Health Features

Health: Reversing the Clock

We live in the best of times, and the worst of times, when it comes to individual beauty. It’s the best because modern medical technology can improve just about every aspect of our appearance. The worst because imperfections are less tolerated these days. If it’s true that 60 is the new 40, no 60-year-old really wants to look 60! See what local physicians have to say about the most effective and worthwhile procedures.

[face-lift]
Despite being the butt of jokes about Joan Rivers and Hollywood in general, the face-lift not only can look natural, but it also can reverse the clock to a point in time you never dreamed possible. Important things to remember, though, are that nothing lasts forever (which includes your new face-lift) and no pain, no gain (which refers to both physical and financial tolls).

face-lift 101
Dr. Mike Nayak of Nayak Plastic Surgery explains that just as the body evolves over time, so does the face. “Some things become looser with time,” he says. “Some areas shrink, some areas grow. The bones, fat, muscle, skin and glands—all those layers remodel as you age,” he says. This is why, he adds, the modern face-lift addresses multiple layers of tissue.

“What surgeons call a face-lift means improving the jawline, neck line, jowl line and double chins,” Nayak explains. “We are trying to restore the appearance you had 10 to 20 years ago. If you want to make a convincing outward appearance, you can’t work on just one or two layers. To make a face look younger, we have to remove from some areas, add to some areas and tighten some areas.”

no cutting necessary
“If you had asked me five years ago, I would have said that nothing nonsurgical is worth your time or money,” Nayak says. “But three techniques have been developed that make some real strides in helping a face look younger without surgery.” They address the shrinking, growing and loosening developments unleashed by nature. “Nonsurgically we can use injectable fillers to augment things that have shrunk; these last a year or two at a time,” he says.

“For things that have become loose, there are some nonsurgical tightening devices that make some modest tightening,” Nayak adds. “It is not nearly as good as surgery, but it is visible. It tightens the layers of skin with ultrasound. Ultherapy is probably the most effective of that group.” As for shrinking, like under the chin and jowls, the FDA approved a new drug, Kybella, recently.

“It’s an injectable that selectively destroys the fat under the chin,” Nayak says. “I can add to the cheeks where people typically become empty. I can remove from under the chin where people typically grow. Then I tighten overlying tissue using that ultrasound technology—we can do all three things we typically do with a face-lift.” But are the results as good, or less expensive?

the fake-lift
“It is not nearly as effective as a face-lift, but it is visible, and there is potentially no recovery time,” Nayak says. And just to be clear, the ‘fake-lift,’ a term Nayak uses for the series of measures he described, lasts only a couple of years, not the 10 to 20 years of a face-lift. And by the time he uses an adequate amount of injectables and Ultherapy to get the desired result, “you have spent basically what you would spend to get a face-lift,” he says, which would be in the $10,000 to $13,000 range.

“There are some people who are not candidates medically for surgery—they may be on blood thinners because they have a heart condition,” Nayak says. “And there are other people who are never going to find two or three weeks for recovery time. This is another option for them. We can give them maybe more than a third of the results we could give them surgically. It is very worthwhile for them.”

[slimming the middle]
Belly fat—it’s one of the leading health concerns of our time. It’s not uncommon for the midsection to be the first place unwanted fat gathers. And it’s a stubborn, unsightly problem that has given rise to such euphemisms as ‘muffin top,’ ‘back fat’ and ‘spare tire.’ So what to do with midsection bulge?

predisposed to adipose
“Most people who are overweight carry that weight in their midsection,” says Dr. Richard Moore of The Lifestyle Center. “Certainly some people are more predisposed than others.” Adipose (fat) tissue can accumulate even on those fortunate citizens who do not gain much weight. “We lose bone and muscle mass as we age, so even if you graduated from high school at 150 pounds and 40 years later you still weigh 150 pounds, you are going to be carrying a higher fat mass.”

And there are other issues conspiring to create tummy sag. “A bulging midsection can be the result of fat accumulation or laxity in the musculature of the abdominal wall, and this condition can worsen with age, pregnancy, menopause or weight fluctuations,” says Dr. Judith Gurley of Judith Gurley Plastic Surgery and Medical Spa. “Most plastic surgery practices see more women than men with this problem. A board-certified plastic surgeon can figure out why your abdominal section protrudes and help you figure out the best solution.”

There are genetic components that work against some people, Moore adds. “Some people are going to have loose, saggy skin as they get older,” he says. “Pregnancy is a huge issue because that will stretch the muscles of the abdominal wall and increase the number of fat cells.”

be out, damn fat!
Of course, weight loss is the first thing recommended for midriff reduction, but since that’s easier said than done, plastic surgeons can offer a host of quicker fixes. “Liposuction or a traditional measure of fat removal is the most effective way to reduce bulges without having to lose weight,” Gurley says.

“Liposuction makes sense when you can pinch enough fat that it is worthwhile to take it off,” Moore says. “A patient is not going to lose 30 pounds with liposuction. They are more likely to lose two to eight pounds, but that can become a very motivating factor to go on to lose additional weight.”

Someone with a ‘beer belly’ will be carrying fat behind the abdominal muscles, Moore points out. “What we call ‘visceral fat’ is beneath the muscle and around your organs,” he says. Part of the plastic surgeon’s job is to diagnose exactly where the excess fat is located, Gurley adds. “Intra-abdominal fat cannot be removed by standard measures such as liposuction,” she explains.

but, weight
Fat removal alone might not do the job for tummies that have been stretched by pregnancy or obesity. “There are times when laxity in the muscles or loose skin is causing the appearance of enlargement of the abdominal area,” Gurley says. “Your plastic surgeon can safely and carefully remove the redundant skin or stretch marks and simultaneously tighten your muscles if needed.”

Some people will be better served by a tummy tuck rather than liposuction, Moore adds. “Someone who was markedly obese and lost large volumes of weight can have skin hanging, and the only option for reducing that is through surgery,” he explains.

Non-surgical options for removing fat can be effective, too, Moore says. “We have a device called BodyFX that will destroy about 30 percent of fat cells down to a depth of an inch. It puts radio-frequency waves into the fat, then energy bursts the cell membranes and kills the fat cells.” He points out that fat is not only a matter of vanity, but also of health, especially when it comes to visceral fat. “As abdominal girth increases, there are more and more problems with diseases such as diabetes, hypertension, heart disease and stroke,” he says.

[leg veins]
If you’ve ever had them, you know that varicose veins are as uncomfortable as they are unsightly. They put pressure on the legs, making it hard to stand and walk. Experts agree there is no reason to continue suffering with this problem, considering all the available treatments.

pain in the vein
Varicose veins affect up to 40 percent of women and 20 percent of men by the age of 50, according to the Vascular Disease Foundation. When we sit or stand, leg valves should allow blood to move upward for each heart pulse, then close to prevent the blood from going back down. With varicose veins, the valves are faulty.

“If the valves or the wall of a vein don’t work properly, blood flows backward,” says Dr. Mark Blumenthal of the Vein Center & CosMed. “When you stand, blood flows downhill under too much pressure. That pressure causes the vein to expand and become tortuous and ropey.” The increased pressure spreads, he says, and may injure adjacent valves.

Everybody has 15 to 20 one-way valves, from the ankle to the groin, explains Dr. Norman N. Bein of Vein Specialties. “The physical presence of varicose veins almost always signals an underlying problem,” he says. “There can be symptoms of heaviness, tiredness, aching and itching.”

Pooling blood may clot, Blumenthal adds. “Usually the clot is not serious, but the area turns red, hot and tender,” he says. “Most of the time it can be treated with aspirin, warm soaks and elevation. If it gets bad enough, it will need to be treated with blood thinners.” Wispy, thin spider veins should not be confused with the more serious varicose veins. “These are almost never a health hazard,” Blumenthal says. “They usually don’t result from bad valves, and we are not sure exactly where they come from.”

the curse of eve
Varicose veins definitely afflict more women, especially with pregnancy. “It is a common misunderstanding that the pressure of the fetus and placenta causes varicose veins,” Bein says. “But it’s all hormonal. For the average woman who notices varicosities during pregnancy, sometimes she will see relief following pregnancy. If she continues to nurse, the varicose veins will remain longer.”

Varicose veins may return with a subsequent pregnancy, he says. “But I would not recommend surgery for women who are still nursing because there will be improvement after they stop nursing.”

Due to the likelihood of expansion and serious complications, varicose veins should be treated as soon as they are diagnosed, says Blumenthal. “The gold standard today is using a laser to seal the veins,” he explains. “If we seal the vein, with no more nourishment from blood, it will disappear over time. The remaining veins inside the leg muscles are sufficient to carry blood from the feet back to the heart.”

the cure
An ultrasound will visualize blood flow and identify the area of the vein under increased pressure, Blumenthal explains. “We enter the vein through a little hole about the size of a pinhead and insert a special flexible laser that annihilates a long segment of vein without removing anything,” he says. The procedure is done in the doctor’s office with a local anesthetic to avoid pain, and many people go back to work the next day.

Even though patients enjoy the aesthetics of their ‘new legs,’ varicose vein removal is considered a medical procedure, Bein says. “Insurance covers 95 percent of the people we see.”

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