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.