Renaissance Plastic Surgery

One of our male readers wrote in to tell us a story about the increasing use of Botox for friends of his in their 30's.  This particular fellow has an interesting viewpoint that we don't often hear, which is the thoughts of men and aging.

  ____,

    You've told me a couple times that you have male patients, and I've been skeptical.  Outside of news anchors and guys dating women twenty years too young, I just didn't believe it.  My wife has been telling me for years that botox isn't just to make you her younger.  She claims that you need to start Botox before the wrinkles really begin, and that retards the look of aging.

I may have to eat my words.  I was on a business trip and met a friend from high school who is living down South with his wife.  I thought I was boring him through dinner, because nothing I said seemed to make him laugh or really give me any hint he was listening.  Later that night, he pulled my aside and actually told me that his wife had talked him into Botox.  At the moment it really struck me - his face looked a lot like he did in his 20's, and it was because his forehead was smooth.  He didn't look like a kid - he still had put on a few pounds, but he really did look younger.  This guy isn't on camera.  He's just another business guy with a job, and he's not one of those metrosexual types.

He asked me not to tell our friends, as he was slightly embarrassed by it, but it struck me that if this guy, of all guys, was on the Botox train, then it's clear a lot of men are on it or on their way.  So consider this my mea culpa.  You're still not getting me to do it, but my wife is probably going to win this battle for her skin, and I do have to admit, he did look better.  We may not be talking about it yet, but something is going on.

We have of course held back his name, but thought this was something you might share with that skeptical man in your life.   

I recently took a vacation to Yelapa, Mexico and had the opportunity to venture a little beyond my comfort zone. Yelapa is a beautiful fishing village south of Peurto Vallarta, with great food and wonderful people. It also happens to be one of the paragliding capitals of the world. What is paragliding, you ask? Essentially you jump off a cliff with a parachute, catch the wind and fly like a bird! After some careful thought, a little research and a couple of Corona's, I was going to go for it.

All of this reminded me of what many of my patients deal with when they choose to have surgery. Like many things in life, there are risks. We take chances and weigh the risks versus the benefits. Patients often have the concerns of anesthesia risks, how will they look and how much pain will they experience. To mitigate the risks of surgery, I always recommend that the patient research my credentials and the anesthesiologist's certifications, talk to my previous patients and fell comfortable with me as their surgeon. In a way, I serve a similar role to my patients as the flight instructor I had while on vacation. Had he not been qualified or not done this sort of thing 2000+ times before, I would have never agreed to run down a short embankment, jump off a cliff and have the ride of my life!

I had the pleasure of speaking about plastic surgery to the Mother of Twins support group on Thursday, September 18th at Hodak's in St. Louis and was quickly reminded of how amazing these mothers are. Here there were 97 mothers of twins who had gone through the whole delivery process or were in the middle of a multiple pregnancy. Now keep in mind, I see patients for tummy tucks and such on a daily basis, but, at this meeting, I was quickly reminded of what women go through.

As I prepared my talk, I needed some photos to "break the ice". I knew I had some photos of my wife during her pregnancy and was fortunate to find them. WOW! It had been awhile since I had seen those pictures of my wife, who was 8 months pregnant at the time. I was amazed! I had forgotten how her body changed with pregnancy, especially twins. Here is my wife, petite I might add, with what appears to be a massive watermelon, pumpkin, and basketball - might as well be all three of them - shoved into her belly. What is even crazier is that a month later my sweet twins were delivered!

Well, the pictures did break the ice and the talk went well. At the completion, a great and informative question and answer session followed. Throughout the evening I was reminded of the transition all women encounter after childbirth. Here I was, the sole male among 97 women. Not only do they have to deal with the drastic changes to their bodies, but also to a workload and an inherent responsibility that all of us men try to understand but cannot. In the end, the talk became as much an eduction, or should I say re-education, for me as it was for all those wonderful women. Thank you to all who shared their individual, amazing stories!

A recent New York Times article highlighted these proven treatments for wrinkles: retinol, carbon dioxide laser and hylauronic acid injection.  Even though their description is very accurate of the effects of these treatments on the skin and the science behind how they work, their article is a little long and exhausting to read.  Here are the highlights.

All three of these treatments are well-known to plastic surgeons.  The Vitamin A derivatives (retinol, Retin-A) cause a change at the deeper structural layer of the skin, the dermis.  The product leads to rapid turnover of the skin and by a mechanism not completely understood, the collagen which makes up the dermis, is remodeled and demonstrates a more organized appearance, which in time will translate to a decrease in fine lines.

The laser also generates a more organized collagen layer, however, through tissue injury.  Shallow injury created by either a carbon dioxide laser, erbium laser, dermabrasion or a deep microdermabrasion or some other modality will stimulate this change.  Once the reparative process is set in motion eventual new collagen will be made, often resulting in a more flattering appearance.  Keep in mind, however, too much tissue injury can result in scarring and potential disfigurement.  For this reason, true skin rejuvenation requires a highly trained physician.

Regarding the facial filler, hylauronic acid, the plastic surgeon again relies on the reparative response of the body.  Hylauronic acid is a building block of collagen and when injected leads to an immediate plumping of the skin and a decrease in the appearance of wrinkles.  Additionally, the body will recognize the filler as foreign and over time will remove the substance from the body.  This process, which is rather complex, also forms additional collagen which may further reduce the appearance of a wrinkle.  This process also occurs with many of the other facial fillers that are currently on the market.  Of interest, fillers are thought to be a temporary fix.  When in fact, there is a long term permanent improvement to the area injected that may or may not be noticeable over extended periods of time.

Today's media has a fascination with celebrities and even more so with celebrities who have had plastic surgery.  While occasional unattractive outcomes do occur, more often than not celebrities are photographed in the healing phases following surgery and are thought to have a bad result.  Like all of us, celebrities cannot stay cooped up inside for 3 to 4 weeks to fully recover following surgery.  Swelling and bruising are not uncommon following facial surgery and will often distort not only the person's original appearance, but also what the final outcome will be.  In the end, however, this period of down time is almost always worth it.

Because the recovery period may be psychologically stressful, it is critical that the plastic surgeon fully review the recovery phase with the patient.  Knowing how long the recovery period will last will help patients time their procedure.  I personally have found it helpful to tell my patients not to hide their surgical experience, but share it with those around them.  By simply explaining to your friends and family before surgery that you are doing something to improve yourself, will significantly reduce the anxiety associated with the surgical experience.  What you will find is that family members will be interested and engaged in the recovery period and will not be shocked by your early post-surgical appearance.  Furthermore, they will support you and even cheer the "new you" on.

My advice to patients undergoing cosmetic surgery ......... share it with those around you ......... you will be surprised how many of them will have surgery too!

There has recently been an increasing interest in rejuvenation of the aging hand.  No one likes to look at their hands and see multiple age spots or the skeletonized look, where the tendons are so easily seen.  Unfortunately, these changes frequently happen with aging and are difficult to prevent.

Over the last 10 years, we have corrected age spots quite successfully with the use of lasers and Intense Pulsed Light, or Broad Band Light (IPL or BBL).  However, the ability to correct the loss of soft tissue in the hand has been difficult.  Until now!

Now there are some minimally invasive surgical options which will restore the volume to the hand with essentially no down time and very little discomfort.

One option is fat grafting.  This is a technique where fat is taken from another part of the body, processed, and then injected into the hand.  Approximately 30% of the fat remains permanently, leaving a more youthful appearance.

Another great option which has worked well is injecting Radiesse, an hydroxyappetite substance which is a precursor to bone formation. When injected into soft tissue such as the hand, Radiesse does not form bone or hard nodules, but remains soft and can create a tremendous change in the appearance of the hand.  This improvement, unlike fat is not permanent, but should last on the order of 6 to 12 months, maybe even longer.