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BEAUTY BINGE

Demystifying the Wide Variety of Procedure Options

In terms of health and beauty, 40 is the new 30 and 50 is the new 40. With life expectancy now close to 80 years, it stands to reason that people want to look as good as they feel. Programs like "Extreme Makeover" and "The Swan" have further fueled the cosmetic-enhancement interest. According to the American Society for Aesthetic Plastic Surgery, non-surgical procedures posted a 51% increase and statistics promise to fly off the charts in 2005. Not to say that surgical procedures are in any danger of falling by the wayside. American's spend 9 million dollars on plastic surgery last year alone.

Eight years ago when Dr. Pradeep K. Sinha of the Atlanta Institute for Facial Aesthetic Surgery opened his doors, he wondered if he was going to make it financially. "Today, I can't get a day off," he says.

The difference is that even eight years ago, people waited until they were 55 or 60 to have a procedure and by then they often needed a major facelift. Today, men and women in their 40s come in for minimal procedures or "directed lifts" that require only minimal down time and offer advantages like hidden incisions. "We have better tools today and bruising is often non-existent," says Sinha.

He's also seeing a large number of people in their mid to late 30s who come in for brow lifts that can eliminate the heaviness and meaty tissue above the eye. Using only five slit-like incisions along the hair-line, surgeons tunnel under the skin, detach the brow and place it where it ought to be. "It's all done in an hour and the results last 7 to 10 years," says Sinha.

When the jowl line begins to sag in the 40s, both men and women long for a more youthful look. A popular remedy is a mid-face lift. Dr. Sinha uses a surgical device akin to cleats that grabs the cheeks and lifts them up. The sutures totally dissolve within three months but the face remains anchored for 7 to 10 years.

Two cutting-edge procedures, the "S" lift and the MACS (Minimal Access Cranial Suspension) lift provide a tightening of the jaw line with minimal downtime. Patients can go back to their normal activities within a day or two. Though the incision on the "S" lift is in front of the ear, it's made in the crease and is virtually unnoticeable. "Women can still wear their hair up," says Sinha. With MACS, the incision goes deeper into the hairline. The MACS procedure lasts approximately 20 minutes longer than the S lift or approximately two hours but, "It's less a question of time than what would work best for each patient," says Sinha.

Threading the Way
The ThreadLift has been around for awhile but FDA approval of barbed or cogged threads has created a press frenzy recently. One of a bevy of minor procedures now available, the ThreadLift tightens areas of the face and can accomplish 50 to 70 percent of a facelift. "I have patients who can't believe the results," he says.

One advantage is that a patient who comes in on Thursday can be back at work on Monday. Another is that the threads go underneath the skin, catch the tissues and adjust them more tightly. Sagging of the neck, jaw line, cheeks and eyebrows can be addressed with minimal downtime.

Each zone or area to be addressed requires at least two threads on each side. The ThreadLift can successfully treat patients with asymmetry, Bell's Palsy and nerve damage.

Patients from their late 30s to mid-sixties are appropriate candidates. Though the jury is still out on the lasting benefits, the effects should last three to five years but people age at different rates.

Fat Can Be Beautiful
Facial autograph muscle injection (F.A.M.I.), a fat transfer procedure developed by Roger Amar in Marabella, Spain in 1991 is a non-surgical procedure that uses fat, stem cells and fibroblasts harvested from the patient.

Patients may initially think, "Wow! A younger appearance plus a bonus of liposuction," but doctors quickly deflate the notion. Although the procedure called lipo-harvesting is similar to liposuction, the three to four ounces of fat removed from the abdomen or thigh is too small to make a difference in an unsightly bulge.

Fat is used because it has a better chance of obtaining blood flow early on. Another obvious advantage is that there is no risk of allergy or rejection. The younger the patient, the better the results. The ideal candidate should be a healthy weight. If a patient's weight fluctuates, she or he can gain volume in the fat injected into the face.

The first step in the process is harvesting the fat, which is then cleaned and injected with platelet-rich plasma that is also harvested from the patient. The fat is then reinserted into facial muscles. Local anesthesia or twilight sleep eliminates discomfort for the duration of the two-hour procedure. Swelling lasts for a few days post surgery and the patient can go out within the week.

Doctors look at photos in various stages of a person's life and assess what the aging process has done to the face. Then they select muscles that will replicate what a patient looked like years ago. But patients have to be realistic. The clock can't turn back from age 65 to 25.

Procedures like FAMI are often done in combination with other minimally invasive techniques like ThreadLifts and Erbium laser resurfacing. Erbium laser treatments are similar to CO2 but better tolerated. It can be done under local anesthesia and doesn't cause deep thermal injury. Erbium helps reduce wrinkles and improve the quality of the skin but not for deep wrinkles. People return to work after about a week and the redness disappears in two to three weeks.

The New Lipo
The new, "LipoSelection" procedure uses the VASER System's patented innovative ultrasound technology to remove fat more gently than previous methods. Ultrasound energy emulsifies the fatty tissue, and a special cannulae (the instrument that actually removes the fat) is designed to minimize trauma to the surrounding tissue during the procedure. Because nerves and blood vessels are largely undisturbed, low to minimal pain and bruising is achieved with Vaser. The LipoSelection procedure allows physicians to work with such precision that they can shape delicate areas like the inner thighs, arms, chin and neck with better results.

The Eyes Have It
With several hundred million working parts, the eyes are the most delicate and intricate part of the body. The skin around the eyes is the thinnest skin on the body and as people age, brow tissues sag. It's one of the first things people notice.

Instead of just trusting the advice of the doctor patients should be involved in the process. A patient must ask questions. The doctor's role is to educate, but the decision is the patient's.

When eyelids droop and sag, the tissue appears to have grown, he says. To correct the problem, doctors tighten the upper lid through a small incision at the crease of the eyelid. Fatty tissue either in the lid or under the eye can be removed or reinserted around the eyes. Instead of cutting extra skin off, doctors refreshes it by tightening the middle layer of the dermis, which in turn, tightens the outside layer.

Most commonly, upper and lower lids are done as a facial unit. The advantage is that it looks more natural when completed in one procedure. Also, patients experience less down time and incur less cost because they are paying only once for the anesthesia and recovery room.

Browlifts improve the appearance of the eyes. The procedure involves only four nicks in the hairline and the work is done from within using an endoscope. Patients don't lose any hair and can go back to work the same day. Normally, because the tissue is so delicate, people bruise easily, but by using laser cuts, which cauterize the tissue, patients far less bruising. However, the scalpel is just as effective. When comparing laser to scalpel surgery six weeks out, both look the same but the big difference is in the first week or two.

Once the eyes have been refreshed, care is essential. Take care of them and don't smoke, or it can make a difference of the procedure lasting 6 to 8 years or 15.

Face Forward
"When to do a facelift depends on physiologic age, not numeric," says Dr. Mark Crispin at the Center for Specialty Medicine. "Dr. Brothers and I have done facelifts on patients in their 50s and patients in their 80s. We can redirect the aging process in a more youthful direction."

The aging process is in the genetic makeup, but plastic surgeons can set back the genetic curve. In the past, one technique was used on everyone, but today's surgeons tailor operations to anatomy, particularly applicable in facelifts, which can range from mini to full. One difference is the length of the scar; another is the scope of the results. New procedures create far less noticeable scars, which are hidden behind the hairline or around the ears. Usually a facelift takes two to two and a half hours and recovery a bit over a week. "There may be some residual swelling, but patients are fully functional in a week. By the end of the second week, they're very presentable," Crispin explains.

Results of a facelift are generally striking, taking years off a patient's chronological age. For many, the facelift is their first procedure and contrary to a common myth, patients generally require only one in their life.

The Nose Knows
Dr. Mark Beaty is not only board certified by the American Board of Facial Plastic and Reconstructive Surgery, he holds a second board certification from the American Board of Otolaryngology, Head and Neck Surgery. "Understanding the treatment of salivary glands, the voice box, and familiarity with the anatomy of the neck and how it relates to the lower face gives patients an extra advantage," he says. He also treats nasal, sinus, throat, and ear disorders. One of the biggest changes in recent years is that in the past some of the bone and cartilage was sometimes lost during the procedure. Today, surgeons try to preserve as much nasal architecture as they can by reshaping the nose with sutures rather than removing material.

While rhinoplasty has been a standard procedure for decades, it has changed from a cookie-cutter approach where all "nose jobs" looked alike, to one of total customization. "There is no such thing as a perfect nose," he says. You have to achieve balance and harmony among all facial features," Beaty states.

The scope of cosmetic and plastic surgery procedures seems endless and is still increasing, especially in the arena of non-surgical, minimally invasive treatments. From Botox, dermal fillers/injectables, dermabrasion, brow and threadlifts, to rhinoplasty and full facelifts, today's beauty docs can produce results ranging from reducing wrinkles, lifting saggy, baggy eyes and droopy jaws, to tightening goose-like skin in the neck area. Body procedures ranging from liposuction, tummy tucks, breast enhancement, to full body lifts can restore a youthful shape or enhance coveted features. New technology and skillful doctors continue to work diligently to repair whatever Mother Nature neglected or Father Time took away.
CONSIDERING PLASTIC SURGERY?

Do Your Homework

1. Check credentials. Asking, "Are you Board Certified?" is not enough. Many "board certifications" proclaimed by physicians have little significance. Your doctor must have certification by the American Board of Plastic Surgery or American Academy of Facial Plastic and Reconstructive Surgery.

2. The most important question you should ask is whether your physician has privileges to perform that procedure at his/her local hospitals.

3. Have your surgical procedure done at a hospital or an ambulatory surgical center that has been certified by at least one of the following:
• Accredited by a national or state recognized accrediting agency/organization such as the American Association For Accreditation of Ambulatory Surgery Facilities
• Accreditation Association for Ambulatory Health Care

•The Joint Commission on the Accreditation of Health Care Organizations

4. Verify that your doctor's surgery facility is certified to participate in the Medicare program under Title XVIII.

5. Make sure the facility is licensed by the state in which the facility is located. These are the best measures that the facility complies with adequate safety guidelines for sterility and patient care. If you choose to have a procedure done in the physician's office, ask if your physician has a transfer agreement with a local hospital in the event of a problem. If the answer is "no", or if the physician does not have admitting privileges to a nearby hospital, you should look for another physician.

6. Review pictures of surgical procedures done by the doctor you're interviewing.

7. Make sure the doctor has performed your surgical procedure many times, or in the case of new technology, has received specific training from a credible organization, such as the American Society of Plastic Surgeons. 8. Ask for patient references, particularly patients that have had similar procedures recently.

9. Cost should never be the bottom line when choosing a surgeon. Choose someone with whom you are confident and comfortable, and who will stand behind their work.

10. Ask about revision policies if the results are less than satisfactory.

11. Good pre- and post-operative care is important. These should be detailed by your physician prior to surgery.

Watch out for that dangerous phrase in plastic surgery, "it's only liposuction." Safeguard your health first.

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