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Issue Date: July 2014 Issue


Healthy Living

Doctors talk popular cosmetic procedures and technology.

Body Works

Achieve a more youthful appearance with these advances in plastic surgery.

by Kristen Hampshire

You can't stop your body's clock. But with a bevy of cosmetic treatments and procedures that restore youthfulness and erase trouble spots, you can turn it back.

"The clock will tick forward, but it will never catch up," says Dr. Bahman Guyuron, chairman of University Hospitals' department of plastic and reconstructive surgery. "If we make someone look seven to 10 years younger, that person will look seven to 10 years younger for the rest of his or her life."

New products and noninvasive surgeries have spurred a higher demand for cosmetic surgery. The American Society of Plastic Surgeons reported 15.1 million cosmetic surgery procedures in the U.S. in 2013, up 3 percent from the year before.

"We are not making new people," says Dr. Michael Wojtanowski, of the Ohio Clinic for Aesthetic and Plastic Surgery. "We are taking the fabric that people have and adjusting it so it fits their body better."

Imagine an inflated balloon that loses air over time.

"It gets those crinkly wrinkles on the surface," describes Dr. Amy Kassouf of University Dermatologists in Chagrin Falls.

As we age, our tissues lose elasticity and bone volume decreases, causing hollows to develop in the temples, cheeks and eyes. Nonsurgical and minimally invasive techniques and procedures siphon fat cells from one part of the body to replace lost fat in others, plump up sallow and shadowy areas of the face.

"When we re-volumize, we actually build the face back up to a more youthful face," Kassouf says. "It's very natural looking."

Juvederm's Voluma XC, for example, offers volumizing effects for the entire cheekbone area, including the apex, apple and hollow. The filler gel is designed to last longer than other injectable products — up to two years, says Dr. Renuka Diwan, of the Laser and Skin Surgery Center in Westlake. "[It] takes up slack in the skin," she explains.

If you're considering a botulinum toxin or filler, including Botox, Restylane, Dysport or Xeomin, ask your plastic surgeon what he or she uses and why.

Sculptra, for example, can contour and build up areas of the face while Restylane is ideal for targeted areas such as lips and can help smooth marionette lines, says Dr. Steven Goldman, a board-certified plastic surgeon and the director of Beachwood and Westlake Plastic Surgery and Medical Spa. Because everyone responds differently to fillers, a customized treatment plan is critical for success, Goldman says.

Kassouf likes to use Dysport for patients who want results in time for an event. "If you are in on a Wednesday and you have a wedding to attend on Saturday, the Dysport will kick in before Botox will," she says.

Xeomin, another new injectable, is finding its niche with people who do not respond well to other injectable products, Kassouf says.

People can also opt to refresh skin with their own fat. In this procedure, doctors inject a patient's fat cells into desired areas of the face.

"[Fat injection] rejuvenates the skin physiologically by depositing more elastic and rejuvenated collagen," Guyuron says.

Fat also brings stem cells to the patient's face, which revive tissues that have faded with age. "We are not injecting fillers. When [fat] takes, it lasts, meaning for the person's life," Guyuron says. "These are cells that belong to the patient, and they behave the way native cells do."

For most, the removal of fat from one area to enhance another is a win-win situation. "We are removing fat from where we do not want it and adding fat to where we need it," Guyuron says.

Beyond enhancing your appearance, there is significant interest from medical professionals in determining if fat can be an alternative source of stem cells for other treatments, says Dr. Mark A. Foglietti, founder of the Cosmetic Surgery Institute of Beachwood and co-founder of Ohio Stem Cell Treatment Center, an affiliate of the Cell Surgical Network.

Stromal vascular fraction, a protein-rich segment of adipose (fat) tissue, has a much higher concentration of stem cells than the number found in bone marrow, says Foglietti. Using liposuction, it's also easier to extract.

Once adipose tissue is removed from the body, the regenerative cells may be used to help people suffering from a variety of inflammatory and degenerative conditions. Animal studies have shown promise for such uses. "The list is almost infinite as to what stem cells have the potential to treat," Foglietti says.

   *  *  *  *  

Deep exfoliation, radio frequency, ultrasound and more can work skin into younger shape sans surgery.

For those who want to eliminate fat, Goldman suggests CoolSculpting, a nonsurgical technique that cools the area to a point where the fat cells freeze, damaging fat and causing it to shrink during a three-month period. The procedure isn't appropriate for those who desire significant weight loss, but is ideal for someone who wants to shed his or her love handles, Goldman says.

Spa West in Westlake offers VenusFreeze, a technology that combines radio frequency and magnetic pulses that deeply massage the skin, increasing collagen and improving elasticity. "[It's] the only cosmetic treatment without cutting or injecting that is clinically proven to tighten the skin," says spa director Nicole Ponte. "It's a comfortable treatment."

Ponte received the treatment on the back of her thighs, and the results have lasted for about a year.

"It feels like a hot stone massage, and the firming and lifting treatment tightens skin," she describes.

The Ohio Clinic for Aesthetic and Plastic Surgery offers HydraFacials, which can be combined with fillers or used as a stand-alone facial for the skin.

"It's like washing and waxing a car," says Dr. Michael Wojtanowski.

A HydraFacial exfoliates and captures dead skin cells from the surface, then purifies and rehydrates the skin. The process takes one hour and can be repeated every four to six weeks.

Thermage, a noninvasive treatment, uses radio frequency to tighten collagen.

"Collagen is like a tight rubber band when you are young, and it loosens as we age," Wojtanowski says.

The treatment yields subtle results, but over four to six months, the skin gradually tightens. "It's like getting a little Christmas present every single day," he says.

Ultherapy is a focused ultrasound that provides a noninvasive neck, eyebrow and under-chin lift. Ultrasound waves stimulate deep layers of skin without disturbing the surface, causing new, more elastic collagen to replace the subterraneous tissue.

"It cannot do what a face-lift does, but it does firm the face for selective individuals," Goldman says. "It can be used in conjunction with injectable [treatments] to create a more youthful appearance.

Patients who opt for surgical procedures to fight skin problems often ask surgeons to remove batwings, or skin that drops from the elbow to the armpit. Wojtanowski has noticed an uptick in requests for this surgery — brachioplasty, liposuction plus skin removal — in the last 12 months.

"It's a face-lift of the arm," he says. Wojtanowski believes popular women's fashion may have spurred the increased demand.

Doctors can also now offer a noninvasive treatment for excessive sweating, known as hyperhidrosis, called miraDry. The treatment uses electromagnetic energy to eliminate underarm sweat glands, Goldman says.

   *  *  *  *  

Breast augmentation, nose reshaping and eyelid surgery were the top three cosmetic surgical procedures in 2013, according to American Society of Plastic Surgeons.

Many women seek breast lifts and augmentation after having children. A breast lift removes excess skin, and the augmentation adds volume.

A woman's size can be the deciding factor on whether she can get one or both procedures.

"Some women have a problem with loss of volume," says Dr. Gregory Fedele, of the Art of Plastic Surgery in Beachwood. "And you can get atrophy of the breast tissue after pregnancy."

But problems can occur if an augmentation is performed without a needed lift. "Instead of small, sagging breasts, you will have large, sagging breasts," he says.

As the third most popular surgical procedure last year, eyelid lifts, which address upper eyelid excess skin or bags, appeal to men and women.

"People tend to notice their eyes more than any other part in terms of aging," Fedele says.

"It's a straightforward procedure that makes your eyes more open, more youthful," he says. "It makes your eyes look bigger because you don't look tired."

Forehead lifts can benefit patients who suffer from migraines, according to more than 20 studies performed by Guyuron and his associates. Forehead lifts involve detaching or decompressing a tiny nerve that alleviates temporal migraines.

"We discovered the nerves that cause migraine headaches pass through the muscles to the skin level," he says. "So when we remove those muscles, they can no longer compress the nerves and migraines go away."

Rhinoplasty, or a nose job, is one of the top two procedures performed in Goldman's office. The surgeon takes care to produce a natural looking nose by not removing too much cartilage.

With nose cosmetic procedures, patients can also receive septoplasty, which for some patients can remove pressure inside the nose that cause migraines. And individuals who have struggled with breathing issues and want cosmetic results may address both problems with a single surgery.

"They not only want their nose to work better," Goldman says, "they want it to look better, too."


Grin Keepers

Take advantage of these minimally invasive and affordable options that will give you a bright new smile.

by Roxanna Coldiron

By the time most of Dr. Jeffrey Young's patients plop down in his chair, they already have an idea of what cosmetic dental procedures they'd like done.

"People have become more knowledgeable about dental options," says Young, of Whole Life Dentistry in Lyndhurst. "They're looking to revitalize their smiles."

Patients are asking for crowns more than any other procedure, followed closely by bonding teeth with veneers, whitening treatments and implants, dentists reported in a survey by the American Academy of Cosmetic Dentistry.

The use of stronger, more natural-looking materials, minimally invasive techniques and high-tech partnerships make reinventing smiles more accessible and affordable.

Most crowns and bridges were once made of porcelain over metal, while the rest were made of ceramic, according to Dr. John Pyke, a dentist in Avon Lake.

"Now it's just the opposite. Dentists no longer have to cover up metal, and the result is much better looking," says Pyke. "Crowns made of ceramic are more natural looking. Ceramic is also three times stronger than traditional porcelain over metal restorations."

Dentists frequently use zirconium dioxide, a popular ceramic, for its strength when replacing or rebuilding molars.

"Zirconia can be used to make fake diamonds," says Dr. Colleen Vienna of Vienna Dental and Aesthetics in North Olmsted. "The good news is that we rarely have to use metal anymore, and materials are getting better and better all of the time."

Materials such as the brand name e.max, an all-ceramic restoration made of lithium disilicate and zirconium, allow dentists to choose color shades that can be shaped into natural looking teeth which last for years.

"Historically, it was somewhat of a trade-off between aesthetics and strength," says Young. "But now we can get the best of both materials with the restorative materials today."

For patients who want to improve the color of their teeth, new whitening techniques minimize or eliminate sensitivity.

Zoom whitening, which takes a little more than an hour, is a popular method that uses a laser to activate the whitening gel.

Tray whitening has also improved, says Hudson dentist Dr. April Yanda. A combination of a bleaching gel and a calcium phosphate paste that's only available in the office helps to whiten teeth while taking care of painful aftereffects.

"We create a custom tray for the patient, then place some bleaching gel and the paste inside the tray," she says. "The result is more uniform and very aesthetic."

Patients once had to wear trays overnight.

"Now the products work so quickly that your teeth can be whitened in five minutes," says Hudson dentist Dr. Keith Hoover. "There's much less sensitivity with quicker acting materials."

If you wanted to straighten you teeth, you used to have one option: wire braces complete with elastic bands. The braces could irritate gums and tended to be uncomfortable over time.

Invisalign changed all of that, especially for adults. "Adults find it to be less formidable to wear the clear liners than traditional braces," Young says.

"One of the reasons is that you can pop out the liners when you eat or drink or go to a meeting," she adds. "The key is to wear them at least 22 hours a day and only taking them out for eating and drinking or brushing and flossing your teeth."

Clear Correct offers another option.

"The competition among aligners has brought the cost down, so it's more affordable," says Vienna. "Like Invisalign, they're a series of clear aligners that progressively straighten your teeth."

Mini-dental implants also provide a lower cost, less painful option for people who want to replace missing teeth. Rocky River dentist Dr. Anthony Heibili says they're becoming more popular among patients.

"The implants are about half the size of full-size implants," he says. "It's a simple procedure done right in our office, and it's minimally invasive with a shorter healing time than what is typical with full-size implants."

Regardless of the procedure, Dr. John Heimke of Facial Aesthetic Designers in Rocky River believes in working closely with his patients when designing someone's new smile.

"We're able to use smartphone technology to interact with our laboratories when the patient is in the chair next to us," says Heimke. "We use iPhone's FaceTime or Skype to introduce our lab team to the patient and do a live consultation with them."


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