Spring into Beauty
Sunnier days and flimsier clothes turn our thoughts to … self-improvement. No more hiding behind long pants and baggy tops; spring is just about here, and so is that moment of truth in your mirror. It’s time for a renewed commitment to exercise, diet and those cosmetic tweaks we’ve been putting off.
What do chocolate stains and back fat have in common? They are almost impossible to remove from your clothing. That shouldn’t stop us, however, from trying.
“Back fat is primarily a result of excess weight gain,” says Dr. Michele Koo, a plastic surgeon in Kirkwood. “It is a particularly difficult and stubborn area for reduction. It’s easy to gain weight and inches but extremely difficult to reduce the inches once the skin has stretched. The back and abdominal areas are particularly resistant.”
A fat roll may stubbornly perch on the back of someone who typically has not had much of a weight problem at all, confirms Dr. Sumesh Kaswan, a SLUCare plastic surgeon at SSM Health Saint Louis University. “Liposuction is a tool we have for localized areas of fat that are not going away,” he says. Liposuction reshapes body contours by removing fat cells.
Look at all those bright, form-fitting fashions for spring and summer. Then think pool, gym, golf and tennis courts. Feel doomed? “Back fat creates bulges and lumps in clothing and always has been an issue,” Koo says. “Women particularly are concerned with the ‘B cup on the back’ or the bulges brought out by a tight swimsuit or bra.”
Women compose the bulk of patients with this problem, Kaswan agrees. Genetically, due to the way body fat is distributed, most back fat patients are women.” Most annoying of all, diet and exercise alone often will not resolve back fat issues. “Overall weight loss through better food choices and portion control will help,” Koo says, “but the amount of weight loss required to see a reduction in back fat is significantly more than the pounds gained.”
Localized back liposuction is an outpatient procedure with a short recovery. “Most people are able to go back to regular desk jobs in a week to 10 days,” Kaswan says. “They have swelling and bruising that may take six to eight weeks to settle down. The final result of liposuction will not be noticeable for up to six months, however.”
The average national cost of a liposuction procedure is $2,971, according to the American Society of Plastic Surgeons. Considered a cosmetic operation, it normally is not covered by medical insurance.
Cryolipolysis, also known as cool sculpting, is a noninvasive alternative for fat removal that applies a cold pad to the body. “A probe cools the fat to a low temperature, and the body breaks down and absorbs the fat,” Kaswan says. “That is only for specialized areas that do not have an excessive amount of fat.” Koo doesn’t recommend this option for back fat, because she says it’s too thick and dense.
In dermatology years, everything changed 17 years ago. That’s when a range of safe, effective fillers was born and doctors could use them to address their patients’ wrinkles, lines and other imperfections with minimal discomfort.
variety, the spice of fillers
“Modern fillers were available when I opened my first practice in 2003,” says Dr. Richard Moore, a cosmetic surgeon and medical director of The Lifestyle Center in Frontenac. “Over the years there has been a tremendous increase in the number of fillers. They have different properties that determine where we use them.”
Dr. Joseph A. Muccini, a surgical dermatologist at MidAmerica Skin Health & Vitality Center in Chesterfield agrees. ”We have recognized for a long time that we experience soft tissue loss in the mid-face as we age,” he says. “And now we have a whole tool chest of things that allow us to do fine craftsmanship and make beautiful contours. Fillers are easier to come by, safer to use, and we no longer have to worry about allergic reactions.”
The first attempts at using facial fillers, late in the 19th century, were prompted by the invention of the syringe needle and the desire to assist tuberculosis patients who had suffered facial scarring. The first tested was paraffin, which was quickly found unacceptable. In 1981, the U.S. Food and Drug Administration approved injections of collagen, the main structural protein of body tissues. For two decades, the filler market consisted of cow and pig collagen, as well as the patient’s own (autologous) fat cells.
In 2003, the FDA began approving the current generation of fillers, which include purified, human-derived and synthetic compounds. “The first was hyaluronic acid, a synthetic protein that is naturally occurring,” Muccini explains. “It attracts water so it causes plumpness.”
Collagen injections had a short duration, four to six weeks, reports Moore, and because they were derived from animal collagen, “there were some issues with allergic reactions.” Fat transfer is still done today, Muccini notes. “Microtransplantation of fat works pretty well because it is your own tissue, but it does require more tissue handling and logistics,” he says.
As a bonus, some modern fillers stimulate the body to produce collagen. “These fillers can last one to five years or more,” Moore says. “The effect persists, although our body’s ability to produce collagen diminishes year by year.”
For filling or lifting cheeks, fillers that create volume are used. “You can use a longer-lasting filler that stimulates collagen. There are a number of options: Restylane Lyft, Radiesse, Juvederm Voluma, Sculptra or Bellafill,” Moore says.
But for the nasolabial folds (from the sides of the nose to the corners of the mouth), “we can use a medium- or large-size particle filler, or Sculptra or Bellafill,” Moore continues. “It depends on the duration and expense the patient wants.” The longer the duration, the higher the cost. A single syringe of filler generally runs around $600 in most locations, he says.
Hyaluronic acid, a popular filler, is a natural substance residing throughout the body, especially in fluids of the eyes and joints. “There are 10 to 12 common hyaluronic acid fillers,” Muccini says. “They have slightly different properties and we use them in different ways. If you are doing the thin lines around the mouth, you need a very elegant filler that is not very thick. For problems in the mid-face, I’d use a thicker, more plumping filler and start deep down in the tissue.”
Platelet-rich plasma (PRP), derived from the patient’s blood, can be used, as well. “I like to use PRP under the eyes because it promotes collagen growth and tightens wrinkles and bags,” Moore says. “It has been very effective. We can easily take five to 10 years off of someone’s appearance with fillers.”
Even after a century of resistance training with a 20-foot copper torch, Lady Liberty’s famous right arm needed a bit of cosmetic surgery during her centennial makeover in 1986. Nothing to be ashamed of—it happens to a lot of women, judging from the popularity of upper arm surgery.
Saggy skin under the arms, or bat wings, can afflict people for a number of reasons. People who have undergone significant weight loss may find loose skin has been left behind, and others who have not had weight issues may still experience flabby arm syndrome. “There are some who are just genetically predisposed to carry more weight in their arms or have looser skin,” says Dr. Marissa Tenenbaum, a Washington University plastic surgeon.
The development of problematic flab on the back of the arm is usually multifactorial, explains Dr. Charles Nathan, a plastic surgeon at St. Louis Cosmetic Surgery in Chesterfield. “Arm flab usually consists of loose skin combined with excess fatty tissue,” he says. “Major weight gain and loss can lead to loose skin, and genetics play a big part in your body’s natural elasticity. Age, of course, leads to a decrease in elasticity. Sun damage and smoking contribute to laxity. There is no certain age when problematic arms occur; it’s more a function of total body fat or elasticity.”
Tenenbaum adds that the problem typically afflicts aging women because, “as we lose estrogen, our skin is less elastic.”
first, analyze the issue
When sagging arms are not the result of large weight loss, it’s possible the issue can be treated with minimally invasive procedures. “First, you have to determine whether it’s a loose skin issue, a fatty tissue problem or a combination of both,” Nathan says. “For patients with minimal skin laxity and excess fatty tissue, cool sculpting may be a good nonsurgical option.”
Tenenbaum says, “If someone has excess fat in their arms and reasonable skin tone, liposuction can work to debulk the arm because the skin will retract. Cool sculpting can be done in the office with no surgery. It freezes the fat cells and destroys some of the excess fat.”
the arms race
But for many, addressing the problem requires a more extensive approach. “The most unhappy patients are those who have excess loose skin after major weight loss. They are usually candidates for an arm lift,” Nathan says. “Skin removal, or brachioplasty, is typically necessary.”
The process, explains Tenenbaum, requires a surgical excision and a scar along the inside of the arm. “We try to conceal the scar, but if you raise your arms it could potentially be seen,” she says. Brachioplasty can, however, be performed on an outpatient basis in an operating room. “You could go home the same day,” Tenenbaum says. “Typically patients wear compression sleeves for up to a month and should do no strenuous activity. But they can go back to a desk job or normal daily activities in about a week.”
no pain, no gain
The resulting scar begins at the armpit and approaches the elbow. “Everybody scars differently,” Tenenbaum says. “Some patients are prone to a thicker or raised scar. Others heal thin and flat. For the first year to year-and-a-half, it will change and could start pink or raised, then fade.”
The American Society of Plastic Surgeons reports the average national cost of brachioplasty is $5,000, including fees for the surgeon, anesthesiology and operating room. For patients who require extensive excisions, the cost may approach $10,000, Tenenbaum says.
The recent rise in weight loss surgeries has increased requests for body contouring procedures, she notes. “That tends to be the largest group of patients who undergo brachioplasty. It is not as common as the tummy tuck, but we do see a lot.”