The Hidden Powers of Chakra Meditation
Chakra meditation is a unique form of relaxation that involves deep concentration. By achieving an uninterrupted level of focus, psychic energy is able to flow up through your body, energizing and reinvigorating all of your different chakras along the way.
What is a chakra?
Chakra is a Sanskrit word that means wheel or vortex. The chakras can be thought of as energy centers that direct the flow of energy through our bodies,we have goals. Chakras are a part of our consciousness and how we use them reflects on the decisions that we make in our lives.
Achieving Peace
There are different ways to practice chakra meditation, including a method useful for beginners. Before beginning your meditation, ensure that you are dressed in loose and comfortable clothes and find a space that is free from noise and interruption.
The Steps to Inner Harmony
1) Begin by sitting or lying down in a comfortable position.
2) Turn your attention to one small part of your body such as the tip of your nose or your big toe,respect or nurture you,5819 Ugg Classic Cardy Grey Boots. Focus on the feeling you have in that one small area. Attempt to connect with the subtle details of that body part.
3) When you have done this, allow the feeling of concentration to spread to the rest of your toes (if toes are what you are focusing on). Be careful not to try to absorb too much information. This meditative practice should be organic in its flow and should seamlessly spread throughout the body like a gentle wave. If you feel thoughts of stress or worry invading your circle of peace, go back to concentrating on that one tiny aspect of your body.
Do not be impatient with this form of meditation; it does require practice. Many individuals use a special guide as a way to achieve perfection in the practice. A self tuning meditation DVD is an ideal way to perform this practice, and uses soft music and personalized musical tones to lead you to peace (see ).
See the World Differently
Over time, the practice of chakra meditation has the power to change your way of thinking. Achieving success in this form of meditation can bring you to a heightened sense of awareness in the world and allows you to view your environment through clearer eyes. For many individuals,FL told me something I'm only just now beginning to understand. As I sat there in front of her, practicing chakra meditation daily has led them to a keen awareness of the causes behind certain behaviours, as well as a better understanding of others.
Wednesday, October 31, 2012
Tuesday, October 30, 2012
Tom Hart Dyke
Garden of Eden: A Jungle Captive's Lesson in Dreams Come True by Sharif Khan
BBC News recently reported the story of horticulturist and orchid collector,As many mothers know, Tom Hart Dyke, who was kidnapped in 2000 in the Darien Gap in Panama by Colombian Guerrillas and held hostage for nine months in the South American jungle. He was on a plant collecting expedition with his friend Paul Winder when captured,5819 Ugg Classic Cardy Grey Boots.
They experienced a horrific kidnapping ordeal and were both threatened with being beheaded. During this dark passage, in order to stay sane, Tom spent his time jotting down plans in his dairy and dreaming of a map garden containing exotic plants from around the world.
The original plan took root, he recalls, when he was threatened with execution: "My guards kicked down the door on June 16, 2000, my sister's birthday, and said: You've got five hours, mate.' I started scribbling in my diary,in future, drawing the shapes of my garden. It took an AK47 to focus my mind. It was: four walls, start drawing. The whole garden started with that threat. Five hours later the guards came back and we had iguana and armadillo for supper as usual; there was no more mention of being shot." [Taken from Times Online, Aug. 4, 2006]
After his miraculous release, Tom set about building his dream garden and worked hard on cultivating a neglected two-acre garden at his family's ancestral home in Kent. His dream garden is now a reality. Like something out of a fairy tale, Tom's magical walled garden is situated in the historic Lullingston Castle grounds. He calls it "The World Garden of Plants," which is divided into four continents and is now an award winning tourist attraction open to the public.
Think of this article as that AK47 to focus your mind on your dreams. Okay, so this article might not be as threatening, but it'll spare you the nine months of captivity in the heart of darkness -- sans iguana and armadillo,That you're not reaching your fullest potential.
But seriously, since most of us don't have guns pointed to our heads and we live in a predominantly free society, there should be no excuses for not living our dreams. Take the time now to concentrate your thoughts and focus on your dreams:
* Write out your plans for your magical dream world in a diary as Tom did.
* Re-create your plans by sketching them on paper. Use colors to make your drawing memorable.
* Visit your nearest Staples and get a pin cork board to create a Vision Board. Tack pictures, quotes, magazine cut-outs, and drawings that represent the dream lifestyle you want to live or the BIG goal you want to achieve. Look at that board every day and see yourself living that lifestyle.
* Create a replica vision board' by putting similar pictures on your fridge with fridge magnets as a further reminder.
* Put another reminder photo near your bathroom mirror; create a screensaver of it on your computer; and discreetly, or not so discreetly, put that dream sketch or photo somewhere near your workspace where you can look at it daily. During your breaks, you can focus on these pictures with intensity and daydream about what it would be like to actually live out your fantasy.
* Kidnap yourself! Take yourself hostage and go into captivity for a while to focus only on your dream world and the new reality you want to create for yourself. Go on a two day or week long retreat (or longer) to refresh and renew your mind, body, and soul and use this quiet time of solitude to reflect on your dreams.
* Watch the DVD movie The Secret which provides a powerful and visceral experience of the magic that can happen when you concentrate your thoughts on what you want, visualize your dreams, and feel the excitement of what it would be like to actually be living your dreams right now!
Become obsessed with your dream! Write down all the steps you need to take, all the goals you need to accomplish along the way, and list all the resources you need to tap into to recreate that Shangri La in your mind.
By immersing yourself in an oasis of dream thoughts, your heart will overflow with positive energy that will seep through and permeate every pore, cell, and molecular structure in your body. This is the timeless Law of Attraction that The Secret movie makes so vividly clear, where what you want, wants you, and you attract the very thing that is top of mind. You can use these dream thought projections to penetrate the far reaches of space and literally create your own Garden of Eden on earth.
BBC News recently reported the story of horticulturist and orchid collector,As many mothers know, Tom Hart Dyke, who was kidnapped in 2000 in the Darien Gap in Panama by Colombian Guerrillas and held hostage for nine months in the South American jungle. He was on a plant collecting expedition with his friend Paul Winder when captured,5819 Ugg Classic Cardy Grey Boots.
They experienced a horrific kidnapping ordeal and were both threatened with being beheaded. During this dark passage, in order to stay sane, Tom spent his time jotting down plans in his dairy and dreaming of a map garden containing exotic plants from around the world.
The original plan took root, he recalls, when he was threatened with execution: "My guards kicked down the door on June 16, 2000, my sister's birthday, and said: You've got five hours, mate.' I started scribbling in my diary,in future, drawing the shapes of my garden. It took an AK47 to focus my mind. It was: four walls, start drawing. The whole garden started with that threat. Five hours later the guards came back and we had iguana and armadillo for supper as usual; there was no more mention of being shot." [Taken from Times Online, Aug. 4, 2006]
After his miraculous release, Tom set about building his dream garden and worked hard on cultivating a neglected two-acre garden at his family's ancestral home in Kent. His dream garden is now a reality. Like something out of a fairy tale, Tom's magical walled garden is situated in the historic Lullingston Castle grounds. He calls it "The World Garden of Plants," which is divided into four continents and is now an award winning tourist attraction open to the public.
Think of this article as that AK47 to focus your mind on your dreams. Okay, so this article might not be as threatening, but it'll spare you the nine months of captivity in the heart of darkness -- sans iguana and armadillo,That you're not reaching your fullest potential.
But seriously, since most of us don't have guns pointed to our heads and we live in a predominantly free society, there should be no excuses for not living our dreams. Take the time now to concentrate your thoughts and focus on your dreams:
* Write out your plans for your magical dream world in a diary as Tom did.
* Re-create your plans by sketching them on paper. Use colors to make your drawing memorable.
* Visit your nearest Staples and get a pin cork board to create a Vision Board. Tack pictures, quotes, magazine cut-outs, and drawings that represent the dream lifestyle you want to live or the BIG goal you want to achieve. Look at that board every day and see yourself living that lifestyle.
* Create a replica vision board' by putting similar pictures on your fridge with fridge magnets as a further reminder.
* Put another reminder photo near your bathroom mirror; create a screensaver of it on your computer; and discreetly, or not so discreetly, put that dream sketch or photo somewhere near your workspace where you can look at it daily. During your breaks, you can focus on these pictures with intensity and daydream about what it would be like to actually live out your fantasy.
* Kidnap yourself! Take yourself hostage and go into captivity for a while to focus only on your dream world and the new reality you want to create for yourself. Go on a two day or week long retreat (or longer) to refresh and renew your mind, body, and soul and use this quiet time of solitude to reflect on your dreams.
* Watch the DVD movie The Secret which provides a powerful and visceral experience of the magic that can happen when you concentrate your thoughts on what you want, visualize your dreams, and feel the excitement of what it would be like to actually be living your dreams right now!
Become obsessed with your dream! Write down all the steps you need to take, all the goals you need to accomplish along the way, and list all the resources you need to tap into to recreate that Shangri La in your mind.
By immersing yourself in an oasis of dream thoughts, your heart will overflow with positive energy that will seep through and permeate every pore, cell, and molecular structure in your body. This is the timeless Law of Attraction that The Secret movie makes so vividly clear, where what you want, wants you, and you attract the very thing that is top of mind. You can use these dream thought projections to penetrate the far reaches of space and literally create your own Garden of Eden on earth.
Monday, October 29, 2012
"The harder you work
Get Lucky!
"Luck" is what happens when someone wins the Lotto. Against several million to one odds, the six numbers drawn match the six on the winning man's ticket. Or the little old lady pulls the "one-armed bandit", and bells ring and lights light up as she "hits the big one".
There was once a time when one's values, work ethic and determination went a long way in explaining success. Horatio Algerism meant that a well-dressed, hard-working, likable person could write his or her own ticket--climb the corporate ladder, live in a big house in a nice neighborhood, drive a fancy car,Many years ago, and vacation with the family once or twice per year.
But today that's not enough. There's something else--some other factor that separates the ones just getting by (in spite of their hard work, etc.) from those who appear to be living the American Dream. When you try to analyze it, it seems to be, well, luck.
Sure, one can do okay by doing "all the right things." But today, you don't necessarily get the white picket fence just for performing up to your bosses expectations, and running a profitable business. No, today we seem to also need something intangible, some break, some uniqueness. We need luck.
By definition, luck is completely out of our control. I believe, however, that there are certain things we can do to position ourselves for it. Earl Nightingale defines success as "when preparedness meets opportunity." Here are a few ways to "prepare" ourselves for the "opportunity":
Work hard. In the words of Chuck Berry, "The harder you work, the luckier you get." While hard work alone does not guarantee meeting Lady Luck,5819 Ugg Classic Cardy Grey Boots, people who work long enough and hard enough at their goals tend to be lucky,It took Randall many months to be willing to feel his painful feelings.
Be couragious during the storm,this was his third attempt. Over the years of being in and out of recovery. As elusive as good luck seems to be, bad luck seems to happen so naturally. While you can't escape it, how you weather it will have an effect on the kind of luck that follows.
Be positive and optimistic. Being positive helps get you through the bad luck, and also positions you for lucky opportunities to flow your way.
Do what you love. Passion seems to be a conduit for luck. When you have discovered what you love, and focus your energy in that area, you are well-positioned for luck to occur.
So go out, get positioned, and get lucky!
"Luck" is what happens when someone wins the Lotto. Against several million to one odds, the six numbers drawn match the six on the winning man's ticket. Or the little old lady pulls the "one-armed bandit", and bells ring and lights light up as she "hits the big one".
There was once a time when one's values, work ethic and determination went a long way in explaining success. Horatio Algerism meant that a well-dressed, hard-working, likable person could write his or her own ticket--climb the corporate ladder, live in a big house in a nice neighborhood, drive a fancy car,Many years ago, and vacation with the family once or twice per year.
But today that's not enough. There's something else--some other factor that separates the ones just getting by (in spite of their hard work, etc.) from those who appear to be living the American Dream. When you try to analyze it, it seems to be, well, luck.
Sure, one can do okay by doing "all the right things." But today, you don't necessarily get the white picket fence just for performing up to your bosses expectations, and running a profitable business. No, today we seem to also need something intangible, some break, some uniqueness. We need luck.
By definition, luck is completely out of our control. I believe, however, that there are certain things we can do to position ourselves for it. Earl Nightingale defines success as "when preparedness meets opportunity." Here are a few ways to "prepare" ourselves for the "opportunity":
Work hard. In the words of Chuck Berry, "The harder you work, the luckier you get." While hard work alone does not guarantee meeting Lady Luck,5819 Ugg Classic Cardy Grey Boots, people who work long enough and hard enough at their goals tend to be lucky,It took Randall many months to be willing to feel his painful feelings.
Be couragious during the storm,this was his third attempt. Over the years of being in and out of recovery. As elusive as good luck seems to be, bad luck seems to happen so naturally. While you can't escape it, how you weather it will have an effect on the kind of luck that follows.
Be positive and optimistic. Being positive helps get you through the bad luck, and also positions you for lucky opportunities to flow your way.
Do what you love. Passion seems to be a conduit for luck. When you have discovered what you love, and focus your energy in that area, you are well-positioned for luck to occur.
So go out, get positioned, and get lucky!
but without moisture
Afro Curly Hair and Choosing the Right Products & Accessories by Eva D.
For over ten years, I would flit like a butterfly to the vast array of products with the bright shiny labels promising drama free styling for my curly coif. Yet, each time I ripped open the lid and applied my creamy concoctions, planets ceased to collide, minds didn't meld and guess what? My hair didn't grow...not immediately anyway because aside from actually working, effective products and accessories should also support three necessary growth requirements for tight curls over time:
Moisture
Products that promote growth really moisturize your curls. Because curly hair is dry, it can break off and be unforgiving when it tangles. Yet when hair is moisturized, its more pliable and easy to manipulate, but without moisture, curls can become knots when being detangled and break. So products that are most beneficial shower curls with the most moisture possible.
Breakage Prevention
Not only do brittle curls cause breakage, but so do certain styling accessories. For years, I used to routinely wear a flat metal clip for a ponytail or bun style and I often wondered why in that exact place, where I snapped the clip closed, this area of my hair was shorter than the rest. At first I thought my hair just grew that way, but one day, I lost my clips (and was too cheap to buy more),5819 Ugg Classic Cardy Grey Boots. So I needed to figure out another style for a while, and noticed my hair started to grow back in that area. Sometimes we can be using accessories that are hurting our hair and because we've always used them, we don't even think about it.
When I transitioned to being natural, there were a lot of styling practices that I carried over from my relaxed hair days. These practices were bad before and even worse now for my natural fro. For example, I didn't cover my hair at night. I thought I didn't have to,to decide who gets to take the arrangements home. Others donate them to a nursing home., because I could sleep on it, and still comb through it the next day, but not so with natural hair. Now, if I don't moisturize, twist up and put a cap on my curly fro for the night, my hair will rub up against other hair and create a beehive of knots and tangles which will not be sorted out by the time I have to get to work the next day unless there is a scissor involved.
Curly Interactions
Effective natural hair products and accessories also reduce curl to curl friction. I know the phrase sounds bizarre, but researchers have found that when a hair's cuticle layers rub up against each other, there can be lifting of the cuticles causing damage,Kegelmaster A Healer Of Women Ailment by Andrew Rivano. Remember we don't even want to see the cortex of your hair strand. That's not healthy hair.
And curls know this interaction really well, because they just naturally intertwine,patchouli. When hair isn't set and covered during the night, hair will rub against other hair and your pillow causing knots, damage and the beginnings of fractured hair.
Picking the right products and accessories then using them appropriately is definitely important for afro curly hair growth. While styling products work differently for each curl, I will test some products by integrating them into my current routine and will see what happens. I know that I'd like to try some products like emu oil. My last relaxer involved a chemical burn near the area of my temples and hair doesn't live there anymore, but emu oil may be able to help that. So I think I'll try that one first and share the results.
For over ten years, I would flit like a butterfly to the vast array of products with the bright shiny labels promising drama free styling for my curly coif. Yet, each time I ripped open the lid and applied my creamy concoctions, planets ceased to collide, minds didn't meld and guess what? My hair didn't grow...not immediately anyway because aside from actually working, effective products and accessories should also support three necessary growth requirements for tight curls over time:
Moisture
Products that promote growth really moisturize your curls. Because curly hair is dry, it can break off and be unforgiving when it tangles. Yet when hair is moisturized, its more pliable and easy to manipulate, but without moisture, curls can become knots when being detangled and break. So products that are most beneficial shower curls with the most moisture possible.
Breakage Prevention
Not only do brittle curls cause breakage, but so do certain styling accessories. For years, I used to routinely wear a flat metal clip for a ponytail or bun style and I often wondered why in that exact place, where I snapped the clip closed, this area of my hair was shorter than the rest. At first I thought my hair just grew that way, but one day, I lost my clips (and was too cheap to buy more),5819 Ugg Classic Cardy Grey Boots. So I needed to figure out another style for a while, and noticed my hair started to grow back in that area. Sometimes we can be using accessories that are hurting our hair and because we've always used them, we don't even think about it.
When I transitioned to being natural, there were a lot of styling practices that I carried over from my relaxed hair days. These practices were bad before and even worse now for my natural fro. For example, I didn't cover my hair at night. I thought I didn't have to,to decide who gets to take the arrangements home. Others donate them to a nursing home., because I could sleep on it, and still comb through it the next day, but not so with natural hair. Now, if I don't moisturize, twist up and put a cap on my curly fro for the night, my hair will rub up against other hair and create a beehive of knots and tangles which will not be sorted out by the time I have to get to work the next day unless there is a scissor involved.
Curly Interactions
Effective natural hair products and accessories also reduce curl to curl friction. I know the phrase sounds bizarre, but researchers have found that when a hair's cuticle layers rub up against each other, there can be lifting of the cuticles causing damage,Kegelmaster A Healer Of Women Ailment by Andrew Rivano. Remember we don't even want to see the cortex of your hair strand. That's not healthy hair.
And curls know this interaction really well, because they just naturally intertwine,patchouli. When hair isn't set and covered during the night, hair will rub against other hair and your pillow causing knots, damage and the beginnings of fractured hair.
Picking the right products and accessories then using them appropriately is definitely important for afro curly hair growth. While styling products work differently for each curl, I will test some products by integrating them into my current routine and will see what happens. I know that I'd like to try some products like emu oil. My last relaxer involved a chemical burn near the area of my temples and hair doesn't live there anymore, but emu oil may be able to help that. So I think I'll try that one first and share the results.
Friday, October 26, 2012
but more often than not it's because that one product does what it was created to do. Nothing fancy
Brand Loyalty, Does That Still Happen These Days?
Are you someone who must wear the same brand for all your makeup needs? What about your skincare?
Must everything you use be the same brand head to toe or do you believe it ok to be disloyal?
Sometimes when it comes to a favorite perfume, it feels just wonderful to take a shower or bath as your favorite scent fills the air. Starting with the body cleanser you're using and if you're lucky, your brand carries a candle within it line. Why do we go so far in the use of just one scent within one brand?
We all have something we won't use by any other brand no matter who we talk with. We all have a favorite something, I will admit it's the mascara I offer on my website. But there are some who will go out of their way in major hunting in every store around them to on the internet to find that one item within that one brand. What makes us go so nuts over something?
God forbid if a company that has carried the same scent for years decides to drop it, to make a place for a more up to date scent! There are letters written, phone calls made all to get that one scent back! Sometimes it works, but most times it doesn't. Some say it's the marketing that has us all ga ga over it, but more often than not it's because that one product does what it was created to do. Nothing fancy, it just does it.
Does it really matter to use just one brand on your face and/ or body? A lot of high-end stores say that it is a necessity to use only one brand on your face. If that sales lady is really good at her job, you might leave the store with hundreds of dollars worth of skincare that you are going by her word that it works for whatever reason you went shopping. But note,that sales lady was trained to push as much as she can on you to buy. Still, does it really matter?
First off you must remember that if you mix brands you might get more than you bargain for. You might break out and if you are using 4 or 5 different brands, how do you know which one is causing the out break? If you have really sensitive skin, that might be the worst thing to do. Start changing things around because of something you saw advertised on tv,designers still gear their creations towards a size four, or your friends are singing its praises, or even that same sales lady has gotten you to buy it. If your skin tends to break out due to hormones or stress then mixing could cause reactions that take forever to clear up.
What about the rest of us who don't have that many problems with our skin? We just saw that such and such brand came out with something brand-new that is the latest in curing wrinkles. And we just saw this morning a tiny wrinkle that wasn't there the night before. What stops us from trying that new product? Well, nothing is really wrong in doing so but the first thing we need to do is test it!
Most high-end stores will hand out samples which are usually more than enough to tell you if it's going to break you out or not.
Nothing says you must be brand loyal, in fact these days there is so much out there that your favorite brand is not always going to carry everything,general guidelines will guide you on how to choose the right shoes for you..
Go ahead, try it out. Look at everything you use now, that should tell you if you really need something new or if you are just bored with what you using or that advertising is truly doing its job.
Never waste your money on the whole skincare line unless you have used it before and you know it works. There is no need to, get samples. Most high end stores will either have a sample or that same sales lady can go ahead and create you one. Take it home and try it behind your ear and that will tell you if you can use it or not on your face. But take sometime before you decide its going to work or not. If you feel itching or stinging that tells that it's not for you,Over 80% of the people in the Network Marketing industry are women!
If you had bought the whole jar instead of being able to get a sample, most stores will take it back if you have a bad reaction, just remember your receipt.
If you are trying out something new on your body, always check the ingredients just in case there is something you already know you can't have on your skin. There is quite a few of us that are now having reactions to lanolin so its always good to read and get to know your ingredients.
Everyone mixing their cosmetics these days because not one brand carries all that one might need. Some companies create the best foundation and nothing else. Others carry all the most up to date colors in eye shadow. Still others carry the best mascara ever and killer blush, some create the best makeup brushes. Can that all be found within one brand? Sure, but these days it's not likely. We all like too many different things and it would be really hard for one company to have it all. But they do try, you've got to give them that,5819 Ugg Classic Cardy Grey Boots.
Brand loyalty is really a thing of the past. When there were only 2 or 3 major companies that carried everything and there wasn't television to tell us we need something new.
Stay loyal to what works for you, don't stay loyal if it doesn't work any longer. As our skin ages we try new products to better suit its changing needs. Take the time to research the products you do need or think you might be needing to change and pay no mind to that same sales lady who knows you've just got to have the whole line!! Remember where she gets her training from! Trust your own skin, it will tell you best of all.
Are you someone who must wear the same brand for all your makeup needs? What about your skincare?
Must everything you use be the same brand head to toe or do you believe it ok to be disloyal?
Sometimes when it comes to a favorite perfume, it feels just wonderful to take a shower or bath as your favorite scent fills the air. Starting with the body cleanser you're using and if you're lucky, your brand carries a candle within it line. Why do we go so far in the use of just one scent within one brand?
We all have something we won't use by any other brand no matter who we talk with. We all have a favorite something, I will admit it's the mascara I offer on my website. But there are some who will go out of their way in major hunting in every store around them to on the internet to find that one item within that one brand. What makes us go so nuts over something?
God forbid if a company that has carried the same scent for years decides to drop it, to make a place for a more up to date scent! There are letters written, phone calls made all to get that one scent back! Sometimes it works, but most times it doesn't. Some say it's the marketing that has us all ga ga over it, but more often than not it's because that one product does what it was created to do. Nothing fancy, it just does it.
Does it really matter to use just one brand on your face and/ or body? A lot of high-end stores say that it is a necessity to use only one brand on your face. If that sales lady is really good at her job, you might leave the store with hundreds of dollars worth of skincare that you are going by her word that it works for whatever reason you went shopping. But note,that sales lady was trained to push as much as she can on you to buy. Still, does it really matter?
First off you must remember that if you mix brands you might get more than you bargain for. You might break out and if you are using 4 or 5 different brands, how do you know which one is causing the out break? If you have really sensitive skin, that might be the worst thing to do. Start changing things around because of something you saw advertised on tv,designers still gear their creations towards a size four, or your friends are singing its praises, or even that same sales lady has gotten you to buy it. If your skin tends to break out due to hormones or stress then mixing could cause reactions that take forever to clear up.
What about the rest of us who don't have that many problems with our skin? We just saw that such and such brand came out with something brand-new that is the latest in curing wrinkles. And we just saw this morning a tiny wrinkle that wasn't there the night before. What stops us from trying that new product? Well, nothing is really wrong in doing so but the first thing we need to do is test it!
Most high-end stores will hand out samples which are usually more than enough to tell you if it's going to break you out or not.
Nothing says you must be brand loyal, in fact these days there is so much out there that your favorite brand is not always going to carry everything,general guidelines will guide you on how to choose the right shoes for you..
Go ahead, try it out. Look at everything you use now, that should tell you if you really need something new or if you are just bored with what you using or that advertising is truly doing its job.
Never waste your money on the whole skincare line unless you have used it before and you know it works. There is no need to, get samples. Most high end stores will either have a sample or that same sales lady can go ahead and create you one. Take it home and try it behind your ear and that will tell you if you can use it or not on your face. But take sometime before you decide its going to work or not. If you feel itching or stinging that tells that it's not for you,Over 80% of the people in the Network Marketing industry are women!
If you had bought the whole jar instead of being able to get a sample, most stores will take it back if you have a bad reaction, just remember your receipt.
If you are trying out something new on your body, always check the ingredients just in case there is something you already know you can't have on your skin. There is quite a few of us that are now having reactions to lanolin so its always good to read and get to know your ingredients.
Everyone mixing their cosmetics these days because not one brand carries all that one might need. Some companies create the best foundation and nothing else. Others carry all the most up to date colors in eye shadow. Still others carry the best mascara ever and killer blush, some create the best makeup brushes. Can that all be found within one brand? Sure, but these days it's not likely. We all like too many different things and it would be really hard for one company to have it all. But they do try, you've got to give them that,5819 Ugg Classic Cardy Grey Boots.
Brand loyalty is really a thing of the past. When there were only 2 or 3 major companies that carried everything and there wasn't television to tell us we need something new.
Stay loyal to what works for you, don't stay loyal if it doesn't work any longer. As our skin ages we try new products to better suit its changing needs. Take the time to research the products you do need or think you might be needing to change and pay no mind to that same sales lady who knows you've just got to have the whole line!! Remember where she gets her training from! Trust your own skin, it will tell you best of all.
Wednesday, October 24, 2012
High-quality Akoya saltwater pearls have a higher luster than South Sea or Tahitian pearls
How to Buy Pearls
Pearls are an enduring classic of romantic beauty and sophistication suitable for almost any occasions or celebrations. Pearls may be worn with formal eveningwear, with a business suit, or casually with a sweater and jeans. The official June birthstone provides an ideal choice for brides, young women looking for a touch of elegance, or a cherished gift for birthday, Christmas, graduation, sweet-sixteen, anniversary, or just to say I love you.
Once rare and expensive, modern cultured pearls have become an affordable luxury. To choose consider six factors contribute to the value of a pearl: luster, nacre thickness, shape, surface texture, size, and color.
Luster- the Essence of Pearl Beauty
Pearls gain their unique beauty from the play of light reflecting through layers of fine crystalline nacre gradually deposited by an oyster. Nearly transparent nacre gives the deepest luster and the highest reflection. A high-quality pearl will have a brilliant even reflection with a fine warm glow or radiance. Lower quality pearls have a dull sheen.
High-quality Akoya saltwater pearls have a higher luster than South Sea or Tahitian pearls, which tend to have a softer, more diffuse reflection.
Color and Overtones
The dominant color of a pearl comes from the main reflection from the pearl surface. The deeper reflected light draws the inner color from the pearl, called the overtone.
Light colored pearls are available in shades of white, cream, and golden. White with pink or silver overtones are generally the most valuable. The most desirable dark colored pearls are black with green or blue overtones. Color matching is also important when buying pearl jewelry. Perfectly matched pearls in color and size are more valuable than poorly matched pearls.
Shape and Surface Texture
The highest quality pearls are perfectly round with smooth surface, very few surface imperfections, and even coloration. Lower quality pearls may be nearly round, or show more surface imperfections, such as wrinkles or large pits on the surface,5819 Ugg Classic Cardy Grey Boots.
Pearl Size and Necklace Length
The pearls in a strand are measured in a range, such as 7-7.5mm. They are strung with the largest pearls at the center of the necklace and gradually smaller towards the clasp. Larger pearls are more valuable and they create a more dramatic look. High-quality pearls larger than 9 mm are scarce and very expensive.
The classic and most common pearl necklace length is the 17-19 inch princess. It is a good choice for a first pearl necklace because it can be worn with many things.
Decide Pearl Types
There are four types of pearls:
Classic Akoya Pearls
Large Exotic Black Tahitian Pearls
Large Golden or White South Sea Pearls
Inexpensive Decorative Freshwater Pearls
The above four types of pearls are all cultured pearls. Akoya, Tahitian and South Sea pearls grow in ocean saltwater so they are also called saltwater pearls.
Akoya pearls are the most popular type for their appealing high luster, luxury and affordability.
Decide Pearl Quality
Pearls usually have four grades: A, AA, AAA, and AAA+ quality. AAA and AAA+ quality are the highest quality.
AAA and AAA+ quality pearls are the most desired pearls for gifts. They have high luster and very clean surface skins.
AA quality pearls have medium luster and slight to medium surface imperfection. They are ideal gifts for someone who will be happy to own a piece of fine pearl jewelry.
A quality pearls have low luster and medium to heavy blemishes. They are not popular for gifts due to their low quality.
Decide where to buy pearls
You can buy pearls from retail stores, online shops or online auctions. When shop for pearls, it is recommended to buy pearls from these places: stores that grade pearls carefully; stores that provide certificate and offer money back guarantees.
Copyright: 2004 by Premium Pearl Jewelry
Pearls are an enduring classic of romantic beauty and sophistication suitable for almost any occasions or celebrations. Pearls may be worn with formal eveningwear, with a business suit, or casually with a sweater and jeans. The official June birthstone provides an ideal choice for brides, young women looking for a touch of elegance, or a cherished gift for birthday, Christmas, graduation, sweet-sixteen, anniversary, or just to say I love you.
Once rare and expensive, modern cultured pearls have become an affordable luxury. To choose consider six factors contribute to the value of a pearl: luster, nacre thickness, shape, surface texture, size, and color.
Luster- the Essence of Pearl Beauty
Pearls gain their unique beauty from the play of light reflecting through layers of fine crystalline nacre gradually deposited by an oyster. Nearly transparent nacre gives the deepest luster and the highest reflection. A high-quality pearl will have a brilliant even reflection with a fine warm glow or radiance. Lower quality pearls have a dull sheen.
High-quality Akoya saltwater pearls have a higher luster than South Sea or Tahitian pearls, which tend to have a softer, more diffuse reflection.
Color and Overtones
The dominant color of a pearl comes from the main reflection from the pearl surface. The deeper reflected light draws the inner color from the pearl, called the overtone.
Light colored pearls are available in shades of white, cream, and golden. White with pink or silver overtones are generally the most valuable. The most desirable dark colored pearls are black with green or blue overtones. Color matching is also important when buying pearl jewelry. Perfectly matched pearls in color and size are more valuable than poorly matched pearls.
Shape and Surface Texture
The highest quality pearls are perfectly round with smooth surface, very few surface imperfections, and even coloration. Lower quality pearls may be nearly round, or show more surface imperfections, such as wrinkles or large pits on the surface,5819 Ugg Classic Cardy Grey Boots.
Pearl Size and Necklace Length
The pearls in a strand are measured in a range, such as 7-7.5mm. They are strung with the largest pearls at the center of the necklace and gradually smaller towards the clasp. Larger pearls are more valuable and they create a more dramatic look. High-quality pearls larger than 9 mm are scarce and very expensive.
The classic and most common pearl necklace length is the 17-19 inch princess. It is a good choice for a first pearl necklace because it can be worn with many things.
Decide Pearl Types
There are four types of pearls:
Classic Akoya Pearls
Large Exotic Black Tahitian Pearls
Large Golden or White South Sea Pearls
Inexpensive Decorative Freshwater Pearls
The above four types of pearls are all cultured pearls. Akoya, Tahitian and South Sea pearls grow in ocean saltwater so they are also called saltwater pearls.
Akoya pearls are the most popular type for their appealing high luster, luxury and affordability.
Decide Pearl Quality
Pearls usually have four grades: A, AA, AAA, and AAA+ quality. AAA and AAA+ quality are the highest quality.
AAA and AAA+ quality pearls are the most desired pearls for gifts. They have high luster and very clean surface skins.
AA quality pearls have medium luster and slight to medium surface imperfection. They are ideal gifts for someone who will be happy to own a piece of fine pearl jewelry.
A quality pearls have low luster and medium to heavy blemishes. They are not popular for gifts due to their low quality.
Decide where to buy pearls
You can buy pearls from retail stores, online shops or online auctions. When shop for pearls, it is recommended to buy pearls from these places: stores that grade pearls carefully; stores that provide certificate and offer money back guarantees.
Copyright: 2004 by Premium Pearl Jewelry
Tuesday, October 23, 2012
vibratory stimulus
Nipple
The body of literature documenting normative breast sensation and postoperative changes in sensation after reduction mammaplasty has grown considerably over the last several years,5819 Ugg Classic Cardy Grey Boots. Despite this, only two studies have ever been published on the subject of postaugmentation mammaplasty sensory outcomes. The purpose of this study was to precisely measure sensory thresholds at the nipple-areola complex in women who have undergone augmentation mammaplasty by either the inframammary or periareolar approach.
Methods:
Twenty women underwent primary augmentation mammaplasty by either the periareolar or inframammary approach at an average follow-up of 1.12 years. Sensory testing was performed using the Pressure-Specified Sensory Device by comparing moving and static sensory thresholds at the upper and lower areola and nipple. Nine women served as size-matched, nonoperated controls in the study.
Results:
Primary augmentation mammaplasty was found to have a statistically significant negative effect on sensory outcomes when nonoperated controls were compared with women who had undergone augmentation mammaplasty via either the periareolar or inframammary approach. No differences in sensory outcomes were found between the two approaches used. Implant volume was found to be highly predictive of sensory outcomes, with an inverse relationship between implant size and the degree of sensitivity within the nipple-areola complex.
Conclusions:
Plastic surgeons should feel comfortable counseling patients that augmentation mammaplasty by either the inframammary or periareolar approach results in no discernible differences in sensory outcomes. Furthermore, women who choose very large implants relative to their breast skin envelopes should be warned about potential adverse sensory sequelae within the nippleareola complex. (Plast. Reconstr. Surg. 117: 1694, 2006.)
The body of literature documenting normative breast sensation and postoperative changes in sensation has grown considerably over the last several years. This is especially true in women following reduction mammaplasty. In addition to anatomic studies that have outlined the innervation of the nipple-areola complex, precise sensory measurements have been performed on patients who have undergone reduction mammaplasty by several different techniques, including the inferior pedicle, medial pedicle, and breast amputation--free nipple graft approaches.1–6 Despite the expanding knowledge base on this subject, only one study has been published since 1976 on the comparably larger subset of patients who have undergone augmentation mammaplasty.7 As previous studies have demonstrated, women with macromastia are considerably less sensate in the region of the nipple-areola complex than age-matched controls with small to normal-sized breasts.6,8,9 The causal relationship of this finding has been speculative and is thought to be related to nerve traction injury and decreased innervation density in patients with gigantomastia. Although evidence is anecdotal, women with macromastia who present for reduction mammaplasty are primarily motivated by chronic symptoms of pain and discomfort, the inability to engage in vigorous physical activity, and intertriginous infections. Concerns regarding sensory outcomes are usually secondary and frequently inconsequential, since preoperative sensation is diminished. In contrast, women who present for augmentation mammaplasty are highly sensate in the region of the nipple-areola complex, and in the course of the preoperative consultation there are frequently questions about postoperative sensory outcomes. In women with micromastia, sensation of the nipple-areola complex is often of paramount importance and, in some women, an important source of stimulation during intimacy. Until now, informed consent regarding this issue has been achieved by the operative plastic surgeon by suggesting that sensory loss is a potential outcome, but that sensory outcomes are uncertain and variable. It is also the practice of some plastic surgeons to discourage the periareolar approach of implant placement in women who voice concerns about the loss of sensitivity, because of the risk of transection of nerve fibers leading directly to the nipple-areola complex. Although other techniques of performing augmentation mammaplasty, such as the transumbilical and the endoscopically assisted transaxillary techniques, have gained popularity over the last several years, the vast majority of breast augmentations today are performed via either the inframammary approach or the periareolar approach. Unlike the two previous studies on the subject of sensory changes associated with augmentation mammaplasty,7,10 we utilized the Pressure- Specified Sensory Device (Sensory Management Services, Baltimore, Md.). Previous studies have employed modalities such as light touch, pain perception to electrical currents, vibratory stimulus, and Semmes-Weinstein nylon monofilaments. Relative to the technologically advanced sensory testing modalities available today, the techniques used in the two previous studies on this subject are considered unreliable and inaccurate.11 Thus, the purpose of this study was to quantify the sensation of the nipple-areola complex following breast augmentation using the Pressure-Specified Sensory Device and to compare the inframammary and periareolar approaches with respect to sensory outcomes.
PATIENTS AND METHODS
A total of 29 women were included in this study; nine of them were nonoperative controls (group 1), 13 had undergone breast augmentation through an inframammary approach (group 2), and seven had undergone augmentation via a periareolar approach (group 3). All women agreed to a 1-hour sensory examination that was performed in the presence of a female chaperone. No financial or other compensation was provided for enrollment in the study. The breast sensory testing protocol was accepted by our institutional review board, and all study subjects gave informed consent for sensory testing to be performed. No woman enrolled in this study reported a history of diabetes mellitus, thyroid disorders, collagen vascular disease, alcoholism, pernicious anemia, known neurological impairment, or history of previous breast surgery. Sensory evaluation was performed in all 29 women (58 breasts) by one examiner using the sensory device. Women were seated in a reclining chair with one breast exposed for testing and the other draped with a sheet. Women were asked to close their eyes so that the computer screen or the breast being tested could not be seen. A button linked to the computer was placed in the hand opposite to the breast being tested and the women were instructed to press the button to indicate perception of the test stimulus. The nipple and upper and lower halves of the areola were selected as testing sites. At each test site, five readings were recorded. The highest and lowest values were discarded to eliminate outliers, and the mean of the remaining three was reported as the pressure threshold in grams per square millimeter. One-point static and moving pressure perception threshold was measured within a continuous range of 0.1 g/mm2 to 100 g/mm2. Data were entered into an Excel spreadsheet (Microsoft Corp., Redmond, Wash.). Statistical analyses were performed to compare the one-point moving and static sensibility measurements among groups 1, 2, and 3 using the Mann-Whitney nonparametric test between each group. Data for each of a subject's breasts were averaged for each woman, since the left and right sides are highly correlated.
Group 1: Normative Controls
Nine women served as nonoperative controls. The average age of the participants was 28 years (range, 19 to 38 years; SD, 6 years). Breast size among participants ranged from 34A to 36C. A total of 18 breasts were tested and the results were averaged. Data on these patients have previously been published.6
Group 2: Inframammary Approach and Group 3: Periareolar Approach
A total of 20 women underwent augmentation mammaplasty by either the inframammary incisional approach (13 patients; 26 breasts) or the periareolar incisional approach (seven patients; 14 breasts). In study participants in whom the periareolar approach was utilized, the incision was designed from the 4 o'clock to the 8 o'clock position at the inferior border of the areola. Implants in both groups were placed in either the subglandular or submuscular plane. Study group participants were not further subdivided according to the plane of implant insertion, because study cells would suffer from small sample size and inadequacy for statistical analysis. Preoperative breast sizes ranged from 32B to 36C among study participants. The average duration between surgery and sensory evaluation was 1.12 years (range, 102 to 1512 days). The average age of participants at the time of testing was 33 years (range, 20 to 47 years; SD, 7 years). There were no significant differences in age at time of testing or in the interval between surgery and testing between the groups of women who underwent augmentation mammaplasty by either approach. The average implant size used was 375 cc (range, 340 to 475 cc) in the periareolar incisional approach group and 428 cc (range, 315 to 700 cc) in the inframammary incisional approach group; this was not statistically different (p _ 0.05).
RESULTS
Cutaneous pressure threshold values for the nipple-areola complex were determined for study participants in all groups (Tables 1 and 2). There were no statistically significant differences (p _ 0.20) in values between the upper and lower halves of the areola for each group for one-point moving and static tests; therefore, values for the upper and lower halves of the areola were pooled. Sensory measurements for both nipple-areola complexes of each participant were averaged for each participant (left and right nipple-areola complex), and the nonparametric Mann-Whitney test for two independent groups was performed (Tables 1 and 2). No statistically significant differences were found between women who underwent augmentation mammaplasty by the inframammary approach and those who had the periareolar approach (p _ 0.51 for each test, nonparametric Mann-Whitney test) (Table 1). Groups 2 and 3 were therefore pooled and compared as a single group (n _ 20) to normative controls (group 1, n _ 9) (Table 2). Significant differences were found, with p_0.03 for each test. Mean cutaneous sensory thresholds were nearly 10 times greater in women who underwent augmentation mammaplasty by any approach compared with unoperated controls with breast cup sizes ranging from 34A to 36C. Groups 2 and 3 were pooled and then subgrouped into two categories by length of time from the date of surgery to testing. Six study participants were found to have a follow-up time of between 3 and 6 months. Fourteen study participants had a follow-up time of between 6 months and 4.1 years. No statistically significant differences were found, with p _ 0.50 for each test (nonparametric Mann-Whitney test). In comparing sensory threshold variations by age at surgery, incision type, and preoperative cup size, a regression analysis was performed and in each case was found to have a p value greater than 0.05. Once each of the nonsignificant variables was dropped from the statistical model, regression analysis revealed that 50 percent of the variation in sensation was found to be attributable to implant volume (p _ 0.02).
DISCUSSION
The postoperative sensation of the nipple-areola complex after operative procedures on the breast is being investigated with increasing frequency. Despite an increasing body of knowledge on this subject following reduction mammaplasty, there is a paucity of information about sensation after augmentation mammaplasty. No studies, before this one, have compared sensory outcomes utilizing different incisional approaches or sensory outcomes based on differences in implant volume. Although there are a variety of ways to assess sensation, computer-assisted quantitative neurosensory testing represents a significant advance in our ability to perform continuous measurements. The Pressure-Specified Sensory Device is a computer- assisted instrument that uses a hemispheric probe attached to a force transducer to make continuous measurements of cutaneous pressure possible. It allows for one-point static (Merkel cellneurite complexes, Ruffini complexes), one-point moving (Pacinian and Meissner corpuscles), and moving and static two-point (innervation density) discrimination.12 Unlike nylon monofilaments, which provide only an estimate of the logarithmic range of cutaneous pressure thresholds that cannot be intuitively assessed without advanced statistical transformations, the Pressure-Specified Sensory Device provides continuous measurements of cutaneous pressure, making such statistical analyses and comparisons possible. Normative data for breast sensibility of the nipple-areola complex obtained using the device have been previously published.6 This study represents the first quantitative sensibility analysis that compares postoperative sensation of the nipple-areola complex after augmentation mammaplasty via the inframammary and periareolar approaches. Precise anatomic studies have previously elucidated the dual innervation of the nipple-areola complex medially and laterally from cutaneous branches of the third through sixth intercostal nerves.13,14 It has always been a theoretical risk that transareolar techniques of augmentation mammaplasty place the sensory outcome of the nipple-areola complex at risk, because of the direct disruption of nerve fibers traversing the inferior pole of the areola. This study has demonstrated that there is no statistically significant difference in sensory outcomes when augmentation mammaplasty is performed via the periareolar or inframammary incisional approach. In the design of this study, women were not subdivided based on plane of dissection (submuscular versus subglandular pocket position). This was because the number of women within each subgroup was not large enough for a statistically valid comparison. The neural anatomy of the nipple-areola complex has been well described, so there is no reason to suspect that implant position, either above or below the pectoralis muscle, would affect sensory outcomes.13,14 Our study design was also limited by the lack of preoperative and postoperative sensibility data on the same patients. A preoperative study, in which study participants serve as their own preoperative controls, is planned. Since the first published report on sensory outcomes after augmentation mammaplasty, a great deal has been learned. This study disputes the conclusions of the 1976 landmark article by Courtiss and Goldwyn10 that demonstrated a return to normal nipple-areola complex sensation by 6 months after augmentation mammaplasty. Utilizing a far more sensitive testing apparatus than crude touch and pinprick, this study has demonstrated a nearly 10- fold decrease in sensory thresholds after primary augmentation mammaplasty. It was interesting to find that there was no progressive diminution of sensory loss when study participants with an interval of between 3 and 6 months from surgery to testing were compared with participants with a follow-up of 6 months to 4.1 years. One might have expected to find some amelioration of sensory loss with time as the skin envelope of the breast stretches to accommodate the implant, but no discernible differences were recognized. This suggests that sensory impairments found at 3 to 6 months are not likely to improve with time. The relationship between implant volume and sensory outcome was another primary focus of this study. There was demonstrated to be a strong inverse relationship between implant volume and sensory outcomes. Although this relationship was found to be linear, implant sizes from 315 to 475 cc were found to have the least variability with respect to sensibility outcome. Sensibility outcomes were most variable with implant sizes greater than 475 cc. The relationship found between implant volume and sensory outcome is perhaps best explained by the same forces that act on large pendulous breasts in cases of gigantomastia. In an earlier study, it was demonstrated that control women with relative micromastia (34A to 36C cup size) were far more sensate than control women with gigantomastia (36DD to 46EE cup size).6 It was purported that volumetric differences in the breast were likely related to sensory outcomes because of nerve traction and innervation density, both of which are highly predictive of sensitivity. There are additional factors to consider, however, with respect to skin tension and the size of the skin envelope relative to the size of the implant. It would be expected that a large implant in a breast with a substantial skin envelope would create less tension than a large implant in a breast with a smaller and tighter skin envelope, which would consequently cause more nerve traction. In the vast majority of women who choose to undergo breast augmentation, there is an improvement in overall body image.7 Despite the fact that significant statistical differences have been found between women who have undergone augmentation mammaplasty and those who have not, it is not clear whether there is any clinical significance to these findings. Erogenous sensation is a cortical transfer function and is not necessarily correlated to sensory thresholds. The provision of this information regarding sensory outcomes to our patients is only one facet of the informed consent process that patients should undergo before having augmentation mammaplasty. Plastic surgeons should feel comfortable counseling patients that augmentation mammaplasty by either the inframammary or periareolar approach results in no discernable differences in sensory outcomes. Furthermore, women who choose very large implants relative to their breast skin envelopes should be warned about potential adverse sensory sequelae within the nippleareola complex.
The body of literature documenting normative breast sensation and postoperative changes in sensation after reduction mammaplasty has grown considerably over the last several years,5819 Ugg Classic Cardy Grey Boots. Despite this, only two studies have ever been published on the subject of postaugmentation mammaplasty sensory outcomes. The purpose of this study was to precisely measure sensory thresholds at the nipple-areola complex in women who have undergone augmentation mammaplasty by either the inframammary or periareolar approach.
Methods:
Twenty women underwent primary augmentation mammaplasty by either the periareolar or inframammary approach at an average follow-up of 1.12 years. Sensory testing was performed using the Pressure-Specified Sensory Device by comparing moving and static sensory thresholds at the upper and lower areola and nipple. Nine women served as size-matched, nonoperated controls in the study.
Results:
Primary augmentation mammaplasty was found to have a statistically significant negative effect on sensory outcomes when nonoperated controls were compared with women who had undergone augmentation mammaplasty via either the periareolar or inframammary approach. No differences in sensory outcomes were found between the two approaches used. Implant volume was found to be highly predictive of sensory outcomes, with an inverse relationship between implant size and the degree of sensitivity within the nipple-areola complex.
Conclusions:
Plastic surgeons should feel comfortable counseling patients that augmentation mammaplasty by either the inframammary or periareolar approach results in no discernible differences in sensory outcomes. Furthermore, women who choose very large implants relative to their breast skin envelopes should be warned about potential adverse sensory sequelae within the nippleareola complex. (Plast. Reconstr. Surg. 117: 1694, 2006.)
The body of literature documenting normative breast sensation and postoperative changes in sensation has grown considerably over the last several years. This is especially true in women following reduction mammaplasty. In addition to anatomic studies that have outlined the innervation of the nipple-areola complex, precise sensory measurements have been performed on patients who have undergone reduction mammaplasty by several different techniques, including the inferior pedicle, medial pedicle, and breast amputation--free nipple graft approaches.1–6 Despite the expanding knowledge base on this subject, only one study has been published since 1976 on the comparably larger subset of patients who have undergone augmentation mammaplasty.7 As previous studies have demonstrated, women with macromastia are considerably less sensate in the region of the nipple-areola complex than age-matched controls with small to normal-sized breasts.6,8,9 The causal relationship of this finding has been speculative and is thought to be related to nerve traction injury and decreased innervation density in patients with gigantomastia. Although evidence is anecdotal, women with macromastia who present for reduction mammaplasty are primarily motivated by chronic symptoms of pain and discomfort, the inability to engage in vigorous physical activity, and intertriginous infections. Concerns regarding sensory outcomes are usually secondary and frequently inconsequential, since preoperative sensation is diminished. In contrast, women who present for augmentation mammaplasty are highly sensate in the region of the nipple-areola complex, and in the course of the preoperative consultation there are frequently questions about postoperative sensory outcomes. In women with micromastia, sensation of the nipple-areola complex is often of paramount importance and, in some women, an important source of stimulation during intimacy. Until now, informed consent regarding this issue has been achieved by the operative plastic surgeon by suggesting that sensory loss is a potential outcome, but that sensory outcomes are uncertain and variable. It is also the practice of some plastic surgeons to discourage the periareolar approach of implant placement in women who voice concerns about the loss of sensitivity, because of the risk of transection of nerve fibers leading directly to the nipple-areola complex. Although other techniques of performing augmentation mammaplasty, such as the transumbilical and the endoscopically assisted transaxillary techniques, have gained popularity over the last several years, the vast majority of breast augmentations today are performed via either the inframammary approach or the periareolar approach. Unlike the two previous studies on the subject of sensory changes associated with augmentation mammaplasty,7,10 we utilized the Pressure- Specified Sensory Device (Sensory Management Services, Baltimore, Md.). Previous studies have employed modalities such as light touch, pain perception to electrical currents, vibratory stimulus, and Semmes-Weinstein nylon monofilaments. Relative to the technologically advanced sensory testing modalities available today, the techniques used in the two previous studies on this subject are considered unreliable and inaccurate.11 Thus, the purpose of this study was to quantify the sensation of the nipple-areola complex following breast augmentation using the Pressure-Specified Sensory Device and to compare the inframammary and periareolar approaches with respect to sensory outcomes.
PATIENTS AND METHODS
A total of 29 women were included in this study; nine of them were nonoperative controls (group 1), 13 had undergone breast augmentation through an inframammary approach (group 2), and seven had undergone augmentation via a periareolar approach (group 3). All women agreed to a 1-hour sensory examination that was performed in the presence of a female chaperone. No financial or other compensation was provided for enrollment in the study. The breast sensory testing protocol was accepted by our institutional review board, and all study subjects gave informed consent for sensory testing to be performed. No woman enrolled in this study reported a history of diabetes mellitus, thyroid disorders, collagen vascular disease, alcoholism, pernicious anemia, known neurological impairment, or history of previous breast surgery. Sensory evaluation was performed in all 29 women (58 breasts) by one examiner using the sensory device. Women were seated in a reclining chair with one breast exposed for testing and the other draped with a sheet. Women were asked to close their eyes so that the computer screen or the breast being tested could not be seen. A button linked to the computer was placed in the hand opposite to the breast being tested and the women were instructed to press the button to indicate perception of the test stimulus. The nipple and upper and lower halves of the areola were selected as testing sites. At each test site, five readings were recorded. The highest and lowest values were discarded to eliminate outliers, and the mean of the remaining three was reported as the pressure threshold in grams per square millimeter. One-point static and moving pressure perception threshold was measured within a continuous range of 0.1 g/mm2 to 100 g/mm2. Data were entered into an Excel spreadsheet (Microsoft Corp., Redmond, Wash.). Statistical analyses were performed to compare the one-point moving and static sensibility measurements among groups 1, 2, and 3 using the Mann-Whitney nonparametric test between each group. Data for each of a subject's breasts were averaged for each woman, since the left and right sides are highly correlated.
Group 1: Normative Controls
Nine women served as nonoperative controls. The average age of the participants was 28 years (range, 19 to 38 years; SD, 6 years). Breast size among participants ranged from 34A to 36C. A total of 18 breasts were tested and the results were averaged. Data on these patients have previously been published.6
Group 2: Inframammary Approach and Group 3: Periareolar Approach
A total of 20 women underwent augmentation mammaplasty by either the inframammary incisional approach (13 patients; 26 breasts) or the periareolar incisional approach (seven patients; 14 breasts). In study participants in whom the periareolar approach was utilized, the incision was designed from the 4 o'clock to the 8 o'clock position at the inferior border of the areola. Implants in both groups were placed in either the subglandular or submuscular plane. Study group participants were not further subdivided according to the plane of implant insertion, because study cells would suffer from small sample size and inadequacy for statistical analysis. Preoperative breast sizes ranged from 32B to 36C among study participants. The average duration between surgery and sensory evaluation was 1.12 years (range, 102 to 1512 days). The average age of participants at the time of testing was 33 years (range, 20 to 47 years; SD, 7 years). There were no significant differences in age at time of testing or in the interval between surgery and testing between the groups of women who underwent augmentation mammaplasty by either approach. The average implant size used was 375 cc (range, 340 to 475 cc) in the periareolar incisional approach group and 428 cc (range, 315 to 700 cc) in the inframammary incisional approach group; this was not statistically different (p _ 0.05).
RESULTS
Cutaneous pressure threshold values for the nipple-areola complex were determined for study participants in all groups (Tables 1 and 2). There were no statistically significant differences (p _ 0.20) in values between the upper and lower halves of the areola for each group for one-point moving and static tests; therefore, values for the upper and lower halves of the areola were pooled. Sensory measurements for both nipple-areola complexes of each participant were averaged for each participant (left and right nipple-areola complex), and the nonparametric Mann-Whitney test for two independent groups was performed (Tables 1 and 2). No statistically significant differences were found between women who underwent augmentation mammaplasty by the inframammary approach and those who had the periareolar approach (p _ 0.51 for each test, nonparametric Mann-Whitney test) (Table 1). Groups 2 and 3 were therefore pooled and compared as a single group (n _ 20) to normative controls (group 1, n _ 9) (Table 2). Significant differences were found, with p_0.03 for each test. Mean cutaneous sensory thresholds were nearly 10 times greater in women who underwent augmentation mammaplasty by any approach compared with unoperated controls with breast cup sizes ranging from 34A to 36C. Groups 2 and 3 were pooled and then subgrouped into two categories by length of time from the date of surgery to testing. Six study participants were found to have a follow-up time of between 3 and 6 months. Fourteen study participants had a follow-up time of between 6 months and 4.1 years. No statistically significant differences were found, with p _ 0.50 for each test (nonparametric Mann-Whitney test). In comparing sensory threshold variations by age at surgery, incision type, and preoperative cup size, a regression analysis was performed and in each case was found to have a p value greater than 0.05. Once each of the nonsignificant variables was dropped from the statistical model, regression analysis revealed that 50 percent of the variation in sensation was found to be attributable to implant volume (p _ 0.02).
DISCUSSION
The postoperative sensation of the nipple-areola complex after operative procedures on the breast is being investigated with increasing frequency. Despite an increasing body of knowledge on this subject following reduction mammaplasty, there is a paucity of information about sensation after augmentation mammaplasty. No studies, before this one, have compared sensory outcomes utilizing different incisional approaches or sensory outcomes based on differences in implant volume. Although there are a variety of ways to assess sensation, computer-assisted quantitative neurosensory testing represents a significant advance in our ability to perform continuous measurements. The Pressure-Specified Sensory Device is a computer- assisted instrument that uses a hemispheric probe attached to a force transducer to make continuous measurements of cutaneous pressure possible. It allows for one-point static (Merkel cellneurite complexes, Ruffini complexes), one-point moving (Pacinian and Meissner corpuscles), and moving and static two-point (innervation density) discrimination.12 Unlike nylon monofilaments, which provide only an estimate of the logarithmic range of cutaneous pressure thresholds that cannot be intuitively assessed without advanced statistical transformations, the Pressure-Specified Sensory Device provides continuous measurements of cutaneous pressure, making such statistical analyses and comparisons possible. Normative data for breast sensibility of the nipple-areola complex obtained using the device have been previously published.6 This study represents the first quantitative sensibility analysis that compares postoperative sensation of the nipple-areola complex after augmentation mammaplasty via the inframammary and periareolar approaches. Precise anatomic studies have previously elucidated the dual innervation of the nipple-areola complex medially and laterally from cutaneous branches of the third through sixth intercostal nerves.13,14 It has always been a theoretical risk that transareolar techniques of augmentation mammaplasty place the sensory outcome of the nipple-areola complex at risk, because of the direct disruption of nerve fibers traversing the inferior pole of the areola. This study has demonstrated that there is no statistically significant difference in sensory outcomes when augmentation mammaplasty is performed via the periareolar or inframammary incisional approach. In the design of this study, women were not subdivided based on plane of dissection (submuscular versus subglandular pocket position). This was because the number of women within each subgroup was not large enough for a statistically valid comparison. The neural anatomy of the nipple-areola complex has been well described, so there is no reason to suspect that implant position, either above or below the pectoralis muscle, would affect sensory outcomes.13,14 Our study design was also limited by the lack of preoperative and postoperative sensibility data on the same patients. A preoperative study, in which study participants serve as their own preoperative controls, is planned. Since the first published report on sensory outcomes after augmentation mammaplasty, a great deal has been learned. This study disputes the conclusions of the 1976 landmark article by Courtiss and Goldwyn10 that demonstrated a return to normal nipple-areola complex sensation by 6 months after augmentation mammaplasty. Utilizing a far more sensitive testing apparatus than crude touch and pinprick, this study has demonstrated a nearly 10- fold decrease in sensory thresholds after primary augmentation mammaplasty. It was interesting to find that there was no progressive diminution of sensory loss when study participants with an interval of between 3 and 6 months from surgery to testing were compared with participants with a follow-up of 6 months to 4.1 years. One might have expected to find some amelioration of sensory loss with time as the skin envelope of the breast stretches to accommodate the implant, but no discernible differences were recognized. This suggests that sensory impairments found at 3 to 6 months are not likely to improve with time. The relationship between implant volume and sensory outcome was another primary focus of this study. There was demonstrated to be a strong inverse relationship between implant volume and sensory outcomes. Although this relationship was found to be linear, implant sizes from 315 to 475 cc were found to have the least variability with respect to sensibility outcome. Sensibility outcomes were most variable with implant sizes greater than 475 cc. The relationship found between implant volume and sensory outcome is perhaps best explained by the same forces that act on large pendulous breasts in cases of gigantomastia. In an earlier study, it was demonstrated that control women with relative micromastia (34A to 36C cup size) were far more sensate than control women with gigantomastia (36DD to 46EE cup size).6 It was purported that volumetric differences in the breast were likely related to sensory outcomes because of nerve traction and innervation density, both of which are highly predictive of sensitivity. There are additional factors to consider, however, with respect to skin tension and the size of the skin envelope relative to the size of the implant. It would be expected that a large implant in a breast with a substantial skin envelope would create less tension than a large implant in a breast with a smaller and tighter skin envelope, which would consequently cause more nerve traction. In the vast majority of women who choose to undergo breast augmentation, there is an improvement in overall body image.7 Despite the fact that significant statistical differences have been found between women who have undergone augmentation mammaplasty and those who have not, it is not clear whether there is any clinical significance to these findings. Erogenous sensation is a cortical transfer function and is not necessarily correlated to sensory thresholds. The provision of this information regarding sensory outcomes to our patients is only one facet of the informed consent process that patients should undergo before having augmentation mammaplasty. Plastic surgeons should feel comfortable counseling patients that augmentation mammaplasty by either the inframammary or periareolar approach results in no discernable differences in sensory outcomes. Furthermore, women who choose very large implants relative to their breast skin envelopes should be warned about potential adverse sensory sequelae within the nippleareola complex.
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