Winter Skin Survival Guide

Hi friends!

By now, your skin has started to reflect the harshness of the change in climate, and once the bit of color from summer fades, we sometimes see all kinds of "badness". Even those of us who try our best to protect our faces from summer's rays, know that we have a bit of a glow after summer's end that can hide some common skin problems. Plus, the naturally paler color of winter skin can expose common pigmentary problems, large pores and fine lines. Our skin is drier due to less humidity in the air and the colder air and winds of winter. Bottom line...winter is typically the perfect time to correct hyperpigmentation, provide hydration and smoothing, and to more deeply correct the signs of aging, which are all more noticeable during the winter.

I have asked my wonderful staff to list some of their favorite skin care products, and they are found below..."Staff picks"!!! Enjoy the list, and as always feel free to ask us about any skin care advice specific to your needs.

CLEANSERS:

CYNTHIA...lists Dermesse Sugar Scrub among her favorite cleansers. She uses it every day, and who wouldn't want skin like hers...porcelain, I call it! For face, she likes Dermesse Creme Cleanser, especially after laser or chemical peels.

MELANIE, JULENE AND RITA...like Dermesse Cleanser Gel for the refreshing feel it gives oily skin.

TONERS:

CYNTHIA...likes SkinCeutical's Revitalizing Toner for its nice cucumber extract scent (which is a natural emollient with calming, soothing agents - maybe that's why she is so unflappable), as well as its lavendar oil (which is anti-inflammatory, antiseptic, and anti-bacterial). She says, "it also contains horsetail, which speeds connective tissue repair...hee haw!" (never mind that's a noise a donkey makes, not a beautiful horse, Cynthia)

MELANIE, JULENE AND RITA...seem to be in agreement again, that we like Dermesse Toner. It leaves a refreshed feel to the skin and is carefully pH-balanced with the cleanser to set the stage for easier absorption of the corrective products apllied later. It also closes pores to prevent some of the day's damage and helps to control breakouts.

BLEACHING AGENT:

CYNTHIA, JULENE, MELANIE AND RITA...we all apparently agree, hands down, that Neocutis' product for hyperpigmentation, Blanche, is the best. It works to fade brown spots, hyperpigmentation and melasma from a unique combination of ingredients, including 4% Hydroquinone and Melaplex. Also, as Cynthia points out...it is formulated with anti-oxidants and hydrates the skin with shea butter and jojoba oil, is steroid free, fragrance free, and non-comedogenic. If you have an intolerance to hydroquinone, like I do, then Kojic acid is a great substitute and can be found in SkinCeuticals' Phyto Plus. OR...the alternative to a topical for hyperpigmentation is of course to use the laser (Sciton, of course)- for this we would recommend a series of treatments with BBL (broadband light).

EXFOLIATING AGENTS:

CYNTHIA and JULENE...SkinCeuticals' Retexturizing Activator, used morning and night, improves texture and tone by stimulating enzymes that promote desquamation while hydrating the skin via hyaluronic acid and Kombuchka (say THAT 3 times after a Cocktails and Consults evening) to promote its natural barrier functions. It basically smoothes, resurfaces and moisturizes skin, all at the same time! Cynthia says, "This product is UNBELIEVABLE, and I like to use it every day as well as right before a laser or chemical peel."

MELANIE and JULENE...Dermesse Exfoliator, which contains a unique blend of alpha-hydroxy acids, gently smoothes skin and is available in 2 strengths.

RITA...likes Dermesse Sugar Scrub for body, and the Dermesse Exfoliator for face.

SKIN SMOOTHING AGENTS:

CYNTHIA...likes NIA 24's Skin Strengthening Complex Repair Cream, because it has the Pro-Niacin to strengthen the barrier function of skin, as well as vit A to improve texture and elasticity, anti-oxidants green tea and rosemary, and ceramides, evening primrose and wheat germ oil to moisturize the skin. Phew. CYNTHIA and JULENE like SkinCeuticals' A.G.E. Interruptor and A.G.E. Eye Cream (at night only) due to their ability to improve the creping and thinning of our "mature" skin due to an aging process in older skin called glycation, when excess glucose molecules cause collagen and elastin fibers to stick together leading to the formation of Advanced Glycation End-products (A.G.E.) ie, bad things, which cause wrinkles, ick. Also, we both like Neocutis' product Lumiere for eyes, which contains Swiss technology growth factors and proteins specifically well-suited for smoothing the delicate eye area. It also contains hyaluronic acid, which is a natural hydrating agent.

YOUNG MELANIE...thinks her skin never looks smoother and pores smaller than when she uses a combination of Dermesse Cleanser Gel, Toner and Exfoliator!

RITA and JULENE...say "Retin A baby!!!" A longtime favorite skin smoothing agent is good old retin A. Many patients find its precursor, retinol, available in different strengths, to be easier and less drying to use, but you can't argue either's effects of deep penetration to the dermal layer where wrinkles begin.

***special note to self...for the fastest skin smoothing known in these parts, the Sciton laser is a quick way to smoothe skin utilizing laser peels and profractional treatments, alone or in combination! (Stay tuned for my next blog)

SUN DAMAGE AND DNA REPAIR:

CYNTHIA, JULENE, MELANIE and RITA...we all seem to agree on this one, Nia 24 Sun Damage Repair is a nutrient-rich cream that delivers intense moisture while it improves the appearance of photo-damage on the decolletage, shoulders and hands. As Rita says, results are seen very quickly and within 6 weeks! This product works very well in combination with our laser packages to visibly add to results (when used between laser treatments).

***special note to self...one of the nicest things to add to a good home skin care program, is to work in a couple laser resurfacing treatments a year to slowly eliminate the sun damaged layers

SUNPROTECTION AND SUNBLOCKS:

CYNTHIA...likes CE Ferulic Serum in conjunction with either Dermesse or Nia 24's Mineral Sunscreens.

JULENE...likes Dermesse Sunblock SPF 30.

MELANIE...likes SkinCeuticals' SPF 50.

RITA...likes Nia 24 also, because it is not oily and it absorbs instantly.

MOISTURIZERS:

CYNTHIA and JULENE...love the combination of SkinCeuticals' Hydrating B5 Gel and masque, because they contain hyaluronic acid, the body's natural hydrator, to bind moisture to the skin. It is often used along with vit C treatments, and is oil-free.

***note to self...if one can improve the overall health of the skin over time, it really will need less topical moisturization, so most moisturizers will only need to be used in the dead of winter when nature's elements are most harsh!

There you have it! The experts have spoken! But, always after that ONE FAVORITE recommendation, for those of us on a budget who want just a few really good products, I asked each of my staff what single product for each area would they go back into a burning building to save (if they knew they could still get out alive, and the family and household pet were already safe!), and here is what it distilled down to...

for FACE:

CYNTHIA...Phloretin CF is her all-time favorite because it is a serum, it is both preventive as well as corrective, and as an anti-oxidant, it helps to prevent and correct the aging process by supporting elastin and collagen synthesis, while increasing cell turnover, thus giving her skin its radiance and firmness (did you know she's really 75?) Cynthia uses it at night, and notes that it also contains vit C to help with inflammation and in prevention of skin cancer.

JULENE...realizes that although it is expensive, like Loreal says, "it's worth it!" I absolutely LOVE Skin Medica's TNS Essential Serum. I can tell the next morning if I've used it or not, because of the smooth, glowing look it gives my skin. Really. It contains the renowned growth factor formula TNS Recovery Complex in one chamber and APS Corrective Complex (a potent mixture of anti-oxidants and peptides) in the other. The combination - and it comes out together in one expensive little clump of liquid gold - has been clinically proven to improve tone, texture and elasticity, and to work on brown spots and wrinkles, as well as to tighten skin and help it regenerate and protect itself. What else is left to fix? Although this is my all-time favorite single nighttime product, I love mixing it up and using a good serum or cream several nights a week, like Neocutis Bio-Gel, Bio-Serum, or Hyalis, or SkinCeuticals' A.G.E. Inrerrupter. And yes, my cosmetics closet looks like a pharmacy lab.

MELANIE...is a big fan of Dermesse Exfoliator, and says she has man-eating pores the night after she forgets to use it!

RITA...stands by A.G.E. She likes the A.G.E. Interrupter, A.G.E. Retexturizing Activator, and A.G.E. Eye Cream the best.

for the EYES:

CYNTHIA ...A.G.E. Eye Cream AM and PM. She likes the fact that it is good for menopausal skin and that it contains blueberry extract to help prevent future wrinkles in the very thin eyelid skin. (But won't we sell less Botox Cynthia? How can that be good?)

JULENE...likes a serum under make-up for daytime use and a cream at night for extra moisturization, so I like Skin Medica's Uplifting Eye Serum in the morning. RITA likes this too, because it is not oily, and because one tiny drop will take care of both under eye areas, so it lasts a long time. I like either Neocutis' Lumiere at night or SkinCeuticals' A.G.E. Eye Cream.

MELANIE...likes Skin Medica's Eye Repair Cream the best, because it begins to work immediately, and she sees fewer fine lines as early as the next day.

for the NECK:

CYNTHIA...likes Neocutis' Bio-restorative Hydrogel with PSP (processed skin proteins), or Bio-Gel, because it restores a refreshed appearance to aged, stressed skin.

JULENE...likes Neocutis' Bio-restorative Skin Cream (Bio-Cream)) with PSP, for the same reasons, but I just like a cream on the neck rather than a gel, because I think it hydrates better, and lasts longer.

MELANIE...likes SkinCeuticals' A.G.E. Interrupter, because it is not oily and feels like silk! It works very well to diminish fine lines and wrinkles.

RITA...likes A.G.E. Interrupter. (She didn't say why, so I guess you'll just have to ask her. She is a woman of few words SOMEtimes.)

Lastly, I asked the girls to comment on any category I forgot, and Cynthia mentioned the wisdom of a good old skin peel periodically. I think this is a very good alternative for those who do not desire the downtime of a facial laser procedure, or the cost. Although the laser procedures go deeper, the 3 minute Skin Medica Peel is great. It can be modified to be either an Illuminize Peel, a Vitalize Peel, or a Rejuvenize Peel, depending upon the strength of the acid chosen and the depth of penetration. A peel can be formulated to produce varying degrees of exfoliation based on each patient's individual needs, but works on tone, texture, acne, hyperpigmentation, melasma, large pores, fine lines and wrinkles.

Call us with questions!

Ho Ho Ho and Fa La La! Have a wonderful holiday season full of blessings everyone!

Julene, Cynthia, Melanie and Rita

Tips for Surviving the Holidays (and that dreaded "Winter Skin")

Happy Thanksgiving everyone!
I am beginning Part I (of III) today... we will have a discussion involving my personal tips for surviving the holidays (how to improve our bodies and weight management tips), and then I also plan to provide tips on how to use the winter months to work on problem skin, to treat existing problems, but also tips on how to take a more proactive stance on anti-aging. I do not have all the answers, mind you, but I certainly have opinions, and isn't that what blogging is all about Tommy, honey? I get to express my opinions to whoever wants to listen!

As always, feel free to call us for some personal recommendations on anything that suits your fancy. We are hosting another "Cocktails and Consults" here at the office on Friday December 10th, from 10AM to 6PM, during which a portion of our proceeds on services rendered or purchased that day will go to Support The Boys' Haven. Join us for drinks, appetizers and some live talks and demonstrations on Botox, Juvederm, Sculptra and Vaser Shape. We will have special pricing that day on skin care and injectable products, as well as laser services... and it will help a really good cause. Angela Ariatti is helping us to organize the day's events, and is our Boys' Haven sponsor. (She is also Lexie and Kaitlyn's riding instructor and incredible female role model/mentor, ie., "life coach").

The most important things to remember when re-evaluating body proportion and "problem areas", is to do your best to be patient with yourself, and to be realistic as you reset your goals. We can all make some level of improvement in our physical fitness, but a balanced program is required. Diet, exercise, reasonable goals and a real commitment (and sometimes, intervention, surgical or otherwise) are necessary. I am a physician and a plastic surgeon, not a dietician, nutritionist or fitness instructor. I do however, care about my fitness , have done a fair bit of reading and research over the years with respect to diets and exercise disciplines, and have a large experience with different techniques myself on a personal level, and consider my medical background and training to be a sound base for the evaluation and interpretation of various methods of staying fit. Coupled with the fact that I have a significant surgical experience in treating and caring for patients - men and women - who care about their physiques as they age, I think I am at least able to render some sound advice on this subject. So...here are my thoughts, for what they are worth...

After menopause, or even in the pre-menopause or "perimenopausal years", there is no doubt about it...hormonal fluctuation and decreased metabolic rate are all contributing factors to the slow, steady weight gain many women experience, so that despite sometimes our best attempts to stay lean, we are undone. Finding an exercise program that is truly enjoyable to you is often the key to the next challenge, which is finding the time to work it into a busy schedule. I like to run and bike and ride horses...all of which I like (or must) do outdoors. Although I have a treadmill and elliptical trainer, I much prefer to be outside, so I use these devices mostly in the winter months. Although I think the commitment provided by working out with a trainer is wonderful, motivational and ensures that the proper change and flexibility of varying a workout routine is adhered to, I simply find my schedule too restrictive and inflexible to allow me the luxury of a regular workout with a trainer. (Not to mention the cost involved with finding a good trainer and the typical gym membership.) In recent years, my husband and I have just found it more time-efficient and doable for our schedules to buy a bit of workout equipment to keep at home so that we can work out whenever we want. In addition to our treadmill, elliptical and bike trainer, we have some free weights, and I recently purchased the P90X DVDs to firm up "softer" :-) areas this winter. Basically, any regimen that incorporates some aerobic conditioning and training with resistance training using weights or bands will work, and you don't have to spend a lot of money on a home gym. Aerobic training that is consistent and maintained at a certain heart rate level for a sustained 30 to 45 minutes 4 to 5 days a week will improve fitness. Much less than that will probably only help you maintain a certain fitness level, rather than improve fitness.

In addition to the proper work out plan, of course one must add a smart diet. Having read all of the diets my patients routinely ask me about, like...The South Beach Diet, Sugar Busters, The Zone, Atkins, etc...I think of things rather simplistically as follows: If calories taken in exceeds calories out, those extra calories will be stored as fat. If we eat the wrong kinds of carbs, they work just like sugar. Most women are fairly protein-deficient and need to eat more lean meat. The best proportion of food calories consumed is about 30% fat, 40% carbohydrate, and 30% protein. When you eat (in relation to the calories you burn that day) is as important as what you eat. Certain types of work out or training periods may change the recommendation of the above things a bit, but in general, these seem to be sound principles. So what I try to do is eat small frequent meals (around 450 cal per snack or meal 6 times a day, or a larger meal earlier in the day with fewer snacks) so that I can burn more easily the calories consumed, try to eat more lean meat and "good carb" vegies, limit sugary foods, consider the rule of portion size (palm of hand size), and not eat after 8PM. I love what is taught in The Zone...that food really is a "drug" that we put in our systems every day, that the food we eat regulates the hormones insulin and glucagon to regulate glucose metabolism and fat storage, and that if we want to better utilize (rather than store as fat) the calories we consume, we must eat to stay in "the zone", where our body's glucose levels stay fairly constant, we are utilizing the calories we are consuming, there are not large rises and falls in sugar levels which then cause us to store the excess glucose as fat, and we maintain a stable glucagon and insulin milieu (and therefore, stabilize weight). If it is weight loss we are after, then we MUST consume fewer calories than we utilize, and to avoid muscle loss, that means combining calorie restriction with exercise. Although I learned this from every trainer I have ever known, and I still believe this to be the best way to achieve longterm successful weight loss and improved fitness, I would also say that I now believe that sometimes (especially after the onset of those menopauseal years), that I do see the value of jump-starting one's slowing metabolism, via alternative means.

We have recently begun to offer short courses of metabolic supplements to some of our surgical and nonsurgical body contouring patients who are trying to achieve timely weight loss in order to enhance results seen with both Vaser Shape, a nonsurgical method of body contouring now available in my office (see my website or previous Blogs) and Vaser Lipo (operative liposuction). We would be happy to evaluate anyone who wants to hear more about HcG injections or sublingual drops in this context. I do believe that patients who can "reset" their metabolic rates with these supplements will be more likely to maintain results they achieve with (Vaser Lipo) or without surgery (Vaser Shape).

The bottom line is that it is really exciting to get to assist patients with their body change goals in a very holistic manner, because as a woman who is also a plastic surgeon, I can help my patients with diet and exercise recommendations, with metabolic supplements and weight management tips, as well as meaningful interventional techniques, ie, Vaser Shape (non-surgical ultrasound body contouring), and Vaser Lipo (surgical liposuction, with or without tummy tucks or lifts).

As always, we welcome the opportunity to design a plan specific to each patient's needs.
Happy Thanksgiving! (eat more turkey than mashed potatoes)

Julene

Perseverance...

I took my twins to a 3 day horse trial last weekend outside of Knoxville in the Smoky Mountains. They both compete in the sport of "eventing", which is a 2 or 3 day horse trial encompassing the elements of dressage, stadium jumping and cross-country jumping. All 3 phases of riding are scored, and the order of finishing places is determined by the lowest penalty scores after all 3 phases of riding are completed. Usually, 2 of the 3 phases of the riding are accomplished in the first day of the horse trial, with the other element finished the final day of the horse trial. The kids may walk the jumping courses with their trainer prior to that phase of the competition, but the horse is not allowed to school either the stadium jumping course or the cross-country course prior to the actual riding of the courses. Dressage is a practiced, coordinated and very controlled test of horse and rider communication, where form and style over the various gaits are judged in a small arena. Stadium jumping is a timed ride over a variety of jumps in an arena, and cross-country jumping is a timed ride over jumps in open fields over several miles of a cross-country course.

The kids on our "recognized" eventing team are trained by Angela Ariatti in Goshen, KY, and range in ages from 12 to 17. They travel the country competing in horse trials that are recognized by the USEA (United States Eventing Association), and accumulate points over the course of a calendar year, culminating in their qualification (or not) for the AEC's (the American Eventing Championships) year-end competition. This is a competition entered by riders, both amateur and professional, from all over the country, and it serves as a chance for our young riders to associate with and observe high level competitors, many of whom are top-ranked riders in eventing, and even international or Olympic level, competitors.

Angela took 4 of our team members (including my Lexie and Kaitlyn) to River Glen last weekend, a beautiful equestrian park in Tennessee along the banks of the French Broad River. I was so proud of all of the girls, and it was a very mixed weekend of results. We had a rider fall during stadium jumping, which is an automatic elimination from the competition. We had a 6th place finish in the Open Novice division (Lexie), and 2 fourth place finishes, Kaitlyn in Open Beginner Novice, and another in the Open Training division.

All of the kids amaze me over the course of these competitions, because in order to be successful, they learn that all 3 phases of the competition are important, and they all 3 matter. They learn that they must remain focused and competitively optimistic as all 3 phases of the riding progress, and that it is a cumulative score they are seeking. They learn to emphasize their own strengths as well as the strengths of their mounts in order to optimize scores in each of the riding phases, and they learn to persevere on to the next phase of the competition even when one element may not go as well as they'd hoped. They learn to persevere. Can you think of a more valuable lesson in life?

The team member who fell off her horse at stadium stayed to cheer on and support her fellow team-mates even after her own elimination from the competition. Kaitlyn persevered in order to move up consistently through all 3 phases of the competition, from 12th after dressage, to 7th after stadium, to an ultimate 4th after cross-country, behind riders who were all her senior in age grouping and experience.

As the weekend progressed, and as an adult, I thought about how the kids handle the challenge of a 3 day competition, how they handle the nerves and the stess in order to do their best in all 3 phases of the riding. I watch them learn how to watch the mistakes others make and to learn from them, how to plan with Angela their best course of action, and I watch them swallow the hard lumps as they make their own mistakes and learn to go on to the best of their abilities. In the end, Angela only expects them to do the best that they are capable of, and they know this, but it is truly amazing to observe this learning process, for it is a journey they each make.

Achieving goals in life is all about having the courage to dream of the goal, consistently working hard toward that goal, and persevering to never lose sight of the goal...individuals who can do this oftentimes exceed the expectations or achievements of others. And they amaze and inspire us all.

Congratulations girls.

Watch a Vaser Shape treatment and talk to the patient!

This week's update on our Vaser Shape experience is very special...we will be featured on the evening news Thursday at 5PM on WAVE 3. Health reporter, Lori Lyle, was in the office last week to tape an actual patient having the procedure performed. Lori interviewed Tracy, who was gracious enough (and pleased enough with her results) to also allow taping of her actual Vaser Shape treatment. This was Tracy's second treatment with Vaser Shape of the tummy and hips, and her measurement change so far is an unbelievable 2 inches lost above the belly button and over 4 inches at the hips!!! I know what you're thinking...I thought the same thing...this is really too good to be true. So, I measured again, and again...

So, tune in Thursday, and see for yourself! Tracy talks about her goals for the treatment, how it feels, and I speak to its place in our body contouring armamentarium. Lori asks great questions about the evolution of this technology, and results we are seeing in all patients.

One of the best ways to receive more information about Vaser Shape is to join us here in the office for a group or individual consultation. We will outline the technique and its applications in an informal setting with a powerpoint presentation, and then provide one-on-one consultation about who and what areas might be good candidates for treatment with Vaser Shape.

Another way to find out if Vaser Shape is right for you and to view current patient results, is to join us Friday, November 19th, here in the office for our next "Cocktails and Consults", where we will be doing a live demonstration of Vaser Shape. The theme for this evening of cocktails and information gathering will be Mexican...so bring a friend and come and have a margarita with us!

We hope to see you soon!

Best,
Julene

Weekly update on Vaser Shape...

Hi guys! For those of you who may be watching and waiting to hear more about Vaser Shape, I thought I would begin a weekly post to update our followers on what we are seeing as we treat our first patients, the overall experiences we are having, and I would also invite any questions you may have, group chats, etc. This is very exciting and brand new technology, so we will have lots to pass on as the weeks go by.

We completed our training several weeks ago, and were fortunate enough to be one of only a few sites in the US to receive a visit and second round of training from Benedetta Baciucco, the Italian trainer for Sound Surgical Technologies and Vaser Shape, from Florence, Italy. We videotaped some footage of Benedetta's visit, which you can see on Facebook or on our website.

To date, we have treated about 25 patients and/or ourselves : ) - What woman doesn't have a little, eensy, weensy bit of fat she'd like to get rid of? We have not disappointed anyone, and I am pleased to report that we have seen the loss of 1 to 3 inches on average in 1 to 2 treatments, depending upon the size of the area to begin with and the skin tone at the outset. We are measuring and weighing everyone before and after each treatment, so Vaser Shape is not for the light of heart. We are after thorough and honest treatment results! I AM a surgeon after all, so if I don't see results, I can of course still recommend surgery.

I want to say at the outset, that I do not consider the Vaser Shape a "replacement" for surgery, but quite literally, an awesome complement to the sculpting we can achieve with Vaser in the operating room. I also firmly believe it is an alternative for patients who either cannot or will not consider surgical fat reduction.

Another interesting "side effect" is skin tightening, and we are seeing evidence of this phenomenon on the table after just a single treatment. There are a whole bunch of women (and men, I always forget them), myself included, who would like more skin tightening than even fat reduction. Do you know how many women I see each year who ask me what can I do about the loose skin of their knees, arms or inner thighs? It's like the bacteria in a urine sample from a patient with a urinary tract infection..."TNTC", or "too numerous to count"! I used to say, with much true compassion, "not very much", now I may use the Vaser Shape for some of these areas. (Okay, I confess, I did my inner thighs last Friday...and, yes, they are tighter).

We are going to make some noise about the Vaser Shape, look for our ad in The Voice this week, and for upcoming news segments on WAVE3 with Lori Lyle. We can't keep this a secret for long...

And of course, follow us here for updates!

Best to you, and so long fat rolls!

Julene

The "No Down-time Breast Augmentation"

I was visiting another plastic surgery colleague in another state recently, and after learning where I had trained, he told me he had visited one of the surgeons who trained me during my residency. It turns out, the surgeon has been in practice longer than me and does a fair number of breast surgeries, but had always told his patients that they would need significant time off work and daily activities, and that they would require a lot of pain medication during their recovery period. He mentioned this "no-touch technique" and how it so drastically reduces recovery periods to mere days, and I guess I got a pretty quizzical look on my face - I usually try to be more subtle - and he then asked me if I use that technique (especially important when placing the implant under the chest muscle, or pectoralis). I said, "well, yes!" (Again, Ms. Subtle). I put that information away to think about later, as more and more surgeons are using their new-found information about this technique as a marketing tool, and it wasn't until today, when one of my own happy breast augmentation patients said the following (she was here for some October "Boo-tox" and happily telling me of a friend she is referring to me for breast augmentation), "When was the last time one of your breast augmentation patients went to Red Lobster the night of her surgery - you know I did!" I decided right then and there that although I am happy to learn that knowledge of the technique is spreading, because patients will be the huge beneficiaries if their surgeons use this technique, I decided that I must be guilty of not emphasizing the difference this technique can make to my very own patients enough. We do tell patients that we will give them pain meds and muscle relaxants, but most tell us they didn't need them, they take Tylenol and go to back to work in 2 to 3 days. There is virtually no bruising or swelling, and this is true even when we place the implant under the muscle.

The "no-touch technique" is really the use of a very light general anesthetic, so that the chest muscle can be fully relaxed while a pocket is made under it to hold the implant. Traditionally, most surgeons are taught to fairly bluntly pull the muscle up, and although this is moments faster, it allows too much oozing into the submuscular pocket. This blood will usually be absorbed by the body slowly, but leads to much more discomfort, which is the most common cause of post-operative nausea and vomiting. The leftover blood can also stimulate a higher risk of capsular contracture (scar tissue), or if it is enough bleeding, can cause an unexpected trip back to the OR for evacuation of the hematoma. Additionally, post-op asymmetries are more common when more bleeding is allowed to occur.

Instead of this rather brutane method of pocket creation, advocates of the "no-touch" technique utilize a special hand-held cautery device that works much like a laser to control bleeding before it starts. Therefore, the pocket for the implant is very dry and controlled, minimizing down-time, helping to "control" the symmetry of the result, reducing the risk of hematoma or capsular contracture, and most importantly...reducing the risks of revisionary surgery, which I believe is the true "hidden cost" of all surgical procedures...ie, how many times does the surgeon have to operate to get it right? Additional nuances of the technique involve irrigating the pocket once it is made with antibiotic solutions, changing gloves after making the pocket, using talc-free gloves before touching the implant, opening it only when ready for insertion into the pocket, and limiting touching of the implant to the surgeon only. I am also a big believer in offering selected patients intra-operative sizing with temporary, single use sizers if there is asymmetry or uncertainty about ultimate size desired, and sitting all patients up in surgery to assess the final result before leaving the OR. All of these manuevers add seconds to the actual surgery time (still only a little over an hour or 80 minutes if sizing is performed), but drastically reduce the risk of revision or the "post-operative surprise"!

The use of the "no-touch technique" is even more important when I am using the investigational "Gummi bear" device, because this device mandates a tight seal between the implant and the capsule which forms arouond all implants. This device is currently investigational for certain patient indications (revision patients right now), and I am happy to be one of only a very limited surgeons in the U.S. invited to finish the clinical trials for Allergan. It's advantages are a tear-drop anatomic shape, very soft feel, no liquid nature to the filler (fully cohesive silicone gel), low risk of capsular contracture, and low risk of spread of silicone if the device should rupture.

How the Sciton Contour Profile laser can clean up the summer's damage!

I'll share a secret with you...I can't always follow my own advice...after a summer of fun in the sun running, swimming, biking, riding horses and chasing after my girls in the hot sun at various eventing horse trials, the good doctor does enjoy lying down for a series of awesome laser treatments by Melanie or Rita designed specifically to reduce the appearance of sun spots, wrinkles and even laxity of the skin.



I do religiously use my own skin care products...the same ones I recommend for my patients...virtually year-round, but there is really nothing as effective as the laser to provide more aggressive and rapid correction of these common skin problems. Although I have tested every cosmetic laser on the market, the Sciton Profile is quite simply the best.



I use Dermesse cleanser gel and toner morning and night, uplifting eye serum in the morning under my make-up, Latisse lash enhancement at night, and Lumiere eye cream at night. To sleep in for the rest of the face, I alternate using Essential Serum by Skin Medica with Hyalis or Biogel. Every night and every morning I use Biocream on my neck. I know this may sound like a lot of product, but when I told Christa Ritchie of the Courier Journal recently my age, I thought she was going to fall off my couch (God love her!) In addition to these topical products, I never let my Botox fully wear off, and I love Juvederm and Sculptra for filling and tightening between laser treatments.



Despite these truly revolutionary skin care products, I am a big believer in the laser for deeper treatments. I like the combination BBL and Skin Tyte treatments for brown spots and visible vessels, as well as for tightening of the skin of the face and neck. There is absolutely NO down time, no discomfort, and immediate results. The best results are seen with a series of 6 to 12 treatments.



Another favorite combination is ProFractional for skin tightening and MicroLaserPeel for skin smoothing. These treatments can be performed individually or together for even more dramatic results. The downtime is variable, and dependent upon the depth of the treatment that is desired by the patient. The depth of the treatment is chosen by the patient and the nurse or myself prior to the treatment. No anesthesia is required, and the skin is numbed and chilled for comfort.



Come in for a complimentary consultation just for mentioning this blog, and "fall" into a more beautiful Fall 2010!!! Better yet, join us on November 19th for our next "Cocktails and Consults" from 4 to 6PM...our next themed cocktail evening will be all Mexican! Bring a friend and receive special discounts on our favorite skin care products and laser treatments, or even a free texturizing facial peel.



See you soon!
Julene

Join us for our next "Cocktails and Consults" Evening!

Thanks to all of you who joined us tonight for our first "Cocktails and Consults" evening! It was fun to see those of you who could join us, and to celebrate the arrival of fall! Cynthia brewed up a great witch's brew (or two), and everyone enjoyed it. Patricia Young of "Creative Crystals" joined us and brought some of her beautiful Swarovsky crystal jewelry pieces.

We had great appetizers and even pumpkin pie! (Saved some for Kaitlyn and Lexie of course). Dan (Cynthia's cute husband) coined the term "Julene's Juice" for Cynthia's special concoction of Skyy passion fruit vodka, sparkling apple cider and cranberry juice/pineapple juice/ginger ale, a clinically proven recipe for a beautiful complexion, and we all had at least one cup (Melanie took home a cauldron). Even Rita's nose stopped running after 10 cups (or so).

We all gazed at the Vaser Shape box...it will be birthed next week. At this point, Cynthia and I at least think we should name it. Of course, it is a girl...our training is all set up for next Friday, October 15th. A couple months of melting fat and none of my staff will be recognizable, right?

We offered many specials tonight, including 40% off Juvederm, $9.00/unit "Bootox", 50% off laser procedures over $400, and discounts on many of our favorite skin care products.

For those of you who couldn't make it tonight, we are planning another "C & C" for Friday November 19th from 4PM to 6PM. We will likely choose a whole new group of specials, so be sure and call the office to check with us and reserve a space for you...and a friend...which is the only ticket you need for admission! I think we may also demo the new Vaser Shape for fat reduction (see last blog entry). If you'd like to be the evening's model patient for Vaser Shape, let someone in my office know.

Have a great weekend!

Julene

Non-invasive fat reduction

What would you say if I told you there is now a way to get rid of some of that unwanted fat without surgery? No incisions, no anesthesia, no downtime and no pain? We are very pleased to be the first in this area to offer Vaser Shape...brand new European technology now available in the United States through Sound Surgical Technologies. I have been offering Vaser Liposelection (the internal ultrasound liposuction device currently used in the OR) now for over 5 years, and have received much technical support from the company in order to be the first provider in our area for this exciting new technology.

Vaser Shape is a new external ultrasound device that incorporates a dual beam technology of ultrasound energy below the skin's surface to melt fat. Each beam of energy passes harmlessly through the skin to the fatty tissue layer. The dual beams then converge together in a V-shaped configuration below the skin in the fatty layer to cause apparent fat cell destruction. We believe that the body's own lymphatic system is then stimulated to allow absorption of the contents of the fat cell and its eventual elimination from the body...and voila!...the loss of inches occurs!

Although the technology is brand new in the United States, the results from Europe are very nice, even seeing results after a single treatment. SST recommends a series of 4 to 6 treatments to see the very best results, and series of treatments can be repeated if desired by patients. An extra benefit of the heat below the skin may be some slight skin retraction and smoothing as well as true fat reduction. European results show significant longevity of the effect, as long as good diet and exercise practices manage weight stability.

This technology will certainly not replace, or maybe even equal, results achieved with traditional liposuction or surgical body contouring procedures, such as tummy tucks or liposuction, however, it is so nice to now have another option beside surgery to offer patients. I also foresee the benefits of the lymphatic drainage, deep tissue massage and cellulite control (indications for which the device already has FDA approval),as an additional advantage for our surgical patients, as massage of the skin and lymphatic drainage of normal swelling fluid after surgery is such a vital component of the post-operative care recommended for the best surgical results.

Vaser Shape treatments are performed in the office without anesthesia, and feel much as a hot rock massage would feel. The typical treatment time is 2 areas in about an hour, and although costs per treatment in Europe and some parts of the US where it is available approach $1200 to $1500, we will be offering the Vaser Shape series of 4 treatments at an introductory package price of $2600.

You may call our office now to schedule your first treatment, and be sure to check in here periodically or visit us on Facebook for more updates on exciting new technologies! Thanks for being a follower...

Best regards,
Julene

Really awful lip augmentations : (

Okay...I've about had it...I am getting really, really tired of seeing really awful lip augmentations. It's no wonder that, as I embark on a series of lip augmentation treatments for a new patient, that I need to park it on my stool and have an honest discussion of the goals of the procedure. In fact, I often spend a good bit of time at the beginning of many new patient consultations calming valid patient fears. I believe many of the fears that a new patient shares with me are founded on the fact that the bad results are out there...everywhere!

As I tell my patients, especially those who do not know me well yet, plastic surgery is very simple...if you have a plan, a good aesthetic sense, and a good understanding of what the patient wants. Of course, we always have to plan for the unexpected, but in reality, the unexpected is a rare event.

As far as lips are concerned, there is a natural, very beautiful shape to the upper and the lower lips. Rarely, should we ever augment the upper lip exactly as we do the lower lip, or with the very same amount of injectable product. The aesthetic goals may be to ease lip lines, shape the lips, or to make them fuller. As a surgeon, I don't have to always have the goal of making the lips fuller, and this is perhaps what amazes and scares patients the most...that their lips will be HUGE after the procedure. I think that fear stems from the fact that some lip injection results out there look, simply put, like "sausages up and sausages down"! The poorly done lips have lost all sense of natural beauty and proportion in the attempt to create fullness. Sometimes they look very irregular and lumpy.

The upper lip should maintain a Cupid's bow shape, have natural eversion (or pout) at the border of pink lip vermillion and white skin, and have a central fullness that tapers down gracefully to the outer corners. The lower lip should have a natural pout as well, and central fullness, and the lips should maintain a proportion of fullness; that is, the lower lip should be 1/3 fuller than the upper lip (ie, the upper and lower lips have a fullness ratio of 1/3 in the upper to 2/3 in the lower). Too often, as injectors create fullness, they will continue to inject only the upper lip, and this eventually causes an imbalance in the upper and lower lip proportionality, with the upper lip overbalancing the lower lip.

I love to inject lips, and I will tell patients these things, so they better understand my recommendations, and also so that together, we can maximize benefit and reduce overall cost of the injectable materials as we maintain youthful lip contours.

What are my favorite lip injection materials? I love the hyaluronic acid products, such as Restylane and Juvederm, because they are so malleable and longlasting. I dislike the permanent products, because they are too artificial looking, too stiff, poorly animate, or because they are...too permanent. They are less flexible as the patient ages, and cause more problems than they fix in my opinion. They do not replace "like with like", because what we lack often in hypoplastic lips is collagen that provides fullness, or fat...not Goretex or mineralized bone pieces. I like fat injections also, if the patient has fat which can be harvested, although the cost is a bit higher than the shelf products, due to the harvesting step required for fat transplantation and the preparation process necessary to ensure good fat healing and retention.

Lip augmentation by injection of Restylane or Juvederm is an office procedure in my hands, under just a numbing cream and ice, although we also provide lip blocks as well upon request. My office employs 2 nurse injectors, in addition to myself, and we use injectables that last 9 to 12 months or more. The cost depends on how many syringes are needed. I will often treat lip lines by just injecting along the lip edges, and this has the added benefit of shaping the lips better and creating a bit of lip eversion which is very pretty. Injecting the lip edge stretches the lines smooth, and prevents the need to inject each of the vertical lines, which is more painful and can cause ridges where the wrinkles used to be. Injecting just the lines themselves also too often distorts the lips. After the lines are corrected, more product can be injected if desired to create as much fullness as the patient needs. Swelling is temporary, bruising is rare, and both usually dissipate within 24 hours.

Beware...a great lip augmentation can be very addictive!!!

So go ahead...pucker up!!!

Best,
Julene

Choosing a surgeon...choose carefully!

Unfortunately, there was some negative publicity last week in our plastic surgery community. This led me to some introspection regarding my chosen profession (cosmetic plastic surgery), and I wish to share a bit about some personal thoughts on the matter...thoughts I seem to have quite frequently.

I have often considered myself very blessed to have discovered a profession which allows me to inject a lot of myself in the care of my patients, very many of whom are female, and I love what I do. After many years of rigorous college academic preparation, medical school, two surgical residencies, and years of clinical practice, I feel I have earned the true honor of getting to know and care for my female patients. I respect them, I value their intellect and understanding of the cosmetic plastic surgical process and experience, and I really value the relationships I have built with my patients over the years. It never ceases to awe and amaze me regarding the amount of trust that is required of any surgical patient when they elect to undergo a surgical (or even non-surgical) treatment by a surgeon.

These patients may know us well already at the time of their treatments, or they may have just come to us upon the recommendation of a friend, family member, health care or other professional, but at some point, they make the decision to allow me to operate on them, or to treat them in some way. I (personally) do intensely feel a weight of responsibility to provide the best treatment experience available to these patients, and do truly feel honored to have been chosen by them. I think that if all physicians felt this degree of intimacy and privilege with their patients, that we would never read or hear of some of the negativity that sometimes surrounds this profession...lawsuits, sexual misconduct, poor outcomes from poorly selected procedures, or procedures performed on poorly selected patients, lack of attention to safety measures, lack of sound surgical judgement in selection of procedures or their combinations in properly accredited facilities, and on and on...

I am very proud of the road taken which has led me to the place where I believe my patients have selected a plastic surgeon who truly cares about them, involves them in sound surgical decision-making prior to embarking upon a plastic surgical plan, and a surgeon who has strived to maintain the highest standard in achievement of excellent surgical results.

My advice to prospective patients has always been to do your homework, insist upon open and honest communication, ask questions, seek referral opinions of other patients and professionals, pay attention to board certification and membership in aesthetic and professional societies, look for involvement in new research and technology, and maybe above all, look for a great feeling of rapport and even friendship with the surgeon you choose. If it doesn't feel "right", it probably isn't, and don't just look for the cheapest price in making your final decision. You deserve a surgeon and staff with whom you can foresee a long and enduring relationship. My staff and I believe that anyone can be fooled once, but it is the returning patient we feel who most honors us in our endeavors to be the best small practice around.

Best wishes!
Julene

Upcoming Events

Take advantage of our Fall specials - October 1, 2010 - October 31, 2010 ONLY!

Botox $9.00 per unit*
Juvederm Ultra XC $425/syringe (REG $550)
Juvederm Ultra Plus XC $450/syringe (REG $600)
40% off all laser procedures over $400**
30% OFF ALL SKINCARE

Skintyte - buy 1 area get 1 area
of equal or lesser value 1/2 off!

*RN injection
**Excludes Skintyte

Mommy Maintenance

As mothers, we spend a lot of our time taking care of our families. How do we fit attending to our own needs into our already jam-packed schedules? Well, there is never a perfect time to concentrate on yourself...so stop waiting for that perfect time...it's now!

Do you ever look at a picture of yourself, maybe several years ago, and think..."What was I complaining about back then?" It's a fact...we will all get older and lose a bit of our old selves if we just let it happen. It is actually possible to get back your little bit younger and fitter shape, but you may just need a little (or a lot) of assistance. As I tell my patients every day...it's not all your fault, so stop beating yourself up, and it's OK to seek some help from a surgeon who can change your shape. You may want to do as much as you can on your own first, by perhaps losing those 5 to 10 pounds, but then do yourself a favor...go at least see someone you trust (or me!) and see if you are a candidate for reshaping your loving body! A tummy tuck or breast enhancement procedure may be just the thing to give you that fresh start you've been looking for!

Although working out, diet and exercise may help a bit as a start, it is often impossible...I did say impossible...to COMPLETELY correct loose skin or muscle of the abdomen after pregnancy and aging in many cases with totally nonsurgical methods. A tummy tuck with liposuction is a great way to finish up the reshaping process and give women a better body than they had even before pregnancy. The tummy tuck I prefer today has evolved into a total recontouring of the trunk, waist and abdomen...a true combination of skin and muscle tightening of the front of the tummy and waist, and liposuction of the waist, flanks and back fat (up to the bra line even!). In most patients, it is possible to lose over 10 to 15 inches total... 5 to 8 inches from the waist alone...and most patients say they NEVER looked so good! Patients usually choose to stay one night in our private rooms for around $250 per night...probably more for a night to themselves than for any real medical reasons, they walk around immediately the night of surgery, and we provide a 4 day pain pump that is implanted under the skin , and over the sit-up muscles that are tightened, so recovery is described by the patients as even easier than a C-section!

Tomorrow...or soon...we'll talk about breast enhancement procedures after pregnancy and aging...stay tuned!