Health Features

Beauty is in the Details

With all its aches and pains, aging is hard enough. But add to those the changes to appearance, and every new year can be a challenge indeed. We try to hide it with tighter underpinnings and looser clothes, but we know it’s there, and we don’t like it! Help, however, is at hand: a host of rejuvenating procedures is available to restore a woman’s sense of well-being from below the belt on up!

spare tire
Tired of that tire? It appears on the best of us, and the question is: Is there a way to offload—once and for all—this unsightly roll of flab from our middles?

the stubbornest fat
Bulges around the stomach can be particularly stubborn when it comes to diet and exercise because there are other things at play besides fat, explains Dr. Terry Myckatyn, Washington University plastic surgeon. “For women who are older and who have had children, there may be an issue of excess skin and weakened muscles in this area,” he says. In which case, fat-removal procedures like liposuction might not be the best option, and a tummy tuck might be the better bet.

A tummy tuck, or abdominoplasty, addresses both issues by tightening lax muscles and removing sagging abdominal tissue. It is performed under general anesthesia and has a downtime of 10 to 14 days following surgery.

effective tools
Myckatyn says it’s important to be evaluated by a certified plastic surgeon to really understand what’s required. “We might follow up a tummy tuck with a little liposuction on the sides,” he says, adding that a procedure called CoolSculpting—which destroys fat cells by cooling them—can cut down on bra strap flab. “It’s a nice nonsurgical option for a focused area of fatty tissue, but unlike a onetime treatment of liposuction, which can eliminate 60 to 70 percent of fat, CoolSculpting removes only up to 20 percent and requires at least three 35-minute sessions.

an ounce of prevention
Plastic surgeon Dr. Michele Koo says not all fat cells are created equal and differ from each other based on both genetics and the particular part of the body they happen to be in. That’s why we all tend to gain weight in different areas, she says. Furthermore, the amount of energy required to lose the fat within the cells is much greater than the amount of energy it takes to achieve the fat in the first place. “So, the old adage of ‘a minute on the lips, forever on the hips’ is not too far from the truth!” Koo says. This is truer still, she adds, as women go through menopause and metabolism slows.

But Koo also is quick to say that a spare tire can be minimized with good food choices. “All calories are not equal, and this is particularly so as we age,” she notes. “A spare tire is not inevitable if we choose more protein than carbohydrates, reduce the amount of intake, and are careful to stop eating at night.” She recommends a 12-hour fast between night and morning, with nothing to eat after 7 or 8 p.m.

don’t give up!
Like Myckatyn, however, Koo agrees that liposuction is the most effective way to remove stubborn fat. She likes two different methods: suction-assisted lipectomy, which uses a narrow tube (or cannula) inserted through a small incision, and ultrasonic-assisted lipectomy, which is similar but employs ultrasonic energy to liquefy fat before removing it. “It can achieve dramatic results,” Koo says, adding that a tummy tuck also might be performed if excess skin is an issue.

Plastic surgeon Dr. Judith Gurley says the ideal breast is one in proportion to the upper and lower body. “It has a youthful configuration—perky and round, not hanging and tubular. It should have upper, inner, side and bottom fullness, but look natural,” she says. In addition, the skin should be taut and the nipple should sit in a slightly high position. So what’s an old body to do?

strategic surgeries
Over the past few years, Gurley says she has had great success by offering women combined procedures—breast implants for fullness with mastopexy (breast lifts), which also can reposition the nipple and change the size and shape of the areola if desired. “It’s the latest and greatest thing,” she says.

According to Dr. Christina Plikaitis, SLUCare Physician Group plastic surgeon, breast rejuvenation surgeries continue to be some of the most popular plastic surgeries she performs. “These common procedures are very effective tools in reversing changes caused by pregnancy and breastfeeding, as well as those brought on by time and gravity,” Plikaitis says.

today’s safer options
Moreover, she says advances over recent years have improved not only the safety and durability of implants, but also their shape and level of cohesivity (firmness). “Modern implants are very well studied for safety, but may need replacement should a hole wear in the shell over time,” she says, adding that newer implants placed after 2000 can have a shelf life of anywhere between 10 and 20 years. While saline and silicone still remain the only options, Gurley says she thinks silicone feels more natural and has a lower rupture rate. Plikaitis agrees: “Traditional round saline or silicone implants can achieve a fuller look, while shaped silicone implants may have a more natural appearance.” (One benefit of saline is that in the case of breakage, all that leaks is saltwater, which is harmlessly absorbed into the body. A silicone rupture is more complicated and usually requires removal).

maintain the new you
Clinical exams and imaging to check for changes over time may be recommended to detect problems like infection requiring removal, malpositioning and capsular contracture, which is excess scar tissue that forms around the implant. Although an implant can make a portion of breast tissue harder to image on a mammogram, Plikaitis says studies show this does not translate to a delay in detection of breast cancer or any increase in incidence. “But it’s important to continue normal recommended cancer screenings after any breast rejuvenation procedure,” she stresses.

Gurley explains that scarring is kept to a minimum because incisions are small. Most patients are able to stop pain medication within 24 hours, with limited physical activity for two to four weeks.

“There’s so little in this life that we can change,” Gurley says. “But wanting a better appearance is an extension of taking good care of yourself. Most of my patients feel really good about themselves, and with just a little tweak, they can feel even better.”

below the belt
Strenuous vaginal childbirth, multiple births, and the effects of menopause all combine to cause physical changes that can challenge a woman’s sex life. With the drop in estrogen after menopause, the tissues inside the vagina become thinner, drier and less elastic, resulting in atrophy, and a loss of muscle tone in the area can lead to prolapse—the vagina, uterus or bladder falling out of place. A new FDA-approved treatment called ThermiVa, however, aims to treat atrophy by using radiofrequency energy to warm tissue and stimulate collagen growth.

help is available
ThermiVa, says Dr. Teresa Knight, OB/GYN at Women’s Health Specialists of St. Louis, helps tighten the walls of the vagina and make the labia “fluffier.” It also may help stimulate nerve awareness, increasing lubrication and improving muscle tone to alleviate urinary incontinence, vaginal dryness, laxity (looseness) and painful sex. “It’s the biggest news in this area,” Knight says. “So many women are affected and don’t know what their options are. But this is a dream—a nonsurgical procedure with no pain and no downtime.” In fact, Knight says she encourages women to resume intimate relations right away since there is an immediate tissue reaction.

ThermiVa is performed in three 15-minute treatments spaced across three months, and Knight says women continue to see improvement well after treatment has stopped. Because ThermiVa works like certain cosmetic procedures for the face, however, it currently is considered ‘cosmetic’ by insurance companies and is not covered. Knight says the package of three treatments costs $2,400.

to do or not to do?
Dr. Fareesa Khan, a specialist in female pelvic medicine and reconstructive surgery at St. Anthony’s Medical Center, says we need to be careful about what we call ‘abnormal.’ Close to 97 percent of older women, she says, will experience “a little bit of prolapse,” and most will have some degree of atrophy post-menopause when estrogen levels drop. Treatment, she stresses, is not always necessary, adding that the American College of Obstetricians and Gynecologists frowns on vaginal rejuvenation to correct genital appearance since the true efficacy of certain procedures is unknown.

new + notable
Still, Khan says there are things that can be done to improve both atrophy and prolapse, and she cites a new non-hormonal treatment—the CO2 laser. This, she explains, causes a small thermal injury to the vaginal mucosa (mucous membrane), which then prompts new collagen and blood vessel formation. It has been available internationally since 2012 and in the U.S. for the last few years. “While there is some histological data that shows that the tissue looks healthier and more like premenopausal tissues after treatment, there isn’t data to really say if this will help other pelvic floor conditions,” she says. Prolapse that is more severe, meanwhile, can be addressed either with laparoscopic or vaginal surgery, or by wearing a pessary—a rubber ring inserted into the vagina that “holds everything up.” Women may suspect they have prolapse, Khan says, if they experience a bulging or heaviness. Surgery is minimally invasive and a patient can be back on her feet the same day.