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Dr. Jennifer Walden was recently featured on VH1 as an expert in plastic surgery speaking about body dysmorphic disorder, and the celebrities who may fall into that category.

What's in that syringe?

The following was a report by the Associate Press released yesterday. Dr. Walden provides commentary on what is in a “Lipodissolve” injection. Click on the USA Today link here.

WASHINGTON (AP) — The Food and Drug Administration is cracking down on what are billed as fat-melting injections used in spas across the U.S., saying the drugs have not been proven safe or effective.

Lipodissolve injections, a popular nonsurgical alternative to liposuction, are used to dissolve small fat deposits around the legs, arms and belly. The FDA said Wednesday the drugs have not been cleared by federal scientists, as required by law. The agency issued warning letters to a half-dozen spas that offer the injections, citing them for making unsubstantiated claims about lipodissolve therapy.

“The claims made for your lipodissolve products are false and misleading in that they are not supported by substantial evidence or substantial clinical experience,” states a letter to All About You Medspa in Madison, Ind. Other spas cited by the FDA included: Pure Med Spa of Boca Raton, Fla., Monarch Med Spa of King of Prussia, Pa., and three others.

The website for Monarch Med Spa claims that, “Rather than go through the pain and discomfort associated with liposuction, patients now have the option of a series of injections with very minimal discomfort.” Calls to Monarch Med Spa were not immediately returned Wednesday. FDA regulators called on the spas to stop using such claims and notify the agency within 15 working days of steps they are taking to correct the violations.

“FDA is not aware of any credible scientific evidence to support these claims,” said Kathleen Anderson, an FDA deputy director, on a call with reporters. Spas that offer the injections say they are safe and effective. But public safety advocates have called for proof and urge patients to think twice before paying thousands of dollars for an unproven procedure. FDA said it has received reports of permanent scarring, hard lumps and dark spots on their skin after receiving the therapy. The FDA also issued a warning to a Brazilian company that sells lipodissolve treatments on two websites: zipmed.net and mesoone.com.

Lipodissolve and similar treatments use two chemicals, phosphatidylcholine, or PC, and sodium dioxycholate, or DC. Those chemicals occur naturally in the human body, but that doesn’t necessarily make them safe, said Lenox Hill Hospital plastic surgeon Dr. Jennifer Walden.

“They are used in the metabolic process of our bodies to break down fat, but they were never intended to be extracted, mixed with other ingredients and reinjected to break down fat,” said Walden.

According to Walden, lipodissolve injections are often performed by beauty care specialists who have little or no medical training.

Other ingredients in the cocktails often include the drug Infasurf, which is used to treat respiratory problems in premature infants, according to the FDA.

Lipodissolve formulations are usually mixed at medical spas through a process called compounding, in which a pharmacist combines multiple drugs to create a new formulation, Walden said. The FDA does not regulate the practice of medicine and declined to discuss drug compounding. “We’re not aware of where these spas are getting their drugs, therefore we cannot comment on the issue of compounding this product,” said FDA pharmacist Suda Shukla.

The FDA urged physicians who are using the drugs cosmetically to submit an approval application for regulatory review.
Copyright 2010 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

Here is the second part of the Plastic Surgery Gone Awry segment, featuring Dr. Walden and a panel of experts on the “After the Show” Show (watch through the first few minutes to see the panel). Gretchen Carlson and Steve Doocy of Fox and Friends Morning Show ask the questions on their minds about the lack of regulation in the fields of surgery and plastic surgery, as patient safety is in question. The cases of non-medical grade silicone caulk being injected into the buttocks of 7 women in a Newark hotel by a charlatan claiming to be a plastic surgeon are discussed. Also, the case in Florida of a young woman who died after undergoing liposuction at a tanning salon after receiving local anesthetic injections and Propofol (the powerful intravenous anesthetic agent that killed Michael Jackson) is covered. Finding a plastic surgeon who has undergone proper training and credentialing is of utmost importance when selecting a provider, so find out why it is extremely prudent to find a board certified plastic surgeon

The rise of medspas and a recent liposuction death in Florida in a young 37 year old nurse bring to light several issues our specialty is confronted with. Read the news story here.

Liposuction performed by untrained and non-certified doctors and paraprofessionals can lead to detrimental and possibly even fatal outcomes that can be prevented. This case illustrates that point, as a doctor who had only gone to an 18-hour training course in liposuction and was actually an occupational medicine physician performed the procedure on the Floridian woman. The procedure was performed in an unlicensed and non-accredited facility labeled “Tanning Salon” on the outside. Reports show that she likely had seizures from a lidocaine overdose, and she was also given Propofol in the medspa/tanning salon, which is against state law. Propofol is a powerful intravenous sedative and anesthetic agent (the one that killed Michael Jackson), and lidocaine is a local anesthetic that is injected into the subcutaneous fat, often mixed with saline to dilute it, prior to liposuction to cut down on bleeding and for pain control. The dose for a particular human body weight has to be specifically calculated so that overdose and fatality doesn’t ensue no matter what type of case is being performed. It is concerning because an occupational medicine doctor would likely have no specialty training in this particular facet of surgery.

A lack of oversight of medspa facilities has played a part in this young woman’s death after liposuction, as facilities that are not licensed or accredited by state and federal organizations such as JCAHO for hospitals and AAAASF for offices and small facilities should not be able to have practitioners of any kind administering powerful drugs such as Propofol and administering injections of lidocaine. Because this facility had no business performing these procedures, they had no back up emergency crash cart with medications in it to help resuscitate a person who may have complications from these types of drugs and surgeries.

Our state and federal governments are missing the ball in their lack of regulation of physicians, paramedical professionals and technicians performing cosmetic procedures and surgery without proper certification and credentialing. Patient safety is a major issue especially with physicians practicing outside of the scope of their training. Plastic surgery should be done by board-certified plastic surgeons, delivering babies by obstetricians, and workplace injury evaluations by occupational medicine doctors. Surgical training takes many years and requires a vigorous board certification and continuing education process. Israel has laws in place that enforce physicians to practice within their scope of training and advertise in keeping with their training and board certification; the US government should take cues from them.

Prospective patients also need to wise up and educate themselves by doing research on their treating physician. The discount that people get for untrained professionals to do their surgery or procedure is quickly offset by the complications that can be extremely costly, even to their life. Things to look in a plastic surgeon are for are board certification by the American Board of Plastic Surgery, experience with the procedure being performed, and hospital privileges at a local tertiary care center should complications arise that need to be expeditiously treated.

The iPhone has really made life easier by providing top-notch restaurants, shopping, travel, and navigation at your fingertips. The latest iPhone app even makes plastic surgery more accessible! Check out the Plastic Surgery Channel’s iPhone app on the apple.com website.

Get answers to questions about plastic surgery directly from board certified plastic surgeons across the country! You can submit a question, view recent questions and surgeon responses, and even view video commentary posted by the doctors, all at the touch of a button.

The app lets you search by zip code or your current location to access Dr. Walden’s profile (as seen on the screenshot below), as well as a list of board certified plastic surgeons within a 5 to 50 mile radius. Click through to read their profiles, get phone and email information, map their office location, or visit the surgeon’s website. You can even download the doctor’s contact information straight into your iPhone. The country’s leading experts in plastic surgery are in the palm of your hand!

Move over Urbanspoon!

Screenshot

Above you will see the latest updates from this week’s medical news on the first Medical Rewind of 2010 on Fox and Friends! Topics include the effect of ginkgo biloba on memory, an update on causes of chest pain, and the herbal supplement Kava and how it is being used in relaxation drinks for all those who want to put down the Red Bull! Dr. Walden is interviewed by Dave Briggs and Clayton Morris on morning’s top-rated news show.

Check out Dr. Walden on this week’s Medical Rewind on Fox and Friends. She is interviewed on the breaking health news this week including tap water contamination, several interesting things that may decrease the risk of prostate cancer, and public school meal quality and safety.

Watch the above video as Neil Cavuto interviews Dr. Jennifer Walden, Manhattan Plastic Surgeon, on Fox Business News on the proposed cosmetic surgery tax in the Senate version of the health care bill. Many plastic surgeons and surgical societies oppose this tax as discriminatory, arbitrary and ineffective.

As Dr. Walden explains, about 90 percent of cosmetic surgery patients are female so
elective surgery taxes unfairly target women. Contrary to popular belief, cosmetic surgery is no longer an
exclusive luxury reserved for the very wealthy – the vast majority of patients are women who work.
Research by the American Society of Plastic Surgeons targeting those who plan to have cosmetic surgery
within the next two years reveals that 60 percent of the respondents report an annual household income of $30,000-$90,000. Most importantly, 40 percent of those report income of
$30,000-$60,000. Only 10 percent of the respondents report
household income of more than $90,000.

It would be an inappropriate position for physicians to be put in to be tax collectors, and the government is in no position to determine medical necessity. A similar program in NJ is about to be repealed as it failed in that state with a huge administrative burden and budget shortfall. We hope the politicians come to their senses on this proposed tax and do not set this precedent of taxing patients and physicians to solve their budget crisis in healthcare reform.

In the above video, watch Dr. Jennifer Walden being interviewed at the by Neil Cavuto on Fox News. Dr. Walden discusses the proposed cosmetic surgery tax on working class women in the Senate Bill that is currently being debated.

An insightful article, Bo-Tax Backlash, was written this week in the New York Times by Judith Warner. Excerpts from it are below, as she describes a “newer” version of feminism that actually supports women trying to stay looking good. The reason being is that our society basically devalues aging of women in particular, and staying looking healthy and competitive can equate to more longevity and sustainability in the workplace for women which can lead to a better and more fulfilled quality of life for themselves and their children. Interestingly, we learn that the feminist icon Gloria Steinem herself has had a blepharoplasty, or eyelid lift. More power to her.

The health care reform bill currently being debated in the Senate contains a provision known as the Bo-Tax — so called because it would levy a 5 percent tax on cosmetic surgery procedures. This would be in order to tax those who indulge in medically unnecessary procedures in order to pay for medical necessities for everyone else. The government is ill-equipped to be the ones to determine what surgical procedures are necessary or not for patients whom they don’t even know, and this would be a huge administrative burden to place on physicians, their staff, and government officials. See the article below:

This sounded like a refreshingly good idea to me, until I read that Terry O’Neill, the president of the National Organization for Women, is against it.

So the debate over the benefit of screening mammography has been ongoing the past several years and has recently heated up due to a study in the Journal of the American Medical Association that was discussed earlier this week in the New York Times. There have been several recent papers like this one stating that some women (1 in 3–a disputed figure) are overdiagnosed by screening mammograms, and some women are in age groups that do not necessarily benefit from screening of their breasts by mammography (the under 50 and over 70 year-olds). Click above for the Youtube video where Alisyn Camerota of Fox and Friends top rated morning show interviews me on this hot topic. I am reluctant to fully accept a change in the screening mammography recommendations of the American Cancer Society at the present moment for the following reasons:

-Breast cancer is a lethal disease that occurs in 1 in 7 women. Deaths from breast cancer have fallen to the lowest levels in 50 years, although the overall # of cases has risen due to early screening and detection. When dealing with cancer, you want to avoid people dying unnecessarily by performing screening tests (in this case, mammography). When patients are faced with a diagnosis from a screening test, they are usually going to opt for treatment. Screening saves over 1000 lives per year. Unfortunately, we cannot predict which cancer will go on to develop into a more dangerous and life-threatening cancer and which won’t. It would be very difficult to say “no, let’s go ahead and just watch that” to a woman with a suspicious lesion on her mammogram.

Many researchers and clinicians still think the benefits of screening mammography outweigh the risks. Doubts raised by the authors of these studies that question mammography in 40-50 year olds and over 70 year olds are still too weak shake many experts’ belief in breast screening. Women cannot take the risk of not being diagnosed and treated and screening is a major way for this to happen. One of the troubles with any screening program is that it turns up people whom the disease would run a benign course…you overdiagnose in some instances and therefore overtreat that person. As it is not possible to distinguish between lethal and “harmless” cancers on an imaging study, all detected cancers are treated. Overdiagnosis and overtreatment are therefore inevitable. As the author of the JAMA study said, more studies will be needed to distinguish between slow growing and very aggressive tumors. But for now, if a woman wants to reduce her odds of dying of breast cancer (by at least 24%), then the current screening regimen should be followed. Besides just a cookie cutter approach to every female going to get an x-ray of the breast, public education campaigns should also be reinforced to teach women how to assess their own risk including not having kids till late in life, dense breast tissue, family history of breast cancer, genetic testing for BRCA gene, aging, taking female hormones for menopause symptoms, etc. This should be addressed on a case by case basis between an individual and her health care provider, and women should be made aware of the risks of possible overtreatment and overdiagnosis, radiation exposure, and limitations of screening mammography in picking up some quickly growing breast cancers that can be deadly. MRI can also be useful in picking up some lesions and later stage cancers that mammography may miss.

I also have a personal interest in this topic as my mom’s life was saved by a screening mammogram. One year she had a normal study and the next year she had a breast cancer that was picked up on the yearly mammogram. It had already spread microscopically to her lymph node, meaning it was an aggressive tumor and if she had just skipped a year or blown off that year’s mammogram, she would have missed picking up the cancer and it would have likely spread beyond the breast and been metastatic by then which is often lethal. It should be noted she was in her late 60’s at the time of her diagnosis, which means she falls in the 50-70 year old category that studies have demonstrated a clear benefit of yearly screening mammography. So it’s hard to imagine backing down on mammograms in the absence of more sophisticated screening measures when you have a personal story like this one that make you so thankful for screening studies; many people besides myself have these stories since so many women are affected by breast cancer.