 
The War

Against Aging!

How to Win

in the Youth Game

A QUICK GUIDE TO STAYING YOUNG

IN THE 21ST CENTURY

Ebook edition

The world's first televised makeover took place in 1971,

performed by Dr. Kurt J. Wagner.

Jason N. Pozner and Kurt J. Wagner, M.D.

SMACBOCA.com

Copyright 2012 *renewing 2005) by Kurt Wagner and Jason Pozner.

You are encouraged to share this document – if you quote from it, please attribute it to us.

This ebook contains photos that show the human anatomy. If you are squeamish, please don't look inside.

Parents: Use your discretion.

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.

Added message from 2012:

This is all about "how to win in the youth game."

Head to toe,

This is a practice with many players

Medical spa

Age management

Cosmetic surgery

And the evolution of the practice

Means we have to update this book.

It' sno long just age management.

We will teach you how to age successfully.

How to LIVE successfully.

You will see new prescriptions and new suggestions about diet.

We have new thoughts about what should be added to make living a pleasure

You can find more thoughts about how to live successfully in the modern world on my youtube channel and at smacboca.com

Remember we change the picture and make things more attractice. Something is in our DNA to give preference to what we think is attractive. The breasts can be bigger or smaller, but there is a certain loo for every face and figure. We strive to make an ideal angle. Your eye tells you what is nice and what is possible.

I did the first televised extreme makeover 41 years ago in 1971.

It was a hit.

There is something in appearances. We are all victims of lookism. There is psychological value in beauty. You can paint a history for a child from the moment it is born. If they say she is a pretty baby, that is the best for the future. 99% will agree that Elizabeth Taylor was a beautiful woman. We have a concept in our minds about what is beautiful. It can be easily reproduced in many people.

Kurt J. Wagner

April 2012

\-----------

To begin...

Favorite sayings and tips

By Dr. Wagner

"You name it, we'll frame it!"

"If your face or body is unbecoming to you, you should be coming to me!"

\- Kurt Wagner

===================

Charge it! (with apologies to MasterCard)

Next Birthday: 57

Cell Age: 32, thanks to Dr. Brizel's 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)

The look on her ex-husband's face: priceless.

==================

TIP: Drink two cups of coffee or tea a day. Research can't explain why, but caffeine appears to significantly reduce the onset of Parkinson's or Alzheimer's diseases

=========

TIP: When you have back pain, don't 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 you're in pain is better than just lying there because the other back muscles that are not in pain can be exercised.

===============

Here's a story that Dr. Wagner likes to tell...

The impact of carefully

chosen procedures

You can take a patient," says plastic surgeon Dr. Arthur Swift, "who has been a wallflower - who has been sort of sitting back socially and has been very introverted because she is self-conscious about a large nose, large bust, or small bust and you operate. Their personality literally blooms and a parent will come back and tell me 'you have had a wonderful effect on my child. She is so much more self-confident. She's lost a lot of those inner inhibitions and she feels she's out there.'"

February 25, 2002, From an article by Ray Lawson, Look Good, Feel Good: The link between surgery and emotional health http://canoe.talksurgery.com

===============

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 Reader's Digest, sudoku, crosswords (the tough ones) and reading complex articles. Warning: most newspapers are graded down to a 14 year old's vocabulary, so look for tougher material.

================

LAUGH TIP: For Your Circulation

When we laugh, the linings of the blood vessels expand and positive chemicals flow.

==============

LAUGH TIP: For Your Belly

There's 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.

=======

"You name it, we'll frame it!"

"If your face or body is unbecoming to you, you should be coming to us!"

========

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 that's good for others to see!).

=============

A Thought

I'm too young to have a full face lift. I'm 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 don't have to go through the preparation for surgery a second time – so soon!

I can't 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.

============

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.

===========

Dr. Wagner likes to quote other plastic surgeons:

Look Good, Feel Good

Society places an enormous emphasis on looks. Studies have shown that better looking people earn more, are promoted sooner and are more likely to occupy senior positions within corporations. Given the same qualifications, the more attractive person, male or female, is more likely to get the job. Similarly, when it comes to choosing a partner or mate, do looks count?

So when you look better, you feel better. Your productivity is likely to go up and perhaps you become a more valuable member of society. If you look like a million bucks, are you worth a million bucks?

\-- Dr. Dirk Lazarus, Plastic Surgeon

MBChB (University of Cape Town), FCS (South Africa, Plastic and Reconstructive Surgery), http://www.plasticsurgery.co.za/news1.htm

=============

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.

=============

Remember, you have a great role to play in creating your own "Forever Therapy." We're here to help. Enjoy, live long and live well!

smacboca.com +1 561.391.9101

====================

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

\--------------

Foreword

"You're beautiful." There, I said it. That's the compliment you've been waiting for.

"You're pretty, you're lovely, you look so young for your age."

If you're a guy, let's say, "You're 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 aren't enough. People can say nice things, but if you don't believe it, it's not enough.

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. It's 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 won't help if you don't have the energy you're 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.... It's about exercise and relaxation.

The Youth Game is also about the knife and the laser. When you have your energy back, then it's 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.

### "Mom, I think you're good for a little while longer."

Why is there humor in this book?

Because if you laugh more you live a lot longer.

Look for hints as you read on.

www.smacboca.com

Your Self-Image and Plastic Surgery

Improving your self-image with plastic surgery...

Each of us has a "self-image," a perception of how we believe we look to others. People who are happy with their self-image are more likely to be self-confident, effective in work and social situations, and comfortable in their relationships. Those who are dissatisfied tend to be self-conscious, inhibited, and less effective in activities.

Plastic surgery -- whether cosmetic or reconstructive -- encourages and promotes a strong, positive self-image. Even a small change on the outside can create an extraordinary change on the inside, allowing an individual's self-confidence to flourish.

Because the changes resulting from plastic surgery are often dramatic and permanent, it's important that you have a clear understanding of how surgery might make you feel-- long before a procedure is scheduled. http://www.plasticsurgery.org/public_education/

. . . . . . . . . . . . . . .

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 can't live with their – often quite ordinary – looks because society places such a high value on physical beauty. Susan Walls, juniormagazine.co.uk

Let's start the journey.

Before considering plastic surgery, let's cover what you should be putting into your very special body.

TABLE OF CONTENTS

Chapter 1 10

INTRODUCTION

Chapter 2 12

MUST WE GET OLD SO QUICKLY?

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 83

Chapter 9

COSMETIC SURGERY- CUTTING UP 89

WHO'S DOING WHAT

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 you're 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 middle-aged? 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. It's all worth just a little more effort on our parts.

There are a myriad of offerings bombarding us on a daily basis: A one-hour 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!

Author Kurt J. Wagner with his wife Kathy (2001).

# www.smacboca.com

Chapter 2

Must we get old so quickly?

What is old? Must we equate chronological age with metabolic aging? In 1960 there were about 3,000 people over 100 in the USA. Today there are over 100,000 centenarians and that group is increasing at a geometrical rate. In fact those individuals living to reach 85 or over are the fastest growing segment of our population.

You don't have to look in the mirror to see the signs of aging. Every day gradual changes in every cell and organ contribute to the effects that we see and feel.

Is there any way to slow down the process? More and more scientist and physicians seem to think so. Let's go into a brief system review of the changes that the calendar brings.

Cardiovascular (Heart & Blood Vessels)

Cholesterol builds up in the artery walls causing inflammation and calcium plaques. The result - blood pressure increases because of the loss of elasticity and the danger of heart attack and stroke goes up along with it. In addition the heart muscles weaken as well.

Brain

After the age of 20 it starts getting smaller, losing firmness and with it some of the memory capability and thought processes as well.

Endocrines

In women menopause is feared by some almost as much as malignancy, because of declining levels of estrogen , progesterone and testosterone (more about this later).

In men, testosterone levels start their descent after the age of 30, with a progressive decline in sexual desire and performance. While the testosterone level goes down, the prostate increases in size affecting over 90% of men by the age of 70.

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 A Joint with osteoarthritis

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.

Hair

If you have the right genes, you may keep your hair, but the strength and color gradually fade.

Skin

If you're 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 can't stop the inevitable, but why make it easy for Father Time? Let's 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.

Chapter 3

Face the facts!

That's what we examine when we wake up and again before bedtime. Our face. When did those lines appear? And all those spots, the crow's feet, the bags under my eyes? I didn't even have a drink last night.

Numerous psychological studies, not to mention personal experience, attest to the fact that when we look our best, we feel and do our best! Let's start by seeing what's available to help restore the "Beauty that was Greece and the Grandeur that was Rome."

To Cream or Not to Cream?

That is The Question

An age-old one at that! Anthropologists and researchers found a makeup kit in a royal tomb in Babylon. We know that Cleopatra had the following items in her possession: brow and hair dyes, bleaches, powders and rouge and, yes, even moisturizers, wrinkle cream, freckle cream, sunburn lotions, depilatories, lubricants and cleansers. A motivational researcher summed it up on national television over 40 years ago, "When a woman applies cream, there's a sort of feeling of something magic happening."

Nowadays we can add men to the quotation as well.

Before we get into what's new, let's pay homage to the physician Galen who first developed the basic formula for cold cream: oil, beeswax and water. And it happened in the 2nd century AD. Added ingredients can come from the sea, from animal, vegetable, fruit or mineral, ever expanding the multibillion dollar business that shows no signs of bursting at the seams. It is more and more apparent that there is nothing superficial about the connection between a person's looks and the way they feel.

Let's look at some of the real changes that these chemicals cause.

Skin - What would we do without it?

Cole Porter's immortal classic "I've Got You Under My Skin" couldn't be a more appropriate way to start this phase of our journey, because part of staying young is mirrored by the surface.

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.

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 what's 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.

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.

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 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.

Topical application of some products can work

How to Peel Without Getting A Sunburn

So far, we have discussed many ways to rejuvenate the skin with various modalities. However, a discussion would be incomplete without summarizing the various peeling agents, some of which should only be used by an EXPERIENCED practitioner.

Light Peels for Common Use

Alpha - Hydroxy Acid (AHA)

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.

Let's 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.

Before the phenol peel One month after the peel

(without a peel, she's (plus face and neck lift – now

without appeal) that's "appealing"!

TIP: Laugh your blood sugar down

Diabetics should read joke books and watch America's Funniest Videos. Glucose levels in your blood actually stabilize when you laugh heartily.

The Brilliance of Botox

A prominent medical dictionary published just twenty years ago defined botulism as "an intoxication due to the ingestion of clostridium botulism toxin in improperly preserved or canned food; mainly affecting man, sheep, horses. etc. It is characterized by paralysis in all species."

Remember that word "intoxication."

The disease is caused by a neurotoxin that is produced by a bacterium, clostridium botulinum. This bacterium can live for a long time as a spore wheel, which is a reproductive stage of certain bacteria or fungi.

Place it in a moist low-acid setting without oxygen and the spores quickly grow into adults and give off their nerve-damaging toxin that can cause death if not checked.

Let's not get too medical. The neurotoxin blocks an important enzyme, acetylcholine, which signals muscles to function by contracting. The botulism toxin can stop your muscles from functioning, so therefore it is a potential powder keg.

But here modem science has come to the rescue. Take a poison, refine and purify it, use it in small amounts on specific parts of the body and the results are truly INTOXICATING. By the end of 2004, botox injections were the most popular cosmetic treatment in the world. They provide happiness to countless millions, not to mention to the TV stations, magazines and newspapers that have run the ubiquitous commercials on a daily basis.

What Botox can do

Frown muscles

Between the eyes

In the forehead

Around the eyes

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 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 athlete's 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, let's 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.

Around the eyes

Wrinkles near the eye, before and after Botox.

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, let's 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, M.D. and Levine, D.C.M. as a possible primer (note Dr. Pozner's remarks).

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. It's 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 South America and Europe to get tips from Dr. Pozner.

Fill to Your Heart's Content --

with Caution and at a Price!

When I was a young plastic surgeon, people were still looking for an ideal filler for wrinkles or necessary tissue. It should be non-toxic, non-allergenic, long-lasting, easily introduced, relatively affordable and free of mistakes.

The search began in the late 19th century when a Dr. Neuber used a person's own fat to correct facial depressions. There is even a reported case of the successful implantation of a fatty tumor (Lipoma) taken from the buttock of a patient to replace breast tissue removed at the same time. In the early 1900's, the paraffin injection craze swept the world until, alas, almost every patient developed foreign body tumors with resulting disfiguration and infections.

In the 1940's injectible silicone became available as a dermal implant and it seemed the search was over!

This substance could be transformed into liquid gel or solid by the simple addition of a catalyst. What could be simpler?

A potent house of horrors was released that occasionally continues to hit the headlines to this day. Pure liquid silicone can migrate because there is no tissue cohesion. How many patients was I to see with swelling in their nose, checks, or jowls? There have even been reports of deaths to accidental injections of silicone into the blood stream.

When combined with other material (would you believe even snake oil in "The Sakari Formula"?), silicone injections can give patients terrible experiences. In some cases, there were granules, infection, tumors, sometimes resulting in the removal of massive amounts of face and breast tissue. Attempts to stop its discriminate use resulted in only seven centers in the USA being authorized to use minimal amounts by the American Society of Plastic Surgery and the FDA for 20 years.

There have always been other alternatives, some of which require surgical intervention. But the real thrust came about 20 years ago with the introduction of collagen, a product derived from denatured cow protein. So let's go into a brief summary of what's available for a quick fix for varying periods of time.

Collagen occurs within the skin and its loss secondary to aging causes sagging wrinkling and decreased smoothness. At first it was manufactured from animal (cow tissue) and required sensitivity allergy 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 injector's 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 (à 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.

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 non-allergenic, 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 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.

The Wonders of Fillers

Some of the many uses of fillers (before and after).

There are a number of synthetic products in popular use, such as Gore-Tex (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.

Lip Enlargement and Eye Liner

Before One month later – Wow!

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!

INJECTIBLE FILLERS

Name | Composition | Uses | Length of

effectiveness | FDA

Available

---|---|---|---|---

Zyderm

Zyplast | Animal Collagen | Fine lines, wrinkles

Lip enhancement | 3-4 months | Yes

Rest lane

Perlane | Hylaronic Acid

Present in all

Species | Fine lines

wrinkles, lip

enhancement | 6 - 12 months | Pending

Radiesse | Calcium Hydroxyl

Apatate

(Synthetic) Main

constituent of bone and teeth | Same as above

+Cheekbone

+Chin

+Soft Tissue

enhancement | 3-5 years | Pending

Cosmoderm

Cosmoplast | Human Collagen

(no skin test

required) | Same as above

Zyderm and Zyplast | 3-4 months | Yes

Articoll | Methacrylate, Microspheres and

Bovine Collagen | Wrinkles and Scars | 2-3 months | No

Hylaform Gel | Hylaronic Acid (from rooster combs) | Wrinkle, Scars lip enhancement | 3-6 months | No

Reviderm Intra | Dexran Beads in Hylan Gel | Wrinkles, Atrophic scars and lips | Permanent | No

Silicone

Biopolymer | Silica (man made

polymer) | Wrinkles and Scars | Permanent but difficult to keep

from shifting | Only Ophthalmic

Use

Ectoplast 50 | Soluble Elastin and Animal Collagen

(skin test) | Wrinkles and Scars | 1 year | No

New Fill (Sculptra) | Polylactic Acid | Soft Tissue Hands, Cheeks,

Liposuction Defects | Two years | Yes

Chapter 4

Keep Your Heart

Ticking On Time

You don't have to be a genius to know that a young heart is the key to remaining vibrant and energetic. With the amount of information pouring into our awareness highway, perhaps a brief summary of where current thinking stands is in order.

In October 2000 the New England Journal of Medicine published three articles linking the presence of blood indications of inflammation to those people more prone to develop coronary heart disease and stroke.

One of the culprits is a protein called fibrinogen, which causes the blood to thicken and clump and clotting. Those with higher levels of fibrinogen showed twice the chance of succumbing to a heart attack. Another marker is C Reactive Protein, which stimulates the destabilization of atherosclerotic plaques, freeing them to flow freely in the blood stream. The result is three times greater likelihood of death from a heart attack.

The third indicator is hemocysteine, a protein marker. This substance may cause lesions on the arterial walls that enable cholesterol (low density lipids or LDL = bad, think "low is no") and fibrinogen to accumulate and obstruct blood flow. It is a potent free radical that can work its damage even with normal cholesterol levels. While we're at it, let's look at the levels acceptable in helping to prevent cardiovascular diseases.

Blood Test Standard Optimal

Acceptable Level Where I want to be

and so should you

Fibrinogen less than 460 mg/dl less than 300

C Reactive Protein less than 4.9 mg/dl less than 2

Homocysteine 15 micro mol/l less than 7

Glucose less than 109 mgm/dl less than 100

Iron less than 180 mg/dl less than 100

Cholesterol less than 199 mg/dl 180-220

LDL less than 129 less than 100

HDL more than 35 more than 50

Triglycerides less than 199 mg/dl less than 100

DHEA female 35 mcq/dl 350-430

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.

ANTIOXIDANTS, VITAMINS, MINERALS, ENZYMES -MIX AND MATCH

From the very first we have all been told to drink our milk, clean our plate and take our vitamins. One-A-Day made its mark over 50 years ago but alas, unless it's the size of a boulder and time-released, I'm afraid it just won't do the trick anymore. More and more exploration leading to information and at times misinformation has led to the steady increase of products lining the shelves of almost every store with counter space. Let's try to make sense of it.

Part of the aging process is due to the production of "free radicals" by the cells of the body. These are called pro-oxidants and in reality are damaging chemicals which have been shown to contribute to the development of arteriosclerotic heart disease, cancer vision impairment, and arthritis.

We manufacture our own antioxidants, but in quantities insufficient to counteract the ever-increasing enemy. Supplements containing certain vitamins, minerals, amino acids and enzymes should theoretically neutralize a great deal of the circulating antagonists.

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.

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.

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 physician's 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. It's 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 couldn't 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. It's 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.

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.

Fish Oils –

There's Nothing Fishy about the Results

If you want to believe the American Heart Association (and you should), fish oil supplements drastically reduce the risk of sudden death. They came to this conclusion by studying over 11,000 patients who had suffered a heart attack within three months before the start of the study.

All of the patients had a diet alteration which included increased portions of fruits, vegetables, fish and olive oils. One group received an additional 1000 mg (one gram) of fish oil supplement daily. After three and a half years, this group had 45 percent fewer deaths from heart-related disease. They postulated that fish oil helped to prevent arrhythmias, a condition where the heart muscles beat out of control, causing the cessation of effective blood flow. In addition, fatty acid imbalance has been linked to a litany of disorders which have a common link:

\- aging

\- hypertension

\- arthritis

\- memory loss and dementia

\- adult diabetes

So, take your fish oil and slip off the hook of these debilitative disorders.

Human Growth Hormone

A key to the fountain of youthfulness?

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 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.

Remember the catalysts

In order to absorb many supplements, you need other micronutrients. There are catalysts that help the absorption. These added ingredients bring up the costs of most supplements, including the "Forever" pill (that contains ingredients used to repair chromosomes). Many people think they are saving money by buying a supplement without these catalysts. They could get double the effectiveness by purchasing the bottle that costs $5 or $10 more but includes the needed catalyst. That catalyst might be an enzyme, a vitamin, whatever. If you don't have the catalyst, much of the supplement goes unused and leaves the body. You might have gotten only $3 value of benefit from a $20 supplement.... Talk about being pennies wise and pounds foolish!

You need the catalysts -- we all do! So, do the right thing and look for the catalysts in the pills you take. – Dr. Brizel

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 it's an awful lot to swallow, but in divided doses, it may be just the right medicine for you.

Charge it! (with apologies to MasterCard)

Next Birthday: 57

Cell Age: 32, thanks to Dr. Brizel's 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)

The look on her ex-husband's face: priceless.

TIP: Drink two cups of coffee or tea a day. Research can't explain why, but caffeine appears to significantly reduce the onset of Parkinson's or Alzheimer's diseases

Chapter 5

Hormones – Heaven or Hell?

Not a week goes by without a story appearing with conflicting reports about the effects, good or bad, of hormonal supplements and their role in our daily life style. If that isn't enough, we have to weed through the TV supplications to take everything but the kitchen sink in an effort to restore or mend whatever ails us or can go wrong! The next pages will help in finding your way to a clearer understanding of what is, what isn't and what could be. Come along.

Why Worry about Hormones?

How does the modern woman differ from her predecessors? In the past, the female had a shorter life span and was concerned with multiple cycles of pregnancy and breast-feeding diseases, sanitation deficiencies or a hostile environment. With luck, a few adults lived to a ripe old age of 65.

What we have seen is nothing short of miraculous in the past century. A woman doesn't have to become a mother shortly after the onset of puberty. She can shape the time and size of her family, if she wants one. We have birth control pills. Morning-after pills, career opportunities, the realization that the "Venusians" woman can control her external and internal environments to an extent never before dreamed of.

But the stress of daily living brings its own demands. The barrage of environment, chemicals, stress in the career and increases in newly recognized diseases and hormonal abnormalities has tempered the joy of so-called liberation.

As we all admit, most people are confused about aging and the role hormones play in accelerating the process of slowing it down. And the media doesn't help. It seems that not a week goes by when some study is quoted about the erroneous_ information given to the public by overzealous practitioners.

"Study Links Breast Cancer to Hormone Use" (LA Times)

"HART Causes an increase in Senility" (NY Times)

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 Institute's 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. It's 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?

Natural hormones may be the answer

What are they and where do they come from? The majority of anti-aging specialists use substitutes made from soy beans and wild yams. With a little bit of chemical gymnastics these plants can produce hormones that are IDENTICAL to human production. But, before you go on a steady diet of these foods, just know that your body can't do what the chemist does!

There is no shortage of these compounds, available either through prescription or over the counter. However, to stop the rush to a health food store, let's go over a few ground rules. In the first place, each of us is unique and although we fit into certain groups and categories, individual responses must be recorded. We know that the presence of hormones decreases at an astounding rate as we age.

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? Let's get some hormonal level readings and compare them to the patient's 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. Capsules

2. Vaginal creams

3. Topical creams and gels

4. Sublingual drops

5. Suppositories

6. Lozenges

7. 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.

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, let's go on to another often-overlooked source of improvement.

TIP: When you have back pain, don't 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 you're in pain is better than just lying there because the other back muscles that are not in pain can be exercised.

Testosterone - For Men Only?

We claim to be better informed today in the Information Age, but maybe we're not. A Yale study in 1997 found out that over 66 percent of women believe that estrogen and progesterone are naturally occurring female hormones, while less than half thought that testosterone had anything to do with their bodies.

Wrong! All female estrogen is produced from androgen male hormones (including testosterone), which begin to emerge as puberty erupts, In fact, teenage girls' interest in boys is the results of the increase in the libido power of male hormones, which include flights of fantasy and arousal. While estrogens may make sex more comfortable by increasing lubrication, don't discount testosterone for getting you there in the first place.

Where are the male hormones produced? The adrenals and ovaries. As we age, the output decreases. You saw that between the ages of 20 to 40 the amount of female circulating testosterone decreases by up to 50 percent. With the onset of menopause another 30 to 50 percent disappears. So, while hot flashes and vaginal dryness may make the headlines, for some women (not all) the decrease in sexual arousal is strictly related to the level of testosterone. In addition, some medications like birth control pills, certain mood elevators and some blood pressure medications add to a further decrease.

How does a women suspect that she is suffering from a deficiency? The first sign is when no man, let alone her partner, arouses any interest. Her nipples and clitoris feel more like dead tissue than hot spots. There are also the usual symptoms of deficiency - loss of muscle tone, decreases in genital tissues, dry skin and loss of pubic hair.

So what can the addition of testosterone do for a female? There have been several studies proving that testosterone can boost desire, increase psychological well being, strengthen bones, and ease menopausal symptoms in those patients not responding to estrogens alone.

Sounds too good to be true? There may be a downside. Images of hairy, acne-faced, muscle-bound women with a clitoris reaching the size of a penis may sway many women away from the benefits of testosterone therapy. There have been enough studies to assure us that physiological doses may cause some hirsuitism (excessive growths) in a few patients, but little else to cause concerns. In addition, changes in 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.

A Solution to Andropause

(and whatever else ails the men?)

We are quick to recognize the word "menopause" as an integral part of our treatment program targets to maintain youth and vitality but what about the male counter part?

For time immemorial, the literature is filled without awareness of the importance of testosterone in maintaining the image of a "Real Man." The eunuchs in the harems and the "castrati" in Italy are but a few of the popular examples of early attempts to modify male development for special reasons. I even used to laughingly tell my balding male patients that I could stop their problem with a simple operation - Castration! Needless to say, no one accepted my suggestion.

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.

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 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.

Viagra - Cocked and Ready to Fire!

How many men don't imagine what it would be like to be James Bond? The similes comparing guns to penises are a source of amusement and entertainment. If the most serious things are said in jest, what better examples can we give? Cocked, ready to shoot, pull the trigger – BANG, BANG.

As we well know, the ideal match would be a teenage boy with a more mature woman. But aside from a few well-publicized exceptions usually ending in prison time for the unlucky lady, such is not the case. What is a man to do when faced with a partner who has a reawakened sexual zeal after her hormone replacement therapy (HRT), one of the modern miracles of our time? Thanks to Pfizer, Viagra comes to the rescue.

Although most men deny it, impotence, whether occasional or continual, is one of the most prevalent fears of the male population. A Massachusetts Male Aging Study in 1993 that included almost 2,000 men aged 40 to 70 revealed that about 50 percent of them had difficulty in maintaining an erection at some time. That's truly an epidemic of increasing proportions due to decreasing proportions.

1998 marked the dawn of a new era with the introduction and FDA acceptance of VIAGRA. It came about quite by accident because it was the product of studies testing nitric oxide, a relatively new compound to be tested within the human body within the last ten years or so. It was hoped that by playing around with its metabolism, a pill could be developed that would dilate the blood vessels of the heart and relieve the pain of angina. A researcher at Pfizer set up a study of a drug call SILDENAFIL (Viagra). This was known to increase nitric oxide production, but unfortunately did little to ease chest pain. When he asked his patients to return their pills, many refused, saying that while their chest pains remained their erections returned with a BANG! And so it was that a wonder drug was born with quick FDA blessing.

Like Shaquille O'Neal and Dwayne Wade or Batman and Robin, another dynamic duo is ready to keep us springing into action in our search for staying young -TESTOSTERONE \+ VIAGRA Check it out. Incidentally it also works for the ladies. We'll talk later.

Get To Love Avenue In The Fast Lane

I've devoted several chapters to love and how to feel more attractive. Let's summarize what's available to put more bang in the boudoir, or lust in the living room if you choose.

Ladies, just because male chauvinists have occupied most of the headlines, there are still any number of avenues worthy of exploration for the fairer sex.

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.

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.

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!

Chapter 6

Food for Thought –

Power or Poison?

Sir Henry Taylor, a 19th century intellectual, made this telling quote: "His food was glory, which was poison to his mind and peril to his body."

Truer words may never have been spoken and since Sir Henry lived from 1800 to 1886, he obviously practiced what he preached and used his mouth for something besides speaking.

Food, of course, is the fuel for running the human machine. The whole trouble with eating is the associations it carries. From infancy to the grave, we use it to satisfy some psychological and emotional hungers. It is love, a fact established by the nursing or feeding mother, indelibly etched into our being. It can make up for frustration, rejection, failure, and a lousy sex life. And when it comes to socializing, isn't it usually a meal that is set before us with a dazzling display of culinary delights?

It's no mystery why a person gains weight. Some genetic diseases aside, if we take in more calories than we use up, the scales show it and the fat bulges don't lie. Here are some basic facts we learned in high school:

1 gram of carbohydrate = 4 calories

1 gram of fat = 9 calories

1 gram of protein = 4 calories

Take into consideration the basal metabolic rate (BMR), which is the amount of energy we use to help the vital organs function properly. Add to it the amount of energy used when we work or play and you have the number of calories needed to get through the 24-hour day. Adjust the calorie intake and you're home free. Sounds easy, but there are mysterious forces at work.

Read the papers, watch the news, open the magazines - it's no mystery at all! Sue McDonald's, give Burger King and Taco Bell the heave ho, surely we couldn't have been to blame!

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 Height

(Pounds) (feet, inches)

5'0" 5'3" 5'6" 5'9" 6'0" 6'3"

140 27 25 23 21 19 18

150 29 27 24 22 20 19

160 31 28 26 24 22 20

170 33 30 28 25 23 21

180 35 32 29 27 25 23

190 37 34 31 28 26 24

200 39 36 32 30 27 25

210 41 37 34 31 29 26

220 43 39 36 33 30 28

230 45 41 37 34 31 29

240 47 43 39 36 33 30

250 49 44 40 37 34 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.

So, how do we tip the scales on our direction?

There are literally hundreds of different diets that have been promoted as the safest and quickest way to lose that extra flab. They usually involve eliminating or severely curtailing entire food groups for a limited time or forever. Currently high protein, low or no-carb diets are in vogue. They include Atkins, Sugar Busters, Protein Power, Low Carb Living, and the new kid on the block - The South Beach Diet. In addition, we now have a new table to worry about: the Glycemic Index. It has been introduced as a variable in some of the aforementioned regimens.

Possible Choices for Weight Control

Glycemic Index \- This was established in 1981 to help people maintain stable blood sugar levels. It is a rating of foods on a scale of 0 to 100 according to the extent to which they raise blood sugar levels after eating. Individual foods with a high number release glucose more rapidly causing a rapid increase in blood sugar levels. Used since then by diabetics and endurance athletes, it has become a mainstay for several investigators. However, many experts downplay its importance, citing its drawbacks in assessing food combinations (peanut butter and jelly) and high fat products (chocolate).To help a little, a list of common food indexes is on our web site DrKurtWagner.com.

Atkins \- Dr. Atkins opened up the door. He maintained that by cutting out carbs, our body would naturally lose weight by burning stored fat in spite of a diet laced with bacon, eggs and Roquefort dressing. Reviled at first, more and more of his products and copy cats thereof fill shelf space, even in convenience stores. But even he permits the gradual inclusion of limited amounts of certain carbs.

South Beach \- The latest rage was initiated by a cardiologist Dr Agatson, who decided that there was not one eating pattern that would improve the cholesterol and insulin levels of his cardiac patients. It is a combination of protein intake and good carbs, based on their, you guessed it, glycemic index. It forbids all the supposed culprits for the first two weeks - fruit, bread, rice, potatoes, pasta, and prepared desserts. The same goes for alcohol of any kind. Following this indoctrination period, high-fiber carbs such as whole grain bread are added. It looks like South Beach has convinced more than a few to plunge right in, while many Atkinsonians cry foul!

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 and most fat, be my guest. There's no doubt you may live longer if you don't go crazy at mealtime.

Blood Types \- If you believe in genetic predetermination, our primordial origins may serve as clues to what we should eat. Type O, the Hunter Gatherers, thrive on a diet laced with meat and berries, while the Cultivators (Type B) can deal with lots of carbs. In addition, there are a number of blood tests that base their success on exposing certain hidden food allergies. It works for some.

Eat Less, Exercise More \- That's the philosophy of Dr. Andrew Weil in a nutshell. He urges his readers to be realistic and not fall for quick fixes. The weight will come back, one or two pounds a week is fine. His formula is a little different from the Zone, but includes all food groups: Carbohydrates 50 to 60% (no prepared carbs, please), fats 20 to 30% (monounsaturated), protein 10 to 20%, preferably from a vegetable source like soy. And get out those dumbbells!

Weight Watchers \- In order to maintain a different eating style, many of us need constant supervision. Ask any therapist: repetition and compulsion are hard to overcome. That's why this concept has had such a long run. Instead of just telling their members what they can or can't eat, the goal of Weight Watchers is to help them make healthier choices as part of a different lifestyle in the mental, emotional and physical arenas. Because you have to crawl before you can walk, their initial goal is modest - a weight reduction of 5 to 10% with an ultimate BMI of less than 25%.

"Eat the food you love and lose weight" is their motto and they use the "point system." Each food is assigned a number of points on the basis of its calories, total fat, and fiber content. Depending on your starting point, you may consume a certain number of points on a daily basis. For instance, a six-ounce steak = 8 points while a cup of broccoli is 0 points. Stay in your daily range calculated on body weight, earn points by exercising, have intense group support, and you'll be successful enough to get a "point number" on many food labels. It's no wonder that WW is so popular and the Bible of many.

Pritikin Plan \- If you're over 40, you've at least heard of this, a low-fat 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 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 Reader's Digest, sudoku, crosswords (the tough ones) and reading complex articles. Warning: most newspapers are graded down to a 14 year old's vocabulary, so look for tougher material.

Prescription Weight Loss Medicine

Physicians like to limit the use of prescription drugs for individuals with a BMI over 30 and no obesity related problems or a person with a BMI over 27 with two or more problems.

Most available drugs fall into the "appetite suppressant" category. These medications work by increasing two brain chemicals, serotonin and catecholamine, that trick the body into thinking that is not hungry or full. These include: Didrex, Tenuate, Saganor, Adipex, Meridia, and Phenteramine. The latter was part of the ill- fated Redux which was hailed as the ultimate solution in the 1990s until heart valves started to malfunction at an alarming rate.

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!

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?

• 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. Don't look for a quick fix - slow and steady wins the race. If you need help, don't 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.

Chapter 7

Exercise – What's Enough?

Does this scenario sound familiar? The alarm rings, you wake up full of energy. Without hesitation you get out of bed and think "it's a great life, great time to start exercising." If that was some time ago and not now or never, perhaps the next few pages can help get you on the right track (pardon the pun , runners).

It is well documented that a person's maximal strength decreases with increasing age - why? Is this due to aging or a decrease in physical activity? The answer is both - but we can dramatically slow the effects of chronological changes by a steady program of exercise.

The reasons for exercising are so numerous that an entire book would not be enough. Since I am not an exercise physiologist, but do still know that every morning is a call to arms (and legs and stomachs), let's make a list of why everyone should be motivated.

Benefits of exercise on the

cardiovascular system

1. Lose weight, especially fat

2. Increase your body's ability to use oxygen effectively in delivery to muscles

3. Something called V02 max is regarded as the best indication of physical fitness

4. Lower or help control blood pressure

5. Lower resting heart rate by making each beat more efficient

6. Reduce total cholesterol while increasing HDL, the good kind

7. Reduce the circulating level of triglycerides, the amount of free fatty acid in the blood

8. Reduce the incidence of stroke, heart disease and type II diabetes (adult onset)

Not enough benefits? There's more.

Effect on aging and functional capacity

1. Increase your level of muscular strength although both testosterone and growth hormone show marked decreases of not treated. The maximal strength of a 76 year old man can still exceed his 20 year old grandson

2. Increase stamina

3. Maintain bone mineral density; decrease osteoporosis

4. Increase endurance

5. Maintain weight

6. Decrease injury to joints to tendons

7. Improve balance and coordination

8. Decrease incidence of colon and breast cancer

That takes care of your body - now, let's get on to your...

Mental health and sense of well being

1. Look better

2. Decrease depression

3. Handle stress more effectively

4. Increase self esteem

5. Sleep better

6. Be healthier

7. Learn how to set goals and keep them

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.

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!

Two Types of Exercise

AEROBICS

Exercise that involves oxygenation, stretching muscles and cardiovascular exertion: running, swimming, walking, spinning

ANAEROBICS

Exercise that focuses on isometric resistance, strengthening muscles and weightlifting

If you have a gut or cellulite don't think that doing crunches and squats will work off a specific area. That's 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

There's 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.

Chapter 8

Arthritis – Don't let it get you down!

You get up in the morning and your back aches. The old piano fingers are not as nimble on the keyboard. When you're on the tennis court, by the second set, your knees are killing you. What's going on? The answer, more often than not, is osteoarthritis (OA).

Arthritis is a general term for inflammation of the joints and degeneration of the cartilage. OA is the most common form. It affects over 16 million men and women in the USA alone, and while the majority of those afflicted are over 60, many younger folks suffer as well.

What causes OA? Several factors increase your chances such as heredity, obesity, injury or overuse of certain joints.

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.

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.

How do we know we have it?

Symptoms

1- Joint aching and soreness particularly after normal movement

2 - Pain after exercise or after long periods of inactivity

3 - Bony enlargements in the middle and end joints of fingers, with or without pain.

When a joint is inflamed, the cartilage breaks down and the ease and range of motion is compromised. OA does not cause fever, weight loss, or anemia. X-ray examination easily confirms the diagnosis.

Treatment

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 anti-inflammatory 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.

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.

Chapter 9

Cosmetic Surgery –

Cutting Up

Who's doing what

When I co-authored a book Beauty by Design in 1979, it was clearly obvious to me that the rapid changes in knowledge and technique were bound to have an effect on the way we perceived and did things. Cosmetic surgery is now accompanied by innovations and procedures that enhance and prolong youth fullness both inside and out. However, although the roads may have been repaved, the basic routes remain unchanged in finding the way to a better existence.

I have had two little sayings always get my patients or friends to smile.

"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.

An Example of

Before and After:

Face and neck lift,

nose surgery, eyelid surgery

and chemical peel.

Look what a few procedures can do

when skillfully brought together

Face and Neck Procedures

Face and Neck lift \- There are continuing modifications on the depth of dissection to ensure a longer lasting result. One thing for sure -removing skin without tightening the muscle structure will not do the job. The endoscope has also enabled us to do more with fewer cuttings. More about this later.

Facelift and eye brow lift with liposuction of the neck.

 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.

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 Doctor's drawing (K. Wagner)

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.

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.

Open Nose Technique

1. Connect both cuts

2. Start the exposure.

3. Raise the skin

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.

Trading Faces

What a good plastic surgeon can do

Before

After: A good start

Incisions for a face lift

Face and eyelid lift

Quite a finish...

Before 6 months later

Face lift, eyelid lift and liposuction of the neck

Facial Implants

Facial implants and grafts: where they can go.

Side view

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.

An example of a chin implant and liposuction on the neck.

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 it's all the rage, but beware -- know the operation and the operator.

Tummy Tuck \- If only muscle tightening is necessary, endoscopy may suffice. Liposuction at the same time may obviate the need for a larger incision.

Parents

The part of the book with the photos of human anatomy starts to get interesting here. Please use discretion about what to allow your children to look at.

REPEAT

Parents

The part of the book with the photos of human anatomy starts to get interesting here. Please use discretion about what to allow your children to look at.

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.

Body Lift (front view) Picking up the front

Body Lift (rear view) Bringing up the rear

Body lift

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.

Older Reduction Technique: step by step.

1

2

3

4

5

The end result

Before

After

Avoiding the horizontal scar

Vertical Breast Reduction

Bunching of the scar Two years later

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

A little of both

Breast Lift plus Augmentation

A different way to measure aging?

A QUICK LOOK AT COMMON SURGERIES

If you don't like to look at charts...

Face and Neck Procedures

Face Lift and Neck Lift

What Doctors Call It: Cervical facial rhytidectomy

What Does It Involve: Excess skin gone from face and neck, muscles tightened excess fat removed.

Operating Room Time: 3-4 hours

How Long Does It Last? 10 to 15 years

When Are All the Stitches out? 10 to 14 days

Return to Work or School: 14 days

Nose Job (to change appearance)

What Doctors Call It: Rhinoplasty (cosmetic)

What Does It Involve? Bone and Cartilage realigned to reshape

Operating Time: 1-2 hours

How Long Does It Last? Forever

When Are All the Stitches Out? Not applicable

Return to Work or School: approximately 7 days

Nose Job (to improve breathing)

What Doctors Call It: Septoplasty (to breathe)

What Does It Involve? Partition straightened to improve air flow

Operating Time: 1 hour

How Long Does It Last? Forever

When Are All the Stitches Out? Not applicable

Return to Work or School: Approximately 7 days

Eyelid Surgery

What Doctors Call It: Blepharoplasty

What Does It Involve? Fat and excess skin removed to eliminate bags and pouches

Operating Time: 1-2 hours

How Long Does It Last? 5 to 10 years

When Are All the Stitches Out? 5 to 7 days

Return to Work or School: 7 days

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

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

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

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

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

Before face lift, neck lift and eyelid surgery.

One month later Two months later

The impact of carefully

chosen procedures

You can take a patient," says plastic surgeon Dr. Arthur Swift, "who has been a wallflower - who has been sort of sitting back socially and has been very introverted because she is self-conscious about a large nose, large bust, or small bust and you operate. Their personality literally blooms and a parent will come back and tell me 'you have had a wonderful effect on my child. She is so much more self-confident. She's lost a lot of those inner inhibitions and she feels she's out there.'"

February 25, 2002, From an article by Ray Lawson, Look Good, Feel Good: The link between surgery and emotional health http://canoe.talksurgery.com

The Feather Lift or Thread-Lift

This is the newest facial procedure to hit the scene and capture the fancy of the viewers of NBC's Today morning show, among others.

What is it? It is an office-based procedure that uses fine surgical threads to lift the brow, cheeks, jowls and neck.

What are the threads? They are made of a nylon like material called polypropylene and have directional cogs. After being inserted in the skin, they form a support structure for the tissues.

Who are the best candidates? Patients with premature aging, drooping of the tissues, and a flossed flat face.

How is it done? Under local anesthesia or light sedation, the threads are placed under the skin using a special needle. After insertion, the tissue is lifted on the cogs at the desired level.

What are the advantages?

  1. No scars to speak of

  2. Minimal discomfort for most patients

  3. Quicker recovery with patients returning to work in less than a week.

What do we think? Our enthusiasm for this procedure is not quite as overboard as some. For me, it is a wonderful adjunct to total and more lasting rejuvenation. Combined with a minilift and a full face laser procedure, it is a welcome addition to our armamentarium.

The Thread Lift

Source: .yestheyrefake.net/feather_lift.htm

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 that's good for others to see!).

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 breast's 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

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 !"

Who is having what done?

Here's a list of surgical and non surgical procedures, broken down by gender (performed in 2003). Overall, the ladies account for 8 out of 9 cosmetic procedures.

Name of the procedure Number of

Procedures on females

(% of procedures requested by females)

Surgical procedure

Abdominoplasty 79,709 96%

(tummy tuck)

Blepharoplasty 192,777 84%

(cosmetic eye surgery)

Breast augmentation 249,641 100%

Breast lift 62,453 100%

Breast nipple enlargement 501 93%

Breast nipple reduction 2,205 87%

Breast reduction 125,614 100%

Buttock augmentation 1,909 91%

Calf augmentation 101 67%

Cheek implants 7,033 77%

Chin augmentation 19,598 83%

Face lift 113,463 91%

Forehead lift 58,653 90%

Hair transplantation 864 5%

Lip augmentation 25,512 98%

Lipoplasty (liposuction) 316,469 85%

Lower body lift 4,378 91%

Otoplasty 16,698 50%

(Cosmetic ear surgery)

Rhinoplasty (nose reshaping) 118,028 75%

Thigh lift 4,026 96%

Umbilicoplasty 1,363 66%

Upper arm lift 6,180 98%

Procedures for men

Gynecomastia, treatment of 16,551 (men only)

(male breast reduction)

Pectoral augmentation 671 (men only)

(male chest)

Total Surgical procedures 1,424,939 85%

Non-surgical Procedure

Botox injection 1,424,939 86%

Cellulite treatment 46,671 99%

Chemical peel 453,505 92%

Collagen injection 729,075 93%

Dermabrasion 16,131 84%

Fat Injection 67,540 90%

Laser hair removal 588,549 80%

Laser skin resurfacing 68,248 94%

Laser treatment of leg veins 52,271 99%

Microdermabrations 936,228 91%

Sclerotherapy 291,051 98%

Total Non-surgical procedures 4,674,208 88.7%

Total procedures 6,081,857 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 everyone's pain management program.

Chapter 10

The Endoscope –

A Different Point of View

It's a surgical technique that has been used for decades in a number of different procedures including gall bladder removal, tubal ligation and knee exploration.

For those of us who own a digital camera, the technology is humdrum. The endoscope has two basic parts - a long tubular probe fitted with a tiny camera and bright light capable of being inserted through a small incision and a view monitor that magnifies the images of the body's internal structures. This enables the surgeon to watch the screen while moving the tube through the surgical area.

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.

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.

A Thought

I'm too young to have a full face lift. I'm 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 don't have to go through the preparation for surgery a second time – so soon!

I can't 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.

Chapter 11

Flash Gordon Arrives –

Or at least his lasers do!

For those of us old enough to recall the thrills of Flash's super ray gun which stopped Ming's Merciless Mercenaries again and again, fantasy may have become reality. No quite like Darth Vader and Obi-Wan Kenobi, but we're well on the way.

 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 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.

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. 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.

A Further Comparison of Laser Resurfacing, Chemical Peel and Dermabrasion

Use on forehead with simultaneous brow lift

Laser: Safe

Chemical: Unsafe

Dermabrasion: Risky

Use on eyelids with simultaneous blepharoplasty

Laser: Safe

Chemical: Unsafe

Dermabrasion: Risky on eyelids at any time.

Use on simultaneous facelift flap

Laser: Safe with appropriate technique

Chemical: Unsafe

Dermabrasion: Unsafe

Treatment of acne scars and fine details

Laser: Good

Chemical: Poor

Dermabrasion: Good

Precision of depth control

Laser: Excellent (20 micrometer increments)

Chemical: Minimal control of dermal depth

Dermabrasion: Minimal precision: dermal depth uncertain.

Immediate visual assessment of degree of skin tightening

Laser: Excellent

Chemical: Not possible

Dermabrasion: Not possible

Viral risk from prolonged blood aerosol

Laser: No

Chemical: No

Dermabrasion: Yes

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.

Chapter 12

Anesthesia –

It's not necessarily a gas

No discussion of any operation experience would be complete without dealing with the nuances of anesthesia improvements that have paralleled advances in surgical techniques.

When I was younger, I was both cook and server in my operations suite. The first 7,000 or so of my patients had me at the anesthesia controls. Although I am more than a little egotistical, in this respect I was not stupid. Part of residency training included six months of exquisite experience under the tutelage of some of the best anesthesiologists in the LA area of the time.

But like everything else, not so subtle changes have occurred. As out patient surgery has grown, so has the phalanx of anesthesiologists and quicker techniques that are needed to bring the patient to a state of normalcy without much risk.

Unless you're capable of throwing yourself into some kind of trance, some form of anesthesia is required for every kind of cosmetic surgery. There are four modes of anesthesia that are used:

1. Local anesthesia \- the surgeon can do it.

2. Local anesthesia with sedation.

3. General anesthesia \- you are unconscious and must continually be monitored.

4. Regional anesthesia \- the nerves are blocked by injection along the course of a nerve, numbing an entire area from a distance.

If you've been in a dental chair, you've experienced local anesthesia. For skin lesions or other minor procedures, it's in continual use. You're numb and aware but you don't care.

For procedures a little more complicated, we add sedatives, sometimes orally but usually by the intravenous route. Now you're asleep, unaware and with the proper choice of agents, you don't remember or sense anything about the operation.

From Dr. Wagner's 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!

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 shouldn't mind a few questions about the depth of his or her skill and your depth of anesthesia.

TIP: Don't worry about cracking your knuckles. Remember seeing who could make the loudest "click" during those boring lectures in 8th grade? Well, your mother's scolding about "you'll 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

Chapter 13

From the Top of Your Head to the Bottom of Your Feet

We've covered a lot of ground and now let's get more specific about some areas that will affect many of us

in our life journey.

We'll go down the line

to open some doors or,

at the very least,

open some eyes!

Baldness: It's no Longer a

Hairy Situation

W

One year and 300 plugs later

hat a difference a generation or two makes, thanks to innovations, inventions, scientific advances and super specialization. The hair on my head is a living example of the success of hair transplantation, and has stood the test of time for over 35 years.

When I started my practice almost 40 years ago, there were only a handful of men (mostly dermatologist) who were skilled in the art of moving hair plugs from place to place on the scalp with varying degrees of success. Today it is a burgeoning industry with hair transplantation centers spanning the globe and newsletters available on the Internet.

Before we get to today's techniques, let's just review the whip and wherefores of hair loss. Hair is on a genetic time table, an inherited trait. It can come from either side skip a generation involves both sexes and is random in its affect on siblings. It is totally independent of hair care. If you're unlucky to have the gene responsible for hair loss, your hair follicles are being genetically coded to make them sensitive to dehydrotestosterone (DHT).

As we enter adulthood the follicles begin to shrink the hair becomes finer and finer and their growth is stunted. Sooner or later thinning becomes receding, perhaps followed by baldness.

Many years ago we started varying degrees of surgical gymnastics in order to decrease the balding areas or transfer larger amounts of hair at one time. We used expanders, flaps, scalp reductions or strips to create a hairline. Not to belabor the point, improvements in knowledge and techniques have minimized gargantuan surgical efforts in favor of medication and Micro Surgical procedures.

How it's done today.

Hair: Where it's put

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 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.

Common Drugs That Cause Hair Loss

It is well known that many cancer chemotherapy medications cause baldness. Most people are willing to put up with hair loss when accepting treatments for life-threatening diseases. But a large number of popular medications can cause hair loss while neither pharmaceutical industry nor your doctor will tell you about this side effect.

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

The Eyes Have It or

Here's Looking At You

B y now, our readers are aware of the numerous cosmetic procedures available to beautify that area frequently referred to as the "Mirror of the Soul." That shy, coy, come-hither look, the sly wink, the look of innocence all emanates from the orbs regaled, honored, sanctified, adored and adulated in song, verse, prose or in the more banal advertisements in magazines, movies and television.

We have spoken about blepharoplasty, botox injections, forehead lifts, tattooing of lashes, peels and filler to enhance the beauty that gazes out while we gaze in. The eyeglass industry flourishes, providing products costing up to the $1,000 to frame that part of human countenance.

Here beauty and youth are frequently on parallel paths, but recent advances in corrective surgery have given us more of an edge in the fight to improve not only our appearance, but our sight as well.

LASIK

You've heard about it, seen it advertised, but I bet you didn't know it stands for: Laser Assisted In Situ Keratomieuses (now you can forget it). This is a relatively new type of laser surgery for correcting nearsightedness and astigmatism. LASIK, sometimes referred to as "flip and zap," works by making a small flip in the cornea and removing some of the tissue under the opening. Because of the preciseness of the laser beam, the offending tissue can be removed without damaging the surrounding structures.

The benefits are manifold. The procedure takes 10-15 minutes per eye, it is performed in the surgeon's office or same-day outpatient center and requires no hospital stay. Pain is minimal and aftercare is straightforward.

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.

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!

Can You Hear Me Now?

It sneaks up on you before you know it. The volume on the radio needs to be turned up. When you are at a party, you have difficulty understanding what your friends are saying even though you're next to them. There's a message on the answering machine and you were home.

About 10% of our population has some degree of hearing loss. A major cause is age. One third of people over 65 and half over 75 suffer from presbycusis,( age related hearing loss).At the present time there is no known cure for this condition, so let's turn to what we can do to improve our environment.

The biggest single cause of hearing loss is on the rise- LOUD NOISE Who doesn't want ultrastereophonic surround the theater super real sound systems? What about the boom boxes, the blow dryers, the personalized walkmen? When was the last time that the whole neighborhood didn't hear the Rock concert a mile away? I'll tell you who -the sensory cells in the inner ear that are damaged from loud noise and don't grow back!!!! It's bad enough that these cells naturally deteriorate with age so, why should we add fuel to the fire? According to the National Institute of Health, more than 30 million American children and adults are exposed to loud noise on a regular basis.

Before you throw your hands in the air or bemoan our fate, there is a light at the end of the tunnel and it's not an oncoming train. The last few years have seen some significant advances in the treatment of hearing loss. The newer hearing aids are digitalized, smaller and virtually unnoticeable, so wearing them causes less embarrassment. New surgical techniques are enabling people to hear words and sounds that were impossible to think of.

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?

  * 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.

Smile, Even if You're not on Candid Camera

Before and after a whitening procedure.

For a plastic surgeon not to be concerned with the state of a person's teeth makes about as much sense as forgetting to pour part of the foundation of a building. As is the case with other modalities, the techniques are constantly being refined and expanded, with the preservation of an alluring smile becoming more and more important.

The field of cosmetic dentistry has spread somewhat more slowly then surgery, but there is hardly a city or town that doesn't have a cosmetic dentist in it's phone book.

While I make no presumption of being a expert in the field, my personal experience with dentists started at age 6 and continues to the present. Improved techniques have softened my original antipathy and turned it into a remarkable friendship, frequently working hand and hand with a colleague (so to speak) to create the perfect smile.

Cosmetic dentists can whiten teeth, replace missing teeth and repair chipped teeth through any number of techniques including bleaching, dental implants, porcelain binders, bonding, dental crowns and bridges.

Most common options

Tooth Bleaching \- There are two methods available- Laser whitening is performed in the office. At home bleaching uses take home kits or newer tooth pastes containing whitening additives (peroxide gel).

Porcelain Binders \- A ceramic shell is applied to the front of the teeth that is whiter than the original .

Dental Implants \- Artificial teeth are placed in the gums and bone structure to replace missing teeth.

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.

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.

Breast Surgery –

Get it off (or on) your chest!

Here's the truth - the female breast is a modified sweat gland and skin appendage, but what a modification!

Incisions for Breast Augmentation

What doctors say What we say

Breast Implants: Where can they go?

Where implants go

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.

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 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.

Breast Elevation with an Implant (editor's choice)

Most of the patients have 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.

Do I Always Have to Diet?

Fat, Fat - Make it Go Away

When this author first wrote about body contouring in the 70's, little did he realize that we were on the brink of an explosion called liposuction – or did he?

In the late 60's, I tried to improve body contours by making small incisions, taking the curette we used for abortions and inserting it under the skin to loosen the fat and then suction it out by very primitive techniques. For awhile I thought I had really discovered something until a careless patient became infected and found her way into the office of a venerable colleague (now departed). Not being a friend of mine ( to say the least), he wrote this to her malpractice attorney "Only a maniac sucks fat out of a body!" After prodding by my insurance carrier, I put my thoughts into moth balls until it became the sensation of the 80's, but what the hell! Welcome to the mad house- open for a booming business!

Contour transformation has been documented since antiquity. Today's increase in tattooing and body piercing is the latest fad following centuries of scarification, binding feet and foreheads and the like. Tattooing for medical reasons and cosmetic enhancement of eyeliners and eyebrows are in our armamentarium, but let's stick to unwanted curves.

Back Front Legs and Thighs

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 we're 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.

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 TV's 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!

D on'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.

Ultrashape: The future?

Before liposuction

The old way

Liposuction – The New Way

No visible scars

A Little of Both

Tummy tuck and liposuction.

I've Got You Under My Skin

The Cellulite Story

Cole Porter wrote the song, but he never mentioned the real problem that most women have: "Cottage Cheese or Orange Peel" thighs. Ladies dread it, hoping they'll never get it, but sooner or later, 90 percent will and men shouldn't be so smug either. Not as many, but a good number of felloes will succumb to this annoying condition.

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 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, let's 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)

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 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 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.

Look Good, Feel Good

Society places an enormous emphasis on looks. Studies have shown that better looking people earn more, are promoted sooner and are more likely to occupy senior positions within corporations. Given the same qualifications, the more attractive person, male or female, is more likely to get the job. Similarly, when it comes to choosing a partner or mate, do looks count?

So when you look better, you feel better. Your productivity is likely to go up and perhaps you become a more valuable member of society. If you look like a million bucks, are you worth a million bucks?

\-- Dr. Dirk Lazarus, Plastic Surgeon

MBChB (University of Cape Town), FCS (South Africa, Plastic and Reconstructive Surgery), http://www.plasticsurgery.co.za/news1.htm

Ways to Lose Weight

When All Else Fails

As plastic surgeons, we have seen people who have lost tremendous amounts of weight for resculpting and restoration of the body image. For many, it has been due to diet, sheer willpower and determination. For those who have become morbidly obese, sometimes a surgical solution may be the only way to start the ball rolling.

We have touched on BMI in the previous chapter. A person with a BMI over 30 is considered to be obese. Another parameters are these body measurements:

1) BMI between 25 and 34

2) Waist Size

Men = over 40"

Women = over 35"

If you fall into these categories, you are at especially high risk for obesity-related problems, such as diabetes, high blood pressure and heart disease. If you have a BMI of 40, your risk of premature death by any cause will increase by 50% to 150%.

Before the use of the endoscope, operations to decrease the size of the stomach and intestines were uncommon, but the last ten years has seen the development of more and more "Bariatric Surgery Centers," proudly heralded in newspapers, magazines, TV sports and the Internet.

Bariatics is the name for that branch of medicine that deals with the prevention, treatment and control of diseases related to obesity. For most of those people getting there it means surgical intervention sooner or later.

To be considered for surgery you usually must need certain requirements:

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 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.

 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 what's 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.

The Vagina – It's Not Always a Monologue!

No journey would be complete without talking about the possibilities of rejuvenation of one of the areas glossed over or embarrassingly avoided - The Vagina.

The object of man's desire, the ultimate goal of youth, is the victim of use for childbirth and is, under the best of conditions, not exempt from aging. In addition to laxity and loss of muscle tone, many women area displeased with the external appearance of their genitalia. So what's a woman to do? The answer is plenty.

First let's talk about the outside: the labia majora and menora. That's right men, women do look at Playboy models, too, and don't want to look ugly down there. Some women complain about the unevenness of elongated lips and, occasionally, large labia can be pulled inside during intercourse (ouch!). Chafing can be a problem as well during everyday activities. Here a plastic surgeon or gynecologist can come to the recourse, using either simple surgical or laser techniques. Only local anesthesia is necessary and, within a couple of weeks, you're ready to face the world or that special someone.

I became aware of hymenoplasty over 40 years ago to give the patient that unused look popular in the Far East (it cost $60 when I read about it in Time Magazine). It's still around for the occasional request.

Incontinence

There are a growing number of patients who have involuntary loss of urine with sneezing, coughing, laughing, exercising or sex. This is due to vaginal relaxation as the tone, strength and muscle control diminishes. The sensual sexual gratification is lost and women have been the butt of male jokes on more than one occasion due to the enlargement of their cavity.

Here we have two options: exercise or surgery. My good friend Dr. Alan Stein of Tampa, Fla., has come up with a device that I feel should be a household fixture for every woman over 40 or who has had children. It's called Gyneflex™. What is it? Something like Suzanne Summers' Thighmaster™ for the vaginal vault. Made from gentle plastic to conform to the contours of the musculature, it allows the user 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?

The Third Leg: Lengthen it?

We've talked at great length about the importance of sexuality in our perception of staying young. While it is true that increasing awareness of the various interactions of medication has led to the decreasing role of surgical intervention in the treatment of penile problems for some it may be the only way.

Potency is and always has been something special in human culture. Early common and church law required marriages to be consummated. Failure to do so was grounds for annulment. If you consider the infrequency of divorce in those times, you can appreciate the magnitude of the "offense."

The joke and asides still exist and although less drastic nowadays, don't tell that to a man who has lost his ability to perform.

Let's talk about the problems on an anatomical and physiological level. It's called "erectile dysfunction" or ED for those in the business.

ED is the loss of the ability to produce and maintain a functional erection secondary to anatomical, psychological or physiological problems.

The causes of ED are multifactorial (lots of things). They are usually classified as hormonal, neurological, arterial (not enough blood getting there), and venous (incompetence of valves). Injury to nerves and blood vessels can result from trauma, prosthetic surgery, and long standing diseases such as diabetes and hypertension. Neurological causes include multiple sclerosis, and other degenerative diseases. Hormonal imbalance can be a major factor, such as depressed testosterone production, adrenal insufficiency, and diabetes. Increasing the problem can be the fact that certain medications taken to treat hypertension and prostate disease (as well as antihistamines and drugs of abuse) produce ED as a side effect. Peyronie's disease, which is scarring of the underlying fibrous structure of the penis, may be a factor.

That's it in a nutshell. Considering the fact that up to 50 percent of men experience ED by age 70, the little guy faces an uphill fight. Thanks to drugs like Viagra and injection techniques, he's more than halfway there but, how about the rest of us when the magic pills, hormones, or direct shots fail?

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.

Let's 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 it's 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!

Devices to avoid

How's this for a crutch?

Proceed at your own risk

There are some operations that make a little more sense, if the concept makes any sense at all. There is a procedure that cuts some ligaments that attach the member to the pubic bone. The organ will be almost two inches longer when not in use (maybe the boys in the gym won't stare?) but, when called to attention, the increase is virtually negligible. If girth is a problem, dermal fat grafts or fat injections may make it thicker, but not longer or stronger.

The fact is that most men had much bigger expectations and are visibly disappointed. Complaints range from pain to ugly penises, scars and impotency.

Here is the real scoop. What is normal? One doctor measured 60 penises to try to come up with what's "okay." Get ready:

• Flaccid 3.5 inches

• Erect 5.1 inches

• Circumference 3.9 inches

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 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!

Another Point of View

I have checked into the situation thoroughly, and the sad fact is that if nature has equipped us with a ding instead of a dong, well, we must just learn to live with it, and that is all there is to it. A consulting urologist at the sexual behavior consultation unit at Johns Hopkins Hospital in Baltimore tells me that there are no known methods, surgical or otherwise, of permanently increasing penis size for what we might call "cosmetic purposes."...

In short, your best bet is to reconcile yourself to your present equipment. Remember, it's not the meat, it's the motion.

Cecil Adams, advice columnist

http://www.straightdope.com/classics/a1_056.html

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.

Vein? –

What's the Best Course?

If you walk around the streets, particularly during the hot spring or summer days, you shouldn't be surprised to know that millions of men and women have varicose vein disorders. According to a national data bank survey by the American Society of Aesthetic Plastic Surgery, sclerotherapy (injections) is the sixth most commonly performed non-surgical procedure in the US, comprising over 500,000 treatments yearly.

The visual appearance of veins is a useful but not always reliable indicator of the health of the venous system, particularly of the legs. We'll deal with this a little later.

What causes venous disease?

Sex and age has something to do with it.

Varicosities by age and sex

Age Female Male

20-29 8% 1%

40-49 41% 24%

60-69 72% 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. 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).

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.

The Thermal Catheter at work

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 public's 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 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 Pretreatment After After

6 weeks 2 years

Leg Pain 85% 6% 5%

Leg Fatigue 85% 12% 5%

Edema

(swelling) 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!

Shoo Away the Shoe Blues!

Before we come to the end of our journey, let's not forget an important part of our anatomy that's 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 don't necessarily wait until we reach the later decades. Flat feet, athlete's feet and fungal infections surely can put a crimp in anyone's 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.

Let's 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 I'm 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 it's easy to see why your tootsies are sore.

We've 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.

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 – it's called Morton's Toe. A pretty easy procedure, if you're 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, you've landed in the right chair anyway!

# www.smacboca.com

Chapter 14

Get Set and Ready to Go

From I to I to I...

In my younger days, I used to joke with some of my friends and patients and say, "I'm the best left lower eyelid and right upper eyelid surgeon in the world." Although that really was not the extent of my expertise, perhaps in my mind that was a portent of things to come.

Superspecialization is rapidly becoming the rule of the day. In contradistinction to the general practitioner or specialist of yore, the growing store of knowledge is no longer capable of being handled by solo practitioners. While I decry the increase in lack of personal contact between doctor and patient, it is increasingly important to explore the level of the doctors' training and experience.

In today's world, it is easier than ever to ascertain the background of almost every person that holds a license, even without being a member of the CIA or FBI. It's called the Internet. Stored with a certain amount of 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.

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?

We've come a long way...

Your New Beginning

How, when and where do I start?

You bought this book!

The mirror is a good place, a real evaluation of what you don't like and a realistic expectation of what you can expect. Separate fact from fiction.

Don't be blinded by the metaphors and come-ons from so many directions. Recognize that whatever path you take, sometimes you can't do it alone. Do your homework and be careful in your choice of traveling assistants and aides, whether it be exercise or your diet.

Remember, you have a great role to play in creating your own "Forever Therapy." We're here to help. Enjoy, live long and live well!

smacboca.com 561.391.9101

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

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

# www.smacboca.com

Chapter 15

Appendix

This book is updated by visiting the web pages of ASI (smacboca.com).

Other helpful web sites

Gyneflex.com A web site that gives an animation showing the use of the gyneflex device.

Medlineplus.gov A web site paid for by the U.S. government and the National Institutes of Health, providing "trusted health information for you."

plasticsurgery.org/public_education American Society of Plastic Surgeons

iom.edu The Institute of Medicine, especially the web page giving Dietary Reference Intakes (suggested minimum daily requirements) of various nutrients. http://iom.edu/Object.File/Master/21/372/0.pdf

bluepeel.sandycarter.com/threadlift_looplift.html Thread lift information; also at: yestheyrefake.net/feather_lift.htm

store.nutecint.com Feather Lift information

Look at smacboca.com for other links to useful information.

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.

## The authors are Jason Pozner and Kurt Wagner.

We look forward to sharing with you more at www.SmacBoca.com

## This is the 2005 edition

## It is distributed here for your learning pleasure.

## Look for Dr. Wagner's autobiography on Lulu.com.

## Find his ebook.

## Write to Doctor Wagner at Truk1934@gmail.com

## Thank you!

## ========================

## A collection of his favorite tips and witty sayings is here:

Favorite sayings and tips

By Dr. Wagner

"You name it, we'll frame it!"

"If your face or body is unbecoming to you, you should be coming to me!"

\- Kurt Wagner

===================

Charge it! (with apologies to MasterCard)

Next Birthday: 57

Cell Age: 32, thanks to Dr. Brizel's 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)

The look on her ex-husband's face: priceless.

==================

TIP: Drink two cups of coffee or tea a day. Research can't explain why, but caffeine appears to significantly reduce the onset of Parkinson's or Alzheimer's diseases

=========

TIP: When you have back pain, don't 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 you're in pain is better than just lying there because the other back muscles that are not in pain can be exercised.

===============

Here's a story that Dr. Wagner likes to tell...

The impact of carefully

chosen procedures

You can take a patient," says plastic surgeon Dr. Arthur Swift, "who has been a wallflower - who has been sort of sitting back socially and has been very introverted because she is self-conscious about a large nose, large bust, or small bust and you operate. Their personality literally blooms and a parent will come back and tell me 'you have had a wonderful effect on my child. She is so much more self-confident. She's lost a lot of those inner inhibitions and she feels she's out there.'"

February 25, 2002, From an article by Ray Lawson, Look Good, Feel Good: The link between surgery and emotional health http://canoe.talksurgery.com

===============

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 Reader's Digest, sudoku, crosswords (the tough ones) and reading complex articles. Warning: most newspapers are graded down to a 14 year old's vocabulary, so look for tougher material.

================

LAUGH TIP: For Your Circulation

When we laugh, the linings of the blood vessels expand and positive chemicals flow.

==============

LAUGH TIP: For Your Belly

There's 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.

=======

"You name it, we'll frame it!"

"If your face or body is unbecoming to you, you should be coming to us!"

========

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 that's good for others to see!).

=============

A Thought

I'm too young to have a full face lift. I'm 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 don't have to go through the preparation for surgery a second time – so soon!

I can't 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.

============

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.

===========

Dr. Wagner likes to quote other plastic surgeons:

Look Good, Feel Good

Society places an enormous emphasis on looks. Studies have shown that better looking people earn more, are promoted sooner and are more likely to occupy senior positions within corporations. Given the same qualifications, the more attractive person, male or female, is more likely to get the job. Similarly, when it comes to choosing a partner or mate, do looks count?

So when you look better, you feel better. Your productivity is likely to go up and perhaps you become a more valuable member of society. If you look like a million bucks, are you worth a million bucks?

\-- Dr. Dirk Lazarus, Plastic Surgeon

MBChB (University of Cape Town), FCS (South Africa, Plastic and Reconstructive Surgery), http://www.plasticsurgery.co.za/news1.htm

=============

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.

=============

Remember, you have a great role to play in creating your own "Forever Therapy." We're here to help. Enjoy, live long and live well!

smacboca.com +1 561.391.9101

====================

About Kurt Wagner

## In his 77th year (2011), this is a tribute to the life and working achievements of one of the pioneers of modern plastic and cosmetic surgery and reconstruction - a man whose efforts have beneficially affected the lives of more than 25,000 of his patients.

