Friday, February 27, 2009

The buzz on caffeine (It’s good for you)

It may come as no surprise to coffee-fueled Seattleites, but the latest research from the University of Washington here has caffeine addicts buzzing. Turns out that caffeine is not only a health food, but perhaps the next exciting skin care ingredient, according to UW skin cancer expert Dr. Paul Ngheim. I have been following the caffeine story for a while, even including some interesting data about caffeine’s healthful properties in the first edition of Age Gets Better with Wine.

This latest research is based upon findings from the UW and Dr. Allan Conney at Rutgers University, which found that caffeine protected mice from the effects of ultraviolet radiation, a known trigger for skin cancer. But as with many such findings, it wasn’t where they expected the research path would lead. They started with an evaluation of tea extracts, assuming that the polyphenols-antioxidant molecules similar to those found in red wine-were the active ingredients. Tea is known to have great antioxidant properties, and polyphenols have been shown in a number of studies to confer protection against UV radiation. But when the decaffeinated version failed to work as well as the full octane type, attention focused on the caffeine, which when tested independently turned out to be the key. Coffee, by the way also has good levels of antioxidants, and both coffee and tea drinkers enjoy lower rates of cancer overall.

But the news gets even better for latte lovers. Another large study out this month from Harvard found that caffeine consumption-whether from coffee or tea-was associated with a lower risk of stroke, particularly for women. There are actually several studies with similar results published in recent years. And does anyone remember the cellulite creams that were so popular a decade ago? They did work (although they had to be applied 5 times a day) and the active ingredients were caffeine and similar compounds. Caffeine seems to shrink fat cells too.

So if you will excuse me, I am going to make a run to Starbucks. Can I get you anything?

Wednesday, February 25, 2009

Wine, skin, and the spa experience

Many of you know about my ongoing interest in the use of wine polyphenols, especially resveratrol, for healthy skin. I had a chance to sound off on the subject in an article in the March/April issue of Spa magazine. They took notice of my published research in the Journal of Cosmetic Dermatology last year, in which I made the case that resveratrol and other botanical antioxidants are likely to be the next big thing in skin care.
Why all the fuss? To begin with, antioxidants are increasingly being recognized as important elements in anti-aging skin treatments, but the ones we have been relying upon for years--vitamins A, C, and E--just aren't potent enough. Even the active ingredient in Prevage, an enhanced derivative of coenzyme Q called idebenone, is 17 times weaker as an antioxidant than resveratrol. But it is the other capabilities of wine polyphenols that make it really interesting: anti-inflammatory, anti-cancer, and estrogen-like properties that may help the skin retain moisture. There are other ingredients contending for a role in the new science of skin care, such as acai, and a milk thistle extract called sylimarin, but the most extensively studied and head of the class is resveratrol.

Monday, February 23, 2009

Plastic Surgery at the Oscars

Normally I watch the Academy Awards for the same reasons many others do: to marvel at the fashions, dismay at the choices for the awards, and in my case critique the results of the stars' plastic surgery. This year was a pleasant surprise on many fronts though. Even though nominee Mickey Rourke has publicly bemoaned his plastic surgery experiences, he actually looked pretty good so maybe he has had some touch-up work done. In any case, my read overall is that the overdone look is out. We do know that both movie stars and ordinary people are still getting their maintenance work done, whether it is strategically placed Botox or a subtle enhancement with Restylane or Juvederm injections, but a more natural look is in fashion. That of course is what we have been doing here in the Northwest for quite a while.
A particular joy was seeing the short documentary "Smile Pinki" get recognized. This inspirational movie told the story of a girl with a cleft lip and palate from a poor section of rural India. Her cleft was repaired by a volunteer plastic surgery team working with the international organization Smile Train, one of many such groups. I can tell you from personal experience that there is no greater calling or reward than doing this type of work. It is a rare opportunity to make an intervention in a child's life that changes it permanently and dramatically for the better. Many plastic surgeons believe that for this reason, this is the "heart and soul" of plastic surgery.
Does that mean that cosmetic surgery is on the way out? Not by a long shot. Statistics do show that less invasive procedures are being done while some postpone their facelift or tummy tuck, but there are limits to how much can be accomplished without surgery. And surgical procedures are getting less invasive and producing more natural looking results anyway, so one way to view it is simply part of a long-term trend. Like the designers who displayed bright colors at Fashion week in New York last week, I am optimistic that good work will continue to be appreciated, whether it be fashion, plastic surgery, moviemaking, or any of the other endeavors that enrich our lives.

Monday, February 16, 2009

How does art inform plastic surgery?

I was at my regular life drawing group yesterday, and reflecting on how drawing relates to my "day job” of aesthetic plastic surgery. Plastic surgeons love to talk about artistry in their work, but it is actually a tricky thing to pull off. Surgery is partly a manual skill, but one that is fundamentally based on science. Art on the other hand is a "right brain” thing: more intuitive. At least that is according to Betty Edwards, author of the now classic work “Drawing on the Right Side of the Brain.” I had some interesting correspondence with her last year, as she had been invited to participate in a drawing course for plastic surgeons at our annual meeting and she was trying to figure out how plastic surgeons think. “Right brain” plastic surgeons tend to be less verbal during the surgery, as the verbal domain is on the left side.
In my view, the key is to be able to integrate both sides, truly blending the rational scientific side with the spatial, artistic side. It’s more difficult to do than it sounds, and it is something that I have consciously worked on over the years. But the artistic side needs to be freed up sometimes, just for its own sake. That is where the drawing groups come in. A little Mozart music, the model strikes the pose, and everyone just draws, saving the conversation for the breaks.
This right brain-left brain thing works both ways of course. Just as a surgeon needs to acquire a substantial base of knowledge in order to employ the best judgment about how to manage a case, artists need to study the techniques of the masters. And in both instances, the ability to envision the final result in the mind’s eye before starting is hugely beneficial. As my technical proficiency has increased with experience in performing surgery, my drawings have become more anatomically precise but perhaps less artistic. So it is a constant effort to keep the artistic side engaged in concert with the logical left brain. It helps me as a plastic surgeon and as an artist.
Check out a sample of my sketches here:

Thursday, February 5, 2009

What is it about male facelifts?

I saw an interview with Sir Paul McCartney this week and couldn’t help noticing the work he has had done. (Perhaps I need to keep up more, apparently this was done last year.) I honestly don’t know the details, but in appearance at least he has now joined the unfortunate (in my opinion) ranks of other notable male facelift misadventures including the Olympic decathlete Bruce Jenner and country music legend Kenny Rogers. It’s sad in a way to see such accomplished people have such obvious work done. The best work always looks natural, and we wouldn’t all be talking about these cases if it did.
So what is it that went wrong? The common denominator is that they look feminized. This typically comes from applying the same strategies to men as with women. It isn’t so much the lower face-we all want a clean jawline and a smooth neck-but the upper face where it really makes a difference. Consider the upper eyelid/eyebrow: In a woman, the ideal brow shape is most often considered to be an arch, lower in the middle and with the highest point just lateral to the pupil. For men, we typically see a flatter eyebrow shape. So when the brow is lifted in order to “correct” a tired look, the brows often come up too much and arch more than they should in men. Related to this is displacement of the hairline; when the cheek and temple skin is pulled up and tightened, the hairline moves up and back, unless the procedure is modified to prevent this. That I think was part of Sir Paul’s problem.
The other treacherous area for men is the upper eyelid. A procedure called a blepharoplasty is usually done to remove excess skin that is hooding and contributing to the tired look. Often some of the fat is removed too, which removes bulges that can be part of the problem. In both men and women however, I think historically too much fat is removed, resulting in a hollowed look which paradoxically makes the patient look older. But especially in men, the look can seem like a vacant stare. Regardless of gender, each situation is different and a variety of techniques need to be considered in order to avoid ending up as fodder in someone’s blog about what went wrong!