Dr. Bev's Blog

We all know that body contouring procedures such as liposuction help to make us look and feel great, by removing excess fatty deposits and allowing a natural redistribution of tissue. The end result is an improved shape, and better body proportion. But what if it resulted in a reduction of risk for certain cardiovascular diseases? A study was presented at the annual meeting of the Society of Plastic Surgeons this year that has suggested just that.

Patients were divided into 2 groups undergoing either liposuction or liposuction and abdominoplasty. The men and women in the study who had elevated triglyceride levels (a component of fat in our body) before the surgery demonstrated a reduction of 43% in those levels. Taking into account all of the patients undergoing liposuction alone, 37% of patients demonstrated a significant reduction of Triglyceride levels. A smaller percentage of patients undergoing liposuction and tummy tuck demonstrated an improvement. Elevated triglycerides may be associated with Diabetes, Stroke, Heart Disease and Peripheral Vascular Disease.

The role of subcutaneous fat in the mechanism of certain diseases has yet to be illuminated. This study has shown that liposuction may reduce the risk of certain diseases in a group of patients with elevated Triglyceride levels. Liposuction is a procedure that has a high satisfaction rate. It recontours the body by removing excess fat using cannulas attached to vacuum devices. The cannulas are introduced through small openings about ½ inch long, resulting in inconspicuous scars frequently hidden in the natural folds of the skin. After surgery there is swelling which persists for several weeks, and is controlled by wearing a compression garment or girdle. There are few side effects of the surgery, but most commonly there is bruising swelling and transient numbness.

Much has been written about the fat coming back after liposuction. We know that the fat does not come back to the same areas after the surgery. It cannot because a lrge percentage of the fat cells have been removed. There may be a specific amount of fat that is genetically predetermined for our bodies, but this fat can no longer be located in the areas treated so the end result is an improvement in the way we look as we long as we eat healthy and remain active.

If you are interested in learning more about liposuction and body contouring or any of the procedures mentioned above, you can go to DoctorBev.com.

Did you ever wonder where the expression “an apple a day keeps the doctor away” came from? In days past, when Medicine was not the science that it is today, people as far back as Hippocrates realized the importance of certain foods. These foods had healing powers and were needed for normal growth and appearance. With the advent of modern science we have been able to identify what it is in these foods that make them important to our health. For example, Vitamin C, a nutrient found in citrus fruit, is needed for the synthesis of collagen, the most abundant protein in the body. Collagen found in the skin provides support- reducing skin laxity and hydration -creating youthful soft skin. Vitamin C has other functions in the skin. It is a very potent anti oxidant which helps to protect against and to repair sun damage. Vitamin C is used as an additive to skin care products to stimulate healthy skin, but as we all know, it is found in citrus fruits like oranges, grapefruits, kiwi and strawberries which are delicious as a snack or as part of a healthy meal. Vitamin C nourishes and protects your skin, and also is a healthy addition to your diet keeping your weight in check.

By now, many of you have heard me extol the virtues of drinking lots of water, staying out of the sun, staying active and for those of you, who continue to smoke, stop smoking. I have blogged about skin care products which I think are a vital part of protecting and nourishing your skin. I have wholeheartedly supported the use of Botox and fillers to correct the cruel realities of getting old. But, these are meaningless in the absence of a healthy diet. I am not talking about weight loss diet. I am talking about the food that you put in your mouth every day. By adding these items to your diet, and possibly substituting them for items that are high in sugars and fat, and therefore have little nutritional benefit, you are able to improve your body’s resources and output.

The following is a short list of foods which can be incorporated into your diet to stimulate healthier skin, and improved vitality. This list is only the beginning to a healthier you.

1. Fresh fruits and vegetables
2. Low fat protein such as poultry and fish
3. Nuts
4. Green Tea

Let’s break the list down now.

Fresh fruits and veggies don’t sound too appetizing, but we can look at the individual foods to get a better idea. Citrus fruits are high in Vitamin C which stimulates collagen and is a potent anti oxidant. It reduces inflammation helping you to heal better. Citrus fruits are delicious as a snack and can be found year round. Berries that are rich in color such as blueberries, blackberries and raspberries are also high in anti oxidants, which help to prevent and correct sun damage. These are great in smoothies mixed with a little bit of low fat yogurt. If you can’t find them fresh, they are available in the frozen section of your supermarket in the unsweetened form. Leafy green vegetables are high in Vitamin C as well. I know many of us don’t like leafy green vegetables, but Romaine lettuce is an excellent source of vitamins and minerals and makes a great salad, and spinach is great in an egg beater omelet, or sautéed with olive oil, onion and a little garlic. Red peppers are a great source of vitamin C also.

Red meats and whole fat dairy products tend to contain saturated or unhealthy fats and cholesterol. These can not only clog your arteries but they can clog your pores. Poultry(remove the skin please) and especially fish contain relatively little cholesterol and saturated fats, and are an excellent source of protein.

Nuts, despite their high fat content are actually good for you, in moderation. A handful of nuts such as almonds or walnuts contain a healthy dose of omega 3 and 6 fatty acids which are heart healthy, and skin healthy. Other foods that are high in essential fatty acids are olive oil, canola oil, salmon and avocados. Essential fatty acids are not naturally found in the body, but are needed because they are the building blocks for certain substances such as hormones, enzymes and substrates that are crucial for body and skin function. Remember to eat these foods in moderation. A diet which is very, very low in fat can lead to dry skin, hair loss and fatigue.

Green tea, although it contains caffeine, a stimulant, is high in anti oxidants.

In summary, to promote healthy youthful skin you need to ensure that your diet contains adequate amounts of Vitamin C to stimulate collagen production and reduce inflammation, and contains anti oxidants which help to prevent and to repair cellular damage caused by the sun and other interactions and that it contains heart healthy or unsaturated fats which are the source of the building blocks used by the body in day to day function.

Websites like Groupon, Living Social and Mom.com to name a few are cropping up like weeds. Some offer great deals on Botox, chemical peels, laser hair removal and microdermabrasion to name a few. Don’t let a deep discount dictate the choices you make.   Safety and quality are key issues that you need to consider before  purchasing your voucher, especially for a medical/cosmetic procedure.

The American Society of Aesthetic Plastic Surgeons recently released a statement “Doctors in other specialties designating themselves as “cosmetic Medicine physicians” may lack the comprehensive training that is needed for administering drugs and treatments to the deeper levels of the skin and lack the experience to achieve optimal aesthetic results…just as you wouldn’t see an allergist to deliver your baby, it’s in your best interest to see a physician who specializes in plastic surgery and dermatology care when seeking cosmetic medical procedures”.

Do your homework:

1. Always check the credentials of the doctor responsible for your treatment.

2. Make sure the person performing the treatment is fully qualified and trained.  Sometimes technicians perform the procedures you have purchased. You don’t want someone without adequate experience or training treating your face or body. Don’t be ashamed to ask for credentials, or better yet to check credentials before you buy.

3. If you are purchasing a coupon for a medical procedure, make sure you know what you are getting, and that the item you have purchased will meet your expectations.  Read the fine print.  For example,  you may purchase up to 20 units of Botox for $149, but if you need 25 units of Botox to treat your problem area, it may end up costing more than you bargained for.

Please remember these 3 key points.  Safety andresults should always  win over savings.

We all want to look our best for the holidays, but how can we do it in today’s economy without breaking the bank? Let’s start with the mantra that we earned it. As working women and men, we put our families and professions ahead of ourselves. We can’t find the time to pamper ourselves although we deserve a break every now and then. Nobody wants to look tired or wasted for the holidays. We want to look refreshed and healthy. Wouldn’t it be nice to be able to sneak away for an hour or 2, and enjoy the benefits of our retreat for weeks or months to come?

You may want to consider a facial that will promote healthier softer skin resulting in a radiant complexion with a reduction in fine lines and wrinkles. Extractions which help to cleanse the skin and reduce acne are performed as needed. Facials are done in a warm soothing environment, with soft lights and music to help you get into a relaxed mood. Aestheticians are well versed in the art of facial and upper body massage. You may find yourself taking a short refreshing nap during your facial treatments. Peels intended to lighten, brighten, repair and firm are well worth the additional time and small cost. I enjoy the 4 Layer Facial by Repechage which utilizes several layers of seaweed based masks to rejuvenate, firm and hydrate the skin. Your skin should look better for weeks to come.

Ideally you should use skin care products to maintain your healthier skin. Try to use products that don’t lock you into to a spa, such as products specially formulated by Dr X and only available in Dr X’s office. These products may be excellent, but you are locking yourself into one source and few options. Products that I call “bookends” are essential. You should always use a cleanser and toner to start, and a sunscreen with an SPF of 30 or higher to finish your morning routine. Minimally you should also use an eye cream to prevent or reduce those pesky fine lines around your eyes, and a vitamin C serum to reduce sun damage as well as a hydrating cream(some people call this a moisturizer although technically it is different from a moisturizer) This routine should be repeated in the evening without the sunscreen. Obagi makes an eyecream called Elastiderm which I love because it feels cool and sooths my eyelid skin when I put it on, and I can use it on my upper lip to reduce fine lines there as well.

Photo damaged skin responds well to Retin A. Photo facials were very popular in the past but are expensive and required frequent touchups to maintain the improvements unless you are on a skin care program formulated for sun damaged skin. Once you are on a program, you no longer need the photo facials.

Facials and skin care address the skin health, but they don’t address frown lines or parentheses around the mouth or crow’s feet. These crop up for a variety of reasons including hereditary or age related collagen loss, squinting and sun damage. They can start early, in your 20’s or later in your 30’s or 40’s. To look your best for the holidays you may wish to treat crow’s feet and frown lines with Botox/Dysport and to treat your smile lines with fillers such as juvaderm, restylane or radiesse. Many people like to maintain the improvement associated with these products year round, so they return for periodic touchups. Some people choose to take advantage of a semi permanent filler, Artefil. All of these products are FDA approved and are safe and effective.

If you are interested in learning more about non invasive plastic surgery to keep your skin healthy and to maintain a youthful appearance ,you can go to
DoctorBev.com.

Good news for women seeking lip enhancement has come at the start of this holiday season. Restylane, dermal filler that has been in use since 2004 has just won FDA approval for use in lip enhancement. Restylane has a long safety record for its use in the correction of moderate to severe wrinkles, such as the nasolabial fold, and this new approval extends that record to lip enhancement. The treatment creates natural looking well proportioned lips that are appropriately sized for the face.

The studies that the FDA used to confer their approval showed that Restylane was safe for submucosal implantation in the upper and lower lip, lasting for up to six months. There is a high degree of patient satisfaction and very few adverse effects. Some of the subjects in the study reported swelling, tenderness, bruising and redness all self limiting.

Restylane is Hyaluronic filler. Hyaluronic acid is naturally found in the body. Restylane also contains a small amount of lidocaine, an anesthetic which takes away a lot of the pain associated with the treatment in the past.

There are a variety of FDA approved fillers on the market. The Hyaluronic fillers are the most commonly used. Other fillers include Radiesse( Calcium Hydroxyapetite), Sculptra( Poly L Lactic Acid) and of course your very own fat. Only Restylane is FDA approved for lip augmentation. All however create beautiful results when used by fully trained Plastic surgeons.

If you are interested in learning more about fillers or any of the procedures mentioned above, you can go to DoctorBev.com.

One of the most common questions I get asked during a liposuction or body contouring consultation is whether the fat will come back after surgery.

Now that answer depends on your point of reference. Liposuction addresses specific areas or problem spots. Spots, that regardless of how many crunches you do or how much you diet, just won’t go away. Liposuction can fix that. Does that mean that we should burn our membership card to the gym or eat anything we want with abandon? Of course not. If we are not careful, we will gain weight. Journalist Judith Newman who is no stranger to liposuction says, ”The very fact that the weight doesn’t come back in the same places generally means that you’ll look better and more balanced, even if you do gain something”.

Plastic surgery is a hot topic. Many writers specialize in writing about cosmetic improvement. In a recent Marie Claire magazine article entitled ”The Fat Came Back” the author suggests the fat is a stalker, lurking in some hidden area, waiting to come back. The truth is the number of fat cells we have doesn’t change. Their ability to store fat does. If we remove fat cells with liposuction, the remaining fat goes into hyperdrive, taking over for the fat cells we removed. What that means is that if you gain weight, even a pound or 2 it has to go somewhere. It can no longer preferentially go to the areas treated with liposuction so it goes elsewhere. This actually makes sense. Liposuction can’t prevent us from gaining weight, but it can redistribute the weight to create better balance and harmony.

Another study from the University of Colorado, looked at 32 non obese women in their 30’s. Half were treated with liposuction for problem areas. All women were told to eat normally and not alter their lifestyle. The study looked at their weight after one year, and found that the weight had pretty much stayed the same, but the liposuction treated areas all looked better.

Liposuction is not a substitute for a healthy lifestyle . Only diet and exercise will bring that weight down. Healthy habits are needed to maintain the results you get with liposuction.

If you are interested in learning more about plastic surgery or any of the procedures mentioned above, you can go to DoctorBev.com.  This and many other tips will be coming soon.

Female Plastic Surgeon – Beverly Friedlander

Now that the summer is coming to a close, many of you are thinking about getting your plastic surgery procedures. After all, it is cooler in the fall and winter, and easier to cover up the post surgical bra or compression garments that need to worn post operatively.

If you are seeking plastic surgery, you are not only looking to improve certain aspects of your appearance, but you may also be looking to improve your self esteem, and possibly your marketability in the work force. It is important to have realistic expectations and to be prepared for the recovery. There may be swelling and bruising. You will need to make temporary adjustments in your life style. Working out and strenuous activity will need to be restricted for 4 weeks. We all know that physical activity releases endorphins, and the absence of this may lead to unhappiness or depression.

Keeping this in mind, I offer the following tips to help you get through the healing process:

1) Review all of the information given to you before the day of your surgery
2) Prepare your post op essentials, such as medications, food, water, TV, books, phone
3) Set up your space(bed) near a bathroom when possible
4) If possible, limit the use of stairs after surgery-it’s just easier
5) Drink lots of water after surgery
6) Avoid alcohol
7) Be prepared to talk to friends and/or relatives. You can’t keep your surgery a secret from everyone. You will need some help at least in the beginning.
Remember there is always swelling in the beginning. Don’t be quick to judge your result. Be patient as the healing occurs.
9) Above all, don’t be afraid to call your surgeon. No question is too small or unimportant
to ask.

If you are interested in learning more about plastic surgery you can go to DoctorBev.com.  This and many other tips will be coming soon.

Female Plastic Surgeon – Beverly Friedlander

Taking measures to practice good skin care and prevent the changes leading to premature aging of the skin is essential any time of year, but especially so during the summer. There are a plethora of products out there that claim to have anti-aging properties. Don’t be fooled by promises to make your facial wrinkles vanish. Some products just can’t live up to their claims.

The best way to protect against premature aging is to protect yourself when heading outside. UV radiation, an invisible component of sun light, causes premature aging of the skin which is difficult to treat. This awareness may be the reason for the recent increase in potions and lotions claiming to have anti aging ability. One newspaper reported a 12% increase in over the counter anti aging products since last year. The FDA keeps track of the various manufacturers of skin care products, and maintains a “Yellow List” of companies that are believed to have “exaggerated anti aging claims.” There are nearly 100 companies on this list.

Products and procedures available form a Plastic Surgeon or Dermatologist are likely to produce better results, than over the counter creams, but may be costly due to the ongoing need to use/perform them regularly. Even though they are preventative, most are not covered by insurance. Most spa services performed without the supervision of a physician are “feel good” services but don’t hold up to claims of “anti aging”.

There are ways to protect your skin and avoid spots of pigmentation and wrinkles. Wearing hats, sunglasses and sunscreens can certainly help. Limit sun exposure and exposure to tanning beds. Use a broad spectrum sunscreen with an SPF of 15 or higher.

Finally, if you are now paying the price for years of unprotected exposure, seek the advice of a Plastic surgeon or Dermatologist regarding the use of procedures which are intended to treat some of the damage caused by the sun. These non surgical procedures can include peels, microdermabrasions and fillers. Please feel free to set up an appointment for a free skin analysis with Melissa, my aesthetician, who is well versed in identifying and treating damaged skin.

If you are interested in learning more about plastic surgery or any of the procedures mentioned above, you can go to DoctorBev.com.  This and many other tips will be coming soon.

Female Plastic Surgeon – Beverly Friedlander

The FDA has finally published an update on silicone breast implants. While this update does not answer the most common question, “What is the likelihood my implants will rupture?” , it does address several other questions. The report confirms that silicone implants are safe and effective.

Many women are under the misconception that their implants will need to be replaced in 10 years. That is absolutely incorrect. Somewhere between 20 – 40 % of women undergoing augmentation had a second surgery within 10 years. The FDA does not recommend routine replacement but does indicate that as with all medical devices that the breast implants may not last a lifetime.

The FDA reports that the most common complication of the surgery is capsular contracture (a hardening of the area around the implant).

The current data continues to indicate that silicone breast implants do not cause breast cancer or connective tissue disorders. The FDA is continuing to study and follow this and other potential problems to ensure ongoing safety of the implants.

Most importantly, just relax and enjoy your new found body image. Please continue to follow up with your doctors, pay attention to any changes that you see and notify your doctor about anything that concerns you and remember to get your routine mammograms. The FDA also recommends that you get MRI’s to detect silent implant ruptures.

If you are interested in learning more about plastic surgery or any of the procedures mentioned above, you can go to DoctorBev.com.  This and many other tips will be coming soon.

Female Plastic Surgeon – Beverly Friedlander

Summer is here, and with it the desire to spend time outdoors, at the beach, at the park or even just in the backyard or on the deck.  Now, more than ever, it’s time to reach for the sunscreen, for your face and body.  But, which one?  SPF 15, 30 or 70- which is better?  Does it matter?  The FDA has finally done something to end the confusion over sunscreens.  They have approved new guidelines for the labeling of these products.
There are 2 types of UV radiation which are the most damaging to skin, UV A and UV B.  Both can cause sun burn and aging or photodamage to the skin, but UV A is more likely to cause aging type photodamage and UV B is more likely to cause burns.  Currently, sunscreen packaging does not distinguish between them and frequently protects only against one of them so that the other can continue to have a damaging effect.  Within the next  1-2 years all sunscreens will provide mandatory protection against both UV A and UV B.  They will have the designation broad spectrum to reflect this change.

Why wear a sunscreen?  What is so bad about a tan?  People who are constantly exposed to the sun, as in warmer climates nearer the equator have been genetically conditioned to have more melanin in their skin so they are naturally darker.  Others who have less melanin in their skin, those who are lighter, have less natural protection. UV radiation oxidizes the natural melanin which creates a darker skin color.  It also stimulates more melanin production.   Excessive exposure to sun light or tanning overpowers the protective effect of the natural melanin causing oxidation and free radical formation resulting in burns, premature aging of the skin, and in skin cancers. Sunscreens reduce amount of UV radiation penetrating into the skin, reducing the oxidation of the natural melanin and reducing the suntan but allowing for safer outdoor exposure.

Some sunscreens claim to be waterproof or sweat proof.  This will disappear from the packaging.  We all know rubbing our face with a towel after swimming or while sweating can reduce the protection afforded by sunscreens.   The only way to stay protected is to apply the sunscreen 30 minutes before exposure, about 30 minutes after exposure begins and after swimming, excessive sweating or rubbing.  If you are outside for extended periods of time, it is wise to reapply the sunscreen after a few hours as well.

The term SPF has created a significant amount of confusion.   The new regulations will limit claims for Sun Protection Factor (SPF) to 50.  What exactly does this mean?  SPF refers to the effectiveness of the sunscreen.  Specifically, it compares the amount of UV radiation required to cause sunburn with the sunscreen as compared to without the sunscreen.   Don’t be fooled.  These studies were done with controlled situations and do not reflect actual conditions.  An SPF of 15 doesn’t mean that you can stay out 15 times longer than if you were not wearing a sunscreen.  It means that 15 times the damaging effect of the sun will be prevented as long as the product is reapplied, it is not absorbed by the skin and it is not rubbed off.  An SPF of 30 provides a little more protection than an SPF 15.  In real everyday situations, there is probably no difference in protection afforded by SPF’s higher than 30, as long as applied properly.

Certain areas are forgotten or not easily addressed with sun exposure such as the eyes, the top of the head, the ears, the neck and even the skin where the clothing ends.  Remember to wear sunglasses and a hat and follow the guidelines above to prevent the harmful effects of the sun.  We can’t be too careful when it comes to protecting ourselves and our loved ones.

This is first change in sun protection labeling here in the United States since 1978.  Its about time.

If you are interested in reading more about more tips for healthy living, you can go to DoctorBev.com.

Female Plastic Surgeon – Beverly Friedlander