[the terrific tummy]
Who hasn’t craved a flat, toned stomach—especially come bikini season? For most of us—whether due to genetics or too much fondness for sweets—that look is simply not in our future. Unless, of course, we turn to the miracle of modern medicine known as the tummy tuck.
mommy fat & more
Tummy tucks are not the cheater’s way to get a flat abdomen, notes Dr. Terry Myckatyn, a plastic surgeon with West County Plastic Surgeons of Washington University. No amount of diet or exercise, for example, can repair split muscles, a common result of pregnancy. “When the muscles are separated from one another, we sew them together to tighten up the torso. We’ve done tummy tucks on marathon runners with six packs,” he says. Tummy tucks also are frequently performed on people who have lost a significant amount of weight. “This is not a weight loss operation: that’s a really key point,” Myckatyn says. “A poor candidate is someone who has a very large abdomen from internal fat (visceral fat), not from excess skin or a lax abdomen,” adds Dr. Michele Koo, a plastic surgeon with Aesthetic & Hand Surgery Institute. “And smokers are poor candidates because they have complications with healing.”
added benefits
According to Koo, some people find that tummy tucks offer benefits beyond the cosmetic. “If a person has a very lax abdomen because of muscle and fascia being stretched from previous pregnancies or weight gain, then it is difficult for them to ever feel satiated after eating. A tummy tuck with muscle repair can help a patient actually feel full with much less food,” Koo says. (See side bar) And tummy tucks today are safer than ever, adds Myckatyn. “The procedure has improved in terms of pain control and safety, and to a lesser extent, scar control. We know how to significantly reduce the pain after surgery. We have improved technologies for controlling scars. Most important, we understand more how to care for people after the operation,” he says.
the right tuck for you
There are four different types of tucks: the mini, standard, extended and body lift. “A mini only removes the skin below the belly button. This is suitable forpatients who truly have only a lower abdomen ‘pooch’ or for women who have not been pregnant, Koo says. The standard involves a longer incision—from hip to hip along the underwear line—allowing the surgeon to remove more skin, explains Myckatyn. It’s for someone who has lost a great deal of weight and who has saggy skin extending to the sides of the torso. Finally, for people who have lost a massive amount of weight (80 to 200 pounds or more), a lower body lift can address not just the tummy, but also the sides, flanks and buttocks. The incision for this goes around the entire midsection like a belt.
For the ultimate makeover, Koo suggests adding breast rejuvenation (breast lift, reduction and/or augmentation), as well liposuction to contour the entire trunk. “Liposuction and tummy tuck can be performed at the same time safely,” she says. “The amount of liposuction that can be performed on the actual abdomen depends on how much skin needs to be removed.”
[the quest for perfection]
Tyra Banks recently predicted that in the future, “Plastic surgery will be as easy and quick as going to the drug store for Tylenol!” Americans do appear to have a love affair with cosmetic procedures. According to the American Society for Aesthetic Plastic Surgery, we spent more than $12 billion on them in 2013—a 12 percent increase over the previous year.
it’s for everyone
“Overall, I think people are realizing that more options are available, and not all are invasive,” says dermatologist Dr. Joseph Muccini of MidAmerica Skin Health & Vitality Center. “People used to think cosmetic work was only for the really vain and really rich. Think of it this way: just like it’s not a sin to wear nice clothes, there’s nothing wrong with trying to look better.” Ultherapy is a new, noninvasive procedure that tightens and lifts skin above the eyebrow, on the neck and under the chin. Muccini explains this ultrasonic treatment works by heating up tissue and causing it to contract and shrink. For most people, one treatment is enough to get the job done. Muccini says fewer than 10 percent of his patients request an additional treatment, and many do it to put off more invasive procedures.
i-lipo
Imagine if you could tell your body which areas to target when you exercise, taking fat from your problem areas rather than all over. That’s essentially how the noninvasive i-Lipo procedure works, Muccini says. Unlike other body-contouring procedures, which either permanently remove or kill fat cells, i-Lipo cold lasers stimulate fat cells to naturally break down their stored triglycerides, shrinking the fat cells. “It’s for the person who is working out and can’t get the results they want in a specific area,” explains Muccini. “It only addresses the fat under the skin, closer to the surface.” I-Lipo requires eight to 12 treatments over the course of four weeks, and you can treat only one area at a time. It is noninvasive, painless, requires no downtime and is more affordable than liposuction. Muccini cautions that the results will never be as impressive as surgery, but it’s a great alternative.
lovin’ lasers
Muccini’s current favorite laser treatments include:
- Cutera CoolGlide: for unsightly veins on the face and neck, as well as some spider veins on the legs.
- Cutera LimeLight: for skin redness, tiny veins, brown spots and sun damage.
- Pearl and Pearl Fractional Lasers: for fine wrinkles, discoloring and sun damage.
Podiatrist D. Mike Horwitz adds that lasers also treat toenail fungal infections, using heat to eliminate the fungus. It works best in combination with oral and topical antifungal medications, he says. “We recommend treating all the nails with the laser to protect against the possibility of spreading.”
focus on feet
The American College of Food and Ankle Surgeons recently took a stand against cosmetic foot surgeries—including injectables, toe shortening and bunion/ hammertoe surgeries when there is no pain or dysfunction—aimed at aesthetics or enabling women to wear fashionable shoes. According to Dr. Mike Horwitz, CEO of Feet for Life, foot surgery should be considered only when there is pain, dysfunction, juvenile deformities or deformities that inevitably will lead to a painful condition. Among the most common foot procedures is the hammertoe reduction (correcting a toe that is permanently bent). “Be wary of the fusion implant on the market today,” Horwitz says. “It often is not necessary, but patients should be aware that some temporary fix, such as pinning of the toes, may be necessary. He says most doctors today will not treat bunions (a foot deformity where the bone behind the big toe shifts out, causing that toe to point toward the second toe) unless these are causing pain. If surgery is necessary, Horwitz recommends conventional surgeries rather than fad procedures that promise easier and better cosmetic results.
[face lifts]
When you hear the term ‘face-lift,’do you envision taut-faced celebrities? Today’s technology has come a long way from that always-surprised look. In the hands of a skilled surgeon, a face-lift can shave a few years off your face—with finesse.
facing the facts
“A young face has strong cheek bones and jaw bones, ample fat cushioning the upper face, cheek, eye and temple areas, and no excess fat in the jowl or double chin area,” explains Dr. L. Mike Nayak, director of Nayak Plastic Surgery. “It has an appropriate, toned, muscle foundation to provide shape and support and a supple, well-fitted skin layer draping effortlessly over this bone/fat/muscle foundation.”
“Aging faces lose fullness in the eye area, front of the cheek and temple, contributing to the appearance of sagging, bags, valleys and dark circles under the eyes and around the mouth. Aging faces gain fat at the jawline and under the chin, creating jowls, a double chin and a loss of jawline. The bones around the teeth fade, causing a weak chin and/or a sunken or puckered mouth. The muscles of the face and neck wear out, and the skin itself weathers, causing it to appear wrinkled and marked with spots and broken blood vessels. Poor elasticity prevents the skin from fitting perfectly to the shapes underneath,” Nayak says. In reality though, the skin itself has almost nothing to do with the shape changes that occur in the aging face, he adds.
is surgery for you?
According to Dr. Judith Gurley, director of Dr. Judith Gurley Plastic Surgery & Spa, the quality of a face-lift depends on genetics and maintenance. Generally, patients who don’t smoke and have taken good care of their skin age pretty well and do not have excessive hanging skin. Instead, they may have a deflated or a flat face that makes them look older than they are. These patients may be candidates for less invasive procedures, such as laser therapy, a fat graft to bring youth back into the face, eyelid lifts, and Botox and/or fillers around the mouth wrinkles, Gurley says. However, genetically, we don’t all age the same, she notes. “So even if you’ve taken great care of your skin, you may benefit from a skin-tightening procedure simply because of the way your family ages.”
Nayak agrees. There is simply no substitute for a surgical facelift when it comes to ‘lifting’ an aging face, he says. It requires removing fat in some areas, adding fat in other areas, tightening facial muscle, tailoring the skin and more. “Obviously, no cream or laser applied to the surface of the face can accomplish any of these things, no more than a cream could fixa hernia, tumor or broken bone. Reshaping various layers of tissue, each in its own appropriate way, requires surgery at the hands of a skilled surgeon,” he says.
the surgeon
When choosing a plastic surgeon, Nayak says it is important to confirm s/he is qualified (trained specifically in plastic surgery or facial plastic surgery) and actively performs face-lift surgery as a major part of his/her practice. He recommends looking at actual before and after photos to ensure your tastes match his/hers, and meeting an in-person consultation.
nothing is forever
Face-lifts are not a permanent fix. In fact, aging continues from the moment healing is complete. However, a face-lift can reset the aging clock. “The person who undergoes such a lift will look better than their age-matched peers forever. Patients with good skin genetics, stable body weights and good diets can often see 10 to 15 year durability,” Nayak says.
