All of us want to be a better version of our self, so as the calendar turns over another year, it is the occasion to declare a fresh start. Most of us pick goals that have personal meaning, often connected to how our bodies look and feel. My friends are working out more, de-toxing, exercising, eating organic and losing weight. Health clubs get a surge of new member in January and Weight Watcher’s sessions are full.

So why is it that by spring 90% of  New Year’s resolutions have been abandoned? It is human nature to lose our resolve and return to old habits. So how do we convert to that healthy lifestyle and make it stick? Here are a few suggestions:

1. Start simple and concrete. Resolutions that are too broad, too big, or too drastic are doomed to fail. Think big, but start small.
2. Write down the change you plan to make and post it several places. The act of writing it makes the commitment more engrained. Posting a reminder in several places re-enforces the plan. 

You may choose to stop drinking soda or other high calorie drinks. Reminders on the refrigerator or near your bathroom scales can keep it fresh in your mind. Outlook or smart phones can be good to keep you on track. Try emailing yourself daily.

1. Give a commitment of 21 days, rather than forever. It takes 21 days to form a habit and the short time frame will help you avoid discouragement.
2. Re-evaluate at three weeks. If you could not reach this goal, try to identify the challenges and come up with solutions. Write down your revised strategy to re-new your commitment. If you did succeed, try adding a new habit to change.
3. Don’t procrastinate. The next time you start you will wish you had done it sooner. No time like the present. Just do it.

Once you change a small habit you can keep it for a lifetime. Being a better version of ourselves is an accessible goal!

Aging is the Most Common Cause

Your eyes are believed to be a window to the soul. They convey a full range of expression and make a difference in how you are perceived in terms of health and beauty. Dark circles beneath the eyes are detractors. They suggest fatigue or sadness or being past your prime. The physical characteristic can suggest troubles even when your emotions do not match. What causes dark circles and what can be done about them? 

Some people have dark eyelid skin that they inherited from their parents. “Hyper pigmentation” is benign, but just as it is impossible to erase a leopard’s spots, it is difficult to change the natural color of your skin if that is your genetic type. 

Illnesses can cause changes in the tissues around the eyes. Lack of sleep, smoking, and excessive alcohol intake are lifestyle choices that negatively impact the appearance of your eyes. Thyroid, kidney and liver disorders can contribute to dark under-eye circles. Allergies, asthma, and circulatory diseases cause swelling that may lead to eyelid changes. 

For those of us in good general health who were not born with dark lower eyelid skin, the most common cause of circles under the eye is simply aging. Eyelid skin is thin and cheek skin is thick. The zone where thin meets thick is called the “lid-cheek junction.” This line begins to drop as we age. The zone between eyelid and cheek becomes more pronounced and the surface irregularity casts a shadow that creates the dark circle. The lower eyelid shape changes and looks like an upside down triangle with its peak pointing away from the middle of the eye. The line from the inner corner of your eye to the peak of the triangle is referred to by plastic surgeons as the “tear trough deformity.”

The problem can be a combination of dark skin pigment, loose skin, fine wrinkling, excess fat, or loss of fat, gravitational forces and irregular contour.

So what choices are there for dark lower eyelids? Treatment begins with identifying the cause.

1. Hyper pigmentation is caused by excess brown pigment (melanin) in the skin. This may be responsive to fade creams, such as hydroquinone, chemical peels, and sun screens. Other skin care products such as Retin A can be useful. 

2. If the cause of the shadow beneath the eye is a contour abnormality, then injectable fillers such as Restylane and Juvederm can be placed in the tear trough deformity for an improvement that lasts 6-9 months.

3. A blepharoplasty is eyelid surgery that gives long lasting improvement for the eyelid changes of aging. It tightens eyelid skin, repositions fat in the orbit, and smoothes the transition from lower lid to cheek. For more on this topic check out Services>Surgical Facial and visit my Facial Procedures gallery.

Sixty percent of Americans choose homeopathic drugs, food supplements, or herbal products as an alternative to traditional medications to enhance their health. These products are pharmacologically active and naturally occurring plant extracts. Because their source is “natural” and they are sold without a prescription, they have increased in popularity for those seeking a wholesome life style. Despite their natural source, supplements can contribute to prolonged and excessive bleeding at surgery. Here is a list of some of the commonly used complementary/alternative medical products that can be harmful when combined with surgery. The following should be tapered and then discontinued two to three weeks before surgery.

BAICAL SKULLCAP (Chinese Skullcap)- This herb has been used by the Chinese for irritability and dysentery. It interferes with coagulation and can cause bleeding.

BROMELIN. This extract of pineapple is used to treat arthritis. It interferes with platelet function and can cause bleeding.

CHINESE AGRIMONY- This remedy is used for cough and colds, pain relief, and infections. It markedly increases the risk of bleeding.

CHINESE PEONY- Used for gastric upset, this flowering plant interferes with coagulation.

FEVERFEW- Used to reduce fever, treat arthritis and prevent migraines, feverfew can result in withdrawal symptoms as it is discontinued.

FRITILLARIA- This bulb is cooked and eaten to treat hypertension, lung problems and opium toxicity. DAN S HEN- This Chinese product is used for stroke, angina, arthritis, insomnia, and menstrual disorders. It has a powerful antiplatelet effect that leads to bleeding.

DEVIL’S CLAW- Used for centuries in South America for pain, fever, and digestion, Devil’s Claw interferes with normal coagulation.

GARLIC- Garlic has been used as a medicine for centuries. It has been advocated for high blood pressure, fungal infections, heart attack and cancer. There is good evidence of garlic in high doses resulting in bleeding, nausea and vomiting as well as low blood sugar.

GINGER- Ginger is for gastric, distress, migraines and headaches. It is known to interfere with platelet function.

GINSENG- Conditions treated with ginger include colic, infections, aging, and stress. It can increase bleeding, and have side effects of nausea, headaches, and blood pressure changes.

GINKO- Used to treat Alzheimer’s and other memory disorders, ginkgo has been associated with excess perioperative bleeding.

LICORICE- Used for peptic ulcers, cancer, and adrenal insufficiency, licorice can increase bleeding, result in hypertension and lower potassium levels.

CAPSAICIN (red chili pepper)- Capsaicin has been recommended for pain relief, itching and psoriasis. It interferes with platelet function.

SAW PALMETTO- this is a treatment for an enlarged prostate and urinary tract infections. It interferes with normal coagulation.

OIL of WINTERGREEN- Prescribed for inflammation, joint pain, and hypertension, this food flavoring agent has been associated with prolonged surgical bleeding. GEUM JAPONICUM- This diuretic can cause prolongation of clotting time.

JAPANESE HONEYSUCKLE- Homeopathic remedy for fever, ore throat, headache, and infection, Japanese honeysuckle interferes with platelet function.

DAN SHEN- Conditions treated with dan shen include atherosclerosis, insomnia, menstrual disorders, HIV, stroke, angina, and prostatitis. It blocks platelet function and can lead to prolonged bleeding.

VITAMIN E- Popular as an anti-cancer anti-oxidant there is increase in bleeding risk with high does.

FISH OIL- Fish oils are popular for their anti-cardiovascular disease benefits. It is also used to treat dry eyes. Prolonged bleeding times occur and is dependent on the dose.

ARNICA MONTANA- Used in Europe to treat arthritis and muscle aches, it has been popular to reduce postoperative bleeding and swelling. It is associated with bleeding as it interferes with platelets.

CHONDROITAN and GLUCOSAMINE – These two are often taken together to enhance cartilage repair. They increase bleeding potential. Supplements and old-fashioned remedies are not generally thought of as medicines and thus many do not mention them to their doctors. These substances may have been in use for centuries, but they can have harmful effects at the time of surgery. They are classified as a food rather than a drug, so they escape FDA regulation. This can make them variable in quality or dosage.

Make sure your surgeon knows what non-prescription items you are taking so as to avoid any unsafe interactions at the time of your procedure.

In the United States one third of adults are Obese (BMI >30). OBESITY brings a burden of increased medical problems and risk of premature death. Excess body mass significantly decreases energy, activity and sense of well being, not to mention body image. Many resources, public and private are being devoted to combating this epidemic. MICHELLE OBAMA has made anti-obesity her signature issue in the “Let’s Move” campaign.

The Nov 24, 2011 NEW ENGLAND JOURNAL of MEDICINE published a randomized controlled study in 415 obese people to compare two different approaches to supporting WEIGHT LOSS. All patients were followed by their doctors for a two year period. One group of subjects had weight loss coaches that provided in-person support with both group and individual sessions. A second group had its counseling provided remotely by e-mail, phone or web site. The third group was entirely self directed without supplemental advise or support.  

The self directed (non-supported) control group had a mean weight loss of .8 kg, not much change at two years. The two groups that received support both were able to maintain a 5% weight reduction. This modest weight loss is a good start on decreasing cardiovascular and diabetic risk even if it is still a far distance from being at ideal body weight. The group with face-to face coaching did slightly better than those who received their support on line, but support was critical.

The take home lesson is that lifestyle changes are hard to maintain especially when attempted all by yourself.  Education and encouragement make a difference in being able to sustain change in habits. You may lack both time and money for one on one coaching, but taking advantage of on line support systems may be a very good method to reinforce behavioral modifications. Most health clubs offer a supervised program to track diet and exercise. There are multiple web sites for monitoring calorie intake and exercise to track progress in those key behaviors. Here are a few you might find helpful:

www.healthdiscovery.net – Weight Watcher’s Support Network

win.niddk.nih.gov/ – Weight-Control Information Network

www.obesityhelp.com – Web site with resources for surgical weight loss

www.overeatersanonymous.org – Successful group based on the 12 Steps model

Don’t forget to keep moving!

Summer seems to be an ideal time for setting  personal fitness goals. When the days are long and the sun is out Seattelites seem to have lots of energy and see that much is possible. I have long been a fan of triathlons, especially the Danskin. The terrific thing about the Danskin is that there are women of all ages and sizes who have just decided to get more fit. The idea of the race seems to be for the many participants to have a goal to work towards and have fun accomplishing that goal. It’s a helpful supportive environment that is about enjoying fitness, not competition.  

Having a summer sporting goal such as a triathlon can be a good way to schedule exercise on a regular basis to maintain a healthy lifestyle.  It’s helpful for weight loss, body toning, aerobic fitness and of course, fun.  

Many of my patients are athletic and recognize that regular workouts are a critical part of feeling good about your body.  Plastic surgery works best on those who maintain their fitness. For some, body contouring procedures can be a confidence lifting step that helps to motivate them for healthy choices.

I’ll be doing the Seafair and the Danskin triathlons this summer.  Hope to see you there.