A report released yesterday by the Campaign for Safe Cosmetics (CSC), a coalition of women's, public health, and environmental groups campaigning for
the phasing out of toxins in cosmetics, has suggested that over half of 33 top brands of lipsticks on sale in the US contain detectable levels of
lead.
The report said that tests conducted by an independent laboratory during September this year found that 61 per cent of 33 brand-name red lipsticks contained
detectable levels of lead ranging from 0.03 to 0.65 parts per million (ppm). The lipsticks were bought in Boston, Hartford, Connecticut, San Francisco and
Minneapolis.
One third of the lipsticks tested by the laboratory were found to contain more than the 0.1 ppm limit imposed by the US Food and Drug Administration on candy
and sweets. Although the limit for candy was set to protect children from ingesting lead, the CSC is using this comparison to show that lipstick, which is
put directly onto the lips, is also a source of directly ingested lead, to which pregnant women for example are particularly vulnerable. But the CSC pointed
out that the FDA has not set a limit for lead in lipstick.
The CSC report said 39 per cent of the lipsticks tested had no detectable levels of lead, suggesting it was possible to make them without lead. However,
cost does not seem to be a factor, they said, since cheaper brands such as Revlon, selling at 7.49 dollars an item had no detectable levels of lead but the
most expensive lipstick they tested, the Dior Addict brand, selling at 24 dollars 50 an item had higher levels than some of the other lipsticks.
The CSC said that the top brands that tested positive for lead in their red lipsticks included:
L'Oreal Colour Riche "True Red" (lead level of 0.65 ppm),
L'Oreal Colour Riche "Classic Wine" (0.58 ppm),
Cover Girl Incredifull Lipcolor "Maximum Red" (0.56 ppm), and
Dior Addict "Positive Red" (0.21 ppm).
Referring to studies that said there is no safe level for lead, and that it is a toxin that builds up in the human body because we can't excrete it, Dr Mark
Mitchell, president of the Connecticut Coalition for Environmental Justice, said:
"Lead-containing lipstick applied several times a day, every day, can add up to significant exposure levels."
Stacy Malkan, author of the new book, "Not Just a Pretty Face: The Ugly Side of the Beauty Industry", also referred to the build up of toxins like lead in
the body, and said the cosmetics industry needs to "clean up its act" and take immediate steps to reformulate products that contain lead.
John Bailey, EVP for Science Cosmetic, Toiletry, and Fragrance Association, said yesterday in a statement responding to the CSC report that despite repeated
allegations to the contrary over the years, the cosmetics industry does not add lead to its products; the metal occurs naturally in a range of ingredients, as
it does "everywhere in the environment".
He said consumers were exposed to lead every day when they "eat, drink water, and breathe the air".
Bailey pointed out that the average quantity of lead a woman would be exposed to from using cosmetics amounted to 1,000th of the amount she would ingest from
eating food, breathing in air and drinking water that met the drinking water standards set by the Environmental Protection Agency (EPA).
Referring to the FDA, Bailey said the agency set daily safe levels of lead exposure for adults, children and women who were expecting. And, implying a
contradiction to the CSC report, he said the FDA also set limits for lead in the colours used in lipsticks, and also tests them to make sure the limits are
obeyed. In fact he also said that the "products identified in the Campaign for Safe Cosmetics (CSC) report meet these standards."
Bailey said that for decades the cosmetics industry has worked to "minimize all product contamination, including lead", and they employed some of the world's
leading scientists to do this.
The Houston Chronicle reported yesterday that the FDA had no plans to act in response to the CSC report and the agency has been aware of concerns about lead
in lipstick for some time.
A pediatrician and assistant professor at Baylor College of Medicine, Dr Sara Rizvi, who was contacted by the Chronicle said the report's findings were
"troubling". However, she said there was no cause for panic since the report was inconclusive and even showed different levels of lead in the same
brand.
But Rizvi also went on to say that although more research was needed to establish conclusive evidence one way or the other, the industry should reformulate
products to remove lead completely, since this was an avoidable risk.
In high doses lead has been linked to learning and behavioural problems in children, such as reduced IQ, poorer school performance and aggression, said the
CSC. The unborn and the very young are especially vulnerable because lead affects early brain development.
Click here for the CSC report on lead in lipstick.
Click here to learn more about lead exposure and toxicity from the US Centers for Disease Control and
Prevention (CDC).
: Catharine Paddock
четверг, 25 августа 2011 г.
четверг, 18 августа 2011 г.
University of Michigan Study Finds Women Underrepresented In Cancer Research
Women are under-represented in clinical cancer research published in high-impact journals, according to a new study by researchers at the University of Michigan Comprehensive Cancer Center.
Taking into account the incidence of particular types of cancer among women, studies included a smaller proportion of women than should be expected. The analysis looked specifically at studies of cancer types that were not gender specific, including colon cancer, oral cancers, lung cancer, brain tumors and lymphomas.
The authors looked at 661 prospective clinical studies with more than 1 million total participants. Results of this study appear online in the journal Cancer and will be published in the July 15 print issue.
"In the vast majority of individual studies we analyzed, fewer women were enrolled than we would expect given the proportion of women diagnosed with the type of cancer being studied. We're seeing it across the board in all cancer types," says study author Reshma Jagsi, M.D., D.Phil., assistant professor of radiation oncology at the U-M Medical School.
"It's so important that women are appropriately represented in research. We know there are biological differences between the sexes, as well as social and cultural differences. Studies need to be able to assess whether there are differences in responses to treatment, for example, between women and men," she adds.
The National Institutes of Health's Revitalization Act of 1993 explicitly calls out the importance of including women in clinical research, noting that clinical trials should enroll adequate numbers of women to allow for subgroup analysis.
The U-M researchers found that studies reporting government funding did include higher numbers of women participants, but the impact was modest - 41 percent, compared to 37 percent for studies not receiving government funding.
Traditionally, researchers were told not to include people of vulnerable populations in their studies. This group included women of childbearing age. "By protecting them from research, we're excluding them," Jagsi notes.
Previous studies have found some barriers to clinical trial participation are lack of information, fear and a perception of interfering with personal responsibilities, such as child care.
"Sometimes participating in research studies can be time intensive. Women today are often stretched very thin trying to deal with the balance between domestic responsibilities, their cancer diagnosis, and often a career as well. They may be particularly likely to find clinical trials too burdensome. In that case, researchers should consider providing compensation to help with transportation or child care expenses," Jagsi says.
This under-representation of women is not necessarily the result of conscious decisions, points out senior author Peter Ubel, M.D., director of the Center for Behavioral and Decision Sciences in Medicine at U-M.
"Clinical researchers are not purposely trying to exclude women from their studies. All the more reason they need to consciously and earnestly revise their recruitment methods to give more women a chance to volunteer," Ubel says.
Notes:
Methodology: The researchers looked at all original clinical cancer research published in five top oncology journals and three top general medical journals in 2006. The journals included were the New England Journal of Medicine, the Journal of the American Medical Association, the Lancet, the Journal of Clinical Oncology, the Journal of the National Cancer Institute, Lancet Oncology, Clinical Cancer Research and Cancer. Articles were analyzed to determine factors including the number of participants, gender of participants, type of cancer and funding source. The percent of women was summarized in two ways: The overall percent of women from all studies; and the average percent from each study that were women. The first method gives greater weight to larger studies, while the second method allows each study to have equal weight. Women's representation was lower than expected, based on general population incidence data, according to both analyses. Additional authors: Amy R. Motomura, Sudha Amarnath, Aleksandra Jankovic, M.S., Nathan Sheets, Peter A. Ubel, M.D. Funding: University of Michigan Institute for Research on Women and Gender.
Source:
Nicole Fawcett
University of Michigan Health System
Taking into account the incidence of particular types of cancer among women, studies included a smaller proportion of women than should be expected. The analysis looked specifically at studies of cancer types that were not gender specific, including colon cancer, oral cancers, lung cancer, brain tumors and lymphomas.
The authors looked at 661 prospective clinical studies with more than 1 million total participants. Results of this study appear online in the journal Cancer and will be published in the July 15 print issue.
"In the vast majority of individual studies we analyzed, fewer women were enrolled than we would expect given the proportion of women diagnosed with the type of cancer being studied. We're seeing it across the board in all cancer types," says study author Reshma Jagsi, M.D., D.Phil., assistant professor of radiation oncology at the U-M Medical School.
"It's so important that women are appropriately represented in research. We know there are biological differences between the sexes, as well as social and cultural differences. Studies need to be able to assess whether there are differences in responses to treatment, for example, between women and men," she adds.
The National Institutes of Health's Revitalization Act of 1993 explicitly calls out the importance of including women in clinical research, noting that clinical trials should enroll adequate numbers of women to allow for subgroup analysis.
The U-M researchers found that studies reporting government funding did include higher numbers of women participants, but the impact was modest - 41 percent, compared to 37 percent for studies not receiving government funding.
Traditionally, researchers were told not to include people of vulnerable populations in their studies. This group included women of childbearing age. "By protecting them from research, we're excluding them," Jagsi notes.
Previous studies have found some barriers to clinical trial participation are lack of information, fear and a perception of interfering with personal responsibilities, such as child care.
"Sometimes participating in research studies can be time intensive. Women today are often stretched very thin trying to deal with the balance between domestic responsibilities, their cancer diagnosis, and often a career as well. They may be particularly likely to find clinical trials too burdensome. In that case, researchers should consider providing compensation to help with transportation or child care expenses," Jagsi says.
This under-representation of women is not necessarily the result of conscious decisions, points out senior author Peter Ubel, M.D., director of the Center for Behavioral and Decision Sciences in Medicine at U-M.
"Clinical researchers are not purposely trying to exclude women from their studies. All the more reason they need to consciously and earnestly revise their recruitment methods to give more women a chance to volunteer," Ubel says.
Notes:
Methodology: The researchers looked at all original clinical cancer research published in five top oncology journals and three top general medical journals in 2006. The journals included were the New England Journal of Medicine, the Journal of the American Medical Association, the Lancet, the Journal of Clinical Oncology, the Journal of the National Cancer Institute, Lancet Oncology, Clinical Cancer Research and Cancer. Articles were analyzed to determine factors including the number of participants, gender of participants, type of cancer and funding source. The percent of women was summarized in two ways: The overall percent of women from all studies; and the average percent from each study that were women. The first method gives greater weight to larger studies, while the second method allows each study to have equal weight. Women's representation was lower than expected, based on general population incidence data, according to both analyses. Additional authors: Amy R. Motomura, Sudha Amarnath, Aleksandra Jankovic, M.S., Nathan Sheets, Peter A. Ubel, M.D. Funding: University of Michigan Institute for Research on Women and Gender.
Source:
Nicole Fawcett
University of Michigan Health System
четверг, 11 августа 2011 г.
High Insulin Levels Raise Risk Of Breast Cancer In Postmenopausal Women
Higher-than-normal levels of insulin place postmenopausal women at increased risk of breast cancer, researchers at Albert Einstein College of Medicine of Yeshiva University report. Their findings, published in the January 7 issue of the Journal of the National Cancer Institute, suggest that interventions that target insulin and its signaling pathways may decrease breast cancer risk in these women.
Breast cancer is the most common cancer among women in the United States. Last year, approximately 182,000 women were diagnosed with breast cancer and more than 40,000 died from the disease. The majority of breast cancers arise in women past the age of menopause.
Obesity is a well established risk factor for postmenopausal breast cancer, but just how obesity and breast cancer are connected is unclear. Many researchers have assumed that the link is estrogen a hormone that is known to increase breast-cancer risk and is found at higher-than-average levels in obese women. But obese women also have other hormonal imbalances that may play a role in triggering breast cancer. One such imbalance is elevated levels of insulin, which stimulates the growth of breast cells in tissue culture. The Einstein study is the first to prospectively identify insulin's role in breast cancer while controlling for estrogen levels.
The multi-year Women's Health Initiative (WHI) the largest study of postmenopausal women ever funded by the National Institutes of Health followed health outcomes in more than 93,000 postmenopausal women. At enrollment, each participant donated blood samples that were stored for later analysis.
In 2004, the Einstein researchers selected a subset of more than 1,600 of these participants: 835 who had developed breast cancer during the study, and a random sample of 816 women representative of the WHI as a whole. Using the blood samples and other measurements taken when the women enrolled, the researchers assessed their fasting insulin level, naturally occurring levels of estradiol (a form of estrogen), and body mass index, or BMI (a measure of obesity). After dividing the women into four groups based on their fasting insulin levels and controlling for estrogen levels, the researchers found that women with the highest insulin levels were nearly 50 percent more likely to have developed breast cancer compared with women who had the lowest insulin levels.
Most of this effect was observed in the large subset of women from the WHI study who did not use hormone-replacement therapy. HRT has a strong effect on insulin and other hormonal factors, so eliminating this variable gives a clearer picture of insulin's effect on breast cancer. "Among these women, the influence of insulin on breast cancer risk was quite high," says lead author Marc Gunter, Ph.D., assistant professor of epidemiology & population health at Einstein. "Women with the highest insulin levels in their blood were more than two times more likely to develop breast cancer than women with the lowest insulin levels." Moreover, "when we controlled for insulin, the association between obesity and breast cancer became much weaker," adds Dr. Gunter. "This means that a large component of that obesity-cancer relationship may be mediated by insulin levels."
The findings have important implications for prevention, and possibly treatment, of postmenopausal breast cancer, according to Howard Strickler, M.D., M.P.H, who was senior author of the paper and a professor of epidemiology & population health at Einstein. "Research now needs to focus on ways to reduce insulin's effects on cell growth and replication in the breast while preserving its positive metabolic effects.
There are several possibilities and working with our laboratory collaborators we hope to make fast progress," said Dr. Strickler.
"It is also possible that screening non-diabetic postmenopausal women for high insulin levels could prove useful in identifying individuals at high risk for breast cancer," says Dr. Strickler.
The current study is part of a broader research program at Einstein. Researchers are focusing on how the effects of insulin and insulin-like growth factors on cell replication and survival influence a variety of conditions. "Every cell in the body carries insulin receptors and most carry IGF-1 receptors, so it makes sense that this biologic pathway could play a major role in health and disease across a broad range of conditions and we have to do much more to understand these relationships," notes Dr. Strickler. So far, studies by Dr. Strickler and his colleagues have shown that insulin and/or IGFs also play a role in endometrial and colorectal cancer, as well as the progression of certain viral diseases, including HIV, hepatitis C virus in the liver and human papillomavirus (the cause of cervical cancer).
About Albert Einstein College of Medicine of Yeshiva University
Albert Einstein College of Medicine of Yeshiva University is one of the nation's premier centers for research, medical education and clinical investigation. It is the home to some 2,000 faculty members, 750 M.D. students, 350 Ph.D. students (including 125 in combined M.D./Ph.D. programs) and 380 postdoctoral investigators. Last year, Einstein received more than $130 million in support from the NIH. This includes the funding of major research centers at Einstein in diabetes, cancer, liver disease, and AIDS. Other areas where the College of Medicine is concentrating its efforts include developmental brain research, neuroscience, cardiac disease, and initiatives to reduce and eliminate ethnic and racial health disparities. Through its extensive affiliation network involving five hospital centers in the Bronx, Manhattan and Long Island which includes Montefiore Medical Center, Einstein's officially designated University Hospital the College runs one of the largest post-graduate medical training program in the United States, offering approximately 150 residency programs to more than 2,500 physicians in training. For more information, please visit aecom.yu.edu.
Albert Einstein College of Medicine of Yeshiva University
1300 Morris Park Ave.
Bronx
NY 10461
United States
aecom.yu.edu
View drug information on Estradiol Transdermal System.
Breast cancer is the most common cancer among women in the United States. Last year, approximately 182,000 women were diagnosed with breast cancer and more than 40,000 died from the disease. The majority of breast cancers arise in women past the age of menopause.
Obesity is a well established risk factor for postmenopausal breast cancer, but just how obesity and breast cancer are connected is unclear. Many researchers have assumed that the link is estrogen a hormone that is known to increase breast-cancer risk and is found at higher-than-average levels in obese women. But obese women also have other hormonal imbalances that may play a role in triggering breast cancer. One such imbalance is elevated levels of insulin, which stimulates the growth of breast cells in tissue culture. The Einstein study is the first to prospectively identify insulin's role in breast cancer while controlling for estrogen levels.
The multi-year Women's Health Initiative (WHI) the largest study of postmenopausal women ever funded by the National Institutes of Health followed health outcomes in more than 93,000 postmenopausal women. At enrollment, each participant donated blood samples that were stored for later analysis.
In 2004, the Einstein researchers selected a subset of more than 1,600 of these participants: 835 who had developed breast cancer during the study, and a random sample of 816 women representative of the WHI as a whole. Using the blood samples and other measurements taken when the women enrolled, the researchers assessed their fasting insulin level, naturally occurring levels of estradiol (a form of estrogen), and body mass index, or BMI (a measure of obesity). After dividing the women into four groups based on their fasting insulin levels and controlling for estrogen levels, the researchers found that women with the highest insulin levels were nearly 50 percent more likely to have developed breast cancer compared with women who had the lowest insulin levels.
Most of this effect was observed in the large subset of women from the WHI study who did not use hormone-replacement therapy. HRT has a strong effect on insulin and other hormonal factors, so eliminating this variable gives a clearer picture of insulin's effect on breast cancer. "Among these women, the influence of insulin on breast cancer risk was quite high," says lead author Marc Gunter, Ph.D., assistant professor of epidemiology & population health at Einstein. "Women with the highest insulin levels in their blood were more than two times more likely to develop breast cancer than women with the lowest insulin levels." Moreover, "when we controlled for insulin, the association between obesity and breast cancer became much weaker," adds Dr. Gunter. "This means that a large component of that obesity-cancer relationship may be mediated by insulin levels."
The findings have important implications for prevention, and possibly treatment, of postmenopausal breast cancer, according to Howard Strickler, M.D., M.P.H, who was senior author of the paper and a professor of epidemiology & population health at Einstein. "Research now needs to focus on ways to reduce insulin's effects on cell growth and replication in the breast while preserving its positive metabolic effects.
There are several possibilities and working with our laboratory collaborators we hope to make fast progress," said Dr. Strickler.
"It is also possible that screening non-diabetic postmenopausal women for high insulin levels could prove useful in identifying individuals at high risk for breast cancer," says Dr. Strickler.
The current study is part of a broader research program at Einstein. Researchers are focusing on how the effects of insulin and insulin-like growth factors on cell replication and survival influence a variety of conditions. "Every cell in the body carries insulin receptors and most carry IGF-1 receptors, so it makes sense that this biologic pathway could play a major role in health and disease across a broad range of conditions and we have to do much more to understand these relationships," notes Dr. Strickler. So far, studies by Dr. Strickler and his colleagues have shown that insulin and/or IGFs also play a role in endometrial and colorectal cancer, as well as the progression of certain viral diseases, including HIV, hepatitis C virus in the liver and human papillomavirus (the cause of cervical cancer).
About Albert Einstein College of Medicine of Yeshiva University
Albert Einstein College of Medicine of Yeshiva University is one of the nation's premier centers for research, medical education and clinical investigation. It is the home to some 2,000 faculty members, 750 M.D. students, 350 Ph.D. students (including 125 in combined M.D./Ph.D. programs) and 380 postdoctoral investigators. Last year, Einstein received more than $130 million in support from the NIH. This includes the funding of major research centers at Einstein in diabetes, cancer, liver disease, and AIDS. Other areas where the College of Medicine is concentrating its efforts include developmental brain research, neuroscience, cardiac disease, and initiatives to reduce and eliminate ethnic and racial health disparities. Through its extensive affiliation network involving five hospital centers in the Bronx, Manhattan and Long Island which includes Montefiore Medical Center, Einstein's officially designated University Hospital the College runs one of the largest post-graduate medical training program in the United States, offering approximately 150 residency programs to more than 2,500 physicians in training. For more information, please visit aecom.yu.edu.
Albert Einstein College of Medicine of Yeshiva University
1300 Morris Park Ave.
Bronx
NY 10461
United States
aecom.yu.edu
View drug information on Estradiol Transdermal System.
четверг, 4 августа 2011 г.
At ASPS Annual Meeting: Innovative 'No Breast Implant' Procedure
Women who desire a mommy-makeover, have had major weight loss, or are unhappy with the toll age has taken on their breasts can breathe easier. An innovative procedure to correct severely deflated, sagging breasts left looking like "pancakes" will be presented at the American Society of Plastic Surgeons (ASPS) Plastic Surgery 2008 conference, Oct. 31 - Nov. 5, in Chicago. The procedure corrects misshapen breasts by lifting and restoring them to a more natural, full shape and position without the use of breast implants.
"In the past several years I've seen more women in their 50s who are unhappy with their breasts," said Dennis Hurwitz, MD, ASPS Member Surgeon and course instructor. "These women have had numerous pregnancies, waited later in life to have children, lost a lot of weight, or simply haven't aged well and want to restore their figure. The breast irregularities these patients share are unique. These are extreme cases - not your 'run of the mill' augmentation patients who simply want to enlarge their breasts from an A to C cup."
The procedure presented at Plastic Surgery 2008 uses unwanted tissue and fat from the patient's tummy, along the bra line, or beneath the upper arm, shapes it into a breast mound and secures it with absorbable sutures into a tissue sheet that acts like a sling to hold the flap into position. This "spiral flap" is mobile enough to permit artistry in shaping, positioning and enlarging the breast. According to Dr. Hurwitz, the breasts are not only enlarged and better-shaped; they are soft and shift naturally with changes in body position. Patients also get the dual benefit of body contouring.
Currently, the majority of these patients are treated with conventional breast surgery, generally with less patient satisfaction. However, the "spiral flap" technique should not be substituted for standard breast implant augmentation, augmentation with breast lift, or breast reduction in all patients. While the procedure may be an option for a small percentage of women (post-pregnancy or as a result of aging) with extremely flattened chests who have ample excess skin around their mid torso, the majority treated with this technique are massive weight loss patients.
"For these women, so much volume and skin elasticity is gone that a basic breast augmentation or lift just doesn't produce optimal results," said Dr. Hurwitz. "By using the patients own tissue, they get a more natural augmentation with the dual benefit of body contouring."
Nearly 348,000 breast augmentations were performed in 2007, making it the number one cosmetic plastic surgery procedure last year, according to ASPS statistics. In addition, more than 106,000 breast reductions and 104,000 breast lifts were performed last year.
The American Society of Plastic Surgeons is the largest organization of board-certified plastic surgeons in the world. Representing more than 6,700 physician members, the Society is recognized as a leading authority and information source on cosmetic and reconstructive plastic surgery. ASPS comprises more than 90 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the Society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada.
Source:ASPS Public Relations
American Society of Plastic Surgeons
"In the past several years I've seen more women in their 50s who are unhappy with their breasts," said Dennis Hurwitz, MD, ASPS Member Surgeon and course instructor. "These women have had numerous pregnancies, waited later in life to have children, lost a lot of weight, or simply haven't aged well and want to restore their figure. The breast irregularities these patients share are unique. These are extreme cases - not your 'run of the mill' augmentation patients who simply want to enlarge their breasts from an A to C cup."
The procedure presented at Plastic Surgery 2008 uses unwanted tissue and fat from the patient's tummy, along the bra line, or beneath the upper arm, shapes it into a breast mound and secures it with absorbable sutures into a tissue sheet that acts like a sling to hold the flap into position. This "spiral flap" is mobile enough to permit artistry in shaping, positioning and enlarging the breast. According to Dr. Hurwitz, the breasts are not only enlarged and better-shaped; they are soft and shift naturally with changes in body position. Patients also get the dual benefit of body contouring.
Currently, the majority of these patients are treated with conventional breast surgery, generally with less patient satisfaction. However, the "spiral flap" technique should not be substituted for standard breast implant augmentation, augmentation with breast lift, or breast reduction in all patients. While the procedure may be an option for a small percentage of women (post-pregnancy or as a result of aging) with extremely flattened chests who have ample excess skin around their mid torso, the majority treated with this technique are massive weight loss patients.
"For these women, so much volume and skin elasticity is gone that a basic breast augmentation or lift just doesn't produce optimal results," said Dr. Hurwitz. "By using the patients own tissue, they get a more natural augmentation with the dual benefit of body contouring."
Nearly 348,000 breast augmentations were performed in 2007, making it the number one cosmetic plastic surgery procedure last year, according to ASPS statistics. In addition, more than 106,000 breast reductions and 104,000 breast lifts were performed last year.
The American Society of Plastic Surgeons is the largest organization of board-certified plastic surgeons in the world. Representing more than 6,700 physician members, the Society is recognized as a leading authority and information source on cosmetic and reconstructive plastic surgery. ASPS comprises more than 90 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the Society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada.
Source:ASPS Public Relations
American Society of Plastic Surgeons
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