Just a reminder that we do more than skin care, Botox/fillers, and surgery.  Our nurses offer other services that help improve appearances.

 Tired of shaving underarms, bikini, facial and other areas?  Laser hair removal significantly reduces the number of hairs in these areas.  Men use it to decrease the thickness of hairs on backs and shoulders.  It usually requires 4-6 treatments six weeks apart and package pricing is available.

 Unsightly leg veins (spider veins) can be treated by injections of solutions that clot off these superficial veins, allowing the body to reabsorb them.  A tiny, virtually painless needle is used.  We offer two solutions that work on most small but noticeable veins. 

(Did You Know?   Laser hair removal and sclerotherapy (vein injection) require months to effectively work.  Now is the time to get started to be ready for summer.) 

 Permanent makeup enhances eyelids, lips, eyebrows and other areas.  The tattooing causes little discomfort.  Once done, there is little need for makeup in those areas.  Karine has years of experience.

Skin care is not only popular but effective in improving aging skin.  Our office has the latest in prescription and research developed products.  However, there are several products that advertise improving facial appearance.

 The first is an oxygen facial.  It involves a blast of high-pressure oxygen that helps to kill bacteria and injects hyaluronic acid into the skin.  The second device is an ultrasound machine that uses sound waves to “rebalance the skin”.  The last uses a mild electric current to stimulate the facial muscles.  The recommendation for this is 8-10 weekly treatments followed by maintenance treatments every 2-4 weeks.

 (Did You Know?  Tomorrow, Tuesday, November 15 is Botox Day with discounts on Botox and fillers.  Call for your appointment!) 

Whether it is the latest device or procedure, a skeptical, scientific analysis should be done to ascertain any benefits.  The general consensus is that these devices improve the look of the skin, but temporarily.  Yale dermatologist David Laffell points out that any good moisturizer also improves the appearance of the skin.  The prices range from $125-400 per treatment session.  

Remember, if it sounds too good to be true, it usually is.

A recent article in the New York Times discussed cosmetic surgery during the “golden years”.  In 2010 there were almost 85,000 cosmetic surgical procedures performed on patients over the age of 65.  Facelifts and cosmetic eyelid operations were the most common.  The two most obvious questions this brings up are why and is it safe?  

As we live longer, healthier lives, more patients want to “look as good as they feel”, matching physiques to their psyches.  The practical advantages to this are presenting their best for current or potential mates and (especially with this economy) competing with those younger for jobs.

 (Did You Know?   It began January 1^st of this year.  Now, each day, over 10,000 baby boomers turn 65, EVERY DAY!) 

Safety is always an issue in elective surgery and even more so as we age.  The Journal of Plastic and Reconstructive Surgery recently reported complications in patients over 65 were not statistically greater than those younger.  The Cleveland Clinic reviewed the medical records of 216 facelift patients and found no significant difference of complications of a group who averaged 70 years of age compared with one of 57.6.   

Whether for their physical safety or fulfilling psychological needs, choosing patients that are healthy emotionally and physically are the keys to patient satisfaction and a successful practice.  Age is not a barrier to healthy, motivated patients who understand the risks, complications, and limitations of cosmetic surgery.  It is my job to educate them and provide the best services within these parameters.

Male breast tissue or gynecomastia causes an embarrassing prominence to the chest of many men.  It often limits the activities that men do with their shirts off such as swimming and the beach.  In fact, often men wear two shirts daily to help cover the prominence.

 The causes can be from excessive breast tissue, fatty tissue, or both.  During adolescence many men go through a period where breast tissue is noticeable but it usually involutes.  If not, a mass beneath the areola can be felt.  The development of fatty tissue to the chest usually occurs with aging and weight gain just like “love handles”.

 (Did You Know?   Good Morning America did a special on gynecomastia on 7/28/11.  While I don’t completely agree with all that was said and done, you can view the segment at abcnews.go.com.) 

The treatment is based on the cause.  Surgical removal of breast tissue is helpful.  Liposuction removes the extra fatty tissue to improve the contour.  Again, both treatments simultaneously may be necessary.  Interestingly, exercising the chest muscle pushes out the deformity making it more noticeable.

“Franchise” facelifts are those you see advertised on television by a national company that claims little recuperation and remarkable results.  Most involve a shorter scar than a traditional facelift.  Known to very few, this approach began in the 1920’s in France.  However, it is a rare patient that truly benefits from a short-scar facelift. 

Younger, 40 year olds, with little jowling and a smooth neck are the best candidates.  Anything more and the limited access of a short-scar fails to provide the best possible result.  These short-scar surgeries cost thousands of dollars and generally have a shorter longevity.

 (Did You Know?  The two-layer approach to a facelift I use separates the skin from the underlying tissues that cause jowling.  By tightening the underlying tissues separately the skin does not have to be over-pulled.  Therefore, the results look more natural.  (Go to mckennamd.com to see pre- and post-op pictures.)  

The best facelift is one that provides safe, natural, and effective results.  Dr. Nayak from Saint Louis University Medical School puts it best:  “Not every patient can have a larger lift for numerous reasons, such as health, cost or recovery.  Every patient, however, is due the ethics of full disclosure as to what each type of lift will and won’t do.”  Ethics is sometimes forgotten in the world of advertising, even in medicine.

We are often asked why we don’t inject Botox directly into the wrinkles between the eyebrows.  The answer is that the muscle that causes the wrinkle is next to it.  The corrugator muscles begin at the wrinkles and go just above the eyebrow almost to the end of the eyebrow.  Its contraction causes the scowl resulting in the wrinkle between your eyebrows.  Injecting Botox next to the wrinkle as well as along the length of the muscle minimizes its movement and maximizes the improvement in the wrinkle. 

 (Did You Know?   We have a NEW skin care nurse who will increase our evening and Saturday skin care hours.  Call to schedule an appointment with Joy who will make it easier for those of you working or have help with the kids on Saturdays.) 

We have had such a terrific response to our skin care offer where you buy $200 worth of skin care products and receive a free micropeel that we are upping the ante.  For the first 20 patients who purchase $400 worth of skin care products, we will provide a FREE dose of Botox.

Call to set up your next skin care appointment or Botox treatment.

Just a reminder that we do more than skin care, Botox/fillers, and surgery.  Our nurses offer other services that help improve appearances.

Tired of shaving underarms, bikini, facial and other areas?  Laser hair removal significantly reduces the number of hairs in these areas.  Men use it to decrease the thickness of hairs on backs and shoulders.  It usually requires 4-6 treatments six weeks apart and package pricing is available.

Unsightly leg veins (spider veins) can be treated by injections of solutions that clot off these superficial veins, allowing the body to reabsorb them.  A tiny, virtually painless needle is used.  We offer two solutions that work on most small but noticeable veins.

Permanent makeup enhances eyelids, lips, eyebrows and other areas.  The tattooing causes little discomfort.  Once done, there is little need for makeup in those areas.  Karine has years of experience.

Last week I discussed fat and its physiology. Today I will go over the latest two machines that remove fat and how they compare with the gold standard, liposuction.   Much of this information comes from Melinda Beck at the Wall Street Journal.

The first machine from Zeltiq is called CoolSculpting.  You sit while the device the size of a paperback is applied to the skin overlying the fat to be removed.  The area becomes cold then numb.  In about an hour the fat cells crystallize from being frozen.  The fat cells die over time and results are seen in 3-4 months.  The costs are roughly $1,500 - $3,000 per site.

Zerona from the Erchonia Corp. uses low level laser energy to create pores in fat cells that cause the fatty contents to seep out.  Patients lie on a table as the machine rotates around the fatty areas.  It takes about 20 minutes on each side and is repeated three times a week for two weeks at which time results can be seen.  The cost is between $1,800 and $3,000.

 (Did You Know?  Liposuction began in France in the late 1970’s and was introduced in the U.S. in the early eighties.) 

 Both techniques provide very little down time for the patient.  There is also minimal pain involved.  However, there are major drawbacks to these that prevent an optimal result for most patients.  While both work on a general area, they are nonspecific to areas that may need more attention.  Secondly, the machines affect mostly superficial fat. The best contouring however, involves removing amounts of fat from various depths to maximize results and minimize depressions. Smartlipo is also nonspecific machine using lasers that requires the removal of fluid that occurs when the fat cells liquify.  

For thirty years liposuction has been the standard for body contouring.  The results are predictable and safe when patients are chosen appropriately.  Recuperation is modest for most patients and the costs competitive with the above.  Importantly, most surgeons who do liposuction were trained in their residency and have spent years developing appropriate decision-making JUDGEMENT.  This is the professional you want as your plastic surgeon.

This week and next week’s email will discuss fat and its removal.  Today will focus on the fat and next week the new types of removal and how they compare with liposuction.  Much of this information comes from Melinda Beck at the Wall Street Journal.

Fat cells are variable types, have many functions, and numerous locations.  Originating from stem cells, some become early-stage fat cells called preadipocytes while others turn into adult fat cells.  They are amongst the longest living cells in the body and can enlarge up to about 64 times their initial size.  A lean adult has about 40 billion fat cells and an obese adult 120 billion.

Fat cells release over 100 chemicals that regulate growth, puberty, healing, disease-fighting and aging.  Common ones are adiponectine (affects metabolism), leptin (affects appetite), and estrogen.

The location of fat also affects the body differently.  Subcutaneous fat or fat beneath the skin are the cells we remove during liposuction.  Deeper cells, around the organs, like the heart and liver, release fat and raise the risk of heart disease, diabetes, stroke, and Alzheimer’s.  As we age we lose more of the subcutaneous fat and gain more of the deeper or visceral fat.

Misconceptions about risks of anesthesia could lead one out of four patients to postpone surgery according to the American Society of Anesthesiologists.  They point out that advances in anesthesia over the past 25 years have drastically lowered the rate of anesthesia-related deaths.  There are a couple of common misperceptions of general anesthesia.  While similar to sleeping, there are distinct differences which allow control of pain, memory, and other surgical factors. Also, some confuse numbing a part of the body with being under general anesthesia.

A 6-year study of surgical outcomes from a Medicare database has determined that there is little difference in complication and mortality rates in states that allow CRNA (certified registered nurse anesthetist) only anesthesia and states that require physician supervised anesthesia.

Safety always has and will continue to be our first priority for our patients.  We use a CRNA, Jenny, with almost 30 years of anesthesia experience.  Our operating room is certified by the state of Ohio and national certifying organization AAAASF.  The proximity to Bethesda North Hospital provides access to care beyond the operating room within minutes.