Everywhere you turn these days you see advice about getting more antioxidants in your diet, in your skin care products, and your vitamins. The theory about oxidative damage as a major factor in aging has been around for several decades, and it’s a good one. It’s those products of metabolic combustion (we are essentially burning caloric fuel with oxygen) that cause so much damage to our DNA, which in turn means the proteins and other things that constitute the tissues of our bodies improperly manufactured. Eventually, things just break down. So if we can limit the oxidation, we can slow down aging.
That’s where antioxidants come in. For years, faith was placed in the antioxidant vitamins (A,C, and E) for salvation, but every major study has found no benefit to taking supplements above the recommended daily allowance. It’s not for lack of studies, there are actually dozens of them, there is just no benefit and it appears that it may actually be harmful. But don’t look to this lack of effect to question the antioxidant theory, it’s just that there are better antioxidants out there. These are a family of molecules called polyphenols, which include the pigments in berries and fruits, and the now famous extracts of wine such as resveratrol.
So which one is best? I’m banking on the wine polyphenols. A couple of years ago, I tested a skin care product containing resveratrol at the same concentration as another antioxidant called idebenone in the product Prevage. Previously, Prevage had tested their formula against all other antioxidants out there: alpha lipoic acid, vitamins, you name it. Prevage announced that it was the strongest antioxidant on the market. But using a standard antioxidant test called ORAC (there are different ways to measure antioxidant potency) we found that the resveratrol product was 17 times stronger.
So rather than pumping vitamins, it makes the most sense to just eat whole foods with antioxidants already in. These include pigmented berries, pomegranate juice, acai, and of course red wine.
Monday, September 28, 2009
Wednesday, September 23, 2009
Have the Amish taken over the FDA?
The Amish must have taken over the FDA. How else could their recent proclamations be explained? This week they sent a letter to Allergan, the makers of the eyelash-growth product Latisse, requiring them to suspend their marketing materials until they could be suitably revised. The concern is that they weren’t emphasizing the potential risks enough. I emphasize “potential” because the primary issue troubling the FDA seemed to be that Allergan was downplaying the possibility of a problem that could occur with a different product containing the same active ingredient, a condition of iris pigment change in a small number of patients. In that case, the product is an eyedrop formulation for glaucoma treatment; in other words, it is placed directly into the eye, unlike Latisse, which is placed onto the skin of the eyelid. So even though there is not a single reported case of Latisse causing iris pigment change, the FDA felt that mentioning the risk as relating only to a “similar” drug was not scary enough. Come to think of it, there are a lot of things that we put on our skin that could cause problems if you get some in your eye. Apparently the FDA just wants women to be plain.
But there’s more to my theory that the FDA is being run by a fundamentalist cult that scorns modern beauty technology. They have also recently updated their requirements for Botox labeling, requiring that practitioners hand patients a “Medication Guide” listing a range of effects than can occur from the toxin spreading beyond the injection site, causing things such as difficulty speaking, trouble breathing, even loss of bladder control. It’s a pretty frightening document until you come to the part about there not being any confirmed cases of any of this happening at the recommended doses. In fact, like Latisse, Botox is an extraordinarily safe and effective product when used properly. It is a bit like having a requirement reminding people every time they start their car that driving 80 miles an hour through a school zone is probably going to cause problems. Or perhaps we should all go back to the horse and buggy. But whether you are following the FDA’s guidance or walking behind a horse, either way you need to watch where you step.
But there’s more to my theory that the FDA is being run by a fundamentalist cult that scorns modern beauty technology. They have also recently updated their requirements for Botox labeling, requiring that practitioners hand patients a “Medication Guide” listing a range of effects than can occur from the toxin spreading beyond the injection site, causing things such as difficulty speaking, trouble breathing, even loss of bladder control. It’s a pretty frightening document until you come to the part about there not being any confirmed cases of any of this happening at the recommended doses. In fact, like Latisse, Botox is an extraordinarily safe and effective product when used properly. It is a bit like having a requirement reminding people every time they start their car that driving 80 miles an hour through a school zone is probably going to cause problems. Or perhaps we should all go back to the horse and buggy. But whether you are following the FDA’s guidance or walking behind a horse, either way you need to watch where you step.
Monday, September 21, 2009
How long do breast implants last?
One of the most frequent questions we get about breast implants is how long they are supposed to last. Our good friends at the FDA have added to the confusion by requiring disclosure that implants will probably need to be replaced every 10 years, so patients naturally assume that is the case when they read it. That would indeed be quite a commitment, but on the other hand the manufacturers of breast implants also have a lifetime replacement policy so that if the implant ever does develop a hole on the outer shell they will provide a new one free. Obviously they are not planning to do this every 10 years.
One reason the actual number is so hard to pin down is that implant designs and manufacturing standards continue to improve, so data from implants made 25 years ago isn't really applicable to implants made today. Another reason is that patients tend to drop out of studies over time, valuing their privacy over the need to contribute personal information to long-term clinical data. And of course people move, names change with divorces and marriages, and just keeping track of a large population of women with a specific type of implant is impossible over the long run. Adding to the problem is that most implant "ruptures" (really the wrong word) are silent and harmless events. So it isn't for lack of effort that the long-term data is hard to come by.
There are some numbers to go on though. Prior to FDA approval of silicone gel implants a couple of years ago, statistics from what is called the core study were submitted. In that group, the rate of "ruptures" was 2.7% at 4 years (for Allergan implants), implying that for the vast majority the implants will last a very long time. In my own experience, having used the implants for some 15 years (initially as part of what is called the adjunct study), I can't recall a single silicone implant rupture from one that I put in. About 80% of our patients are now going with silicone, for a more natural feel than saline.
One reason the actual number is so hard to pin down is that implant designs and manufacturing standards continue to improve, so data from implants made 25 years ago isn't really applicable to implants made today. Another reason is that patients tend to drop out of studies over time, valuing their privacy over the need to contribute personal information to long-term clinical data. And of course people move, names change with divorces and marriages, and just keeping track of a large population of women with a specific type of implant is impossible over the long run. Adding to the problem is that most implant "ruptures" (really the wrong word) are silent and harmless events. So it isn't for lack of effort that the long-term data is hard to come by.
There are some numbers to go on though. Prior to FDA approval of silicone gel implants a couple of years ago, statistics from what is called the core study were submitted. In that group, the rate of "ruptures" was 2.7% at 4 years (for Allergan implants), implying that for the vast majority the implants will last a very long time. In my own experience, having used the implants for some 15 years (initially as part of what is called the adjunct study), I can't recall a single silicone implant rupture from one that I put in. About 80% of our patients are now going with silicone, for a more natural feel than saline.
Monday, September 14, 2009
The implant index: Is cup size the new economic indicator?
A retired colleague of mine came up with the idea that plastic surgery bookings are a marker of returning consumer confidence and predict a rebound from a faltering economy. If that is the case, then we are headed in the right direction. One sign is that women who have been postponing their facelifts are no longer waiting, and breast augmentation is more popular than ever.
But I have noticed another trend. It appears that no only do hemlines come down during a recession, but the choice of breast implant size drops too. Interestingly, while breast augmentation surged past liposuction to claim the number one spot in cosmetic surgery popularity despite economic woes last year, the implants seemed to be smaller after years of edging ever larger. The smallest category, 300 cc’s or less (a full “B” cup for the typical patient) increased from less than a third of all patients to about half, in tandem with more widely recognized economic indicators. Breasts were almost literally shrinking as our economic institutions collapsed.
There is of course no way of knowing why this should be the case but I have a few ideas. (It isn’t cost, all implants cost the same regardless of size.) Women in the Northwest have always favored a more natural look, whether it be with their facelift or their breast implants, but in some parts of the country it became almost a status symbol to display the results of the plastic surgeon’s touch. Fake became the new natural. But when so many started feeling the pinch of the recession, flaunting one’s assets became less fashionable.
According to a recent article in the Wall Street Journal, fashion trends are definitely moving in the direction of a less edgy look, and the models being featured most prominently during Fashion Week reflect this. Managers at Elite Model management are quoted as saying that models like Joan Smalls are more “commercially viable” because they fit the natural aesthetic. Models with the classic look are replacing the ones with more exaggerated features.
Whether or not this is useful will depend on how the Implant Index performs during the return to economic stability. If it holds true, the “C” cup economy is where we want to be. It certainly makes more sense to me that some other ideas that have been proposed, like the size of boxer shorts (true!), but in any case signs are positive. Meanwhile, I will continue to focus on the natural look regardless of size.
But I have noticed another trend. It appears that no only do hemlines come down during a recession, but the choice of breast implant size drops too. Interestingly, while breast augmentation surged past liposuction to claim the number one spot in cosmetic surgery popularity despite economic woes last year, the implants seemed to be smaller after years of edging ever larger. The smallest category, 300 cc’s or less (a full “B” cup for the typical patient) increased from less than a third of all patients to about half, in tandem with more widely recognized economic indicators. Breasts were almost literally shrinking as our economic institutions collapsed.
There is of course no way of knowing why this should be the case but I have a few ideas. (It isn’t cost, all implants cost the same regardless of size.) Women in the Northwest have always favored a more natural look, whether it be with their facelift or their breast implants, but in some parts of the country it became almost a status symbol to display the results of the plastic surgeon’s touch. Fake became the new natural. But when so many started feeling the pinch of the recession, flaunting one’s assets became less fashionable.
According to a recent article in the Wall Street Journal, fashion trends are definitely moving in the direction of a less edgy look, and the models being featured most prominently during Fashion Week reflect this. Managers at Elite Model management are quoted as saying that models like Joan Smalls are more “commercially viable” because they fit the natural aesthetic. Models with the classic look are replacing the ones with more exaggerated features.
Whether or not this is useful will depend on how the Implant Index performs during the return to economic stability. If it holds true, the “C” cup economy is where we want to be. It certainly makes more sense to me that some other ideas that have been proposed, like the size of boxer shorts (true!), but in any case signs are positive. Meanwhile, I will continue to focus on the natural look regardless of size.
Tuesday, September 8, 2009
Calling all collagen
For all the talk about collagen, the primary structural protein of which we are made, there remains a fair amount of misinformation about it. Here’s a primer: The collagen molecule is composed of long coiled strands, or fibers, which interconnect and weave together to form the matrix of everything from skin to tendons. There are different types, such as elastin, which as the name implies contribute more to flexibility. And like all molecules in the body, collagen is continually broken down and replaced. However, with age and environmental damage, the new collagen has defects, which leads in turn to the visible signs of aging in the skin.
So the real question is how do we encourage new healthier collagen to form? There are several strategies, the primary one being prevention. This involves all the simple things like sunscreen. A healthy diet may be helpful, but only in a general sense. Consuming the tendons rather than the more tender portions of meat, a common practice in Japan, is unlikely to make a difference. Vitamin C is often touted, both in the diet and as an ingredient in skin creams. The logic is that since it is a co-factor for the enzyme that builds collagen (which is why the disease scurvy develops when it is absent from the diet), extra C builds better collagen. But while it is true that collagen can’t be adequately made if it is lacking, extra doesn’t drive the process any faster. The worst idea of all is collagen or elastin in skin creams; skin is a barrier to prevent large molecules like these from entering. So it’s like throwing bricks at a wall and expecting them to somehow be taken in and make the wall stronger.
There is hope though. One sure fire way to encourage new collagen is to recruit the body’s healing processes by essentially creating a controlled injury. This is how chemical peels and lasers work. Thermage functions this way too, and has the advantage of no downtime. And because it works by building new collagen, the results are long-lasting.
So the real question is how do we encourage new healthier collagen to form? There are several strategies, the primary one being prevention. This involves all the simple things like sunscreen. A healthy diet may be helpful, but only in a general sense. Consuming the tendons rather than the more tender portions of meat, a common practice in Japan, is unlikely to make a difference. Vitamin C is often touted, both in the diet and as an ingredient in skin creams. The logic is that since it is a co-factor for the enzyme that builds collagen (which is why the disease scurvy develops when it is absent from the diet), extra C builds better collagen. But while it is true that collagen can’t be adequately made if it is lacking, extra doesn’t drive the process any faster. The worst idea of all is collagen or elastin in skin creams; skin is a barrier to prevent large molecules like these from entering. So it’s like throwing bricks at a wall and expecting them to somehow be taken in and make the wall stronger.
There is hope though. One sure fire way to encourage new collagen is to recruit the body’s healing processes by essentially creating a controlled injury. This is how chemical peels and lasers work. Thermage functions this way too, and has the advantage of no downtime. And because it works by building new collagen, the results are long-lasting.
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