Wendy Lewis & Co Ltd cannot provide specific answers to individual questions about surgical procedures, treatments, products, conditions, diagnoses, fees, or any other specifics. These queries and the responses contained herein are intended only as general guidelines, and reflect the opinions of Wendy Lewis & Co Ltd. The information presented is NOT to be considered a substitute for a consultation with a medical doctor. All information is provided "as is" and "as available" without warranties of any kind, express or implied, including accuracy, timeliness, and completeness. In no event shall The Corporation or its agents and employees be liable for any direct, indirect, incidental, special, exemplary, punitive, consequential or other damages whatsoever, without regard to the form of any action arising out of or in connection with this Site, any content on or accessed by use of the site, or any copying, display or other use hereof.
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ACNE
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"I had bad acne in my 20's, but now I have scars on my cheeks that look like little holes. What can I do to get rid of the scars?"
There are many suitable treatments available today for acne scars, such as laser resurfacing to smooth out the outermost layer of the skin. Dermabrasion is not commonly used since the world has embraced laser technology. There are many less invasive treatments now including a series of Intense Pulsed Light treatments, Thermage or radio frequency skin contraction, and a variety of chemical peeling agents including trichloracetic acid. If you've never done anything for your scars yet, you might consider starting with something less aggressive first. Micro-dermabrasion or mechanical abrasion of the skin with a fine spray of crystals has been known to improve acne scars. If the scars are depressed, they can be injected with fillers like Restylane or fat to fill out the contour. The best treatment may be a combination of injectables and some method of resurfacing. Make sure that your acne is under control before you begin a program to attack the scarring.
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"What are milia and how do you get rid of them?"
Milia are little "sebaceous cysts" that sometimes occur as a response to skin trauma. They can show up around the eyes, sometimes from makeup application, and on the forehead. They can also be caused by overmoisturizing or using rich, creamy products on the skin. Check your skin care regimen first - that may solve the problem. Milia sometimes occur after laser resurfacing, and can also be an expression of sun damage. Many older people�especially men �get them on their cheekbones and around their eyes. They can be treated by extraction, microdermabrasion and superficial peels.
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ANESTHESIA
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"What is the difference between Local and General anesthesia?"
With local anesthesia, there is no loss of consciousness, so patients are able to communicate with the physician and an anesthesiologist is usually not present. Regional anesthesia involves the injection of a local anesthetic to provide numbness, loss of pain or loss of sensation to a large region of the body. Regional anesthetic techniques include spinal blocks and epidural blocks that are usually supplemented with medications that will make you comfortable and drowsy.
Cosmetic procedures are often performed under local anesthesia with the addition of �twilight� or a sedative given intravenously so you can be thoroughly relaxed. These medications supplement local anesthetic injections, which are usually given by your surgeon. You will be in a sleepy state, but may drift in and out of consciousness.
A general anesthetic provides loss of consciousness and loss of sensation, and is commonly used in larger surgical procedures where the body may sustain a substantial amount of trauma, or if multiple procedures are being performed, or when it is necessary to turn the patient over. A general anesthetic causes you to fall into a deep sleep.
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ARMS
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"My flabby arms make me want to hide in long sleeves even in the heat of August. What can I do?"
Bat wings can really put a damper on your fashion experience. Anything sleeveless, strapless or bare is out. A brachioplasty is like a facelift for the arms. This surgery will recontour your upper arms but at a big price - a scar that typically runs from the elbow to the armpit. Most women wouldn't go sleeveless with a long scar, so it may end up defeating the purpose. Traditional liposuction can work well if your skin is elastic enough to shrink successfully. On older women with very loose skin, liposuction is not a good risk and surgery is really the only option. In some cases, a modified incision with a scar confined to the armpit fold might be possible. None of these options are ideal, but they are all there is right now.
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ARTECOLL
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"What is ArteColl, and is it safe?"
ArteColl� (ArteFill as it is called in the USA) is a semi-permanent filler currently used in Europe, Canada and Mexico. It is currently pending approval by the FDA, but most doctors we have talked to are not terribly anxious to use it. It is made up of 75% percent bovine collagen and 25% polymethyl-methacrylate microspheres (PMMA) which are carbon-based polymers. PMMA has been used in dental work, hip prostheses, and bone cement. The product is mixed with a local anesthetic, lidocaine to numb the area to be injected. Over 3 months, the collagen fibers get absorbed, leaving the PMMA behind, which are too large to be broken down and remain permanently. It is tunneled under the skin, massaged and molded to fill the area to be treated. ArteFill� can be used for acne scars, naso-labial folds, and for filling depressions such as sunken cheeks. Possible complications include lumping, inflammation, granulomas or localized hardening, rash, and the migration of the microspheres into other areas. Because of its permanence, ArteFill requires greater skill to inject and may be more risky than other biological fillers. Collagen resorbs in 3 months, PMMA particles are permanent.
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BOARD CERTIFICATION
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"I saw a cosmetic surgeon who says he is board certified, but I couldn't find his name listed and no one I know has used him. How can I check on what his training is?"
The specialties which comprise the newly extended definition of 'cosmetic surgery' are governed by the following boards in the US: the American Board of Plastic Surgery, American Board of Dermatology, American Board of Otolaryngology, American Board of Opthalmology. Oral surgeons, dentists, gynecologists, general surgeons, as well as general practitioners do cosmetic surgery today and it is not illegal. To find out if an M.D. is board certified in a particular specialty, click on wlbeautylinks for websites that will give you doctors' credentials all over the world. If you think it's tricky in America, it's twice as hard in other countries. There are many groups that call themselves 'boards' but are not recognized as official organizations of any kind. Most importantly, board certification by any board does not guarantee that your doctor is good at any specific procedure, especially when it comes to aesthetic surgery. It should be a starting point, a minimum standard from which the search for a qualified surgeon can begin. A doctor who advertises himself as a 'board certified physician' or 'board certified surgeon,' will often turn out to be neither a Plastic Surgeon, Dermatologist or Dermatologic Surgeon, Facial Plastic Surgeon nor Oculoplastic surgeon. And do you really want a urologist doing your liposuction or a dentist doing your browlift?
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BOTULINUM TOXIN
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"I have deep lines from my nose to my mouth and some on my forehead. Would BOTOX� make them less noticeable?"
Botulinium Toxin is not a filler like collagen that plumps up wrinkles. It softens wrinkles that are caused by muscle contractions. It is not commonly used for naso-labial folds (the lines from the nose to the corners of the mouth) unless the folds are the result of overactive muscles, but it is great for glabellar creases (between the brows) and lines running across the forehead. For the N/L folds, you can try COSMODERM OR COSMOPLAST(tm), autologous fat (taken from your abdomen or buttocks), hylauronic acid like Restylane, or CosmoDerm, a human derived collagen. The best combination for facial wrinkles is usually a filler to fill the lines up and Botulinum toxin to prevent them from getting deeper.
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"Does BOTOX work around the mouth for the lines above the lips and the drooping corners?"
BOTOX is most commonly used to treat the lines and creases caused by facial muscles from the forehead to the upper cheeks. However, it is often used for fine lines around the mouth, popply chins and to turn up the commissures (corners of the mouth). If you are a smoker, the fine lines on the upper lip can be softened which also may help your filler (like Restylane or CosmoDerm) last longer. The risk is that unless the BOTOX is injected directly into just the right spot, you can end up with a drooling problem or a crooked or asymmetric smile.
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BREAST IMPLANTS
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"I'm in my 30's, and am considering having breast implants, however I have not yet had children-which I plan on. Should I wait?"
Timing always matters. Since you are in your 30s, it is likely that you may have children in the next 5-10 years. It may be prudent to wait until you are done having children, but certainly not mandatory. You are right in the middle, so it's a tough choice. If breastfeeding is important to you, there is a very small possibility that you will not be able to breastfeed after implants which should be discussed with a plastic surgeon. Your breasts will surely change after childbirth and breastfeeding, so your shape will be somewhat different after, with or without implants. This is a very personal decision for you -in terms of dating, men, relationships, as well as finances. It derserves careful consideration.
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"Are soybean oil breast implants still on the market?"
In the US, the implants never made it through the FDA approval process. If you've got soya oil breast implants and live in the UK, your breasts have been recalled! The British Medical Devices Agency (MDA) advised against pregnancy and breastfeeding as a precautionary measure and to consider having these implants removed. There is a risk that the oil can seep out over time and a danger of toxicity when the oil gets rancid. It seems very unlikely that we will ever see these implants again on the market. For more info, www.trilucentinfo.com
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BROWLIFT
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"I had a consultation with a plastic surgeon who suggested an endoscopic browlift. He showed me what it would look like with computer imaging, and promised that my hairline would not be raised. It is now 6 months and my forehead is still tight and my hairline is definitely higher. What can I do now?"
It's easy for me to tell you to be patient, when it's not my face in the mirror every day. At 6 months, most surgeons would consider it too soon to do any more surgery, and you might have to wait it out. Your brows may still drop over the first 12 months and settle into a position where you like the way they look. Go back to the original surgeon, unless you have totally lost confidence in him, and let him follow you. Ask him what your options are in terms of future surgery vs. botulinum toxin to lower your brows. Time passing also has a way of shifting your focus to something else hopefully.
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CELLULITE
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"Do creams that claim to reduce cellulite really work?"
There are no topical products that can eliminate cellulite. Firming and toning body lotions may temporarily make the skin appear tighter and smoother, but they cannot affect the fatty deposits that contribute to cellulite on the hips and thighs. Cellulite is adipose tissue and waste that is trapped in vertical strands in the subcutaneous layer of your skin. It is caused by behavior and eating habits and genetics. Diet and exercise can help, along with drinking lots of water to flush out toxins. Avoid food additives, fats, starches, artificial colors and flavors, sodium, and alcohol.
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CHIN IMPLANT
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"I'm 42 and I've noticed lately that my neck isn't looking as sharp as it used to, Do I need a chin implant?"
When you say your neck isn't looking 'sharp', it sounds like you mean that you don't have a clean line from where your chin meets your neck. The culprit may be just fat or loose skin and fat, or a muscle that needs tightening or a gland that needs to be tucked up. If it is just the fat pocket beneath the skin that is making your neck look fuller, the fat could be liposuctioned through a tiny incision under the chin. If your chin recedes so it doesn't extend enough to form an attractive angle with the neck, an implant may be placed through an incision under the chin (or inside the mouth, although this is thought to be more susceptible to infection). A small chin implant combined with liposuction at the same time can go far to give you a cleaner neckline. At 42, your skin may have good enough tone to shrink up nicely. Just remember that placing a chin implant will make you look different, so stay on the subtle side. A too big chin implant can make a girl look a little like Jay Leno. If what you really need is a facelift, a chin implant won't tighten loose skin or muscles.
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COSMECEUTICALS
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"Are true �cosmeceuticals� actually doing things in the skin which previous creams couldn't do?"
It depends on the formula. Some cosmeceuticals do make visible improvements, and others are no different than anything you ordinary moisturizer you can find at any drugstore. It all depends on the quality of the ingredients, the delivery system, how well you follow usage directions, and whether it is the right product for your skin type and condition. If you are expecting high tech wrinkle creams to give you the skin of an 18 year old when you're in your 40's, you are destined to be disappointed. Keep your expectations realistic. These are creams, NOT surgery or injections.
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"What about the heavily marketed skin care miracles that are sold on the Internet and through infomercials?"
The category of "cosmeceuticals" has been greatly broadened to include what I like to call "psuedo cosmeceuticals" - they talk the talk, but they don't necessarily walk the walk. The descriptions and names sound like they are mimicking cosmeceutical brands because the marketers have figured out that these are what consumers want today - they want some science in their skin care at all price points. That is, they are fashioned to resemble true cosmeceuticals found in a doctor's office, but are no different than garden variety OTC skin care ranges. The beauty buyer should do her homework, and at the end of the day, let your skin tell you what works. No one knows your skin better than you do.
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COSMODERM
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"What is the new collagen alternative and does it work as well or better?"
A human tissue filler received approval in March 2003 marketed under the name of CosmoDerm� and CosmoPlast� (Inamed Corp). It contains human collagen that has been purified from a single fibroblast cell culture. This product does contain 0.3% lidocaine, so additional local anesthesia is not required. Topical numbing creams are helpful. No skin test is required because this is fashioned from human tissues rather than an animal source. CosmoDerm� and CosmoPlast� are injected surperifically under the surface of the skin to fill in fine lines and to define the border of the lips. This substance works the same way as bovine or cow collagen does, and lasts about the same length of time - 3 - 4 months.
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EARS
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"My earlobes are all stretched out from years of wearing heavy hoop earrings and it makes me look older. What can be done to make them smaller?"
First, take your chunky earring collection to the nearest jeweler and trade them in for a tasteful pair of diamond studs. Then see a plastic surgeon who can stitch up your holes and reduce the size of the lobe itself. This is a simple, inexpensive office procedure called a 'bifid earlobe'. Six weeks or so later, you can have your ears re-pierced and start fresh.
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ENLARGED PORES
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"I have large pores around my nose area. How can I make them look smaller?"
Everyone has larger pores around the nose because skin has more oil-producing sebaceous glands in the center panel of the face than on the sides or around the eyes. On the face, upper chest and upper back, the oil glands are larger and open directly onto the skin surface, unlike elsewhere on the body, where the oil glands open into a hair follicle, and are smaller. The size of the 'pores' on the skin is directly proportional to how much oil is being produced by the underlying sebaceous gland. Consequently, because the center panel of the face has the largest size and number of these glands, the openings of them appear larger. To diminish the size of the pores on the nose, keep them clear of any clogging debris that is keeping them 'open.' Small blackheads can be manually removed and an anti-bacterial lotion applied. Keep the pores free of debris by using clay-based cleansers, masques, and products to absorb surface oils. Retinoids can unplug dead cells and cause the skin to swell slightly, making pores appear smaller. You can't really 'shrink' the size of the pores permanently since the openings of the oil glands have no muscle surrounding the opening. The key is a daily oil-controlling skin care program with a toner to close pores, coupled with regular professional treatments including microdermabrasion. Intense Pulsed Light (IPL) treatments may also shrink the pores somewhat by gently tightening the skin. These require a course of 3-5 treatments.
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EYELIDS
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"Is there a way to eliminate the baggy skin around the eyes without surgery?"
In a word, NO. Excess skin of the upper or lower eyelids has to be removed to be eliminated. A browlift may also be recommended to lift the eyebrows, if you are a candidate for it. Your eyelid skin may not be the problem, it may be the brow skin or both. You should have a consultation with a plastic surgeon, facial plastic surgeon or ophthalmic plastic surgeon to find out.
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"How many times can you have your lower eyelids done?"
The skin around the lids is the thinnest anywhere and tends to be very unforgiving. More than twice, you can get into trouble. Although people start earlier today, so if you have some fat taken out at 35, then skin removed at 45, by your late 50's or so, you might need the muscles tightened. In general, eyelid surgery is semi-permanent; you may do it again, but not every few years for sure.
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"Can you do liposuction on your eyelids or must you have eye surgery to get rid of the heavy lids?"
Liposuction is not done around the eyes, however, fat can be removed. One way to remove excess fat from heavy upper lids is via a scalpel or laser as a cutting tool. An incision is made, and the fat is removed with a forceps. An alternative, if you are trying to avoid a scar on your upper lid, is the �transconjunctival� approach, which is a tiny incision underneath the eyelid to get at the fat pocket.
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"Do I really need to buy a separate eye cream? I am having a hard time finding an eye cream that does not make the eyes blurry or cause an allergic reaction."
Your problem may not be the eye cream itself, but how you are using it. The area around the eye can be very sensitive and some people react to light, penetrating formulas and need a less active type of eye treatment. The choices run from beeswax to a vitamin E stick, with more active formulas somewhere in the middle. Don't let eye products extend past the orbital bone that surrounds the eye. The heat of the body will cause the eye cream to move inward, toward the eye. If the product is placed too close to the eye, or if too much is used, it will enter the eye, causing blurred vision. Eye cream should be placed on moistened eye tissue. The humectants will help to help the added moisture, and at the same time, prevent the overuse of the product. Body cream would be too heavy on the face, and face products are generally too thick for use around the eye area which can leave the eyes looking puffy. Some face creams are suitable for use around the eyes as well, but it's better to play it safe and buy a proper eye cream.
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"I've always had really dark circles under my eyes and they make me look tired. I went to see one doctor who recommended laser resurfacing, but I'm afraid of lasers"
Everyone is afraid of lasers � even doctors. They are powerful tools that work in mysterious ways. You can try bleaching agents, but it will take a long time to see improvement. Trichloracetic (TCA) acid peels can lighten up lower lids. If fat deposits are creating a shadow that makes your circles look worse, you might be a candidate for conservative fat removal or repositioning, with or without laser resurfacing. The skin of the lower eyelid area generally lends itself well to lasers, depending on your skin type. If you are fair, you will probably get a better result. Inquire about using prescription bleaching agents like Hydroquinone based formulas for your lower lid skin as well to lighten pigment. The skin around the eyes is thin and the vessels are close to the surface, which often contributes to the darkening you see in that area too.
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"Is there a way to eliminate the baggy skin on top of the eyes without surgery?"
Excess skin of the upper or lower eyelids has to be removed to be eliminated which requires a surgical procedure called a blepharoplasty. A browlift may also be recommended in addition to or instead of eyelid surgery to lift the eyebrows, if the position of the brows is contributing to fullness of the upper lids. Lasers and peels can help soften the lines and Botox� is great for crow�s feet, but neither will relieve the problem of excess skin.
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FACELIFT
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"How long should a face lift last for a 59 year old women?"
A facelift lsast from 5-10 years, not much longer no matter whose face it is. At age 59, you may never have another facelift in your lifetime, although it is not uncommon to have one in the late 60's and into the 70's. Look at it this way, if you are 59, you could probably stay looking good until close to 70, then have another tuck if you're game. Don't wait, do it now, so you get the most out of it. If you really want your lift to last, stay out of the sun and don�t smoke or drink. Genetics plays a role too - but you have no control over that.
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"I had a facelift 5 months ago and I still have discomfort and numbness in front of and behind the ears and the earlobe, and one cheek is sunken. What should I do?"
Probably nothing yet. You are only 5 months out, and some of the numbness and lumps and bumps will still settle down. If at 9-12 months, your cheek is still sunken, then injecting fat is a possibility. The other option is redraping one or both sides of the face, which you hopefully won't need to have done. Unless you have lost confidence in your surgeon, stick with him or her through this at this stage to get it resolved. The ears are always numb, and the nerves return sooner in some than in others. If you are really troubled, at some point, a visit with a neurologist might be advised, but probably not yet.
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"I don't want to have a scar in front of my ear, but the surgeon I really want to use doesn't want to put the scar inside my ear. Does it matter?"
That is a very personal decision. The truth about facelift scars are that they usually heal very nicely, even in front of the ear which worries women most. The actual length of the incision in front of the ear is so miniscule and falls in the natural creases of the skin. The other factor is that having the incision placed inside the ear (intra-tragal or retro-tragal) can sometimes be more noticeable
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"What is the ideal age to have a facelift?"
There is no ideal age, and it varies from person to person. However, the trend is to do it earlier, before you really need it and your neck meets your d�collet�. Women who have their first lift in their 40�s, tend to look really good in their 50�s. The average age today is early 50�s.
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"When are you considered too old to have a facelift?"
You are never really too old to have a facelift, as long as you are in good health, but the results will not be as good if your skin has lost elasticity. If she is active and vital, and her GP will clear her for surgery and anesthesia, she could consider having a facelift. I would advise her to do it soon, rather than wait at this stage.
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FACIAL EXCERCISES
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"I saw a facial toning system endorsed by Linda Evans and was tempted to buy it. She looks great. Does it really work?"
Linda may look great, but I doubt it is from wearing any mask contraption that looks like a loan from 'Hannibal Lechter' if you ask me. I don not know of any clinical studies that prove conclusively that facial toning devices have any long term effects on sagging facial skin or tightening muscles. Toning facial muscles can't stop skin from sagging and jowls from forming. These systems probably won't do you any harm, but I can think of better ways to spend your money and your time. Look at it this way; if these methods really worked, the theory of BOTOX would not make sense. BOTOX is used to paralyze muscles so that new lines are formed more slowly. Increasing facial muscle movement will only speed up the process of creating more lines, creases and folds in my view.
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HAIR LOSS
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"My hair is getting thinner and I am concerned about losing more hair. What can I do about thinning hair?"
You are not alone. Hairloss in women is increasing at a rapid pace, especially in the perimenopausal age group. First, see a Dermatologist who specializes in hair disorders to determine the cause. Genetics, hormones, stress and nutrition all play a role. Hairloss can also be related to medical you have taken or are taking, and can be an indicator of a more serious underlying condition. The medical treatment options are still pretty limited. 2%-5% solution of topical Minoxidil applied twice daily may be recommended. Some doctors will prescribe a topically applied .025% estrogen solution once a day or every other day, or recommend an estrogen-dominant oral contraceptive. Post-menopausal women may be given oral Estrogen or Spiranolactone. Next, see your hair stylist to teach you some tricks to maintain and style hair to make it appear thicker. Coloring the scalp to reduce contrast between the haircolor and the scalp peeking through thinning areas, and going lighter may camouflage thinning hair by more closely matching the scalp color as well. Keep hair squeaky clean and conditioned to boost volume.
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"I had an upper facelift go and I am losing my hair. It started only recently and I am terrified. What should I do?"
First of all, the fact that you only started losing hair long after surgery may be an indication that it is unrelated to your surgery entirely. Hair loss can be devastating to women and is more common that you may think. Usually, post surgery hair loss occurs soon after up until about 4 months when regrowth begins and most hair loss is temporary luckily. Go back to your Surgeon for an opinion on what is going on. Then ask for a referral to a Dermatologist in your area who specializes in hair disorders and restoration. Your doctor will ask you about your diet habits, lifestyle, genetics, stress level, hormonal changes, etc. all of which may contribute to losing hair.
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HYALURONIC ACID
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"I heard about a sugar gel that can be injected to fill in lines and lips. Where can I get it?"
The 'sugar gel' you are referring to is a polysaccharide called hyaluronic acid. The dermal filler version comes from two sources; bacteria grown in a lab which is thus non-animal in origin, and avian protein, or rooster combs. The two most common forms on the market at Restylane from Medicis and Hylaform from Inamed. Restylane just received US FDA approval in December 2003! Restylane is a fabulous product and is widely considered the market leader. The thicker version of Restylane is Perlane, which is pending approval in the US now. For all you wrinkle filler junkies, I'll put it in terms you're bound to understand: Perlane would be like the Zyplast and Restylane would be the Zyderm.
If you have been using other dermal fillers in the past, consider trying Restylane as an alternative. The results are very natural-looking, and it lasts from 6-12 months in most cases.
www.restylaneusa.com
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HYPERPIGMENTATION
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"I have these awful brown spots on my arms and was given a Hydroquinone cream to use, but it makes me red and itchy. I heard about Kojic acid. Does it work as well?"
Kojic acid, derived from a Japanese mushroom, is one of the hydroquinone alternatives and can be useful in lightening pigment. It is typically used in 2 � 4% strengths in combination with other ingredients like AHA's. Hydroquinone is considered the 'gold standard' of bleaching agents by most Dermatologists at strengths of 4% and above. Find out if you have a true sensitivity to HQ before you rule it out completely. Over-the-counter bleaching creams are far less effective, and will take longer to work.
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IDEBENONE
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"What is it and what does it do?"
Idebenone is a potent antioxidant receiving rave reviews from researchers because of the clinical data that backs up its claims to be able to protect cells and inhibit inflammation. Studies show that idebenone shields skin from environmental damage, improves the appearance of fine lines and wrinkles, reduces dryness and smoothes skin texture. As you know, antioxidants protect cells from environmental damage, improve the appearance of fine lines, reduce dryness, and smooth skin texture. Studies show that Idebenone is more powerful in preventing cell damage than 5 other popular antioxidants- Vitamin C, Vitamin E, Coenzyme Q10, Kinetin, and alpha lipoic acid. Indebenone will be marketed as Prevage, and is expected to become available in early 2005 from Allergan, the makers of Botox� Cosmetic�.
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INFECTION
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"My friend had an infection behind her ear after a facelift and it took a long time to finally clear up. Does that happen often?"
Unfortunately, infection is a possible complication of any surgery, but fortunately, it does not happen often during cosmetic surgery or facelifts. The statistics are somewhere around 5% of the time generally. Antibiotics are often given to facelift patients before, during and/or after surgery to reduce the chances of infection. If you do suspect you have an infection, get to your doctor's office immediately to be treated for it. The sooner it is treated, the sooner you can get on with your recovery. Some ways to avoid increasing your chances of developing an infection include keeping your hands away from suture lines, keeping hair and skin clean, and avoiding the telephone receiver.
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INTENSE PULSED LIGHT
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"I live at the beach and I read about a laser peel that's supposed to leave no redness like some other lasers. Will it take away my brown spots?"
Intense Pulsed Light (IPL) technology delivers a broad spectrum of light. It is often used for the full face rather than just for small areas like around the eyelids or mouth, and works well on the chest, hands, legs, and neck. IPL's are typically done in a series of about 3-6 treatments spaced at 4 week intervals depending on what you are trying to treat. The treatments are good for rosacea, telangiectasias (broken capillaries), fine lines and overall skin texture. This is a good choice if you don't have severe photodamage. If your brown spots are deep, you may need a higher frequency or more potent laser treatments to fade them completely. If you are determined to go back into the sun, don't waste your money because your brown spots will return and more will show up in the future.
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LASER HAIR REMOVAL
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"Are laser diode hair removal systems safe and are they permanent? I am thinking of trying it, but it is so expensive."
If cost is an issue, consider putting it off. Diode lasers reported to work well, better on some than on others, but laser hair removal is a true luxury. You might get a summer out of it, but it is not a one-shot deal and can end up costing several thousands of $. If you are curious, try doing one small area like underarms or bikini area, instead of legs which is more difficult. If you have dark skin or olive skin, you are at a greater risk of scarring and skin lightening or darkening so be careful where you go.
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LASER RESURFACING
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"Can I have laser resurfacing done at the same time as a facelift?"
A facelift won't take away wrinkles, thus, it is common to have some laser resurfacing or chemical peeling done at the same time, but not as aggressively as a stand alone procedure. Carbon dioxide resurfacing at the same time over the entire face may cause too much stress on the skin flap, and has fallen out of favor due to the advent of newer, less invasive laser technologies. Many surgeons use an Erbium:YAG or CO2 on deeper wrinkles in selected areas like around the eyelids or the mouth or forehead. Resurfacing can add the finishing touch to a great facelift. It is best done at the same time, since anesthesia will be required and there is some downtime - from 7-10 days in most cases of redness, crusting and peeling.
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LIGHT EMITTING DIODES (LED)
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"What is LED technology and does it replace laser resurfacing?"
Unlike laser technology that relies on high-powered coherent light to create heat energy, LED photomodulation triggers the body to convert light energy into cell energy without damaging the tissues with heat. The treatments involve sitting in front of a panel of low level light emitting diodes called LED�s for literally only seconds. A course of several treatments will be needed, and results are variable and VERY superifical so far. There may be a place for these systems in the anti-aging arsenal one day, but right now, don't expect miracles. However, LEDs are painless, fast with no downtime and relatively inexpensive as these treatments go.
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LIPOSUCTION
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"How long does it usually take for the scars to go away after liposuction?"
Every skin type heals differently. AVOID the sun - use a total block on your scars so they don't darken in the sun exposure. The scars are pretty teeny though, so no one has to know you had anything done. Some people they will be pink, red, or brown, but the scars will still be visible for about 6 months in most people or possibly longer.
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"Can you just do a chin liposuction for jowls rather than an entire facelift?"
Only if your skin has enough elasticity left to contract well. If you are over 45, make sure you won't end up with more sagging skin after taking the fat out. It is a great procedure for men too. The limitations are the quality of your skin. Generally, the chin and jowls would be done through tiny incisions under the chin in the crease and behind the ears. Recovery is fast with some bruising and swelling, and most people return to work in a week tops.
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"I'm in my early 20�s and contemplating liposuction to get rid deposits of fat that aren't going away from running or weight training. Is it worth it?"
Liposuction is a luxury, but it works wonders. It would be worth it if you can afford it (that means without charging it on a Visa and paying a little each month for years on end....) and if you really want it. Judging whether it is worth it or not is for you to decide. Young women tend to do outer and inner thighs, hips and knees most often, which are more resistant to diet and exercise. The results can be terrific with a qualified and talented surgeon.
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"I had two babies, and my stomach still looks like I'm 5 months pregnant. I went to one doctor who said I needed a tummy tuck, and another who said he would do liposuction. What should I do?"
Go see a third doctor for some kind of confirmation. Liposuction strictly takes out excess fat, but if your skin has some elasticity left it may shrink to some degree. If your goal is a flat abdomen, go for the tummy tuck. If you would be satisfied with less fat and a slimmer look, and plan to get on an exercise program to tighten your abdominal muscles, then you could try liposuction first. If liposuction doesn't give you enough of an improvement, you can always go back and have the tummy tuck but of course, no one wants to have another surgery soon after the first one. Fees and recovery for a tummy tuck vs. liposuction are much greater, which should be a primary consideration. If you already have an incision from a C-section, you're probably going to be happier with an abdominoplasty. A tummy tuck is a bigger procedure and there is a significant scar, but it will give you a more permanent and tighter result than liposuction alone. P.S. If you are not sure that you are finished having children, definitely wait on the tummy tuck until you are.
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"I'm afraid to be asleep but I also don't want to know what's going on or feel anything during my liposuction. What should I do?"
Choose a safe surgeon and let the surgeon decide on the type of anesthesia and the anesthesiologist best for you. For the right patient who is not nervous and has had surgery before, local anesthesia can be fine for a short procedure like liposuction of the neck or small outer thighs. Most of the women I talk to prefer to have some sedation. Every surgeon has a particular preference, but if you are having a large volume liposuction where several areas are being suctioned, you might prefer to have twilight or general anesthesia. The drugs available today are shorter-acting, the rate of nausea is lower and patients are alert, talking and walking very soon after surgery. Talk to your surgeon and/or anesthesiologist before surgery so you understand the differences in the terminology of anesthesia (General vs. Intravenous Sedation vs. Local or Tumescent).
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"What is Power Assisted Lipoplasty and is it better than other methods?"
Power assisted lipoplasty (known as PAL) utilizes nitrogen or compressed air that causes the instruments to vibrate as the fat is extracted. PAL can sometimes be more expensive because the equipment is more costly. Ultimately, the end result is usually about the same as traditional liposuction techniques. Some surgeons prefer to use power assisted instruments because it can make the job of removing fat deposits less physically demanding for them. The benefit to the patient - the more comfortable and less tired your surgeon is, the more energy he has left to devote to your thighs.
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LIPS
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"I have so many little lines around my mouth that look awful. What can be done?"
'Smoker's lines' as they are commonly called are sometimes caused by pursing your lips. They can also be caused by sun damage and the natural aging process. To stop the lines from getting deeper, wear a waterproof full spectrum sunblock on your lips and around your mouth, and use a lip balm to exfoliate dead skin and keep lips supple. To get rid of the lines or soften them, the options start with wrinkle creams like retinols, Vitamin C and antioxidants, and include micro-dermabrasion to soften the lines. For deeper lines, you can have a Trichloracetic acid peel or injections (like fat, Restylane, CosmoDerm) to plump them up. The best option for deep lines is more invasive laser resurfacing. Don't expect anything to rid of every line in that area, but you can see tremendous improvements with a variety of treatments.
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MALE FACELIFT
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"I'm a 50 year old male, and I have a sagging neck and loose skin. My wife says I need a facelift, but isn't there any other way to get rid of it?
At age 50, it is possible that your skin is still elastic enough to contract after liposuction of the neck and jowls, but that would depend on your anatomy. The better operation would clearly be a face and/or neck lift. Facelifts on men are trickier because of the scars and hairline changes, but can surely be done conservatively if you choose a good surgeon. There are some modified neck lift techniques that may be ideal for you as well, with shorter scars around the ears and perhaps one under the chin crease.
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MENS SKIN CARE
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"Should men use different products than women for their skin?"
A man's skin is different. For starters, theirs is thicker which comes as no surprise to any female in the free world, approximately 0.5mm thicker than ours. Male skin is oilier, with larger pores, a richer blood supply, and more of a tendency to break out in a sweat, so the lucky dogs are less prone to wrinkling. They also have more hair all over their body, often in the most unappealing places, in case you haven't noticed. Men seem to have hair follicles like women have fat cells.
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MICRO-DERMABRASION
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"What is the difference between dermabrasion and micro-dermabrasion?"
Many people are confused with these technologies. 'Micro-dermabrasion' or 'derma-peeling' or 'micro-abrasion' is a technology that entails blasting the face with sterile microparticles to abrade or rub off the very top skin layer, then vacuuming out the particles and the dead skin. The results are like light glycolic peels and they remove the outermost layer of the skin to reveal a more supple and fresher looking texture. This is truly a 'lunchtime' procedure, and is one of the most popular techniques on the market today. Dermabrasion is the mechanical sanding of the skin using a hand held rotary instrument with a fine wheel attached. The doctor goes over the skin to be treated with the wheel (called a fraise) to smooth out uneven skin surface and improve scars. This technique was used effectively for many years to resurface the skin, but is rarely done today due to the advent of laser technology.
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MOLES
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"I have hairs growing from a mole. Is it safe to shave over a mole?"
It might be wiser to clip the hairs close to the skin's surface or consider having them removed permanently with electrolysis so you don't have to worry about nicks. The best choice would be laser hair removal under the care of a qualified Dermatologist or laser surgeon.
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NECKLIFT
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"Is there a procedure for "lifting" the neck without having a full facelift?"
If you dont have much sagging skin and fat, you might be a candidate. Modified lifts tend to work best on younger people - 40's, early 50's - with less aging symptoms. It can be called a mini tuck, mini lift, neck lift, short scar lift, S-Lift, other names that mean different things to different doctors. Cost - depending on where you are, less than a full facelift and more than liposuction of the neck ($4-7,000). Every woman alive wants to have her face lifted without having a real facelift.
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NOSE
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"I had my nose done 4 times and still don't like the way the bridge looks. One surgeon suggested a graft from behind my ear, but that sounds too radical. Is there another option?"
One doctor's ideal graft material is not necessarily the same as the next doctor. Ear cartilage is a common grafting choice for secondary nasal reconstruction, and considered essential by some surgeons as the next best thing to septal cartilage. Since your nose has been re-operated on many times, you may not have enough of your own septal cartilage left to use as a graft at this stage. Other options are cartilage grafts from the rib, bone grafts from the hip which typically involve a longer healing period, synthetic implant materials or fascia, human tissue sheeting, fat, etc. The advantages of ear cartilage is that it is yours so your nose won't reject it. The disadvantage is that you will have a donor site that needs to heal and a small hidden scar. Discuss all your options with your surgeon, or get a second opinion if you are unsure about it, especially for a secondary rhinoplasty where there are many methods possible to achieve a good outcome.
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"I'm a 45 year old man. I dislike the shape/size of my nose and have long considered rhinoplasty. Is there an optimal age for this type of procedure?"
It's never too late if you are healthy and sane, and have reasonable expectations. There is no optimal age, although rhinoplasty used to be considered a rite of passage from high school to college or so. Having a nasal refinement in your 30's and 40's is not uncommon, since people have more money and tend to be more stable and then have it done. As you age, your nose will start to look bigger as the soft tissues of the face shrink, and the tip tends to appear as though it drops, so if you still don�t like it now, you wont like it any more in 10 years.
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"I'm getting married in 3 months and would really love to have my nose done to look good in the pictures. Do I have enough time left?"
Just barely. It's always better to leave more rather than less time between surgery and a big event in your life, especially your own wedding. If you have a relatively simple nose to do with a bump and a droopy tip and reasonably normal or thin skin, you could be safe. If your nose is difficult, thick-skinned, wide or crooked, the healing period may be longer. Whatever you decide, move quickly and see 2 or 3 surgeons before you decide. It may take you a few weeks to get a consultation appointment and a few more weeks to have surgery, which may be cutting it too close. At the very least, leave yourself one month (4 weeks) between the date of surgery and the first photo op (i.e. bridal shower, rehearsal dinner, etc.
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"I had my nose done years ago and I like the way it looks, except that the nostrils flare out too much and it make the nose look wide. Can I have just the nostrils made smaller?"
Wide nostrils can be made narrower through a procedure called an 'alar base resection.' A wedge-shaped strip of skin can be removed from the base of the nostrils through small incisions. The nostrils are repositioned and sutured in place. Sutures are removed in about 5 days, and there will be a scar from the incisions which generally fades well over time. Since you are pretty happy with your nose overall, you have to decide if it is worth having another operation. Go back to your original surgeon (unless he is retired by now), or see one or more plastic or facial plastic surgeons who specialize in nasal surgery to decide. Unless you and the surgeon you choose are confident that he can make it better, leave it alone.
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"How can I make enlarged pores around my nose look smaller?"
Everyone has larger pores around the nose because skin has more oil-producing sebaceous glands in the center panel of the face than on the sides or around the eyes. On the face, upper chest and back, the oil glands are larger and open directly onto the skin surface. To diminish the size of the pores on the nose, keep them clear of any clogging debris that is keeping them open. Small blackheads can be manually removed and an anti-bacterial lotion applied. Keep the pores free of debris by using clay-based cleansers, masques, and oil-controlling products to absorb surface oils. Vitamin A derivatives can unplug dead cells and cause the skin to swell slightly, making pores appear smaller. You can't really shrink the size of the pores permanently since the openings of the oil glands have no muscle surrounding the opening. The key is a daily oil-controlling skin care program with a non-alcohol toner to close pores, coupled with regular professional treatments including microdermabrasion.
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RADIANCE
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"What is Radiance and is it safe?"
Radiance FN or Radiesse FN (BioForm) is composed of calcium hydroxyl apatite, which has been used in the body for multiple applications including cheek and chin implants. Radiance� is injected into the face adding volume through microspheres that are suspended in polysaccharide carriers until encapsulation occurs. Radiance� is a pure, synthetic calcium hydroxyl apatite composed of calcium and phosphate ions which occur naturally in the body so they are biocompatible. The particles are in a gel carrier made up of cellulose, glycerin and purified water. CA Hydroxyl apatite has been used for many years for other medical purposes in both injectable and solid implant forms, such as facial reconstruction. The product manufacturer claims that Radiance� will remain soft and pliable as it permeates soft, fibrous tissue. As with any long term filling agent, there is a possibility of a foreign body reaction which can cause lumps or granulomas, and migration. Generally, it is NOT recommended for use in the lips, and is most commonly used in deep nasal labial folds and commissures or marionette lines. It may last from two years to up to seven years in some cases - so be careful. Radiance� is only FDA approved only for vocal cord paralysis and urinary incontinence, however, off-label use is permitted in the US.
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RECOVERY
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"Will I have bruising after a face or necklift and for how long?"
Black and blues are part of the program, but the life of a bruise is very individual. If your skin is thin and fair, you can expect more bruising than someone who is darker and has thicker skin. Certain areas of the face bruise more than others like delicate skin around the eyelids. The side of the face or neck that requires the most work or bleeds more in surgery will also bruise more. Gravity pulls bruising down, so you will be bruised more on your lower face and neck than the mid face or forehead. In general, bruises start out as dark solid purple fading to mottled purple to bits of purple in green to green and yellow to yellow, and then they fade away in about 3 weeks in most people.
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RESTYLANE
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"Is it finally approved in the USA?"
YES, the wait is over....in December 2003 the wise men and women that comprised the FDA panel voted to approve Restylane in the USA for use in facial folds and creases. You should have no problem locating a qualified doctor to do it now, since most Dermatologists and Plastic Surgeons are thrilled to finally be able to offer it to their patients. This is a wonderful product, and one that I have had injected into my lines, folds and lips for over 4 years in Europe. Highly recommended! www.restylaneusa.com
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ROSACEA
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"My cheeks sometimes look pink and flushed, and lately, I'm beginning to think I might have rosacea. What can I do to stop it?"
If you think you have the symptoms of rosacea, (flareups, redness, irritation, blushing, occasional pimples) you need to see a dermatologist. Don't self treat which could make it worse. Avoid steam, facial massages that can activate oil glands, very hot or cold water temperatures, and sun exposure. Be careful about what you put on your skin, and look for mild, fragrance and detergent-free products specifically developed for sensitive or easily reactive skin types.
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SCARS
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"I have a horizontal scar on my forehead from a fall. Can it be repaired and how?"
Most scars can be improved, but all scars are permanent. A scar on your face is obviously far more critical than on your body. If the scar is red or brown in color, lasers can lighten the pigment. If the scar is raised or bumpy, it might be injected with steroids to flatten it out. Laser treatments can also help fade the scar�s appearance and shrink it. For depressed scars like chicken pox scars, injectable fillers can be used to plump up the area. Often a combination of treatments will be used to get the best results. The cost factor will vary from a few hundred dollars to thousands, depending on what needs to be done.
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"I have a scar on my chest where I had a cyst removed. Is there anything I can do to make it disappear?"
Depending on how long you have had the scar, you may be able to use a silicone gel sheeting applied to the scar to soften and fade it. This method works best on scars that are under one year old. If the scar is raised or red, it may also be injected with a steroid to break up the scar tissue or resurfaced using laser technology. The skin of the chest is generally thick and does not always heal the best. If you are interested in finding out about your options, consult with your Dermatologic surgeon.
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"How long do you have noticeable bruising and scars after surgery?"
Bruising may occur for up to 3 weeks or longer, depending on the extent of the procedure you are having. Scars are permanent, but normally fade and thin out over several months. Scars may be revised or treated with laser therapy if they do not heal sufficiently on their own.
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SCHEDULING
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"How long are waiting lists normally for cosmetic surgeons?"
That depends on how busy the surgeon is, where he or she is located, and the time of year. A typical wait may be several weeks to several months. If you can be flexible with your schedule, you may be able to get squeezed in when there is a cancellation. It is always worth waiting for the right surgeon for you.
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SKIN CONDITIONS
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"I've got zillions of little bumps on my arms and thighs that make my skin feel rough and pebbly. I've tried different body lotions, but nothing gets rid of them."
You might have 'Keratosis Pilaris', a chronic condition that can plague the backs of arms, upper legs, and buttocks. The 'bumps' could be skin plugs. You should see a Dermatologist to find out. Using lactic acid like Lac-Hydrin 12% or Amlactin (available in a drugstore behind the pharmacy counter without a prescription) or Retin-A� (only by prescription) can be very effective. A glycolic acid body cream or lotion can also help. Try exfoliating with a loofah or natural bristle body brush in the shower. Micro-dermabrasion treatments at home or in a salon or doctor's office can also help.
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SKINCARE
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"Is there a danger in over-exfoliating?"
The key term here is 'exfoliating' as opposed to 'peeling.' Exfoliation is the process of removing or sloughing off the very superficial dead skin cells on the skin surface. By removing these dulling, dry surface cells, we can expose the fresher surface skin, which has a more intact barrier protection. Skin 'peeling' is a process of liquefying or aggressively removing the skin surface, which may involve the more sensitive and vulnerable underlying tissue. Mild exfoliation with over-the-counter gentle scrubs, frequent-use alpha hydroxy acids and fruit enzymes can be used several times per week Any product that is burning, causes redness or severe irritation might be too irritating to use on your own.
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"How often should you have a professional facial treatment?"
For normal skin, facial treatments with extractions and gommage when needed should be done every 4-6 weeks on normal skin. For problem skin and acne, a professional facial should be done more frequently, once every month. For skin prone to blackheads, a deep cleansing and extraction may be recommended every 2-3 weeks to keep clogged pores under control.
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"My elbows and knees get rough and scaly during the winter. What can I do to make them softer?"
Winter winds and cold temperatures can be brutal on your skin. Some of the symptoms of dry skin are severe roughness, cracking, scaling and flakiness commonly found on elbows, knees, calves, feet, hands. The cause of the flakes is the build up of the uppermost layers of skin (stratum corneum) which have difficulty shedding. In the winter, due to cold air and heating systems taking humidity out of the air, your skin is much more prone to dehydration, irritation, and rashes. Dry skin is thinner, more fragile, and has less of a protective barrier. As a result, moisture is lost through the skin. A way to combat dry winter skin is to use a mild cleanser without soap or detergents, and use a moisturizer that contains an alpha hydroxy acid at least once a day. Apply your moisturizer after the shower when your skin is still damp for maximum effectiveness. Keep a tube of hand cream with you to apply during the day.
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"I'm 48 and I see my skin changing for the worst. Does my menopausal skin have special care requirements?"
Regular facials with massage can help increase the skin's circulation. Firming masks and hydrating treatments with mild exfoliation will also help to rejuvenate the skin's appearance. Sun avoidance is critical. Use moisturizers and products that contain anti-aging ingredients like retinoids, plant enzymes, AHA's, anti-oxidants, and humectants that help to reduce the visible signs of aging skin and the ravages of hormone loss. Don't forget to moisturize the skin of the neck as you do facial skin.
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"How important is moisturizing?"
Areas prone to dryness need hydration, but oily areas don't need as much or as often, or areas prone to clogged pores and breakouts like the T-zone and chin. Lighter formulas prevail for men or teens or oilier skin types that are more greasy. Stick with oil-free formulas that won't add shine. During colder weather or on older, drier, thinner skin, use a moisturizer with heavier emollients.
Most moisturizers don't actually replace lost moisture. They work by keeping your skin's natural moisture from evaporating by forming a barrier between the skin and the air. Moisturizers temporarily trap water in the skin, which plumps up the skin and gives it a smoother look and feel. A small amount of moisturizer goes a long way on damp skin. Different parts of your skin have different weights and textures. The skin around the eyelids and the lips is the thinnest on the body. Facial skin is thicker than eyelid skin, and body skin is thicker than facial skin.
Selecting the right moisturizer depends on your skin type. Dry skin needs more of it and in richer formulas like creams. Using the wrong moisturizer or the wrong formula can have disastrous effects on your skin. Too much of a moisturizer that contains oils on oily skin may cause clogged pores and acne breakouts. For young, oily skin, moisturization is far less vital than dry, dehydrated aging skin. Use a lighter moisturizer during the day and a heavier one for deep moisturizing at bedtime. If skin gets too dry and flaky, the dead cells will build up and make skin look dull and lifeless.
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"Is it better to use an anti-aging serum or an anti-aging cream (or indeed, both)?"
Some women are serum users, other prefer creams. Most of us need both. Typically serums are more concentrated and thus, more expensive. In terms of cosmeceutical formulations, that may mean your skin will sting upon first use of a serum if you are not used to using more active products. We are programmed to think wrinkles, than we need moisturisers, and the creamier the better. This is a common misconception among skin care users. Women tend to overmoisturise in an attempt to obliterate lines and creases. Oily skins don't really need extra cream - a light lotion or lotion/gel formula might do better. Serums are NOT moisturisers either - they are often drying and meant to be used under your moisturiser. Serums can also be drippy - used with an eye dropper or applied from an ampoule - so let your personal preference guide you.
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"How do I choose the best anti-wrinkle regime for my skin?"
There is no miracle cream that is suitable for all skin types. However, retinoids or vitamin A derivatives come pretty close. Try using some form of retinol or prescription strength Retinoid (Renova�, Avage�). It is the universal anti-aging favorite, and works well for acne, lines, discoloration, and sun damage. A smart skin care regime for any woman over 35 should include an anti-ageing treatment product plus gentle cleansing and exfoliation, adequate moisturization plus mandatory daily sun protection. Whatever products you choose, consistency is critical to see results.
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SMOKING
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"I've been a smoker (one pack/day) for ten years, and have quit on and off. I went to see two plastic surgeons who told me I had to stop smoking before I could have any surgery."
If your skin is being destroyed from the inside, there isn't much you can do to make up for the damage from the outside. Smoking robs your skin of vital oxygen by restricting the vessels that allow blood to flow through capillaries to the top layers of the skin. Depriving your skin of oxygen results in wrinkles, roughness, dryness, and interferes with the skin's natural ability to heal itself. Smokers make lousy candidates for cosmetic surgery because they are more prone to complications, bleeding, bruising, bad scars and delayed healing. Not every smoker will have a problem from surgery, but the odds are against you and the risks go up considerably. The doctors gave you good advice. P.S. 'No smoking' means no nicotine patches, gum or other tobacco substitutes either.
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STRETCHMARKS
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"I lost 80 pounds and have stretch marks. How can I get rid of them?"
Bravo. Congratulations on losing all that weight! Most stretch marks in adults won't disappear entirely, but they get markedly less obvious over time. In a year, they fade as much as they probably will. To diminish them more, ask a dermatologist about lasers, micro-dermabrasion treatments, and topical applications of retinoids. Areas with the most muscle tone (such as arms and thighs) respond best to laser treatment. Stretchmarks are a little like cellulite; they both plague most women and there are no perfect remedies, at least not yet.
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SUNSCREEN
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"Should I wear sunscreen under or over my moisturizer?"
Ideally, a sunscreen should adhere directly to the skin surface to perform as a 'barrier' coating the skin to prevent burning. If you are using one of the 'chemical-free' sunscreens, you can apply it directly to your skin. The term 'chemical-free' applies to sunscreens that use natural minerals such as titanium dioxide or zinc oxide. If your moisturizer contains a sun block, then you have an all-in-one product. Whatever you use, apply enough product to coat the skin, and reapply it often during sun exposure.
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"I use foundation with an SPF, but do I still have to wear a separate sunscreen underneath my foundation?"
It depends on your lifestyle, where you are, and your specific plans for the day. Foundation with an SPF 15 or higher should give you enough protection for normal workday activities ONLY if those two magic little words, 'broad spectrum' can be found somewhere on the label. Any significant sun exposure should necessitate added sun protection, waterproof, and increase the number of times you reapply. This is one of those instances when 'more is more' - when in doubt, it's better to use more.
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"Is it worth paying for a good cream or should we be more concerned about using sunscreen and the perils of UV light than repairing the damage?"
There is NO substitute for a good broad spectrum quality sunscreen. You don't have to spend a fortune to get an effective SPF. You need both - you need to repair the damage you did before you learned that sun exposure causes premature wrinkles and blotchiness, AND you need to protect yourself from future UV damage. I like to recommend that you choose your face SPF product carefully so you will be sure to use a lot it. Skimp on body lotions with SPF so you are more inclined to use enough. Most of us don't buy the wrong products as much as we use the rights products in the wrong way - when it comes to sun protection, use a ton of it and reapply as needed.
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THERMACOOL
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"What is thermal tightening and is it really like a facelift?"
These thermal tightening devices utilizing radiofrequency waves are being used to tighten loose skin on the face and body. They work by delivering deep intense heat into the skin without injuring the epidermis. The system is comprised of a radio frequency (RF) generator with a cooling system and a hand-held treatment tip. They are being touted as the newest version of a "non surgical" face and browlift. Results are variable at best, and sometimes insignificant and not very impressive. One or more treatments may be needed, and some anesthetic is definitely necessary, topical or intravenous sedation depending on how squeamish you are. This method doesn't replace a face, neck or browlift, but it can produce some skin tightening which we all want.
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THIGH LIFT
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"I hate the way my inner thighs look in a bathing suit because the skin is loose and it bunches up at my knees. I had liposuction already, but now I want to make my legs look firmer."
Take comfort in the fact that few women over 18 actually like their thighs in a bathing suit. If loose skin is your concern, forget liposuction. You have now entered the THIGH-LIFT-ZONE. To tighten inner thighs, incisions are placed in the groin to remove excess skin. Recovery can be long and the incisions loosen up over time and may drop somewhat. If you are really committed to having this surgery done, choose your plastic surgeon with great care. This is a major procedure.
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THREAD LIFTS
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I saw a procedure on Oprah where a suture was used to lift the cheeks. What is that called?
Thread lifts are a hot topic in cosmetic surgery worldwide. The threads are actually fine sutures that have tiny barbs or cogs to hold tissues in place. The threads are placed into the deep layers of the skin using an attached needle. Once inserted under the skin, they are fixated to form a support structure without the need for visible scars. The effects can last for several years and the procedure is entirely reversible, or additional threads can be added as needed. This technique may be used for the brows, midface and neck areas.
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TUMMY TUCK
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"I am desperate to have a tummy tuck, but I am frightened of the operation going wrong. What are the risks?"
A tummy tuck is considered major surgery, but the results can be well worth it, especially after childbirth or weight fluctuations. The surgeon has a duty to tell you about complications that occur in more than one percent. Most common risks include skin loss, infection, blood clot, raised scars, asymmetries, contour irregularities, and reaction to anesthetic, which is usually GA.
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