ALL YOU CAN BE…AND THEN SOME

YOU SEE, "BAD FEATURES" AND "PHYSICAL FLAWS," IN AND OF THEMSELVES, ARE NOT IMPORTANT, BUT WHEN THEIR MERE EXISTENCE MAKES US FEEL TIMID, SELF-CONSCIOUS OR UNSURE OF OURSELVES, THEIR SIGNIFICANCE IS GREATLY MAGNIFIED.

Sure, everybody knows “beauty is only skin-deep” and what really makes a person beautiful is his or her “inner self.” We all know that “externals” really don’t matter. That’s right. We know this. Trouble is, few of us believe it-at least as it applies to ourselves.

That’s because knowing something and believing it are two different things.

You see, “bad features” and “physical flaws,” in and of themselves, are not important, but when their mere existence makes us feel timid, self-conscious or unsure of ourselves, their significance is greatly magnified. Then, we’re not talking about the features anymore, we’re talking about their impact on a person’s psyche-how they make us loathe cameras and mirrors and. ultimately, shy away from the world.

“I think it’s natural to want to improve one’s appearance,” adds Maria Morris, aes-thetician and owner of the Dallas Center for Clinical Aesthetics. “It’s just human nature. It’s like a plant going toward the light. We all just want to look our best.”

Sometimes that can be achieved by merely accentuating good features and applying reasonable levels of grooming and fashion sense to the rest. But more serious types of minimizing and maximizing may be needed if you’ve spent your whole life hating a particular body part.

And these days, it’s tough to find an area that can’t be addressed, There’s a whole bevy of professionals out there equipped with scientific knowledge, technical expertise, and arsenals of lasers, scalpels, and cannulas-all set to correct specific physical flaws and help your inner beauty shine through.

“There’s no crime in trying to age a bit more gracefully,” adds Dr. Brenda Draper, a plastic and reconstructive surgeon with Sierra Surgery Center in Dallas. “I suppose it used to be considered sheer vanity for people to undergo surgical procedures to try to improve themselves, but now it seems more reasonable than vain because we’re living so much longer. It just makes good sense to try and maintain healthy good looks as long as we can.”

Adds Dr. John Tebbetts, another Dallas plastic and reconstructive surgeon: “The thing about plastic surgery is that it addresses the things you can’t do anything about. Like the sagging and shrinking of the breast that occurs after childbirth. In that sense, even cosmetic surgery is ultimately reconstructive.”

Very often, the value of this “psychother-apy” can’t be measured in dollars or even in post-op pain. Not for the individuals who swear by their aesthetic enhancements and lout the wonders they do for the soul.

Maybe you’re one of them-or should be.



PUTTING YOUR BEST FACE FORWARD

Face lifts

“The ’pulled look’ is out and the ’actual I look’ is in,” says Dr. Salyer, who won national recognition this fall with an Outstanding Plastic & Reconstructive Surgeon Award from the American Society of Plastic and Reconstructive Surgeons (ASPRS).

“Face lifts have changed so much in the last 10 years with technical advances and artistic changes in techniques, ” he explains. “Now. we can offer patients rejuvenation without it looking like they’ve been operated on. That’s a critical difference from the face lifts of old.”

Bearing the technical name of rhytidecto-my, a face lift can’t stop the aging process, but it does improve some of the most visible signs of aging by removing excess fat, tightening underlying muscles and uplifting the jowls and loose, sagging skin around the neck that gravity, age, and genetics bestow upon the human face.

The surgeon separates the skin from the fat and muscle below, generally making incisions at the temples above the hairline, in a natural line either in front of the ear or inside the cartilage at the front of the ear, and behind the earlobe to the lower scalp. Additionally, a small incision may be made under the chin if the neck needs “work.” Fat may be trimmed or suctioned from around the neck and chin to improve contour; then the deep tissues are tightened and the skin is pulled up and back, with the excess removed.

“With all the modalities we have available today, we can accomplish what a patient wants with minimal invasion,” Salyer explains.

Cheek, chin, and jaw enhancement implants are used to improve or change facial contours. They help strengthen the jawline or bring the cheekbones or chin into balance with the rest of the face.

Many face lifts are performed under local anesthesia, combined with a sedative to make the patient drowsy. It usually takes several hours, unless it is done in conjunction with other procedures such as eyelid surgery or nose reshaping. The best candidate has a well-defined bone structure and retains some skin elasticity. Complications are rare but can range from injury to the nerves that control facial muscles, infection, and hematoma. In this surgery and almost all others, doctors advise patients to stop smoking at least two weeks before the procedure and to refrain from smoking for at least two more afterward. Smoking inhibits blood flow to the skin and thus can interfere with healing.

Recovery usually entails about 10 days “out of the public eye” with facial bandages and even chin straps during the healing period.

Cost estimate: $8,000-$14,000



Vertical Face lift

A newer technique developed in recent years is one that local plastic surgeons say sometimes replaces eyelid rejuvenation (blepharoplasty) as well as brow lifts.

“It’s called a vertical mid-face lift,” explains Dr. Steve Byrd, a plastic and reconstructive surgeon and partner with the Dallas Plastic Surgery Institute. “Sometimes people call it the ’scarless face lift’ because its real significance is the minimal scarring and minima] invasion involved as compared to a traditional face lift with scars reaching from ear to ear.”

Byrd explains that the vertical mid-face lift does, of course, involve scars, but they are an inch and a half in length and hidden up in the hairline by the temples, This endoscopic procedure achieves “lift in the eyes that isn’t accomplished with other procedures.” Byrd says, “because it affects the eyelids, brows, and mid-face-giving a ’blended look’ and more distribution of the rejuvenation than with eyelid or brow surgery.”

The vertical mid-face lift won’t replace the traditional face lift because it doesn’t address the jowls, he adds, but it can “essentially remove 10 years from a person’s face.”

Post-operative results still involve the usual seven to 10 day time frame of bruising and “hiding out,” but Byrd says healing is less involved and a bit faster than with the traditional procedure.

Cost estimate: $4,500



Rhinoplasty

Today, the trend in nose jobs is to maintain a natural appearance while scaling down or improving the original nose structure.

“The older procedures were destructive of the nose,” says Byrd. who in addition to his private practice serves as Professor and Vice Chairman of the Department of Plastic Surgery at the University of Texas Southwestern Medical School and also as chief of service in the plastic and reconstructive surgery department at Baylor University Medical School. “There’s a new standard today.”

“Noses are extremely customized now,” adds Dr. Scott Harris, another Dallas plastic and reconstructive surgeon. “Because individuals are so different, you can’t just offer one type of thing or do the surgery a certain way for everyone. We give people an extremely wide range of choices.”

“There should be a real structured analysis of what fits the dimensions of the patient’s face,” Byrd explains, “so instead of a perfect little nose which might not look good on everyone, we can produce results that are particularly well-suited to each individual.”

“The nose is the central feature on die face,” Harris says, “so even the smallest changes to it are very noticeable. It’s a short surgery and only lakes about two hours, but it requires one of the highest degrees of precision and planning, and the results are very rewarding.”

During surgery, the skin of the nose is separated from its supporting framework of bone and cartilage, and the latter is sculpted to its desired shape. There are two main rhinoplasty procedures, “closed” and “open.” In the first, incisions are made inside the nostrils, which produces no visible scarring. The nostrils also can be made smaller with liny wedges of skin removed at the base so the sides can be brought closer together. In “open” procedures, generally reserved for more complicated cases, the small incision is made across the “columella,” the vertical strip of tissue that separates the nostrils. Byrd says it gives more precise access in certain cases, and scarring is hardly noticeable because it’s at the base of the nose.

After surgery, a splint will be applied to help the nose maintain its new shape, and nasal packs and soft plastic splints may also be used to stabilize the septum. During the 24 hours immediately following the procedure, patients should stay in bed with their heads elevated. Swelling and bruising around the eyes will initially increase, peaking two or three days afterward.

Most patiens say they feel better than they look for up to two weeks afterward, although Byrd says most can be back at work within 10 days, “looking better than they did before the surgery.” Mild swelling, probably unnoticeable to others, may last for several months. (Note: glasses cannot be worn normally for quite some time-at least six to seven weeks afterward. Instead, they have to be taped to a patient’s forehead or propped on the cheeks until the nose is completely healed.)

Cost estimate: $4,000



Blepharoplasty

The eyes are one of the first places to show age, with the tissue above the eyes drooping over the lids and the delicate tissues underneath growing baggy and puffy as gravity takes its toll. The heavy lids give the appearance of fatigue and make it harder to keep the eyes open, and then, to top it all off, there are the crow’s feet-and even the sweet euphemism of ’’laugh lines” doesn’t make anyone happier about having them.

Eyelid rejuvenation surgery is performed on the upper lid to restore die eyelid platform and on the lower lid to reduce under-eye bagginess. Dr. William K. Miles, a facial plastic and reconstructive surgeon with the Advanced Cosmetic Surgery Center in Dallas, says he usually performs a blepharoplasty in conjunction with other facial procedures. “It’s not unusual for someone to get their eyes done at the same time they’re having a full facial rejuvenation,” Miles explains. “They might have it along with a face lift or forehead lift, nose, cheek or chin implants, and probably a skin treatment too, like a chemical peel or laser resurfacing.”

Interestingly enough, the same CO2 laser that is used for skin resurfacing has also revolutionized eyelid surgery, enabling ophthalmic plastic surgeons and facial plastic and reconstructive surgeons to trade in their knives and metal for the precision of the laser and a suture-free operation. The CO2 laser cauterizes blood vessels as it removes excessive skin and underlying fatty tissue, with the incisions placed within the natural crease of the eyelids and underneath, on the underside of the lower lid.

“With the CO- laser,” says opthalmic plastic surgeon Mark Jaffe of Key-Whitman Laser Center, “there are no stitches and more precision. It’s been a big improvement for the procedure.”

In terms of facial improvements resulting from eyelid rejuvenation. Miles says the puffy fat pad that causes “baggy lower eyelids” is smoothed out, and some of the tissue is pushed downward to fill the recessed ring underneath that creates the common problem of “circles under the eyes.” (“There’s a shortage of fat between the skin and the bone right at that point.” Miles explains.) Above the eye, “the upper eyelid/eyebrow complex is what we’re looking at,” Miles says, adding that the eyelid is often heavy because the eyebrow is low. Using the CO2 laser, surgeons can “go in through the crease in the eyelid, lift the eyebrow and even trim the little muscle that makes frown lines between the eyes.”

Cost estimate-upper lids: $2,000: lower lids: $2,000

STAYING ABREAST

Breast augmentationl mammaplasty

Local plastic surgeons say breast enlargement is not a procedure reserved for “sex symbol wannabe’s” or women who want their breasts to enter a room before they do. According to Dr. John Tebbetts, who has designed many implants and specialized in breast augmentation for 20 years, “new” breasts or repaired breasts are frequently a concern for women who have had their children and discovered firsthand the toll pregnancies and breast-feeding can take in terms of sagging and loss of breast tissue.

“Over 200,000 women a year are not doing this because they want to be topless dancers,” he says. “They just want to look good in their clothes and fee! ’normal’ again.”

Currently, saline implants are the order of the day since the Food and Drug Administration effectively banned the use of silicone gel implants in January 1992-a response to growing public concern about the safely of silicone and claims from some plaintiffs in a class-action suit against the manufacturer that the implants had caused symptoms similar to diseases of the immune system and “connective tissue disorders.” (The American Society of Plastic and Reconstructive Surgeons still maintains that 90 percent of implant patients were satisfied with their devices at the time of the FDA ban.) Meanwhile, on the horizon is a newer type of implant already being used in other countries but not yet FDA-approved for use in the U.S. Called anatomic cohesive gel implants, the newer type is likely to alter the complexion of breast augmentation in the not-so-distant future by combining the best properties of gel and saline and offering a matrix of shapes regarding implant height and projection.

Meanwhile, anatomical implants have grown in popularity, often supplanting the round implants that were the standard in the ’80s and early ’90s. These teardrop-shaped implants give more fullness to the lower portion of the breast than the rounded, upper fullness common in round implants-thus producing a more anatomically correct profile.

Tebbetts says augmentation patients’ choices have been “tremendously expanded, even in just the last three years,” with four incision options, placement (either over or under the pectoral muscle), and a wide range of round or anatomic and smooth or textured implants.

“Ninety-five percent of our patients have no bruising, no special bras to wear, no drainage tubes and no limits on their activities almost immediately after their surgeries,” Tebbetts says. “It’s a result of three things: improved techniques, improved technologies and better patient education.”

With incisions made in the crease below, in the armpit or around the nipple, breast tissue and skin is lifted to create a pocket for the implant, either behind the breast tissue or beneath the pectoral muscle. Some surgeons believe the latter placement interferes less with mammogram exams and may reduce the potential for an implant problem called capsular contraction, although recovery from this is slower and a bit more painful because the muscle is stretched.

Tebbetts, meanwhile, explains that sub-muscular placement is only partial when positioned correctly, so only the upper one-third or top half of the implant is placed behind the pectoral muscle. This, he says, avoids visible “rippling” in the upper breast and interferes least with mammograms and breast and muscle function. However, because implants do change ihe way mammograms are done to detect breast cancer, women in the appropriate age groups (generally, this means over 40) who opt for augmentation should be prepared to “shop” for their radiology centers and make sure their mammographie technicians are experienced in the special techniques required for X-raying breasts with implants. Additional views are usually required, and ultrasound examinations are beneficial as well for detecting breast lumps or even evaluating the implants themselves.

Capsular contraction, the most common complication of breast augmentation, occurs when the capsule of scar tissue that forms around the implant begins to tighten. This squeezing of the soft implant causes the breast to fee! hare and can be painful. It may necessitate a subsequent surgery to either remove or “score” the scar tissue, or to remove or replace the implant itself.

Occasionally, a woman develops an infection around an implant, usually occurring within a week of the surgery; in some cases, the implant may need to be removed until the infection clears and a new implant can be inserted. Additionally, implants may break or leak on occasion. This can be the result of an injury or even the normal compression and movement of the breast. The saline-filled implants of today will deflate in a few hours with the salt water harmlessly absorbed into the body, although replacement would obviously require a second operation. Fortunately, such secondary surgeries are much quicker and less complicated than initial mammaplasty procedures, Tebbets adds, because the “pocket” housing die implant has already been created.

Recovery from breast augmentation is relatively quick, with most patients back at work within a few days. The post-operative swelling will make a C cup look like a D cup at first, but that can be concealed with loose clothing and should subside in several days.

Some augmentation patients report a burning sensation in their nipples for a couple of weeks due to the bruising, and it’s not unusual for a person’s new and improved breasts to have areas of numbness near the incisions, with nipples that are numb, desensitized, or even oversensitive. Some of these irregularities of nerve sensation repair themselves over time; others may be permanent.

Cost estimate: $5,000-$7,000



Breast LiftslMastoplexy

Breast lifts are for women who like the size but not die shape of their breasts,” says Dr. Brenda Draper “If they’ve had a lot of volume loss with their pregnancies, they may also want an implant with the lift, and we also see a lot of people with disproportionately large breasts who want a reduction at the same time.”

Many women seek out mastoplexy because pregnancies and nursing have left them with stretched skin and diminished breast volume. The scars, more prominent than those found in augmentation, flow around the areola and straight down from the nipple, then up on either side, following the natural contour of the breast. With tissue removed and the breast actually raised, die nipple and areola are relocated to a higher site. The skin formerly located above the nipple is brought down and together to reshape a higher, firmer breast.

“We have a new technique that is very good at maintaining the duct system,” Draper says. “The nipple is moved up, but it’s not actually disconnected.”

As such, although plastic surgeons don’t usually recommend breast lifts for people planning on having more children simply because pregnancy is likely to stretch the breasts again and offset results of the procedure, the operation should not negatively impact a patient’s ability to breastfeed since the milk ducts and nipples are left intact.

In the case of a breast reduction combined with a lift. Draper says It entails “removing a certain amount of tissue and then lifting it.” Post-operative swelling does occur with the reduction, she adds, but “you’re not manipulating muscles or tissue with the breast lift, so it doesn’t swell,”

In either case, she explains, recovery is pretty quick; “The scars are uncomfortable in terms of being itchy, but it’s not a painful procedure.”

Loss of feeling in the nipples and breast skin is common and usually fades as the swelling subsides. However, it may last a year or more and, in some instances, is permanent.

Cost estimates: lifts/$6,700; reduction/$7,500



ALL TUCKED IN

Abdominoplasty

For many women, about the only thing more upsetting than what pregnancies do to one’s breasts is the havoc they can wreak on both the muscles and skin of the abdominal wall.

“I see a lot of women who have had babies and want to have both tummy tucks and breast lifts at the same time,” Draper explains.

Dr. Diane Gibby, a plastic and reconstructive surgeon and founder of the Women’s Center for Cosmetic and Plastic Surgery, explains that women can “exercise like crazy” in an attempt to improve the appearance of their torso, but if the abdominal muscles have split apart and the connecting fibrous tissue called the “fascia” is stretched as well, “it might help the muscles a little, but it won’t get the fibrotic tissue back together.”

Abdominoplasty, more commonly dubbed a “tummy tuck,” entails tightening of the muscles of the abdominal wall and the surgical removal of excess skin from the lower abdominal region. It’s usually attributable to childbirth or a substantial loss of body weight.

“It’s a really good procedure,” Draper says. “The scar is large, but it’s very well hidden under the bikin line. The vertical muscles which have gotten stretched and separated are tightened all the way from the sternum on down. It makes a big improvement for women who are in relatively good shape but had a lot of stretching from their pregnancies.”

A different gradation of the abdomino-plasty is a “mini-tuck,” in which the amount of excised skin is less and the underlying muscles either remain intact or are only tightened from the belly button on down. In this procedure, the scar is smaller-averaging about 4 to 6 inches in length and hidden just above the pubic bone.

A lot of women start out wanting abdominal liposuction.” says Gibby. who specializes in breast and body contouring procedures. “But, they find out they’re not good candidates for it b?cause they have too much loose skin, and lipo doesn’t look good if there’s too much skin elasticity.”

Their disappointment doesn’t last long, she adds, because liposuction is “built in” to the abdominoplaity procedure.

“Were already tightening the muscle and contouring the skin,” she explains. “The liposuction just works in tandem with that and improves the results.”

Draper says abdominoplasty is a major cosmetic procedure which entails a six week “acute healing phase.” During that lime, patients are usually “very sore and slowed down” for two weeks, then just “uncomfortable” for a month. A mini-tuck has a shorter recovery time, Gibby adds, with time off work closer to “one week,” although it still requires about four to six weeks of “less than a full level of activity.”

Cost estimates: $4,500 -$6,500



THE BUBBLE-WRAPPED BLUES

Liposuction

By promising the removal of unwanted fat from such trouble spots as the hips, thighs, buttocks, and stomach, liposuction seems the ultimate panacea for many a woman. But plastic surgeons warn that although it can help sculpt the body and improve some imperfections, it is not a substitute for dieting and exercise and can only be viewed as an adjunct to a healthy lifestyle.

“It’s not a quick fix for people who are overweight or out-of-shape,” explains Dr. Craig Hobar, founder of the Dallas Plastic Surgery Institute. “It’s a refining procedure for people who’ve been doing all the essenrial things to take care of themselves and stay in shape, but who still have stubborn areas of fat which haven’t responded to their traditional weight-loss efforts.”

Also known as lipoplasty and lipectomy, the procedure reduces fat accumulations in the underarm and breast areas for women and under the chin, cheeks, and neck for both genders. For men, it is usually performed on the waistline and also for reduction of enlarged male breasts, a condition called gynecomastia.

As liposuction procedures have been developed and refined in recent years, several newer variations have been introduced. Hobar says the value of traditional liposuction “is mostly historic now” because the technique of inserting a tiny tube, or cannula, through a small incision to vacuum the fat layer beneath the skin was often associated with significant blood and fluid loss. The three newer and more common techniques are tumescent, super-wet, and ultrasound.

Tumescent liposuction gets its name from the fact that the fatty tissues are filled with fluid-sometimes as much as three times the amount of fat to be removed, and thus, swollen and firm, or “tumesced.” The medicated solution, a combination of intravenous salt solution, a local anesthetic, and epinephrine (a drug that contracts blood vessels), allows the fat to be removed more easily, reduces blood loss and even reduces the amount of post-op bruising.

The super-wet technique is similar, but less fluid is used, usually with the amount of injected fluid matching the amount of fat to be removed. Ultrasound-assisted liposuction (UAL) uses a special cannola or tube that produces ultrasound energy to explode the walls of the fat cells and liquefy the fat. Then, the fat is removed with die traditional liposuction technique. Shown to improve the ease and effectiveness of the procedure in fibrous parts of the body such as the upper back and in enlarged male breasts, it is commonly used in secondary procedures where “enhanced precision” is required.

“We usually combine the different techniques,” Hobar says, “because they each have tremendous benefits. To me, state-of -the-art means having all the tools available to get the best overall effects.”

Good results are the norm, but complications can and do occur. The greater the number of areas treated, the greater the number of risks for infections, delays in healing, formation of fat clots or blood clots, excessive fluid loss or fluid accumulation, friction burns, or unfavorable drug reactions. The ultrasound device used in the UAL technique may cause injury to the skin or deeper tissues, while the long-term effects of ultrasound energy on the body, if any, are not truly known.

Patients may return to work within a few days, although post-op inconvenience lasts for six weeks. Activity more strenuous than walking should be avoided for a month. To minimize fluid accumulation in the space between muscle and skin where the fat deposits previously resided, a compressive girdle is worn at all times for three weeks (removed only for bathing and showering), then 12 hours a day for another three weeks.

Some swelling may take as long as six months to subside, and although the scars are small and strategically placed, imperfections in the final appearance of liposuction are not uncommon. Skin surfaces may appear irregular, asymmetric or even “baggy,” (especially in older patients). Pigmentation changes and numbness may also occur.

Cost estimates: $2,800, plus $750-$1.000 for each additional siteCellulite Treatment



A new, nonsurgical treatment for cellulite that’s been making headlines is ender-mologie. Termed a French technique of “tissue aspiration and manipulation,” it reportedly improves skin quality and the appearance of cellulite. According to Hobar, il does not replace liposuction for the deeper fat pockets, but it does address the more superficial skin dimpling commonly referred to as “cottage cheese.”

“Most of us feel having a bubble-wrapped body just isn’t attractive,” says Beverly Breshers of Somatique, a Dallas medical skin care center that has provided endermologie treatments since 1995. “It’s expensive, so it’s not for everyone,” she adds. “But a lot of women think it’s worth it.”

Often endermologie is done as a follow-up to enhance the results of liposuction. And, Breshers says, newer protocol is to undergo a series of treatments both before and after liposuction surgery.

With a series of 10 to 15 treatments each lasting 35 minutes and perfomed in a salon setting, endermologie resembles some types of massage, with a combination of rolling and suctioning to help break down fat and cause a resorption of it underneath the skin. Results are not permanent, however, and patients are encouraged to continue with one to two “maintenance treatments” per month.

“We recommend a series of 14 treatments,” Breshers says of Somatique’s regimen, “twice a week for seven weeks. It takes that much to really see the tightening and toning of the skin and the contour changes. After that, an evaluation for results will determine if the patient is ready to go to maintenance, which is once a month.”

Results are variable, with some plastic surgeons reporting success rates of only 60 percent. Although that means a significant portion of patients may invest considerable time and money in a procedure that may have disappointing results, the new procedure still remains the most beneficial noninvasive cellulite treatment outside of diet and exercise.

Cost estimate: $100 per session



TURNING BACK THE CLOCK

Laser resurfacing

Skin is the largest organ of the body, and probably the one most markedly affected by heredity and time. What starts as a smattering of freckles across a young child’s nose leads to acne scars and wrinkles and moles. By the time most people hit 40, it seems unimaginable to think any of us ever really started off with flawless, baby-soft skin.

There are numerous procedures out now, all designed to eradicate some of the most visible signs of aging sun-damaged skin. Laser resurfacing employs the same CO2 laser used for eyelid rejuvenation, and it’s one of the hottest skin treatments going.

“It’s not a minor procedure.” says Dr. Mark Jaffe, who has been using the CO2 laser at Key-Whitman Laser Center for three years now. “but it is an excellent alternative to a face lift.”

Specifically, Jaffe says resurfacing entails short bursts of the laser that “polishes off the aging evidence and generates collagen production, which contracts and firms up the skin.” Initially, the technique “vaporizes” the outer layer of skin. Meanwhile, blood vessels are cauterized and collagen production is stimulated, resulting in smoother, healthier-looking skin.

“It addresses extensive amounts of sun damage, pigmentary problems, and acne scarring,” Jaffe adds. “And it’s one of the greatest procedures for the wrinkles around the face.”

Laser resurfacing is said to take “five to 10 years off a person’s face,” and best results are seen on people with lighter-colored skin tones. It doesn’t work well on the neck, so Jaffe “feathers” the treatment along the jaw-line to avoid a clear demarkation between the resurfaced face and the not-so-lucky neck.

The carbon dioxide laser has been around for more than 30 years but only recently began being used to alter damaged skin. Proponents also tout the procedure’s superiority over chemical peels because the precision of the laser controls how deep into the skin it goes, while chemicals and solutions applied to the epidermis can soak in deeper, sometimes causing scarring or hyperpig-mentation problems. Additionally, the precision of the laser reportedly allows surgeons to tailor treatments, not only to the needs of particular patients, but also to specific areas of the face.

Recovery entails a full week of wearing bandages over reddened and sensitive skin, which “weeps” as new skin is formed. Ointment masks and frequent washing may also be prescribed. After seven to 10 days, the skin fades to pink and may be camouflaged with make-up. Patients should stay out of the sun for two to three months, and sunscreen is always advised to avoid future damage.

Cost estimate: $3300



Microdermabrasion

A less drastic treatment with results that are reportedly dramatic is microdermabrasion, a system of gentle skin abrasion in which pulverized vitamins are applied to the skin.

Using terms like “micro trauma” and “clinical facial,” Maria Morris, founder of the Dallas Center for Clinical Aesthetics, says microdermabrasion regenerates the epidermal cell structure and increases skin elasticity by as much as 30 percent. “With a series of treatments, we actually peel sun damage off,” she says. “I know it sounds miraculous, but we’ve seen it.”

A licensed clinical skin-care specialist who opened her clinic last January (after microdermabrasion received FDA clearance the summer before) Morris says her business specializes in the process because it’s the best she’s seen during a 20-year career. It address fine lines and wrinkles, brown spots, sun damage, acne and other types of scarring, enlarged pores, and even pigmentation problems.

The procedure involves a small electrically powered glass instrument that sprays a jet of fine aluminum oxide crystals across the surface of the skin. With this gentle abrading action, the system removes and vacuums dead and damaged skin cells, along with the particles, into a self-contained tube, resulting in stimulated collagen production and increased blood supply and lymphatic flow.

“Microdermabrasion is very gentle, but it retexturizes the skin and stimulates collagen growth,” Morris explains. “Most people notice a change even with the first treatment, but the longer you use the system, the greater the effect-so it’s cumulative.”

Laurie Patten, Director of Operations for EpiCentre, a service of the Dallas Plastic Surgery Institute, says microdermabrasion is “very precise and very noninvasive,” and as a result, it’s replacing many of the chemical and acid peels mat people have traditionally sought out when looking to improve their skin.



Spider Vein Therapy

Sclerotherapy often requires several treatments. Patten of EpiCentre says, because “veins are very individual and not so predictable.” With the medical name of telangiectasia, spider veins take an average of three to five treatments to fade from view.

“It’s not an involved procedure, but problems can arise,” Patten explains. “A small percentage of people can have allergic reactions to it, and if someone has asthma or diabetes, that needs to be discussed in the initial consultation because they can be problematic for sclerotherapy. Most people don’t think about these kinds of things because they think it’s cosmetic instead of medical, but it’s both.”

In conjunction with sclerotherapy, laser therapy is often used to treat smaller, redder veins. When “zapped” with a pulse of laser light, the blood vessels absorb the heat, their walls are damaged, and the veins collapse. As with the injections, repeated treatments are often necessary.

“You want to start off conservative with the laser because it can bum and scar the skin,” Patten explains. “That’s a trade-off- and not a very good one, because you’re trading off one problem for another.”

As such, she warns that people should be careful in choosing where to have the procedure done, and she encourages patients to “ask a lot of questions,” particularly about the medical background of the people doing the injections and what type of solutions they use.

“People shouldn’t approach this as a quick and easy fix. It’s not risky in terms of whether it will work or not, it’s just a matter of time and making several visits until the desired results are achieved,” she says.

Cost estimate: $225 and up



Facials

There are a lot of therapeutic “clinical facials” available now, which skin care centers use to precondition patients’ skin before they undergo surgical procedures such as face lifts and laser resurfacing. ’They range from superficial chemical peels to light exfoliation peels,” says Rose Mary Gonzales, a licensed clinical esthetician (L.C.E) and skin-care coordinator with Renaissance Skin Care Center in Dallas.

“We use alpha hydroxy cleansers and blending agents like Retin A to stimulate collagen before a resurfacing procedure,” Gonzales explains. “That helps speed up the healing process afterward.

“Most of our treatments are clinically oriented,” she adds. “I think of it as science and beauty working together.”

Skin centers like Renaissance commonly offer a selection facials and peels as well as skin-care and cosmetic products, some of which are prescription-grade to address the post-operative skin needs of people who have had cosmetic procedures such as face lifts and laser resurfacing.

“A lot of people come to us to get their skin preconditioned before a procedure.” Gonzales says. “Then they just keep coming back for the ongoing management of their skin-care and cosmetic regimens.”

“You can get really burned with chemical peels if the people administering them aren’t properly trained.” Gonzales warns. “They’re really good treatments if they’re done right, but the personnel have to know exactly what they’re doing because there’s no room lor guesswork.”

Cost estimates: Skin-care assessments ami consultations-$6o-$1oo; therapeutic facials- $75-$150; peels-$60-$150.



SOMETHING TO SMILE ABOUT

Aesthetic Dentistry

Dentistry has been on a technological fast track in recent years, and cosmetic dentistry is on the leading edge. That’s good news for many of us because teeth sometimes give us little to smile about. Whether the problem is crooked, chipped or discolored teeth, gum erosion, darkened areas around old crowns, or large silver fillings just waiting to crack the shells of the molars housing them, mouths are problematic.

Likewise, the “fun quotient” of going to the dentist generally ranks right up there with getting poked in the eye with a sharp stick- causing more than a few of us to shrink away from those twice-annual dental exams and avoid our dentists’ eyes until tooth pain sends us howling into their wailing rooms.

But now, high-tech advances and scientific developments are starting to change all that, making dentistry more patient and friendly by the minute. In fact, believe it or not, local dentists claim growing numbers of people are actually seeking them out-not just to fix broken things, but to freshen up their smiles.

What is generally termed “aesthetic dentistry” ranges from whitening and resurfacing teeth with porcelain veneers to addressing caviiies with tooth-colored fillings and periodontal disease or gum erosion with tissue resculpting-and the results are nothing short of amazing.

“We’ve come such a long way in such a short time,” says Jimmy Eubanks, D.D.S., of Piano. “There’s just no excuse anymore for people to continue tolerating the kind of tooth problems that so many of them have been told they would just have to live with. Not anymore.”

“For example.” he adds, “if you’ve got crowns, the gum area around them probably looks dark and discolored, and sometimes the gum recedes, too. It becomes a source of embarrassment for a lot of people.”

A procedure called “tissue resculpting” can reposition gum lines, bringing them down with skin grafts to surround crowns or fill-in areas of gum erosion, and pushing them up higher in the case of “gummy smiles.”

“Dentists have always done gum surgery for gum disease,” says Mark Sowell, D.D.S., also of Piano. “But now were doing it for cosmetic purposes. That’s very new, and it’s a whole new ballgame. It’s a tool we can use to actually ’design’ a person’s smile.”

At the root of such advances in aesthetic dentistry are improved laser bonding techniques, which actually attach porcelain and composite materials to teeth as strongly as a tooth is bonded to itself. That’s been a boon to tooth-colored fillings as well, because they used to be discounted by many dentists as not strong enough to use on the grinding surfaces of back teeth. Improved adhesive materials and techniques, however, have aesthetic dentists confidently advising people to forego the amalgam (silver) fillings for the tooth-colored composites.

“I haven’t used silver fillings for a full 10 years,” Eubanks says.

“Silver fillings are fading in popularity,” adds David Nix, D.D.S., of Irving. “A lot of people have problems with them-being sensitive to hot and cold temperatures, being concerned about the mercury leaking, and having them come out because they don’t stick to the teeth.”

Over time, silver fillings often discolor and weaken teeth, frequently leading them to crack or chip, which then leads to root canals and overlays.

The newest generation of tooth-colored fillings, meanwhile, has improved considerably over the earlier offerings, so in addition to being cosmetically preferable, they’re almost as hard as the silver and actually bond to the tooth (which the silver does not). As such, cosmetic dentists argue that even though the tooth-colored fillings are almost three times more expensive than the traditional offerings, the question is not about whether the money will be spent, but whether it will be spent in stages or paid upfront for “better-looking work.”

“Silver fillings are fine if the ones you’ve got are working for you.” adds Jim Reisman, D.D.S., of Dallas. “But when they wear out, we replace them with the tooth-colored ones.”

Similarly, Sowell talks of “facially generated treatment plans” and “smile makeovers,” with porcelain veneers and recontoured gums creating a perfect smile within the “picture frame” of the lips. Employing computer imaging to start the process, Sowell makes a “mock-up” of temporary bonding material to allow a patient to “try on” a new smile. He then produces a mold for creating temporaries, which patients wear for two weeks before the permanent changes are made.

Reisman also utilizes these types of state-of-the-art systems to help patients “recreate and rebuild their smiles.” He cautions patients, however, not to blindly assume their porcelain veneers are a cure-all. “There’s a real art to doing these and to doing them well,” he explains.

“We have a lot of technique-sensitivities with the newer technologies,” adds Ritchie Beougher, D.D.S.. of Piano. “Veneers, as well as tooth-colored fillings, are very tricky. They’re harder to do. They can’t be done sloppy and done right.”

Implants, once viewed as experimental, provide an example of that. Titianum, a material commonly used for artificial body parts because the body doesn’t reject it, has been used as the “artificial root” in tooth implants for at least two decades. However, Reisman says crowns were placed on top immediately, and the “failure rate was high.” Research gradually accumulated in support of waiting three months “to give the bone a chance to heal over the titanium before placing the crown,” and now Reisman says implants have an excellent proven track record. “The success rate on implants now is about 95 percent that it will last for 20 years. It’s wonderful.”

Orthodontic “tricks” sometimes fall into the realm of cosmetic dentistry, Beougher adds, “A lot of people come in wanting crowns or veneers because their front six or four teeth are crooked,” he explains. “But it seems a shame to cut down teeth and cover them with porcelain when they’re perfectly good teeth, so instead I can sand off tiny amounts of enamel in between the teeth and then start moving them around.”

Beougher claims he “can straighten front teeth with a retainer in about four months.” That’s important to the many adult patients who had braces in their youth and don’t want to repeat the process, but are disappointed by how their teeth have shifted over time.

As such, in addition to retainers for straightening, Beougher and others often make “night guards” to help teeth-grinding patients protect their teeth.

Various whitening procedures have been available in dental offices and over the counter for a number of years, but most involved cumbersome mouth molds and considerable awkwardness. A newer technique is laser whitening, and Nix, who serves as secretary of the Texas Academy of Laser Dentistry, believes it is the best offering yet.

“We still copy the shape of the teeth and then pour plaster into that shape to make something that looks a bit like a mouth guard.” he explains. “But it’s only two millimeters thick, so it’s smaller and much more comfortable to wear. “

Nix explains that the technique involves a two-to three-hour office treatment in which the dentist applies a creme bleach to the teeth, shines two different lasers on each tooth for 30 seconds apiece, and then vacuums off the mixture. This process is repeatcd three to five more times for an end result that completes two-thirds of the bleaching process in the first treatment. The rest is achieved in home applications using the tiny mouth guard, twice a day for six days.

“The most common thing people have to say when they first look in the mirror after that first treatment is, “LWow!”’ Nix says, “But we don’t stop there.”

Cost estimates: Crowns-$600-$ 1.000 per tooth; Veneers-$60041.000 each; Tooth-colored fillings-$80 per surface (averaging about $300 per filling); Implants-$ 1,000-$1,500 to place root, $1,500 for the crown; Orthodontic Retainers-$200-$600; Laser Whitening-$900-$1,200 plus $375-$500 for the home treatment system.



THE EYES HAVE IT

Photo-Refractive Keratectomy

Cosmetic surgery isn’t just about making something look better; sometimes. it’s about making something work better. And in the case of LAS1K eye surgery, it’s actually about making something see better.

“Vanity has a lot to do with why people are interested in vision correction,” says Scott Tennant, education coordinator for Tylock Eye Care & Laser Center in Dallas. “They get tired of the nuisance and discomfort of contact lenses, and they don’t like how they look in glasses. When you live with those sorts of things your whole life and then find out that a quick little medical procedure could make it all unnecessary-well, it’s pretty attractive.”

PRK addresses the surface of the comea while LASIK treats the inner tissue, a difference which advocates of the newer procedure say makes it able to treat higher levels of refractive error, resulting in smaller healing surfaces, less risk of scarring, less risk of corneal haze, and less post-operative pain.

“The end effects of PRK and LASIX are basically the same,” Tennant says, “but LASIK is the “cad iliac ride.’”

Specifically, LASIK corrects vision by reshaping the comea so that light rays focus more precisely on the retina, thus reducing or eliminating refractive errors, The cornea can be made flatter to treat nearsightedness, steeper to treat farsightedness and even more spherical to address astigmatism.

Dr. Gary Tylock, one of the first surgeons in the country to perform the ALK procedure, the immediate predecessor of LASIK, is the only surgeon in the metroplex to offer the expanded treatment capabilities of three Eximer lasers.

What all this means to people who are tired of their glasses and even more tired of their vision problems is that they can have the surgery on a Friday (under the relaxing effects of Valium and a local anesthetic), go home and rest that evening, drive themselves back to the doctor’s office for a follow-up visit on Saturday, and be back at work on Monday-sans the specs.

“Afterward, we give patients some pain medication,” Tennant says, “but most people get by on Tylenol. The eye feels irritated for about five hours. like there’s a foreign object in it or a bad-fitting contact lens. Usually, patients just try to sleep through that time, and then the next day, they feel fine.”

Tennant explains that Lasik eye surgery does not address the issue of presbyopia, which stands for “old eye” and is well-understood by anyone over the age of 40. However, it’s still worth it to many patients, he says, because .it least they can avoid bifocals and only have to wear their newer glasses for reading.

Cost estimate: $4,400-$4,800

LEAP of FAITH

Although many of us think about plastic surgery in terms of beauty and cosmetic enhancements,for children born with severe facial deformities, it’s much more basic than that. Rather than aesthetics or improved self-esteem, reconstructive surgery is about achieving a level of normalcy and not being shunned or having to hide anymore,

Indeed, having a big nose Is a far cry from being horn without an ear, something plastic and reconstructive surgeon R Craig Hobar witnesses every day. As head of the craniofacial plastic surgery department at Children’s Medical Center in Dallas and a partner with the Dallas Plastic Surgery Institute,he enjoys the balance between cosmetic and reconstructive surgery. In 1991, however, he tipped the scales.

Founding a non-profit organization called Life Enhancement Association for People, or LEAR he now leads teams of more than 100 surgeons, nurses, anesthesiologists, and other volunteers on missions to underprivileged countries to perform life-changing reconstructive surgeries on children who otherwise might live their whole lives without correction of their cleft lips, cleft palates, and other deformities.

“I knew some people who wanted to do this sort of thing,”Hobar explains,”and I knew of a hospital in the Dominican Republic where there was a serious need. I just wanted to give the same kind of quality care to those children that the kids at CMC get.”

Currently, LEAP takes three trips a year to medical facilities in the Dominican Republic and Belize to perform surgical procedures free-of-charge to those in need.During its seven-year history, Hobar says the medical missions have”toucbed over 1,000 lives.” Supplies donated by various Dallas area hospitals and medical supply companies are distributed through the program,

“We want to make sure that when we leave, there’s an infrastructure in place to take care of the patients’ post-op needs,” Hobar says. And, although the focus of the trips is surgical correction of facial deformities, the participants also “have a broader focus to respond to needs that present themselves.” An example of this occurred on a recent trip when volunteers based at a Dominican Republic hospital discovered that a nearby school was constructed without any bathroom facilities, and a team was spontaneously organized to build one.

“The LEAP trips are very rewarding,”Hobar says, “it’s a lot of effort, and all our volunteers sacrifice a lot to make the trips because they take vacation time to do it and they spend that time away from their families, But, It’s always a positive experience for everyone involved because when you give a baby back to his mother with a lip where there wasn’t one before, and you see her tears of joy, well, it reminds us of why we went into medicine in the first place, If really rejuvenates us all.”

For more information about LEAP and how you can help the cause, call 214-823-8423.

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