Lower Rate Of Liver Disease In African-Americans May Be Explained By Difference In Fat Storage

Where different ethnic groups store fat in their bodies may account for differences in the likelihood they’ll develop insulin resistance and non-alcoholic fatty liver disease, researchers at UT Southwestern Medical Center have found.

According to research reported in the online edition and the March issue of Hepatology, African-Americans with insulin resistance might harbor factors that protect them from this form of metabolic liver disease.

Despite similarly high rates of associated risk factors such as insulin resistance, obesity and diabetes among African-Americans and Hispanics, African-Americans are less likely than Hispanics to develop non-alcoholic fatty liver disease, or NAFLD. The disease is characterized by high levels of triglycerides in the liver and affects as many as one-third of American adults.

“If we can identify the factors that protect African-Americans from this liver disease, we may be able to extrapolate those to other populations and perhaps develop targeted therapies to help populations prone to NAFLD,” said Dr. Jeffrey Browning, assistant professor of internal medicine in the UT Southwestern Advanced Imaging Research Center and the study’s senior author.

Previous research has shown that when African-Americans do develop NAFLD, they’re less likely to reach the later stages of liver disease. Prior work by Dr. Browning and other UT Southwestern scientists has revealed that NAFLD is more prevalent among Hispanics than African-Americans or Caucasians.

For the current study, Dr. Browning and his colleagues analyzed data gathered in the multi-ethnic, population-based Dallas Heart Study. Starting in the year 2000, more than 2,100 participants provided blood samples and underwent multiple body scans with magnetic resonance imaging and computed tomography to examine the liver, heart and other organs. Body composition, including fat distribution, also was scrutinized.

The study found that African-Americans and Hispanics both have obesity rates of about 48 percent among their respective populations, as well as diabetes rates of about 21 percent. Only 23 percent of African-Americans, however, have NAFLD, compared with 45 percent of Hispanics.

Similarly, African-Americans are less likely to have high levels of triglycerides and abdominal fat – both characteristics of insulin resistance – when compared with Hispanics or Caucasians, even though overall rates of insulin resistance among all groups are the same, researchers found.

“This presents something of a paradox,” Dr. Browning said.

The explanation might lie in where different ethnic groups typically store fat.

Obese Hispanics tend to deposit fat in the liver and visceral adipose tissue – the area around the belly. Obese African-Americans deposit fat predominantly in subcutaneous adipose tissues – the area around the hips and thighs, Dr. Browning said.

“This may be protective,” Dr. Browning said. “In animal studies, if subcutaneous fat is increased as opposed to visceral fat, you can actually reverse fatty liver disease.”

Scientists aren’t sure why the location of fat storage matters.

“This seems to argue that there is a fundamental difference in the lipid metabolism between African-Americans and Hispanics or Caucasians, and this difference is maintained even when insulin resistance is present,” Dr. Browning said.

Differences in liver-fat content in Caucasians seem to be based on gender. Caucasian males are at the highest risk for NAFLD, on par with the risk faced by Hispanics in general. Caucasian females are on par with the African-American population, at about 23 percent. Caucasian females, like African-Americans, might benefit from the greater predilection to store fat in lower extremities.

“Research studies traditionally have been based on examining Caucasian males, but this information suggests that there are sometimes ethnic and gender differences that need to be studied individually to determine if there are important clues we’re missing because we’re lumping everybody together,” Dr. Browning said.

Researchers next will study how differences in metabolism affect fatty liver disease.

Notes:

Other researchers from UT Southwestern involved in the study were lead author Dr. Richard Guerrero, a postdoctoral trainee clinician in internal medicine; Dr. Gloria Vega, professor of clinical nutrition; and Dr. Scott M. Grundy, director of the Center for Human Nutrition.

The study was funded by the Donald W. Reynolds Foundation and the National Institutes of Health.

Source:
LaKisha Ladson
UT Southwestern Medical Center
Article Date: 28 Mar 2009
Medical News Today

Stop Using Hydroxycut Says FDA

The US Food and Drug Administration (FDA) are warning consumers to stop using Hydroxycut, a range of dietary supplements that are marketed for weight loss, fat burning, energy enhancing, low carb diet aids and water loss. The product has been linked to at least one death and cases of serious liver damage.

The FDA warning came on Friday 1st May, and said that the Canadian manufacturer and US distributor have agreed to recall all 14 products which are sold through grocery stores and pharmacies. The products are advertised as containing natural ingredients, and about 9 million items were sold last year.

Hydroxycut ban by FDA

Hydroxycut is made by Iovate Health Sciences Inc, of Oakville, Ontario and is distributed by Iovate Health Sciences USA Inc. of Blasdell, New York.

The FDA has received 23 reports of serious health complaints in connection with the product. These range from jaundice and raised liver enzymes (a sign of possible liver injury), to liver damage that is so bad the patient needs a transplant.

There is a report of 1 death linked to the product, said the FDA.

Dr Linda Katz, interim chief medical officer of the FDA’s Center for Food Safety and Applied Nutrition, said:

“The FDA urges consumers to discontinue use of Hydroxycut products in order to avoid any undue risk.”

“Adverse events are rare, but exist. Consumers should consult a physician or other health care professional if they are experiencing symptoms possibly associated with these products,” she added.

Other health problems have also been reported. These include: seizures, cardiovascular problems, and rhabdomyolysis, a type of muscle damage that can result in serious problems, including kidney failure.

The people who have suffered liver injury from using the product said they were using it at the doses recommended on the label.

Symptoms of liver injury include jaundice (when the skin and/or the whites of your eyes go yellow), brown urine, loss of appetite, nausea, vomiting, light-coloured stools, feeling very tired or fatigued, feeling weak, itching and pain in the stomach or abdomen.

The full list of 14 products affected is given in the FDA news alert.

Although the FDA hasn’t received reports of serious liver problems linked to all the Hydroxycut products, the manufacturer has agreed to recall all of the ones in the list which does not include Hydroxycut Cleanse and Hoodia products.

If you have any of the products affected you should stop using them and take them back to where you bought them, said the FDA.

The FDA said it does not know which ingredients, dosages or health-related factors are at the bottom of the risk problems linked to these products, which contain a range of herbal extracts and other ingredients.

Main sources: FDA.

Written by: Catharine Paddock, PhD
Medical News Today
Article Date: 04 May 2009

New Research Evidence: Lipodissolve Injections Cause “Profound Adipocytolytic Effect”

New Evidence for Lipodissolve: Sprawling new research by the Max Delbrück Center for Molecular Medicine in Germany has finally proven that Lipodissolve injections really work, causing “profound adipocytolytic effect”.

A group of researchers with the Institute for Clinical Pharmacology, Center for Molecule Medicine in Germany, took to task to investigate  Lipodissolve and whether science would prove any cosmetic improvements from Lipodissolve injections. The study has not only shown that Lipodissolve works, but according to research results it may work better than expected.

The group investigated human preadipocytes, adipocytes, vascular and skeletal muscle cells as well as renal epithelial cells and incubated these in the compound. Morphological changes were described, and cell vitality was measured. The findings discovered that a strong cytolytic effect resulted from the injections, signified by lipid release and dyed adipocyte nuclei. The results from the studies showed that more than 90% of cell death occurred after 90 s in preadipocytes, after 6 min in vascular smooth muscle cells, skeletal myotubes and renal epithelial cells, and after 15 min in adipocytes. Dilution slowed down cytolysis, but still >50% of the cells disappeared during 30 min incubation. Neither osmotic effects nor differences in medium acidity were responsible for cell death.

Surprisingly, mature adipocytes and differentiated lipid laden adipocytes were more resistant to the cytolytic effects than other human cell types such as fibroblast-
like preadipocytes, vascular and skeletal muscle cells, or renal epithelial cells.

The research group did not determine the cytolytic effects of any single ingredient of the mixture compound because phosphatidylcholine is the main component with a significant share of 93%. However, desoxycholate, a bile salt with known chemical activity as a detergent of lipid droplets and cell membranes, also demonstrated cytotoxic activity in porcine skin when compared to a common detergent used in the molecular biology laboratory, Triton-X. This observation already lead to a small openlabel uncontrolled clinical study of desoxycholate injections into human lipomas. The mode of action of injecting the compound into subcutaneous fat pads thus clearly is cytolysis, and the reduction of lipoma size appears to be in part due to cell destruction and in part to emulsification of released lipids that are then removed via lymphatic drainage.

The study emphasized that proper training is essential to avoid injections into wrong tissue, in the case of accidental intramuscular injections.

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Note: The chemical composition and raw materials in the proprietary condensed, high quality phosphatidylcholine PCX100, the new compound for ASAL Lipodissolve, is the same as in the product used in this research study. PCX100 is only for sale through AnazaoHealth Corporation, Tampa, FL.

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Cream used to treat skin cancer also wipes out wrinkles, say researchers

By Jenny Hope
Last updated at 9:02 PM on 15th June 2009

Potential: A cream used to treat signs of skin cancer ‘is a promising cosmetic’

A cream used to treat the early signs of skin cancer can erase wrinkles and make skin look younger, claim researchers.

Doctors prescribe the cream called Efudix to treat actinic keratoses, a form of precancer usually found in the face, neck and forearms.

But new tests show it may reverse changes associated with the ageing effects of too much sun, including fine and deep wrinkles, dark spots, shadows and sallowness.

When used as an injection, the chemotherapy drug, also known as fluorouracil, is used to treat a number of cancers including those of the pancreas, bowel, and head and neck.

US researchers carried out tests on the topical form of the drug to see whether its wound healing effect might produce younger-looking skin.

Dr Dana Sachs and colleagues at the University of Michigan said the drug had been around for 40 years, and there was anecdotal evidence it improved the appearance of wrinkles.

They studied 21 people aged 56 to 85 with actinic keratoses, which emerges as scaly or crusty bumps on the skin, and sun damage.

The volunteers used the cream twice daily on the face for two weeks and the team measured changes in the skin, taking facial biopsies over a six-month period.

The drug had a significant effect, according to a report in the Archives of Dermatology (must credit).

Dr Sachs said ‘People’s skin was much softer.

‘The texture was improved. There are fewer wrinkles around the upper cheek and eyes.

‘People have commented for years that they look better. Not only are their pre-cancers gone but the quality of their skin seems to be improved.’

The researchers also noticed skin appeared less yellow and more even toned with fewer brown spots.

Almost all the patients rated their skin as ‘improved’ and said they would be willing to undergo the therapy again – even though it caused redness and inflammation that some described as ‘looking like raw hamburger meat’.

The researchers claimed the cream has potential as a cosmetic treatment because of its relative low cost compared with laser resurfacing, a widely available treatment for improving sun-damaged skin.

But leading consultant dermatologist Dr Nick Lowe, of the Cranley Clinic, London, who also works in California, said he had stopped prescribing it for patients.

He said: ‘I stopped using it around five years ago in Santa Monica and London because the side effects heavily outweigh the benefits.

‘It causes uncontrolled irritancy that is a major problem during the four weeks of initial treatment and sometimes for weeks afterwards.

‘Patients would stop using it before they were supposed to because of the irritancy and redness of the skin.

‘It produces its effect by peeling away the surface of the skin, which would make it appear younger, but only works on lines that are produced by sun damage.

‘If your wrinkles are due to any other cause then it won’t work.

‘I use much better treatments now including lasers and Solareze, a non-steroidal anti-inflammatory cream that does not have the same side effect,’ he added.

How accurate are anonymous sources of criticism to medical treatments?

How accurate is “accurate” anonymous unverified references and critique on new and emerging treatments?

In a recent investigation on online reviews on mesotherapy, lipodissolve and injection lipolysis (realself.com) the results showed that over 80% of reviews were fabricated. The negative reviews in particular originated either from a medical clinic or doctor trying to divert patients to other treatments they were offering, or from paid commercial efforts to discredit the treatments to try another treatment, all in the disguise of genuine patient feedback. In April 2007 the Physician Coalition for Injectable Safety began media announcements against emerging aesthetic treatments. By the summer of 2008 a presentation given to ASOPRS reveal the coalition was encouraging its members to forward disparaging feedback to medical colleagues, in press releases, through forums and blogs such as realself.com, articles in Health magazines and ‘desk-side chats’ to Women’s magazines to discourage both patients and physicians from using new emerging treatments. The coalition also encouraged members to use Youtube to instill the public with apprehension about new trends, and to influence insurance companies to withdraw any insurance protection for clinical users of these new treatments. By acting in this fashion, the PCIS has neglected to base their reasoning and review on scientific fact and research, but acted in a manner to malign and eliminate market competition by misleading the public.

On reviewing the realself website of the many faux feedback and commentaries, a few genuine feedback originated from actual patients who had not been able to complete their treatments, or receive a refund due to the closing of Advanced Lipodissolve Center in 2007. The Center became a victim of targeted negative marketing by a pharmaceutical company and their paid representatives, resulting in hundreds of patients being left in the middle of treatment at the tune of $33 million, and having to battle refunds for incomplete sessions. The same campaign group has filled media and forums with alarms and concerns about the treatment with no scientific basis to support the warnings, to encourage patients to seek plastic surgery instead as a ‘safer’ alternative although FDA assert that more patients die in liposuction per year, than car accidents.

In real life facts, actual recorded patient feedback from clinics reveal that over 88% of patients rate their treatment as “very satisfied”. The individual rating on post-treatment results compared to pre-treatment condition show that most patients found a 90% improvement to their condition. This correlates with outside feedback. In a recent published study in the Clinics of Plastic Surgery (2009, Vol 36, Issue 2, 195–209) all patients who had received the treatment expressed a high rate of satisfaction in the outcome; a mean of 4.48 out of 5, where 5 was the maximum with “dramatic improvement”. On average the patient satisfaction level can be given a mean 80% in consideration of the variety of products and protocols on the market, creating some differences on outcome.

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Q: On the website lipotreatmentfacts.org, one gets the impression that Lipodissolve is illegal or dangerous.

A: This is unfortunate and a misrepresentation. The website lipotreatmentfacts.org is an anonymous site created by paid representatives of a pharmaceutical company. The sources behind this website is in process of creating a new product and are trying to prepare the market for this product by eliminating competitors, and by discouraging users to utilize Lipodissolve, mesoteraphy or injection lipolysis based on misrepresented facts. Why anonymous? Real facts need not come from anonymous websites. The effort with the site is to use outdated concerns and notices, most that are no longer valid. Most of the concerns have been generated in media, recycled and originating by the efforts created by the websites own creators. The intentions is to cleverly give the public the impression that Lipodissolve, injection lipolysis, or mesotherapy are banned, have no back-up of research data, are high risk or illegal. Nothing could be further from real facts!

Be careful to rely on anonymous sources for facts, references, and data about any medical treatment, device, or substance. These are not trusthworthy sources for accurate and reliable information and remain anonymous due to various reasons, i.e,

1) The information may be faulty or misrepresented and could be subject to legal consequences for the site owner,

2) The information is old and outdated, making it libel – again a source for potential legal processing against the site owner,

3) The source has other intentions, – such as monetary gain and profits, competing products, diverting business due to turf protection,- than real facts or concerns for patient safety.

There are often many reasons why critics remain anonymous, and these reasons may be commercial and ulterior, and can therefore not be a real source for accurate information.

Is Patient Safety Undermined for Surgeons Profits?

Thousands are risking their looks – and even their lives – as a growing number of cosmetic surgeons place profit before patient safety, experts have warned.

More than 35,000 people go under the knife every year in their quest to improve their appearance, and the industry is worth more than £1billion annually, according to the British Association of Aesthetic Plastic Surgeons (BAAPS).

But a recent undercover survey by Which? revealed widespread evidence that prospective clients are being subjected to hard-sell techniques, and concluded that sales targets are often taking precedence over integrity.

At risk? Experts warns profit is being put ahead of patient care with ‘cowboy’ surgeons sometimes putting lives at risk (file photograph)

BAAPS has also recently warned that lives are being put at risk by cowboy cosmetic clinics using irresponsible adverts to seduce women into having multiple operations at once, and raised

concerns about adverts encouraging false expectations of cosmetic surgery.

Douglas McGeorge, past president of BAAPS, said: ‘For some clinics, it’s all about getting people through the till, rather than patient care.’

The most recent figures from the Medical Defence Union, which provides insurance to doctors, show that over a tenyear period bungled cosmetic surgery operations and patient dissatisfaction resulted in claims against private surgeons amounting to £8.5million.

Personal injury lawyer Mike Saul said the rapid growth in the cosmetic surgery industry is responsible for problems that he sees on a daily basis.

‘What I am seeing is extremely frightening,’ he said at his Manchester office.

‘People are innocently booking in for surgery, believing it will transform their lives for the better, and they’re coming out maimed and disfigured, often for life.

‘The result of the boom is that a number of commercial clinics have sprung up, and are putting profit before patients, and commerce before ethics.

‘The result is that operations are being rushed to fit more patients in, which means mistakes are more likely to be made. The industry also suffers from inadequate regulation.’

He said the operation which most frequently results in claims for compensation is breast augmentation.

‘Our clients have experienced everything from asymmetry, nerve damage, inappropriate scars to cases in which breast implants have slid down from the breast and ended up over the stomach area,’ said Mr Saul.

‘I also frequently see significant injury – both physical and psychological – resulting from facelifts, eyelid work, tummy tucks, nose jobs and liposuction.’

Mr Saul is also concerned about the trend for operations to be mis- sold. He said this most often occurs when patients are seeking to correct breast droopiness following childbirth.

‘The procedure they are most likely to need is an uplift, possibly with implants too,’ he said.

‘The problem is that an uplift leaves visible scars, which clinics know will put patients off having surgery.

‘To ensure a sale, they convince the patient that all they need is breast implants.

‘It will never achieve the results the patient is looking for and the weight of the implant is likely to make the drooping even worse.

‘In a legal sense, it is completely negligent.’

Enlarge

Probe into cosmetic surgeon who ‘powered his 4×4 with his patients’ excess flab’

By Paul Thompson
Last updated at 8:21 AM on 24th December 2008

If you’re keen to establish your green credentials you can install solar panels or stick a wind turbine on your roof.

Or you could become a patient of Dr Alan Bittner.

The leading Beverly Hills cosmetic surgeon claims to be saving the planet by using fat removed from clients in liposuction operations to power his 4×4 car.

Dr Alan Bittner says he turned fat sucked out of patients in liposuction operations into biodiesel – or ‘lipodiesel’ – for his 4×4 vehicle

According to Dr Bittner, his patients are more than happy to be involved in the extraordinary eco-friendly scheme.

‘The vast majority of my patients request that I use their fat for fuel  –  and I have more fat than I can use,’ he declared.

‘Not only do they get to lose their love handles or chubby belly, but they get to take part in saving the Earth.’ U.S. authorities are less impressed and have launched an inquiry into his claims that he is converting the waste fat into bio-diesel  –  or ‘lipodiesel’ as he calls it.

Dr Bittner posted his claims on a website lipodiesel.com, which has since been taken down following the sudden closure of his clinic on Rodeo Drive.

He is believed to have moved to South America after several patients filed a lawsuit against his practice for allegedly allowing his unlicensed girlfriend to carry out operations. U.S. business magazine Forbes reported that Dr Bittner used the ‘lipofuel’ to power both his Ford Explorer and his girlfriend’s Lincoln Navigator.

Bio-diesel is commonly made from vegetable oils, although half of the U.S. supply comes from beef or pig products.

Animal and vegetable fat contains triglycerides that can be extracted and turned into diesel.

U.S. authorities have launched an inquiry into Dr Bittner’s claims he used human body fat to power his car

It is not known how Dr Bittner went about turning the fat sucked out of patients into fuel. But he claims to have carried out more than 7,000 lipo operations  –  and according to Forbes, a gallon of fat will produce about a gallon of fuel, and drivers can get about the same amount of mileage from fat fuel as they do from regular diesel.

However, it is illegal in the U.S. to use human medical waste to power vehicles.

The doctor is being investigated by California’s public health department. Dr Bittner’s lawyer didn’t return calls seeking comment.

The magazine said his activities came to light after recent lawsuits filed by patients that allege he allowed his assistant and his girlfriend to perform surgery when neither held a medical licence.

Lawyer Andrew Besser, who represents three patients, claims the assistant and girlfriend removed too much fat from clients and left them disfigured. Dozens of other patients have complained to the state medical board, according to Mr Besser. On his official clinic website Dr Bittner claims he offers patients a more advanced form of liposuction called liposculpture.

The website says: ‘After years of experience with various cosmetic procedures, Dr Bittner founded Beverly Hills Liposculpture and personally trained his team of specialists to focus solely on liposculpture  –  a far more advanced form of liposuction.

‘By focusing on liposculpture, Dr Bittner has developed a unique minimally invasive technique that allows patients to remain awake and comfortable while his team sculpts and contours their body.’

A small notice on the website reveals that Dr Bittner has gone to Bogota, Colombia.

He says: ‘After ten years in practice, I have treated over 40,000 patients, including almost 7,000 liposculpture patients. I am proud to be able to tell you that the record of my liposculpture practice has been impeccable; not one single serious complication or infection.

‘Liposculpture is truly my passion and I have been extremely fortunate, however after ten years of private practice, I am going back to South America to volunteer with a small clinic that is very similar to where my medical career began decades ago, where I can help those most in need.’

Police track down ‘boob bandit’ by using barcodes on her discarded implants

By Paul Thompson
Last updated at 3:30 PM on 26th March 2009

Boob bandit: Yvonne Jean Pampellone is accused of using a stolen credit card to pay for her cosmetic surgery

Police were able to track down a woman known as ‘boob bandit’ by the  old implants she left behind.

Surgeons used barcode numbers on the silicon bags to find out her real identity and tipped off police to her real name.

And within 24 hours Yvonne Jean Pampellone had been forced to give herself  up after her body theft made headline news in the US.

Pampellone had used a fake identity when she underwent breast implant surgery at a California cosmetic clinic.

The blonde, 30, had used a stolen credit card to pay for the £10,000  operation.  She also had liposuction during the four hours of  surgery.

Surgeons at the Pacific Centre realised they had been fooled when  Pampellone failed to turn up for a follow-up appointment to check on her new  36DD figure.

They were later contacted by the real owner of the credit card who queried  the £10,000.

A television show gave this air hostess an ‘extreme makeover’ – then her body began to explode

By Alison Smith Squire
06th April 2009

There was a time when Nicola Stratton could not bear to undress in front of her husband, Kirk.

In her eyes – although not in his, it should be said – Nicola was a flat-chested giant with the feminine allure of a fridge-freezer.

So when she sashayed into the bright lights of a television studio looking like a demure cousin of Jessica Rabbit, the viewers were suitably astounded.

Nicola, an air hostess from Bolton, Lancashire, had endured a total of 30 hours on a Los Angeles operating table, all paid for by Brand New You, an ‘extreme makeover’ show on channel Five.

At a cost of £110,000, the surgeons reshaped her nose, her brow, her ears and, most triumphantly of all, her breasts, transforming a healthy but modest B-cup into a substantial DD.

There was no shortage of critics, and for a while Nicola’s radical surgery was a talking point. Yet the results appeared to speak for themselves – a boost not just to her appearance but her confidence.

It was proof to sceptics and devotees alike that plastic surgery works.

Nicola’s delight knew no bounds. ‘It is like eating a bar of chocolate,’ she was moved to say. ‘Take just one bite, and you want to go on eating.’

Now, though, she has lost her appetite. Elegant and curvy, she is still a woman to turn heads.

But the new-found confidence has vanished and one important aspect of her proud new appearance has, literally, shrunk.

A few weeks ago, Nicola was disturbed to find that one of the expensive implants had burst, leaving her left breast like a shrivelled balloon.

Now, worse still, the programme makers are refusing to pay towards corrective surgery.

Nicola, 35, claims that the American surgeon who carried out her breast augmentation in 2004 has already offered to put it right under a ten-year warranty.

Additional fees for her hospital stay, though, mean it will cost £5,000, which she cannot afford. What was promised as a life-changing experience has left her not just disfigured, but anxious that her other implant might burst, too.

‘When I saw my left boob had deflated I was devastated, but I thought at least I’m covered by this warranty and I could have it fixed,’ she says.

‘Although I have emailed, rung and written to RDF Television many times, they say it is up to me to foot the bill.

‘Having differently sized breasts is an absolute nightmare. Quite apart from the sheer inconvenience of having to pad my bra, I feel like a freak – as if I’ve lost my femininity. I’m desperate to get this surgery done, but I don’t know how I will afford it. It’s money I just don’t have.’

Desperate to Change: Nicola said she felt like an ugly duckling and is thrilled with her new look

Nicola’s surgery was a radical undertaking. It involved a brow lift, an eye lift, rhinoplasty (a nose job), having her ears pinned back, liposuction on her chin, jaw, stomach, back and hips, saline breast implants, laser eye surgery and £22,000 of dental work.

At the time, friends and relatives, including her mother, questioned whether a 30-year-old woman should be subjecting herself to such extensive and unnecessary medical procedures. But she went ahead, obsessed by the idea that, whatever her husband thought, she was plain and unattractive.

‘At 5ft 10in I always felt too tall,’ she explains. ‘My boobs, 36B, were too small and my hips were too pear-shaped. So when I saw a newspaper advert for a TV makeover show, I jumped at the chance.

‘Before I had plastic surgery I was so self-conscious about my body that, on our wedding night, Kirk and I made love with the lights off. I didn’t even like him seeing me naked. I had a flat chest, flabby tummy, bad teeth and glasses. My ears stuck out and my nose was too big.

‘At the time it seemed as if all my friends were petite with big breasts, whereas I was incredibly tall with these smaller breasts, which made me feel out of proportion.’

Nicola claims her job as a flight attendant contributed towards her negative self-image.

‘It is a glamorous life and I felt like an ugly duckling among swans,’ she says. ‘Flying also took its toll on my face and my figure.

‘Eating irregularly meant that in my late 20s I put on weight on my hips.
I remember looking in the mirror when I was just 29 and thinking how much older travelling had made me look.’

She insists that her upbringing is not to blame for her lack of confidence. ‘My parents were loving parents – they always told me I was beautiful and I was always the apple of my dad’s eye,’ she says. ‘In fact I didn’t dare tell my dad I was having so much done because I knew he’d be upset.

‘When I finally admitted how much of me had changed I think he was a bit sad, although he came round, saying that it didn’t matter and that I was still his
little girl.’

The operations took place in Los Angeles, which has a global reputation for high-class cosmetic surgery. ‘I was petrified when I discovered it would all be done in just a six-week period,’ says Nicola, ‘but also excited. Although some of the procedures were terribly painful, I’ve had no regrets until now.’

And she recalls: ‘The hospital was a world away from any hospital in the UK. It was a beautiful, big building with deep-carpeted consultation rooms and enormous lifts. It was more like a plush office block than a hospital.

‘There weren’t wards full of patients.  I counted only around 12 people there, and of course each person had a wealth of staff to attend to their every whim.’
Nicola also found a very different attitude towards cosmetic surgery.

‘It wasn’t something to be hidden, as it is so often in Britain,’ she says. ‘People wandered around in their bandages. They were happy to show that they’d undergone some cosmetic procedure, even in the street. It was quite acceptable to show the healing scars from a facelift.’

Nicola emerged from the operations and the subsequent hour-long programme with a feeling of elation.

‘It seemed as if, overnight, I had become a celebrity. I suppose $250,000 was a lot of money to spend on one person in one go. Friends thought I looked amazing, I dropped from a dress size 14 to a 12 and my confidence soared. I loved my new figure.’

Six weeks after the surgery, she and Kirk, a steel worker, renewed their wedding vows. Within a few weeks, however, their relationship was over.

Kirk, 33, had never been convinced by the surgery, saying he liked her as she was. And for Nicola, the change in her appearance brought an altered state of mind.

‘Having the surgery changed me,’ she admits. ‘I became so much more confident. Before, Kirk used to say I looked fine and that he fancied me as I was. In fact, I think he liked my smaller breasts. However, I don’t think he ever really appreciated how much I didn’t like my looks.

‘Even when I applied for all the surgery, he never imagined I’d actually be chosen. Or, when I was, that I would go through with it.’

Nicola confesses that at first she was concerned only about having her breasts enlarged.

‘But when the consultants looked at me,’ she recalls, ‘they saw lots of other things that could be improved, such as pinning back my ears and removing fat from my face. They were the sort of changes to your appearance you would never even think about unless you were a professional surgeon.

‘Neither Kirk nor I could have imagined how much having all that surgery would change our lives. We’d been together for ten years and married for just 15 months when I went on the programme. And although the surgery obviously changed me, afterwards I changed even more.

‘Within months I’d developed the confidence to go blonde. I also changed my diet. I started eating healthily and exercising. And I began wearing high heels. I’d always worn flatties before because I felt too tall, but after my surgery I didn’t want to hide any longer.

‘My new look attracted lots of attention from men. I would walk into a bar and, for the first time, people were looking at me.’

But Nicola denies that this new interest from men led to the break-up of her relationship with Kirk. ‘The truth is, having the surgery didn’t split us up,’ she says. ‘We had been growing apart before it, but it gave me the confidence to walk away.

‘Had I not had the operations, I might have struggled on a lot longer in an unhappy marriage. Who knows, we might even still be married today.’

There were no regrets, in other words, until January when Nicola was taking a shower.
‘As I dried myself I noticed my left breast felt more wobbly and softer than usual,’ she says. ‘When I looked in the mirror I realised to my horror that it was noticeably smaller, like a popped balloon.

‘I knew straightaway that my implant, which was made with saline, had burst. I was terrified for my health, worried that something poisonous might have seeped into my system.’

She sent frantic emails to her Los Angeles surgeon who reassured her that the saline would pass harmlessly through her body.

‘Doctors don’t know why this implant has not worked,’ she says. ‘It isn’t anything to do with flying apparently, but I have now been told there was always a four per cent chance of failure.’

Recently, Nicola has developed worrying lumps in her left breast – another cause for anxiety, and one that will remain until an operation is possible.

‘I tell myself that these lumps are just a harmless side-effect of the saline seeping out and the implant casing growing harder,’ she says. ‘But I am still very worried and desperate to get it sorted out.’

She has now been warned that her other breast is at risk of deflating, too, and her surgeon has recommended that both her implants should be replaced with silicone, which is more robust.

Every year about 10,000 British women choose to have breast augmentations. Saline, or salt water, implants have become the most popular because of concerns about the older silicone and oil implants. Failed implants have been blamed for severe health complications.

Saline implants are claimed to leave a smaller scar because  they are inserted empty and then filled with the solution. Silicone implants are filled before surgery is performed.

However, it is saline  implants that are more likely to cause cosmetic problems such as rippling, wrinkling and to be more noticeable to the eye or to the touch.

When saline implants leak, they often deflate quickly but they are easy to remove and replace.

Silicone implants do not deflate but a leak may be harder to detect. The dangers of this are a matter of fierce contention, although most surgeons claim there is no evidence that a leak will harm a patient.

It is only eight months since Nicola met a new partner, 42-year-old Andy, a scaffolder. He knew all about the surgery, but now she has had to tell him it has gone badly wrong.

‘I couldn’t help but worry how I would explain to Andy that my boob had deflated,’ she says.

‘I was in tears telling him about it, but thankfully all he is worried about is helping me.

‘When I first realised my bosom had deflated, all those old self-conscious fears came flooding back. My relationship with Andy was relatively new and I found myself terrified that he wouldn’t fancy me any more and that my popped breast would put him off sexually.

‘It has been hard letting him see me like this. But he’s just worried that because I still have the implants inside me I could develop some kind of infection. Still, however understanding he is, I haven’t wanted him to feel the lumps.

‘When I do manage to get the money together, I have decided not to go back to the States to have the boob job. Next time I will stick to a surgeon in the UK just in case anything goes wrong again.’

A spokesman for RDF, which produced a single series of eight Brand New You shows for channel Five and also makes Wife Swap, Faking It and Secret Millionaire, says: ‘We have been in direct correspondence with Nicola regarding this matter and feel that we have responded to all of her questions in full, therefore concluding the matter.

‘Nicola entered into a direct contract with the surgeon, following a series of consultations, psychological assessments and interviews, the terms of which we are not privy to and therefore cannot comment on.’

Nicola replies ruefully: ‘It’s a cautionary tale. People going in for surgery on these TV programmes need to check the small print very carefully. For years I felt lucky that I’d had more than £100,000 worth of surgery for free, with a ten-year warranty against anything going wrong. Now I know it was too good to be true.’

But it seems that, even now, Nicola is neither wholly dissatisfied nor reformed. As she puts it: ‘Whatever risks implants have, I couldn’t face going back to how I was.’

LA confidential: No Botox please, I’m British

As an Englishwoman living in youth-obsessed Los Angeles – where Botox and liposuction are considered routine beauty maintenance – Elaine Lipworth (below) feels like an outsider among her lifted and stretched friends. So will she ever be tempted to join them?

By Elaine Lipworth
Last updated at 11:55 AM on 08th May 2009

After my 50th birthday I went to see my GP for a checkup. She reassured me that everything seemed fine and I was just about to say goodbye when I noticed her staring at my face rather oddly.

‘You do know, Elaine,’ she said briskly, ‘that we offer Botox and Restylane at the surgery now. It would make a big difference,’ she added, scrutinising the lines on my forehead and the bags under my eyes. (I suddenly noticed flyers in the waiting room advertising for ten ‘units’ of Botox, enough to iron out forehead lines and crows’ feet.)

‘Oh really, thank you,’ I mumbled, before dashing out of the door, racing home and examining my sagging jaw line in the bathroom mirror.

My shock at the thought of how haggard I must be looking was only slightly tempered by the realisation that this conversation could only happen in Los Angeles.

I am British, but I’ve lived in LA for 18 years. I moved here to work as a TV reporter for Richard and Judy’s This Morning and now make my living as a film journalist and celebrity interviewer for newspapers and glossy magazines such as YOU.

In many ways, I have a typical LA lifestyle. I live in Santa Monica (my American husband, Stephen, is a property manager), watch a lot of films, meet dozens of stars, sip cappuccinos at outdoor cafés and go jogging with our two dogs. Weekends with our two children are spent having barbecues, skateboarding and swimming at the beach.

Yet there’s one big difference between me and my circle of American female friends – I’m the only one who hasn’t had any work done: no fillers, no face-lifts, no fat injections, eyebrow lifts, chemical peels, laser treatments or liposuction.

Sometimes I see myself as a lone pioneer; mostly, though, I feel like an outsider.

The women I mix with socially (whose ages range from 30 to 65) live on the Westside of LA like me. All the ones who work are connected to Hollywood in one way or another. But most are full-time mums married to wealthy film and TV executives.

What all my friends have in common is that they view regular cosmetic procedures as an essential part of their ‘maintenance’ package, along with pilates sessions, facials, manicures, eyebrow shaping and massages.

‘My friend turned to me at a party and said, ‘You look good for your age, but you would clean up real good with a little work’

When I first came to Hollywood in 1990, I was in my early 30s and amazed to discover that women my age were already having face-lifts, liposuction and collagen treatments.

Now the lines on my face mark me out as a foreigner, perhaps even more than my English accent. I feel increasingly alien. The only people around my age who haven’t had any ‘work’ done are expats like me.

‘You’re so European,’ gushed a lithe, plastic-looking blond woman at a yoga class the other day. I think that was a euphemism for wrinkled – which made me laugh as my English friends are always telling me I’m
‘so LA’ because of my addiction to yoga and swimming, and the fact that I’m vegetarian.

Sometimes, when I meet A-list actresses, my resolve weakens and I fantasise about a ‘mini-lift’ because they all look so good. Most celebrities hotly deny that they’ve ever had surgery or Botox. ‘I have good genes, work out and eat well,’ they tell you.

Jane Fonda is an exception. She has admitted to having had extensive surgery when she was younger, and claims it was a big mistake and did nothing to boost her confidence. If anything, she told me during an interview, it made her more insecure. ‘You don’t need a face-lift,’ she said, grabbing my hand emotionally. ‘You look lovely; we must all learn to age gracefully and be happy with ourselves.’

Easy for Jane Fonda to say, 71 and still extraordinarily beautiful (whether because of the surgery or in spite of it). But I do agree with her point of view. Getting older is hard for everyone, but fighting the ageing process is an even tougher battle; one that’s impossible to win.

At a recent dinner party, my usually positive frame of mind spiralled downwards in seconds.

I was feeling quite confident about my appearance. The conversation among the women having inevitably turned from the flagging economy to face-lifts, my friend Nancy turned to me and said, ‘You look pretty good for your age, but you would clean up real good with a little work.’

Later in the evening I noticed my husband (who professes to be adamantly opposed to plastic surgery) showering another friend, Grace, 49, with effusive compliments. ‘Why did you tell Grace she looks fantastic, when she’s had loads of Botox, collagen, everything?’ I asked him peevishly on the way home. ‘She did look good,’ he said.

‘So you think I need a face-lift?’ ‘No, I think plastic surgery is ridiculous vanity and a waste of money. And you look adorable…for your age.’ Which was not the response I was hoping for.

‘What does that mean?’

‘Everybody changes when they get older: you look fine.’ End of conversation.

I confess I’ve had some shaky moments since that dinner party, which
led to a consultation with a Santa Monica plastic surgeon (just for research, of course) who showed me a series of dramatic before and
after images on the computer and told me that his pioneering fat injections would give me back a ‘youthful plumpness in the face’ and knock at least 15 years off my age.

I definitely liked the way I appeared in the ‘after’ pictures – still me, just a bit perkier, less tired-looking.

But I knew that it would only be a temporary boost. And as a Brit who appreciates quirky, natural beauty, I don’t want that ubiquitous LA look. (Also I found the procedure offputting: they ‘harvest’ fat from your stomach or thighs and inject it into your face.)

I do understand why my friends choose to have surgery, because the pressure to look good here is intense. And by ‘good’, of course, I
mean young.

Yet in some ways it all seems like a case of The Emperor’s New Clothes. They think they look youthful; in fact they invariably look smooth and frozen, which doesn’t amount to the same thing.

Everyone has an image of stunning Hollywood actresses with perfect figures, but what has always struck me is the unnerving uniformity of the LA women, with their stretched faces, fake tans, thin, sculpted bodies and huge breasts. It was not a look I wanted to emulate and I still don’t.

I am not saying all my friends look like that; cosmetic surgery can be subtle if performed, in limited doses, by skilled doctors.

Recently I noticed that a friend I hadn’t seen for a while looked ‘fresher’. When quizzed, June admitted that she’d had a face-lift. She proceeded to e-mail me the name and number of her doctor: I deleted the message.

Even if I did change my mind, the expense of most treatments would be prohibitive. A mini face-lift or breast enlargement with a reputable doctor costs up to £20,000, while Botox with a reputable dermatologist can set you back around £400.

It is all way beyond our family budget. (Interestingly, surgeons and dermatologists I have spoken to in LA say business is only slightly down despite the recession, suggesting that, for women here, it is a priority.)

But it’s not just the expense that puts me off: a few years ago I turned down the chance of thousands of dollars’ worth of free treatment from a leading Beverly Hills plastic surgeon I interviewed.

Essentially, I didn’t want to start on the surgery treadmill. When women who’ve undergone surgery have the odd line on a part of the face that hasn’t been treated, it looks really pronounced. It means that as soon as any new wrinkle appears, immediate action is needed to iron it out.

It’s a slippery slope to nowhere. There are women in my neighbourhood as young as 25 and as old as 75 who have regular nips and tucks: it’s practically impossible to tell how old anyone is any more. I would rather have a face that has character than a frozen, expressionless mask.

I haven’t let myself go completely: I have my hair highlighted, love
buying clothes and I wear make-up. In fact, I’m a sucker for any new anti-wrinkle creams.

Naomi Watts told me she swears by a serum from South African cosmetics company Environ and I raced out to buy it. I did the same thing when Michael Caine mentioned that he and Shakira use Crème de la Mer. And I forked out £60 on an anti-ageing cream by Kinerase, after seeing a commercial featuring a glowing Courteney Cox.

What’s the difference between potions and surgery, one of my friends asked me? She claims it’s hypocrisy to accept one but not the other. But creams are one thing, whereas I draw the line at anything invasive.

Personally, I think things have gone too far when books about cosmetic surgery are aimed at children as young as four. My Beautiful Mommy by plastic surgeon Michael Salzhauer uses cartoons to reassure children that their mothers’ bruises and bandages are temporary and that new improved ‘mommy’ won’t be different – just prettier.

I am happy to say my daughters detest the idea of plastic surgery. ‘Has Gina’s mum had Botox?’ Ava, my ten-year-old, whispered, glancing at her friend’s mother when I picked her up from her gymnastics class one afternoon.

Chace, my 14-year-old, says she’ll never forgive me if I go under the knife, even though her group includes the daughters of Janice Dickinson, Demi Moore and Rosanna Arquette. I don’t know what they must think of me. They haven’t said anything to my daughter; perhaps they’re being polite.

‘Look at Helen Mirren,’ Chace said. ‘She looks fantastic and she hasn’t done anything.’ It’s all right for Helen: she has that fabulous bone structure and has clearly inherited exceptionally good genes.

I’ll never look like that, and there are moments, I confess, when the idea
of waking up with a smooth, youthful face is tempting. But not
tempting enough.

My husband still finds me attractive (despite his comments to my Botoxed friend) and doesn’t think I need to change anything about my appearance. But even more important is my own conviction that cosmetic surgery does not make you happier.

In fact, some of my lifted and stretched friends are very unhappy. Ageing naturally is challenging, but at least I know my face is real. So I have decided to stick to my principles – perhaps spark a new ‘natural’ trend.

And if that doesn’t work and I really can’t stand the pressure of a city obsessed with youth, I can always move back to Britain.