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The Changing Face of Plastic Surgery- Part One—The Millennial Factor

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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.

LIGHT-YEARS. 7 Things you need to know when choosing lasers and light energy to help you look years younger!  

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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

 

The International Age—Anti-Aging Answers for Every Ethnicity

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The association of youth and beauty is universally accepted in society. The desire for beautiful skin color and texture, absence of wrinkles, lustrous hair has fueled huge growth in the cosmetic and surgical industries. Women who possess a youthful appearance are consistently rated more attractive than older appearing women. Studies on skin texture and color have demonstrated that humans have a preference for younger appearing skin that is viewed as both healthier and more attractive.

In the current cauldron of political correctness, it may seem impolitic to say, but facial wrinkles, spots, saggy skin and aging faces discriminate based on skin color. White, Black, Latino, Middle Eastern, Asian are all different skin types, which  develop lines, laxity and loss of volume  in different ways and at different rates.  Indeed, the aging process transcends politics and national borders.  It’s how we battle back that makes the difference.

Aging is a complex process that reflects biological, environmental and genetic influences. Deeper pigmented, darker skin has characteristics that make its aging process unique.  The thicker and more compact dermis  makes facial lines less noticeable.   Increased  concentration of the pigment melanin  also make the skin more vulnerable to pigment changes and scaring.  It is critical to understand the unique structural and functional differences among ethnicities, and to have the appropriate modalities for various skin types, both of which are essential to treat the signs of again. Over the past 20 years we have specialized in rejuvenation of the aging face, and the unique requirements of patients from around the globe

**Here is the simple truth about White skin; the Irish, English, Scandinavian “peaches” complexion is going show more signs of aging.  Blame the sun, and the fact that light skin has very little pigment, or melanin, to protect against it.  UV rays from the sun break down collagen, and cause wrinkles that start as early as your 20’s.  Your skin produces pigment to protect itself.  Along with that come the dark spots.

And the skin cancers.  I have seen many young people in there 20’s with their first skin cancer.

The good news for this skin type is that we can be more aggressive with laser and other anti-aging treatments, since light skin does not absorb as much laser energy and we don’t have to worry about hyperpigmentation,

The essentials for your skin type;

  • Sunblock, sunblock, sunblock.  At least SPF 30 or greater, every day, re-applied every 3 hours or so.
  • Good anti-aging skin care regimen. We have designed an anti-aging and anti-pigment protocol unique to this skin type. There are others, but there is also a lot of junk.   Make sure you are investing in quality.
  • Quit smoking. It is the fast track to wrinkles, and worse.

 

**“Black is beautiful” has never been more true than when talking about aging skin types. You can smile and laugh and squint all you want because you wont even begin to see wrinkles until your 50”s.  The increased melanin, which gives the skin its deep pigment, along with thicker dermis and prolonged keratinocyte life, protects it against wrinkles, often for many decades.

Increased pigment, however does lead to uneven skin tone.  The pigment cells are larger and can react dramatically to minimal irrigation with dramatic color irregularities and scaring   Volume loss is also a telltale sign of aging in people with this skin type

Things to think about include topical skin care regimens, which include bleaching and fading creams, and fillers for volume replacement.

 

** Middle Eastern Skin types are blessed with extra pigment in the skin, so that lines don’t show up until well into your 40’s 50’s or even later.  I have seen many women with this skin type who never develop permanent wrinkles

But when in comes to skin, no one gets a free ride.  Folks with Middle Eastern skin have also been exposed to Middle Eastern sun…. This skin type has a good chance of developing dark blotches from enhanced sun exposure, dryness, irritation, and hormonal changes.  UV exposure also leads to breakdown of collagen and volume loss at an earlier age.

There are many new modalities now available to treat this skin type.  I use the E-matrix Sublative Laser, designed specifically to treat this skin type. It is important to maintain the skin tone with regular light/laser based peels to continue to correct and improve dark spotty skin.  We also create a personally designed skin care program of products to treat pigmentary changes and keep acne under control. I recommend a multi-tiered approach to early volume replacement and maintenance with products determined by specific location.  And of course, don’t forget the sunblock.

 

**The Asian paradigm for beautiful skin is pale and silky.  And while many Asian women want lighter, radiant and luminous skin, this skin type is actually thicker; with more pigment producing cells that fair skin.  Asian skin is prone to prominent dark spots, very uneven skin tone especially around the cheeks and forehead, melasma that makes the skin look dusty and dull.  This skin type is also prone to raised round keratoses that may require early surgical intervention. Because of the facial contour, volume loss is common.  I recommend appropriate custom designed skin care regimen, control of acne, Syneron EPL and RF based therapy, specifically programed to Asian skin, and volume replacement when it becomes necessary

Pigments in Latina skin can be as varied as the cultures. There are light skinned Latinas who age more like Caucasians, and very dark pigmented Latinas whose skin ages like black skin.  The universal complaint is discoloration of the cheeks, chin, upper lip and forehead.  According to one survey up to 66% of women will develop some form of melasma during pregnancy.  Sunscreens are important, but melasma is not just from UV radiation so it is important to use a sunblock that contains zinc oxide or titanium dioxide.

Home remedies to correct pigment changes are often used, and generally a bad idea.  Lime and lemon based treatments can cause a toxic reaction when applied to sun exposed skin, and lead to severe hyperpigmentation.   Cocoa Butter is very thick and occludes the pores, leading to acne and further scarring and pigmentation.  Plus, they don’t work to lighten the skin

Across all skin types, across all continents and cultures, the aging process includes photo damage, volume redistribution, and loss of connective tissue and wrinkling of the skin. As life expectancy continues to increase, almost doubling over the past century, and as youthful appearance has become more pivotal to personal success and wellbeing, appearance continues to become of increasing concern.  Our global cultures are now intermixed.  Society has become more heterogeneous.   Ethnic differences are clearly evident every day, in every culture.  Dark Skinned individuals have firmer smoother skin than those with lighter skin of the same age, however aging does occur in all cultures with regard to pigment, wrinkles, volume loss and laxity

When seeking plastic surgical rejuvenation of the aging face our patients know we have been caring for the international community for over two decades, and offer a comprehensive knowledge of the functional principles of ethnic and aging skin, and can property care for aging skin of all populations.

 

 

Guy M  Rochman MD

Assistant Professor of Surgery, Harvard Medical School

Chief, Division of Plastic Surgery, Beth Israel Deaconesss Hospital Milton

CEO, WorldPath Health