One pill makes you larger, and one pill makes you small. And the ones that mother gives you, don’t do anything at all.” I remember those Jefferson Airplane lyrics from a past world. Somehow these words are never more relevant than today. Indeed we have many more pills, potions and solutions than ever before for what ails us. To be sure, we are all the beneficiaries of all that is new in healthcare, medication, and technology. Many of these advances have found their way into down line solutions for the challenges faced by plastic surgeons as we address the challenges of an aging population that embraces youth and vitality. Some are exciting and dramatic. Some have yet to be proven. But is seems, as we edge ever closer to Ponce De Leon’s centuries old journey for the fountain of youth, many of the up line causes for aging remain quite the same, and very preventable.
As I began a recent trip to visit my daughter, headed down Storrow Drive in Boston, for Logan International Airport. I was struck by the hundreds of young people baking in the summer sun, along the banks of the Charles River, in an area often referred to as Boston University Beach. It was a vivid illustration of how people manage to get 80% of their total lifetime sun exposure before the age of 30. The aging process was taking place right in front of me. The sun is the most insidious, sinister and preventable cause of photo aging of the skin.
While passing time with a magazine on my flight, I was fascinated by a statistic that suggested women preferred sleep to anything else on a long list of seemingly far more exciting options. Could that really be factual? To test the premise, I conducted an informal poll among my nurses and patients and indeed it was true. Without sleep, almost nothing else matters!’ In a technologically connected world, where immediate access and accountability has become the expectation, sleep has become even more elusive. Certainly there are many scientific reports of the importance of sleep as part of the body healing process. And since skin is the largest organ in the body, sleep is a critical time for damaged skin cells to repair. Without adequate sleep, the skin ages more quickly.
As a Plastic Surgeon, I am always looking for the best solutions for my patients to fix the flaws and address the signs of aging. We always embrace the latest technologies. We have state of the art lasers to erase wrinkles, simulate collagen synthesis and tighten skin. We have the best fillers to restore facial volume lost in the aging process. We have medications and ultrasound to permanently dissolve unwanted fat.
But all of our treatments work best when the skin is robust and healthy, so we should never overlook one of the most important prescriptions for men, women and children- all skin types and all ages- The magic bullets—More Sleep, Less Sun.
Guy M Rochman MD
Assistant Professor of Surgery, Harvard Medical School
Chief, Plastic and Reconstructive Surgery
Beth Israel Deaconess Hospital- Milton
“Summer time, and the livin’ is easy. Fish are jumping, and the cotton is high.
Your daddy’s rich, and your momma’s good lookin…” Those George Gershwin lyrics from Porgy and Bess are 8 decades old, but still easy to relate to, especially as the days get shorter, the shadows get longer, and we savor the last days of our soft, short summer in Boston.
When we think of summer, we think of vacations. When my daughters were little ones, we would keep a special diary for each summer family vacation. Everyone was encouraged to make a daily entry. Everything was fair game.
Today, my daughters are successful and beautiful women. And as the summer draws to a labor day close, and the academic world comes to life, we found ourselves sitting around the dinner table this past Sunday and reliving past summer holidays. Somehow, as if by magic, those decades old vacation diaries appeared on the table, as we savored our apple pie. The memories, dimmed by the background noise of life, seemed to jump off the pages, yellowed and wrinkled by the passage of time. So there we sat for hours, reading our commentaries on vacations from years past. So hilarious, we laughed and laughed till our sides hurt!
I could not remember laughing so much in a long, long time. And when my eyes closed to a wonderful night, I marveled at how good I felt … invigorated, refreshed and uplifted. How good it was to laugh
As a physician, and a surgeon, I know how important it is for our health and well-being to nourish our five senses. Our Sunday dinner reminded me of how important it is to exercise the sixth sense— our sense of humor!
Every day we find ourselves facing difficult and trying situations. But when we laugh, somehow we are reminded that there is more than one way to look a situation. Laughter shifts our perspectives. It opens our minds to new possibilities
The scientific literature is replete with evidence documenting the importance of laughter in many aspects of health. Laughter reduces the body production of numerous stress hormones. Laughter boosts the body immune system. Laughter increases our pain tolerance and enhances our creativity. Humor has been shown to lower blood pressure, reduce anxiety and lessen depression. It makes us more likeable. It’s fun. And guess what…it keeps us young!
As world-renowned associate professor of Neurology at Harvard Medical School. Dr. David Simon has said “discussing laughter is like talking about making love or talking about a good meal. The real value is not in the description but in the experience. Let yourself get carried away with laughter”
“I want to look like me, just better.” Those are the words of one of our patients who so elegantly and simply defined her wants. I believe she also captured the essence of facial rejuvenation. I rail against the “FOX TV” expressionless foreheads and monster lips that scream Botox and fillers. An understanding of the aging face, characterized by volume loss, is absolutely essential to providing the best treatment options. We refer to the parts of the face as aesthetic units, each with its own unique character and requirements. As we now have more options than ever for non-invasive and subtle treatment of the aging face, knowing which injectable product will provide the best solution to every area is critical to great outcomes.
FOREHEAD – Forehead wrinkles are best treated with muscle relaxers, which block the release of the neurotransmitter acetylcholine. This freezes the muscles that cause the skin to wrinkle in the forehead, and creates an aesthetically pleasing smooth new look to the forehead. Botox and Desport are both temporary in duration and need to be injected every four months to maintain maximum correction
BETWEEN THE EYES – Glabellar frown lines, between the eyebrows, often called “ the elevens” or “nickel slots” are caused by contraction of the skin by the corrugator and procerus muscles. Botox is a perfect solution to these problems as well as the “crows feet” on the sides of the eyes,
UNDER THE EYES- Hyaluronic acid fillers such as Restylane or Juvederm are the treatment of choice to replace volume loss that appears over time, causing the face look older and tired. Hyaluronic acid is naturally occurring substance in many foods like sweet potatoes leafy veggies, citrus fruits and even red wine. It also occurs naturally in our body. There are studies to show that injecting hyaluronic acid also increases hydration to the skin by attracting water to the filler. Some suggest that injecting fillers may actually encourage the body to make more of its own hyaluronic acid in response to the injection
CHEEKS – Skill and finesse are needed to correctly replace volume in the upper face and restore the youthful contour of the cheek and cheekbone area. Hyaluronic acid products including Voluma and more long acting volume replacement injectable work well in this area. Understanding the facial anatomy, and the location of the arteries veins and nerves in the face, is essential to preventing complications
THE LOWER FACE- There are numerous HA products that have a role in this aesthetic unit. Correction of the “smile line” or nasolabial folds from the nose to the upper lip, softens the face and blunts the jowl that results as these lines deepen and loose volume. Marionette lines are folds, that extend downward from the sides of the mouth to the chin, making the mouth look stern, sad or angry. Correcting these lines also blunts lower faces jowls and makes the mouth and lower face look brighter and happier.
THE LIPS Studies have shown that when we look another person in the face, the first thing that our eyes focus on is the mouth. The lips and mouth are a very important aspect of the first encounter. As the aging process continues the lips become thinner and roll inward, showing less teeth in smile and conversation. The face appears more stern. Oral commissures, where the corners of the mouth turn downward contribute to an angry or grumpy appearance. The Judicious and conservative use of fillers in the lips is an important part of restoration of the youthful appearing in the aging face. Fillers in younger patients also have a role in making the elements of lip, cupids bow and vermillion, appear more beautiful, sensuous and inviting.
THE NECK- The area under the chin develops fullness over time, referred to as sub mental sagging. Kybella is a relatively new injectable recently approved by the FDA for treating the ‘double chin’ by dissolving the fat in that area. One caveat, the treatments can be uncomfortable and uneven appearance has been reported. Some success has also been reported using this injectable for “ off label “ fat deposits elsewhere. So…. stay tuned.
The results of using a combination of fillers and Botox definitely produce a “wow” effect, and are a quick way to brighten the face, or take away years of aging.
While the process may appear easy, there is a very long learning curve to becoming excellent with injectables and achieving reliable and safe results. Beware of who does your fillers!! Complications, while unusual, can and do occur and can be devastating. Fillers placed incorrectly can interfere with circulation to the skin and areas of the face. Filler is also an implant that has the potential to become infected if absolute sterile technique is not used. Fillers should always be done in a physicians facility, with all of the necessary equipment and medications to treat any complication immediately should one occur. In our facilities, all injectables are done by Plastic Surgeons only. We believe this is the best way to assure excellent results with ultimate safety.
General Mark A. Milley, 39th Chief of Staff of the United States Army and member of the Joint Chiefs of Staff, United States Department of Defense, and Dr. Guy Rochman, Chairman and Chief Operating Officer of Worldpath Health and Assistant Professor of Surgery, Harvard Medical School, discuss the importance of the Worldpath Health role in international healthcare, and agree that healthcare transcends politics and national borders.
General Milley is from Massachusetts, having attended Belmont Hill School and Princeton University with a Bachelor of Arts degree in political science. He holds a Master of Arts degree in international relations from Columbia University and the United States Naval War College. He is also a graduate of the MIT Center for International Studies.
Dr. Rochman is the founder of Worldpath Health, headquartered in Cambridge, Massachusetts. Dr. Rochman graduated “cum laude” from Harvard University and Boston University School of Medicine. He served as a General Surgery Intern and resident at the Beth Israel Deaconess Medical Center, Harvard University, Boston, Massachusetts, and completed his plastic surgery fellowship at Johns Hopkins Hospital in Baltimore, Maryland.
The winter is about to begin…. Don’t forget about your skin.
“Oh the weather outside is frightful” as the popular holiday song reminds us, but there is no reason why your face needs to be. Winter climates mean we must pay a bit more attention to our skin, if we want it to be youthful for many seasons to come and avoid the risk of permanent injury.
The rosy red cheeks we get after coming in from the cold can cause dryness tightness, flaking, cracking and inflammation of the skin called eczema. And although the warmth from the heat or fireplace when you get inside feels great, that too is drying to the skin. If left unattended, this will lead to premature aging and potentially irreversible damage to the skin.
Here are some simple tips to keep the skin kissable, once the mistletoe is no longer around.
Find a skin care specialist to help you choose the products that are right for you. All skin and skin care products are not the same. Many have little or no value, and some can actually cause injury to the skin. Our office is committed to the science of skin care programs to address the specific needs of various skin types, areas, and pigmentation. And our products will not break the bank in the process.
Moisturize your skin because once the damage is done, it’s done! While you may have found a moisturizer for your skin that works in the summer, the winter is more demanding. Depending upon skin type, many lotions labeled “night creams” may be more protective to the skin and help retain moisture, in part because moisturizer is oil-based.
Sunblock is not just for summer. Winter sports and snow glare make sunblock important. Remember the rule of 30’s – SPF 30 and apply 30 minutes before you go out. Photo-damage leads to permanent skin changes including wrinkles, deep pigment changes and skin cancer.
Don’t forget about your hands. Because the skin is thinner on the hands, it is much more difficult to keep them moisturized in the winter.
Avoid wet socks and gloves. They can irritate the skin and cause cracking, drying and infection.
Adding a humidifier at home can help to bring healing moisture into the air and prevent drying, cracking and ulceration of the skin.
Don’t forget about your feet. Use an exfoliant to get dead skin off the feet so moisturizers will work better. And consider using a petroleum product for greater moisturizing.
Avoid alcohol-based toners, cleaners and astringents, which strip protective oils from your skin. Consider cleansing milk, deep foaming cleaners or deep hydrating products we have in our office. We also carry Epionce products and often combine them to restore youthful healthy skin.
While winter is “the most wonderful time of the year” to many, it does require some preparation. Follow these simple winter tips or call or visit our office. We’ll give you what you need to look your best. Then, “let it snow let it snow let it snow.”
The danger of Sun Exposure and Ultraviolet Exposure (UV-A and UV-B) has long been known. I have written about the importance of protection from the sun in numerous articles and reports both here and elsewhere. Even on cloudy days we must respect the power of the sun’s rays both in terms of cancer as well as premature aging of the skin.
However, our industrialized society also poses signification risks and hazards by exposure of chemicals and impurities to the protective barrier to the skin.
Pollution and smog result from chemicals that have become aerosolized and thus impact upon the purity of the air. While urban areas are generally prone to higher risks, “air pollution” can be present and look different depending upon where one lives. Arid and desert environments have a high incidence of dust pollution, areas near forests can have air polluted by smoke from wild fires, and agricultural areas can have air polluted by chemicals used on farms.
Any time chemical particulate matter is in the air, this type of pollution will play a role in the aging of skin. This is why it is essential to defend your skin with a well-designed skin program.
Our office has created skin care protocols and programs for both male and female skin which are uniquely designed to:
Reduce the visible appearing of aging
Clean out the pores and particulate matter and smooth the skin
Add anti-aging vitamins for the skin
Protect from UV damage
Provide a barrier against environmental factors that compromise the skin
The skin is the largest organ in our body, and our first line of defense against the environment. With just a very few minutes of attention every day, our skin can remain youthful and healthy. Contact our office for a consultation today to find out more about how to keep your skin at its best.
Remember, when it comes to sun, smog and smoke, we all have skin in the game!
America’s appetite for plastic surgery continues to grow, rising by a staggering 115% since the new millennium. It seems, however, that some of the popular “menu items” are different. The types of procedures that patients are choosing is changing, as more specialized treatments become available. There are several reasons for both the continued growth and the shift in trends.
We are seeing a new group of consumers entering the market place. According to a report released in April 2016 by the Pew Research Center and The United States Census Bureau, Millennial (born 1981-1997) have surpassed Baby Boomers (born 1946-1964) as America’s largest generation. This generation came of age in the most technologically advanced time in the world, with plastic surgery as a household word. Their growing presence has helped to advance the market place in the direction of less invasive, more proactive and more sophisticated procedures to “stay young”.
According to David H Song MD, President of the American Society of Plastic Surgery, “Patients have more options that ever before, and working closely with their surgeon, they’re able to focus on specific target areas of the body to achieve the look their desire.”
Over 1.7 million plastic surgery procedures were performed in 2015. The top 5 procedures are breast augmentation, liposuction, nose reshaping, eyelid surgery and tummy tuck. For the first time since the year 2000, facelift surgery is not in the top 5. Also of note is the fact that liposuction is down 37% since 2000, eyelid surgery is down 38 % since 2000. This reflects the move toward new non- invasive or minimally invasive applications (e.g., lasers, light based procedures, ultrasonic fat reduction procedure) .
A closer look at the 15.9 million cosmetic procedures performed in the United
States in 2015 reveals that 14.2 million were minimally invasive. Botox heads the list of the most common non-invasive procedures, up 759% since 2000. Soft tissue fillers (e.g. Restylane, Juvederm) are the second most common procedure, up 274% since 2000. Also on the list are non-invasive facial rejuvenation (lasers, peels etc.) and laser hair removal. Less invasive procedures can be more affordable and appear to a broader range of patients.
Male patients now comprise about half of the cosmetic surgery market. What is more dramatic than that number is the fact that men also account for more than 40 percent of aesthetic breast reduction surgeries. A total of 27,465 procedures were performed on men in 2015 for reduction of male pattern breast tissue (gynecomastia) reflecting a 35% increase since 2000.
Statistics also show that 2015 was ‘the year of the rear’ with buttock implants being the most rapidly growing type of cosmetic surgery. On average there was a buttock procedure performed every 30 minutes of every day?
The incontrovertible fact is that none of us will ever be any younger that we are this minute. And the numbers clearly demonstrate that while the demographics may be changing, America’s love for plastic surgery remains a passionate affair.
Laser resurfacing is a proven way of enhancing the appearance of your skin. It not only reduces wrinkles, age spots, acne scars, and unwanted hair, it will also tighten the skin and improve tone.
Because lasers can do so much, and there are so many competing products and promises on the market place, it can be difficult to choose the best treatment. It is very important to be informed, but it is also easy to be overwhelmed.
So, before you get lost on the Google information highway, lets step back from the hype and confusion and focus on some important things that you need to know when considering facial rejuvenation.
Don’t get hung up on brand names, new gadgets, great deals, groupons, the latest article in Cosmo, or the newest “med spa” in your mall. The cosmetic world is full of ‘great new ideas’ that ended up with bad results and unhappy patients. I love a great deal as much as anyone. But your face is not the place to go with the lowest cost option. First, focus on your goals; what problems you want to address and what are the results you can reasonably expect to achieve. Second, find a plastic surgeon you trust and respect to help you to tailor the best treatment options for your skin type.
Who performs your laser treatments will have a profound effect on your results. In the hands of a highly trained plastic surgeon, lasers are a safe and easy way to improve your appearance. But in the hands of a poorly trained practitioner, laser treatments can be dangerous, lead to bad outcomes, or simply waste your time and money. Choose the person to perform you procedure based upon experience, training, qualifications and trust.
Different lasers are optimal for different treatments. If you aren’t being treated with the best laser for your skin and goals, you won’t get the best results. A professional with a long track record of success and access to numerous devices can choose the correct tools and treatment for you specific needs. Remember, if all you have is a hammer, everything looks like a nail. Your plastic surgeon will have different lasers available and work with you to pick the right one for you
Having dark skin tones is no longer a contraindication to laser treatments. While it is true that darker skin tones can experience pigment changes, there are now lasers that can safely treat darker skin types including Hispanic, Asian, Middle Eastern and African American without affecting tone. It is critical, however, to be certain that the correct device is used for those skin types. Your plastic surgeon will know what treatment is appropriate and safe for you.
Plan on having multiple treatments. While a single treatment will address patient needs in some cases, multiple procedures will often be part of the treatment plan to achieve the best results. This trade-off comes with no down time and excellent long-term results. Treatments should be custom designed for each patient.
Depending upon the procedure you choose, you may have some down time. Some treatments may require you to make adjust your social and work schedule for a few days. It is important to have a discussion with your Plastic Surgeon regarding the timing of your procedure and your tolerance for down time. Our office offers evening and weekend hours to help you heal on your own time and get back to work and play quickly.
Certain medications and underlying medical conditions will affect the way your skin reacts to laser treatments. Your Plastic Surgeon will always take a detailed medical history, including any medications or medical supplements that might affect your recovery. Some acne medications can lead to poor healing or scaring following laser treatments. Over the counter medications including aspirin and non-steroidal anti-inflammatories can lead to bleeding. If you are prone to cold sores, laser treatments may lead to an outbreak. Your physician will want you to take medications before and after your treatment to help prevent post treatment cold sores and the problems associated with them. Cigarette smoking, diabetes and other chronic medical conditions can also delay healing and adversely impact outcomes. Your plastic surgeon will have a detailed discussion with you before your procedure and chose the best treatment for you.
Laser and light-based treatments can be a very safe, easy and effective way to maintain youthful appearance, healthy skin, and rejuvenate the aging face. Our team has been an international center of excellence in facial rejuvenation for over two decades.
Please contact our offices at The Mount Auburn Hospital in Cambridge Massachusetts or The Beth Israel Deaconess Hospital in Milton Massachusetts (www.rochmanmd.com) or WorldPath Health (www.worldpathmedicine.com) and schedule a consultation to learn what options are best for you