Cracking the Code: Facial Recognition

Scientists disclose the sophisticated math behind the brain’s visual perception of faces.

Family, friends, colleagues, casual acquaintances—how does the brain process and recognize the countless sea of faces we wade through every day? New research from Caltech reveals that the brain uses a simple and elegant mechanism to represent facial identity. The findings demonstrate a near future in which monitoring brain activity can lead to a reenactment of what a person sees.

The work was conducted in the laboratory of Doris Tsao (BS ‘96), Professor of Biology, Leadership Chair and Director of the Tianqiao and Chrissy Chen, Center for Systems Neuroscience, and Howard Hughes Medical Institute (HHMI) Investigator. A paper detailing the work has been published in the June 1st issue of the journal Cell.

The main focus of the new work is that even though there exist an infinite number of different possible faces, our brain requires only about 200 neurons to uniquely encode any face, with each neuron encoding a specific dimension, or axis, of facial variability. In the same way that red, blue, and green light merge in various ways to create every possible color on the spectrum, these 200 neurons can unify in numerous ways to encode every possible face—a range of faces known as the face space.

Some of these neurons encode aspects of the skeletal shape of the face—such as, the distance between the eyes, the shape of the hairline, or the width of the face. Others encode features of the face that are independent of its shape, such as the complexion, the musculature, or the color of the eyes and hair. In addition, the response of neurons corresponds with the strength of these features; for example, a neuron might reveal its strongest response to a large inter-eye distance, an intermediate response to an average inter-eye distance, and a minimal response to a small inter-eye distance. However, single neurons are not mapped onto specific nameable features. Instead each neuron codes a more abstract “direction in face space” that integrates different elementary features. By measuring where a face lies along each of these different directions, the brain can then perceive the identity of the face.

“This new study represents the culmination of almost two decades of research trying to crack the code of facial identity,” says Tsao. “It’s very exciting because our results show that this code is actually very simple.”

In 2003, Tsao and her collaborators determined that certain regions in the primate brain are most active when a monkey is viewing a face. The researchers called these regions face patches; the neurons inside, they named face cells. Over the past decade, research had disclosed that different cells within these patches react to various facial features. For example, some cells respond only to faces with eyes while others respond only to faces with hair.

“But these results were unsatisfying, as we were observing only a shadow of what each cell was truly encoding about faces,” says Tsao. “For example, we would change the shape of the eyes in a cartoon face and find that some cells would be sensitive to this change. But cells could be sensitive to many other changes that we hadn’t tested. Now, by characterizing the full selectivity of cells to faces drawn from a realistic face space, we have discovered the full code for realistic facial identity.”

Two critical pieces of evidence demonstrate that the researchers have cracked the full code for facial identity. First, once they knew what axis each cell encoded, the researchers were then able to develop an algorithm that could decode additional faces from neural responses. Specifically, they could show a monkey a new face, measure the electrical activity of face cells in the brain, and recreate the face that the monkey was seeing with extreme accuracy.

Second, the researchers hypothesized that if each cell was essentially responsible for coding only a single axis in face space, each cell should respond identically to an infinite number of faces that look extremely different but all have the same projection on this cell’s preferred axis. In fact, Tsao and Le Chang, Postdoctoral Scholar and first author on the Cell paper, found this to be true.

“In linear algebra, you learn that if you project a 50-dimensional vector space onto a one-dimensional subspace, this mapping has a 49-dimensional null space,” Tsao says. “We were stunned that, deep in the brain’s visual system, the neurons are actually doing simple linear algebra. Each cell is literally taking a 50-dimensional vector space—face space—and projecting it onto a one-dimensional subspace. It was a revelation to see that each cell indeed has a 49-dimensional null space; this completely overturns the long-standing idea that single face cells are coding specific facial identities. Instead, what we’ve found is that these cells are beautifully simple linear projection machines.”

“Our results could suggest new machine-learning algorithms for recognizing faces and providing new tasks to train networks with,” adds Chang. “It gives us a model for understanding how objects in general are coded within a large brain region. One can also imagine applications in forensics where one could reconstruct the face of a criminal by analyzing a witness’s brain activity.”

The paper is titled “The Code for Facial Identity in the Primate Brain.” Funding was provided by the National Institutes of Health, HHMI, the Tianqiao and Chrissy Chen Institute for Neuroscience at Caltech, and the Swartz Foundation.

In Human Cells and Live Mice Aging is Reversible

A new study reveals changes to gene activity that transpire with age can be reversed.

New research implies it is possible to slow or even reverse aging, at least in mice, by undoing changes in gene activity—the same kinds of changes that are the result of decades of life in humans.

As reported by a study published recently in Cell, by modifying genes that turn adult cells back into embryoniclike ones, researchers at the Salk Institute for Biological Studies reversed the aging of mouse and human cells in vitro, extended the life of a mouse with an accelerated-aging condition and successfully promoted recovery from an injury in a middle-aged mouse.

The study bolsters the scientific argument that aging is largely a process of so-called epigenetic changes, alterations that make genes more active or less so. Over the course of life cell-activity regulators get added to or removed from genes. In humans those changes can be triggered by smoking, pollution or other environmental factors—which dial the genes’ activities up or down. As these changes accumulate, our muscles weaken, our minds slow down and we become more susceptible to diseases.

The new study indicates the likelihood of reversing at least some of these changes, a process researchers believe they may eventually get to work in living humans. “Aging is something plastic that we can manipulate,” says Juan Carlos Izpisua Belmonte, the study’s senior author and an expert in gene expression at Salk. In their study Belmonte and his colleagues rejuvenated cells by turning on, for a short time frame, four genes that have the capacity to convert adult cells back into an embryoniclike state.

In living mice, they activated the four genes (known as “Yamanaka factors,” for researcher Shinya Yamanaka, the Nobelist who discovered their combined potential in 2006). This methodology rejuvenated damaged muscles and the pancreas in a middle-aged mouse, and extended by 30% the life span of a mouse with a genetic mutation responsible for Hutchinson–Gilford progeria syndrome, which causes rapid aging in children.

Because the Yamanaka factors reverse changes made to gene regulators, some scientists view the study as further evidence that aging is driven by epigenetic changes. “I do think that epigenetic reprogramming is the ultimate way to reverse aging,” says David Sinclair, a Harvard University geneticist and anti-aging researcher who was not involved in the study but is doing similar work. “My lab has a lot of evidence that the primary driver of what we call the hallmarks of aging is the epigenetic change.” Sinclair says his lab is preparing a paper explaining what causes these changes as we age.

The Salk study was conducted on middle-aged mice. But in theory, reprogramming epigenetics should work on mice and people at any age, remarks first author Alejandro Ocampo, adding that even cells from human centenarians could eventually be rejuvenated. He and Belmonte say they think they can improve the efficiency and results of the technique with more research—and that they can nullify the epigenetic changes responsible for aging by using easier-to-handle chemicals instead of the Yamanaka factors, hopefully advancing toward the potential of treatment for people.

Matt Kaeberlein, a molecular biologist at the University of Washington who studies aging but was not part of the work, says other researchers have found that the Yamanaka factors can rejuvenate cells—so in some ways this study is not astonishing. But Kaeberlein notes no one else had yet shown that the factors can treat age-related diseases in an animal by making the same changes. “That’s the wow factor,” he explains.

Kaeberlein says the study insinuates it may be possible not just to slow aging but to reverse it. “That’s really exciting—that means that even in elderly people it may be possible to restore youthful function,” he says. Plus, it is easier to imagine a treatment that makes changes to the epigenome than to consider going into every cell and changing its genes. He also notes that the results of the new study are very comparable to those seen when senescent cells—those that have lost function due to aging—are removed from an organism. It is not yet clear, he says, whether “this is another way to shut down or maybe reprogram senescent cells.”

Manuel Serrano, an expert on senescence at the Spanish National Cancer Research Center in Madrid, was not associated with in the new research but says he is impressed with the study and its results. “I fully agree with the conclusions. This work indicates that epigenetic shift is in part responsible for aging, and reprogramming can correct these epigenetics errors,” he wrote in an e-mail. “This will be the basis for future exciting developments.”

The study also demonstrated how fine the line can be between benefit and harm. When the researchers treated mice continuously, some developed tumors and died within a week. When the scientists reduced the treatment to two days out of seven, however, the mice benefited significantly. Sinclair says this should be taken as a note of caution by anyone trying to increase the human life span. “We’ve all been playing with fire,” he says, adding that this fine line will make it challenging to get a drug approved by regulatory agencies. “This is going to be what we spend the next 10 years figuring out: how to reprogram cells to be young again without taking it too far so they become tumors.”

Both Sinclair and Kaeberlein indicate they wish Belmonte’s lab had demonstrated that a normal mouse could live longer after the gene tinkering—instead of just reversing an aging-related illness.

Belmonte, like some other anti-aging researchers, says his initial goal is to increase the “health span”—the number of years that someone remains healthy. Extending life span, the number of years someone remains alive, will likely take longer to achieve. Most major killers, including heart disease, cancer and Alzheimer’s, are diseases of aging that become far more common past middle age. “This is not just a matter of how many years we can live but how well we can live the rest of our life,” Ocampo says.

Belmonte says his team is also trying to determine if aging is a process that occurs concurrently throughout the body. Or, as he puts it, “Is there some tissue that regulates aging—and when that goes bad, the entire organism goes bad?” He says they currently think the brain’s hypothalamus—known as the seat of control for hormones, body temperature, mood, hunger and circadian rhythms—may also act as a mechanism of aging.

Other methods that have been discovered to have anti-aging benefits in animals include calorie restriction, the drug rapamycin and parabiosis—the practice of giving old mice a blood supply from younger ones. The fact that these diverse strategies all seem to work suggests there may be more than one way to age, and that multiple complementary therapies may be necessary to significantly extend longevity, Kaeberlein says.

Some compounds such as resveratrol, a substance found in red wine that seems to possess anti-aging properties in high concentrations, appear to delay epigenetic change and protect against damage from epigenetic deterioration, Sinclair says. These approaches can reverse some aspects of aging, such as muscle degeneration—but aging returns once the treatment stops, he adds. With an approach like the one Belmonte lays out in the new study, theoretically “you could have one treatment and go back 10 or 20 years,” he says. If aging starts to catch up to you again, you simply get another treatment.

“This work is the first glimmer that we could live for centuries,” Sinclair says, adding that he would happily do so himself: “Forty-seven years went by pretty quickly.”

Yearning to Remain Viable, an Increasing Number of Americans 65 and Older are Turning to Plastic Surgery

Maria Vargas resented looking like an old woman. That was how the 68-year-old felt when she walked down the street. “I’d lost the looks of men,” said Vargas, who is divorced. “I’d walk by men and men would probably go, “Yeah, there’s a cute grandma’.” So in February, after months of grappling with the choice, she decided to have a Neck Lift.

“I got so excited about the difference that it made that I was like, ‘Oh my god, I want more’,” said Vargas, a Sacramento, CA resident who had never undergone elective Plastic Surgery before. Now, she said, “No 30-or 45-year-old guy is going to ask me, ‘Hey, what’s your number, honey?’ But a 60-year-old will.”

As reported by the American Society for Aesthetic Plastic Surgery, the number of people 65 and older receiving Facelifts and Cosmetic Eyelid Surgeries has more than doubled over the last two decades, with much of that increase occurring over the last five years. In 2015, 39,772 Eyelid Surgeries and 37,632 Facelifts were performed on people 65 and older. Although there is no age analysis within the category, doctors report that most of their older patients are between 65 and 75, and around three quarters are new to Plastic Surgery.

Part of it is related to demographics. People are living longer, and the baby boomer generation started turning 65 five years ago, so there are more people over 65 than in the past. But even taking that into consideration, the rate of Eyelid Surgeries among that age group has increased 62% and the rate of Facelifts has doubled.

The trend seems to reveal both cultural and economic shifts, including a growing acceptance of elective surgery helped along by popular shows like Nip/Tuck and a reduction in the procedures’ cost and invasiveness. Then, too, people are remaining in the work force and dating game later in life and dread becoming victims of age discrimination.

Some supporters argue that in trying to avoid the latter, older people who undergo Plastic Surgery to look younger are unintentionally bolstering ageism. But simultaneously, they acknowledge that in a world that fetishizes youth, the impulse may make practical sense.

“People are making a calculated decision, trying to escape the stigma of aging and buy a little time, be in the world and not be sidelined because of their appearance,” aid Bill Thomas, a Geriatrician who is trying to push Americans toward accepting old age as a welcome stage of life.

“It’s the age equivalent of ‘passing’,” Thomas stated. “You’re actually in this cohort but can you get everybody to believe you’re in a different cohort?”

Recently, both surgical and non-surgical options have increased. Doctors operating on older patients face factors like whether they are on blood thinners or need a stress test. Many people are forgoing the far more expensive Traditional Facelift, choosing minimally invasive in-office surgical procedures instead that cost $4,500.00 to $6,500.00, and also minimize the risk of medical complications more prevalent in older patients.

“Over the past five years, I have definitely seen in a dramatic increase in patient requests for minimally invasive Facelift Surgery using only Local Anesthesia. Yet, many are demanding the same results that a Traditional Facelift achieves. I developed the SLUPlift™ mini lift, which addresses all concerns. I have performed this procedure on patients from 40 years of age up to 79 years of age with excellent results.”

— Dr. Slupchynskyj

The reduced cost has made Plastic Surgery an option for more individuals. A generation ago “you may have had the odd movie star having something done, but it wasn’t something for the masses,” said Colin Milner, CEO of the International Council on Active Aging, an organization that promotes healthy aging. “Where it was once exclusive, it’s no longer exclusive.”

Presently, there are numerous economic factors. More Americans 65 and older are working than at any time since the turn of the century, and many encounter age discrimination.

If opportunities are favoring the young “and you begin to get old, you want to fit in….You’re invisible. And maybe this is the way for people to be visible.” Milner said.

But the change also reflects an evolution of how older people perceive themselves—which is to say, typically not as old as they have previously.

“I’m 60 and I remember when my grandfather and grandmother were 60 and it was like they had a foot on a banana peel and the other in the grave—and now (people their age) are skiing,” said Dan Mills, president of the American Society for Aesthetic Plastic Surgery.

More and more, as Americans stay more physically fit later in life, they often see a disconnect in how they look versus how they feel. That concern is not limited to baby boomers. Mills recalled a 78-year-old woman who played tennis and yet was constantly fending off a little boy who wanted to carry her groceries. After a Facelift and a Forehead Lift, the offers stopped.

It should come as no surprise, now that women are under more pressure to remain physically attractive, most older patients are women. But rather than the wholesale change in appearance that was more common in the past, they are more often seeking to return to work or social lives looking more refreshed than transformed.

When Linda Dodson, 68, of Oroville, CA, had a complete Facelift in March, “a lot of people, unless I told them, they didn’t really notice. They all just said I look great.”

She made the decision after receiving treatment for Breast Cancer, including a Mastectomy. “Things had been taken away from me personally, because of the cancer, and this was something I wanted to do for me,” she said.

Not everyone was convinced. “My husband was totally against it. He’d say, ‘I don’t want you to change, I love you the way you are.’ It made me feel good, because that’s how a husband should feel about you, but…I wanted to wake up in the morning and feel better about myself.”

Her husband wound up liking it—and it had other effects. “As I became older I had noticed that the general public isn’t as interested in what you have to say,” she said, “but afterwards I noticed a big change in how people react to me.”

That reality is discouraging for Ashton Applewhite, an anti-ageism activist who likens Plastic Surgery to “a prejudice against your own future self.”

“I really, really get the reasons why people dye their gray hair, lie about their age, and have Cosmetic Surgery,” she said. “But it’s not good for us, because it’s not authentic and it gives a pass to the underlying discrimination that makes those things necessary.”

She recommended that older women seeking romance “look around at your friends who are dating—they’re not the thinnest, they’re not the most wrinkle-free. They’re the ones who believe they’re the most fun in bed and who feel the best about themselves.”

However, Jean Stark, 83, a retiree in Lakewood, CO, isn’t interested in dating and sees no need to hold off as a political statement. She had work done on her eyelids a decade ago and is planning further procedures, including to her neck and jaw.

“It’s no big deal,” she says.

“If you look in the mirror and you don’t like the way you look, if you can improve yourself, why not?” Stark said. “I would have done this years and years ago, but then a lot of this wasn’t available years and years ago…What in the world have I got to lose? If I drop dead the next day, at least the undertaker will have a good face to look at.”

Millennials Apt to Post Plastic Surgery Results Via Social Media

Millennials post Plastic Surgery Results on Social Media

Everybody knows millennials rule social media.

Also called Generation Y, the typical 18 to 34-year-old crowd has grown up immersed in the digital age. Millennials typically feature their lives on multiple social networks.

Social media offers a sanctuary where people openly share every intimate part of their life, one post at a time. Very little is taboo ranging from captivating to the everyday, even provocative subject-matter.

With so many details about people’s lives visible the Internet, it’s no surprise that the results of Plastic Surgery procedures are also candidly broadcast and discussed on social media.

When it comes to honest posts about Plastic Surgery millennials dominate the social space. From posting about their surgery journey—snapping selfies in the waiting room—to flaunting photos of obvious body changes, there is virtually no shame affiliated with the choice to go under the knife for the sake of beauty.

According to the American Society of Aesthetic Plastic Surgery, by and large, Plastic Surgery has seen a dramatic increase in the U.S. over the past 19 years from about 1.6 million total procedures in 1997, to nearly 13 million in 2015.

The ASAPS is an organization comprised of Plastic Surgeons certified by the American Board of Plastic Surgery who focus on Aesthetic Surgery rather than Reconstructive Surgery. The group works on providing research and education on Plastic Surgery.

ASAPS research revealed Americans spent $13.5 billion on combined surgical and non-surgical procedures in 2015. That’s a $1.5 billion increase since 2014. Non-surgical procedures refer to services such as Botox or lip fillers as in comparison with Breast Augmentation or Liposuction.

Over the past five years, the demand for cosmetic procedures have increased 39% in the U.S.

As per the ASAPS, Millennials comprise nearly 18% of all procedures performed in 2015. They may not be the age group with the most procedures performed, but it’s still a large group.

Although many patients still remain tight-lipped about their Plastic Surgery, Dr. Daniel C. Mills, the President of the ASAPS, said sharing on social media is commonplace inside Plastic Surgery Centers and hospitals.

“The number of millennials willing to do that is a lot more than any age group,” Mills said. “They’re just used to it.”

Mills expounded that for millennials, it’s not about whether or not to share a post about their Plastic Surgery, it’s which social platform to feature it on.

“They’re just much more open about it on social media,” Mills remarked. “They’ve grown up with it.”

Social media can also play a major role in urging or inspiring a person to surgically enhance their body.

With nearly 78 million followers on Instagram, Kylie Jenner, famous member of the Kardashian family, is one of social media’s reigning queens.

The 19-year-old launched a media frenzy in 2015, when she admitted to having lip injections to create her now highly sought-after lips.

There may be no proven scientific connection between Kylie’s lips and millennial Plastic Surgery, but according to the ASAPS, lip fillers, formally known as hyaluronic acids or collagen, saw a 27% increase in 2015 with more than two million procedures performed.

These filler enhancements ranked as the third most popular non-surgical procedure for millennials in 2015, following hair laser removal and Botox, according to ASAPS research.

Many millennials have their front-facing cameras ready for their not-so-secret beauty enhancements when going in to see a Plastic Surgeon, even for a basic consultation.

“Being tight-lipped about having had a Plastic Surgery procedure is a thing of the past, not only with Generation Y. We see patients in my waiting room exchanging their selfie before and afters and they are many times patients in their 40s 50s and even beyond. They see the young crowd feeling quite comfortable sharing their everything including cosmetic procedure experiences with each other on social media and so they think, Why not? I have a group of ladies who friended each other on Facebook in my waiting room and now, they even like to book appointments together and follow each other’s progress.”  

— Dr. Slupchynskyj

Millennials may love to highlight their Plastic Surgery, but those social media posts come at a cost.

The average cost of a hyaluronic acid treatment in the U.S. is $591.00, according to the ASAPS. Lip fillers are temporary, meaning it’s a recurring.

ASAPS research reveals Breast Augmentation was the most popular surgical cosmetic procedure for millennials in 2015. The surgery will set a patient back an average of about $4,000.00 for silicone gel implants and $3,500.00 for saline implants.

1 in 5 American Women Ponder Undergoing Plastic Surgery: Body Image Issues Don’t Discriminate

women and Plastic Surgery

Body Dysmorphic Disorder (BDD) may not just be restricted to young girls inundate with skinny girl propaganda and media; a new survey discloses that older women are afflicted by the same body image problems.

85% of 55-to 64-year-old women said they were not satisfied with the appearance of “at least one” body part, according to the survey, commissioned by RealSelf.com. Additionally, 1 in 5 American women proclaimed they had planned or at least considered Plastic Surgery. 7% said they had undergone cosmetic operations previously. Over 90% of women between the ages of 18 and 24 are dissatisfied with at least one body part, the survey also found. That’s an extremely high number that doesn’t vary much as women mature.

“While the total market has previously been calculated by the procedures performed in the past year, we can see that the total addressable market is actually far greater,” remarked Tom Seery, CEO of RealSelf.com, in a press release. “As cosmetic procedures continue to become mainstream, millions of women are overcoming social stigma to pursue cosmetic changes they have been researching, often for years.”

Although many of these women might consider the idea of Plastic Surgery, most don’t actually go through with it. Their hesitancy stems from several factors. Among the biggest reasons why they don’t go through with it is debt (60%), fear of complications (58%), fear there would be a great deal of pain (5%1), fear from hearing negative stories (47%), fear it would leave them look worse (41%), fear of death (37%), long recovery time (54%), and the difficulty finding an honest, reliable doctor (40%). All very valid reasons to not have Plastic Surgery.

The survey revealed that young women were more likely to go out of their way to get help to change a certain body part, including going to spas, retail stores, Dermatologists, or Plastic surgeons. Though all women, regardless of age, were likely to mention their midsections, abdomens, backs, legs, thighs, buttocks, and skin as “problem areas” they were most displeased with.

“I have patients from 18 up to 80 years young who have pursued cosmetic changes. There is no age discrimination when it comes to enhancing one’s appearance.”

— Dr. Slupchynskyj

BDD involves believing that your appearance is defective, and therefore it must be fixed, hidden, or altered in some way to become more attractive. Many people with BDD turn to eating disorders or Plastic Surgery to quell these disturbing thoughts.

2016 Plastic Surgery Techniques Showcase Regenerative Medicine

Facial Plastic and Reconstructive Surgery

There have been numerous advances in Plastic Surgery over the past 10 years — both socially and medically. Patients wonder what advancements are on the horizon in the realms of Facial Plastic and Reconstructive Surgery? Looks like regenerative medicine may be the next big thing in this constantly evolving field.

Matthew Q. Miller of the University of Virginia, Charlottesville, and fellow coauthors have recently written a review article that considers regenerative medicine techniques in Facial Plastic and Reconstructive Surgery and revealed suggested directions for future studies. The researchers studied stem cells, growth factors as well as synthetic scaffolds. This burgeoning field provides hope to patients suffering crippling disorders of the face and other body parts, in addition to individuals seeking anti-aging remedies.

For instance, “Plastic Surgeons and researchers are developing regenerative medicine-based treatments for people with congenital anomalies of the hands and face, such as microtia, cleft lip and cleft palate; burns; limb and muscle loss; facial aging; facial nerve injuries; breast cancer; and other reconstructive needs,” the Mayo Clinic reported.

“Regenerative medicine is an exciting field with the potential to change standards of care in FPRS [Facial Plastic and Reconstructive Surgery]. This review touches on soft-tissue, cartilaginous and bony regeneration in Facial Plastic Surgery using stem cells, growth factors, PRP [platelet-rich plasma] and/or synthetic scaffolds. Our subspecialty has to continue to clinically investigate these techniques to show whether the new frontiers of regenerative medicine improve outcomes and cost-effectiveness in FPRS while not adding to the risks of treatment,” the review article noted.

As reported by Miller, regenerative medicine focuses on unlocking the regenerative potential of allografts and flaps, which are the foundation of surgical reconstruction.

“Regenerative medicine is a game-changing area of medicine with the potential to fully heal damaged tissues and organs, offering solutions and hope for people who have conditions that today are beyond repair,” the Mayo Clinic stated.

“I am very excited about the possibilities regenerative based medicine opens up, as it will positively affect the standards of care we have for crippling facial disorders and anti-aging treatments.”

— Dr. Slupchynskyj

Scientists anticipate that this new field could be a supplement or replacement for other tactics and procedures that have dangerous side effects or may not be good long-term solutions like Botox.

Recently, a similar study regarding Botox has been published. It provides evidence that injected Botulinum Toxin, can actually jump between neurons and hit areas it wasn’t intended to treat — adding legitimacy to a fear that began when the product first hit the market.

In 2009, the U.S. Food and Drug Administration added a warning to Botox’s prescribing information “to highlight that Botulinum Toxin may spread from the area of injection to produce symptoms consistent with botulism.”

Source: Miller MQ et al. The next frontier in Facial Plastic, Reconstructive Surgery. JAMA Facial Plast Surg. 2016.

Most Popular Plastic Surgery Ranked by State. Google’s Top-Searched Procedures in the U.S.

In 2015, 15.9 million cosmetic procedures were performed across the U.S. As reported by the American Society for Plastic Surgeons, Breast Augmentation was the most popular Plastic Surgery, but what are proclivities ranked by state? The Plastic Surgery Portal compiled information from Google to determine which procedures Americans are most curious about, but might not actually go through with.

On a map revealing the top-searched Plastic Surgery categorized by state, procedures include Breast Implants, Laser Hair Removal, Lip Injections, Penis Enlargement, Eyelid Surgery, Vaginal Rejuvenation, and Liposuction.

“I have seen a dramatic increase in the demand for Juvederm®™ and Microdroplet Silicone Lip Injections in the last two to three years.”

— Dr. Slupchynskyj

Adjoining states such as New York and New Jersey saw some drastic differences in popular procedures: the former searched mainly for Liposuction, while the latter was curious about Laser Hair Removal. Currently, the country’s two newest states, Hawaii and Alaska, were most interested in Penis Enlargement Surgery.

Overall, most state residents in the southeast region of the country were searching for information about Liposuction. Presently, Breast Implants were a top-searched term in the northwestern United States.

Compared to the previous year, Americans saw a 2% increase in Plastic Surgeries in 2015. Breast Augmentation has remained the most common procedure since 2006.

For Patients Who Require Bone Grafts, a 3-D Printer Could Provide Relief

Scientists have successfully 3-D-printed splints for babies’ airways, faux brains to study cortical folding — and now they’ve generated synthetic bone. A team of researchers at Northwestern University has created an extremely pliable, artificial bone that helps expedite recovery and that can be easily manipulated by surgeons in the operating room.

“This could also be adapted someday to accommodate Nasal Implants and Facial Implants in general.”

— Dr. Slupchynskyj

The “hyperelastic bone,” revealed in the journal Science Translational Medicine, could be cut, folded and sutured to tissues, and could lead to cheaper, customized and more effective bone grafts.

“It really fulfills a major need in the clinical world,” remarked Senior Author Ramille Shah, a Biomaterials Engineer at Northwestern University.

In order to repair damaged bone, surgeons typically use ceramic fillers or scaffolds made of hydroxyapatite, a mineral full of calcium and phosphate. Because a modified form of hydroxyapatite comprised the majority of human bones, these man-made ceramics should meld well with the natural tissue, enabling cells to grow.

There are numerous problems with these materials. They’re usually really stiff, which makes it extremely difficult for a surgeon to modify the implant without breaking it. And if doctors choose a more malleable putty instead, full of tiny granules, these tend to get washed away by blood flow during the operation. Many materials are also too dense, lacking the pores that would allow blood cells to colonize the area and for the body to integrate the graft.

Shah and her team wanted to 3-D-print a composite material that would have several key qualities: biocompatible, to avoid inflammation or rejection; porous, to permit blood vessels to grow; and pliable, easily handled by surgeons. They also wanted to make a material that didn’t need to be cured by heat.

If human bones were comprised of hydroxyapatite alone, they’d be extremely brittle. But because they’re composite materials, they also have some collagen, which is much softer. The combination of the two enables bones to be stiff while also being flexible enough to withstand all kinds of forces without snapping (most of the time, anyway).

Shah’s composite material operates in a similar way. In weight, its contents are 90% hydroxyapatite, which should make it very brittle, and yet it can be squeezed and stretched and still recover. There are probably two reasons for this. First of all, the remaining 10% is made of a soft polymer that coats the hydroxyapatite, providing just enough flexibility. In addition, the material is very porous, which gives tiny filaments of material enough space to bend when they’re bearing a load, and then recover without actually breaking.

“That porosity also leads to the very unique mechanical properties that we see with hyperelastic bone that has never been seen with this type of composite before,” Shah said. The result is a material that can be compressed to less than 50% of its original height without suffering damage.

“It can get pretty squished and then still bounce back,” Shah noted.

Oddly enough, if the scientists put more soft polymer into the mix (hence filling many of those pores), they found that the material actually became more brittle. Those empty spaces were key to the flexibility.

“That’s why it was very surprising,” she said. “You wouldn’t imagine, with such little elastomer in there, [that] you can make a huge difference in mechanical properties.”

The scientists discovered that the hyperelastic bone actually helped expedite spinal fusion in rats; in a macaque with a skull defect, they saw the start of bone regrowth in just four weeks — a process that would normally probably have taken two to three times as long.

Shah says this technology could be useful for infants born with craniofacial birth defects, not just for more typical bone breaks. She’s interested in learning whether different types of bones or kinds of defects will require that they 3-D-print different kinds of shapes.

Those designs can probably be very sophisticated, as the researchers can already print artificial bone that might be very stiff in one direction but very pliant in another. They can also incorporate antibiotics or other drugs into the scaffolding, for the sake of reducing infection or encouraging growth.

Shah’s team can print fast, as much as 275 cubic centimeters per hour. The scientists are optimistic that they’ll be able to scale up production of their artificial bone, theoretically providing such materials as an affordable option for more patients.

Good Genes and Evidence of a Skinny Gene

It is fascinating for doctors to hear patients inquire about whether they inherited good or bad genes. Individuals with a parent who lived to be 95 years are usually optimistic that they inherited the “good genes.” Conversely, in some families, the males die due to a massive myocardial infarction from coronary artery disease in their late 40s. Which factors are responsible for such drastic variations?  The human APOE e4 gene enables intestinal absorption of lipids and the efficient storage of fat in body tissue. While APOE e4 allowed humans to nutritionally survive to reach the the age of reproduction, it caused heart attacks and strokes, a phenomenon known as antagonistic pleiotropy; however, about 200,000 years ago when Homo Sapiens emerged from Africa, an APOE e3 allele appeared that is present in 60-90% of currently living humans. This new gene evolved to metabolize meat and fat rich diets and these individuals demonstrate lower serum cholesterol, lower incidence of coronary artery disease, and minimal cognitive decline. APOE e3 carriers typically live 6 years longer than APOE e4 carriers; therefore, APOE e3 can be deemed a good gene.

Many patients wonder why some individuals are prone to gain more weight than others. This had led medical researchers to search for the presence of a “skinny gene,” but, alas, none has ever been discovered. There is some evidence that specific bacteria in the gut are capable of promoting increased caloric absorption and the gut bacterial flora may be genetically controlled. Yet, “skinny” gut bacteria are not commercially accessible…Varying body fat inclination might be directly related to dietary animal fat absorption. Several genes possess the capability to absorb more lipids through the gut than others, such as the APOE e4 gene. Numerous human genes compensating for increased use of dietary materials have been highly coveted given that adequate food has been a constant struggle for man. Recently, copious amounts of food have become plentiful and the capacity to efficiently use every possible calorie has become a drawback, not an advantage.

The Most Desirable Facial Features for African-American and Caucasian Female Patients

In a recent article published by The Huffington Post, regarding a Facial Plastic Surgeon in London, Dr. Julian De Silva, who apparently tracked over 1,000 patients for the past 10 years, who requested certain characteristics possessed by celebrities worldwide, compiled attributes that comprise the perfect face that women are seeking in Cosmetic Facial Surgery; however, two Fox News Reporters who are both African-American women, indirectly suggested that these features are prominent among Caucasian women and slightly ridiculed Dr. De Silva’s findings.

In my previous 18 years’ experience, preforming Cosmetic Facial Surgery on both Caucasian and Ethnic patients, particularly a large portion of African-American, Hispanic and Asian patients, the trend of patients seeking cosmetic facial feature improvements are somewhat influenced by celebrities, but on the whole, patients are looking to have more balance and harmony in their facial features, rather than emulate other celebrities; therefore, stating that patients seek celebrity looks, is somewhat of a narrow-minded view in an all-encompassing world of Facial Cosmetic Surgery that includes all ethnicities: Caucasians, African-Americans, Hispanics, as well as Asians. The fact of the matter is that most patients who seeks Cosmetic Facial Plastic Surgery are looking to improve their looks somewhat, and they may use celebrity photos to demonstrate what they may want to look like, but the majority of those patients are not looking to look like celebrities, but rather to improve their facial features and make changes best suited to balance their facial harmony has been described in other aesthetic facial studies that have been published in peer-reviewed journals.

Although it is true that many patients seeking facial cosmetic procedures may provide photos of celebrities to give the Cosmetic Facial Plastic Surgeon more information about the results they are seeking, the Fox News Anchors’ criticism does bear some merit in the fact that many patients who I’ve seen in my office are not only Caucasian, but are of other ethnicities, including, African-American, Hispanic, European and Asian. Many of the non-Caucasian ethnicities bring celebrity photos that are not of female Caucasian celebrities. Patients typically seeking to restore some facial harmony typically have realistic expectations regarding results, which are shown to them via computer imaging. Furthermore, it has been well-studied and documented that there are particular facial features which are universally attractive to all ethnicities. There are specific angulations and proportions, as well as divisions of the facial anatomy that appear to be attractive features among all ethnicities, including African-Americans, Hispanics as well as Asians. The conclusion that Dr. De Silva made is flawed, due to the mere fact that over the last 25 years non-Caucasian ethnicities have increased their desire to have facial cosmetic procedures. The celebrities that these patients choose to emulate include African-American, Hispanic and Asian celebrities, not only Caucasian celebrities.

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