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The worlds first televised makeover took place in 1971, performed by Dr. Kurt J. Wagner.
SMACBOCA.com
This edition was created in 2005. We invite you to visit Smacboca.com to learn about the advances in cosmetic and plastic surgeries as well as age management strategies.
Foreword
Youre beautiful. There, I said it. Thats the compliment youve been waiting for. Youre pretty, youre lovely, you look so young for your age. If youre a guy, lets say, Youre in good shape, you look great. There, that should be enough to make you feel better.
-------------------------------------------What?!? You want more? Of course you do. Compliments arent enough. things, but if you dont believe it, its not enough. People can say nice
The reality is that we are our first and harshest critics. We ask for cosmetic procedures and we fight aging for ourselves and not for others. We are in the Youth Game because we want to feel better and look better than we do today. The Youth Game is about more than looks. Its also about that get up and go, that joie de vivre that you remember having in your twenties and now you want it back. Compliments and plastic surgery wont help if you dont have the energy youre missing. Where can we find the magic bullets and the special formula to get back our joy of living? Popeye the Sailor had spinach to get a boost of energy where is our spinach? The Youth Game is about what you put into your body: vitamins, hormones, antioxidants, CoQ10, fish oils, smart pills, amino acids. Its about exercise and relaxation.
The Youth Game is also about the knife and the laser. When you have your energy back, then its time to think about how you want to change your appearance. We are cosmetic surgeons artists, sculptors, renovators. We offer a wide variety of services at the SMAC Boca in Boca Raton. This book describes virtually every procedure, treatment and nutrient used today to help ourselves stay vital and healthy.
www.smacboca.com
Do looks matter?
Dr Kate Gleeson, a psychologist working at The Centre for Appearance Research, conducted a study among university students, and discovered that they all carried with them the barbs of childhood. Nasty comments that other people had made about their appearance when they were only five or six had stuck firmly in their psyche. One girl wore only black because she believed she had pudgy legs, even though her body was now very slim, says Gleeson. The American Society for Aesthetic Plastic Surgery reports an increase of 23 per cent in cosmetic procedures. A recent survey showed that half of all Americans approve of cosmetic medical procedures. In the USA, the television series Extreme Makeover gives ordinary people the chance to have movie-star reconstructive surgery. Some get a complete new body and face. This season, ten million viewers applied to appear on the show. All contestants report that they cant live with their often quite ordinary looks because society places such a high value on physical beauty. Susan Walls, juniormagazine.co.uk Lets start the journey. Before considering plastic surgery, lets cover what you should be putting into your very special body.
TABLE OF CONTENTS
Chapter 1 INTRODUCTION Chapter 2 MUST WE GET OLD SO QUICKLY? 10 12
Chapter 3 15 FACE THE FACTS TO CREAM OR NOT TO CREAM? THE BRILLIANCE OF BOTOX FILL TO YOUR HEART'S CONTENT - AT A PRICE Chapter 4 38 KEEP YOUR HEART TICKING ON TIME ANTIOXIDANTS, VITAMINS, MINERALS, ENZYMES, AND HOMEOPATHIC HELPERS CoQ10 - A MOST IMPORTANT VITAMIN ALPHA LIPOIC ACID - UNIVERSAL ANTI OXIDANT? FISH OILS - NOTHING FISHY ABOUT THE RESULTS HUMAN GROWTH HORMONE Chapter 5 51 HORMONES - HEAVEN OR HELL? WHY WORRY ABOUT HORMONES? TESTOSTERONE - FOR MEN ONLY? A SOLUTION TO ANDROPAUSE-WHATEVER AILS MEN VIAGRA - COCKED AND READY TO FIRE GET TO LOVE AVENUE IN THE FAST LANE! Chapter 6 67 FOOD FOR THOUGHT - POWER OR POISON ? A - DIETARY PLANNING B - PRESCRIPTION WEIGHT LOSS MEDICINES C - OVER THE COUNTER AND HERBAL REMEDIES - BETTER SAFE THAN SORRY Chapter 7 EXERCISE - WHAT'S ENOUGH? 78
Chapter 8 ARTHRITIS - DON'T LET IT GET YOU DOWN Chapter 9 COSMETIC SURGERY- CUTTING UP WHO'S DOING WHAT 89
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Chapter 10 THE ENDOSCOPE - A DIFFERENT POINT OF VIEW 127 Chapter 11 FLASH GORDON ARRIVES OR AT LEAST HIS LASERS DO! Chapter 12 ANESTHESIA - IT'S NOT ALWAYS A GAS! 140
Chapter 13 FROM THE TOP OF THE HEAD TO THE BOTTOM OF THE TOES 144 BALDNESS - NO LONGER IS IT A HAIRY EXPERIENCE! THE EYES HAVE IT! 152 CAN YOU HEAR ME NOW? 155 SMILE, Even if youre not on Candid Camera 157 BREAST SURGERY Get it on or off your chest 161 FAT, FAT - DO I ALWAYS HAVE TO DIET? 167 I'VE GOT YOU UNDER MY SKIN - CELLULITE 173 WAYS TO LOSE WEIGHT WHEN ALL ELSE FAILS THE VAGINA - IT'S NOT ALWAYS A MONOLOGUE 184 THE THIRD LEG - LENGTHEN IT? 186 VEIN? WHAT'S THE BEST COURSE? 190 SHOO THE SHOE BLUES AWAY 196 Chapter 14 GET SET AND READY TO GO 196 A - FROM I TO I B - WHEN AND WHERE DO I START? Chapter 15 APPENDIXES 203
Chapter 1 Introduction
The Magic of Rejuvenation
Doesn't time fly when you're having fun? It seems impossible that over 30 years have passed since I first put down my thoughts and they were published. We have entered a new century on the information highway. What was science fiction 100 years ago has become reality. Computers, lasers, supersonic transport, the Atkins Diet, aerobic exercise, cloning, nanotechnology the list is endless. Our concept of aging has undergone a drastic overhaul. Who is middleaged? Was Strom Thurmond middle-aged - a Senator at 100? I used to tell my patients, "Old is dead." It seemed true when I was 40 and much more plausible as I pass 70. Being in private practice in Beverly Hills for over 30 years has given me a great deal of interpersonal experience with over 20,000 patients. I consider every one of them as a star. I thought that retirement would enable me to leave the hectic arena of daily stress, but as much as I love Kathleen (my wife of 38 years) and the occasional 250-yard drive off the tee, it's hard to keep this racehorse in the paddock. What about the practice of plastic surgery? My dream was always to offer the patients not only a better-looking exterior, but also to give them the tools to enjoy their illusion of beauty and turn it into reality. That brings us to today's options and opportunities. Not only do we know more about technical improvements in the mechanics of surgical intervention, but today's expanding frontiers in hormonal replacements, exercise options and healthier diets offer us a chance to enjoy life to the fullest. Its all worth just a little more effort on our parts. There are a myriad of offerings bombarding us on a daily basis: A onehour face lift; lose ten pounds in two days; have an erection that lasts forever. What is a person to do in today's world? What is truth? What is reality?
My associates and I propose to give you a guide to help you along the way encompassing many phases that will avoid the pitfalls of superficial hype. After all, the more things change, the more basic truths remain the same! Read on and enjoy the journey. Maybe the magic of rejuvenation can really get you and your loved ones fit for life! So far, it has worked for me!
www.smacboca.com
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Joints Cartilage wears away and the cushion between the bones disappears resulting in osteoarthritis. Flexibility decreases as well, but not the pain associated with movement.
Normal joint
Lungs Somewhere between the ages of 20 and 80, lung capacity may fall by as much as 40% even with exercise and no smoking. Metabolism All of the glands including adrenal, pituitary and pancreas decrease their output resulting in a myriad of digestive, sexual and thinking problems. Almost 50% of woman and 33 % of men over 45 experience various types of sexual dysfunction that are the basis of a burgeoning worldwide industry. Muscle Strength If you exercise, you won't lose 5 to 10 percent of your muscle mass each decade after the age of 20 (like your couch potato friends), but lose some you well. Vision Acuity diminishes, cataracts increase, the retina degenerates. Hearing, Smell and Taste Needing to listen more closely begins after age 30. Although we may think that we savor food and drink, our ability to taste and smell also diminishes.
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Hair If you have the right genes, you may keep your hair, but the strength and color gradually fade. Skin If youre reading this far, you know that wrinkles, sagging, spots and sun damage are near the top of my level of interest, but improvement can not happen by the knife alone! Summary Not a pretty picture, is it? Maybe we cant stop the inevitable, but why make it easy for Father Time? Lets get started and see what we can do to make the most of what we have and even improve on it?
"You name it, we'll frame it!" "If your face or body is unbecoming to you, you should be coming to me!
- Kurt Wagner
LAUGH TIP: For Your Lips Full open-mouthed laughs increase breathing. Immunoglobulins (which fight diseases) have been found at higher levels after a belly laugh, showing that comedy can improve our immune systems. Norman Cousins, a famous editor and writer, watched the Three Stooges and sitcoms to help fight a cancer.
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Skin is the largest organ in our body, accounting for over nine square feet of surface area and 20 percent of our weight. It is complex stratified into three compartments, epidermis, dermis and subcutis (or hypodermis), and contains hair follicles, sweat glands and sebaceous glands (oil producers). Its functions are many: 1. Barrier - Keeps our fluids in and external fluids out 2. Temperature control Cooling through sweat and dilation of blood vessels Heating insulation and constriction of blood vessels 3. Sensory Input - nerve ending between the top 2 layers tell our brain what we're touching or feeling 4. Site of Metabolism - Melanin and keratin absorb ultraviolet light to protect cellular DNA, Vitamin D synthesis 5. Immune response - role in antigen identification by special cells to initiate or regulate antibody response. The various layers of the skin are the targets of constant irritation (e.g., sun exposure, smoking) or therapeutic relief by topical or surgical methods. As we shall see, there's much more than meets the eye.
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Since a visit to any store will provide us with an immediate bombardment of liquid creams, pills and potions promising to help us stay young and beautiful, let's see what's for real and whats just pie in the sky. Sorry, but a little science is necessary, at least to become familiar with the labels. There are several skin cells that are vital in maintaining the properties of the skin. Epidermis Keratinocytes (ke RAH ti no sight) make up 80 to 90 percent of the epidermis, the top layer of the skin. Their entire life cycle is 30 to 40 days as they journey upward to the surface to be shed. They are very sensitive to exposure to ultraviolet light, which, when unchecked, causes damage to their DNA, the gateway to cancerous changes. They are the targets of chemical peels, laser resurfacing and topical agents, which we'll discuss later. Melanocytes - These are the second major group of cells. By producing melanin in varying amounts, melanocytes determine skin color. When exposed to ultraviolet light in limited amounts, we can tan, but too much UV and all hell breaks loose. Hormones, inflammations, medications, injury and genetic factors all can affect the cells of response that extend from inactivity to overproduction to death. Have you ever seen a bad skin peel? Dermis This thin layer is made up of cellular and extra-cellular elements that interact within a scaffold. This scaffold maintains the integrity of the skin as the barrier to damage. Collagen is the main structural element in the extra-cellular matrix and is composed of sequences of amino acids. They are responsible for the smoothness and youthful appearance of the skin. Type I collagen, the most common, is produced by fibroblasts cells, which are constantly remodeling the skin. They can be stimulated to produce excess amounts after an injury. Type III to VII have varying roles in the maintenance of a health or regimenting matrix. Elastin - These fibers are necessary for the skin and all other organs to stretch and recoil (like a rubber band). They occupy only one to two percent (by dry weight) of sun-protected skin. Materials like hylaronic acid, glycosamine, and fibril are becoming household words due to their increasing presence in creams, pills and fillers. All of these and others are necessary parts of the dermal framework.
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The cells of the dermis also include: Fibroblasts, which are responsible for imitating the healing response after injury. Mast Cells stimulate the healing response. Macrophages are the street cleaners, removing damaged tissue to pave the way for regeneration. In addition, they initiate granulation tissue in healing wounds, by promoting the formation of new blood vessels. Dermal photo aging That's what we are most concerned with, but what exactly are we talking about? It is the combination of two parts: chronological and sun damage. Much as we try, we can't halt Father Time (but we're sure going to slow him down). Outdoor life seems to be the major culprit. My mother was allergic to the sun, so she made considerable efforts to stay in the shade. Although her skin sagged, her first deep wrinkle appeared only at age 80. The subtle gradual changes of chronological aging are much more marked and prominent in people who have endured chronic sun exposure. The fine wrinkles and sagging are replaced by deep furrows and leathery skin under the microscope, a condition called solar elastosis. A hodgepodge of broken, disorganized tissue replaces the neat array of youthful dermis. What's out there? Here are some guidelines: skin feels good when it is soft and pliable, depending on the quality of the stratum corneum (top layer) and the pores. Alpha Hydroxyl Acids (AHA) These are organic acids primarily found in fruits. From the first report of the therapeutic benefits of AHA almost 25 years ago, its use has increased exponentially. These compounds have been shown to increase skin thickness without wounding the dermis. They act by removing the superficial layers and stimulating collagen growth to give the skin a smoother appearance. Some histopathological studies have revealed an increase of epidermal thickness of up to 60 percent. (As we age, our skin becomes thinner. AHA makes the skin more elastic and younger.) The level of glycosamine compounds has shown a similar increase. In some concentrations, glycosamine binds water to the superficial cells, enhancing skin softness, but when we stop AHA treatment, after two or three weeks, it's back to square one.
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Beta Hydroxy Acids (Salicyclic Acid) BHA kills keratinocytes (which harm the skin) and induces smoothness of the skin, but at a price. It is irritating, it increases skin sensitivity and it can cause allergies in daily use. If you have warts or some form of acne, beta away, but for wrinkles or scars, forget it! Trentinoin - Retinoic Acid (TRA) This is a retinoid that has also been shown to increase skin thickness and glycosamine levels. TRA creates increases in procollagen (the precursor to mature collagen) just under the outer skin layer. Increased moisture and softness last for as long as four months after discontinuing its use. Retinol This pure form of vitamin A probably becomes metabolized into retinoic acid in the skin. Since it is less concentrated, retinol is less irritating than retinoic acid, but less effective. Kinerase A newer product that some people compare to trentinoin, although it probable is more of a moisturizer. Vitamin C - (Ascorbic Acid) Some recent evidence shows that the topical form may act as a potent antioxidant, reducing ultraviolet effects on skin aging. It might be a really potent sun screen. Vitamin E This antioxidant works the same as Vitamin C by protecting the skin. Moisturizers Take your pick. They work by supplying the stratum corneum with liquid protection from the extreme elements - wind, cold, heat. To some investigators, moisturizers do more harm than good on the cosmetic scene. Does "dry skin" have to be nourished? Must moisture be restored? Why don't children and men need moisture as well? Adverse effects? Some well-known practitioners in the field (Dr. Obagi) have linked the habitual use of moisturizers to dependencies, increased skin sensitivity and possibly accelerated aging. I and many other surgeons who have spent countless hours washing our hands have never needed assistance to overcome dry palms. Moisturizers can actually aggravate some dermatological problems, such as acne rosaceae, seborrhea, and clogged
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pores, while tending to reduce the efficiency of other agents such as Retinoic Acid and AHA. So what do we do about really dry skin? It is probably due to a decrease in the dermis of glycosamine production, which affects its capacity to combine water. If you reverse these changes (maybe with trentinoin), then the dryness lessens or disappears. So what does this mean to us? Before we start any programs to improve or maintain our outward appearance, we must aim for certain objectives 1. Improve the quality of all layers of the skin. 2. Increase skin circulation. 3. Improve hydration and tolerance against the elements with 2 goals. How to do it? Let an experienced professional lead you.
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Already discussed above. They are derived from such common substances as citric acid, milk, tomatoes, apples and mangoes. By varying the concentration from less then 10 percent to 70 percent, they can be purchased over the counter or can be applied by professionals. It acts by removing the superficial layers and by mild irritation, thickens the skin. Beta Hydroxy Acid BHA comes from salicylic acids. In low concentration, it causes mild peeling, with limitations discussed earlier. Lets go to the doctor! He has some serious solutions for all kinds of skin problems!
Stronger solutions
Trichloracetic Acid (TCA) This is the most commonly used agent in strengths ranging from 20 to 50 percent. By destroying the outer layer of the skin, it stimulates the dermis to produce more collagen and elastin, resulting in fewer wrinkles. This is the mechanism for all chemical peels. The deeper you go up to a point, the better and longer lasting the result. But, as the saying goes, "no pain, no gain." The increase in discomfort must be dealt with by varying degrees of sedation and anesthesia. Phenol I discussed this at length over 30 years ago and nothing has changed my mind about it. Phenol is the most effective method of skin rejuvenation with the possible exception of newer lasers IN THE PROPER HANDS! After it enjoyed soaring popularity in the sixties (stolen from lay practitioners by the medical profession), its use died down quite a bit because of the inability of some doctors to master its measure. Unskilled use resulted in reported cases of scarring and disfigurement. Once applied to the skin, phenol is immediately absorbed and its effects can not be neutralized (however, TCA can). It is metabolized through the liver and kidneys, so its application must be gradual and regimented. It is painful, so sedation is a must. It results in depigmentation in varying degrees because of its ability to penetrate deeper layers, so there will always be some lightening of the skin. After 40 years of use, I still marvel at what a proper treatment can do. While a day may not make the difference (you're bandaged for a while), a week can evoke a miracle.
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One month after the peel (plus face and neck lift now thats appealing!
TIP: Laugh your blood sugar down Diabetics should read joke books and watch Americas Funniest Videos. Glucose levels in your blood actually stabilize when you laugh heartily.
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Before
After
Before
After
The late 1980's marked the first time a purified botulinum (trademark Botox) was used in humans to treat certain ocular disorders. While treating crossed eyes and eyelid spasms by temporarily weakening the
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muscles responsible, an ophthalmologist noticed that the wrinkles her husband (a dermatologist) was filling with collagen were easily erased with Botox and improved for a longer period of time. In addition, her patients seemed more relaxed and appeared younger. And so we can thank Drs. Alastair and Jean Carruthers of Vancouver for opening the flood gates due to a bit of serendipity and alert observation. From this auspicious beginning, Botox has risen to Number One with no obvious contender in sight, and now with the complete approval of the FDA. Even the tyro has heard of the increase in the number of Botox parties where a group of patients gather together to save a little time, a little money and share a camaraderie. Like the title of a popular song of the late 1950's, "Little Things Mean a Lot, Botox is sealed in small vials and packaged in 100 units. The lethal dose is 3,000 to 3,500 units. The average treatment ranges from 30 to 100 units, leaving a large safety margin. Thus a poison has become a pleasure. But wrinkles are not the only target for which botox is intended. The medical improvements of cosmetic surgery are legion, ranging from achalasia (esophageal spasm, a spasm in the esophagus) to athletes foot to migraine to hyperhydrosis (sweaty palms and armpits) to other forms of muscle spasm that are beyond the scope of our discussions. In addition, new uses seem to be springing up on a monthly basis. Before we go overboard on this new miracle, lets look at the downsides, albeit they are few and far between, and thank goodness only temporary.
Side Effects
(Usually due to poor administration by someone inexperienced.) 1. Eyelid and eyebrow drooping 2. Difficulty in swallowing 3. Muscle weakness (too much too soon) 4. Antibody production - no results (fortunately less than 5 percent) The pessimists with their philosophy of the glass is half-empty will pick up this banner of negativity. However, the legions crying for continued treatment stand ready to crush these objections.
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What's Available?
Aside from Botox, a form of Botulinum A manufactured by Allergan (the number one in use), there are several other medical toxins available. Myobloc is the newest and is made from botulinum B. It has the advantage of being more stable in liquid form and works on those patients who have developed a resistance to Botox. That product may be used alone or in combination in certain diseases such as hyperhydrosis (sweaty palms). In addition there is a newer contender, Dysport, which is manufactured in Europe and is essentially the same as Botox but in a lesser concentration. Before we become completely INTOXICATED, lets go over what botox can do in the constant fight against the ravages of age. What's possible? Do you have wrinkles caused by muscle tension or muscle action (such as neck bands or forehead grooves)? Do you have spastic muscles? Need to soften the signs of aging such as jowls? Do you want to turn a frown into a smile? Get out the needle. What's not! Do you have spots or blotches? Do you have lizard-like skin? Is your collagen in need of tightening? Do your neck and cheek areas remind you of a bloodhound? Don't worry because we are here to help with laser, the surgical knife, chemical peels and hormonal adjustment. Our own Dr. Jason Pozner is one of the foremost administrators in the art of Botox treatments and has contributed to several books on the subject. For those avid researchers who need a more thorough exploration into other uses of Botox, I would recommend The Botox Book by Lautin,
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Pozner's
So we add another package to our travel bag on the road to rejuvenation. Let's continue on our trip to the fountain of youth. We've only just begun!
Is Botox forever?
No. Three to six months. Does it make sense to keep paying for fewer wrinkles? Is there a more permanent procedure? Sure -- Light laser. Its expensive, but paying for a one-time procedure might work better than multiple visits to the bovine injection station. In fact, Jason Pozner, the Light Saber expert on the ASI staff, takes a pay cut two days each month to teach other doctors the finer techniques of this delicate procedure. Some doctors travel from
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testing via a skin test. Now it is derived from human collagen (foreskin) and has a much lower incidence of problems. It is effective in minimizing facial lines, grooves creases and scars. It was the first injectible to be used to plumb lips on a common basis. However, the body digests the animal-derived collagen, requiring refills at 3 or 4 months intervals even with the human form. It may be an injectors delights - very safe with a need for a constant replacement like tooth paste, but what about the patient? Here are some of the newer injectible fillers: Inamed, Zyplast, Zyderm, Restylane, Perlane; they are comprised almost primarily of hylaronic acid molecules. The latter is a natural structural element occurring in the skin, subcutaneous connective tissues, and synovial fluid. Since hylaronic acid is identical in all living tissues, there is less chance of reaction, although occasionally a few reactions in humans have been reported. It has the advantage of lasting over twice as long as collagen and has enjoyed popularity, particularly in Europe. Articoll - according to articles appearing in the newspaper including Wall Street Journal this material is soon to be approved by the FDA If this made up of tiny beads of polymethacrylate suspended in bovine collagen ( la zyplast) and lidocaine (anesthetic). When injected the tiny beads cause the body to produce its own collagen to wall off the foreign droplets. Of 200,000 patients treated in Europe, the manufacturers reports only 15 developed the most serious complication (granuloma) tests in the US have not been as positive and there have been reports of late problems. Since the results may be permanent, we should proceed with caution. In addition, a skin test is also indicated before onset of treatment. Radiesse - this product has burst into the rejuvenation scene with a roar. The principle component of this material is synthetic calcium hydroxylapatite a biomaterial with over 20 years of use in orthopedics, neurosurgery, otolaryngology (ear nose and throat) and ophthalmology. Calcium hydroxylapatite is the main mineral constituent of bone and teeth. It is suspended in a gel carrier for injection. After instillation, the gel (carboxy menthyl cellulose CMC) is replaced by soft tissue growth, while the carbon crystals remain at the site of injection. The result may be one to three years of improvement compared to 3 to 4 months with collagen at a bargain price of $600/cc (cubic centimeter). While the initial expense may seem high, there is less need for repeated injections, which is the case with other fillers. Longer-lasting results suggest that this may be a way to go at the present time.
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Reviderm-Intra (Treviderm) This material is made up of dextran beads suspended in a non animal hylan gel. The proposed mechanism of action is similar to articoll, causing a foreign body reaction that results in new collagen formation on a permanent basis. It is used to treat wrinkles, skin defects, and in Europe for lip augmentation. A preliminary study of 300 patients seems to confirm its permanence but no FDA approval as yet. Endoplasm 50 - Another European product made up of soluble elastic particles naturally occurring in the skin suspended in cow collagen. It needs 2 skin tests and may last 1 year. New Fill a.k.a. Sculptra - A European contender made of a non animal polylactic acid supposedly biodegradable, bio-compatible and nonallergenic, good for everything including massive tissue replacement in the cheeks and hands and post liposuction deformities. It is distributed freeze-dried, has a long shelf life and like instant coffee only needs water to make it ready for use. It has been approved in the USA as Sculptra; early results are promising. Hylaform Gel - This is made from hylaronic acid taken from rooster combs of domestic stock. A more concentrated from called SYNVISC is used to treat osteoarthritis of the knees with FDA approval. It is used world wide for wrinkles, scars and lip fills, with an effect lasting up to three times as long as collagen it also is easier to inject. Who's chicken now? Biopolymer - Before we leave the injectible fillers, we should mention the questionable availability of liquid droplets of silicone (that's what I said) on a limited basis. In the hands of some practitioners it may be ideal for acne scars and fine lines. Filling The Surgical Way So far we have discussed augmentations with materials from a manufactures that only require an injection. There are a number of other products or procedures that require an incision for placement or harvesting of material. Fat Injections What a great idea! Why not make a small incision in hidden areas like the lower abdomen or buttocks, use a careful liposuction or harvesting technique to gather fat cells, and then inject them into the lips, local folds or other crevices as needed? We usually offer fat injection as an adjunct to facial surgery, but in our hands and in the experience of many
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others, the results are equivocal. Fat cells do not take as readily as skin grafts, but the use of fat injection continues. Dermal Fat Grafts have been used with success for decades with varying degrees of success. The proclivity for dermis (deep layer to be accepted makes it an ideal choice for deeper folds between the eyes and the nasolabial (nose and lip) lines. However, before implanting these grafts through a small incision, the surgeon must remove the entire layer of outer skin (epidermis). If just a few cells are left, subcutaneous cysts with infections may result. Therefore, the use of dermal fat grafts is limited.
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Some of the many uses of fillers (before and after). There are a number of synthetic products in popular use, such as GoreTex (that's the same material used for ski wear, bathing suits and the like). It is inserted under the skin to act as a filler and is stabilized by the growth of natural tissues into it. My wife has had it in her nasal reconstruction for over a decade with excellent results, but a few patients show a reaction. In passing there are two other materials in limited use. Alladerm - Human skin with living cells removed - used like Gore-Tex in folds or rolls and acts as a matrix for tissue growth. Cynetra is the injectible form.
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Before
Soft Form - A hollow tube of synthetic material inserted in the proper tissue plane to fill grooves or depressions. The tissue growth fills the tube for a permanent improvement, but (like the Three Bears) it can't be placed too high to be noticed or too low to be a waste, but at just the right below the skin. A word of caution before we continue our exploration. As you have probably guessed by now, these procedures are not like putting in a padded bra. There are some risks! 1) Bleeding or bruising - No aspirin-like medication or Vitamin E before or after surgery for at least a week. 2) Allergic reactions - Keep in touch with your doctor 3) Local skin death. 4) Bacterial or viral infections - A predilection for cold sores should be reported before treatment. 5) Irregularities of the overlying skin - Your doctor can usually correct them. 6) Shock, stroke, death, blindness - But don't worry! You have a much better chance of winning the lottery or becoming an astronaut. So what's a person to do? Know your options, know your doctor and listen to his advice. I do!
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INJECTIBLE FILLERS
Name Zyderm Zyplast Rest lane Perlane Radiesse Composition Animal Collagen Hylaronic Acid Present in all Species Calcium Hydroxyl Apatate (Synthetic) Main constituent of bone and teeth Human Collagen (no skin test required) Methacrylate, Microspheres and Bovine Collagen Hylaronic Acid (from rooster combs) Dexran Beads in Hylan Gel Silica (man made polymer) Soluble Elastin and Animal Collagen (skin test) Polylactic Acid Uses Fine lines, wrinkles Lip enhancement Fine lines wrinkles, lip enhancement Same as above +Cheekbone +Chin +Soft Tissue enhancement Same as above Zyderm and Zyplast Wrinkles and Scars Wrinkle, Scars lip enhancement Wrinkles, Atrophic scars and lips Wrinkles and Scars Length of effectivenes s 3-4 months FDA Available Yes
Pending Pending
3-4 months
Yes
2-3 months
No
3-6 months Permanent Permanent but difficult to keep from shifting 1 year
Ectoplast 50
Two years
Yes
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Blood Test
Standard Acceptable Level less than 460 mg/dl less than 4.9 mg/dl 15 micro mol/l
Optimal Where I want to be and so should you less than 300 less than 2 less than 7 less than 100 less than 100 180-220 less than 100 more than 50 less than 100 350-430
Fibrinogen C Reactive Protein Homocysteine Glucose Iron Cholesterol LDL HDL Triglycerides DHEA
less than 109 mgm/dl less than 180 mg/dl less than 199 mg/dl less than 129 more than 35 less than 199 mg/dl female 35 mcq/dl
Low density cholesterol is bad (L for Less, bad) High density cholesterol is good (H for Happy) There are some differences of opinions about the level of healthy cholesterol, but currently it is important to keep the LDL (bad) below 100 and the HDL (good) over 50. If overall cholesterol levels are too low, this may increase the chances of spontaneous hemorrhages. So what can we do about it? Pharmaceutical companies are making a small fortune (watch TV) with statin drugs (Lipitor, Zocor) that lower cholesterol dramatically. But, in what doses? The proper combination of supplements outlined in the following pages will help. If ever we needed a gatekeeper, we need one for nutrition.
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VITAMINS:
Vitamin A - Fat soluble improves the normal process of enhancing the immune system and promoting eye and liver health. Vitamin C - Cold and cancer preventative (according to Dr. Pauling) which has antihistamine, anti-viral and anti-bacterial properties. Vitamin E - Positive cardiovascular effect, decreases LDL (bad cholesterol), enhances skin health and protects cell membranes and blood cells from breakage. Vitamin B6 - enzyme activator which promotes B-12 absorption, immune system function and antibody production. Vitamin B12 - aids in food metabolism, necessary for red blood cell formation, prevents cataracts, acts in cell reproduction and growth.
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AMINO ACIDS
l-cysteine, taurine, 1-methionine, important in all phases of cell metabolism including muscle building, fat metabolism, liver, eye and brain protection.
ANTIOXIDANT MINERALS
Minerals are catalysts for many biological reactions and are important in maintaining and no nutrition would occur. Hormones, enzymes and cells metabolism are intimately associated with these trace elements. So is the proper functioning of the central nervous system, muscles and heart. Without these minerals, no skin would heal, no muscle would twitch. Zinc - Part of 25 enzymes associated with digestion and metabolism, a complement of insulin and necessary for wound healing. Selenium - Destroys free radicals and is necessary for tissue elasticity. Manganese - Necessary for the central nervous systems, for synthesis of fatty acids and cholesterol, blood sugar and central bone growth. Copper - Aids in bone fixation, hemoglobin and red blood cell activity, works with Vitamin C and zinc to form elastin, increases healing, and plays a role in hair and skin coloring and taste sensitivity.
ENZYMES
Enzymes are energized protein molecules, necessary for life which are found in all living cell. They catalyze and regulate every biochemical reaction in the human body. The food we eat, the energy we use all need enzymes for utilization. There are three enzymes types. Two (digestive and metabolic) are produced by our body when needed. Food enzymes are introduced into the body through the raw foods we ingest. Some of these enzymes have antioxidant properties. Catalase - builds up the immune system Super Oxide Desmutase - the destroyer of the most common free radicals, SOD aids in the proper utilization of copper zinc and manganese, and it revitalizes cells.
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HOMEOPATHIC HELPERS
DHEA - dehydroplandrosterone - Introduced about 20 years ago and is currently enjoying an increasing popularity. In addition to possibly controlling the levels of fibrinogen and c-reactive protein it has the ability to improve many of the symptoms attributable to both andro- and menopause. This is due to the fact that it is metabolized to produce both testosterone and estrogen, a bonus for many and a curse for a few such as men with prostrate cancer or severe prostatic hypertrophy (large size). Women with estrogen-dependent cancers should also be aware. Better to be under a physicians care!
DHEA has been shown to prevent obesity, diabetes, cancer and heart disease, stimulate the immune system and even extend longevity. These observations led investigators to theorize that some of the degenerative changes associated with human aging could be linked to a progressive deficit in circulating DHEA. Thus, DHEA may represent biomarkers of healthy aging. -- Dr. Brizell Melatonin This is a time-keeper hormone secreted by the pineal gland and is regarded by some as holding the secret to aging. It seemingly works in harmony with growth hormones to maintain tissue health and promote sleep. Its implications in being a possible anti-cancer therapy are being explored. A recent study in Europe showed a statistical improvement in the one-year survival rate of advanced metastatic (spread) cancers. To use the words of many a Jewish grandmother, it couldnt hurt to take melatonin. Besides, it helps you sleep. CoQ 10 - A Most Important Vitamin About 20 years ago this new compound was introduced to the North American market. Coenzyme CoQ 10 is a powerful antioxidant and is instrumental in protecting the mitochondria and the cell membrane from free-radical damage. Its also an essential part of the cellular respiratory cycle, since it generates ATP, the cell's energy. In addition, recent research reported the role of CoQ 10 in preserving the antioxidant property of Vitamin C, possibly preventing atherosclerosis, causing improvement in advanced heart disease. There may be a link to brain disease due to insufficiency of this nutrient. Orally administered CoQ 10 works by helping the mitochondria (energy powerhouse) regulate the transformation of fats and carbohydrates into energy.
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A biogenetic theory of aging was introduced by an Australian scientist, Linnane, which linked the relation of oxidative stress in a vicious cycle to cellular DNA defects, bioenergetic decline and aging and degenerative disease. If this is partially correct, the role of CoQ 10 as an integral part of any anti-aging regimen can not be overlooked. Alpha Lipoic Acid - The Universal Antioxidant? A leading expert in the field of free radical research is Lester Parker, who heads a prestigious department at the University of California at Berkeley (where else could you find someone making free radicals?). In his review article, Dr. Parker analyzed the biochemical reasons and other important criteria for evaluating the potential and therapeutic applications of an antioxidant. Is the antioxidant able to neutralize free radicals? Does the antioxidant have a chelating effect on metals? Does the antioxidant interact with similar components? What are the effects on gene activity? Availability and how well is it absorbed? Does it concentrate in tissue cells? Is the antioxidant active in fat and water metabolism? To be effective, an antioxidant needs to fulfill only a few of these criteria. For instance, Vitamin E acts only in fat metabolism, but has been shown to be a very important requirement. After reviewing several studies. Dr. Parker came to the conclusion that ALPHA LIPOIC ACID may be the closest substance to an ideal universal antioxidant - Why? 1. It is readily absorbed. 2. It neutralizes free radicals in both fat and aqueous (water) metabolism. 3. It regenerates other antioxidants like Vitamin C and E, CoQ 10 and some amino acids. 4. It has metal-chelating properties. 5. It may have an effect on genes and regulatory proteins involved in normal growth and metabolism. The downside is small because those patients with B12 deficiency may cause a worsening of symptoms. But aside from occasional skin rashes and hypoglycemia in diabetics, no serious side effects have been reported even at high doses.
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Whoever gets e-mail must be aware of the ever-increasing advertisements regarding the availability of HGH products in various proprietary forms. The hormonal extract, produced by the pituitary, has been used for many years to deal with delayed growth patterns in children. It is given by injection and is relatively costly. Within the past decade there has been an expansion into the commercial market. Why the interest? In 1990 a seminal study in the New England Journal of Medicine by a Dr. Rudman appeared. Although only 12 men, aged 61-81, received supplements of HGH, it was concluded that 6 months of therapy reversed 10-20 years of aging on lean body mass and fat tissue accumulation. The reports of improvement are almost unbelievable and even if only 25 percent are half-true, supplementation may be worth a try. Here is a partial list: l. Increased muscle mass and strength 2. Decreased body fat 3. Decreased blood pressure 4. Increased immunity 5. Decreased wrinkles, smoother skin 6. Increased memory and blood flow 7. Increased joint flexibility 8. Increased sexual function 9. Decreased blood sugar 10. Decreased total cholesterol 11. Increased stamina 12. Increased cardiac strength 13. Hair growth 14. Decreased PMS 15. Stronger fingernails How do we get a hold on this stuff? One of two ways - either by injection of the pure extract (expensive, but it works), or by the injection of HGH stimulants, precursors that supposedly assist the pituitary gland to release more of the hormone that declines with age. As far as we know, there has not been a really
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definitive study to show that oral growth hormone releasers get the job done, despite the claims of the manufacturers. The only thing true is that these precursors, a combination of amino acids and vitamins, can cause a slight rise in HGH, but only a fraction compared to injections of the hormone itself! But they are eminently more affordable, although you may wind up taking 20 or more pills a day. What else can we do to affect growth hormone levels? These sound like sensible ideas: 1. Don't be fat. Protein is good (Thanks, Dr. Atkins) 2. Sleep well. 3. Get plenty of exercise (aerobics for sure). 4. Controlled stress. How do we do that? Mental gymnastics, for one. (Use it or lose it!) Create opportunities to do something different (drive home a different route, learn another language, speak in public). But there surely must be a downside to HGH. Of course, there is! Some people complain of increased blood pressure, others report an increase in the size of the prostate, others still say that their fat stays. We owe it to ourselves to taste a little before we swallow it hook, line and sinker.
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The Four Gs So what is a person to do? Anyone seriously interested needs professional guidance. Although there are many claims for adding certain compounds to enhance health, there are some potential side effects, particularly for someone contemplating surgery. For instance, the four Gs (ginger, garlic, ginko biloba and ginseng) have been shown to have some deleterious effects. Ginger - It may alleviate nausea but bleeding time is increased (the time it takes to stop bleeding). Garlic - Whether your breath is bad or not, garlic can lower blood lipids and it has antioxidative properties. However, it can also increase bleeding time. Gingko Biloba - It may clear your mind a little, but it also increases bleeding time. Ginseng - It is used to increase energy, but when combined with certain stimulants, it can increase heart rate and blood pressure. It may also cause blood to clot too readily.
Summary
There you have it... This information is a mouthful, to say the least, and its an awful lot to swallow, but in divided doses, it may be just the right medicine for you.
Charge it!
Next Birthday: 57 Cell Age: 32, thanks to Dr. Brizels Chromosome Repairing Formula ($78 per month) Mental Age: 28, thanks to Smart Pills ($62 per month) Metabolism: like a 35-year-old, thanks to HGH ($231 per month) TIP: Drink two cups of coffee or tea a day. Research cant explain why, but caffeine appears to significantly reduce the onset of Parkinsons or Alzheimers diseases.
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Is it a wonder that many women go around in an emotional quandary? Are hormones the continuation of a good life or the beginning of the end? What is the news not telling the public? Can the same hormones that keep us young and vital for so many years become a slow poison as we grow old? According to many practitioners, including our Institutes medical director of age management, there is nothing much in common between the reports and the hormones produced in the body. The estrogen hormone is not derived from human sources. It owes its existence to pregnant horses. Its surprising that more women don't whinny while they're on Premarin. Similarly, Provera is derived from petroleum by-products. So is it possible to find a safer road to a longer, healthier and more youthful existence? Why have multiple cosmetic procedures to improve the facade if part of the foundation is eroding and in need of immediate repair?
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Age-Related Decline of Hormones Estrogen a 30% drop by age 50 and a continued sharp drop throughout menopause. Progesterone - 75% lost from age 35 to 50 then continuing decline Human Growth Hormone, DHEA, Pregnenoline and Testosterone 50% decrease between ages 25 and 50, then another 50% decrease to age 75 Melatonin - Minor decrease between from ages 25 to 40, then a sharp decline. What can a patient do? Lets get some hormonal level readings and compare them to the patients symptoms. 1. Energy Level - Sluggishness 2. PMS symptoms - Night sweats hot flashes 3. Mental State - Anxiety depression, memory 4. Weight gain 5. Sexuality declining interest. 6. Muscle time soreness, long recovery after using the muscle 7. Bone and Joint problems Then titrate the supplements to achieve maximum results. This means that the patient works with the doctor to find the right level of supplements for the patient. If a woman with low levels is doing fine while another with so-called normal levels has hot flashes and sagging empty breasts, then treat the symptoms and not the bad work. As a rule, start by adjusting the estrogen and progesterone levels. Unlike pharmaceutical hormones, natural supplements leave the body within 8 to 16 hours without an accumulation of effects. They are available in a number of forms. 1. 2. 3. 4. 5. 6. 7. Capsules Vaginal creams Topical creams and gels Sublingual drops Suppositories Lozenges Dermal patches
It is obvious that the dosage will vary with age, the onset of stress, menopause, but who, why, what, where, and how are questions that must be answered and asked at periodic intervals. If a person should take only one or a combination of hormones is a decision that can not be made without thorough evaluation.
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Remember that taking any hormone is like being part of symphonic orchestra. Be sure the conductor not only knows the score, but also gives you the right instruments and pills. If you know how to play them, with the right choice, you can make beautiful music together. Now, lets go on to another often-overlooked source of improvement.
TIP: When you have back pain, dont listen to your friends. Most people recommend bed rest. Unfortunately, after staying in bed more than three days, the back muscles that are in spasm also begin to weaken. The best way to recover is to gently walk. Your body was built to walk, so do it. Even a slow walk while youre in pain is better than just lying there because the other back muscles that are not in pain can be exercised.
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cholesterol and liver function studies are equivocal. In the past testosterone was used to treat breast cancer, so that may be a plus. However, the body can convert it into estrogen, so a little caution is in order. Who should consider taking testosterone? If you have an intention of having a baby, forget it! We aren't sure about patients with heart and liver disorders. So, discuss it before you try it and never start using testosterone on your own. In short, the decision is based upon a complete work up, an experienced physician and a knowledgeable client. Now let's talk to the guys.
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In recent years we have become cognizant of a problem that had fallen between the cracks - ANDROPAUSE. Walk down the street or look in the mirror, guys - the signs are there. The waist thickens and the pot belly appears, the muscles begin to lose their tone and an increasing loss of well being, libido and unexplained sadness start to fill the air. For awhile it was to be accepted as a part of growing old, but there's nothing graceful about it. That was then - this is now! Ever-increasing scientific data is appearing to prove that most of the symptoms prevalent in men over 40 are directly related to hormone imbalances. Moreover, these conditions are now correctable with available drug regimens and nutritional supplements. One of the contributing factors to the problem has been drugs prescribed by conventional medicine for hypertension, increased cholesterol and a host of other diseases that actually can aggravate the underlying imbalance.
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A major thrust in maintaining a youthful and healthy lifestyle is to check the blood levels of testosterone, estrogen, thyroid and other male hormone precursors and restore them to fit the profile of a young adult, rather than just treating symptoms. What is andropause? It is slightly different in meaning than menopause which is derived from the Greek words menses (periods) and pauesis (stop). Greek words andro (male) and pauesis (stop) and is appropriately named "when masculinity ceases" or at least begins to slow down. Malcolm Carruthers in his excellent treatise Revolution has given us several check lists for self-diagnosis before running off to seek professional help. When we compare the symptoms of menopause and andropause, we find that they are identical: reduced libido, fatigue, depression aches, aging, sweating and hot flashes. We can rate these symptoms with points as None (0), Slight (1), Medium (2), Severe (3), or Extreme (4). 0 1 2 3 4 1. Fatigue tiredness, etc. 2. Depression- low mood 3. Irritability- bad temper 4. Anxiety- nervous 5. Memory loss - decrease concentration 6. Relationship problems at home 7. Decrease sex drive - libido 8. Erection or potency problem 9. Increase skin dryness 10. Increase sweating day or night 11. Joint or back aches 12. Loss of fitness 13. Heavy drinking Total
Add 4 points for each of these - mumps, orchitis, testicular problems, prostate inflammation, vasectomy and urinary infections. Andropause rating 0-9 okay. 10-19 possible, 20-29 likely, 30-39 think about treatment, 40+ run, don't walk, for help.
Although andropause may overlap and contribute to the well-examined "Mid-life Crisis," this is another reason to seek professional help in choosing the right paths to regain a feeling of well being. I had trouble determining when or if my mid-life crisis started and ended. I know that
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a song by Peggy Lee (a former patient) called "Is That All There Is?" struck a chord in my heart and many times in my throat. TRT (Testosterone Replacement Therapy) is only one of the steps in dealing with andropause, albeit an important one. By initiating a more positive outlook, it can induce many men to drink less, exercise more, lose weight and deal with stress in a positive way. After an exhaustive work up, you may be ready for a program that may include testosterone in the form of pills, patches and pellets in combination with exercise and dieting regimens. Sounds like a no-brainer. Maybe not. There are natural concerns about possible problems involving the prostate gland, the liver and heart. This stems from the fact that the first pill produced almost 70 years ago, methyltestosterone, was found to cause liver damage (even resulting in cancer), increased cholesterol levels and prostate growth. It can still be obtained over the counter in some parts of the world and should be avoided at all costs. At the present, there are many safer forms of treatment that should be obtained from an expert in the field. It pays to do a little investigation, particularly with the Internet available. For links to more information, see DrKurtWagner.com and click on Hormone Therapy. Or go directly to www.smacboca.com.
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Medications
Viagra - If it's good for the gander how about the goose? Early studies suggest that it increases lubrication and vaginal engorgement, thereby increasing sexual response. Prostaglandin E - Currently used in men by direct penile injection (ouch) it is well suited to be a vaginal suppository or penile gel. The optimal result- the clitoris and vagina are engorged, the nerve endings become sensitized, a tingling sensation has been reported. What could be bad? Psychostimulants - Sorry, but I must get a little technical again. Many women are on antidepressants like Prozac, Zolof, and Paxil. Unfortunately, that's not all they depress due to being Selective Serotonin Reuptake Inhibitors (SSRI's). I've said it-- remember it for just a little while. Suffice it to say that it to say that amphetamine compounds (diet pills)and the like in low dosage enhance sexual libido, women usually more vigorously than men. However, caution is in order because of the potential danger of addiction, arrhythmias and side effects. Ephedrine - The sympathetic nervous system is an integral part of sexual response, particularly during height of arousal. It stands to reason medications and activities that increase peripheral sympathetic response will have a positive effect on excitations. Studies have shown that exercise increases vaginal blood flow and physiological response. Ephedrine should theoretically be a perfect fix. Its plant origin, Ma Huang, has long been marketed as a sexual nutritional supplement. But the use of ephedra as a suppressant for weight control has come under attack, being removed from the market with rapidity and zeal in the wake of a recent $600 million law suit due to the death of a baseball player. Maybe we should really shelve this idea and go to the gym instead.
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Wellbutrin - Pay close attention to this one, because not only is it an effective antidepressant, it's a proven aid to kicking the smoking habit, it does not work by being a SSRI (now you can forget the medical reason). Not only does it not affect serotonin metabolism, but while it is a chemical derivative of ephedrine, it is not metabolized to amphetamine, is not a scheduled drug and has not been found to be abused in over 15 years of use. It works by increasing dopamine reuptake which consistently has been associated with pleasure and sexual arousal in both male and female animal research studies. It may take 10 to 14 days to kick in, but it's worth it. Dephrenyl - It's an adjunction to treat Parkinson's Disease, and a dopamine activator. Male rats love it and their sexual desire virtually increases in leaps and bounds. We're not sure but it may have a mild effect on the ladies and is safe with little side effects. It has enjoyed some attention because it's main chemical action releases a massive amount of PEA (PHENYLETHYLAMNE) the chemistry of love component found in chocolate that has been labeled as an aphrodisiac (Sorry no research to back this up, so stay on your diet). Oxcytocin - This is a "touch" hormone secreted during human and animal intercourse, particularly at climax. It is frequently used to induce labor contractions and to treat post partum milk letdown. Some women have reported tremendous increase in sexual response after oral spray to treat these post partum problems. Since it is intimately associated with the presence of estrogen, HRT therapy may resolve a menopausal oxcytocin deficiency. Research continues. Testosterone, Estrogen We've discussed it at length, there's no doubt that these hormones are some of the things you can't do without. Go back and check out the previous section.
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Alternative Medicines
Ginko Biloba - The Chinese have loved it for centuries. It may: 1. increase vascular flow to the genitals 2. increase activity of prostaglandins 3. affect serotonin and norepinephrine activity 4. but remember it also thins the blood! Ginseng - it may increase the efficacy of the body' own sex hormones, but it also may give hormonally sensitive tumors a boost, so beware! Ma Huang - We have already panned this one enough. As you can see there is a marked cross over in potential efficiency and problems as well. DHEA and testosterone are among the more common supplements with the limitations duly noted. The time is here to recognize that both sexes deserve whatever help they can get to lead a useful life behind closed doors as well. It's obvious that we need a guide, now more than ever, but the results are well worth it!
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Now, let's get down to the subject at hand. One out every two Americans is overweight and our children and grandchildren are heading there at a precipitous rate. How many people have become rich telling us what or what not to eat, what time and in what combination to nourish ourselves, what pills or spells to expose ourselves to in the quest for a better me? We've touched on emotional and binge eating. Before you throw your hands up in frustration and head for the refrigerator, we'll give you a compass to help you stay on course.
Obesity
What is obesity? Simply defined, it is too much fat for your body mass. As you all know by now, it can open a Pandora's box of problems - type 2 diabetes, high blood pressure, gall stones, and arthritis for openers. Of course clinicians have a handy table for calculating it - THE BODY MASS INDEX (BMI).
BMI TABLE
Weight (Pounds) 5'0" 5'3" 140 150 160 170 180 190 200 210 220 230 240 250 27 29 31 33 35 37 39 41 43 45 47 49 Height (feet, inches) 5'6" 5'9" 60" 25 27 28 30 32 34 36 37 39 41 43 44 23 24 26 28 29 31 32 34 36 37 39 40 21 22 24 25 27 28 30 31 33 34 36 37 6'3" 19 20 22 23 25 26 27 29 30 31 33 34 18 19 20 21 23 24 25 26 28 29 30 31
Desirable = 19-24 Overweight = 25-30 Over the top = more than 30. This table will let you know what your BMI score is, unless you're built like the Hulk.
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Zone - If you like the middle of the road and agree that high carb living
can be "dead wrong, this is for you. Proponents maintain that 40% carbohydrates, 30% fat, 30% protein is the ratio that promotes youthful energy and vigor.
Eat More, Weigh Less - Dr. Dean Ornish, well known for his
success in reversing arterial heart blockages without surgery or drugs, takes a different approach. He contends that a high-fiber, low-fat vegetarian diet will keep you healthy while losing weight. In addition, he champions exercise and has a different notion of the origins of our eating habits in prehistoric times. If you can live without meat, all sugar
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and most fat, be my guest. There's no doubt you may live longer if you don't go crazy at mealtime.
Pritikin Plan - If you're over 40, you've at least heard of this, a lowfat diet based on vegetables, grains and fruits. For over 30 years, thousands of people have gone to Pritikin Longevity Centers, learning how to eat and prepare meals while reducing stress. Exercise is a necessary ingredient. At the present time, Pritikin has introduced the "Calorie Density Solution. Fill up on foods that have relatively fewer
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calories per pound and you will stay healthy and slim. If a pound of chocolate chip cookies has 2140 calories and a pound of cucumbers has 100 or so, which one should the dieter choose? That's a quick overview: easy to put down on paper, but hard to stick to in the real world. Some of us turn to prescriptions and herbal assists in times of need or frustration, so a brief scan of the popular ones is in order to set the record straight.
TIP: Exercise keeps your brain alert, too. One of the reasons that people turn to HGH is to keep the mind functioning smoothly. But lifting free weights (dumbbells) in particular stimulates synapses in the brain to maintain balance. So do feats of mental agility: trivia contests, vocabulary quizzes in Readers Digest, sudoku, crosswords (the tough ones) and reading complex articles. Warning: most newspapers are graded down to a 14 year olds vocabulary, so look for tougher material.
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Meridia
Meridia is the only weight loss medication currently approved for long term use but recently questions are being raised about its safety as well. Be careful! Another category of medication is the fat absorption inhibitor-Xenical, also approved for long term use. It prevents the body from breaking down and absorbing fats eaten during meals, eliminating them in bowel movements. Do they work? If you think that a loss of 5-22 lbs over a year is ok-yes! Some people have lost more than 10% of their body weight, but effectiveness diminishes after 6 months of use. Potential addiction is always a consideration, not to mention other side effects like hypertension, sweating, constipation, headaches, and anxiety, to name a few. As far as Xenical is concerned, there's a whole new can of worms to consider. Open it and you may find frequent gas and oily discharge, spotting and the need to be near a toilet more often than not. If that's not enough, because of the blockage of the absorption of fat-soluble vitamins, we run the risk of getting certain deficiencies if we're not careful. In spite of what the Internet says, stick to your doctor!
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Over-the-Counter Remedies
Foolish enough to try it on your own, without some proper medical advice? We'll go though some of the more popular products, most of which are appetite suppressants, lately combined with so-called fat or carb blockers. Ephedrine (Ma Huang) - It is an integral component in the production of "speed" and following the recent death of a professional athlete it has left the market with the speed of a Blitzkrieg. Let the buyer beware! St John's Wort - Primarily touted as an antidepressant, it has so many problems that now that we've said it - forget it! Guarana - It speeds up brain activity and is used to promote weight loss by its stimulant and diuretic properties. But its 2-5%caffeine content raises blood pressure not to mention other possible effects like nausea, nervousness, and dizziness. Chitosan - It's the rage now because this preparation made from starch found in shell fish skeletons does bond with fats in the GI tract and is not absorbed. In theory, it should work but in practice the amount you really have to take with a meal is a meal in itself! 5 Hydroxytrytophan (5HTP) - Found in some weight loss formulas Aside from the fact that it contains a contaminant linked to a rare fatal blood disorder It has no redeeming qualities! Danger, Will Robinson! Aloe - It's a major component in balms and cosmetics and a swig of this will really clean you out! However, sometimes it doesn't know when to stop and can lead to cramping, diarrhea, not to mention nutritional deficiencies. If that's not enough it can interact with Digoxin a drug used to treat heart failure. Forget it! Dandelion - It's a diuretic, but some people think it has a link to cancer. Better left growing in a garden. Glucomannan - Watch out for this one! Made from a root, this herb works by delaying the absorption of glucose from the intestines. It does seem to promote weight loss by swelling up the gut to create the feeling of fullness. The only trouble is that somewhere along the way quite a few people have gotten a little too full , resulting in intestinal and esophageal obstruction !It's even banned in some countries. So?
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Guar Gum - It's a thickening agent for food and medications and works like glucomannan. Same problems plus blood sugar level fluctuations. Steer clear! Herbal Diuretics - Most of these come from caffeine and are found in many over the counter compounds and herbal products. Various products can cause renal failure (juniper), brain damage (equistine), or convulsions (horse tail or shave grass). If that's not enough, they don't work either! Pyruvate - There is at least something positive we can say about this one. It is a by-product of carbohydrate and protein digestion and may do some good. Its presence in red wine and apples makes it relatively safe.
Conclusions?
I know we've touched a few nerves in this part of the journey, but let's try to summarize some salient points. To be effective, you must consider changing a lifelong lifestyle. Besides eating well, you need to increase and handle psychological problems more efficiently. Make sure that whatever path is chosen, it must lead to a place that provides life-long comfort and easy compliance. Dont look for a quick fix - slow and steady wins the race. If you need help, dont be afraid to hold out your hand. Just make sure that whoever grabs it is the right kind of guide!
LAUGH TIP: For Your Circulation When we laugh, the linings of the blood vessels expand and positive chemicals flow.
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As long as we don't get too overzealous and have expectations beyond our ability to reach them ,what you have to lose is a lot of bad things, while gaining a potpourri of positives. The two types of exercise are aerobic and anaerobic. The former stresses the development of cardiovascular strength by intermittent increases to the heart rate at periodic intervals. In that way the heart becomes more efficient by increasing the amount of blood pumped at each beat. A person with an "athletic heart" has a far slower heart rate at rest with a marked capacity to instantly rev up when the situation arises. No mystery to joggers, runners, swimmers, racket ball players and bikers. Anaerobic exercise involves short bursts of exercise followed by periods of rest like weight lifting or pushups. This is designed to increase the strength and capacity of muscles. Although it does not burn fat like aerobics, bigger muscles burn more calories, even at rest. So a combination of the two types are the ideal.
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What is the ideal synergistic program for the individual? Obviously it depends on age, health goals and needs but one thing is certain the big picture. Do it! Start today!
ANAEROBICS Exercise that focuses on isometric resistance, strengthening muscles and weightlifting If you have a gut or cellulite dont think that doing crunches and squats will work off a specific area. Thats not how the body works. If you want to build muscle in a particular area you can make it look younger and firmer but the only way to get ride of a trouble spot is through a program of exercise and calorie control diet. You lose it under the chin before you lose it under the belly. LAUGH TIP: For Your Belly Theres another way to get around those sit-ups. Laugh. Instead of walking for a half hour or spending ten minutes a day on a rowing machine, you could be laughing heartily, since belly laughs increase the heart rate.
Heredity
Some of us are unlucky enough to have a defective gene responsible for the production of collagen, a major component of cartilage. This results in more rapid deterioration of joints, even with common use. It may have been fun to be "double-jointed" as a kid, but this leads to more erosion as an adult. Spine abnormalities like scoliosis or curvature of the spine predispose the patient to problems in later years as well.
Obesity
The age old culprit rears its head again. Remember that we are machines and overloading weight bearing areas increases the risk of wear and tear, particularly of the back, hips, and knees.
Injuries
Have you seen a football game lately? They may look like heroes when they go back on the field, taped and anesthetized, but look at them 20 years later! Broken bones and severe falls don't help either. Overuse of certain joints such as fingers and knees increases the chances of developing OA.
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What is Cartilage?
We've all seen it in its natural form if we've eaten a drumstick. It's that firm, glistening, rubbery material covering the ends of bones in normal joints. Its function is to reduce friction and act a "shock absorber. Because it contains more than 70% water, cartilage can change shape to absorb impact with change of position by compressing then rebounding to its original form. When we walk or stand, some water leaves the cartilage to coat the joint. When we sit down, the water returns to restore the lining to its original shape. As we age, the cartilage may wear down, the water content decreases, diminishing elasticity, increasing stiffness and susceptibility to damage. Tendons and ligaments stretch, bones rub against each other without a cushion resulting in pain and deformity.
Normal Joint
Osteoarthritic Joint
Source: medline.gov
When a joint is inflamed, the cartilage breaks down and the ease and range of motion is compromised.
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OA is usually treated by medications, supplements, hot and cold applications, the use of crutches or canes, weight control or a combination of modalities. Occasionally surgery such as hip or knee joint replacement is necessary when the damage is irreversible and pain is intolerable. Medications 1. Pain relievers such as non-steroid, anti-inflammatory drugs (NSAID) such as aspirin naproxen, ibuprofen, Tylenol and Celebrex. 2. Creams, sprays of many of the above ingredients applied directly to the affected area. 3. Unfortunately, there is no concrete proof that any of these remedies reverse or slow down the progression of OA. Patients seeking effective alternatives have spurred a remarkable increase in the use of supplements. Supplements 1. Glucosamine - there are several published articles from reputable sources attesting to its effectiveness in repair and maintenance of joints. 2. MSM (methylsulfonylmethane) - this is a natural occurring compound found in all living things that acts as an analgesic and antiinflammatory agent. It is important in the constant renewal of cell structure and there are reports of an 80% decrease in pain after 6 weeks of use. 3. Vitamins - C, D, K, and E all have been shown to play a role in maintaining joint health and facilitating bone and cartilage metabolism. 4. Minerals - silica, boron, zinc, manganese, selenium, molybdenum, and copper. More and more of these ingredients are found in multivitamin formulations or the health food sections. 5. Omega-3 fatty acids - no difficulty in adding this compound, because even if there were no other advantage, its protection of the cardiovascular system is well established. We should note that chondroitin sulfate, a compound usually combined with glucosamine in many popular anti-arthritic compounds, is poorly absorbed from the intestinal tract and is of no essential value in the treatment of OA. Exercise What better way to improve joint movement and strengthen the surrounding muscles to diminish the strain of motion? Be smart and stick to low- impact or non-impact workouts like swimming, walking, or biking on flat surfaces. Unless you're a masochist and enjoy more pain, skip jogging and high-impact aerobics.
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Heat and Cold Therapy Good for the temporary relief of pain and stiffness. For many, there's nothing like a hot bath to start or end the day. Supports Canes and crutches, but let's work hard to never get there!!!! Weight Control Hard to digest as we've already discussed, but the benefits are not necessarily confined to the better looking image in the mirror. Surgery I've had two hip replacements already, thanks to some screwed-up genes, so here I can speak from personal experience. This procedure, together with knee-joint replacement, is becoming more commonplace. There are some limitations of activities (goodbye, tennis), but pain relief and the promise of relative permanence of the prostheses as the implanted materials and design improve with each passing year make this a godsend for countless sufferers. Walking is a lot better than a wheel chair! The Future We have recently seen the introduction of SYNVISC, a hyaline compound that is injected directly into knee joints, resulting in remarkable improvement in symptomatology. What doors will stem cell research open? Our knowledge of genetic structure is another path to explore. But for now, the best we can do is treat our body like the temple it is, and maintain it inside and out even if Mother Nature throws us a few curves. TIP: When you have back pain, dont listen to your friends. Most people recommend bed rest. Unfortunately, after staying in bed more than three days, the back muscles that are in spasm also begin to weaken. The best way to recover is to gently walk. Your body was built to walk, so do it. Even a slow walk while youre in pain is better than just lying there because the other back muscles that are not in pain can be exercised.
You name it, we'll frame it! If your face or body is unbecoming to you, you should be coming to us!
To make it simple we have enclosed a compendium of common cosmetic surgical procedures well take them one by one and see what's new or different.
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Face and neck lift, nose surgery, eyelid surgery and chemical peel. Look what a few procedures can do when skillfully brought together
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Brow lift Forehead and Browlift - The endoscope has changed the method more than any other technique. With proficiency, lines, muscles and wrinkles can be removed or modified through several small incisions.
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Eyelid Surgery - There is an increasing awareness of the need to consider taking up skin and ligaments for a more esthetic result. In addition the laser makes tightening of the skin much easier without any excision. We also use incisions inside the lower led to remove extra fat eliminating the external scar. Eyelid surgery: East and West (Eyelid incisions)
The surgical change from Oriental upper eyelids to Western upper eyelids. This procedure creates an extra upper fold for the eyes, changing the Asian upper eyelid to resemble the Western upper eyelid.
Left: A 25-year-old woman with congenitally heavy upper eyelids. Right: Five months after surgery, the upper eyelids are finer and the eyes appear more alert.
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Nose Surgery - There is an increased use in the open technique. The roof of the nose is degloved of its skin (sounds a lot worse than it is) and the surgeon is able to more correctly assess the amount of bone, cartilage and septum to realign. However, good surgeons still do it well the old fashioned way.
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A nose job -- Open and shut Chin and Cheekbone Surgery - Newer implants with different shapes (I am proud to have initiated many of the changes) in friendlier materials make for an increasing ability to modify the skeletal structure on a more natural esthetic basis.
Cheek Augmentation and Otoplasty This is a 38-year-old man who had congenital hemiatrophy (loss of half) of the right side of his face and of dumbo ears. Had a siilicone implant in his face and repair of ears.
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Trading Faces
What a good plastic surgeon can do
Before
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Quite a finish
Before 6 months later Face lift, eyelid lift and liposuction of the neck
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Facial Implants
Side view
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Before After Chin Implant with a nose job Quite handsome now! Double Chin Surgery or Neck Sculpture - Liposuction has made this an easy procedure in some cases, but direct excision still works very well.
Chin augmentation with nose job, eyelid lift and face lift.
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Skin Rejuvenation
Chemical Peel - Tried and true by those who know, but rapidly succumbing to ... Laser Face Peel - Latest advances seem to promise results similar to and in selected cases better than chemical application see the laser chapter. Look at the following tables, I hope you have chuckled at some of my illustrations, marvel at some of the possibilities, and when you're ready, let's move on down the road.
Laser peel
Body Procedures
Liposuction - It didn't even exist when I started practice. Now its all the rage, but beware -- know the operation and the operator.
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Tummy Tuck - If only muscle tightening is necessary, endoscopy may suffice. Liposuction at the same time may obviate the need for a larger incision.
Before liposuction and a tummy tuck.. After. With a little help, but a long way to go Body Lift - With the increasing amount of weight loss in some patients secondary to bariatric surgery, greater amounts of tissue are removed and moved at the same time to achieve remarkable results.
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Body lift
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Breast Reduction - With newer techniques the traditional anchor incision may be replaced by smaller incisions around the nipple only or with a smaller longitudinal excision.
Before
After
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A good result. Breast Augmentation - After over 40 years of use, this procedure has survived a decade of controversy and is more popular than ever. While there is still some debate about the permanence of the implant and the choice between saline and silicone gel newer techniques allow smaller and smaller incisions to put in almost any size implant and with the use of the endoscope, some operations even utilize the belly button as the entering point.
Breast Augmentation
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A little of both
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Sometimes we can get more than two birds with one operation
Before After Chin Augmentation and neck lift, plus Rhinoplasty (nose job) Forehead or brow lift What Doctors Call It: Brow pexy What Does It Involve? Lines and wrinkles are modified by relaxing key muscles; the doctor advances or removes excess skin Operating Time: 1 to 2 hours How Long Does It Last? 5 to 10 years When Are All the Stitches Out? 10 to 14 days Return to Work or School: 10 to 14 days
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Otoplasty Ear Surgery What Doctors Call It: Otoplasty What Does It Involve? Cartilage reshaped to pin back ears Operating Time: 1 to 2 hours How Long Does It Last? Forever When Are All the Stitches Out? Not applicable Return to Work or School: 7 days Chin surgery What Doctors Call It: Mentoplasty What Does It Involve? Implants to augment receding chin or small cheekbones. Operating Time: 30 to 45 minutes
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How Long Does It Last? Forever When Are All the Stitches Out? 5 to 7 days Return to Work or School: 5 to 7 days Cheekbone surgery What Doctors Call It: Malarplasty What Does It Involve? Often done in combination with facelift or rhinoplasty to improve profile Operating Time: 30 to 45 minutes How Long Does It Last? Forever When Are All the Stitches Out? 5 to 7 days Return to Work or School: 5 to 7 days
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Double chin or neck sculpture What Doctors Call It: Sub mental lipectomy What Does It Involve? Fat deposits excised or suctioned out muscles may be tightened Operating Time: 1 hour How Long Does It Last? If you do not gain weight, forever. When Are All the Stitches Out? 5 to 7 days Return to Work or School: 7 days
Before
After the chin and cheek augmentation with rhinoplasty (nose job) and blepharoplasty (eyelid) Chemical peel What Doctors Call It: Chemical exfoliation or facial rejuvenation What Does It Involve? A caustic solution removes the outer skin layer, decreasing wrinkles, age spots and pigmentation problems. Operating Time: 1 hour How Long Does It Last? Some results last forever, depending on the agent. When Are All the Stitches Out? Not applicable Return to Work or School: 10 to 14 days
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Laser face peel What Doctors Call It: Laser rejuvenation What Does It Involve? Similar results as in chemical peel, but using a laser beam. Operating Time: 1 hour How Long Does It Last? Depending on depth and type of laser, years to forever When Are All the Stitches Out? Not applicable Return to Work or School: 7 to 14 days
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lasting rejuvenation. Combined with a minilift and a full face laser procedure, it is a welcome addition to our armamentarium.
LAUGH TIP: For Your Face Fifteen muscles are involved with making a smile when we laugh. Benefits include improved blood flow, which explains why we get a healthy glow when we laugh (and thats good for others to see!).
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Body Procedures
Breast augmentation (breast enlargement, bigger breasts) What Doctors Call It: Augmentation mammoplasty What Does It Involve? An implant is added to enlarge the size and improve the breasts shape. Operating Time: 1-2 hours How Long Does It Last? Forever; you might have to swap inserts When Are All the Stitches Out? 7 to 10 days Return to Work or School: 7 to 14 days Breast Reduction (smaller breasts) What Doctors Call It: Reduction mammoplasty What Does It Involve? Large breasts reduced and made firmer by removal of excess tissue Operating Time: 2 to 3 hours How Long Does It Last? Forever When Are All the Stitches Out? 7 to 14 days Return to Work or School: 10 to 21 days Breast Lift What Doctors Call It: Mastopexy What Does It Involve? Excess skin is removed and breast tissue is sewn together to increase support and elevate the nipple. Operating Time: 90 minutes to 3 hours How Long Does It Last? Forever When Are All the Stitches Out? 7 to 14 days Return to Work or School: 7 to 14 days Liposuction What Doctors Call It: Suction assisted lipectomy What Does It Involve? Fat is suctioned from thighs, hips, abdomen, face, etc. Operating Time: 45 minutes to one hour How Long Does It Last? If you do not gain wait, forever. When Are All the Stitches Out? 5 to 10 days Return to Work or School: 10 to 14 days
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Tummy tuck What Doctors Call It: Abdominoplasty What Does It Involve? Loose skin is removed, muscles are tightened; the procedure is sometimes combined with liposuction. Operating Time: 2 to 3 hours How Long Does It Last? Forever When Are All the Stitches Out? 7 to 21 days Return to Work or School: 10 to 21 days Body Lift What Doctors Call It: Circumferential Torsoplasty What Does It Involve? Loose skin is removed from the front, back and muscles, and lower skin is advanced to higher levels, like a pair of pants Operating Room Time: 6 to 8 hours How Long Does It Last? Forever When Are All the Stitches out? 14 to 21 days Return to Work or School: 21 days
Give us two weeks and it just may benefit you for the rest of your life !
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Surgical procedure
Abdominoplasty (tummy tuck) Blepharoplasty (cosmetic eye surgery) Breast augmentation Breast lift Breast nipple enlargement Breast nipple reduction Breast reduction Buttock augmentation Calf augmentation Cheek implants Chin augmentation Face lift Forehead lift Hair transplantation Lip augmentation Lipoplasty (liposuction) Lower body lift Otoplasty (Cosmetic ear surgery) Rhinoplasty (nose reshaping) Thigh lift Umbilicoplasty Upper arm lift Procedures for men Gynecomastia, treatment of (male breast reduction) Pectoral augmentation (male chest) Total Surgical procedures
79,709 192,777 249,641 62,453 501 2,205 125,614 1,909 101 7,033 19,598 113,463 58,653 864 25,512 316,469 4,378 16,698 118,028 4,026 1,363 6,180 16,551 671 1,424,939
96% 84% 100% 100% 93% 87% 100% 91% 67% 77% 83% 91% 90% 5% 98% 85% 91% 50% 75% 96% 66% 98% (men only) (men only) 85%
Non-surgical Procedure
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Botox injection Cellulite treatment Chemical peel Collagen injection Dermabrasion Fat Injection Laser hair removal Laser skin resurfacing Laser treatment of leg veins Microdermabrations
1,424,939 46,671 453,505 729,075 16,131 67,540 588,549 68,248 52,271 936,228
86% 99% 92% 93% 84% 90% 80% 94% 99% 91% 98% 88.7% 88.3%
LAUGH TIP: For Relief from Pain Research has shown that we can tolerate a higher threshold of pain while laughing. Comedies and funny videos might be part of everyones pain management program.
That's part one - the viewing device. To actually perform the surgery, a separate incision must be made in a different location through which a surgical instrument (such as a scalpel, scissors, or forceps) must be inserted and taken to the tissue to be worked upon. For the younger generation accustomed to using both hands for computer games, it's a no-brainer. For some of the more seasonal vets, it takes a little getting used to. There are some obvious advantages. With an endoscope the scars are much smaller, likely to be hidden and the recuperation shorter. Let's go through a procedure relevant to cosmetic surgery to illustrate.
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Forehead Lift: Prior to endoscope use it was necessary to make a long incision usually from ear to ear to do the job. With the endoscope, 3 or more incisions less than 1" are all that is necessary to disrupt the muscles and raise the eyebrows. The risk of sensory loss from nerve damage is decreased as well as the possibility of bleeding bruising or swelling. In addition many other endoscopic procedures can be performed under local anesthesia and sedation with out an overnight stay.
Forehead lift
Under the right conditions it can be used in tummy tucks, breast augmentation or evaluation of existing conditions such as capsular contraction, and face lifts particularly med force elevation. The downside - All surgery carries a certain amount of risk and every incision leaves a scar. Because, endoscopy is a relatively new technique in plastic surgery it's more important than ever to make sure that your choice is the right one. Nothing can beat training and experience. Our center is the paragon of the above.
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A Thought
Im too young to have a full face lift. Im thinking of doing a simple thread lift. Response: Are you over 40? How long will a thread lift last? Five years, maximum? Why not think about a full face lift, which lasts a lot longer? Why should I go through two procedures? I would rather get it all over with in one operation. The general rule is: If you have a choice between a simple procedure that lasts less than five years and a more complex procedure that lasts longer, which will you take? Most people will suggest the more permanent solution because you dont have to go through the preparation for surgery a second time so soon! I cant get over the change in my gums. They used to bleed. I started taking hormones and now my dentist tells me that I have great gums -- Linda M., Fort Lauderdale, Fla. Response: Hormone therapy and HGH often help restore strength in the gums.
Scton: one of our favorites The fundamentals of lasers was first described by Albert Einstein in the early 1900s. Not to belabor his work which defies understanding to all but the smartest of us, lasers are the result of electromagnetic radiation reacting with matter in such a way to produce a light beam. The beam has been harnessed to trial a myriad of medical conditions as well as fording a place in many commercial enterprises (aerospace communications) LASER (Light Amplification by Stimulated Emersion of Radiation) it took over 40 years to put it into medical practice. Theodore Marman is given the credit. He created his laser by polishing a synthetic crystal at both ends and wrapping it in a flash tube. The first physician to bring lasers into the medical field was Leon Goldman, a dermatologist who did much of the early work using a ruby laser to treat childhood birthmarks. He and some brave souls started the American Society of Laser Medicine and Surgery, which brought increasing attention to other specialties. The early use of laser consisted mostly of removing birthmarks, tattoos, and benign skin lesions. Although there were some problems, (skin
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pigmentation and scaring), there was enough interest to start research on the effects of light beams on tissue interaction and reaction. With each year, newer and more diversified machines were developed and its use in treating other conditions increased, much like an Orwellian novel. Various attributes of the light production became obvious. The theory of SPTL (Selective Photo Thermolysis) was introduced in 1983. This explained how the benefits of treatment could be controlled or altered by varying 3 factors: wavelength, pulse duration, and energy loading. What this means in plain English is that some lasers can treat the surface like chemical peels, while others can go below and stimulate cell production. Hoping to not having thoroughly confused you as one might be when they read about all the machines available and the prices (wow), let's see what a successful experience can and can't do. VASCULAR LESIONS (problems with blood vessels) Port wine stains - One of the earliest conditions to be treated, requires multiple treatments, starting the younger the better. The improvement is remarkable and clearing can be complete. Hemangiomas - This is a condition of abnormal blood vessel proliferation. If they are close to the surface of the skin, improvement is considerable. Deep cavernous lesions do not respond because the efficiency decreases in relation to the depth of penetration. Telangectasias - Spider veins and superficial deleted blood vessels can be effectively cleared in one or two treatments. HYPERTROPHIC SCARS, KELOIDS - Some improvement results because of the destruction of the superficial blood vessels. In addition, the laser can flatten scars by releasing collagenase, an enzyme the decreases scar formation. TATTOO REMOVAL - What has awakened the dormant genetic need for self mutilation that dates back to the Stone Age (1200 BC) and permeated ancient civilization (Egypt, China, New Zealand, etc.)? Tattooing is still is practiced with a vengeance in parts of Africa and the South Pacific has provided a boon to some laser specialists. A study in 1991 by Candela Laser Corporation suggested that 9-11% of adult men in the USA, have tattoos, but 50% regret their decision. Not withstanding the athletes and entertainers who serve as role models, the tide will surely turn as every fad runs its course.
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Before lasers we used acids, dermabrasion, and surgery over tattoos with unacceptable results. Since 1979 laser treatment has become increasingly effective and is currently the treatment of choice.
Tattoos removed by laser. PIGMENTED LESIONS Oh, beauty, where is your mark? For some movie stars and models, their signature, for others an unsightly blemish. There are many lesions amenable to improvement, but not all. The most common ones treated by laser are sunspots, usually in the older population (greater than 40). However, some lesions are a definite no-no! The ABC rule provided here is for the doctors and patients alike: Avoid treating a cancerous lesion Biopsy anything suspicious Consult a specialist before laser treatment The key is not to have visions of sugar plums in our heads, when all you can expect are some M and M's. LASER HAIR REMOVAL - For all the female hair pluckers and shavers and the males resembling King Kong, what a breakthrough! Before lasers, electrolysis was the only Rx available -- with poor results. At the present time, this safe and effective technology is available.
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Aside from unwanted facial, trunk and extremity hair, some follicles pulled behind the ears in men after face-lifts can be zapped as well as growth in the ears. In addition, removal from flaps used for reconstruction and pilonidal cysts are some of the other applications. INCISIONAL SURGERY - (What a cutup) This started over three decades ago, fell out of favor because of post operation healing problems, and has reemerged with the advent of better machines. At present, its use is increasing in eyelid surgery, with somewhat less acceptance in face lifts, hair transplantation and endoscopic eyebrow and forehead lifting. However, its utilization is directly proportional to the experience of the operator, so a little investigation is in order. Laser Resurfacing The modern concept of treating photo aging is to use a combination of modalities. Before the availability of laser machines, popular methods for removing the superficial layers of the skin and permitting regeneration included dermabrasion (scrubbing the skin) and chemical peels. Unfortunately, many of these results depended upon the skill and experience of the operator. However, the first popular laser, which used a continuous wave of carbon dioxide, produced similar results in the wrong hands. The problems usually were due to excessive damage to the dermis, inhibiting regeneration and resulting in prolonged healing times and in some cases severe scaring. To some extent, this has been limited by the introduction of lasers that bypass the surface and attack several components of the extra cellular matrix (the under surface mentioned earlier), resulting in tightening and other signs of rejuvenation. The combination of preparing the skin by the application of certain creams (alpha hydroxyl compounds) before treatment, whether by lasers or by surgery and laser in combination, followed by a regimen to maintain the benefits for treatment makes one thing clear. Know your doctor, preferably your entire team of care givers, before you make your decision! The following tables will help.
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Nw 42nd st.
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Potential for Systemic toxicity Laser: No Chemical: Yes Dermabrasion: No Swelling Laser: Moderate Chemical: Massive Dermabrasion: Massive Pain Laser: Minimal to none Chemical: Severe Dermabrasion: Severe Risk of hypopigmentation Laser: Mild to moderate Chemical: High Dermabrasion: Mild to moderate Reliance on delayed scar contracture for result Laser: Minimal Chemical: Total Dermabrasion: Moderate
A Laser result.
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From Dr. Wagners cartoon collection (a gift by the artist) Regional anesthesia involves the blockage of nerves to the operative site, most commonly by epidural or spinal techniques. It is also used in hand surgery by blocking the nerves in the axilla (armpit) this by some sort of intravenous sedation to ease the anxiety invariably accompanying entrance into the OR suite. General anesthesia is becoming more and more common in outpatient facilities. Technological improvements and drug advances with high tech monitoring equipment make even the longest procedure practically risk free. Today's anesthesiologist, using short-acting narcotics and modem anesthetic gases, can control the level of anesthesia provide complete amnesia for recall and control post operative nausea. Post operative recovery can now be measured in minutes instead of hours. Getting anesthetics is very analogous to taking a trip. The shorter the trip, the less you need. The longer excursions are like airplane rides - the take offs and landings require the greatest skill. In addition while you're in the air, no one should switch to autopilot! Now we come down to the nitty gritty - choosing the pilot. Taking local anesthesia aside for a moment when we deal with general anesthesia techniques we have a choice - nurse anesthesia or anesthesiologist. Only one is a doctor. It's very much a kin to delivering a baby. Who would you rather have at the foot of the bed? A midwife or an obstetrician!
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I was blessed to have a 25-year relationship with a Dr. Tom Gumas, whose skill saved me a lot of wear and tear on my coronary arteries. At our center ASI it seems to me that we have a clone, Dr. Kenneth Kushner. He is what every doctor should be kind, caring, skilled and efficient. And incidentally, he happens to be a great pilot as well. Now remember, if your decision is to have a surgical procedure in your quest to stay on the path to Youngstown, make sure that the person with the potions at the head of the table knows his stuff. He or she shouldnt mind a few questions about the depth of his or her skill and your depth of anesthesia. TIP: Dont worry about cracking your knuckles. Remember seeing who could make the loudest click during those boring lectures in 8th grade? Well, your mothers scolding about youll get arthritis if you keep doing that was accurate only if you felt pain while cracking the joint. When the two bones move quickly apart, the motion causes gas to be expelled, making the snap sound. Keeping the joints flexible is a standard technique in yoga and encourages less rigidity in later life.
www.smacboca.com
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Chapter 13 FROM THE TOP OF YOUR HEAD TO THE BOTTOM OF YOUR FEET Weve covered a lot of ground and now lets get more specific about some areas that will affect many of us in our life journey. Well go down the line to open some doors or, at the very least, open some eyes!
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techniques have minimized gargantuan surgical efforts in favor of medication and Micro Surgical procedures.
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Typical result after six months Medical Treatments 1988 marked a milestone in the treatment of hair loss, when the FDA approved the first medication for scalp applications to regrow hair Minoxidil (2 to 5 percent). It was obvious that, while it could slow down or halt hair loss and even regrow hair in the vertex in some cases, the frontal areas remained unaffected. In addition, daily application is necessary for the medication to be effective. In 1997 another step forward was achieved. Propecia (finasteride) became the first anti-hairloss pill to gain FDA approval. Available only by a doctor's prescription, over 1 million men in the US take Propecia daily. In contradistinction to Minoxidil, most users reported an increase in hair count, a decrease in hair loss, and an improvement in appearance. This has been joined by Avodart, which is more effective and treats prostatic hypertrophy as well. Asteride compounds work by decreasing the formation of the hormone dehydrotestosterone (DHT), a key factor in the development of male patterned baldness. Although this is a major step, there are several short comings. It takes several months up to a year to start seeing some results. If your hair loss is long-standing (shiny bald), the chances of salvaging follicles decrease dramatically. Like Minoxidil, it must be taken forever to maintain any positive results. In addition, a small percentage of men (greater than 2%) report a decrease in libido while taking the drug. Thankfully, most wives will like this: the loss is present only as long as treatment goes on. So what is hair transplantation? Hair implants are simply taking the hair from where it does grow and be expected to remain for the life of the patient and implanting it into thin or balding areas. If you have the Nero
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fringes and hair at the sides, you maybe eligible for a successful experience. Hair grafts are compatible composite skin grafts that must include the root to be successful. The first common method of transplant was the punch invented by Dr. Orentreich. The current treatment is simply a variation of the theme, like planting a garden. The implants have become smaller and smaller, the sessions longer and longer and the number of implants at one time have increased dramatically. The "corn rows or doll's hairline" have been replaced by virtually undetectable hair replacement, thanks to improvements in techniques. Where I used to do up to 100 plugs at a sitting, it is now common to implant up to 1,000 and up at one time. The numbers of hairs has increased in a session at the cost of the size of an implant. It is not unusual to have sessions last 6-7 hours with the patient awake, watching TV or even being fed while a team harvests the hair, meticulously divides them into grafts of 1-3 hairs with the aid of high magnification and then inserts them into tiny closely arranged openings in the empty or thinning areas of the scalp. Two or 3 sessions usually finishes the job. The results are not immediate. It isn't instant hair. The new follicle goes into shock and the hair falls out. After 2 or 3 months and a lot of looking in the mirror, a fuzzy appearance followed by real genuine hair, that with proper planning is "good to go" for the next 50 years or so. The permanent genetics trigger is in the follicle and is constantly reloading. What does the future hold? How about cloning? It's starting to find a home in some European centers and seems like our next logical step, particularly if Washington doesn't interfere with future experimentation. Like everything, only the very rich will be able to afford the first attempts, but as with all technical advances (remember TV and computer - decreased costs invariably follow) the 21st century is opening the door to this intriguing chances of revenue. Who knows- I might even give it a try! Just a word to the women. In contradistinction to some procedures, the techniques are unisexual as are the causes and treatments, and although the patterns of hair loss are slightly different, finding hair to transplant is usually not a problem.
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Here we compile a list of drugs that are known to cause hair loss in some patients: Cholesterol-lowering drug: clofibrate (Atromis-S) and gemfibrozil (Lopid) Parkinson Medications: levodopa (Dopar, Larodopa) Ulcer drugs: cimetidine (Tagamet), ranitidine (Zantac) and famotidine (Pepcid) Anticoagulants: Coumadin and Heparin Agents for gout: Allopurinol (Loporin, Zyloprim) Antiarthritics: penicillamine, auranofin (Ridaura), indomethacin (Indocin), naproxen (Naprosyn), sulindac (Clinoril), and methotrexate (Folex) Drugs derived from vitamin-A: isotretinoin (Accutane) and etretinate (Tegison) Anticonvulsants for epilepsy: trimethadione (Tridione) Antidepressants: tricyclics, amphetamines
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Home Care: 1. You may need an eye patch or bandage for a few days after the operation. 2. Sometimes vision is blurry for several days, so work and driving are a no-no for awhile. 3. Eye drops may be prescribed to decrease inflammation or chance of infection for a time. 4. Vigorous exercise, eye makeup and water activities are put on the shelf for a bit and that even includes showers. So come clean! Who should have it! First of all, let's get one thing straight. This is an elective cosmetic procedure. If you have mild to moderate nearsightedness and want to take a chance on giving up glasses, consider it seriously. Since it's a fairly new procedure, we're not really certain about long-term results, but with more and more experienced centers opening up all the time, techniques are improving constantly. Before we talk about the risks, let's look at some alternatives. PRK (Photo Refractive Keratectomy) This was an earlier attempt to use laser technology to correct nearsightedness. The surgeon uses a laser which emits as "cold" ultraviolet beam to remove a precise amount of tissue from the cornea. Using a sophisticated computer program, the exact amount to be removed is determined that will change its curvature. By doing this, the focal point is moved closer to the retina, thereby improving distance vision. Before LASIK, PRK largely replaced the older procedure called Radial Keratotomy (RK). Radial Keratotomy (RK) I guess the longer the acronym,, the better the result and the shorter time the surgery takes. In brief, RK is a non-laser surgical procedure using a highly precise diamond blade to make predetermined radial incisions (like the spoke of a wheel) determined by the degree of nearsightedness. The cornea can bugle outward, flattening its central part and bringing the focal point closer to the retina. The Downside As with all technical advances once the new kid on the block flexes his muscles, proves superior again and again and he soon takes over. LASIK is quickly replacing PRK and RK as the procedure of choice particularly as its use increases and the risk of complications continues to decline. But they do exist and should be considered.
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1. Clouded vision - sometimes referred to as corneal haze and is less common with LASIK, this condition tends to go away quickly. 2. Night vision abnormalities such as "halos" around headlights and street lamps LASIK causes fewer halos than PRK or PK. 3. Glare or increased sensitivity to bright light 4. Double vision (diplopia) usually in one eye 5. New astigmatism secondary to flap or poor surgical healing 6. Some loss of correction- overcorrection or undercorrection Then we must mention the heavy hitters which are exceedingly rare: 1. infection (keratitis) 2. development of glaucoma secondary to increased intraocular pressure 3. Dare I say it - blindness, but the odds are beyond winning the lottery range. Remember this is cosmetic, but after you know the facts and are satisfied with your choice of surgeon, go for it! You can still wear great glasses!
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That's not all. Recent studies have revealed genetic mutations that predispose people to this malady, preparing the way for experiments in gene therapy. What can we do in the meantime?
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Protect yourself from loud noises Don't blast the music Wear earplugs in unavoidable noise-producing situations. And most importantly, don't avoid an annual exam and don't be ashamed to accept help.
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Bonding - A tooth colored material is applied to the teeth, polished and shaped to a conforming size. Dental Crowns - A cap much like a overcoat used to repair decayed or damaged teeth, or to replace older unsightly fillings. Before placement the cap is shaped to look like the rest of the tooth. Bridges - Just like the name implies. 2 crowns and a dental implant are used to fill the empty space. The crowns are placed on either side connecting to the dental implant that replaces the missing tooth. This superficial magic is in addition to a long recognized specialty "Orthodontics" which has been around for almost a century (my braces came off 50 years ago). By using corrective appliances, braces and retainers, crooked teeth are straightened or an irregular bite is repaired. Recently newer techniques featuring invisible (transparent appliances) have enjoyed increasing popularity and the typical orthodontist's office now includes adults in their 50's and 60's. My own Kathie just finished a refresher course because she didn't wear her retainers like a good girl. The course may take several years to complete, but even that time is decreasing rapidly.
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Appliances
Braces - This is the active phase whereby continuous pressure is applied to achieve movement in specific directions. They consist of brackets or plastic applied to the teeth with wire or a bonding agent. The pressure is adjusted many times during the course of treatment to guide the teeth to their new position. Braces can be stainless steel, plastic or ceramic the latter two substances being chosen for cosmetic reason. Costs are directly proportional to the type of braces and the length of treatment. Retainers - This orthodontic appliance is made of plastic and stainless steel wire and is placed over the realigned teeth after the braces are removed. They keep the teeth in their new position until the surrounding bone and gums adjust around them. The length of time that the retainer must be worn will vary, but on the basis of my experience keeping them around for a long time is a great idea. Sounds pretty straight forward. We are lucky to have one or two associates whose work rivals masterpieces. The choice is easier when many before and after pictures are available, so if you like what can be, why not? TIP for Thinking The bigger the laugh, the more work your diaphragm does. When the lungs work harder, the blood gets more oxygen which leads to more oxygen getting to the brain.
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What we say
Where implants go
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In our society, breasts are a yardstick (more or less) in the sexual and sensual evaluation of a woman and in her own mind as well. The only thing comparable in the male is the size of his penis. No one is unmindful of the importance in maintaining the health, shape, function and sensitivity of what's up front where it counts. Therefore, let's have a little review of exactly what we're dealing with. Essentially the breast is composed of glandular tissue, connective tissue, fat and blood vessels covered by a skin brassiere. In addition, there is a rich supply of nerves that account for its extreme sensitivity to pain, pressure and erotic stimulation. Any procedure, whether it be enlarging, reducing or modifying the position, is designed to maintain all of the normal characteristics of an unoperated breast. The breast is attached to the chest wall almost as an afterthought of nature. The exchange of nutrients and information takes place through the nerves and blood vessels that act as conduit between the inside and the outside environment. Hormones control not only the function of lactation but cause monthly changes in sensitivity as well. There are no significant masses of voluntary muscles within the breast, so exercise is of no use in changing anything but your chest circumference. In many respects you can consider the breast to be very much like a weight suspended from an elastic band. For a while the strength and elasticity are enough to hold the breast in its proper position, but after a time the band stretches and both the shape and position will change. For some I don't have to tell you what pregnancies, breastfeeding and weight change have done to the image you see in the mirror. One of the sadness of losing extra pounds is that thinner face and smaller hanging breast show up long before a slim waistline or fashionable butt. For most of the world's women, it is the inadequacy of the bust curve that is the problem. I have made quite a reputation by ADDING to what is in short supply. Consider that upwards of 300,000 women have augmentation procedures on a yearly basis in the U.S. alone.
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Before and after breast enlargement About 10 years ago there was uproar about the safety of silicone implants and their possible linkage to auto immune disease like Lupus, Fibromyalgia, and other collagen problems. The original giant in the implant industry, Dow Corning, went into chapter 14 bankruptcy and set aside several billions to settle its caseload. Since I was a designer of a popular implant, I did not escape unscathed. After years of bantering and controversy, there has not been a proven case of the direct relationship between the implant and the onset of autoimmune disease. However, the myth of forever has been shattered. The implants have to be monitored to check their integrity. Manufacturers have taken care to strengthen the silicone sac to prevent early disruption. The majority in use today are saline filled implants which provide an easy way to replace the problem- much like changing a flat tire. What else is new? I have mentioned the changes in techniques regarding incision, placement and the use of the endoscope for liposuction in select cases. The incision under the breast and placement over the muscle has virtually been abandoned. The problem of encapsulation has decreased considerably but still may present a problem for some. Remember the insert is a foreign body and every individual reacts differently. How about the other side of the coin? Reduction mammoplasty and mastopexy have been refined (they still are two of my favorites). No
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longer a hospital procedure, the scars are shorter as well as the time of the operation For most post operative complications are markedly reduced and awareness of the population has increased, thanks to Dolly Parton and Oprah among others. Let me set aside one fear -- any of the procedures has not been shown to increase the incidence of cancer. On the contrary, in my experience with over 5,000 augmentations, I think the insertion of an implant may actually decrease the incidence. Could this be due to the continual activation of the immune system by a foreign body? And as long as we're on the subject of cancer, it was almost 40 years ago that I championed an alternative to radical mastectomy at a meeting of the American College of Surgeons - a Subcutaneous Mastectomy. It has fallen by the wayside, but the road to smaller and smaller excisions for malignancy with better and better immediate reconstruction techniques has given women hope instead of mutilating despair. It strikes me as funny because at that talk I suggested that if cancer of the penis were as common as breast cancer within 45 seconds the male surgical establishment would have discovered an alternate method of treatment. It only took us about 100 years! Just a word to the men: Don't think you're the forgotten sex. Some plastic surgeons are the advocates of chest augmentation for men. It's a little tricky, but for those who've had it, most feel good about their new image, the result of any insert under the pectoral muscle. Gynecomastia or enlarged breast in men is another avenue worth exploring. Putting aside the growth of male breast tissue that is secondary to rapid hormonal changes during puberty, most cases seen in later years are due to medications taken either to control hypertension, prostatic disease tuberculosis or psychological imbalances The feminization in most cases is due to the effect of these compounds on liver metabolism, resulting in more estrogen circulation.
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lipomastia rather than actual breast tissue enlargement. It was not particularly difficult to deal with before by surgical excision, but with the introduction of liposuction techniques, it has become a virtual one day local procedure with no down time to speak of. As the Peacock Generation is reaching their later decades we can expect more and more requests as part of over body sculpting repertoire. Let's head down south.
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Back
Front
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Liposuction is the most popular cosmetic surgical procedure among women, totaling over 300,000 cases in 2001. It is not a substitute for legitimate weight loss programs, but for localized or congenital areas that won't respond to dieting or exercise, it can't be beat. Ask anybody who had love handles or riding breeches syndrome what a godsend this has been. Liposuction techniques have improved, , the equipment is refined and the post operative results are markedly better due to increasing familiarity with the operations. Since it's relatively new to some, we'll deal with the basics. It's invariably an outpatient procedure done under the gamut of anesthetic techniques ranging from local to general anesthesia. The most common technique involves making small incisions, and inserting small tubes through which a solution containing xylocaine (a local anesthetic) and saline is introduced into the areas to be treated. This serves to numb the area and decreases bleeding during and after the operation. Following a brief wait, a vacuum suction tube is inserted into the incisions and by carefully measured strokes, removes the offending tissue. Afterwards a girdle or stocking is applied, which remains for several weeks until the tissues conform to the new planes. Aside from stopping strenuous exercise for 2-4 weeks, return to normal activities takes a matter of days. We now have: 1) Microliposuction- for those people who want to look good in miniskirts and cropped shirts. In addition we have gone from 2) Ultrasound lipoplasty - the fat is liquefied prior to removal and now were going to: 3) PAL (Power Assisted Lipoplasty) - a machine amplifies the power to minimize physical effort to remove fat quickly and 4) VAL (Vaser Assisted Lipoplasty). Here sound waves liquefy the fat. All well and good, but you can't get to Carnegie Hall if you haven't practiced, practiced, practiced. The same goes for the surgeon you choose! A few raindrops to consider: If you're over 35, you may need some skin removed because your elasticity may be compromised.
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In addition, if you gain weight after liposuction, you may be surprised to find chubbier places in other parts of the body. Therefore, for some patients, liposuction is not the answer and there will always be tummy tucks, buttock and body lifts to improve body curves. A few new doors are opening. It may be possible to harvest stem cells from the suctioned material. These primordial cells have shown the ability to differentiate into different types of tissue such as fat, nerve, cartilage and muscle in the laboratory under proper conditions. Will it be possible to suspend the cellular aging process in this way? We're only beginning on this part of the journey, but this may be a fast track in the future. Let's go into other avenues of removing fat without surgery. One is called Mesotherapy, popular in South America and featured on ABC TVs 20/20 only recently. This involves injecting the fat deposits directly with a substance that melts the cells. A similar technique is called Lipostabil, which involves shots as well. More about this in the next part of our trip, but since this chapter is being written, mesotherapy centers are opening up in the major cities. Be careful! Don't like injections? How about a device called the ULTRASHAPE? According to the inventors and users, it uses ultrasonic impulses to destroy fat cells without damaging any surrounding tissue. It's pretty sci-fi sounding and is new on the market, but if it works, look for centers to pop up quickly. After all, who wouldn't go for non-invasive body sculpting? I bet in a year or two you won't find anyone who hasn't tried one thing or the other. Let's go on.
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Before liposuction
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Medlineplus.gov What is cellulite? The dictionary says it is lumpy fat found in the thighs and buttocks of some women. The fat is believed to be trapped in pockets beneath the skin. Fat cells on the lower part of the body store fat six times more readily than those on the upper body. They also release fat six times less readily. This makes weight loss from the lower body almost impossible without looking emaciated from the waist up. It is not something which plagues the obese or slightly portly. Anybody, the skinny kid or the muscle woman at the gym, can fall prey. One thing to get straight - cellulite is "normal fat" pressed up against or constructed by the bands of connective tissue which extend from the muscle to the dermal areas of the skin. Gaining weight can make it worse because the deeper fat layer may push up the layer to cause more
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dimpling. It is the fibrous septae (connective tissue) bands that force the fat against the skin. OK, we know where it is, but what causes cellulite and how do we get rid of it? There is no definite cure yet, because there are any number of factors causing it. Diet and exercise go a long way in helping to prevent it, but if you've chosen the wrong parents, too bad. Some physicians believe it to be secondary to weak circulation and connective tissue. Health healers and some witch doctors blame toxins. Others say it is too much water, some say too little water. Before you suffer from water intoxication or unbelievable thirst, lets see what is and what isn't and, more importantly, what shows the greatest promise in controlling it. Let's start with things that I think don't work or at least recommend that you show me otherwise. Body Wraps You might as well wrap your brains if you fall for this line of baloney. Sweat it out and, as soon as you drink a glass or two, it's back. Garments of Vinyl, Latex, Neoprene, etc. They make you sweat more whether you're working out to a Richard Simmons or Jane Fonda tape (check out their plastic surgery) or sitting on a sofa. But it's much ado about nothing. Cellulite Pills Don't you think if any of them worked, the producers would be zillionaires? If they contain stimulants like ephedra or ma huang, you may lose weight all over, but remember you have to lose a lot before you see a little down there! Electromagnetic Treatments (Cellular Electro Therapy) There are those who would have you believe that changes in electromagnetic fields would cure anything form arthritis to cellulite. Proponents contend that movement of stagnant or bound fluid in and out of cells s caused by changing the electronic charge. Maybe they can - I haven't been convinced yet! But if you must, get charged up while you're being charged! Endermalogue TM (a.k.a. LPG or Liponic Sculpting)
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This machine was invented in France in the early 80's and after 15 years of use, it found its way into the USA to be approved by the FDA as a Class I device. At the time, it was the only machine to temporarily rid the body of the appearance of cellulite and improve skin texture and irregularities. How does it work? It is a combination vacuum device and massage machine that lifts the skin, theoretically stretching the septa while massaging the tissue to free the fat cells from their fibrous connection. The resulting improvement has been reported to be due to increased circulation or increased collagen growth that strengthens the connective tissue to prevent the fat globules from pressing through the honeycomb, thereby hiding the dimpling. While I am not a physicist, I suspect that the vigorous massages cause subclinical swelling that masks the "orange peel" effect. That is possibly why it is temporary and that maintenance on a monthly or bimonthly schedule is required. Many treatments are needed in the first place and it is uncomfortable for some, but many patients report losing several inches in the treated areas. But, as some say, What goes up, must come down! With this treatment it is vice versa. If you have deep pockets and like rough massage, try it. The bottom line is, if there is any way to improve the appearance of cellulite, there must be a physical interference or contact with the fat in question. So what's left? External Ultrasound This may work, albeit not in larger amounts yet. The sound waves can cause the outer wall of the fat cells to burst. The body then removes the debris through its regular waste removal system. No big trials yet, but promising. Remember, Ultrashape is being tested (warning, warning). Liposection, Lipolysis with laser assist, Liposculpture These are all a variation on the theme of sucking the fat out. It's been around for about 15 years, but if your surgeon has no clue of what he or she is doing, watch out!! More people can get skin irregularities and excessive because of the delicacy of the procedure. The closer you get to the surface, the bigger the chance for permanent deformities. Mesotherapy You have to hand it to the French even if you don't agree with their politics. In 1958 Dr. Michel Pastor devised a technique to treat everything but the kitchen sink rheumatism, infectious diseases, circulatory disturbances and, yes, even cellulite! Mesotherapy involves injecting small amounts of homeopathic medicines immediately under
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the skin surface, which somehow breaks down the cellulite and improves circulation. Each treatment takes about 10 minutes and is tolerable without much pain being reported. Micro-injections are given two times a week over a 4-to-8-week period, giving measurable results. At the present moment, the recommended maintenance is on a yearly basis over a 4-to-6-week period.
Before and after mesotherapy What's in it? It's a mixture of solutions including amino acids and vitamin C and other closely guarded ingredients and you can be sure that these treatments will become increasingly popular in the years to come, particularly in combination with the emergence of a relative newcomer on the scene - Lipostabil. Lipostabil - phosphatidy Choline This material is made from a soy-lecithin base. This introduces on enzymatic reaction into our body that breaks down fat cells. The fat is dissolved into liquid and eliminated through urine and feces. Lipostabil not only can treat cellulite, but it can destroy lipomas (fatty tumors) as well. Side effects are minimal, limited to bruising, and lipostabil is part of the treatment techniques of thousands of European and South American physicians. What else is it good for? Minor and medium sculpting of specific areas of the body like - stomach (want a perfect six-pack surgery?), upper arms, chin, hips and thighs. Once again a word of caution: improper techniques may result in uneven fat loss, but there seems to be little else to be worried about. For a celebrity endorsement, listen to Roberta Flack, who's singing its praises. She's sporting a 32-pound weight loss as well as being able to fit
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into a size 10 (originally size 16). Maybe we'll be able to join the chorus! One way or another, the audience is hoping that this is a hit.
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1) Be 75 pounds overweight 2) Have failed nutritional and medically supervised diets 3) Be willing to make certain necessary changes in eating habits 4) Be between the ages of 18 and 60 5) Have not had previous weight loss surgery 6) Your BMI is over 40 or between 35-39 with life-threatening conditions (hypertension, etc.) 7) Have no history of alcohol abuse 8) Be willing to go through psychological and medial evaluations to evaluate all possible causes of obesity other than intake Since this is a serious decision, it's obvious that an exhaustive evaluation is the first step. What are the current procedures being done by the prominent centers? 1) Laparascopic - Roux-en Y gastric by pass 2) Stapling and banding 3) Mini gastric bypass Roux-en Y This was the most widely used and successful operation until recently. By a variety of techniques (stapling, banding and sutures) the size of the stomach is turned into a small pouch to limit the amount of food needed to give a feeling of fullness. Next, a Y-shaped section of the small intestine is attached to the pouch to bypass a significant portion of the upper parts. This procedure reduces absorption of calories and nutrients.
Can you find this fellow on the next page? Lately, a variation of this procedure has caught attention. According to its proponents, it takes only 30 minutes through the Laparoscope and requires a 24-hour post-op hospital stay with good results. It involves
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attaching the pouch to the lower jejunum with one less attachment - it is the Mini-Gastric Bypass.
One way to do it
Notice that the stomach and part of the upper small intestine have been avoided by entering lower down the tube. The stomach is also smaller.
These operations are not without consequence. Total cooperation is required and these risks must be considered: 1) Pouch stretching - for some the stomach gets bigger resulting in more food intake. 2) Band erosion -- the band enclosing part of the stomach disintegrates. 3) Failure of staples 4) Peritonitis - caused by leakage of contents into the abdominal cavity since acid is very irritating 5) Dumping syndrome - if the stomach empties too rapidly into the small intestine, it can result in nausea, weakness sweating, faintness and occasional diarrhea. In addition eating sweets can cause uncontrolled weakness. 6) Gall stones 7) Nutritional deficiencies - decrease in your Vitamin B 12 and foliate levels 8) Psychological problems secondary to massive changes in body image 9) Osteoporosis: Does it work? Most people begin to lose weight and continue loss for up to one year. Various studies have pegged the losses at up to 85 percent of excess weight over a period of five years. Does that give a lot to think about? The amount of food ingested at one time, the vitamins and mineral supplements, all must be part of a carefully planned lifestyle.
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No discussion would be complete without mentioning the Gastric Stimulator, a device available in Europe for more than a year and under FDA consideration at the present time (2004). It involves a device the size of a pocket watch that is implanted into the chest or abdomen through four small endoscopic incisions with wire connections to the wall of the stomach (see illustration). The surgery takes less than an hour. Most patients walk 30 minutes after the procedure is over and are home the next day. Two weeks after surgery a doctor, using an electronic wand, turns on the device. Stimulated nerves may send signals to the brain, affecting food intake, hunger sensations and hormonal changes. Why the excitement? A study in Europe examined 50 women who were 23 to 62 years of age with a BMI of 30 to 35. The range of weight loss was 21 to 34 percent after 24 to 30 months. There will soon be centers in the USA attempting to duplicate the results. For a procedure that is reversible and has minor side effects (dyspepsia), it is a possible boon to many.
Who is the fellow on the right? (Hint: see the photo on the previous page). Dr. Pozner is in the center. So whats the bottom line? At the present time, maybe Weight Watchers is your best bet or you can really learn to watch your weight. The usual culprits in life are prepared carbohydrates like soda, milk shakes and sweets. Please be prepared to think before you get ready to eat. The life you save for a little longer may be your own.
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to exercise the vaginal muscles akin to using dumbbells to strengthen the biceps.
www.gyneflex.com If that's not enough, vaginoplasty can be performed. It's a little more complicated because it requires an excision or laser introduction within the vault. There's a slightly longer recovery period, but the results are well worth it. In passing, there is a new technique call "G-Spot Amplification" being done at some clinics. It is a safe, painless injection done in the doctor's office to heighten orgasm. It lasts for up to 4 months and, besides making both partners feel good right then and there, you can bet they feel good for longer than that. So what are you waiting for?
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Before 1960, treatment of any kind was rare. People with ED were sent to the psychiatrist couch with little else to offer not now. Let's talk about the surgical approaches that are available. In 1970, an inflatable penile prosthesis was developed. Although it was the treatment of choice, the device needed to inflate the rod frequently failed. Because of this, some urologists developed semi-rigid designs to implant directly into the shaft that are constantly being improved in function and reliability. Today there are approximately 20-30,000 devices implanted annually worldwide. Small in number compared to the enormous success of Viagra like compounds, but a god send to the rest. There are problems, of course, as with any surgery such as infection, erosion, and potential discomfort and unfortunately you can't try before you buy. However, more than 90% of men who have these types of procedures are more than satisfied. Lets go to another side of the coin: penile enlargement for "Bigness Sake. If big boobs are ok for the goose, how about a little more for the gander to gander at? We'll start with the ridiculous. In my joke repertoire there is a story about a little Jewish man who is standing next to Wilt Chamberlain at a urinal during a Lakers game. He can't help but admire the length, strength and girth of this fabled 7-footer's member. Not meaning to pry, he asks Wilt if he was born that way or are there any exercises he could suggest. Annoyed, Wilt replied, "Sure, put a strap around the glans, tie it to a 2-pound rock and let it hang there without touching the ground. You'll see results! One week later, the scene is repeated. Our little guy, very pale and soaked in perspiration, approaches the not-so-gentle giant and remarks, It's not any longer, but already its turning black!" Funny, you say? Not for some. How about a current contraption on the market called the Hangman? It features 10 to 22 ounce weights and the designer claims that by hanging it from the penis for a few hours a day you can gain as much as one-and-a-half inches within a year. I'll bet!
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Devices to avoid
He and other researchers have concluded that anything above 2.8 inches should be considered normal! So, after you've put down your rulers, if
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you still suffer from penis envy, make a move toward the therapist's couch. You may find out that the power of the wand is not measured in inches!
TIP: ED is not inevitable. The more you can do it, the longer you last. Follow the guidelines for keeping your arteries open and blood flowing: diet, exercise and reducing high blood pressure and cholesterol levels. This will keep blood pumping to every body part.
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Varicosities by age and sex Age Female Male 20-29 8% 1% 40-49 41% 24% 60-6972% 43%
Choose the right mom and dad. If your parents had it, you're twice as likely, too. Relatives with the problem increase you changes as well. Pregnancy is an important risk factor, explaining part of the difference in incidence between boys and girls to a larger extent. It's not hard to imagine what a larger uterus can do to the venous system of the legs or the vulva. In addition, occupations that require long standing contribute to the problems, and cyclical changes in progesterone secretion can affect venous wall and valve distention. Increased age plays a role because, over time, the elastic lamina and the smooth muscle layers degenerate as well. What happens if we don't treat it? Chronic venous insufficiency can cause swelling, discoloration, dermatitis, cellulitis, skin loss, ulcers and even malignant changes.
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Aside from cosmetic disfigurement, we can get burning, throbbing, cramping and leg fatigue. That's just the beginning. If you're interested in more of the anatomy and the whys and wherefores of physiology and pathology of the problems, please go to several articles and books listed in the bibliography section. (Or you can search on the Internet chronic venous insufficiency and long term problems with venous disease.)
Varicose veins
Treatment So, what do we do about veins big or small, whether they are on the face, body or leg? The treatment is either medical or surgical, depending on severity or location. The standard for treatment of spider or reticular veins is sclerotherapy. This involves the careful injection of solution that irritates the venous walls, causing them to collapse and disappear. Compression by bandaging is appropriate when indicated. Alternatively, some of the newer lasers are effective as well. The diagnosis of complex problems has been greatly facilitated by the introduction of improving gadgets like the color flow duplex ultrasound (CFDU). It is quickly replacing magnetic resonance imaging (expensive) and radio-labeled injections because CFDU is inexpensive and non-invasive and gives precise information about the breakdown of structure and function (in color). It takes some time getting to know how to interpret the findings, so it pays to ask the doctor how long he or she has been using it (six months is not too long to expect).
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After local anesthesia around the vein, a flexible rod is threaded to the junction, then it is slowly removed, destroying the vein.
When I was in medical school (a lifetime ago), venous ligation and stripping was what we had to offer and was what we did. It seemed barbaric; thank goodness the patient was asleep. We would put a rod down the length of the offending vein and yank it out, followed by sewing up many small incisions and applying compression. It worked, but often the recuperation was quite painful and long.
The vein showed here after the procedure has collapsed and will be absorbed.
With the introduction of the ultrasound, the first improvement over surgery was the guided introduction of sclerosing solutions along the paths of the offending veins. It made a lot of things much easier for many patients. A long catheter, threaded carefully, is pulled along the inside of the vessel as the solution is introduced.
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Watch how the laser seals the vein (like a zipper). Left: Catheter inserted. Middle: Vein heated and collapsing. Right: Catheter withdrawn, closing vein.
A typical result with spider (surface) veins Before 48 hours later With the publics and physicians fascination for lasers, could the light at the end of the tunnel by anything but? At the present time, there are a growing number of centers offering endovaricous vein thermal treatments (big words for a relatively simple procedure). Since I've had sclerosing solutions and compression treatments myself, I can tell you that they seem the way to go. Under local anesthetic, a small incision is made to catheterize the vein. An injection of anesthetic solution is then introduced around the targeted vessels followed by the insertion of a specialized flexible rod along the
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path to the vein's origin. As the magical wand is slowly removed, the vein is zapped by turning on the power (laser or thermal). Imagine an outpatient procedure, no real downtime and results that are permanent.
Before
After
Patient Satisfaction
Symptom Leg Pain Leg Fatigue Edema (swelling) Pretreatment After After 6 weeks 2 years 85% 6% 5% 85% 12% 5% 19% 8% 0%
Any remaining superficial veins can be treated by direct sclerotherapy or minor surgical removal. As with anything, there is no free ride and, since many people are older and may have various medical problems as well, thorough medical evaluation is in order in these cases. The complications range from dermatitis, pigmentation and creation of new veins, to skin loss, thronihoplilebitis nerve and arterial injury. Like All State Insurance, you want to be sure you're in good hands. Don't let your treatment be labor in vain!
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the
Shoe
Before we come to the end of our journey, lets not forget an important part of our anatomy thats gotten us this far the feet. Father Time is a severe adversary and since the average person will walk the equivalent of four times around the world in the course of a lifetime, is it any wonder that feet bear the brunt of the burden for many of us? Most of the problems that befall us dont necessarily wait until we reach the later decades. Flat feet, athletes feet and fungal infections surely can put a crimp in anyones step. As many subspecialties have grown, so has the branch of health care devoted to lead and foot care: podiatry. Such a doctor is a D.P.M. (Doctor of Podiatric Medicine) and, as we make it further along the way, sooner or later a visit to his office is inevitable.
Lets talk about aging feet first. Corns, calluses and bunions can show up anytime, thanks to the torturers we laughingly call shoemakers. For some reason, designs seem to be far more important than comfort and function. The ladies know what Im talking about. Add to this fact that the fat pads that cushion the foot frequently diminish over time, that arthritis and arteriosclerosis increase with the years and its easy to see why your tootsies are sore. Weve discussed the merits of diet, exercise and circulatory repair in previous chapters and they are as important as ever. Paying as much attention to your toenails (you too, guys) as your fingernails pays off in the long run.
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For those of you with specific cosmetic problems, never fear! Surgical intervention is an ever-increasing reality. Some of you may be upset because your second toe is longer than the big toe its called Mortons Toe. A pretty easy procedure, if youre so inclined, removes a small portion of the bone from one of two joints to bring it down to its proper size. Toes too short? Like penises, toes can get a little visible length with a silicone strut. After a two-day bed stay and a month of care, you can proudly parade your perfect digits for all the world to see. The bottom line: if your feet are giving you trouble, hike down to the foot specialist. Relief may be just a spray or a shoe change away. If not, youve landed in the right chair anyway!
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Information (I know this book will help), a little Investigation, a personal Inspection, and an Interview, the level of comfort can be Increased to make an Intelligent Independent decision about your
treatment. Here are a few questions to help you along the way.
Internet.
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Questions to ask
What is the extent of your training and experience in your field? Are you board-certified in an accredited specialty? Can I see some of your results? Are you published? Is your facility accredited to handle the procedure and any unforeseen problems, should they arise?
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Remember, you have a great role to play in creating your own Forever Therapy. Were here to help. Enjoy, live long and live well!
smacboca.com 561.391.9101
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Suggested Reading
Cosmetic Surgery for Dummies by R. Merrell Olesen, Olesen Marie. B. V. Facercise: The Dynamic Muscle Toning Program for Renewed Vitality and a More Youthful Appearance by Carole Maggio Change Your Looks, Change Your Life: Quick Fixes and Cosmetic Surgery Solutions for Looking Younger, Feeling Healthier, and Living Better by Michelle Copeland Secrets of a Beverly Hills Cosmetic Surgeon: The Expert's Guide to Safe, Successfully Surgery by Robert Kotler The Smart Woman's Guide to Plastic Surgery: Essential Information from a Female Plastic Surgeon by Jean M. Loftus Plastic Surgery without the Surgery: The Miracle of Makeup Techniques by Eve Pearl The Essential Cosmetic Surgery Companion: Don't Consult a Cosmetic Surgeon Without This Book! by Robert Kotler The Wrinkle Cure: Unlock the Power of Cosmeceuticals for Supple, Youthful Skin by Nicholas Perricone Understanding Cosmetic Laser Surgery by Robert Langdon You Don't Need Plastic Surgery: The Doctor's Guide to Youthful Looks with No Surgery, No Pain, No Downtime by Everett M. Lautin, Suzanne M. Levine, Kathryn Lance Age-Less: The Definitive Guide to Botox, Collagen, Lasers, Peels, and Other Solutions for Flawless Skin by Frederick S. Brandt, Fredric Brandt, Patricia Reynoso Your Best Face: Looking Your Best without Plastic Surgery by Brandith Irwin, Mark McPherson Safe Cosmetic Surgery by Dai Davies, Judy Sadgrove Your Complete Guide to Facial Cosmetic Surgery by Jon Mendelsohn, William Truswell, Kriston Kent, Kriston J. Kent
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Complete Idiot's Guide to Cosmetic Surgery by George Semel, Jeff St. John, Jeff St. John The Unofficial Guide to Cosmetic Surgery by E. Bingo Wyer, Macmillan Publishing Permanent Makeup and Reconstructive Tattooing by Eleonora Habnit
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Chapter 15 Appendix
This book is updated by visiting the web pages of ASI (smacboca.com).
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Old is dead. Young is what you can be. Dead is for a long, long time. Young is now. And we can help you regain your youth.
Kurt Wagner Spoken at Gauchos Restaurant March 11, 2005
This edition was created in 2005. We invite you to visit Smacboca.com to learn about the advances in cosmetic and plastic surgeries as well as age management strategies.