Health Features

Staying Beautiful

When you look in the mirror, do you like what you see? Women and men are increasingly turning to surgery for help achieving their health and beauty goals. And oftentimes, the two are closely related.

Even rhinoplasty, the proverbial ‘nose job,’ can have a functional impetus, although it is more often an Aesthetic Surgery. Reportedly more popular than ever, today’s rhinoplasty can improve function and enhance the unique look of the individual.

a matter of balance
Unlike your eyes, hair or lips, your nose should never be the focal point of your face, points out Dr. Scott Walen, a SLUCare otolaryngologist. No one ever says, “Wow, she has a great nose!” If your nose is being noticed, it’s probably for the wrong reasons. Additionally, surgery serves to improve nose function. In fact, Walen says most of his patients have some type of structural problem or nasal blockage that causes chronic congestion and breathing problems. Others may need to correct a previous trauma to the nose.

Whether it’s strictly cosmetic or strictly functional, rhinoplasty changes the look of the nose, so patients need to make decisions about what outcome they want. Most are looking for subtle, soft changes, Walen reports. “There’s not one perfect nose for everyone,” he says. Your perfect nose depends on your face shape, age, ethnicity and personality. Whether you want to remove a nose bump, straighten the bridge or reshape the tip, ultimately you still want to look like you.

Dr. William Hart, director of Hart Cosmetic & Reconstructive Surgery Institutes, says today’s patients are more aware of proportionality in the various facial features. “This may be due to more close coverage of celebrities in the media who’ve had this type of surgery,” he says. Ethnic rhinoplasty is growing in popularity, especially on the coasts. “An ethnic rhinoplasty would be one that is designed to change the appearance of the nose, but yet stay within the boundaries of the patient’s normal ethnic
features,” Hart says.

managing expectations
Hart advises choosing a surgeon whose vision for what can and should be done is in line with your own. “Surgeons today are focusing on not only improving the look of the nose, but also the structure and airway. We have much more knowledge of the anatomy and physiology of the nose and are focused on building it up with cartilage and tissue—not just taking tissue away. The long-term results are far better because of it,” Walen says.

And while this surgery has always been popular with women, Hart reports seeing an uptick in male patients. “I definitely have seen more men interested in changing the contour and shape of their nose,” he says. He adds it’s important for surgeons to develop a rapport with their patients and educate them about the process and what to expect. “Swelling can take anywhere from a few weeks to a year to go down completely,” he explains.

not your mother’s surgery
“Cartilage grafting and the use of suture fixation of the cartilage have helped make the rhinoplasty more refined and predictable,” Hart says. Because these procedures were not used 30 or 40 years ago and noses change over time, older rhinoplasties may not age well. In some cases, these patients can develop airway problems due to nasal collapse.

Preoperative imaging helps patients imagine how they will look following the procedure, but with all rhinoplasties, there is an element of unpredictability, says Walen. “Reviewing photographs of a physician’s prior cases can be helpful,” adds Hart. He says some of the newer injectable fillers can be used to correct contour abnormalities, offering a relatively longterm effect of one to two years. But injectables can be used only to make additions, not to remove tissue. Hart explains that in some cases, that could be enough, since they can create the illusion of a smaller and/or better-proportioned nose, and/or hide minor bumps on the bridge.

[foot loose]
No one wants feet with unsightly bumps and twisted toes. But more important, conditions like bunions and hammertoes affect function. The good news is twofold: patients can mitigate these problems by avoiding non-supporting shoes, and physicians today have the technology to help.

about bunions
Bunions are bony bumps that form at the base of the big toe where it attaches to the foot. Often, the big toe pushes toward the other toes causing bone overgrowth, which can be very painful. “Genetic predisposition is the usual cause for bunions,” says Dr. Michael Horwitz, a podiatrist at Feet for Life. However, improper shoe choices can aggravate an already established bunion.

The key to prevention is strengthening the intrinsic muscles in the arch of the foot, says Dr. Vincent Travisano, a podiatrist in Webster Groves. “With custom orthotics, you’re going to functionally maintain the structure of the foot, as opposed to an arch support that is just going to maintain the arch of the foot,” he explains.

help yourself
Bunions will not improve or go away on their own, but there are a number of conservative home treatments that you can try to alleviate the pain and discomfort caused by chronic irritation of the bunion. Travisano recommends soaking your feet in Epsom salt, taking nonsteroidal anti-inflammatory medications like ibuprofen, and using non-medicated bunion pads. Most important, choose comfortable shoes that conform to the shape of your foot without squeezing or pressing on the bunion.

“While home treatments can provide relief, many patients under the age of 70 want more immediate results,” Horwitz says. For this reason, bunion surgery is fairly common, and appropriate when the patient is in pain, he adds. The most common bunion surgery is the Austin bunionectomy, he says, in which the surgeon cuts the bone close to the big toe joint and shifts it into the correct position. Bone screws are typically used to hold the cut bone in place, providing necessary compression and helping the bone heal quickly.

These form when the arch muscles weaken and have a difficult time keeping the toes straight, Horwitz explains. As a result, the toes buckle or curl down. Like bunions, the predisposition to hammertoe is genetic, and shoe choices can exacerbate the problem. Horwitz recommends wearing minimalist shoes for at least 20 hours per week to keep the feet strong.

Hammertoes may be flexible, meaning the toe can still be moved at the joint, or rigid, which usually causes pain and needs to be treated with surgery. A number of conservative options can be tried for flexible hammertoes, including stretching, switching to shoes with deep toe boxes (to prevent the top part of the toe from rubbing against the shoe), non-medicated pads, and shoe gear like gel toe separators.

if all else fails
“One interesting fact about hammertoe surgery that most people don’t understand is that it’s somewhat tricky and should never be performed by surgeons who do not have a great amount of experience performing hammertoe correction (arthroplasty),” Horwitz says. “Complications include drifting of toes, reoccurrence of deformity and sometimes infections.”

function, not form
While hammertoes and bunions may look unsightly, both Horwitz and Travisano agree that appearance alone is never a good reason to operate. If your hammertoe or bunion is not bothering you, your best bet is to try to prevent the condition from progressing with good shoes. Look for sandals that offer arch support and cushioning in the footbed. Avoid strappy shoes that cut across the bunions and put pressure on them. Very high heels also put unnecessary pressure on the feet.

But there is no reason for people to suffer needlessly, either. “Ninety-nine percent of all foot procedures are done outpatient, with local sedation,” notes Travisano. “And the majority of patients are happy with their outcome.”

[gastric bypass]
Just about nothing affects health more than body weight—and the same could be said about self-image and body weight. Gastric bypass surgery and gastric sleeve surgery are win-wins in both arenas . While not the first line of defense, these surgeries can do wonders for extremely overweight people who have tried unsuccessfully to shed pounds through diet and exercise.

what is it?
Gastric bypass surgery reduces stomach volume, which in turn reduces the sensation of hunger. As a result, individuals consume fewer calories and, over time, lose weight. “To be more technical about it, we usually divide the stomach into two compartments. A very, very small compartment attached to the esophagus and the lower part of the stomach, which food no longer gets into and which is about 98 percent of the volume of the stomach,” says Dr. Christopher Eagon, a Washington University bariatric surgeon.

The National Institutes of Health have established guidelines for gastric bypass surgery. Good candidates are people who have a body mass index greater than 40 or who have a BMI between 35-40 and have obesity-related diseases like diabetes or sleep apnea. According to Eagon, this correlates to roughly 100 pounds over your ideal weight. In addition, patients must attempt some organized medical treatment plan before weight loss surgery.

Gastric sleeve surgery has been growing in popularity over the last four or five years, Eagon says. Surgeons remove a small part of the stomach, turning the stomach into a tubular ‘sleeve.’ On average, patients lose about 55 percent of their excess body weight within 12 to 18 months.

boundless benefits
For the right person, these surgeries act as a silver bullet. “It has a very dramatic effect on many obesity-related comorbidities, primary among them is diabetes,” Eagon says. “Sixty-five to 70 percent of diabetics will come off their medication and develop normal blood sugars, usually over the course of several weeks or a few months after surgery. In addition, it also has beneficial effects on high blood pressure, sleep apnea syndrome, high triglycerides and cholesterol, gastroesophageal reflux (GERD) and osteoarthritis. We also know it reduces your long-term risk of heart attack and stroke.” Multiple studies also have shown that patients who have gastric bypass surgery live longer than they would have without surgery.

Gastric bypass changes the way you look, but it also changes, forever, the way you can eat. “Patients need to be aware that they’re not able to eat whatever and whenever they want,” warns Eagon. “If they do, they may experience adverse effects like vomiting.” On average, he says, patients lose 70 percent of their excess body weight. “Typically the patients remain vigilant with their diet and exercise. But even patients who don’t make good choices still do quite well.”

Another downside is the excess skin left behind. Once the weight they have carried for so many years disappears, patients are left with loose and flabby folds of skin that have nowhere to go. That has given rise to its own menu of body contouring by plastic surgeons.

the final stretch
Dr. Michele Koo of Aesthetic & Hand Surgery Institute recommends that patients wait until their weight has been stable for six to 12 months before undergoing body contouring procedures, unless they need renewed motivation. “Oftentimes, weight loss stalls. If this is the case, intervention with skin removal through a tummy tuck or thigh or breast lift is extremely empowering to return
them to their weight loss journey,” Koo says.

Because the amount of excess skin can be significant, procedures may have to happen in phases, Koo explains. “Surgeries often are separated into two or three stages over one to two years,” she says. “With each subsequent surgery, the patient gets closer and closer to truly feeling ‘normal’ and wearing ‘normal’ size clothes. Anything is possible, but patience and a continued healthier lifestyle are a must.”