammals. Approved in June 2006 by the U.S. Food and Drug Administration, Juvéderm’s prime use is removing nasolabial folds, or “smile lines,” creases of skin which run from the corners of the nose to the corners of the mouth. It is also used as a lip augmentation agent, to fill in hollow places and scars on the face. Juvéderm is being touted as “the next generation” hyaluronic acid facial filler and is said by physicians to be slightly smoother to inject and perhaps somewhat longer lasting in the body than Restylane. However, all hyaluronic acid facial filler products are eventually absorbed by the body, usually within six to nine months, causing the patient to undergo repeat injections to maintain the younger look.[1] Juvéderm is also used by physicians to plump up lips which also lose fat and internal shape with normal aging. Like Restylane, Juvéderm is extremely popular among consumers and medical providers alike because it results, in a younger, more refreshed looking face immediately.

FDA Testing

Before being released onto the U.S. market, Juvéderm was compared with Zyplast dermal filler, a bovine-based injectable facial filler made from collagen. In clinical studies conducted at several U.S. medical centers to evaluate safety and efficacy, or effectiveness, 146 subjects were followed for 24 weeks. The subjects had Juvéderm injected into one nasolabial fold and Zyplast in the other. Using scientific measuring scales, Juvéderm was deemed to provide a more persistent correction in the subjects’ facial folds. At the end of the study, the researchers asked subjects to judge which fold looked better to them. Eightyeight percent chose the area treated with Juvéderm.[2] Before FDA approval, two other clinical studies on Juvéderm were done on a total of 293 subjects in the United States. The safety profile and effectiveness was found to be similar to the first test.

History

In 1934, medical researchers Karl Meyer and John Palmer, scientists at Columbia University in New York, found that one of the chief functions of hyaluronic acid is maintaining skin volume and hydration, along with other body maintenance functions and tasks.[3]

Meyer and Palmer first isolated the substance from the eye of a cow and named hyaluronic acid by combining the Greek word for glass — hyalos — and the uronic sugar contained in hyaluronic acid.

Hyaluronic acid later found uses in the baking and food industry in the 1940s and, by the 1990s, found its way into the medical field for use in joint pain, treating wounds, eye surgery and, finally, in 1996, for facial tissue augmentation in Europe.

Current Usage

Juvéderm’s current competitive edge in cosmetic surgery is possible because, according to the manufacturers, Juvéderm is “cross linked.” In hyaluronic acid’s natural form, the substance is a liquid which the body metabolizes in about half a day. Cross linking is a process that chemically binds the individual chains of the acid so that it is changed into a gel that lasts much longer once injected inside the face. Several other facial fillers used in Europe and the U.S. — like Restylane, Belotero and Hylaform — are also cross-linked, with competition driving the other fillers toward even more highly cross linked compounds, according to Professor Berthold Rzany, professor of dermatology at the Universitaetsmedizon Berlin, Germany.

Mechanism of Action

Juvéderm works well for cosmetic and plastic surgery applications because hyaluronic acid can absorb up to 1000 times its own weight in water, thereby adding new volume under the surface of sagging skin. Older faces take on more youthful aspects because hyaluronic acid is known to bind with collagen — the material that supports human facial skin — and elastin to move more basic nutrients into the skin. Moreover, Juvéderm continues working as time goes on by adding even more collagen to the face, according to the manufacturer.[4]

When the University of Michigan organized a study on the dermal filler Restylane — a close chemical sibling of Juvéderm — researchers found that hyaluronic acid stretches cells in skin known as fibroblasts in a way that causes the skin to create new collagen. The new collagen helps decrease the appearance of facial creases and wrinkles. An unexpected — and welcome — finding cropped up: hyaluronic acid also seems to stop the breakdown of existing collagen.

Potential Risks and Side Effects

Patients, physicians and researchers say usual, expected side effects include temporary redness, pain and tenderness during injections and swelling and bruising at the injection sites. The more serious side effects include immune system reactions that result in facial lumps and bumps known as granulomas, bothersome reactions that are very difficult for physicians to treat.[6] According to Allergan, Juvéderm’s manufacturer, the substance should not be used in patients with severe allergies, particularly those who have allergies to bacterial proteins or patients with a history of anaphylaxis, which is a potentially life threatening hypersensitivity to some drugs and proteins.

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Laser Hair Removal

Epilation by laser was performed experimentally for about 20 years before it became commercially available in the mid 1990s. Intense Pulsed Light (IPL) epilators, though technically not a laser, use xenon flash lamps that emit full spectrum light. Laser and light-based methods, sometimes called phototricholysis or photoepilation, are now most commonly referred to collectively as “laser hair removal”. One of the first published articles describing laser hair removal was authored by the group at Massachusetts General Hospital in 1998.[1][2]

The efficacy of laser hair removal is now generally accepted in the dermatology community, and laser hair removal is widely practiced. Many reviews of laser hair removal methods, safety, and efficacy have been published in the dermatology literature.

Mechanism of action

The primary principle behind laser hair removal is selective photothermolysis. Lasers can cause localized damage by selectively heating dark target matter, (melanin), in the area that causes hair growth, (the follicle), while not heating the rest of the skin. Light is absorbed by dark objects, so laser energy can be absorbed by dark material in the skin (but with much more speed and intensity). This dark target matter, or chromophore, can be naturally-occurring or artificially introduced.

Hair removal lasers selectively target Melanin:

* Melanin is considered the primary chromophore for all hair removal lasers currently on the market. Melanin occurs naturally in the skin (it gives skin and hair its color). There are two types of melanin in hair: eumelanin (which gives hair brown or black color) and pheomelanin (which gives hair blonde or red color). Because of the selective absorption of photons of laser light, only black or brown hair can be removed.

Both men and women seek laser hair removal services to have superfluous or unwanted hair removed. Hair removal is commonly done on lip, chin, ear lobe, shoulders, back, underarm, abdomen, buttocks, pubic area, bikini lines, thighs, face, neck, chest, arms, legs, hands, and toes.

Laser is attracted to dark pigment and therefore works best with dark coarse hair. Light skin and dark hair are an ideal combination, but new lasers are now able to target dark black hair even in patients with dark skin.

Hair removal lasers have been in use since 1997 and the Food and Drug Administration approved it for “permanent hair reduction.” Laser hair removal has become extremely popular because of its speed and efficacy, although some of the efficacy is dependent upon the skill and experience of the laser operator, and the choice and availability of different laser technology at the clinic which is performing the procedure. Some will need touch-up treatments, especially on large areas, after the initial set of 3-8 treatments. It has also been observed that some people seem to be non-responders – this is not confirmed and reasons are not known, and may in fact be due to lack of skill on the part of many laser operators and/or the type of machine and settings they are using. Keep in mind that it’s hard to judge whether someone’s lack of results is due to a potential underlying medical condition that causes continuous growth and makes it seem like laser isn’t working, if the treatment wasn’t performed properly, or whether for some people it just doesn’t work for currently unknown reasons. In essence, you can’t determine what your personal results would be like unless you try it. Results depend on many variables involved, including the tech’s experience, type of laser used, how settings are set, etc. It is recommended to start with one area and see how your hair reacts before committing to a set of treatments on many areas at once.

Electrolysis is another hair removal method that has been used for over 135 years.[22] It involves treating one hair at a time and is an option for smaller areas (like eyebrows or upper lip) where precision is necessary, although even in these areas it has fallen out of favor because of the possibility of scarring and the pain of the procedure. In addition it takes so many treatments compared to laser to complete a large area, and the extreme cost and discomfort are such that electrolysis is rarely used for large areas. At this time, it is the only permanent option for very fine and light-colored hair. The FDA currently allows the term “Permanent Hair Removal” for electrolysis only. Unlike laser epilation, electrolysis is effective on all hair colors.

Laser parameters that affect results

Several wavelengths of laser energy have been used for hair removal, from visible light to near-infrared radiation. These lasers are usually defined by the lasing medium used to create the wavelength (measured in nanometers (nm)):

* Argon: 488 or 514.5 nm (not used for hair removal anymore)
* Ruby: 694 nm (not used for hair removal anymore; not safe on most skin types as it frequently produces side effects such as pigmentary changes (lightening or darkening of the skin), or worse, for patients of all but white skin.)[23]
* Alexandrite: 755 nm (most effective, but safest on light skin)
* Pulsed diode array: 810 nm (for light to medium type skin)
* Nd:YAG: 1064 nm (for darker skin; Yag is capable of treating all six skin colors. However, there is not sufficient evidence that this laser can produce effective long-term hair removal)

Pulsewidth is an important consideration. It has been observed in some published studies that longer pulsewidths may be safer for darker skin. However, shorter wavelengths may be more effective in removing hair.

Spot size, or the width of the laser beam, affects treatment. Theoretically, the width of the ideal beam is about four times as wide as the target is deep. Hair removal lasers have a round spot about the size of your finger (8-18 mm). Larger spot sizes help make treatments faster and more effective.

Fluence or energy level is another important consideration. Fluence is measured in joules per square centimeter (J/cm²). It’s important to get treated at high enough settings to cause permanent damage to the hair follicles.

Repetition rate is believed to have a cumulative effect, based on the concept of thermal relaxation time. Shooting two or three pulses at the same target with a specific delay between pulses can cause a slight improvement in the heating of an area. This may increase the “kill rate” for each treatment slightly.

Epidermal cooling has been determined to allow higher fluences and reduce pain and side effects, especially in darker skin. Four types of cooling have been developed:

* Clear gel: usually chilled
* Contact cooling: through a window cooled by circulating water or internal cryogen.
* Cryogen spray: immediately before/after the laser pulse
* Air cooling: forced cold air at -34 degrees C (Zimmer Cryo 5 unit)

Multiple treatments, usually 3-8, have been shown in numerous studies to provide long-term reduction of hair. Current parameters suggest a series of treatments spaced at 3-12 weeks apart for most areas, although the timing of treatments has still not been standarized.

Number of sessions

The number of sessions depends on various parameters, including the area of the body treated, skin color, coarseness of hair, and gender. In addition, since hair grows in several phases, (anagen, telogen, catagen), and laser can only affect the currently actively growing follicles, (anagen), several sessions are needed to kill hair in all phases of growth.

In general, it is necessary to foresee between 3 - 8 treatment sessions. Coarse dark hair on light skin is easiest to treat. Finer hair and hair on darker skin is harder to treat and may require more treatments. Certain areas (notably men’s and women’s faces) may require considerably more treatments to achieve desired results.

It’s important to note that laser does not work on light hair and very fine and vellus hair, (”peachfuzz”). Electrolysis is the only permanent solution for those types of hair but has shortcomings such as possible scarring, expense, and discomfort, as noted above.

Intervals between sessions

Usually, treatments are spaced 3-12 weeks apart to start, although the spacing depends upon individual response to treatment. Instead of following an arbitrary schedule, you should wait until you have experienced shedding of the treated hairs, which should complete within 2-3.5 weeks, and see enough hair come in after the hair-free period to have another treatment. Treatment spacing also depends on area treated as hair cycles vary based on the body part. For example, women’s faces usually require more frequent treatments, whereas backs and legs require less frequent treatments.

Other uses

Hair removal lasers are effective treatment for pseudofolliculitis barbae (commonly called ingrown hairs or “shaving bumps”). For darker skin patients with black hair, the long-pulsed Nd:YAG laser with a cooling tip can be safe and effective when used by an experienced practitioner.

They have recently been reported as helpful treatment for pilonidal cysts, since they eliminate the ingrown hairs that produce the troublesome foreign body reactions in this congenital malady.

Cost

The costs of laser hair removal vary by vendor, and by surface area and location treated.

Risks

Risks include the chance of burning the skin or discoloring dark skin with the laser, hypopigmentation (white spots), and flare of acne. Some point to the lack of proper government regulations in many countries as meaning that patients are at risk of being treated by improperly trained staff.

Relative contraindications

Laser hair removal should be used cautiously, if at all, by patients in the following categories: Recently acquired dark tan; fine, light hair in people of color; blonde or red hair in areas with tan skin; patients who cannot afford or do not have the time for multiple sessions, because one treatment is rarely adequate.

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