Enhanced results with lipo plus Thermage

As usual, the Hot Topics session at this week's meeting of the American Society of Plastic Surgeons served up a number of issues. I had the opportunity to present the data from our studies proving that Thermage given immediately after liposuction enhances skin tightening. The reason that this is important to prove in a scientific way is that skin shrinks all by itself after lipo, so additional shrinkage can only be claimed if it is demonstrated to be greater than what occurs normally. Patients who benefit from this are those who have some looseness to the skin, such that lipo alone would not give a good result, but not so much that they need something like a tummy tuck. This latter part is important because some plastic surgeons are pitching laser lipo as an alternative to tummy tucks. It's a risky proposition because I am already seeing patients who should have had a tummy tuck but chose laser lipo instead, and the results are not pretty.
To be fair, there was some data presented showing enhanced skin shrinkage with smart lipo (though not as much as with lipo-Thermage) and another suggesting that VASER ultrasound helps too. But each of these has its own risks and benefits, so for now my money is on the one designed to tighten skin in the first place.

Fat chance: Has the time for breast enlargement with fat injection arrived?

The annual meeting of the American Society of Plastic Surgeons (ASPS) is just about to wrap up here in Seattle. As a member of the Emerging Trends committee, I am involved in putting on the “hot topics” session, which always has a few zingers. I’ll be posting on some of those in the coming days, but the question of whether or not it is safe and effective to use one’s own fat for breast augmentation is front and center.
It’s a simple idea: why can’t we just take some fat out from the bottom, or the love handles, or some other area where it isn’t wanted, and use it to enlarge the breasts? Certainly, there can be no more natural means of breast enhancement. In recent years, techniques for fat grafting have improved a lot and they are being used to improve the results from breast reconstruction and some cases of implant augmentation, by smoothing out contours and irregularities. Why not just do it for the entire breast in the first place?
At the meeting there were a few reports of some success, but also a few cautionary notes. For one, the volumes used are low, with no more than a cup size or so of enlargement possible. Concerns about the grafts leaving lumps that interfere with mammograms seem to have been addressed, so that barrier is coming down. But a French surgeon reported some evidence from animal studies that it is theoretically possible that the grafted fat could stimulate breast cells, resulting in an unknown effect on the risk of breast cancer. There is no evidence of this in humans, but it is a sign that we should proceed cautiously. So stay tuned, but don’t expect every plastic surgeon to be offering the procedure in the immediate future.

Winterize your skin

The Seattle rain festival appears to be in full swing, but forecasters are predicting clearing by June or July. In all seriousness though, it’s time to think about winter skin care. We do love our sunshine, but given that skin cancer is the most common type of cancer, it’s not all bad to have a break. True, most skin cancers are of a non-aggressive type, but deaths from skin cancer are up 50% from the 1970’s, and melanoma-the deadliest type-has risen dramatically too. Even teenagers are now being diagnosed with skin cancer.
So the gray months of the year are a good time for what we might call “corrective” skin care. The basics are moisturizers, because of dry air, but more intense therapies are in order too. Skin peels leave the skin more sun-sensitive for a while so they tend to be less popular during the summer. Products such as tretinoin (Retin-A) are a mainstay of corrective skin care but again the issue of sun sensitivity limits their use for some during sunny times of year.
Just giving your skin a break from UV exposure is a good thing too, but don’t assume that there isn’t any just because the skies are overcast and the days are short. Sunscreen SPF only measures UVB protection from burning, but not UVA which is aging. The deal with UVA is that it penetrates window glass and clouds just as it does skin.
All of this has to be placed in perspective of course. Sun exposure converts cholesterol into vitamin D, and you should probably be taking a D supplement especially during the winter. But there is a growing movement of “sun haters” who take matters to the extreme. So while I do recommend “pleasantly pale” over “terminally tanned,” let’s not get carried away.

Anti-aging: a "Nobel" cause

Mark Twain famously said “Age is an issue of mind over matter. If you don’t mind, it doesn’t matter.” Great advice to be sure, and there is ample evidence to support the notion of a healthy attitude as an anti-aging strategy. But of course how the body ages is important too.
I spend much of my time practicing what is called anti-aging, but the term has lost some of its meaning in recent years. What we call anti-aging these days has more to do with restoring the appearance of youth more than with slowing the aging process itself, or at least steering it in a healthy direction. Recognition of that fact is one of the things that motivated my book Age Gets Better with Wine, out next week. But the science of anti-aging is regaining credibility, as evidenced by last week’s announcement of the Nobel Prize in physiology and medicine. Three Americans-Elizabeth Blackburn, Carol Greider and Jack Szostak-were named winners for their chromosome research that has profound implications for cancer and aging.
Here’s what they found: whenever a cell divides, which it must do in order to heal a wound, refresh the skin, and rebuild organs to maintain their function, it must replicate the chromosomes that hold the DNA programming code. This is accomplished by a sort of unzipping of the DNA strands, but at the end of each one is a sort of cap like on a shoelace called the telomere. These normally limit the number of times the DNA (and therefore the cell) can replicate, but an enzyme called telomerase rebuilds the telomere. In cancer cells, this goes on continuously and out of control, but for anti-aging it may hold the key to extending the cell’s replicative lifespan. This in turn translates to healthier organs, glowing skin, and a sharper mind.
A lot remains to be learned about this process, but the promise is more than enticing. In the meantime, focus on that positive attitude and healthy lifestyle.

Is beauty truly in the eye of the beholder?

I may not be a beautician with a scalpel but thre is no question that I am in the beauty business. As such, I spend a lot of time thinking about beauty. There are even academic books on the history of beauty, and when you put it all together it becomes obvious that superficial beauty is meaningless without inner beauty. When we think about beauty being in the eye of the beholder (an idea first put forth in classical Greece but written in its modern form in the 1878 book Molly Bawn by an author going by the pseudonym "The Dutchess"), it would seem that it is up to others to decide. Some find this a liberating idea, assuming that all that matters is how we feel about ourselves, but like so many aspects of human nature it is more complicated than that.
What it comes down to is that how others perceive us matters whether we like it or not. When we express a positive attitude, others will respond in kind, and that in itself is a beautiful thing. But that isn't to discount physical appearance completely. How we take care of ourselves, our own sense of confidence, is manifest in appearance, and that has tangible benefits too.