- In recent past I saw many sad stories. One should be careful before using such things.
- Doctors warn that even if she survives she will almost certainly be permanently brain damaged
source: dailymail
Posted in: hair
By Fiorella Valdesolo
|
Posted in: hair
Brandishing a syringe the size of a caulking gun, hair-transplant surgeon James Harris, M.D., injects local anesthetic into the scalp of a male patient, a married financial analyst in his early forties who has asked not to be identified. We'll call him Scott. For five hours, I've been watching Dr. Harris perform a hair transplant called surgically advanced follicular extraction, or SAFE. A follicular unit is a miniature, self-contained hair factory embedded in the skin. Each square centimeter of human scalp contains 80 to 120 follicular units, and each of those has one to four hairs.
Though Scott is sitting upright, his scalp is a gruesome battlefield. Rivulets of blood seep from thousands of BB-size puncture wounds. A trash can is brimming with blood-soaked gauze. But Scott feels nothing. He's watching CNBC's financial roundup on a wall-mounted TV while thumbing through e-mails on his BlackBerry, oblivious to the mayhem topside.
Dr. Harris is using a motorized tool he designed himself, in a procedure that, for all its bloodshed, represents the current state-of-the-art in baldness treatment. The instrument has a blunt hollow tube that lets Dr. Harris make incisions less than a millimeter wide, in rapid-fire succession, around clusters of hairs without damaging the underlying follicles. It's painstaking work. I watched earlier as Dr. Harris donned mantislike headgear (dual loupes with six-fold magnification) and extracted follicular units from a band of hair between Scott's ears, a region of scalp hair docs call the "horseshoe fringe." In virtually all men, this fringe is impervious to balding, a vestigial result of genes that dictate how skin forms during fetal development.
By the time he's through, Dr. Harris will have made 1,045 incisions along the front and top of Scott's head, enough to accommodate the same number of follicular units removed from his fringe. An assistant counts the extracted follicular units under a microscope, tabulating the number of individual units and the number of hairs protruding from each one. Single-hair units are reserved for the front to create a feathered widow's peak. "I want to avoid a wall of hair jutting from the forehead," explains Dr. Harris, citing a common blunder of botched transplants. "SAFE is a lot less traumatic than other transplant procedures, such as a surgery in which a strip of scalp is extracted, because it's minimally invasive." Even so, the procedure looks medieval, and it's hard to believe this gory mélange will have a happy ending.
Hair transplants have improved dramatically in the past 10 years, although in the hands of unskilled surgeons, mishaps can occur that leave patients with gruesome doll heads. But transplants remain hamstrung for a more fundamental reason: You can shuffle only so many hairs from fringe to forelock. This is Scott's fourth surgery, and at this point he's simply running out of hair. It's a dwindling game of musical chairs that confounds surgeons and frustrates patients. The average age for undergoing a hair transplant is 40, but hair is doomed long before that. To be precise, its fate is decided in utero, during the tenth week of pregnancy, when the human fetus is the size of a peanut shell. That's when the fingers and toes take shape and the brain starts to evolve. It's also when the hair follicles form—roughly 5 million over the entire body. This number is fixed: After exiting the womb, the human body can't produce a single additional follicle.
That's why a revolutionary technique known as hair cloning, or hair multiplication, holds so much promise. It changes the game because it gives transplant surgeons an endless supply of follicular units to restore the vanishing manes of their patients. Researchers in a handful of labs around the world have been testing the technique on mice with impressive results. Several start-ups have formed, and these companies are racing to complete successful human clinical trials. It could have a profound effect on the landscape: Male pattern baldness, or androgenetic alopecia, affects 40 million men in America. Although it doesn't have any known physical downsides, the specter of premature aging and the perception of waning virility and diminished sexual attractiveness can be mentally debilitating and lead to personal, social, and work-related problems, according to Nigel Hunt, Ph.D., an associate professor of applied psychology at the University of Nottingham, in England. In 66 percent of men, hair follicles start to shrink around age 35 (in some men, it starts at age 21), causing hair to thin. By age 50, hair follicles are dying and 85 percent of men have significantly thinning hair. For these men, the cure for balding can't come soon enough.
The dawn of hair cloning
The eureka moment for Colin Jahoda, M.D., Ph.D., and Amanda Reynolds, Ph.D.—a husband-and-wife team of biologists at the University of Durham, in England—involved an experiment that also served as a nerdy version of a "Colin Forever" tattoo. Dr. Jahoda removed a hair follicle from his head, put it under a microscope, and snipped off a cluster of dermal papilla cells, which are located in a bulb at the root of the shaft. He then nicked his wife's forearm with a scalpel and transplanted the cells. A few days later, a thick tuft of dark hair (complete with Dr. Jahoda's male DNA) emerged. The experiment demonstrated, for the first time, the possibility of growing hair from transplanted dermal papilla cells. It seemed the two had found a new treatment for hair loss. Yet they soon discovered that, once removed from the body, dermal papilla cells quickly lose their ability to make hair if they are not transplanted immediately.
Angela Christiano, Ph.D., a professor of dermatology and genetics and development at the Columbia University College of Physicians and Surgeons, collaborates closely with Dr. Jahoda on hair-related research. "Not long after you remove them, the cells don't even know they're dermal papillae anymore," says Christiano, who is sitting in her office behind a desk piled two feet high with books and papers. "It's like taking an Etch-a-Sketch and shaking it," she says. "You erase their identity."
The Jahoda-Reynolds experiment worked because a clump of hair follicle cells were promptly relocated, which preserved their inductivity, a measure of their capacity to remain uniquely hair cells before devolving into something more generic. While I'm in her office, Christiano calls England and puts Dr. Jahoda on speakerphone. "These cells seem to have an in-built regulatory system," he explains. "We don't know how it works. Getting the cells to remain inductive is still the basic challenge."
Christiano became interested in hair follicle research in 1996, when a common hair disorder called alopecia areata caused patches of her own hair to fall out abruptly (steroid injections have revived it to a formidable whorl of ebony locks). Two years later, she made headlines after announcing she'd pinpointed several specific genes that are responsible for other genetic forms of hair loss—a scientific first. She is now focused almost exclusively on finding new genes for hair loss, as well as using dermal papilla cells to develop new ways of treating it. Scientists are still unclear about precisely what occurs, but they do know that whenever you pluck or shave a hair, molecular compounds in the follicle begin a complex dialogue with surrounding cells. These include dermal papillae, epithelial cells (those lining the wall of the hair shaft), and stem cells in a little-understood region referred to as "the bulge."
The dermal papillae are encoded with genetic instructions that respond to cues sent from surrounding cells and tissues in the follicle. Once signaled, the dermal papillae begin hatching hair fibers. What Christiano and Dr. Jahoda are trying to figure out is how to trick the cells into growing hair by themselves, without guidance from the rest of the follicle. Doing this would allow scientists to culture, or clone, thousands of dermal papilla cells in the lab that would retain their knack for producing hair. "With current transplant surgery, if you take a thousand follicles from the back of the head and move them to the front, you still only have a thousand," says Christiano. "With the cloning approach, you could start with a small biopsy of cells and then grow enough of them to repopulate your entire scalp with hair."
A researcher named Claire Higgins informs us she has just received a fresh dime-size chunk of live scalp donated by a male hair-transplant patient. We join her in a lab, where she is hunched over a steel table, staring into a microscope. With forceps and a long needle, she scrapes dermal papillae from each follicle. I look through the eyepiece. She tells me I'm viewing roughly 3,000 dermal papillae packed into a ball of cells just a fraction of a millimeter wide. They resemble golden tobiko, the flying-fish roe dolloped onto sushi rolls. These cells will end up in an incubator, where they'll be cultured for at least four weeks and then transplanted into mice to see if they'll produce hair.
Several factors determine whether this happens. One is the growth medium, the soupy broth fed to the cells to help them thrive. Another is how quickly the cells multiply: As Dr. Jahoda and Reynolds showed, the less time cells spend outside the body, the better they retain their inductivity. A third factor is how the cells are transplanted. Do you inject them? Or position them surgically under the skin? "We're trying to get into the heads of the dermal papillae and understand why they lose their inductivity," says Christiano. "Then we'll do the reverse: Take old cells that have been in culture for many months and bring them back into the fold, coaxing them to grow hair."
I ask Christiano how she and Dr. Jahoda intend to accomplish this. She smiles, clearly not wanting to tip her hand, and replies, "We have a few ideas. I will say that if we figure it out, a lot of hair-loss sufferers will be very, very happy." Their research could also inform next-generation baldness cures, genetic fixes that reprogram the cells, much like a software patch, and override the genes responsible for androgenetic alopecia.
Training hair cells to grow
Nude mice are the foot soldiers for the war on balding. These dainty pink-hued rodents have been bred or genetically altered to remain hairless throughout their lives. They can be ordered by the mischief-load from medical suppliers and endure poking and prodding and other unspeakable horrors for the sake of balding men everywhere. In Philadelphia, Ken Washenik, M.D., Ph.D., executive vice president of scientific and medical development for Aderans Research Institute and a clinical assistant professor of dermatology at New York University's Langone Medical Center, shows me slides of nude mice on his laptop. They have undergone a new type of hair-cloning procedure that Dr. Washenik has been developing for Aderans. The company, which has its headquarters in Tokyo, is the world's largest manufacturer of wigs. It also owns Bosley, which operates 88 hair-transplant clinics in North America.
When I arrive at Aderans, Dr. Washenik hastily ushers me past several labs, perhaps wary I might glimpse some sort of trade secret, and into an empty conference room. What he does reveal is that his approach to hair cloning (he calls it follicular neogenesis) doesn't rely solely on dermal papillae. "We are using a two-cell construct, growing not just dermal papillae but also another type of cell from the follicle," he explains. As the thinking goes, disparate cell types already communicate with one another in the follicle to regenerate hair. Dr. Washenik believes that if he can recreate that environment in the lab, cultured cells won't get dementia and forget how to make hair. "The different cells in the follicle are smarter than we are," says Dr. Washenik. "They already know they are supposed to be hairy. In eight days, we grew a ball of hair that never existed before on the back of a mouse."
Dr. Washenik clicks an image file on his computer: The photo shows what looks like Piglet—but with a sable Mohawk. But there is a caveat: "These were hair cells from a mouse that were injected into a mouse. When researchers injected human cells into a mouse, they didn't get the same results." This disappointed Dr. Washenik and other researchers, because unlike other organs, follicles are supposed to be immune privileged: When transplanted across or between species, they're expected to grow normally, without being rejected or provoking infection. He hopes to have better luck in clinical trials, when he will transplant human cells into humans. Aderans is in the second phase of a human trial, which is expected to be completed by the end of the year.
The company is pouring serious cash (Dr. Washenik won't say how much) into its hair-cloning effort. Dr. Washenik is also intrigued by other researchers who are pursuing another pathway. They're cultivating in-vitro microscopic hairs, or "proto-hairs," as Dr. Washenik dubs them. "These are early follicular structures that you can place in the scalp with the same technology that's used for a hair transplant," he says. "The big hurdle so far is getting the cells to multiply to make enough hair. Once we culture them, they sometimes die or de-differentiate."
But Dr. Washenik remains confident. "The sooner we figure this out, the better," he says. "So many people are waiting for this technology. I know that with every medical advance, the first one to market becomes the leader, and everyone else plays catch-up." Like many of the scientists I meet, his passion for a cure is personal. "I started going bald at 25," he says, tussling his hair to flaunt his 2,200-graft transplant. "While I was working on my Ph.D., I was mixing up homemade minoxidil [the active ingredient in Rogaine] in my lab."
A few blocks away is a start-up called Follica. One of its cofounders, George Cotsarelis, M.D., is a cutaneous biologist and associate professor of dermatology at the University of Pennsylvania. In 1990, Dr. Cotsarelis was investigating the biological mechanisms of skin regeneration. "I was studying stem cells and found a population of them in the hair follicle, in a strange area called 'the bulge,'" he tells me when I stop by his office at U. Penn's School of Medicine. "We didn't know the function of the area, and we almost blew it off." From then on, Dr. Cotsarelis started paying more attention to hair follicles. After a series of more recent experiments on mice, he made two important discoveries. First, he found that bulge cells aid in the formation of new hair follicles, suggesting that these cells influence hair growth during embryonic development, when we were bobbing around in the womb. He also learned that, throughout our lives, these same stem cells awaken to mend minor cuts and burns, as well as deeper wounds in the skin. What baffled Dr. Cotsarelis is why, if a healing wound is populated with bulge stem cells, new follicles don't form. The answer would at least explain why hair doesn't grow from scars.
Dr. Cotsarelis conducted further studies designed to reveal what kinds of molecular compounds (e.g., hormones and proteins) are present during hair-follicle development in mice embryos and are also present in adult mice. A major one, which he wrote about in a 2007 Nature article, was something called Wnt (pronounced wint), a network of proteins first identified in fruit flies. Curious, Dr. Cotsarelis applied Wnt to small lesions purposely cut into nude mice (such gracious, noble critters). To his shock, follicles formed and sprouted hair. So if a person is bald, the obvious strategy would seem to be to douse his scalp with Wnt and wait for hair to grow. "The problem is that Wnt is involved in a lot of other things, one of which is skin cancer," says Dr. Cotsarelis. "It's very tricky business."
The idea behind Follica is to develop a procedure in which a surgeon would lightly wound the scalp—something akin to microdermabrasion, an antiaging treatment—to disrupt the skin and then apply a compound that would influence hair development in the area. This would trick the cells into reverting to an embryonic state, one in which they are genetically pre-programmed to make hair rather than simply repair skin, as they're predisposed to do after we're born. "Just when cells are deciding, 'Do I make a hair follicle? Or do I make an epidermis?' we can influence them with a protein to go down a hair-follicle pathway."
Testing the science on humans
My hair started thinning when I was 32. I'm now 40, and my shedding has eased up. Dr. Harris informs me I have plenty left for a follicular unit transplant. But after watching Scott's procedure, I'm a little freaked out. Yet, all the specialists I speak with urge anyone dealing with hair loss to act fast, because once the hairs are gone, they're gone for good.
"Absolutely no one concerned about hair loss should wait," says Dr. Washenik. He started taking Propecia when he was in his thirties (he's now 50), and he uses Rogaine religiously. He is a big advocate of drug therapies, and readily champions surgical options such as follicular unit grafting. Dr. Washenik examines my scalp and announces, "Rogaine is made for you. You're not bald; your hairs are just miniaturized." I'm a chemical-phobe, so I'd rather save my dough and wait for a viable hair-cloning procedure, which many of the experts I talked to claim is less than five years away.
Intercytex, a public company based in London, may be closest to a marketable product, says Jerry Cooley, M.D., a transplant surgeon who has been consulting for the firm since 2001. Nobody directly employed by Intercytex would speak to me for this story. "We do not feel that exposure of our research is helpful," wrote Jeff Teumer, Intercytex's director of research, in a curt e-mail. But Dr. Cooley, who works closely with Teumer, tells me that Intercytex scientists have successfully grown large batches of cloned proto-hairs similar to those that other researchers have been struggling to keep alive. What's more, in animal experiments, the Intercytex team has observed cloned hair follicles growing hair again after the original hairs were plucked. This suggests that their cloned follicles cycle through the entire life span of hair—three phases known as anagen (growth), catagen (transitional), and telogen (resting)—something no other researchers have been able to do.
A key to the team's success has been growing proto-hairs in a special medium, licensed from a Japanese inventor, which contains cultured skin cells known as keratinocytes. "I'm very excited about this technology," says Dr. Cooley. "It's not a matter of if, it's a matter of when."
Bessam Farjo, M.D., a hair-restoration surgeon contracted by Intercytex to run its ongoing clinical trials, says, "All I can tell you is that we've grown a significant number of hairs on animals through this technique." It sounds encouraging, and Dr. Farjo expects to complete clinical trials this year.
Hair cloning will be pricey initially, so early adopters may be men who are not only wealthy but also desperate because they don't have enough hair left to do a follicular unit transplant. Cloning could also be ideal for younger men who aren't good candidates for follicular grafting. "Younger guys aren't suitable for current surgical techniques because we don't know how much hair they are going to lose," says Dr. Farjo. Imagine if the receded hairline of a 25-year-old male were replaced with a follicular unit transplant. If the rest of his hair were to fall out—and going bald at an early age generally means it will—he wouldn't have enough hair to complete a second or third follicular unit transplant, so he'd end up with a solitary plume sprouting from his forehead. "It would look like unfinished business, which is why we typically avoid working on young guys," says Dr. Farjo. "But if I know I'll never run out of hair, thanks to the new cell therapy, I can treat anyone."
Nobody is sure how the actual cloning process will be implemented. Most surgeons speculate that they'll use boring tools similar to the existing ones used for harvesting follicular units. The follicular units will be sent to centralized labs, where industrial incubators will mass-produce millions of follicle cells for a relatively low cost. Another question is how will the cloned cells be transplanted? Instead of transplanting follicular units, your surgeon may inject cloned cells into micro-incisions, or he may implant lab-grown hair follicles. It could be fast, clean, and painless. Or it might entail something closer to Dr. Cotsarelis's method at Follica. At Intercytex, technicians are tinkering with sundry techniques. "We're experimenting with varying the number of cells in each injection, and whether we have to inject the cells into the skin as it is, or if we have to pre-stimulate the skin," says Dr. Farjo.
Whatever the outcome, choices will abound. In the future, hair cloning will coexist alongside follicular unit transplants, drug therapies, and emerging technologies still incubating in the labs. For his part, Dr. Harris is also part of a team designing the world's first follicular extraction robot: It will fully automate the procedure, making it magnitudes faster and less expensive. While Scott, our balding financial analyst, was being prepped for surgery, Dr. Harris took me into his office to show me a photo of the $25 million speed surgeon (the actual machine was locked in a storage closet a few floors above us). At about six feet tall with a fixed base and a mechanical arm with multiple joints, it resembles one of those space-age automatons you might see on a vehicle assembly line at a Toyota plant. Dr. Harris has already tested it on a couple of willing volunteers (with no alarming mishaps) and is preparing to apply for FDA approval under the name Restoration Robotics.
"We think the robot might be able to extract a thousand grafts an hour," says Dr. Harris. "That's more than triple what can be done by hand. This will broaden the market so that more people can afford the procedure. There may be a time soon when hair-transplant surgery will be available to everyone."
Q: What causes split fingernails? Can the splitting be prevented?
Becky / No state given
Split fingernails are typically a result of repetitive or prolonged contact with water — think dishwashing and tub baths, for example. Nail polish remover also can contribute to split fingernails. Split fingernails usually aren't a sign of vitamin, mineral or other nutritional deficiencies.
To prevent split fingernails, treat your nails gently:
If the splitting doesn't improve or you're concerned about your split fingernails, ask your doctor for additional suggestions.
Just 36 hours after getting a pedicure at an upscale nail salon near her home in Lafayette Hill, Pennsylvania, Jamie Joffe, 38, had a fever of 101 degrees and a very scary-looking toe—“It was about five times its usual size, and there was greenish goo oozing out from under the nail,” she recalls. Joffe went to the emergency room, where they diagnosed her with a staph infection, probably from scissors or a cuticle pusher contaminated with the bacteria. “The doctor made an incision and drained all this stuff out of it,” she says. “If I hadn’t gotten the infection treated quickly, it could have spread to the rest of my body.”
After taking antibiotics for 10 days, Joffe was fine, but the experience left her with more than a scarred toe. “I still get pedicures, but I now bring my own tools and watch what they’re doing very carefully,” she says. “I had no idea you could get so sick from a pedicure.”
Most of us aren’t aware of the potentially ugly side of manicures, pedicures, Botox injections, haircuts, or waxing. “We assume that if a salon is operating it must be safe, but that’s not true,” says Shelley Sekula-Gibbs, M.D., a clinical assistant professor of dermatology at Baylor College of Medicine, who has studied salon infections and salon safety. “There’s lots to worry about, including poorly trained technicians and dirty or illegal instruments.”
Each state has its own rules for salon safety, but even those with the strictest standards, like California and Texas, can’t scrutinize the businesses as carefully as they’d like. “Each of our 18 inspectors is responsible for 3,500 to 4,000 shops, which means most salons get inspected only about once every six years—unless we get a complaint,” says James Jacobs, a supervising inspector with the California Bureau of Barbering and Cosmetology. “About 75 percent of the salons we inspect have violations. Sometimes they’re minor, like a nail file being re-used when it should have been tossed. But lots of times they’re real health hazards, like filthy foot spas.”
That’s bad news because, like hospitals, salons can harbor dangerous infection-causing bacteria and viruses, including methicillin-resistant Staphylococcus aureus (MRSA) and hepatitis B. That means it really is buyer beware, and the onus is on you to protect yourself. Here’s how to make sure all your beauty treatments are totally safe.
At the nail salon
Trouble spot: Foot spa
There’s nothing more relaxing than soaking your feet in a tub of warm, bubbling water—or is there? In 2000, 110 women who had pedicures at the same northern California salon were infected with a nasty bacteria, Mycobacterium fortuitum; some of the women had dozens of boils and were on antibiotics for months. Afterward, scientists from the California Department of Health Services took swabs from 30 whirlpool foot spas in 18 nail salons around the state and found potentially dangerous bacteria in all but one.
Since then, California has required nail salons to follow specific cleaning and disinfection procedures for their foot spas, but not all states have the same requirements—and not all salons follow the rules. In fact, 27 California salons were put on probation for foot-spa violations in the first six months of 2008 alone, says Kevin Flanagan, spokesman for the California Bureau of Barbering and Cosmetology.
Other foot-spa worries: warts and fungal infections. “Both spread on wet skin,” says Carolyn Jacob, M.D., director of Chicago Cosmetic Surgery and Dermatology.
Protect yourself
Wash your hands and feet with antibacterial soap before any procedure, and ask your technician to wash her hands.
Ask to see the foot-spa-cleaning log, Flanagan says. Salons with the highest standards drain all the water, scrub the residue from the walls, and run a cycle of disinfectant for 10 minutes between every client—a procedure that’s particularly important for older machines with pipes that can harbor standing water, a haven for bacteria. Many salons are switching to pipeless foot spas, which don’t have a place for water and bacteria to build up; they still should be disinfected between clients and at the end of the day, and filtration screens should be periodically removed and cleaned.
Don’t shave your legs the day of your pedicure because even a small cut can offer an entry point for minuscule bacteria and other infection-causing bugs. “See a doctor if you have a suspicious spot that won’t go away or gets worse after a pedicure,” says Oliver Zong, a New York City podiatrist. If your aesthetician has a cut on her hands, reschedule your appointment, ask for a different technician, or ask her to wear gloves—a practice some salons employ automatically.
Trouble spot: Mani and pedi instruments
You wouldn’t poke yourself with a sharp instrument at home without making darn sure it was clean, so don’t let someone working on your nails do it, either. The most dangerous tool in the salon is the Credo blade, a razor-like device that’s used to shave off calluses. It’s illegal in most states, but pedicurists routinely violate the rules, as Stacy Nartker, 25, of Kalida, Ohio, discovered when she received an inch-long gash on her foot from a Credo blade. “I didn’t need stitches, but I hobbled around for a few days afterward,” she says.
Nartker got off easy, according to inspector Jacobs. “People have had tendons cut because a manicurist slipped while shaving a callus on the heel,” he says.
Even legal instruments, like cuticle cutters and scissors, have the potential to transmit staph infections, hepatitis B and C, and, yes, HIV if they’re contaminated with even microscopic drops of blood from an infected person, says Sonia Badreshia-Bansal, M.D., a dermatologist in private practice in Danville, California. Far more common than serious bugs are annoying ones like fungal infections that can be picked up from contaminated tools, files, brushes, and cuticle instruments. “The best way to treat fungus is with a topical antifungal cream, but some require a prescription-strength oral medication,” she says.
Protect yourself
Ask how the salon disinfects its instruments. The most foolproof device is an autoclave, which sterilizes metal tools overnight. At a minimum, implements should be disinfected between clients; they should be washed in soap and water, then soaked in disinfectant in a covered container. “The solution should say bactericidal, fungicidal, germicidal, or virucidal on it,” Flanagan says. Clean tools should then be stored separately from used ones. Items that can’t be disinfected—nail-buffer blocks, nail brushes, emery boards—should be thrown away immediately after being used. To be supersafe, bring your own.
Just say no to razor-edge cutters and cuticle cutters. “Using a Credo blade is actually considered minor surgery—not something you want performed in a nail salon,” Dr. Sekula-Gibbs says. It’s easy to slice the skin with cuticle cutters, too. “Cuticles actually serve an important purpose, providing a protective barrier to microbes that could seep under your nails with water and cause an infection,” she explains. If your cuticles are too long, have the aesthetician gently push them back—or do it yourself at home with your own tools.
Avoid pedis and manis if you’re diabetic or if your immune system is compromised because of chemotherapy or a recent bout with a serious illness like breast cancer. “You’re much more susceptible to all sorts of infections if your immune system isn’t functioning well,” says Vincent DeLeo, M.D., chairman of dermatology at St. Luke’s Hospital, Roosevelt Hospital, and Beth Israel Medical Center.
At the hair salon
Trouble spot: Chemicals and relaxers
In 2007, doctors at Chicago’s Sumner L. Koch Burn Center reported that a young woman had received chemical burns while getting highlights at her local salon. She was hospitalized and received skin grafts, and was left with two 3-centimeter bald patches at the top of her head.
Although such severe injuries are rare, the Food and Drug Administration (FDA) says that hair straighteners and dyes are among the top consumer complaints and can cause everything from itchy, raw skin to trouble breathing. “I’ve had patients who have had allergic reactions—their faces and eyelids swell or they break out in hives—after salon hair treatments,” Dr. DeLeo says.
Protect yourself
If you feel a burning sensation on your scalp while you have color on your hair, alert your stylist and have her wash the chemicals off ASAP. Also, make sure your technician is paying attention when wielding hot blow-dryers, curling irons, and flat irons.
“Have your stylist test any chemicals on the inside of your elbow the day before you get your hair done to make sure you’re not allergic,” says Dr. DeLeo.
Trouble spot: Combs and brushes
Even at top hair salons, stylists toss used combs and brushes back in the drawer at their stations. It seems innocent enough, but those styling tools can carry fungal infections (ringworm and dandruff, for instance), as well as lice. “We regularly see outbreaks, especially of lice, that are spread through hair salons—and not just low-end places,” inspector Jacobs says.
Protect yourself
If you can see that the stylists are using combs and brushes on client after client, bring your own during your next visit. “That’s what I do,” says Zoe Draelos, M.D., editor of the Journal of Cosmetic Dermatology. “I don’t want to catch anything, particularly dandruff. Who wants a crusty, scaly scalp?”
Trouble spot: Shampooing sink
Having someone else shampoo your hair is a true pleasure of a salon visit. In rare instances, though, tilting your head back can cause a tiny tear in an artery in your neck, triggering a stroke.
Protect yourself
Tilting your head backward into a sink while shampooing can alter blood flow to the brain, but researchers at the University of Medicine and Dentistry of New Jersey reported that using a support, such as a towel, minimizes the problem.
Be sure you know the signs of stroke—sudden numbness or weakness of the face, arm, or leg on one side of the body; confusion or trouble speaking or understanding; trouble walking; dizziness or loss of balance or coordination; difficulty seeing in one or both eyes; a sudden, severe headache—and get medical help immediately. To prevent permanent damage, the anticlotting drug t-PA must be given within three hours of a stroke’s onset.
At the waxer
Trouble spot: Hot wax
Three years ago, Kathleen Croissant, 50, of Westlake, Ohio, had her eyebrows waxed before a black-tie event. The wax felt very hot the moment it was applied, but the aesthetician assured Croissant that the temperature of the wax pot was carefully controlled. After the wax was removed, Croissant’s skin started oozing and scabs began to form. “It was obvious that I’d been burned,” she says. “I had to go to a formal event with scabs on my eyebrows—and to this day the skin is crepey and wrinkled.”
Burns are actually fairly common during body waxing, according to inspector Jacobs. Even though wax pots are supposed to be temperature controlled, he says, it’s easy for them to overheat if they’re plugged in all day.
The other serious wax-related woe: infection, particularly if the aesthetician double dips the waxing sticks. “I’ve cultured wax, and there’s often bacteria in it,” Dr. Sekula-Gibbs says. “Since people have everything from staph to herpes to viral warts on their skin, double-dipping the sticks is a no-no—especially during a bikini wax.”
Waxing can also leave little red bumps called folliculitis on the skin, says Shelly Holmstrom, M.D., assistant professor of obstetrics and gynecology at the University of South Florida in Tampa, who has seen many clients with folliculitis from bikini waxes: “It happens when bacteria get in your hair follicles and cause a little localized infection.”
Protect yourself
If the wax feels too hot, say something right away,” California Bureau of Barbering and Cosmetology inspector James Jacobs says. “Even fairly minor burns on the face can leave permanent scars.”
Don’t use numbing products before waxing: Absorbing too much lidocaine-containing cream can be dangerous (particularly if you cover it with, say, plastic wrap). Plus, you can’t tell if the wax is too hot if your skin’s numb.
Make sure your technician has a license for waxing; a hairstylist, for instance, is not automatically licensed to wax.
To avoid infection, ask for a new wax stick with every application. And if you’re lying on a table for a bikini wax, be sure a clean towel or clean paper is beneath you.
To prevent folliculitis, wash the freshly waxed area gently with soap and water, apply a dab of antibiotic ointment, and keep it as clean and dry as possible, Dr. Holmstrom says.
Don’t get waxed if you’re using an antiwrinkle or acne treatment containing retinol; get tweezed instead. “The chemicals in Retin-A and similar products make your skin sensitive, so the wax can actually pull a layer off,” Dr. Vincent DeLeo says.
For a bikini wax, make sure the aesthetician wears disposable gloves.
At the medi-spa
Trouble spot: Injections
In 2006, a woman in Salinas, California, died after receiving injections of fake Botox (it was cooking oil) from a hairdresser who was not licensed to do the treatment; the stylist was later charged for causing the death.
Although serious side effects from cosmetic injectables are extremely rare, counterfeit products have caused the most serious problems. “It’s a big issue because there is only one real Botox cosmetic currently approved by the Food and Drug Administration (FDA), but there are lots of cheaper fake and foreign products,” says Julius Few, M.D., spokesman for the American Society for Aesthetic Plastic Surgery and director of the Few Institute for Aesthetic Plastic Surgery in Chicago. “When considering a cosmetic filler, it’s extremely important to make sure you’re getting something that’s FDA-approved.”
There can even be trouble with real Botox: If diluted incorrectly before being administered, its effectiveness can be reduced. “Botox comes as a powder and is mixed with a saline solution, so it could be overdiluted by someone trying to stretch profits,” says Bruce Cunningham, M.D., director of the division of plastic and reconstructive surgery at the University of Minnesota. “I hear patients say, ‘The Botox I got at the spa lasted only three months instead of the usual six.’ That may be because it was diluted.”
Cosmetic injections are considered extremely safe, but they can cause side effects, like bruising, redness, lumps, and bumps. Most are temporary, but some, like droopy eyelids and a frozen expression, both of which can happen with Botox, can be upsetting. “An under-
standing of dynamic facial anatomy—what the muscles do when you talk and express emotions—can make the difference between a natural-looking outcome and something that’s just plain bizarre,” says Richard D’Amico, M.D., president of the American Society of Plastic Surgeons. “The farther you get from a plastic surgeon’s or dermatologist’s office, the more likely you are to have less-knowledgeable or inexperienced people doing the procedure.”
Protect yourself
Make sure your initial appointment is with a physician. A nondoctor may not know the ins and outs of where a filler versus Botox would work best, says Alan Gold, M.D., president of the American Society for Aesthetic Plastic Surgery.
Check the credentials, training, and expertise of the person doing the injections. (In one state, a physician’s assistant with a day of training may be licensed.) Someone experienced in cosmetic fixes will know that the hyaluronic acid in Restylane and Juvederm, for example, can be dissolved by injecting a substance called hyaluronidase if something goes wrong—they’ll also know that some people are allergic to hyaluronidase.
Beware of prices that sound too good to be true. According to a recent analysis in the Wall Street Journal, the average price for Botox is $363; injectable fillers range from about $390 for collagen to $557 for Restylane, a hyaluronic acid. Prices can be much higher in urban areas, however.
Look at the product, Dr. Gold says: Make sure that the package is unopened and the brand name and manufacturer are the same as what you were promised. Allergan, for example, has put a hologram on its Botox packaging to foil counterfeits.
Find out the spa’s emergency procedures. “You should be told what could go wrong and how quickly a doctor can get there,” says Hannelore Leavy, executive director of the International Medical Spa Association and the Day Spa Association.
Ask about ongoing training. With new Botox-like products expected to reach the market in the next year, the situation will soon be more complicated. “All the new products disperse differently in the tissues, so you’ll need to inject each one somewhat differently,” Dr. D’Amico says. “People performing these procedures are going to need to understand the differences.”
Collagen is a natural protein in your skin and muscles that provides resiliency, shape and texture. Unfortunately, collagen production decreases with age— but you can fight back with dark fruit. "Blood oranges, cherries and blueberries are full of antioxidants, which decrease aging and disease by lowering inflammation. Antioxidants also increase collagen production and thicken the skin, making you look younger and healthier," says Julia Tatum Hunter, M.D., of Skin Fitness Plus in Beverly Hills. "Antioxidants also decrease [the severity of] rosacea." Blackberries, raspberries, plums, pomegranates, cranberries, Asian dragon fruit and kiwis also contain antioxidants.
Dry winter air can cause your skin to crack, chafe, itch and develop dry patches, but there are a number of things you can do to protect your skin, says Jeff Moore, an instructor of pharmaceutics at the University of the Sciences in Philadelphia.
"During cold spells, your skin is constantly bombarded, dried out, and increasingly susceptible to infection," Moore said in a university news release. He offered a number of winter skin care tips:
It's best to start taking care of your skin early in the winter, before dryness has a chance to set in, Moore said.
"While we often neglect our skin, or only treat it for cosmetic reasons, it's important to remember that our skin is an organ, part of the body just like anything else, and requires constant care," he said.
Step up your looks with these 30 simple tips that make a big difference -- and get noticed:
Bright smile. Before a wedding or party where you're going to be photographed, rub the juicy side of cut strawberries across your front teeth to brighten them.
Silky legs. If you suffer from ingrown hairs following hair removal, get into the Nivea Creme habit. Ingrown problems should become a thing of the past with a daily application as dry skin causes hair to imbed. Nivea helps to retain moisture, meaning existing hairs pop out and new ones don't appear.
Skin reviver. If you have jet-lagged or hungover skin, makeup artists swear by gel cloth masks like SK-II's Facial Treatment Mask. After cleansing, leave one on for as long as you can. There's no mud, no rinsing to remove gunk -- just a fuss-free mask that livens up your skin and saturates it with moisture.
Banish roots. If you have grey roots showing, a quick touch-up with dark mascara will do until you get to the hairdresser. For blondes, try a little hairspray focused at the roots and a dusting of loose, gold eyeshadow.
Baby-soft feet. For beautiful feet, use Benefit "Touch Me Then Try to Leave" cream. Rub all over, then wrap in cling wrap, put socks on, and leave overnight for totally soft skin by morning. Do this once a week, and your feet will be gorgeous by sandal season.
Polish fixer. Splash a drop of olive oil over freshly painted nails. This forms a protective film over the polish, encouraging it to dry more quickly and stop smudging. Alternatively, transform grubby nails by rubbing chalk under the tips with a nail brush to give a French manicured look.
Roller hair. If you've used hot rollers and your hair looks tight or dolly curled, spray a generous amount of Eau de Toilette on to a clean hand towel. Give your hair a gentle rub and tug -- this will break up the curls and settle it, giving a more relaxed, sexy look.
Don't be flaky. Dandruff? Crush up an aspirin and mix it with your regular shampoo. Properties in the painkiller will calm the dry scalp and save you splashing out on special brands.
Hair teaser. Instead of back-combing your hair, use a firm bristled toothbrush, digging it into the roots and lightly teasing. Softer baby toothbrushes are also a secret weapon on shoots as stylists use hairspray on them and smooth wispiness around the hairline.
Beat puffiness. Splashing your face with iced water in the morning will reduce puffiness. But did you know that if you hold an ice cube against the roof of your mouth with your tongue, the chill will help reduce facial puffiness from the inside out?
Smooth hands. Don't throw out used ground coffee -- it makes a great hand exfoliator. After it has cooled, place in a plastic bag in the fridge. Twice a week, scoop out a teaspoon and rub on your hands before rinsing and applying your usual cream.
Nail it. In a dire nail emergency, the rough ignition part of a box of matches will serve as a nail file for troublesome snags when you can't find an emery board.
Two-minute face-lift. An egg white and lemon juice mask has an instant tightening effect on skin, so it's ideal to do an hour before you go out to a party.
Add volume. If limp hair needs an injection of oomph after work, wet fingertips and massage the roots. Using a blow dryer, flip your head over, then blow your hair forward, getting heat on the scalp. Allow hair to cool before flipping back. If you've no access to a dryer, pin your hair up on top of your head, mist hairspray on the roots, wait to dry, and then brush hair upside-down.
Natural glow. To fake the natural look, dab some cream blush on the apples of your cheeks, then apply light foundation or tinted moisturizer over the top to the flushed-from-within look.

