A survey sent to 600 liposuction patients looked at their long term satisfaction, asking a long list of questions, such as:

• How would you rate your appearance after liposuction?  87.3% rated “good or better.”
• Are you more productive in your work?  Better productivity reported in 27%, no change in 71%.
• Would you have the procedure again? 79% said yes.
• Would you recommend the procedure to family and friends?  86% said yes.

The vast majority reported favorably to each of these questions. However, it was found that those who ate a healthy diet, exercised regularly, and maintained a stable body weight were 2x more likely to have increased productivity, 15x more likely to have dropped in clothing size, 2.5x more likely to have a high self appearance score, and 3x more likely to have improved health. Those who took active control of their health were far happier.  

The authors concluded that there are four elements to having a good long term result from your liposuction procedure.  The first is having a good surgeon performing a well executed procedure, but the other three are controlled by you, the patient. Healthy eating habits, regular exercise, and commitment to a positive lifestyle are huge determinants of satisfaction with the choice. So, real satisfaction involves team work with your doctor. The authors developed a map of how to tell what factors affected your happiness with the choice.

PRS Vol.114, No.7, p.1945 

www.PRSJournal.com The_Key_to_Long_Term_Success_in_Liposuction__A.40

My office received a phone call last week asking if we offered either stem cell facelifts or vampire facelifts?? We were happy to say no…not that we do not like being early adopters of new technology, but because these two procedures have marketing claims that are far ahead of any science. In other words…HYPE.

So what might advertisers mean by stem cell facelift? Fat is one of the body’s tissues that carry adult stem cells. When a facelift is performed, fat can be added to bring fullness to sites of volume loss. In fat transfer to the face, a small number of stem cells may be moved at the same time. We do not know how many (if any!) are being transferred, and we do not know if they will become activated in their new home, to provide the hoped for repair and youthful, healthy look. The procedure for fat grafting is a good one, but calling it a “stem cell” facelift is hyperbole (HYPE!!).

The “vampire” facelift is also not ready for prime time. The procedure involves drawing a tube of your blood, spinning it down to isolate the portion that contains the most white cells, known as the buffy coat. The theory is that this fraction contains more growth factors and possibly stem cells. To date this is all unproven. Surgeons that use this as a selling point for their services  are trying to win confidence by suggesting that they are employing a “cutting edge” technology, but these claims are unfounded.

The American Society of Plastic Surgery and the American Society of Aesthetic Plastic Surgeons published a joint position paper in 2011 on stem cells and fat grafting. In this paper they state:

“Extreme caution should be exercised when a physician is promising results from any treatment that sounds too good to be true. Stem cells in aesthetic surgery are promising, but marketing claims are far ahead of the science.”

I am a closet fan of the “What Not to Wear” show…not that I want anyone to know that I watch a reality TV show….but I love the concept that everyone should be comfortable with their own body and that external changes can make a world of difference for one’s psyche. Stacy London, co-host of TLC’s What Not to Wear, has just come out with a new book, The Truth About Style (Viking Press, 2012) in which she describes her philosophy of style. Her Zen-like mantra is “take what life has given you, accept it wholly, and then build on it.”  With that as a baseline style can be healing.

Style, according to London’s philosophy, requires an unbiased acceptance of self, where your body is and what your life circumstances are. Style starts with your brain before it gets to your body.

Stacy discusses how to dress well, why to dress well and why we often do not. She helps us get into the mindset that leads to a happier and healthier sense of self. She talks about the kinds of psychological obstacles we place in our own path that keeps us from owning our personal style. Style, unlike fashion, is personal. It’s about the individual. 

Style is about enhancing who you are and not attempting to look like someone else. 

“By changing your style, you are forced to change the way you perceive yourself. And if you can see yourself differently, you can start to feel differently.” Eventually we believe because we can see.  

In her book Stacy tells stories of ten women that she helped to see themselves differently. Each is a metamorphosis from cocoon to butterfly.  Her tales provide a “kick in the step, a swing in the hips, and a twinkle in the eye.” Try her short enjoyable read and see how comfortable you are in your own skin!

Seattle had a beautiful summer this year that stretched out through most of September. It was easy to stay inspired for outdoor sports. As the leaves are turning and daylight is shorter don’t let weather hold you back from training. Here are a few suggestions:

1. Train with friends. Having a buddy helps to keep you accountable. It is too easy to let yourself off the hook when you are tired, and besides you can accomplish your social goals at the same time as your fitness goals. Consider it multi-tasking.
2. Work on your core. The stronger your trunk muscles are, the better your balance and stability.  It enhances any other sporting activity. Yoga and Pilates classes are popular ways to strengthen your abdomen and back.
3. Increase aerobic endurance. Thirty minutes three times a week is an important baseline for aerobic fitness. Make that 30 minutes increasingly difficult to improve stamina after your routine becomes habit.
4. Return to the gym. Spinning classes, swimming pools and treadmills are easier to use when there are others around. The energy from other people is contagious. Sports equipment at home is a great idea, but it seems to collect dust before it ends up in garage sales.

What ever you do, be adventurous, creative and open-minded. Staying fit is good for your mood, good for your brain, good for generating energy, and good for your health. Don’t let it lapse when it is unseasonable!

Studies have shown that beauty is hard to define, but there is a universal consensus on what constitutes the beautiful face. Balance, or facial harmony, is seen as beautiful when the face is divides into roughly equal thirds of the brow, mid face, and jaw line. A poorly defined neck or jaw line is considered less attractive than one that is well defined and represents a proportional third of the face.

So chin and neck aesthetics are important. Statistics from the American Society of Plastic Surgeons showed that in 2011 there was a big increase in the number of people that chose to have chin augmentation. No one knows for sure what prompted this increase, but it does reflect an awareness of how the lower face is a huge contributer to attractiveness. 

A small chin or a “weak” chin is seen in our society as indecisive, less confident. Poor definition of the jaw line accompanies sagging  of skin from aging. The neck can reveal things that the face is trained to hide.

A chin augmentation (enlargement) is a great way to enhance facial harmony and balance. It is a procedure that is often combinrd with a facelift or a rhinoplasty to improve the overall results.  

Chin and jaw line contouring can be accomplished by a variety of techniques. The jaw bone can be made larger by repositioning of your own bone, placement of a scaffolding that will allow your bone to grow into (cancellous bone chips), biocompatible implants, or fat grafting of your own tissues. The best choice should be individualized with you and your plastic surgeon.  

A beautiful neck may require removal of excess fat, repositioning of musles,or tightening of stretced out skin. There are anumber of ways to accomplish this improvement and each person should have a very individualized plan that considers the interplay of the variables.  

If your neck and chin seem to be a detracting factor  for  you, a considered consultation can help you develop a plan personalized to yourown needs. Dr. Peters can help you think through the possibilities.

Also, for additional information read more at Hive Health Media.

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.

“Research finds that cosmetic surgery patients do not differ from nonpatients in body satisfaction, except that they are more likely to express dissatisfaction with the specific body region targeted for surgery.”

MSNBC conducted an online study of 50,000 volunteers to research how satisfaction with body image correlated with interest in plastic surgery. A 27 point questionnaire posed questions like:

*How comfortable are you in a bathing suit?

*Do you like your face?

*How many times a day do you check yourself in the mirror?

*Are you self conscious about your weight?

The respondents were heterosexual men and women between 18-65 years of age There were equally divided between men and women. The large sample size allowed for statistical significance. 71% of women and 40% of men expressed interest in cosmetic surgery. Here are some of the interesting findings of this large scale survey.

1. Body image satisfaction was gauged by self rated attractiveness and comfort in a swimsuit.  There was no difference between those women interested in plastic surgery and those not interested. 
2. Men interested in plastic surgery were not any different in body image satisfaction than those with no interest. 
3. Appearance investment was gauged by self reported mirror checking. Both men and women that monitored their appearance in the mirror frequently showed more interest in plastic surgery.
4. Relationship status did not correlate to interest in plastic surgery. Those who were married, co-habitating, or dating seriously were no more interested in cosmetic surgery than singles.
5. The study subjects were divided into five age groups. The percentage of men and women interested in plastic surgery was relatively constant across the entire spectrum.

The study suggests that plastic surgery has become a widely accepted form of enhancing physical attractiveness, and that those interested in this type of body change have much in common with those with no interest.

Madonna brings up the rear of the baby boomer generation.

Here are a few “Baby Boomer” facts:

• Those born between 1946 and 1964 constitute 28% of the US population.
• 76 million Boomers will hit 65 over the next two decades, at a rate of 10,000 a day.
• Boomers account for half of all consumer spending.
• The typical Boomer feels 9 years younger than their chronological age, according to Pew Research Council data.
• Elective cosmetic surgery is up 65% in this age group since 2005.
• Non-invasive plastic surgery procedures are up 87% in the same time period.

So what is contributing to the upsurge in plastic surgery in this demographic? Boomers have chosen to redefine what it means to age. They are re-inventing themselves. Sixty is their new forty. They pay more attention to health, diet, exercise and general sense of well being. They are not afraid to spend money on improving quality of life. They expect the quality of the last third of their life to be high.

 Americans are living longer.  For women, life expectancy has lengthened 34 years over the last fifty years. But the focus for Boomers is not so much on life span as it is getting to the end of their health span in better shape. They are working longer than anticipated. Older workers want to look better to fit in with younger co-workers. Boomers want to stay active, relevant, and engaged with society in important ways. Their outlook on life is to do what they can to enjoy the years they have left.

Pablo Picasso once said, “It takes a long time to become young.” Boomers are taking their time and savoring it.

Diagrams of MR imaging findings in implant rupture. At left, intracapsular rupture where silicone is contained by the surrounding fibrous scar tissue (black arrows). The collaped outer shell (curved arrow) and often fluid droplets are seen within the gel. At righ, an extracapsular rupture, where silicone gel extends beyond the fibrous scar or capsule.

Silicone breast implants are one of the most extensively researched medical devices in the US. They have a high safety profile and are being used increasingly with good product performance. Breast implant shell failure is one of the concerns many women express when investigating choice of implant type. If the shell of a saline implant develops a break the fluid spills out and deflation occurs within days. If a silicone implant experiences a break in the shell, it generally requires an imaging study to confirm.

The implants currently marketed in the United States are referred to as “Fourth Generation Responsive Gel.” These implants have a silicone center that is thicker than earlier implants. Because of the viscosity, if there is a break in the envelope, shell failure, the gel tends to stick to itself, rather than oozing out of the sac like syrup.

Detecting a leak involves some form of an imaging study. Mammograms give a certain amount of information about the status of an implant, but are not sensitive enough to pick up every rupture. A negative study can give false reassurance that the implant is intact.

An MRI, magnetic resonance imaging, is considered the Gold Standard. The FDA has recommended a post operative MRI at year three and every two years thereafter. There is no scientific evidence that backs the timing of this recommendation, and most plastic surgeons believe the recommendation is overly cautious. Both the cost and the inconvenience of MRI exams are barriers to women using this for follow up. Additionally, MRI exams can over read, meaning give the appearance of a rupture where none exists. This can lead to unnecessary surgery.

Technology advances in some areas with mind boggling speed. Medical imaging is a field of rapid technological expansion. As predicted, there is an emerging technology that is not yet market ready that promises to vastly improve post operative imaging of silicone implants.

High resolution ultrasound is being studied for its ability to give accurate information about the shell of silicone breast implants. Preliminary research is published in the Aesthetic Surgery Journal, February 2012, p.157. The authors report that as they refine this ultrasound technique, it may provide relative affordability, accessibility, and availability. It’s good news for the future of monitoring the shells of silicone breast implants.

The VI Peel

For many of us it is hard enough to achieve a work life family balance, much less take time for personal needs. We might enjoy the benefits of plastic surgery but have trouble finding downtime for it. As fewer people have taken time for aesthetic surgery during the recession, there has been a rise in popularity of non invasive cosmetic procedures. Minimally invasive techniques have become a maintenance routine for aging faces.

For those interested in improving skin quality, there is a new product that I like, the VI Peel. I tried it on myself a couple of months ago. This medical grade peel is a light peel that requires minimal downtime and creates little interference with your daily obligations. 

The Vitality Institute Skin Care System has produced the VI Peel to decrease fine lines, fade age spots or sun damage and improve acne scarring. The peel also promotes collagen and elastin growth. This results in better skin clarity and texture and younger looking skin. The procedure takes a few minutes in our office. Your skin turns red like mild sunburn and peels within three to seven days. It can be used on all skin types including Afro Americans and Asian skin. The peel removes the damaged upper layers of skin and repairs from new cells below. 

The peel has a combination of peeling agents that enhance one another. TRICHLOROACETIC Acid (TCA) penetrates the skin. RETIN a causes a rapid turnover of skin cells to reduce wrinkles. SALICYLIC ACID is an exfoliant. PHENOL is antiseptic and helps numb the skin. VITAMIN C is an antioxidant and an exfoliant. 

The peel does not replace a facelift if that is what you need, but it can make a great difference in your skin quality without missing a day of work!

Medical therapy for aging skin can reverse some of the cellular damage that has occurred and create a healthier, younger looking skin.