Friday, May 27, 2016

Baby butt..palms and soles,dandruff,pilaris,face rejuv @ Multipurpose Lumina Gel 30%

Lumina Gel- our signature 30% lactic acid with skin lighteners ,used by many clients since we introduced it last year October 2015. Many of you are satisfied with the use.

Not only do we use it for  facial pigment,fine lines,superficial acne scars, and pre laser, IPL skin conditioning but also for-

a. treament of pilaris- once a week application to exfoliate the horny layers of the skin for 2-3 mintues and wash off with water.Apply moisturizer and sunblock SPF 30 regularly
Pilaris is a common, harmless skin condition. It causes small, hard bumps that may make your skin feel like sandpaper.The bumps are often light-colored. They usually appear on your upper arms, thighs, and buttocks, sometimes with redness or swelling. They can also show up on your face, but that's less common.Except for some itching, keratosis pilaris doesn't hurt and doesn't get worse. Many children and teens get it, and it usually disappears as they get older. Keratosis pilaris is caused by a buildup of keratin, the protein that protects skin from infections and other harmful things. You can exfoliate the dead cells with Lumina gel once a week.It will improve.

b. Smoothing the palms- baby butt palms- apply once a week on palms for 2 minutes and wash off with cold water; apply vaseline and leave on till morning. Your palms will become very smooth and soft over a few weeks use.

c. Dandruff- mix about one ml with a bit of shampoo and apply well,massage onto scalp and leave on for ten minutes. Do not touch your eyes with it. If it gets into eyes,rinse with cold water for two minutes. Wash off and apply vit A or other oil. Wash off next morning.Once a week treatment, It will improve your dandruff condition significantly as the dead cells on your scalp are removed,allowing your hair roots to breathe better.

d. Rough soles treatment with Lumina and vaseline as explained in the previous blog.

Bon Chance with your Lumina Gel 30%  at smilemakernyc.com




Advantages:  Multipurpose Lumina Gel 30%


1. Cost effective facial rejuvenation ; 2 oz bottle which lasts for over one year with significant  rejuvenation and pigment removal/decreasing effects over several months of regular use

2. Collagen Stimulation and biosynthesis of GAGs (glycosaminoglycans) which attract water into the cells and give the skin a plumping effect

3. Tyrosinase inhibiting effects  at concentrations  above 5% lactic acid means this peel is good for pigment;it also acts as a good skin moisturizer . Lactic acid decreases blemishes and fine lines as a result

4. The addition of vit C increases the collagen stimulating effects; vit E in the peel also has beneficial antioxidant effects

5. Kojic acid and alpha arbutin (berry extract) further lighten the skin and is good for age and sun spots

The peel is a superficial alpha hydroxy peel with no downtime and is also what I call an invisible peel because you do not see obvious peeling except for a after peel glow in 2-3 days time. It is easy to use  every ten days and all one needs post peel is good amounts of sunblock with SPF 30  because lactic acid sensitises your skin to the rays of the sun.

It is also very useful as a skin conditioning agent because it  exfoliates your dead skin cells,improving tone ,color and texture. Regular use of lumina peel  will also  protect your skin from unwanted post inflammatory inflammation and  pigmentation following more invasive procedures like lasers,IPL,deeper peels and dermabrasion.  It is also useful for post acne superficial scarring and PIH(post inflammatory pigmentation).


Poor man's petroleum jelly? The rough problem sole with flipflop soles

The most annoying problem we face with regular use of flip flops,or sandals are rough calloused feet which are not easy to treat when they become chronic and very hard.

Several methods have been tried with variable results.If the underlying problem is the flip flop or sandals, it would help to change to regular soft footwear instead,first of all as a preventive measure. Even if you soak and scrub your feet and abrade the foot,the callus will recur because you are still using flip flops and sandals.

The simplest method really is:

1. stop wearing those flip flops and exposing your soles to frequent trauma which make your soles rougher by the day

2. Soak your feet in warm water every night and gently remove the chunks of skin with a pumice stone

3. Apply a superficial peeling agent for half an hour Lumina Gel (lactic acid) 30%  smilemakernyc.com ( every week for a few months ) . Do not use on cracked heels.

4. After half an hour wash off the peel with cold water and while the foot is still damp,apply white petroleum jelly(vaseline) .This is the poor man's petroleum jelly,cheap and very effective.

5. Wear thick cotton socks and sleep.

6. Do this daily, and you will notice significant improvement .Your feet will be much smoother and softer.

pic: before and after of  rough soles treated by another clinic ( for demo purposes only)

Gentler techniques of lipocontouring


Useful tips on gentler techniques of lipocontouring ,safer way ,using finer suction needles 2-3 mm and dilute concentrations

Tumescent solution:

Ringer Lactate (no need of NaHCO3)  1000 ml with 1cc adrenaline(1: 1 million, very safe ) and below 35 mg/kg of lidocaine ( to avoid lidocaine toxicity may use 5cc to 10cc only of 2% lidocaine)
Mildly warm the solution first and then add the adrenaline so it does not get degraded
Use BP cuff infiltration
Superficial first then deeper

Wait 20 minutes and aspirate with fine cannulae, Vaser/smart ,tickle lipo  where there is very little bruising and low downtime post op. The machines are prohibitively expensive for most doctors practising  the art and require careful planning,good funding and a large client list.
The procedures are expensive.

In the past the procedures were traumatic and dangerous for the patient requiring larger contouring
In some countries ,the techniques are still outdated and  should not be encouraged ( using outdated cannulae and common OT suction machines-used by many plastic surgeons ; as a result the recovery time is painful and a bad experience for patients) 



Lecon: A look at innovations on the workhorse of head and neck recon



The pectoralis major myocutaneous flap is a favorite among head and neck recon surgeons because of it's relatively easy learning curve and  good arc of rotation for head and neck defects. Most surgeons should master this useful technique.

Here is an educational you tube video from Miami demonstrating their excellent technique.



An Australian group further modified the  flap by  offering some innovations on closure of the donor defect which might be difficult to close in some patients. (fig) 
Here, a fascio cutaneous flap on the aponeurosis of the rectus abdominis is included; the pect major is divided around the pedicle which is raised a s a small cuff of surrounding fascia to gain the required length of the pedicle.
The relatively large defect is closed using a medially based transposition flap ,raised as a fasciocutaneous flap. Most fasciocutaneous flaps have an excellent supply of random vessels and survive well,making them very popular flaps for reconstructive surgeons.
The flap is transposed to the defect and  the donor site closed by direct closure using this flap.


Thursday, May 26, 2016

Hippocrates Hijacked: Death of medicine and the last doctor

The medical world is getting more and more complicated with countless add-ons in the media and market place.
The results are not pleasant and have far reaching consequences. The rise of  SUPER BUGS and many other side effects will continue to remind all of us that one cannot buy medicine with money alone.



Marketing to doctors: John Oliver


Aesthetic Concerns- dark on fair and blackish on whitish complexions ?

 Some annoying and generally harmless color mismatches we all have to deal with in our daily lives

The dark circles under our eyes,what are they ?

Dark circles are due to microvessel breaks under your skin leading to hemoglobin leak and dark pigmentation
The skin of your eyelids is thin and this pigment shows easily
The only way to lessen this condition is to use vitamin K 1% under eye cream every night ;
it will repair the vessels and improve the condition

Also,do not stay up too late. Worsens the condition.



And what about my dark knees and elbows?

Dead cells accumulate on your pressure points when you constantly lean on your elbow and knees
Over time these get tougher and harder to exfoliate,unlike your face
The areas that are traumatized are bound to get darker  and using scrubs is not the answer,In fact,aggresive scrubbing in tye 3-4 FP tyes will make the traumatized area  darker.

The best way is to avoid  pressure on these dark areas.

Next start light exfoliation using  Lumina Gel (30% lactic acid with lighteners) and  Chi 7 lightener
( www.smilemakernyc.com) which reduces melanin production and lightens even stubborn dark spots

However,remember that your face  responds faster to this treatment, and the pile of dead cells on your dark pressure points is gonna take months to clear and improve
Do not expect an overnight or short cut "miracle fairness "for such a chronic problem

Aesthetics is great..but results take time to show, especially in chronic pigmentation problems.






Tuesday, May 24, 2016

Medical catechisms ..learning the art of mnemonics and staying informed

The life of a doctor is hard. Always reading and updating but forgetting concepts in between. I find mnemonics a very useful way of remembering medical facts which are difficult to remember.Sometimes,one remembers the mnemonic and forgets what it is all about.An occupational hazard,generally  and not early onset Alzheimers.

How does one remember all the bacteria that are urease positive? The answer is Latin ..ish catechisms


"Prote Crypto Helico! UNK..Ureaplas Nocardi Klebsi! StrEpiderm SSaprophyticus"

followed by potentiate stru vite cal culi...  was not so hard,after all.  What we have here is the entire list of bacteria that are able to secrete urease and give a positive urease test.
Urease hydrolyses urea to ammonia and carbon dioxide. This increases the pH of urine leading to the next step-potentiate struvite calculi  -ammonium magnesium phosphate stones!

So next time you think about urease positive bacteria apart from helicobacter pylori..you can remember the complete forms..
Proteus  Cryptocococcus Helicobacter!  Ureaplasma Nocardia Klebsiella! Strep Epidermidis and Staph Saprophyticus.   You nailed it now..:-)


Catechism 2: 
" Nocardi Pseudo Listeri!ACE.. Aspergi Candida Ecoli! Staphylo Serratia B cepacia Helico"


You can guess the names of all the bacteria that are catalase positive now.

Catalase enzyme degrades hydrogen peroxide into water and oxygen bubbles before it can be converted to microbicidal products by the enzyme myeloperoxidase.
Patients with chronic granulomatous disease have NADPH deficiency and get recurrent infections with catalase positive bacteria. 




Monday, May 23, 2016

Starvation in a poor Arab country surrounded by many rich Arab nations

Glycogen reserves get depleted after day one of starvation .

Blood glucose levels are maintained by :
a. glycogenolysis- the liver beaks down glycogen .
b. release of free fatty acids from adipose tissue.Muscle and liver shift fuel use from glucose to free fatty acids.
c.hepatic gluconeogenesis-glucose production from peripheral tissue lactate,alanine,adipose tissue glycerol and propionyl L-CoA

What happens after day 3 of starvation?


Adipose tissue stores are used as a source of glucose.
The priority is to supply glucose to the brain and RBC,and to preserve protein.

The ketone bodies become the main source of energy for the brain. After these are depleted, your body's vital proteins are broken down to provide much needed energy,leading to organ failure and death .

Over 330 days of starvation:

Yemen babies die due to war starvation


Welcome to reality now that you have understood some of the mechanisms by which we humans stay alive.

 A few weeks is enough to collapse our system and reserves. What about a war zone where children have been starving for over 330 days? The effect is beyond imagination.

This time as you think of  dining on delicacies  ,think about the poor children of Yemen who are being systematically starved in a cruel and meaningless war between warlords fighting for control in an impoverished and desperate nation. Only innocent citizens pay the price with their lives.

.

www.smilemakernyc.com

“Cui bono?” (to whose benefit?) Diet pill that kills

Despite warnings about potentially lethal "diet pills" sold over the net,some still try self medication ,with disastrous results.  Not only are lay people at risk,but medical personnel also often abuse such drugs.

There is no quick fix or miracle fix for weight loss.

The poison diet pill contains  2, 4 Dinitrophenol(DNP) .But unscrupulous merchants still try to sell to unsuspecting buyers.


In many parts of the world,the medical profession has been reduced to a mockery of quacks and fast-buck seekers. This is true ,especially of the aesthetic medical world which is valued at over 23 billion dollars. Little wonder then,there are so many gamblers in this business,selling their wares and often poisoning or crippling people in the process.

DNP is used illegally in many parts of the world, as a diet pill. It is also used by some body builders to "shed fat". It is not fit for human consumption.(FSA UK).

How does the substance act?
Metabolic processes in the body  use ATP (adenosine tri phosphate) as an energy source. ATP transports chemical energy within your cells for metabolism. The passage of electrons (NADPH) results in the formation of a proton gradient (the product of the electron transport chain) which drives the production of ATP. A higher concentration of protons outside the inner membrane of the mitochondria than inside the membrane is the driving force behind ATP production.

2,4 DNP  collapses the proton gradient and also "uncouples the formation of ATP from ADP(oxidative phosphorylation reaction) -uncoupling generates a lot of heat and raises the body temperature to dangerously high levels,increases oxygen consumption in your body and raises your metabolic rate.
Your body stops producing ATP but the electron transport continues  since this poison increases the permeability of your membranes to the electrons .As a result more heat is generated and death can follow hyperthermia.

An acute toxic reaction that includes vomiting,dizziness and loss of weight needs immediate treatment in the emergency dept with a muscle relaxant called dantrolene . But there is no specific antidote to  DNP.

www.smilemakernyc.com




Thursday, May 19, 2016

Collapse of medical infrastructure and food supplies in a war ravaged zone

War brings with it some of the worst humanitarian disasters. In Arabia Felix, following the collective punishment of innocent civilians by warring factions and invading forces, most do not have any access to medical clinics, water or food.
Some friends have formed networks with local volunteers to help the most underprivileged sections who are caught in between-the homeless and destitute,whom nobody wants to talk about and are even ignored in aid distribution.
Following the collapse of essential food, water and medical services,most rely on small handouts for their communities to live from one day to the next,praying for a miracle that peace will return soon.

Yemen 2016 May-the reality of war








Tuesday, May 17, 2016

PS : Meeting Urushiol in PI and PO


Clouseau and his aide are on a  pleasure trip  looking for adventure with Urushiol,a seemingly elusive beauty hiding somewhere in the wooded areas of Connecticut. Their search is futile even after a week and so they return to their HQ in the city.


 Later Clouseau complains of itching skin; there are numerous erythematous papules and vesicles on both limbs ,in linear array.
He enters a primary care clinic in Gotham city ."Mon Dieu,I am itching all over! Docteur,please do something."

Doc," Yo! Where on earth have you been?"

Clouseau: In les woods of CT looking for la belle Urushiol .Perhaps from Siberia or nearby. Le legend has it ,this is one elusive beauty hiding in your country under a false ID. I was told by some friends to look for  clues like PI,PS and PO. But I am not successful


Doc: You found the three, all right! You got PS, PI and PO . All three in one! And they got Urushiol,the itch you searchin' for. Urushiol is what we call here an allergen found in PI,PO and PS. For the time being, I suggest you take prednisone for the next 14-21 days! 










Clouseau: Mon Dieu! This is diabolique. Hmm..I smell a fourth in Gotham City zis November

Sunday, May 15, 2016

The sniffle ridge design in bilateral cleft lip surgery

The sniffle ridge is a key component of bilateral cleft lip design.

A straightforward way is to measure the prolabial skin flap and  after the initial white line placement sutures following muscle approximation,the ridge is designed:

The lateral suture is superficial wheras a bigger bite is taken at the medial prolabial flap end.
This creates the desired sniffle ridge.

Bon chance with the new smiles.

pic:

All Skin Types 1-6 FP -International Aesthetic Plastic Missions in Arabia Felix over the years


Type: Aesthetic Plastic Smile missions

Skin Types: All Types Fitz Patrick,  1-6

The majority of cases in Plastic Surgery Missions are

Cleft lip and palate cases;over 70 -percent of your cases will be in this group

Aesthetic Plastic: usually liposelection,aesthetic procedures for the face mainly nose and eyelids,breasts,

Burns: Mostly secondary reconstruction of contractures

Other reconstructive procedures for congenital anomalies and trauma

Aesthetic Medical non invasive and minimally invasive like lasers,botox,fillers