CDC Warns Against Cosmetic Charlatans: “Liquid Silicone Injections” Linked to Kidney Failure
ATLANTA, May 2008 — The federal Centers for Disease Control and Prevention (CDC) is warning consumers against undergoing cosmetic surgery by unlicensed providers.
An article in the May 2nd issue of the Morbidity and Mortality Weekly Report details the cases of three women in North Carolina who developed kidney failure after they received soft-tissue filler injections in their buttocks of what they were told was liquid silicone. The women received the injections from an unlicensed provider at a single facility.
In December 2007, the North Carolina Division of Public Health was notified of the three kidney (renal) failure cases. All of the injections were administered by an unlicensed provider, whose only medical training was as a radiology or x-ray technician. Investigators were not able to definitively identify the substances injected, but records indicated that the injections contained liquid silicone.
Potentially fatal, acute renal failure occurs when the kidneys suddenly stop working, The kidneys are charged with removing waste products and helping to balance water and salt, as well as other minerals known as electrolytes, in the blood. When your kidneys stop working, waste products, fluids and electrolytes build up, causing potentially fatal problems.
According to records, the women all had large volumes of silicone oil and saline injected in their buttocks. Renal failure has not previously been linked to silicone injections, but since the contents of the syringes were not verified, it is unknown whether silicone oil or another substance in the injections caused the problem. All three women recovered. The practitioner was arrested and charged with practicing medicine without a license.
“These findings underscore the risks posed by cosmetic injections administered by unlicensed practitioners,” the researchers write.
The bottom line is that soft-tissue filler injections should be administered only by licensed providers with appropriate medical training, the CDC warns.
Think it can’t happen to you? Think again. Any person can claim to be a plastic surgeon. Safeguard yourself by doing the right research and asking the right questions before you choose a plastic surgeon or procedure.
Protect yourself from cosmetic charlatans by:
- Carefully checking credentials. Information about a surgeon’s education, licensure, board certification and disciplinary action is available from many sources, including your state medical board. The Federation of State Medical Boards in Euless, Texas at (817) 868-4000 provides the contact information for your state’s board.
- Choosing a board-certified plastic surgeon or dermatologist. A doctor’s board certification is the best indicator of his or her training in a specialty. [Read our article about requirements for plastic surgery board certification.]
- Checking facility accreditation. Cosmetic surgery can be performed safely in a hospital, a surgicenter or an office-based surgical facility. That said, many office-based surgical facilities are not accredited. Make sure the one you choose is, by checking with the American Association for Accreditation of Ambulatory Surgery Facilities at (847) 949-6058.
- Checking hospital privileges. Hospital review committees evaluate a surgeon’s training and competency for specific procedures before granting them permission to practice at that hospital.
Sources:
CDC, Morbidity and Mortality Weekly Report, May 2, 2008; vol 57: pp 453-456.
American Society for Aesthetic Plastic Surgery website. “Credentials: How to Check”
“The public needs to know that we are experiencing a skin cancer epidemic,” says Dr. Perry Robins, founder and president of the Skin Cancer Foundation. “We encourage people to enjoy the outdoors, but we want them to do it safely. By following our basic sun protection tips, you can enjoy outdoor activities and keep your skin healthy at the same time.”
- Seek the shade, especially between 10 a.m. and 4 p.m.
- Do not allow your skin to burn.
- Avoid tanning and UV tanning booths.
- Use a sunscreen with an SPF of 15 or higher every day.
- Apply 1 ounce (2 tablespoons) of sunscreen to all exposed areas 30 minutes before going outside. Reapply every two hours or immediately after swimming or excessive sweating.
- Cover up with clothing, including a broad-brimmed hat and UV-blocking sunglasses.
- Keep newborns out of the sun from head to toe every month.
- See your physician every year for a professional skin exam.
Written by: Diana Price
Women & Cancer Magazine
Ask why there’s a need for nonsurgical approaches to the treatment of nonmelanoma skin cancer, Dr. Bar responds, “Despite the proven cure rates of surgery – with Mohs it’s somewhere around 98 or 99 percent for a primary basal cell or squamous cell skin cancer – there’s always interest in noninvasive treatments, and there’s always a progress in medicine. The nonsurgical approaches are especially useful in treating actinic keratoses, which are precursors of cancer. They’re also useful in some of the more superficial types of skin cancer, and they may prove to be useful in people who are too frail to even come to the doctor’s office to go through surgery.”
Dr. Bar notes, however, that these other procedures haven’t been studied as extensively as surgery has been: “That’s one of the limitations of our knowledge base right now.” She also points out that people shouldn’t choose a nonsurgical approach simply because they’re afraid of surgery. “Part of the reason that people are worried about surgery is because there are many perceived risks of surgery, and some of them are misconceptions. Skin cancer surgery is extremely safe, and it’s performed almost exclusively under local anesthesia.” Additionally, reconstructive techniques used by fellowship-trained Mohs surgeons are highly advanced and design to restore appearance after surgery.
Written by: Kari Bohlke, ScD
Women & Cancer Magazine
Surgery is the most extensively studied approach to treating nonmelanoma skin cancer, and it generally results in excellent cure rates. Furthermore, surgery for nonmelanoma skin cancer is usually done under local anesthesia. “Skin cancer surgery is one of the safest surgeries performed in the United States,” says Dr. Bar.
Depending on the size and the location of the cancer, the surgical procedure used may require only a few minutes (curettage and desiccation) or up to several hours (Mohs surgery).
Written by: Kari Bohlke, ScD
Women & Cancer Magazine
Here are some possible signs of nonmelanoma skin cancer:
- A sore that does not heal
- Areas of skin that are:
Small, raised, smooth, shiny and waxy
Small, raised, and red or reddish brown
Flat, rough, red or brown, and scaly
Scaly, bleeding, or crusty
Similar to a scar and firm
Any changes to your skin should be discussed promptly with your healthcare provider.
Written by: Kari Bohlke, ScD
Women & Cancer Magazine
Skin cancer is often divided into two broad categories: melanoma and nonmelanoma. Nonmelanoma skin cancer refers to several different types, but the most common are basal cell carcinoma and squamous cell carcinoma.
Basal cell carcinoma account for roughly 80 percent of all cases of nonmelanoma skin cancer. It most commonly develops on sun-exposed skin, with the head (particularly the nose) and the neck being the most common sites. This type of skin cancer very rarely metastasizes (spreads beyond the skin), but it can cause extensive local damage to the skin and the surrounding tissues.
Squamous cell carcinoma accounts for roughly 20 percent of all cases of nonmelanoma skin cancer. Squamous cell carcinoma is more likely than basal cell carcinoma to spread to lymph nodes or distant parts of the body, though this happens infrequently. Squamous cell carcinoma may be preceded by a precancerous condition known as actinic keratoses (also known as solar keratoses), which often appears as rough scaly patches on the skin.
An alarming trend in both melanoma and nonmelanoma skin cancers is that the frequency of these cancers is increasing – including frequency in children and young adults. This increasing frequency is likely due to changing patterns of sun exposure. Sun exposure is an important risk factor for both melanoma and nonmelanoma skin cancer.
Written by: Kari Bohlke, ScD
Women & Cancer Magazine
Each year in the United States, more than one million people are diagnosed with basal cell or squamous cell skin cancer. Unlike melanoma, these types of skin cancer are rarely deadly. They can, however, cause extensive tissue destruction and disfigurement, and they commonly occur in cosmetically sensitive areas such as the face.
To reduce the likelihood of cancer recurrence – and the more extensive treatment that may be required to manage a recurrence – effective initial treatment is important. For a majority of patients, this involves treatment with one of several different types of surgery. “The benefits of surgery,” explains Anna Bar, MD, assistant professor of dermatologic surgery at Oregon Health & Science University, “are that it can be done in one day, it’s time tested, and it’s proven to be the most effective form of treatment with the highest cure rate.”
In certain cases other options may be considered. Nonsurgical approaches to the treatment of basal cell and squamous cell skin cancers include radiation therapy, topical medications, and still-experimental approaches such as photodynamic therapy.
Written by: Kari Bohlke, ScD
Women & Cancer Magazine
Because skin cancers are highly curable if detected and treated in the early stages, screening for skin cancer is one of the most important steps that people can take (besides staying out of the sun) to prevent skin cancer altogether or to optimize the chances for a cure.
Some people are at higher risk of developing skin cancer than others. For that reason individuals with risk factors that increase their chances of developing skin cancer are advised to visit a dermatologist for a screening. Risk factors, according to the American Academy of Dermatology, include the following:
- A close blood relative who has had melanoma, several more-distant relatives with a history of melanoma, or a family history of other skin cancers
- A personal history of skin cancer
- A history of exposure to UV rays from the sun, tanning beds, or sun lamps, whether intermittent or year-round, even if the exposure was years ago
- A past experience of severe, especially blistering, sunburn(s)
- Fair skin, especially when the person has blond or red hair and blue, green, or gray eyes
- Sun sensitivity or a tendency to burn and freckle rather than tan.
- Large, asymmetrical, or unusual-looking mole(s)
- 50 or more moles
- A history of X-ray treatments for acne
- A current regimen of immunosuppressive medications for severe arthritis or to prevent organ rejection
After the initial visit, the dermatologist will recommend to high-risk patients the optimal screening schedule. But keep in mind that even individuals who are not considered high risk of developing skin cancer are not in the clear; their risk of developing skin cancer is just not as high as people with the risk factors – they are still at risk. At the very least, everybody should speak with his or her health care provider regarding screening for skin cancer.
During a screening visit, a dermatologist will often put on glasses that magnify the skin. Dermatologists are trained to identify areas of the skin that may be cancerous – often areas that you or I would not recognize as abnormal with the naked eye.
If your healthcare provider identifies a “precancerous” area of skin, he or she may opt to remove it. Though not cancerous, such areas of concern are potentially cancerous and are therefore most often removed at the earliest opportunity. Removal eliminates virtually all risk that skin cancer will develop at that site. The procedure is typically performed during a short, outpatient visit in which the healthcare provider numbs the area and removes the precancerous skin. Often stitches are not required. The sample is sent to a laboratory to ensure that cancer is not present. Physicians may also burn or scrape the area of skin or apply an agent that will kill the top layers of skin.
If the dermatologist or other healthcare provider suspects skin cancer, other the area will be removed and sent to the lab for diagnosis. If the area is found to be cancerous, the diagnosis should identify whether it is BCC, SCC, or melanoma. Often the initial surgical removal may have eliminated all the cancer. If not, patients may be asked to come back for further removal or evaluation of potential spread.
Even if the skin cancer is not life threatening, early detection and treatment may lead to less scarring from surgical removal and may minimize treatment.
Written by: Jenny Maxon, RN
Women & Cancer Magazine
Skin cancer is the most commonly diagnosed type of cancer in the United States, and its rates continue to rise. In fact, according to the American Academy of Dermatology, at the rate at which skin cancer incidence is increasing, one in five Americans will be diagnosed with skin cancer in their lifetime.
So what are we being diagnosed with? There are three main types of cancer: basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and malignant melanoma. The different types of skin cancer refer to the type of cell within the cell from which the cancer has originated. Cells can become cancerous when exposed to the sun’s ultraviolet (UV) rays.
The good news is that BCC and SCC, which are more common that malignant melanoma, are both highly curable. And if malignant melanoma is caught early, prior to spread, it is also highly curable with surgery. The bad news is that once malignant melanoma has spread from its site of origin, it is one of the most deadly of all cancers, responsible for one death nearly every hour in the United States.
Malignant melanoma has a tendency to spread through the bloodstream and the lymph system to distant sites in the body, often invading vital organs such as the brain, liver and lungs. Once the cancer cells get trapped in these organs, they tend to continue to grow rapidly and crowd out the organs’ normal functions. In these advanced stages, malignant melanoma is difficult to cure with standard therapies. That is why it is important to remove melanoma before it gets a chance to spread.
Written by: Jenny Maxon, RN
Women & Cancer Magazine
Smokers are not good candidates for plastic surgery, or any surgery for that matter. We all know that smoking is bad for us. This is especially true after surgery. Smoking is by far the most important avoidable risk factor for poor healing after surgery.
Nicotine constricts your blood vessels, which deprives your wounds of oxygen and vital nutrients in your blood. Oxygen is needed for wounds to heal properly, and also fights infection. You need your blood to reach these damaged tissues in your body because the blood is delivering your antibiotics. Our immune system works through the blood supply. For tummy tuck and facelift patients (flap patients) it is especially bad because the skin flap can turn black and die.
Nicotine causes damage to the remaining blood vessels that have not been cut during surgery. Blood vessels become smaller due to smoking. Smaller blood vessels take longer time to carry blood and oxygen to the injury.
Smoking also complicates anesthesia. The smoke paralyzes your cilia (the small hair-like structures in your lungs that remove debris), and your risk of pneumonia increases.
Nicotine is present in all tobacco products, not just cigarettes. Some patients think that by using nicotine gum, smokeless tobacco or snuff they will be safe, however nicotine is present in all tobacco products.
You will not get the best possible outcome from surgery if you use nicotine products. It will be a waste of your time and money. Your surgeon might even refuse to operate on you if you refuse to quit. He is trying to protect you. If you tell him you quit, and then don’t, your bad results will be your own fault – don’t blame your surgeon.
