What Happens When Youve Gotten Filler for Years and Then Stop? – Allure

In our three-part series, The Filler Files, Allure explores our relationship with facial filler. It's still one of the most popular nonsurgical cosmetic procedures, yet more of us are looking to dissolve our filler than ever before. What does this mean for our lips, our cheeks, and our approach to injectables?

If you clicked on this headline, you likely have some relationship with hyaluronic acid fillers the injectable gels, like Juvderm and Restylane, that millions rely on to contour, plump, and smooth their features. Whether youre a diehard fan or a casual acquaintance, youve probably wondered how these sugar-based substances behave inside the body and what actually happens when we decide to quit them after years of routine touch-ups.

View more

In posing these questions to dermatologists and plastic surgeons, we discovered that theres a frustrating dearth of formal studies investigating hyaluronic acid fillers over the long term how and when they break down, the ways in which they change over time, and their effects on the quality of our skin and elasticity of our tissues, both during peak injectable use and long after weve sworn off the stuff. Given the paucity of hard data, much of what our experts shared is anecdotal insights informed by their decades of experience injecting and dissecting the human face. Reliable intel, nonetheless.

In the interest of not burying the lede, well start here: If youve been getting filler religiously for years, what happens when you stop will hinge on one critical factor: your average dose at each appointment. People who are getting a syringe or two every 12 months doing a little bit for specific points of volume replacement they have a much easier time than those who are receiving 5 to 10 syringes every six months, because theyre not getting to a place of overinflation and tissue distortion, saysJessica Weiser, MD, a board-certified dermatologist in New York City.

And make no mistake: Countless men and women are walking around with gluts of filler under their skin. While Dr. Weisers self-imposed limit for a single session is two or very rarely three syringes, she believes she is somewhat of an outlier among injectors. There are tons of doctors doing 10 syringes at a time, she tells us. Some of the other physicians we spoke to confirmed that they commonly encounter patients whove received 20 or even 50-plus syringes of hyaluronic acid over a one- to two-year span.

When patients come in with too much filler in their faces, it can be almost disfiguring, saysLara Devgan, MD, a board-certified plastic surgeon in New York City. The problem can be more than skin-deep, affecting both the look of the face and its functionality. Its so common that theres a term for it: filler fatigue.

Board-certified ophthalmologist and oculoplastic surgeonMitesh Kapadia, MD, describes the overfilled face as an epidemic for which a growing number are now seeking a cure namely, hyaluronic acid-melting hyaluronidase, a synthetic version of an enzyme found in the body. Youve no doubt seen celebrities, likeCourteney Cox andAmy Schumer, talking openly about being displeased with the look of their outsize cheeks or lips and having their filler dissolved with this injectable solution. Theyre hardly alone. According toThe Aesthetic Societys most recenttrend report, their members performed 57% more filler reversals in 2021 than they did the year before. Indeed, a common refrain among cosmetic providers is that theyre spending more time dissolving filler than injecting it.

Whats behind the about-face? People are realizing that theyre not looking better, but looking odd, saysElizabeth Houshmand, MD, a board-certified dermatologist in Dallas. It may be an old photo or a well-meaning family member that helps them see the error of their ways. Or a complication will clue them in, as they notice their fillermigrating or swelling. Often, though, they cant pinpoint the exact problem, Dr. Weiser says; they just know that things feel strange.

Sometimes, people break up with filler not because theyreoverfilled, per se, but because theyreover filler the look, the upkeep, the headaches and this too is a form of fatigue. The filler becomes oppressive, a burden. Especially when theyve been through bad injectables and dissolving, they just dont want to deal with it anymore theyre done, saysJonathan Cabin, MD, a board-certified facial plastic surgeon in Arlington, Virginia. In other cases, the filler has just exhausted its usefulness, no longer able to obscure insecurities in a natural-looking way and compelling once-loyal users to pursue a more powerful solution, like surgery.

So whats all this filler doing to our faces?

Overdone or poorly placed filler can muck up the mechanics of a face. The facial muscles may not move properly, and that changes not only how you look, but also how you drain, saysBen Talei, MD, a board-certified facial plastic surgeon in Beverly Hills. By way of explanation: Muscle contractions ordinarily help keep lymphatic channels flowing, but when filler envelops the muscles it restricts movement, straining our expressions and causing lymphatic fluids to stagnate and lymphatic channels to swell. All the while, the hyaluronic acid is pulling in fluid notorious water hogs, these gels intensifying bogginess and bloat. When theres such a high volume of filler going in there that the face is not draining properly, it can give the skin a sort of puffy or doughy look, adds Dr. Weiser.

Filler can also integrate with our tissues over time. In small quantities, its no big deal. It may just make certain layers of the face stronger and slicker, notes Dr. Devgan. But when copious gel piles up from repeated injections, this fusion can elicit a microcystic expansion effect, says Dr. Talei. (He describes the concept in a newstudy published in theAesthetic Surgery Journal.) As he explains, the filler penetrates as little gel particles, soaks into the various layers of the soft tissue, and [acts] like a million tiny water balloons, stretching it all out.

The soft tissue expansion reads as bulkiness, he says, sometimes with a bit of a gargoyle appearance in certain patients. In the lips, it can lend a flaccid, low-hanging look. The consequences of this distension will be more dramatic in those whove been grossly overfilled for many years.

What happens when you stop getting filler?

Patients who were filled normally shouldnt have any issues. The filler either sits around harmlessly or slowly metabolizes over time, says Dr. Talei. Dr. Weiser agrees that if judicious doses (treating every issue with as little filler as possible) were carefully injected (in tiny droplets, versus large blobs, at a safe and imperceptible depth), the bodys own hyaluronidase enzymes should gradually digest it. (In areas of little movement, like the undereyes, hyaluronic acid fillers can be rather tenacious, though, and can sometimes outstay their welcome.)

As filler fades and its effects wear off, previously treated features will shrink and flatten, creases and folds may emerge, and shadows can creep in. Whatever you were aiming to veil will be unmasked and likely accompanied by age-related changes that landed, perhaps unbeknownst to you, during your fillers tenure. Uncovering whats happened while fillers been in your face can be a lot if youre not psychologically prepared for it, cautions Dr. Cabin. On the upside, hyaluronic acid injections have beenshown to stimulate collagen production, so your skin could, consequently, be a tad thicker following years of repeated pokes.

And the post-filler expansion phenomenon the stretching and warping of tissues shouldnt really concern the low-key filler user, who is not obviously inflated. Appropriate amounts of filler do not cause this problem, Dr. Talei reassures us. It is more likely seen when excess amounts are placed [for] over a year.

Whether you let filler dissipate on its own or use dissolver to speed things along, dont expect to be left entirely filler-free. I dont think you ever get 100% back to having no filler in your face, Dr. Weiser says. A portion of it does integrate and its extremely challenging to remove every drop.

Dr. Devgan also acknowledges that trace amounts of filler can remain interwoven with our natural collagen, much like ivy thats grown into a lattice in a garden. But she stresses that this isnot something to fear. Filler disappears on a decay curve, steadily disintegrating at a consistent rate, until it becomes almost imperceptible, she explains. Even if remnants are visible on an MRI [or ultrasound], she adds, theyre not necessarily significant enough to alter a persons appearance.

If you cant see or feel your old filler, and its not acting up, the doctors we spoke with all advise against chasing it with hyaluronidase because that little bit of filler thats sticking around could be totally benign. While the gel may change character in the future, move a tiny bit, or draw in water, Dr. Talei says, in such scenarios, dissolving it is usually easy and predictable.

Getty Images

Overfilled patients can also stop and/or dissolve whats in their face at any time, but it may take them longer to reach their no-filler destination and they may not love the view once they get there.

When people have been filled forever and dont remember what they looked like before, they need to know they may be opening a can of worms, saysFlora Levin, MD, a board-certified ophthalmologist and oculoplastic surgeon in Westport, Connecticut. My consent for dissolver clearly states that you may be just as unhappy, or more unhappy, after I dissolve the filler than you were prior to dissolving.

Younger patients tend to rebound fairly seamlessly, likely because they havent been filled for as many years, which means less filler in some cases and less time for expansion [of the soft tissues of the face], says Dr. Talei. Their tissues are also more resilient with a greater healing capacity.

Rarely, in extreme and prolonged cases of filler use, the face can never go back to what it was, says Dr. Talei, because the gel has damaged and, in a way, aged the tissues. He hesitates to dissolve these patients, because removing the HA (to whatever extent possible) can leave stretched tissues unsupported and desiccated, causing areas of the face to collapse and appear darker. He can usually get them to a better place: They may need to maintain some degree of HA filler while also considering surgery to address laxity, plus stem cell-rich nanofat orplatelet-rich plasma (PRP) injections to help regenerate depleted tissues.

The lips are, arguably, the most frequent victims of superfluous filler and, over time, this can carry serious consequences.

But how much filler is reasonable in the lips department? It depends on your individual starting point the undoctored size and shape of your lips. While everyones are different, a unifying characteristic is that they all have a tipping point: Upon assessing your lips, your injector should know precisely how much gel they can receive without complication.

For lips, I very seldom do more than half a cc at once, Dr. Levin says. And I dont have people come back [for touch-ups] at a specific time period. We leave it open-ended.

When lips are repeatedly filled beyond their inherent capacity, filler can seep across the vermilion border (a.k.a., the lip line) into the philtrum (the area between the lips and nose), producing a shelf-like appearance or filler mustache, says Beverly Hills board-certified plastic surgeonGary Motykie, MD. Filler migration is common here because the muscle encircling the mouth is in near-constant motion.

Beneath the skin of the philtrum is a cushy layer of fibrous tissue called the SMAS (short for superficial musculoaponeurotic system), which overlies muscle. This tissue is responsible for [providing] supple support and hydration to the lip skin, Dr. Talei explains. When an abundance of filler sits in the body of the lips and/or the SMAS for an extended period of time, these tissues can stretch and expand sometimes permanently.

If the filler is left to slowly go away [on its own], the lips may eventually return to normal, or the filler could just stay in place for years, Dr. Talei tells us. Alternatively, patients may choose to melt lip filler with hyaluronidase to take control of the process. Many people dissolve without issue and dont require any follow-up, says Dr. Talei. Occasionally, though, dissolving overfilled lips can backfire: The tissues dont snap back to their original state, he adds, and removing the filler actually may reveal the [tissue] expansion and accelerated aging that occurred while the hyaluronic acid was in place. The lips can look lax, shriveled, or asymmetric, and the skin above the vermilion may appear darker and wrinkled due to changes in the SMAS.

Ironically, the fix for this may be more lip filler a conservative dose, injected periodically, to revolumize and rehydrate the tissues. If the area above the lips looks long and droopy in the wake of overfilling, a surgical lip lift can shorten the space to youthful effect. As with other parts of the face, nanofat or PRP injections may also help repair damaged tissues.

This all sounds a little scary, we realize, and we never aim for sensationalism, so lets be 100% clear on this point: A modest amount of lip filler, even sustained over years, willnot accelerate tissue aging it just doesnt do that, Dr. Talei says. But when lips or any part of the face, for that matter have housed a ton of hyaluronic acid for a time and its inhibiting movement and stretching skin,that can speed aging tremendously.

What to do once you quit

Once youve decided to take a break from filler for however long considerdiversifying your treatment portfolio. When I see patients whove been getting only filler for 20 years and have never had any kind of radiofrequency or ultrasound or laser treatment, what I find is that their skin the luminosity, tone it just doesnt look that good, Dr. Weiser says. Try refining your complexion with a proven device or getting a subtle volume increase from collagen-stimulating Sculptra. Dont lean on hyaluronic acid exclusively. I think if you really maintain the quality of the skin and keep collagen levels boosted, the need for volumization is less, adds Dr. Weiser.

Ultimately, all procedures have limitations and respecting them can keep you looking undone through the years. When your old reliables start to fall short, you can either pause and accept your reflection as is or explore the next-level surgical realm. Happily, the choice is yours.

Check back for the third installment of our three-part series, The Filler Files.

Read more on injectables:

Watch a dermatologist explain how hand fillers work:

Follow this link:
What Happens When Youve Gotten Filler for Years and Then Stop? - Allure

Global Joint Pain Injections Market Report 2023: Growing Occurrence of Osteoarthritis Fuels the Sector – Yahoo Finance

Company Logo

joint-pain-injections-market-size.jpg

joint-pain-injections-market-size.jpg

Dublin, April 07, 2023 (GLOBE NEWSWIRE) -- The "Global Joint Pain Injections Market Size, Share & Industry Trends Analysis Report By Injection Type, By Distribution Channel, By Joint Type Channel, By Regional Outlook and Forecast, 2022 - 2028" report has been added to ResearchAndMarkets.com's offering.

The Global Joint Pain Injections Market size is expected to reach $9.9 billion by 2028, rising at a market growth of 7.7% CAGR during the forecast period.

Key Market Players

Bioventus Inc.

Pacira BioSciences, Inc.

AbbVie, Inc.

Teva Pharmaceuticals Industries Ltd.

Pfizer, Inc.

Anika Therapeutics, Inc.

Zimmer Biomet Holdings, Inc.

Eli Lilly And Company

Ferring Holdings SA

Sanofi S.A.

Direct injections into the joints are used to treat joint pain and reduce swelling and inflammation. Geriatric patients typically have joint discomfort as a consequence of pre-existing medical conditions or illnesses.

For example, joint pain from arthritis, a common condition that primarily affects the knee, ankle, hip, shoulder, elbow, and facet joints of the spine, causes inflammation and adds to joint discomfort. The market for joint pain injections is also anticipated to grow due to the rising prevalence of rheumatoid arthritis and osteoarthritis and the rising demand for economic therapies for these diseases.

The demand for joint pain treatment solutions is increased by the aging population and the rising prevalence of obesity. To meet this rising demand, the main market participants are doing research and development operations to produce more effective treatment options, such as prolotherapy, autologous conditioned serum, platelet-rich plasma, and plasma matrix therapy.

Moreover, platelet-rich plasma (PRP) is created from the patient's blood and injected into a troublesome joint to reduce arthritis-related pain and stiffness.

Furthermore, developing such cutting-edge procedures offers major market participants chances for investment, which is expected to fuel the market's expansion throughout the forecast period. In addition, the primary reason driving the expansion of the joint pain injections market is the rise in the frequency of accident-related injuries in modern society.

Increased R&D efforts by the major market players and innovations like single injection therapy and plasma matrix therapy will present profitable opportunities for the market players to invest.

Story continues

Other factors driving the growth of the joint pain injections market include the prevalence of obesity globally, the rise in geriatric patients, and the increase in the number of arthritis cases along with joint disorders. Nonetheless, physical therapy is frequently used with injections to preserve or increase joint stability and mobility. While physical therapy alone may not be sufficient to control pain &inflammation, the pairing typically produces superior benefits.

Market Growth Factors

Growing occurrence of osteoarthritis

Osteoarthritis is one of the leading causes of disability among the elderly and a prevalent illness (OA). As the population's average age rises, the incidence of knee osteoarthritis (OA) increases. OA is the leading cause of chronic disability and the most common articular disease in the industrialized world, with knee and/or hip OA being the most common form.

As a result of population aging and the incidence of obesity and overweight in the overall population, it is anticipated that the number of people with symptomatic knee OA will increase. Joint stiffness and pain may become severe enough to make ordinary tasks difficult. Due to the rising prevalence of osteoarthritis, it is anticipated that the market for injections to treat joint pain will undergo significant growth.

Increasing global geriatric population

The World Health Organization predicts that by 2030, one in six people will be 60 or older. By this date, there will be 1.4 billion persons aged 60 or older, up from 1 billion in 2020. By 2050, the number of people worldwide aged 60 or older will have doubled. (2.1 billion). The number of persons aged 80 or older is anticipated to triple between 2020 and 2050, reaching 426 million. By 2050, two-thirds of the world's over-60 population will dwell in low- and middle-income countries.

In the elderly, back and neck pain, osteoarthritis, COPD, diabetes, depression, and dementia are all frequent diseases. As people age, they are more likely to suffer from many ailments simultaneously. In light of this, the need for joint pain injections would increase dramatically over the forecast period due to the population's aging trend.

Market Restraining Factors

Lack of knowledge regarding this treatment option

Injections for joint discomfort are unheard of by the general public. Joint soreness is treated with hyaluronic acid injections, corticosteroids, and platelet-rich plasma. It takes extensive knowledge and training to use these injections. Injections for joint pain are often given to patients by doctors and other medical personnel. Professionals are provided the equipment and instruction required to complete this. However, the market's expansion is constrained by the absence of government initiatives to support joint pain injections.

Scope of the Study

By Injection Type

By Distribution Channel

By Joint Type

For more information about this report visit https://www.researchandmarkets.com/r/qx7ca2

About ResearchAndMarkets.comResearchAndMarkets.com is the world's leading source for international market research reports and market data. We provide you with the latest data on international and regional markets, key industries, the top companies, new products and the latest trends.

Attachment

Read this article:
Global Joint Pain Injections Market Report 2023: Growing Occurrence of Osteoarthritis Fuels the Sector - Yahoo Finance

How Hair-Loss Treatments Have Evolved Over Time – NewBeauty Magazine

Since the dawn of time, men and women have been combating sparse strands with a myriad of odd treatments and protocols. In the 21st century, we may have cracked the code and stopped the speed of shedding using breakthrough science and innovation.

In Ancient Egypt, castor oil and almond oil were often used to promote hair growth. They would also use concoctions made of dates, dog paws and donkey feet, says New York facial plastic surgeon Yael Halaas, MD. In India, they also had a tradition of standing on your head to increase blood flow to the scalp to improve hair loss, adds New York dermatologist Julie Russak, MD.

Spices, beetroot, myrrh, and some eyeopening ingredients like urine were used during the Greco-Roman era, when hair was an indicator of youth, wealth and status. The famous Greek physician Hippocrates believed that a mixture of spices, pigeon droppings, horseradish, beetroot, and opium could cure hair loss, which he suffered from himself, says Dr. Halaas.

In 8th century China, safflower oil, rosemary, Fo-Ti root, and various Chinese herbs were ground together with animal parts and used as a hair growth potion. Across Scandinavia, follicularly challenged Vikings would rub goose droppings on their heads in hopes of growing new strands. Saint Hildegard of Bingen, who lived in 12th century Germany, wrote of a baldness cure that called for leaving bear fat and ashes on the scalp for a long while.

Like the Ancient Egyptians, Victorians used castor oil, almond oil and gentle tonics, but also relied on rigorous scalp massages to promote blood flow. Silk nightcaps were also introduced to fight friction and minimize hair loss.

Modern-day restoration stems back to work done in Japan in the 30s, but it wasnt until the 50s that hair transplant surgery was born. A dermatologist named Dr. Norman Orentreich discovered that hair follicles could survive when moved from one site to another, says New York dermatologist Doris Day, MD. At first, the outcomes appeared unnatural in that clumps of follicles, called plugs, were placed with little regard to the natural hairline or final look.

Hair transplant surgery evolved in the 90s with Follicular Unit Transplants, where donor follicles are removed as a full strip from an area of healthy growth, explains Wayne, NJ facial plastic surgeon Jeffrey B. Wise, MD. Follicular Unit Extraction, a technique whereby grafts are harvested individually using a small punch, emerged in the 2000s.

Thankfully, today we dont rely on antiquated animal-based mixtures, but we are using follicle-stimulating growth factors. A treatment plan might include platelet-rich plasma injections, topicals, supplements like Nutrafol, nutritional changes, and lasers, notes Dr. Day. Doctors may prescribe medications like finasteride and topical minoxidil says Dr. Russak. Recently, low-dose oral minoxidil has also emerged as an effective hair growth solution.

At NewBeauty, we get the most trusted information from the beauty authority delivered right to your inbox

Find a NewBeauty "Top Beauty Doctor" Near you

See the article here:
How Hair-Loss Treatments Have Evolved Over Time - NewBeauty Magazine

‘Orgasm Shot’ Caused Excruciating Pain, San Diego Jury Told in … – Times of San Diego

On March 30, 2021, Dr. Nadine Haddad was excited to test a new service at her Fifth Avenue elective medicine spa near Balboa Park. Shed just been certified to give the O-Shot.

But before she could offer clients the clitoral and vaginal injections of their own blood PRP platelet-rich plasma she needed practice.

According to court testimony last week, Haddad asked four or five of her own employees at the B Medical Spa and Wellness Center to volunteer as models for the controversial shot which she promised improved sex drive and oh-my-God orgasms.

Jaime Herwehe, an esthetician, was one of two employees who agreed to the shot.

Two years later, testifying in downtown Superior Court, Herwehe (pronounced HER-way) described a terrifying ordeal.

With another staffer holding open her vagina by hand and the Syrian-trained physician sometimes using an iPhone to shine a light, an extremely nervous and scared Herwehe was injected with a local anesthetic that had expired three years earlier, she said.

Unaware that the liquid lidocaine offered no numbness, Haddad injected PRP into her nerve-rich clitoris, Herwehe told a jury of nine men and three women.

It was beyond excruciating, said the 32-year-old mother and former San Diego City College student. The most excruciating pain in my life.

She soon passed out on the floor a possible seizure, a witness said and has since suffered vaginal numbness.

After the botched O-Shot procedure, plaintiff was unable to have enjoyable sexual relations with her partner, her lawyers wrote. Plaintiff and her boyfriend of almost eight years and the father of her daughter broke off their longtime relationship because of the lack of intimacy and plaintiffs change in mentality towards sex.

Alleging medical malpractice, a lawsuit suit filed Sept. 15, 2021, against medical director Haddad and Haddads husband, office manager Mark Khashram, also claims that Herwehe didnt give written consent for the procedure gone awry.

And wasnt told its risks beforehand.

And according to the complaint filed by San Diego attorneys Josh Gruenberg and Pamela Vallero, Herwehe was fired May 11, 2021, for refusing to sign an O-Shot consent form 42 days after the fact.

No monetary figure is specified, but the legal team that also helped Sandra Maas win a judgment against KUSI-TV seeks a variety of penalties, including punitive damages in an amount necessary to make an example of, and to punish, defendant, and to deter future similar misconduct.

Medical battery and retaliation are also alleged, but several of the original claims were dropped.

In the formal answer to the complaint, submitted Nov. 22, 2021, the defendants said in part that Herwehe had the express knowledge of the risks and hazards set forth in the Complaint, as well as the magnitude of the risks and hazards, and thereafter knowingly and willingly assumed those risks.

The response also said:

Times of San Diego attended trial sessions Monday, Wednesday and Thursday in the fifth-floor Hall of Justice courtroom of Judge Carolyn Caietti Department 70.

Current and former B Med Spa employees testified, text messages were shown and expert testimony given.

Haddad who appeared only days before on Fox5 News and Khashram are represented by Maya Fawcett and Jack Reinholtz of Prindle, Goetz, Barnes & Reinholtz LLP, which has a University City office.

Reinholtz also is defending Haddad and Khashram in a separate lawsuit involving Jessyca De Lara Herwehes older sister who was B Med Spas manager during the same period and alleges wage violations, business fraud and intentional infliction of emotional distress.

(Trial is set for January 2024 in Judge Keri Katzs court, with Gruenberg representing De Lara.)

In Herwehes case, the spas co-owners since January 2021 have mainly attempted to throw cold water on Herwehes motives and veracity and deny she gave no prior consent. At one point, they argued a text suggested Herwehe offered a bribe to a colleague in the case.

With lawyers for both sides using sexual terms seldom heard in a court, the defense team Monday challenged expert witness James Tappan, who has 50 years of experience as an obstetrician and gynecologist.

Bottom line, youre not an expert in performing an O-Shot, Reinholtz told San Mateo-based Tappan, being paid more than $15,000 as a witness for Herwehe and appearing virtually on a video screen.

Happily, yes (not an expert), the 79-year-old Tappan replied after previously labeling the PRP shot not a recognized and accepted modality. He said it was useless to treat sexual dysfunction and that 64 risks are associated with the shot. He also said OB-GYNs dispute the existence of a G-spot, which the O-shot also promises to enhance.

Haddads certificate of completing O-Shot training with inventor Dr. Charles Runels, Tappan said, is a piece of paper not recognized by any national body. (Runels and the O-Shot are roundly mocked by other OB-GYNs.)

Ex-boyfriend Brandon Smith an SDG&E high-voltage lineman who used to live with Herwehe provided some of the most searing (and explicit) testimony.

Under questioning by Vallero, he described their sex life, which he said was great before the March 2021 procedure. But after her O-Shot, the boyfriend since 2014 said he couldnt touch her without her being uncomfortable.

She was so sensitive, she wouldnt want me to touch her anywhere, Smith said. She did a whole 180 from her previous self, showed zero patience, becoming a completely different person. Their relationship constantly turned into a fight, an argument.

Vallero asked Smith if he blamed the O-Shot for the end of their relationship.

Yeah, absolutely, he said. That whole process takes a toll and snowballed since the start of it.

Herwewe dabbed her eyes as Smith said hed made clear he never wanted to wed but planned to have a child, which they did in 2019.

Asked if hed like to get back together, Smith said: Id love to if we could work this stuff out. if we could get back to where we were.

But Herwehe didnt want to, he said.

At the next jury break, in the courtroom hallway, Smith put his arms around Herwehe.

Also on the witness stand Monday was Haddad, who said she told potential volunteers that the O-Shot improves blood supply to that area (and) overall it improves sex drive and sensitivity.

She said spa manager De Lara reported that Herwehe was fine with having the procedure and I thought I could trust her.

I asked consent and she said she signed and was ready. Haddad repeated: I was told it was signed. I hadnt seen it.

Herwehe attorney Gruenberg displayed a printout from the Medical Board of California showing that Haddads medical license had expired the previous Friday and was now delinquent.

Haddad said she had been preoccupied with this case and didnt get to it. (By late Tuesday, the license was renewed and current with an expiration date of March 31, 2025.)

Haddad acknowledged having used expired lidocaine on both her subjects, first on employee volunteer, Jessica Nieto, who didnt proceed to the actual O-Shot because it was so painful she asked me to stop.

On Wednesday, the defense called Andrea Muoz, a physicians assistant who works at Sharp Rees-Stealy but also part time at B Med Spa.

Muoz said that after discussing contraceptive options with Herwehe, she inserted an IUD in July 2021 four months after the O-Shot. She said Herwehe mentioned no pain, sensitivity or numbness.

No abnormalities in the vagina. No abnormal findings, she testified.

Muoz said she hadnt heard of Herwehes O-Shot until yesterday, having learned of it in the past 24 hours through counsel.

Herwehe, an El Cajon native who graduated from Grossmont High School in 2009 (two years after her sister), took the stand next and began describing work-related complaints.

She said everyone was promised pay raises after Haddad and Khashram took over. But it never happened. She said Khashram pressed her to expand her volunteer social media postings for the business, especially Instagram.

Soon she was doing it all the time, including her free hours, and it became exhausting.

It wasnt fun anymore, she said. And worse despite a marketing company posting we werent getting paid for it.

On the day of the O-Shot, Herwehe said colleague Evelyn Hernandez-Cardenas, who had just assisted with Nietos aborted procedure, looked very nervous, very uncomfortable.

But the doctor was still excited, telling how it was the greatest treatment ever, Herwehe testified.

Despite an excruciating lidocaine shot to the clitoris, Haddad told Herwehe: If you are past lidocaine, you should be good to go.

Haddad said shed let the area get numb and then inject PRP into the G-spot of the lying down Herwehe. Haddad used an iPhone flashlight to find the spot and said: I thought you had a kid, Herwehe told the court.

Haddad was heard saying the process was successful.

I couldnt even speak it hurt so bad, Herwehe recalled, saying co-worker Cardenas was out of breath, shaking and crying.

When helped to her feet, Herwehe felt as if she would pass out. Waking up later, as if after a long sleep, Herwehe said Haddad told her: You passed out 30 seconds, tops.

Cardenas looked like shed seen a ghost, Herwehe said. (Later that evening, the aide told Herwehe she had a two-minute seizure.)

Then Haddad noted the 2018 expiration date of the lidocaine and slapped her head, said Herwehe, licensed to give various skin and face treatments.

When Herwehe later texted Haddad about whether she needed to see a doctor, Haddad said no, suggesting she didnt have enough fluids at the time.

On her drive home, starting to feel dizzy, I was very paranoid, Herwehe said. Every injection site was red, puffy and inflamed.

When Cardenas took the stand, she recalled Herwehe falling to the floor and having some kind of convulsion or seizure.

She kept grabbing at her face, Cardenas testified. I panicked and went down to help Dr. Haddad, trying to move her arms away from her. I was scared. I was very much in shock.

Asked about the earlier procedure on colleague Nieto, Cardenas said Nieto screamed and had a lot of blood coming right out of her vaginal area. It wasnt like splashing out, but there was blood.

Cardenas said Haddad told Nieto: Dont tell Jaime how much pain you were in because she wouldnt want to go through with this.

On the stand Thursday was B Med Spa assistant manager Nieto, promoted from front-desk worker.

Attorney Vallero asked Nieto if written consent were obtained before her procedure.

Well, it was a verbal consent, not written, she said.

Nieto confirmed she had felt a high level of pain, but Haddad stopped after Nieto called for a halt. She said her vagina bled, but it wasnt excessive.

Was she asked to sign a consent form after the procedure?

Yes, Nieto said. She signed May 11, 2021 the day Herwehe balked and was fired.

Testimony resumes Monday, with closing arguments expected Tuesday or Wednesday.

See original here:
'Orgasm Shot' Caused Excruciating Pain, San Diego Jury Told in ... - Times of San Diego

Dermatologist Jessie Cheung on How to Make Your Penis Bigger – Men’s Health

NO SURPRISE TO anyone whos been living on planet Earth, but a lot of men want to have a bigger penis. The thing is, we cant go to the gym, do three sets of dumbbell penis reps, and get a larger schlong. If it were that easy, nearly every guy would be walking around with a snake in his pants.

Still, there actually are some things you can do to get a bigger penis, but many of these procedures are not cheap and come with some serious health risks. Nevertheless, we know you're probably curious about the wild world of penis enlargement, which is why we reached out to Jessie Cheung, M.D., a board-certified dermatologist who specializes in some of these techniques. Cheung has been a dermatologist for nearly 20 years, and six years ago, she moved from doing medical dermatology to focusing exclusively on cosmetic and sexual dermatology.

In addition to standard facial cosmetic procedures, Cheungwho's based in Manhattan and Chicagoperforms a slew of penis procedures, including fillers, fat injections, Bocox (that's Botox for your cock, FYI), and Emsella (a form of electromagnetic therapy that helps with premature ejaculation and erection strength.)

We interviewed Cheung about her dermatological methods for making patients' penises bigger, longer, and even capable of lasting longer during sex.

This interview has been lightly edited and condensed for clarity.

I dont want to brag, but a lot, hundreds. As a dermatologist, I'm used to looking at skin everywhere, including the penis, anus, scrotum, and perineum, and dealing with warts, hemorrhoids, and fissures. I stopped doing medical dermatology years ago and now focus on cosmetics, hormones, and sexual health. So that brings in men who need help with their erectile function, libido, premature ejaculation, and men who have purely cosmetic issues. The big one, of course, is increasing their penis size.

Actually, I see more men who complain about erectile dysfunction instead of size, but they always say that even if they are happy with their size, they wouldn't mind more length or girth.

I give them statistics: Numbers are facts. Interestingly, many of my men who want bigger penises have above-average length and girth. I think porn makes them lose touch with reality, just like we're seeing social media distort our perception of beauty.

Penis length must be 2.5 standard deviations below the average for that age to be considered a micropenis. For adults, that is 9.3 cm when stretched or 3.6 inches. In my office, I consider it a micropenis if they are too short to penetrate their partner.

Not that often. I would say my whole career, probably two that were so small they couldn't penetrateand that's really short. When its that small, they may want surgical intervention, and I dont do penis surgeries. So because of that, I don't see many men with a proper micropenis.

Yeah, so I perform filler injections. I also perform P-shots, which are designed to treat ED but have the additional benefit of increasing size, specifically girth. P-shots involve injecting biological substances such as Platelet-rich plasma (PRP). PRP is a source of growth factors for blood vessels and tissue, so activating the hibernating stem cells in the arteries and nerves stimulates repair and the production of healthy tissue.

P-shots start at $1800 and increase depending on the protocol used.

Ill try not to be too technical, but we draw your blood in these special tubes. We spin it down on the centrifuge, and on the top coat, there's a layer that's kinda yellowy, that's very rich with platelets, which contains eight to ten growth factors that are good for your blood vessels, collagen, and stem cell activation. So we inject that into places where you want to turn on stem cells, whether into your scalp to grow hair, your skin to help with wound healing, or the penis to activate stem cells to make blood vessels and nerves again. That said, PRP is about 10 to 15 years old. I prefer to use exomes.

So, I perform a topical infusion of exosomes, which really is the cutting edge of regenerative medicine. Exosomes are basically little email packets of information that your stem cells secrete to turn each other on and talk to each other. And they're filled with RNA, proteins, and peptides. Exomes have hundreds of more growth factors than PRP. They're also anti-inflammatory. So I use exosomes the exact same way I use P-shots, to help with ED, functionality, and size.

Anti-inflammation helps prevent tissue from aging. So in the case of penises, this will help you retain your functionality and erection strength as you age.

Fat is a great filler, and since fat is full of stem cells, I recommend fat for improving size and restoring erectile function. You will see increased girth and can regain lost length, both flaccid and erect.

A fat transfer to the penis is very straightforward. The injection technique is similar to how we inject the penis with regular fillers, but we are harvesting your own fat with gentle liposuction and processing the fat with PRP or exomes. I like to take fat from the pubic mound, which helps to expose more of the base of the penis to create more visible length. I call it pulling the turtle out of the shell.

Fat is a very cost-effective filler, and since fat functions as a natural implant, it lasts much longer than other fillers. The most significant benefit of using fat is the improvement of functionality, as the wound-healing activation of stem cells will target nerves and blood vessels to improve sensitivity and circulation. I like to transfer at least 20 mL of fat, which starts at $8,000.

There are risks associated with any injection! But understanding the anatomy and potential complications will mitigate those risks. For example, you don't want any material getting into large arteries, which can cause tissue to die. You also have to respect the layers and boundaries of the penis to avoid migration of the filler (i.e., the filler all moving to one place and sitting there). Bruising, swelling, uneven appearance, and infection are potential complications that I warn my patients about.

No, I have never had a patient who asked for a smaller penis. But penises do shrink over time, as testosterone levels fall and there is a decrease in blood flow. The blood vessels and tissue scar down and get stiff, so they can't stretch and fill up with blood for a full erection. As a result, men will notice their penis looking smaller while flaccid and erect and report softer erections.

Typically men in their fifties and sixties, though Ive seen men coming and seeking help for their shrinkage in their thirties.

Staying healthy [and] keeping your hormone levels optimized. [And you do that by] having a good quality of sleep, a healthy diet, keeping stress levels low, and not smoking. So things that are generally thought of as bad for you will negatively affect your penis size as you age.

Yes, my patients love Bocox! It helps with size and erections. Botulinum toxin works by relaxing the smooth muscle in the blood vessels of the penis. This means the blood vessels are more dilated and filled with blood at rest, so the penis hangs longer and thicker when flaccid. So its great if youre a grower and not a shower. But even with an erection, the penis is even more full of blood than usual, so it is harder and may be thicker. Bocox is a relatively safe treatment. It's usually two pokes after the application of a topical numbing cream. Risks include mild bruising and swelling.

So it's electromagnetic therapy. Basically, you're sitting on a chair, and a powerful magnet is at the chair's base. That magnet makes your pelvic floor muscles activate. So essentially, you're doing kegel exercises, whether it be for the penis, the vagina, or the anus. For the penis, that can help with premature ejaculation, but also erection strength and even size because of the increased blood flow. We have men who do Emsella for the anus, specifically sphincter control. There's a statistic that you complete over 11,000 Kegel exercises in 28 minutes on the Emsella chair. So it's very legit, and I love using it on my patients.

I will refuse to treat a patient who has unrealistic expectations. Beyond that, everyone has their own desired aesthetic, so I won't judge a man if he wants to have a huge penis. To each their own!

Social media and porn have created unrealistic expectations for bodies, faces, and genitalia. It's difficult to maintain a smooth, pink anus or vagina or penis or even nipples as we age, and sexual confidence is at an all-time low. Sex is excellent for your physical and mental health and appearance, so a therapeutic procedure that encourages sexual wellness and confidence is not really up to public judgment. It's a private health issue.

I had a patient who had filler injections done elsewhere. He had 15 syringes done in one session, and all the filler clumped up at the head of his penis. It was this huge blob. It looked like a golf ball.

So he came after it was botched to get it fixed. But didnt want to get the filler removed. So what I did was add more filler at the shaft and base, essentially to blend it in better.

Aside from the usual wows, what's memorable are the stories I hear when my patients return: sex multiple times a day, getting propositioned on Snapchat, video parties, and underground fame. My patients are definitely more confident. I had one patient who was too short to penetrate his partner, and after a combination of hormones, a P-shot, and fat transfer, he was finally able to have penetrative sex!

See the original post here:
Dermatologist Jessie Cheung on How to Make Your Penis Bigger - Men's Health

From filler to CoolSculpting: Woman ranks 10 best cosmetics procedures and reveals which to avoid – Yahoo News

An aesthetic industry professional has ranked all the cosmetics procedures shes had done and revealed which to get and which to avoid.

Lacey is a 27-year-old content creator living in Los Angeles, California, who shares fashion and beauty advice to her 17,000 followers. Most recently, the cosmetics industry worker went viral on TikTok when she shared all the treatments and cosmetic work shes had done, ranking them from worth it to never again.

Lifes good working in the aesthetics industry, she captioned the TikTok video, which has been viewed more than 650k times since it was posted in December last year.

First, Lacey began by revealing she had platelet-rich plasma (PRP) injections in her under eyes. She ranked the overall treatment a nine out of 10 because it left her under eyes swollen for the first day and gave her a really weird feeling during the treatment. Still, the injections naturally brightens and fills under eyes once its fully healed.

PRP treatments have grown in popularity in recent years. More commonly known as the vampire facial, the unusual treatment involves drawing a persons blood and placing it into a machine that separates the platelets from the rest of their blood. Then, the part of the blood that contains a high concentration of platelets is re-injected into the skin.

According to the American Academy of Dermatology, PRP has been used as a possible treatment for hair loss. Some dermatologists have also used the treatment to give patients younger-looking skin, such as reduced wrinkles, acne scars, or deep creases.

For her second cosmetic procedure, Lacey shared that she had a brow lamination and keratin lash lift, which she ranked an 100000/10. She said: [Im] obsessed with it and it lasts for at least 12 weeks. Bye, mascara.

Brow lamination is a relatively new chemical treatment to help make the eyebrows appear neater and fuller. Its done using different chemical solutions to coat the brows, before brushing the hair upward to remove any curls. Laminated eyebrows can last anywhere from six to eight weeks.

Story continues

Meanwhile, a keratin lash lift is a semi-permanent treatment that uses keratin to enhance the natural look of eyelashes. A keratin lash lift can last from four to six weeks and typically costs $100-$200.

Another cosmetic procedure Lacey recommended was a microneedling treatment using PRP therapy and exosomes, which helps stimulate growth factors using collagen. Microneedling is done using small needles to prick the skin mainly on the face to generate new collagen and skin tissue. This helps create smoother, firmer, more toned skin while minimising scars, wrinkles, and large pores.

Lacey gave the microneedling treatment a 10 out of 10 ranking, saying that shed get it all day everyday. While she warned her followers that you will smell like youre rotting on the first day of the treatment, she added: I swear its worth it

The cosmetics industry professional has also had some injectable fillers placed in her lips and chin. Lacey said she loved getting her lip filler with Restylane Kysse, which is designed with XpresHAn Technology for natural-looking lips lasting up to one year. Lacey said the fillers made her lips appear much more natural and gave the injections a 10 out of 10.

As for her chin filler, Lacey said the treatment can be used for a temporary fix and is amazing for facial balancing. Chin filler is a non-surgical procedure that involves injecting temporary dermal filler into the chin to help its shape and firm the surrounding area of the skin. Lacey gave her chin filler treatment an 8.9 out of 10 and said a chin implant may be better for those who prefer a more long-lasting option.

After Lacey revealed her favourites of the cosmetic procedures shes had done, it was time to go through the ones shed never do again. Beginning with a lip filler treatment using Juvederm, which is a popular injectable gel containing hyaluronic acid, Lacey gave this procedure a -20 out of 10.

Looks nice for, like, three months then migrates like crazy, she said.

The next procedure that she disliked was called Morpheus 8, a microneedling treatment that combines radiofrequency with the microneedling technique. During the treatment, tiny needles that emit radiofrequency energy are stamped into the skin to create a controlled injury to boost collagen and elastin production. Lacey gave this treatment a zero out of 10 for its high pain level but minimal results.

CoolSculpting was another cosmetic treatment that Lacey simply gave a one out of 10. CoolSculpting, which is the brand name for cryolipolysis or fat-freezing, is a non-invasive cosmetic procedure that uses cold temperatures to break down fat cells. It uses cooling paddles, which are applied to areas on the body to suction the skin to break down fat cells. Although Lacey said that the CoolSculpting procedure works for some, it made her body proportions really weird after the treatment.

Although the last two on her list werent exactly cosmetic procedures, Lacey said that applying sunscreen and retinol to her face made it so smooth and bright. Meanwhile, the one that received an infinity out of 10 ranking was having a reputable provider who can recommend what you need based on your goals.

With any cosmetic surgery, invasive or non-invasive, a patient must be made aware of the risks that are involved. Recently, model and TV personality Blac Chyna documented the process of removing her facial filler and silicone implants due to their physical dangers.

The physical dangers of getting illegal fillers are many, said Blac Chynas plastic surgeon, Dr David Matlock, after spending more than eight hours removing the injections from her butt. You can have infections, abscesses, sepsis, sepsis patients can die from that.

The Food and Drug Administration (FDA) has previously warned against injectable silicone and dermal fillers for large-scale body contouring due to risks such as long-term pain, infections, and serious injuries, such as scarring and permanent disfigurement, embolism (blockage of a blood vessel), stroke, and death.

Read this article:
From filler to CoolSculpting: Woman ranks 10 best cosmetics procedures and reveals which to avoid - Yahoo News

For long Covid patients who lost their taste or smell, a new treatment offers hope – NBC News

A numbing procedure usually used to treat pain and post-traumatic stress disorder is being tested as a way to restore smell and taste in people with long Covid.

It's called a stellate ganglion block. In the procedure, a doctor uses a temporary, local anesthetic like what a dentist would give before filling a cavity and injects it into a specific bundle of nerves called the stellate ganglion on both sides of a person's neck. The nerves are part of the sympathetic nervous system, which controls automatic bodily functions, such as blood pressure, digestion and heart rate.

The area is not known to have any impact on how a person perceives odors, however, leaving some experts skeptical of the approach. Other doctors say they have seen real improvements in patients who either can't smell anything or find previously delicious food and drinks now taste repulsive.

Smell disorders tend to become more common with age, and affect millions of people. As many as 1 out of every 8 people in America over age 40 have some kind of olfactory dysfunction, according to the National Institute on Deafness and Other Communication Disorders.

A survey last yearfound that about 15% of people with Covid-related olfactory loss still had trouble smelling correctly six months later.

Not many treatments are available for smell disorders. Doctors may try olfactory retraining, in which patients concentrate on sniffing four scents usually rose, eucalyptus, lemon and clove twice a day for at least three months. Smell therapy has shown promise in some clinical trials.

At Cleveland Clinic, doctors are offering stellate ganglion blocks to long Covid patients, with the hope of launching a clinical trial.

Jennifer Henderson, 54, of Franklin, Ohio, got Covid in January 2021 and immediately lost the ability to taste or smell anything. A year later, her senses came back, but were wildly distorted.

She first tried olfactory retraining "religiously" for months, without success. Peanut butter and ranch dressing still smelled like chemicals.

Chicken was the worst, she said. "It tasted like rotting flesh. I had to spit it out."

Finally, in November last year, she received the stellate ganglion block at the Cleveland Clinic. The effect was immediate. She held a fresh cup of coffee up to her nose and burst into tears.

"It was the best smell ever," Henderson said. "I just cried like a baby."

Dr. Christina Shin, a physician specializing in pain management at the Cleveland Clinic, said that nearly every day at least one or two patients are referred to her from the long Covid clinic affiliated with the hospital system for help with their smell and taste.

She has treated roughly 30 long Covid patients with the block. About half get better, she estimates, though the level of improvement varies between 25% and 90%.

Dramatic responses like Henderson's have made the rounds on social media, igniting enthusiasm in long Covid communities. But many doctors are cautious because no one really understands how it works.

Some experts theorize that it may increase blood flow to the brain. Others suggest the block acts as a "reset button" for the sympathetic nervous system.

Some question whether it works at all.

"There is no scientific evidence that this is effective," said Dr. Justin Turner, an associate professorin the department of otolaryngologyhead and neck surgery at Vanderbilt University Medical Center in Nashville, Tennessee.

"Given the lack of data suggesting efficacy, it's really hard to advocate for this for patients who have a problem that typically resolves with time," he said.

As many as 80% will recover on their own within about six months, said Dr. Zara Patel, a professor of otolaryngology at Stanford University.

That's because stem cells in the nasal cavity have the ability to turn into brand new olfactory receptor neurons that detect odors.

"Throughout our lifetime, probably every three to four months, each olfactory receptor neuron dies off, and a new olfactory receptor neuron comes in and takes its place," Patel said.

Sometimes those new neurons get confused after they regenerate, leading chicken to smell like rotten flesh, as in Henderson's case.

Distorted smell, called parosmia, isn't just about difficulty during mealtimes. The condition can have a profound and deeply upsetting impact on a person's life.

In 2021, researchers in the United Kingdom surveyed people with Covid-related parosmia. Some worried about the effect it had on how they felt about their children.

"A lot of my maternal bonding feelings for my children are tied up with smell," one woman said in the study.

Some reported that the problem was ruining their sex lives. One person wrote about a partner's "rotten breath." The stench was "unbearable, no matter how hard I tried to put it out of my mind."

Some patients fall into despair.

"I have had many patients crying in my office telling me that the parosmia not just the smell loss, but the smell change is destroying their life," said Dr. Nyssa Farrell, an assistant professor of otolaryngology-head & neck surgery at Washington University School of Medicine in St. Louis.

However, she was wary of anecdotes of people getting better after a stellate ganglion block.

"It kind of sounds like voodoo," Farrell said. "I'm a scientist and I don't just believe what people say."

With desperate patients in mind, she started a small study to see if the block would work well enough to justify launching a large, randomized clinical trial that would give the needed evidence.

Among 20 patients with trouble smelling correctly, 10 reported "slight to moderate" improvement after the stellate ganglion block. It wasn't a strong result, but enough to move forward "to see if this is a placebo effect or if this is real," Farrell said.

A larger study is in the planning stages.

A stellate ganglion block is not the only potential remedy under investigation for loss of smell. Patel, of Stanford, ran a study looking at whether an injection of platelet-rich plasma deep into the nasal cavity might help prompt olfactory neurons to form correctly.

The procedure involves drawing the patient's own blood, removing its red and white cells, leaving behind plasma full of platelets and growth factors known to regenerate different types of tissue.

"Hopefully, what platelet-rich plasma is doing," Patel said, is getting those neurons to regenerate in a way "so that the correct signal is sent back to the brain."

Among 26 study participants, those who got the plasma injection were 12 times more likely to report improvements in their smell loss than those who got placebo shots.

Patel is now offering the procedure to all of her patients who have lost smell.

Excitement for stellate ganglion blocks' potential for treating long Covid ramped up in December 2021 when Dr. Luke Liu, a pain specialist in Anchorage, Alaska, reported the successful treatment of two long Covid patients.

Many of their ongoing symptoms, including muscle pain, fatigue, dizziness, brain fog and loss of smell and taste, improved within a week of getting the injections, he said.

Liu theorizes that a "glitch" in the autonomic nervous system plays an important role in lingering Covid and similar post-viral illnesses.

"In the case of long Covid, that glitch prevents the nervous system, and probably the rest of the body, from healing itself from a viral infection," he suggested. "The stellate ganglion block acts by pushing the reset button to that system. By doing so, it allows the entire system to reboot and become more synchronized and organized."

Liu has treated roughly 300 patients, and says about 65-70% "do really well and don't need any other intervention."

Still, he cautioned, it's too early to call stellate ganglion blocks a cure. About 5% of patients, he said, don't have any lasting improvement. About a third must go back to the clinic every few weeks or months for additional injections.

Henderson, who was treated at the Cleveland Clinic, has had to return three times. Her smell and taste are better, she said, but not back to normal.

"This should be treated as a scientific clue rather than a solution at this point," Liu said, adding that larger studies are needed.

The bundle of nerves targeted in the block procedure is right next to the carotid arteries, a pair of major vessels that supply blood to the brain. If inserted incorrectly, the medication can disrupt vocal chords and lead to trouble breathing.

The risks drop tremendously when a highly experienced doctor performs the stellate ganglion block, which has been used for decades by pain specialists to treat complex pain syndromes, Farrell said. She partnered with an anesthesiologist for her studies.

"She does stellate ganglion blocks for a living," Farrell said. "For her, the risks are very low."

The cost of the procedure varies widely and some insurance companies do not cover the block to treat smell disorders.

Liu said that he charges $500 per block, and is disheartened by anecdotes of other clinics billing their patients thousands of dollars.

"To me, this is taking advantage of people who are suffering."

CORRECTION (April 1, 2023, 11:50 a.m. ET): An earlier version of this article misspelled the name of the assistant professor of otolaryngology-head & neck surgery at Washington University School of Medicine in St. Louis. She is Dr. Nyssa Farrell, not Ferrell.

FollowNBC HEALTHonTwitter&Facebook.

Erika Edwards is a health and medical news writer and reporter for NBC News and "TODAY."

Kristen Dahlgren is an Edward R. Murrow award winning journalist. She reports for NBCs Today show, NBC Nightly News with Brian Williams, and also appears on MSNBC and CNBC. Prior to her current posting, Dahlgren spent 9 years working for NBC News Channel NBCs affiliate feed service. She has reported from around the world and covered some of the biggest stories in recent years including Hurricane Katrina, the Japanese tsunami and the Newtown massacre. Dahlgren is based in New York.

Read more from the original source:
For long Covid patients who lost their taste or smell, a new treatment offers hope - NBC News

The Med Spa on the Corner Is Probably Breaking the Law – JD Supra

Look better. Feel better. Fountain of youth promises are making med spas one of the fastest-growing segments in healthcare. Botox injections, laser hair removal, IV hydration and therapy, medical weight loss, and hormone therapy seem to be available on every corner.

But most med spas are not compliant with Texas law. Either they are formed as the wrong entity type, they lack proper oversight and ownership, or all the above.

The consequences can be significant for everyone involved.

Med spa owners face potential civil and criminal liability for the unauthorized practice of medicine. Physicians associated with those med spas could find themselves subject to disciplinary action from the Texas Medical Board. And patients are caught in the middle.

The med in med spa stands for medical because many of the services they provide are medical in nature. Botox, Disport, Juvederm, and Kybella injections, microneedling, chemical peels, laser hair removal, dermaplaning, and CoolSculpting are considered nonsurgical medical cosmetic procedures by the Texas Medical Board.

IV hydration and therapy, platelet-rich plasma injections, medical weight loss injections, and hormone therapy are also medical services. If a procedure involves injecting a patient intravenously or subcutaneously, it is probably a medical procedure.

Before any medical procedure, a physician or midlevel provider (like a physician assistant or nurse practitioner) must perform a good faith exam, establish a medically appropriate treatment plan, and document everything in a medical record.

Midlevel providers must be supervised by a physician under a Prescriptive Authority Agreement. The physician must review a sample of the charts regularly and generally be available to the midlevel if they have questions.

This does not happen in many med spas.

Then theres the business side. The practice of medicine in Texas is regulated by the Texas Medical Practice Act, the Texas Medical Board, and administrative rules. Because med spas provide medical services to the public, they must comply with all these rules just like any other medical practice.

Med spas must be formed as an acceptable legal entity type. In Texas, medical practices are limited to professional associations (PAs), professional limited liability companies (PLLCs), and general partnerships with other licensed physicians. Many med spas are incorrectly formed as corporations or regular LLCs.

This is not just a technical problem. It leads to improper ownership. Medical entities, like med spas, cannot be owned by non-physicians. They must be owned by persons licensed to practice medicine in Texas.

There is a lot of information on the Internet, much of which is incomplete or wrong.

Texas is a Corporate Practice of Medicine state, which means that physicians cannot be employed to provide medical services by companies not owned by licensed physicians. In practical terms, a non-physician cannot start a company and then hire a physician to provide medical services to patients of that company. With very few exceptions, medical services can only be provided through professional entities owned by physicians.

These same prohibitions apply to midlevel providers like Physician Assistants and Nurse Practitioners. Physician Assistants can co-own a medical practice with a physician only if the physician controls a majority interest in the practice. Nurse Practitioners cannot own any percentage of a medical practice.

These are just a few of the compliance issues for Texas med spas. There are also in-office and website disclosure requirements, registration requirements, reporting requirements, and restrictions on the type of marketing or advertising the practice can engage in.

Patients are caught in the middle. Those injured at a non-compliant med spa may not know where to turn.

These types of complaints to the Texas Medical Board are growing at an alarming rate. If the non-compliant med spa has a Medical Director, the Board can discipline the physician for inappropriate supervision or unprofessional conduct. Physicians associated with non-compliant med spas are putting their medical licenses at risk.

For the unlicensed med spa owner, the Medical Board can shut down their business. In extreme cases, the unlicensed med spa owner could be charged with practicing medicine without a license. If the patient suffers a physical or psychological injury, the owner could be charged with a third-degree felony which carries jail time of two to ten years and a fine of $10,000.

If the patient hires an attorney to sue for malpractice, the med spas insurance company may deny coverage if the med spa was not formed or owned in compliance with Texas law.

Med spas are big business and growing rapidly. But with great reward comes great responsibility. Entrepreneurs owe it to themselves and patients to set up the med spa the right way, with the right supervision, and the right ownership.

Read more here:
The Med Spa on the Corner Is Probably Breaking the Law - JD Supra

Top AEW star provides an update on injury, likely to be out for "weeks" – Sportskeeda

Modified Apr 04, 2023 19:50 IST

The AEW roster has undergone another shake-up after one of its top stars suffered an injury that could potentially set them back for months. Matt Jackson has now updated fans on his partially torn bicep, and it seems like he might not be out for as long as initially believed.

According to reports, Jackson suffered his injury sometime during the nine-man Trios Championship match at AEW Revolution. The House of Black ended up walking away with the gold, coincidentally allowing the star to get some much-needed time off to rehab his injury.

During the latest episode of Being The Elite, Matt Jackson explained his injury and the alternate forms of rehabilitation that he'll seek instead.

Jackson continued, emphasizing that he feels good and is hopeful that he'll recover soon.

While not a fully-fledged member of The Elite, Don Callis also recently suffered a gruesome injury during a backstage attack at the hands of The Blackpool Combat Club.

Missed out on last week's AEW Dynamite or Rampage? Catch up with the results right here.

The Brawl Out Incident brought many of AEW's backstage issues to light and became an unfortunate stain on the promotion. While fans were upset by the controversy, it seems like it also deeply affected The Young Bucks.

During the premiere episode of AEW: All Access, The Jackson brothers revealed that they had private talks about hanging up their boots.

Despite this, there were rumors that The Young Bucks could potentially jump over to WWE once their contracts expire. Fans will simply have to be patient until then.

RIP Bushwhacker Butch. We spoke to Luke moments before his passing here

See the rest here:
Top AEW star provides an update on injury, likely to be out for "weeks" - Sportskeeda

What is ‘male pattern baldness’? – Livescience.com

Androgenetic alopecia, also known as male pattern baldness (MPB), is the most common cause of hair loss in men. It begins as a receding hairline or bald spot on the top of the head, progressing over time to the sides and rear of the head. The factors that drive this type of hair loss can also cause hair thinning, where hairs grow smaller in diameter, according to the American Academy of Dermatology (opens in new tab) (AAD).

Male pattern baldness affects males of all ages. Two-thirds of American men will experience some degree of hair loss due to MPB by age 35, and approximately 25% of men begin the process before they reach age 21, according to the American Hair Loss Association (opens in new tab) (AHLA).

People may lose their hair for many reasons, including serious diseases, reactions to certain medications, and in rare cases, extremely stressful events, but most hair loss in men can be ascribed to genetic and hormonal factors. However, the exact mechanisms behind male pattern baldness aren't fully understood, and it is likely to have more than one cause.

People with MPB tend to carry genes that make their hair follicles highly sensitive to dihydrotestosterone (DHT), a byproduct of testosterone, according to AHLA (opens in new tab). An enzyme called Type 2 5-alpha-reductase converts a small percentage of the body's testosterone into DHT; this enzyme can be found in various body parts, as well as in hair follicles. Hair follicles around the temples, mid-anterior scalp and hairline appear to be most sensitive to DHT, and in general, balding scalp may have a higher concentration of DHT than non-balding scalp, according to a 2020 study published in the journal Frontiers in Pharmacology (opens in new tab).

DHT binds to androgen receptors on hair follicles, causing the follicles to shrink and their life spans to shorten. Eventually, these hair follicles stop producing hair.

Hair follicles in balding scalp may carry more androgen receptors (opens in new tab) than those in non-balding scalp. In addition, certain genetic variations in the androgen receptor (AR) gene may make hair follicles more susceptible to the effects of DHT (opens in new tab), which in turn increases the risk of MPB. The age at which MPB starts may also be determined by genetic variations (opens in new tab) in the AR gene.

In a 2017 study published in the journal Nature Communications (opens in new tab), scientists analyzed genetic profiles of 10,846 participants and found that, in addition to genes involved in the hair growth cycle, androgenetic alopecia may also be linked to genes involved in the sleep-wake cycle and the formation of fat cells within the body.

Changes in the activity of stem cells may also play a role in male pattern baldness. For example, a 2020 study in mice suggests that hair follicle stem cells (HFSCs) in aging skin show different gene activity (opens in new tab) than those in young skin, and this may be linked to declines in hair growth. In addition, stem cells derived from fat tissue in the scalp tend to secrete more inflammatory proteins in balding areas than in non-balding areas, according to a 2022 study published in the journal Experimental Dermatology (opens in new tab). Such inflammatory markers have been linked to impaired activity in genes involved in hair growth (opens in new tab).

Researchers have also found that disrupted functioning of testosterone receptors (opens in new tab) in the scalp may lead to the degeneration of blood vessels that nourish hair follicles. This can result in a reduction in supply of oxygen and nutrients necessary for hair growth.

Hair loss can often be treated with a variety of at-home treatments, including over-the-counter and prescribed medications, according to AAD (opens in new tab).

Over-the-counter minoxidil (brand name Rogaine) can help during the early stages of hair loss. Many people see some regrowth when using this medication, but it may take about six to 12 months to see results. Minoxidil appears to be particularly effective when used along with another treatment, such as microneedling, a type of treatment that uses small needles to cause tiny punctures in the skin, AAD said.

Microneedling may stimulate hair follicle growth (opens in new tab) and allow topical treatments, such as steroid creams, to reach deeper layers of the scalp. Available evidence suggests that this strategy is safe and effective for MPB, but more large, gold-standard clinical trials are "strongly recommended to provide more definitive evidence," according to a 2022 review published in the journal Aesthetic Plastic Surgery (opens in new tab).

Prescription medication, such as finasteride (brand name Propecia) can also stimulate hair growth, according to AAD. However, this medication carries a risk of side effects that minoxidil doesn't, such as decreased libido and changes in cognition, including brain fog, according to a 2012 review published in The Journal of Sexual Medicine (opens in new tab).

Other procedures to regrow hair involve injections of corticosteroids into the bald areas, hair transplants and platelet-rich plasma treatment, a procedure that involves injecting blood plasma into the area with hair loss, AAD said. Platelet-rich plasma treatment, in particular, is considered a safe and effective alternative to hair loss medications, because it carries a low risk of serious side effects (opens in new tab).

In addition, there are surgical treatments available for hair loss, including hair transplants and scalp reductions, which involve removing balding tissue from the scalp, according to Stanford Medicine (opens in new tab).

The rest is here:
What is 'male pattern baldness'? - Livescience.com