Enough of hibernating in our homes under layers of fleece. Spring is ready to emerge, but are we? Warm-weather clothes tempt us to bare it all, which means that pound or two (or three or 10) we added to ‘bulk up’ for the cold will be front and center. Between now and swimsuit season is the ideal time to tackle our self-image issues with resolve.

weigh your options
They say the road to a man’s heart is through his stomach. There’s more truth to that than we care to admit. We love to eat, and why wouldn’t we? Great food here is abundant, but great willpower, alas, is not.

the brain connection
The key to successful weight loss begins well before that fork is about to enter the mouth. “It all starts with what is in your head,” says Iris Salsman, weight management mentor and motivational coach who started Been There Done That. And she has been there—many, many times.

After losing and gaining large quantities of weight all her life, Salsman has found the secret to success, she says. “There are a lot of ways to lose weight. There are not a lot of ways to keep it off. From day one you need to have a commitment that every pound you lose will be lost permanently,” she says.

A thorough analysis of your interactions with food is the first step to planning the weight loss strategy, says Teresa Scott Syed of OneLife Weight Loss & Wellness Solutions. “You have to be really committed to understanding yourself and your relationship with food,” she says. “We all self-medicate for the pain, stress, anxiety, lacking and loneliness in our lives. We choose to relieve that with immediate gratification to make us feel better for the moment.”

getting real
So how do we overcome our own sabotaging behaviors? “You finally reach the point where you are willing to do the work and remain focused,” says Syed. There are mental exercises you can go through to get you psyched up for the journey, Salsman adds. “Dig deep and think of 20 reasons why you want to lose weight. It is easy to come up with the first two or three—look better, feel better, fit into your clothes.” The rest of the reasons might push you into more serious territory. “You get into living longer, controlling your blood sugar, not having a heart attack, not having your joints ache,” Salsman says. “You want to fit comfortably into the seat in the theater or airplane. You want to get on the floor to play with your grandchildren.”

Then, she says, print and post that list where it will be seen every day as a reminder of what’s at stake. Once you’re committed to taking this weight-loss program seriously, you need a workable plan.

baby steps
“I suggest sitting down and designing what I call a ‘smart’ goal: specific, measurable, attainable, realistic and timely,” Syed says. “Get on a definable plan that really works. Learn how to manage stress, because stress is a big trigger for eating. Incorporate movement into your life whether it means walking every day or a full-blown exercise program.” And, she adds, “Be mindful of what you put in your mouth. Ask yourself why you are having that ice cream cone.”

A successful nutrition plan can be workable for the long term, preferably the rest of your life. “Take an approach that doesn’t make you feel deprived and sorry for yourself,” Salsman adds. “Don’t be eating little bitty portions or eating the same food over and over. Don’t be afraid to go out to eat or feel like your life is restricted. If you take that approach, you will feel like a caged animal that can’t wait to break free.”

health-cellulitesolving cellulite
It may be a word better left unspoken—cellulite, that cottage-cheesy dimpling on the skin’s surface. But we have to talk about it to let you know whether its spread is avoidable.

“Typically, cellulite involves the thighs and buttocks but also can be seen on the arms and abdomen,” says Dr. Richard Moore of The Lifestyle Center. “Approximately 90 percent of women and 10 percent of men will be affected by it.”

Some researchers and physicians believe cellulite is a normal fat distribution that can be linked to, not necessarily caused by, hormones, genetics, diet and lifestyle choices such as smoking and lack of exercise, explains Dr. Michele Koo. “It’s an enlargement of normal adipose (fat) cells in the superficial layer of our skin,” she says. “Everyone has these, but when they enlarge and stretch the skin, the end result is a dimpling appearance.”

The wavy look of cellulite results from tissues attempting to simultaneously expand and tighten, Moore adds. “As the lymph fluid collects and the fat cells expand and push outward, the fibrous bands tether the skin, pulling it inward. This results in the uneven texture of cellulite. Since it starts to affect the majority of women by their 30s, it is thought to be related to changes in estrogen.”

low weight offers little relief
“Cellulite does not occur in everyone but can occur in people who are thin,” notes Koo. Even women with normal weights who are quite athletic can develop cellulite, adds Moore, who estimates that 90 percent of women are affected. “While cellulite can be made worse by weight gain, exercise and weight loss generally do not improve the appearance, ” he says.

Koo agrees. “There is nothing you can do to prevent cellulite, specifically if you are predisposed to it by the genetics of your body type and fat cell type.” But there is a ray of hope. “Sensible lifestyle choices of regular exercise, no tobacco, adequate hydration and healthier food choices of dark green vegetables and fewer carbohydrates all help to deter and minimize it,” Koo notes.

“Cellulite treatment options, unfortunately, are not very effective,” Koo says. “There is an FDA-approved laser treatment, but the results are minimal, in my opinion. Liposuction may improve the contour and shape to perhaps make cellulite less noticeable, but it also can worsen appearance.”

Lymphatic massage might be beneficial, Moore adds. “Most of the treatment modalities incorporate a form of endermologie (mechanical cell stimulation) to move lymphatic fluid out of the tissue space while stretching the fibrous bands. Most also incorporate some form of energy, either laser or radio-frequency wave, to reduce the size of the fat cells. This may take six to 10 treatments, followed by quarterly or bi-annual maintenance.”

But Koo is not sold on any of the current options. “Mesotherapy, injections of various medications and vitamins, have not been proven to reduce cellulite and fat and can cause more irregularities, swelling, skin changes, and infection. Spa treatments and external massage and wraps are temporary, with results most likely due to temporary removal of the water content of the superficial and deep skin and fat layers. Creams and lotions are extremely tempting but costly and a waste of money!” she says.

“I know I sound like a naysayer, but there is ongoing research for lasers with certain wave-lengths of light that may disrupt fat cells and cause them to shrink,” Koo says. “But they’re only at the research stages.”

face-needledon’t forget the face!
Life is not fair. Just as unwanted fat cells accumulate on the hips and thighs, the friendly fat cells that give us rosy cheeks start to disappear. Fortunately, there are good solutions, mostly in the form of injectables, to plump sinking cheeks and sagging eyelids.

the good fat
“If you have lost cheek volume or are looking a bit older, injectables used judiciously can correct a lot of that,” says Dr. Joseph A. Muccini Jr. of MidAmerica Skin Health & Vitality Center. “For a younger person, we can do a lot to hold off surgery or work on specific areas that are problematic.”

The most popular injectables are fillers, most of them a formulation of hyaluronic acid, a substance present in our cartilage, skin and other tissues. “The hyaluronic acids are naturally occurring sugar acids that are in all living organisms, therefore they are safe to use,” says Jackie Carr, a registered
nurse, board-certified adult nurse practitioner and licensed esthetician at Aesthetic Medispa of West County.

“Hyaluronic acids pull hydration into the area where they are placed so there is a plumping effect,” Muccini adds. “Then the body lays down some of its own material, and you get some collagen remodeling.” Hyaluronic acids are produced under brand names like Juvederm and Restylane. Each offers specialized sub-brands.

know your filler
The different products have varying viscosity, which is why a patient may benefit from a combination of fillers. “We can do a combination with one filler in the cheekbone area to give more volume in the mid-face, then possibly use one or two syringes into the nasolabial folds and another in the chin area,” Carr explains.

Muccini says the process is individualized. “We combine things to create what we need for the end effect,” he says. “If we have to do more than one layer, we will start at the deeper layer and work our way to the surface.” The lifespan of a filler treatment depends on the type used. “A deeper, denser hyaluronic acid treatment may last nine months, sometimes a year. For the very thin and superficial fillers we are looking at six to nine months,” Muccini says.

As for cost, most offices charge about $550 for a syringe of Juvederm or Restylane. Botox is charged by the units used, says Carr. If patients need more than four syringes of filler, they may be a candidate for a surgery, she says.

another useful tool
Neurotoxins based on purified strains of the botulinum toxin type A also are effective in producing a younger facial appearance. The bacteria blocks nerve signals and paralyzes muscles. “By relaxing muscles used in facial expressions, you can release the furrowing that causes undesirable cosmetic effects,” Muccini says. “There are three brands—Botox, Xeomin and Dysport. They don’t lift anything, but we get a desired clinical outcome by not using muscles we don’t want to contract.”

These are a wonderful tool between the eyebrows, in the forehead and in the crow’s feet, Carr says. “You also can use them for the fine lip lines and in what we call the ‘bunny lines,’ where people scrunch up their nose.” A neurotoxin treatment is expected to last three to four months.

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