A New Year; A New You!

For many of us the passing of another year also brings the reality of another year older. As more and more New Year’s Eves pass by, some of us wonder if we can stop the hands of time or at least slow them down a bit. Everyone is looking for a way to look less stressed and more rested in the New Year. Like everything else that comes with age, certain changes take place with our bodies during the different decades of our life. Therefore, plastic surgery should plan to target the different needs and concerns of patients in different age groups.

In our twenties, we are more concerned with looking our best rather than the signs of aging. From teens to twenties, plastic surgery is aimed at more aesthetic features such as the size and shape of noses or breasts. I always recommend that teenagers wait until they are at least 18 before considering plastic surgery because it allows for the completion of any possible growth spurts and the maturation of all facial features. The time between high school and college is an excellent time to address concerns such as protruding ears, nasal deformities or weak chins because it is a time in a teenager's life when they will be making a lot of changes as well as finding new friends.

As we hit our late twenties and thirties our faces and bodies may begin to show subtle signs of wear and tear. The key here is prevention and maintenance throughout the next decade. Skin care is essential and we have many tools in our armamentarium to prevent signs of aging and reverse skin damage. Numerous lasers are now available that can remove unwanted hair and smooth, tighten and reverse sun damage of the skin. In addition, Botox and injectable can fill early facial wrinkles and lines and chemical peels can help improve the texture and complexion of facial skin.

As the forties approach, we begin to notice the consequences of our past New Year’s celebrations. At this age, many women consider ”Mommy Makeovers” because they have had children and are ready to get their pre-baby bodies back. Abdominoplasties (tummy tucks), body contouring with liposuction and breast lift/augmentations are very popular for women in this group. In men, liposuction of the “spare tire” or “love handles” is extremely common. In general, if you have taken some measures to prevent the signs of aging and practiced healthy skin care you should be able to prolong the “big” face surgeries for another decade or so. Common facial rejuvenating procedures in this age group include mini-face/neck lifts to battle sagging necks and lower and upper eyelid surgery to remove bags under the eyes and lift hanging upper eyelid skin.
One extremely effective procedure gaining more favor is facial fat grafting. This procedure borrows fat from somewhere else on the body in order to replace the fat that we have lost in our face due to aging. Fat grafting creates a very natural and soft look that makes people simply looked younger, healthier and refreshed.

As we move into the fifties and sixties, age and genetics catch up with us and we need to take a good, long look in the mirror. Botox and fillers will not produce as effective results anymore because the skin has lost some of its elasticity and needs to be removed, lifted or tightened. On the plus side, if the signs of aging have shown up there are many things that can be done to reverse them. As we age our faces turn upside down and we lose fullness in our upper face and gain it in our lower face and necks. To reverse this we simply need to “reshape” the face towards its more youthful appearance. Neck and facelifts can tighten and lift the lower neck and face. These procedures can be combined with facial fat grafting in the upper cheeks to produce a particularly dramatic result. Fat grafting contains stem cells which may actually help rejuvenate the face from the inside out. At any age, most patients simply want to look like a younger, healthier, more rested version of themselves and not somebody completely different. Just remember that "less is sometimes more" and try to search for a surgeon that listens to your concerns and addresses them directly - in a manner that you agree with and are able to understand. Any procedure that you are considering should make sense to you and not seem “not too good to be true”. Just remember that at every age “healthy is beautiful” and the best was to keep the signs of aging as far away as possible is to eat healthy, exercise regularly and ALWAYS wear your sunscreen.

Battle of the Bulge

As the holidays approach so does the temptation to enjoy all of the wonderful treats they have to offer. From the turkey and pumpkin pie of Thanksgiving to the large family feasts of Christmas, New Years and Hanukah, it is hard to resist home cooking and office dinner and cocktail parties.

What can be done is we can get rid of a few extra pounds after the holidays! As is the case all year round, the key is balancing proportions and to try not to overeat. The second is keeping the pounds off with a little exercise sprinkled in between the holiday treats. Of course when these pounds do not seem to want to leave and you are holding your weight beyond the holidays, liposuction becomes a viable alternative. Although liposuction is not intended for weight loss, it is very effective in giving people the appearance that they have lost a great deal of weight. Liposuction is intended to target those troubled areas that we cannot seem to lose through diet and exercise. In women this area is typically in the thighs (saddlebags) or around the abdomen. In men it is more likely to be in the waist (spare tire) and abdomen. Although maybe only 5 lbs. of actual weight may be removed with liposuction (fat floats because it is not very dense or heavy) it can give the appearance of 20 lbs. of weight loss. Because the waistline is often targeted, it is not unusual that patients may go down several clothing sizes after liposuction!

Although liposuction is not intended for weight loss, it is very effective in giving people the appearance that they have lost a great deal of weight.

Liposuction has been in use for more than three decades and it is an extremely safe and effective procedure when performed by a well-trained and qualified surgeon. It is essentially scarless, since the fat is removed through tiny cannula holes placed in strategic areas on the body. Healing is relatively quick but swelling and bruising may take several weeks to completely resolve so plan ahead. Exercise and diet should always be used in combination with liposuction because they will tremendously enhance the final results. Many patients will use the surgical experience as sort of a “springboard” to changing their exercise and dieting habits. Some people simply need a “little push” in the right direction! As they begin to see definitive results, the motivation to change bad habits is much more effective and longer lasting.

Since liposuction has been around for so long, new techniques are constantly being developed and tested. In the news we now hear about such procedures as tumescent, LASER assisted, Ultrasound, VASER, SLIM, SMART and COOL liposuction. In fact, all of these techniques all have one thing in common. They remove fat from the body through the use of liposuction cannulas. The only real difference is how the fat is treated prior to its removal. All of the procedures will utilize “tumescent” solution to infiltrate the soon-to-be liposculpted areas. The tumescent solution serves to numb the areas, “firm” up the fat to be removed and help with post-operative bruising. Once the fat is ‘tumesced,” or filled, with solution, the fat can be treated with ultrasound, light or LASER in order to “melt” the fat prior to its removal. The intention of this pre-treatment is to provide a smoother result with less post-operative bruising and discomfort.

One area that liposuction can be particularly effective and can yield dramatic results is in the neck. This is an area where a little suction can go a long way. A heavier neck can give the illusion that a person is significantly overweight even though they might only be a few pounds over the norm. In addition, as we age, we tend to acquire more fat under our chin and lose fat in our face. Therefore, not only does liposuction of the neck make you look thinner, it can also turn back time and make you look younger!

Overall, liposuction is an extremely safe and effective procedure. This is why it is always in the TOP TWO cosmetic procedures performed in the United States. Just remember it is intended to target “trouble areas” and that dieting and exercise will ALWAYS enhance what a talented plastic surgeon can achieve through liposculpting.

Dr. 90210's Expert Advice

With the holidays at our doorstep is your body ready for parties or for that winter-getaway vacation? There are many different things that you can do that range from simple to surgery that can improve the way your body looks in clothes and swimwear. Let’s start simple. There is no better way to lose weight than exercise and diet and I always recommend trying these tried and true approaches to getting your body in shape to my patients as a first line of improvement. Exercise and diet not only help you lose weight but they improve your health, lean body mass and heighten your metabolism. All of these things will make you look more beautiful on the beach and in clothes.

On the other hand, we all know, exercise and diet is difficult in a society abundant in hectic work schedules and fast food restaurants. I personally subscribe to the philosophy of “no pain, no gain” but even with habitual dieting and exercise we all
still have our “trouble areas.” Those areas are the ones that always seem to remain no matter how hard we exercise and diet and they are also the first areas to grow larger with weight gain. In women the most common trouble areas are the outer thighs, hips and abdomen (muffin top and saddle bags – ouch) and in men it is the abdomen and waist (love handles and spare tire). Liposuction is a powerful tool to sculpt and remove these unwanted bulges especially when exercise has made them all the more apparent and stubborn. There are many different types of liposuction but they all have one thing in common – they remove fat effectively and safely. Just remember, liposuction is not intended for weight loss but rather for improving
overall body contour. Having said that, liposuction can give the appearance of significant weight loss since fat is strategically removed from areas that give your body slimmer lines and sexier curves.

Summertime is here and with faster recovery periods and affordable procedures; you can still look your best on the beach this summer whether it is through exercise, diet, surgery or a combination of all three. Lastly, if surgery is not in your budget or lifestyle, non-invasive procedures can touch up your body for the beach by removing unwanted hair, tightening skin and reversing prior sun damage. State-of-the-art technology and highly trained professionals can now provide injectables, fillers,
peels and lasers with minimal downtown and impressive results. Remember, a beautiful body never goes out of style, so bring on summer and don’t forget your sunscreen!

Natural is Beautiful...

When it comes to setting the standard for beauty, Beverly Hills is the place to watch out for. And while Hollywood is traditionally known for its flash and flair, the trend in plastic surgery is that women want results with a natural look…results that are not too “visible.”

The true magic in plastic surgery is in making patients look like a younger, more attractive version of themselves; not somebody completely different. Gone are the days of the “Extreme Makeover” because people do not want to look like they have had surgery.

In terms of facial rejuvenation, this means that “less is more.” Patients must always remember that additional plastic surgery can always be performed but it is difficult to undo less than satisfactory results. I prefer to be extremely conservative with my approach to facial rejuvenation and I believe that minor procedures and preventative measures are the key to beautiful, natural results.

Patients should consider maintenance plastic surgery in order to prolong and prevent the “bigger” procedures later on down the road. This means Botox and fillers at a point in time when lines start to appear on the face. Once again, conservative amounts of these simple and non-surgical alternatives to facial rejuvenation keep people looking younger. However, one must understand that too much of even these minor interventions can lead to altered facial expression and plumped-up faces. That is why I always tell my patients to start with only a few areas of Botox to see how they like the results before considering more aggressive amounts and longer lasting alternatives.

In all of my consultations and any discussions with potential patients, I mention that one alternative to facial fillers is facial fat grafting. This is because our own fat contains the most plastic of all cells in the human body: stem cells. These cells are the true creative genius behind all of the tissues of the human body and they are contained in extremely high concentrations in our own fat cells. Unfortunately as we age, we also slowly lose our facial fat. Over the years our faces may begin to look “deflated” and weathered. The good news is that we have discovered is possible to borrow fat from elsewhere on our own bodies and replace the fat that is lost in our faces with aging. In this way, we can restore our faces to a natural, healthy appearance without artificial fillers or over- tightening of the skin. For this reason, I truly believe that a key to facial rejuvenation in the future will be the concentration and incorporation of our own, natural adipose stem cells into aging facial tissues.

When considering facial plastic surgery to alter the appearance of the facial features, a similar philosophy holds true to that of facial rejuvenation. People should always understand that natural results are beautiful. For example, when considering a rhinoplasty patients should know that technology exists to actually see what their “new nose” or profile will look like before every seeing an operating room. Morphing software is available to all surgeons that can place your before and after profiles side-by-side so that you can literally see yourself before and after the surgery without actually having the procedure performed. This is nice because it gives you an idea of how you will appear after surgery and also give you an idea of the artistic skill and aesthetic ideals of your surgeon. If you give 10 different plastic surgeons the same nose to operate on, you will most likely get 10 different noses after the surgery. One of the biggest compliments to a plastic surgeons skill is that a patients looks like a more attractive, younger version of themselves but their friends and even family have a hard time figuring out exactly what has changed about their appearance. The true art of plastic surgery is in keeping a change so natural that the patient can decide whom they wish to reveal their beauty secrets.

Less is More...

We have all seen it… The numerous magazines that line the shelves at the check-out stand, speculating on which young Hollywood starlet has undergone which surgical procedure. We have all combed the pages, comparing the before and after photos, trying to determine, “Is her nose smaller? Are her cheekbones more sculpted?” I, myself, have been asked numerous times by these same publications to contribute my thoughts as to whether or not these beauties have been surgically altered.

At times, one can find themselves wondering, “Aren’t they beautiful enough already? Was the surgery really necessary? I barely notice a difference anyway.” However, these young Hollywood stars are actually reflecting a growing trend in plastic surgery, the “less is more” approach.

Gone are the days when the wealthy 50-something housewife disappeared for the summer to the South of France and came back with her face stretched unusually tight. Today’s approach towards cosmetic surgery is much more subtle, much more natural-looking and largely beneficial to patients of all ages. In my practice, I see more and more young and attractive clients who are seeking multiple, minimal refinements to improve their overall appearance. A “good” result is achieved when friends and family tell you how wonderful you look, but they can’t quite place their finger on what it is that’s different about you.
Traditionally, patients came to a plastic surgeon with a major complaint, “My breasts are too small, my nose is too large, etc.”

Today, more and more patients are coming to the office and asking the surgeon to recommend numerous ways to improve their appearance. A skilled doctor with a good aesthetic sense can suggest refinements that the patient may have never considered before, but will lead to a more beautiful or handsome look overall. Finding a doctor who utilizes computer imaging can be especially helpful in this search. Using computer imaging, the surgeon can not only describe to you what you will look
like after the surgery, but can show you an image of yourself with the suggested changes. While reviewing your new appearance with your surgeon, you can suggest more or less dramatic adjustments which can be applied to your computer image on the spot!

Overall, most people are truly amazed by how drastically they can improve their appearance by undergoing only a few minor cosmetic procedures. No matter what procedure you are considering, make sure that you find an honest and genuine surgeon who will listen and work with you to achieve your aesthetic goals. A good plastic surgeon will not only be able to suggest beneficial procedures that you may not have considered before, but will also be able to tell you “no” in order to keep you from doing too much!

Like Mother, Like Daughter...

We all know mothers and daughters shop together, travel together, laugh together and consider themselves best friends. But in today’s day and age, it’s realistic that these duos even share the experience of plastic surgery. I have noticed a trend in couples cosmetic surgery, including husbands and wives, sisters, friends, and, the most popular of all, mother/daughter plastic surgery, particularly in Beverly Hills.

Last month I had the privilege to perform surgery on a mother and daughter. It’s interesting to witness the differences in the desired outcomes from surgery on two ladies merely one generation apart. Expectations vary greatly from mother to daughter because, as our bodies change with age, so do our ideals, our identities and our social groups and activities. For daughters, plastic surgery strives to achieve to aesthetic perfection by enhancing and maintaining youthful contours and curves. Mothers, more often, desire restoration to a more youthful, rejuvenated version of themselves without the appearance of surgical enhancement or dramatic change. The American Society for Aesthetic Plastic Surgery (ASAPS) reports that here were nearly 11.7 million surgical and nonsurgical cosmetic procedures performed in the United States in 2007, including an increase in couples cosmetic surgery. The majority of the cases seem to be mother/daughter plastic surgery. While we don’t know what the increase is linked to, speculation is that the shared surgical experience increases mother-daughter bonding.

Overall, mother-daughter bonding can occur through simple moral support, the shared experience itself, and/or the recovery time spent together. The most popular mother- daughter plastic surgeries include facelifts, tummy tucks, nose jobs, and breast surgery. In my experience, whether the surgeries are done at the same time or separately, once a family gains trust in a plastic surgeon, it is only a matter of time before mothers, sisters, aunts and uncles come into the office with questions and “wish lists” for better bodies and more youthful features.