Health Features

Health: The Total Package

We can’t make peace with them: We just don’t like our lumps and bumps. Who cares that Rubens loved them, that the Venus of Willendorf clearly was at ease with her paleolithic curves? No, we don’t want overhang, or underhang. We don’t want dimpled. Sometimes, it’s not about food or exercise, but simply age that beats us, that wraps our girths and jellies our thighs. Fortunately, these days there’s a solution for everything. Even if we’re getting older, we don’t have to look it.

gut rehab
At The Lifestyle Center anti-aging clinic, medical director Dr. Richard Moore specializes in both invasive and noninvasive body-contouring. For stomach fat, he says a procedure called Tickle Lipo is particularly effective and far less traumatic than traditional liposuction. Not only does the cannula (a tool used to suction fat) selectively separate (rather than tear) the fat from fibrous connective tissue, but it does so in a relatively painless way. Discomfort is greatly reduced because the instrument ‘tickles’ the nerves and confuses them. “Some people laugh through the entire procedure,” he says. A full recovery takes four to six weeks, but patients may return to work within a few days.

Vanquish ME, is a noninvasive procedure that allows the patient to resume all normal activity instantly. The device works, Moore says, by delivering radio frequency energy to heat (and kill off) fat cells. He estimates between 30 and 40 percent of cells are destroyed in the process, amounting to a noticeable reduction in size after the four-treatment series. A larger person may lose as much as 5 inches on their gut, he says, while someone with a smaller pooch might shed an inch. Moore adds that another benefit of Vanquish ME is it also can tighten skin and improve cellulite. Tickle, on the other hand, is better for sculpting and provides an excellent source of fat for transferring to bottoms and breasts, areas patients sometimes want to enhance. Moore notes that only the subcutaneous fat above the muscle can be removed; the deeper, visceral fat that builds up around the organs and causes life-threatening medical problems can be reduced only by weight loss. “When sculpting bodies, we still always emphasize the importance of a healthy lifestyle,” he stresses.

hitting bottom
As more minimally invasive treatments are developed, an increasing number of people are interested in simpler ways to improve their physical appearance, says Dr. Marissa Tenenbaum, West County Plastic Surgeons of Washington University. Buttock augmentation by fat transfer is particularly popular, she says. “It’s an excellent option for women near their ideal body weight looking to reshape their bottom with some natural tissue,” she says, adding that surrounding areas can be liposuctioned to improve the ‘balance’ of that area. Contrary to expectation, Tenenbaum says sitting is possible post-treatment because fat is transferred to the upper, rather than lower, buttock. Bruising and swelling are the main side effects.

Tenenbaum also uses a new procedure called Cellfina to treat the appearance of cellulite in bottoms and thighs. With a small, needle-sized device, this procedure addresses the primary structural cause of cellulite, the connective bands woven throughout fat in the thighs and buttocks. The FDA -cleared, one-time treatment is done inoffice with numbing medication; it smooths bottom and thighs by ‘popping out’ dents and dimples. Tenenbaum stresses that patients need to maintain their weight for best results, which can last— according to manufacturers—up to two years.

back issues
Arg!—the dreaded bra strap roll. It’s a very common problem, says Dr. Terry Myckatyn, associate professor of plastic surgery and director of cosmetic surgery at Washington University Medical School. Myckatyn, however, offers a solution to this, and other embarrassing fat problems. (Back fat, anyone?) CoolSculpting, a relatively new, noninvasive treatment, kills fat cells by freezing, he explains. A phenomenon called ‘popsicle panniculitis’—the loss of cheek fat from sucking a frozen popsicle—is the idea behind the procedure, which may result in a 15 to 20 percent fat reduction, Myckatyn says.

CoolSculpting machines work by drawing fatty tissue toward the surface and delivering intense, controlled cooling. Myckatyn says fat is more sensitive to cold than other types of tissue, which means it is intentionally ‘injured’ during this process, but well before muscles, bones, nerves and skin can be adversely affected. Until the area numbs, a patient may feel a tugging or pinching sensation. Once the fat cells die, they are eliminated naturally by the body’s immune system. Myckatyn says new fat cells are generally not produced unless a person gains a massive amount of weight. He cautions that if a patient doesn’t pursue a healthy lifestyle, existing fat cells can grow bigger.

“The challenge, however, is not to deflate the balloon too much, or else you’re left with a lot of loose skin, which then requires surgical intervention,” Myckatyn says. He calls liposuction a more effective fat-removal method, but cites CoolSculpting as an option for those who want to avoid surgery. A newer version of CoolSculpting that reduces treatment time from one hour to 35 minutes comes out in May.

about face
If you look in the mirror and feel a change is needed, it could likely be as plain as the nose on your face—literally. While facial fixes are numerous—eye-lifts, cheek and chin implants, face-lifts—many people dislike the size or shape of their nose, the most prominent feature on the face. Yet the thought of having a nose job may be overwhelming. Will I look natural? Will there be telltale signs? Could I develop other complications that affect my look or breathing?

Those issues need not be concerns with modern rhinoplasty, the technical name for a nose job, says Dr. Brock Ridenour, board-certified facial plastic surgeon. First and foremost, he recommends working with an experienced rhinoplasty surgeon, one who has performed the procedure many times and is wellversed in all the options. “Having trained with some of the most renowned rhinoplasty surgeons, I’ve developed a set of guidelines that will give patients optimal results,” Ridenour says, adding that rhinoplasty has become one of the most sought-after procedures among his patients. The one-size-fits-all nose is a thing of the past, he notes. “We focus on modest and measured refinements that will complement the patient’s skin, facial features and ethnic identity,” Ridenour explains. Additionally, today’s procedures strive for minimal excision of bone and cartilage. “Our emphasis, of course, is on achieving a realistic and pleasing appearance while preserving the functions of the nose,” he says. That means rhinoplasty might include contouring of nasal cartilages to correct a deviated septum or other airway obstruction and soft tissue ‘padding’ grafts to prevent visible irregularities beneath the skin, depending on a patient’s particular situation, Ridenour explains. “The ultimate goal is an improved, natural shape that is strong enough to resist change and deformity over time.”

a call to arms
Dr. William G. Hart of Hart Cosmetic & Reconstructive Surgery Institute explains how brachioplasty (arm surgery) can improve a niggling problem for many women. An invasive surgical arm-lift is particularly helpful, Hart says, for people who have experienced massive weight loss following bariatric surgery, and it has gained popularity in recent years. This surgery involves liposuction and leaves a scar that usually runs from elbow to armpit. However, Hart says new barbed sutures designed for deeper layers of skin have greatly improved the scar’s appearance. After the liposuction, excess skin is removed, Hart says.

Post-surgery drains are removed after three to five days, and compression garments are worn for two to three weeks. A patient may require general or local anesthesia with sedation for the surgery, which takes one to three hours. Hart says the most effective noninvasive procedure he has used involves radio frequency energy, administered by a probe, that heats and liquefies fat and cauterizes blood vessels and fibrous tissue between skin and muscle. An added benefit, he says, is the reduction of loose skin. “As the probe moves closer to the skin and heats it, the dermis contracts,” he explains. Scarring is greatly reduced because the probe enters the body through small incisions at the elbow. Compression also is used for two to three weeks, with final results visible in eight to 10 weeks.

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