COSMETIC DERMATOLOGY: PRINCIPLES AND PRACTICE in Visual Studio .NET

Encoder QR Code in Visual Studio .NET COSMETIC DERMATOLOGY: PRINCIPLES AND PRACTICE

COSMETIC DERMATOLOGY: PRINCIPLES AND PRACTICE
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Obesity is defined as unhealthy, excessive fat mass There are many regimens, products, and exercise programs available; however, there is still a rising pandemic in the United States9 when compared to the past10 Obesity and hyperlipidemia are major risk factors and can lead to significant morbidity and mortality PATHOPHYSIOLOGY Obesity results from both environmental and genetic factors Two genes that are known to have direct effects on obesity are the leptin (ob gene)11,12 and proopiomelanocortin (POMC) genes13 These genes can control eating behavior and satiety Defects in these genes can cause severe obesity
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There are many different types of lipoproteins Low-density lipoprotein
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TABLE 3-2 Classi cation of Overweight and Obesity by BMI BMI 250 299 300 300 350 350 400 400 WEIGHT STATUS Overweight Obese Moderate obesity (Class I) Severe obesity (Class II) Morbid obesity (Class III)
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Overweight patients frequently consult plastic surgeons and dermatologists for liposuction27 29 Liposuction is one of the most commonly performed cosmetic surgery procedures in the United States30 Physicians must inform their patients that liposuction is a modality for improving body contour and not for treatment of generalized obesity In addition, excess fatty tissue will return if regular exercise and diet control are not maintained Large-volume liposuction may decrease weight and fat mass; however, there is controversy regarding whether or not it significantly improves insulin resistance and other obesity-associated metabolic abnormalities31 33 The most common areas treated are the neck, jowls, arms, abdomen, thighs, knees, and ankles Other conditions that can be improved by liposuction include lipoma, gynecomastia, buffalo hump, and axillary hyperhidrosis There are strict guidelines from both the American Society of Dermatologic Surgery (ASDS) and the American Academy of Cosmetic Surgery (AACS) on the volume restrictions during liposuction Tumescent liposuction is considered the safest method for performing the pro-
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urinary incontinence; and idiopathic intracranial hypertension Additionally, obesity has indirectly been related to anxiety, impaired social interaction, and depression Obesity is implicated in a wide spectrum of dermatologic diseases, including acanthosis nigricans, acrochordons, keratosis pilaris, hyperandrogenism and hirsutism, striae distensae, adiposis dolorosa, fat redistribution, lymphedema, chronic venous insufficiency, plantar hyperkeratosis, cellulitis, skin infections, hidradenitis suppurativa, psoriasis, insulin resistance syndrome, and tophaceous gout24 To determine the severity of a person s obesity, BMI can be used In fact, the more overweight a person is the higher the mortality rate (Table 3-2) TREATMENT Dietary control is very important in the treatment of obesity Patients must understand the principle of energy intake and expenditure Weight reduction is usually not accomplished without exercise However, exercise alone will usually produce little long-term benefit The combination of exercise with dietary therapy can prevent weight being regained In addition, regular exercise (30 min daily) will improve general health The best results are obtained with education in well-motivated patients Constant supervision by healthcare professionals and by family or friends can help to encourage compliance PREVENTION Prevention of obesity is key because once fat is gained and maintained over time, it is more difficult to lose A high-fat diet can induce an increase in the number of adipocytes25,26 A low-fat and complex carbohydrate diet is recommended to reduce body weight There is an important difference between preventing weight gain and producing weight loss To prevent weight gain, portion size and composition of food are controlled For weight loss, restriction of calorie intake is the most effective treatment
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cedure This technique relies on the infiltration of dilute anesthesia based on body weight, and the removal of limited amounts of adipose tissue during each operation Tumescent anesthesia consists of very dilute lidocaine and epinephrine solutions ranging from 005% to 01% of lidocaine with 1:1,000,000 epinephrine and sodium bicarbonate The total safe concentration of lidocaine that can be used in this formula is 35 to 55 mg/kg based on patient weight and any coexisting medical conditions Table 3-3 is a synopsis of the 2006 ASDS guidelines of care for tumescent liposuction28
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