Issue #3 summary - GO BACK TO ARCHIVE

Facing the years ahead
The causes of age are well documented - the effects of gravity, exposure to the sun, and the stresses of daily life. The effects are apparent - deep creases between the nose and mouth; a slack and jowly jawline; folds and fat deposits around the neck.
   So what can be done to prevent aging? Well, nothing actually. Although you continue to age with a facelift, or "rhytidectomy", it does appear to set back the clock, improving the most visible signs of aging. It achieves this by removing excess fat, tightening underlying muscles, and redraping facial and neck skin. As facelifts treat the bottom two-thirds of the face, it is not uncommon to combine another procedure, such as a forehead lift, eyelid surgery or nose reshaping. Clearly, a facelift can take you towards looking younger and fresher and increasing your self-confidence. What it can't do is give you "a totally different look".
   The best candidate for a facelift is a man or woman whose face and neck have begun to sag but whose skin still has some elasticity and whose bone structure is strong and well-defined. As for age, most patients are in their 40s-60s, but facelifts can be done successfully on older people as well. Complications Just like any other cosmetic surgery procedure, facelifts can have complications. The facial nerve, which supplies movement to the face, creates the most problems. But this occurs in fewer than 1% of facelifts. Deep plane facelifts - those that go deeper than the skin - are associated with a higher rate of injury to the facial nerve (from 1%-20%). Even so, the American Society of Plastic and Reconstructive Surgeons points out that most problems resolve without surgery.
   As we all look different, facelifts are "individual" procedures. In an initial consultation the surgeon will evaluate the face, including the skin and underlying bone, and discuss with the patient the goals of the surgery, explaining the techniques and the anaesthesia that will be used, the type of facility where the surgery will be performed, and the risks and costs involved.

Hair transplantation
Losing your hair can make you feel unhappy about your self-image. This may affect your self-esteem and wreak subtle havoc in many areas of your life. It is not vain to desire hair. Baldness makes you look older and exaggerates wrinkles and facial lines. Self-esteem is very important to the quality of your everyday life.
   The aim of hair restoration is to create a frame around the face and soften the aging effects of hair loss. MPB Male Pattern Baldness (MPB) is the cause of hair loss in more than 90% of men. MPB is defined as hair loss at the front, top and/or the crown/vertex of the scalp (non-permanent area). The back and sides of the scalp are spared and usually grow hair for life (permanent area). The cause of this pattern is genetically programmed receptors in the hair roots of the non-permanent area. No such receptors exist in the permanent area. These receptors attract the male hormone, dihydrotestosterone (DHT), which flows in the blood stream and as a result starts the hair-loss process. The scalp is rich in blood supply and therefore, contrary to commonly heard myths, MPB has nothing to do with lack of blood.
   Hair transplantation is the only real proven long-term solution to hair loss. It is guaranteed to grow for life, or at least into your old age, because of its genetic programming. Hair root microsurgery is a state of the art method that outdates older techniques. It is surgery with minimum trauma which, in the end, results in a natural head of growing hair. The method simply uses the remaining hair in the permanent area and re-distributes it to create the look of a fuller head of hair. In this respect, the success of the technique relies more on art than pure science. Single and double hair root grafts can be individually transferred into tiny nicks in the skin to give a natural looking feathery appearance to the front hairline. Individual hair roots are placed with absolute precision, following the direction of the natural growth of the hair, to form a totally realistic hairline.
   The result is hair that performs in the same way as the hair you used to have. Only you, and the people you choose to tell, need ever know about the treatment.

Riding high on the waves
As adults know all too well, the ravages of acne can last long after the pimples have faded. What was once self-consciousness about the whiteheads, blackheads and redness of acne is often replaced by disfiguring acne scars that can last a lifetime if left untreated. Lasers have had a significant impact in treating acne scarring.
   At a recent meeting of dermatologists, Bruce Katz, MD, associate clinical professor of dermatology, College of Physicians and Surgeons of Columbia University, discussed the latest treatment options available for patients afflicted with acne scarring. "The erbium YAG laser, which emits light through short bursts of energy that is absorbed by the water in the skin, allows for precise sculpting of irregular scars," said Dr Katz. "With new erbium YAG lasers, recovery times are faster - usually three to five days - with a shorter duration of post-surgery redness."    Medical professionals also use the CO2 laser for elevating depressed scars that give the skin a crater-like appearance. "As the CO2 laser produces more heat than the erbium YAG, it allows the energy emitted to penetrate deeper into the skin and tighten the skin's collagen fibres," Dr Katz said. "By tightening the fibres, the CO2 laser causes the depressed scars to elevate and look normal," said Dr Katz. "Today, there are more safe, effective treatments for acne scarring than ever before," said Dr Katz. "Patients who have suffered with acne through their teenage years or beyond, and are now left with this cruel reminder of their condition, are realising that they don't need to live with acne scars. It's important patients understand that the nature of the scarring dictates which procedure will work best for them," Dr Katz said.
   Advances in treating spider veins with lasers were also announced at the meeting. Spider veins, dilated small blood vessels located close to the surface of the skin, can appear anywhere on the body, but most commonly on the legs and face. Robert Weiss, MD, assistant professor, department of dermatology, Johns Hopkins University School of Medicine, said that what makes the newer lasers so revolutionary in treating spider veins is that patients of all origins - including African-Caribbean, Asian and Middle Eastern - can now see the laser in action on their own skin.
   "In the past lasers couldn't safely penetrate darker pigmented skin," Dr Weiss said. "With most lasers, penetrating through a tan is a risky procedure because it absorbs most of the laser energy and can burn the skin," Dr Weiss said. "But the newest lasers use wavelengths just beyond visible light to penetrate the skin without heating the pigment. This reduces the risk of burning or injury."

Instant wrinkle remover
Restylane is a crystal-clear gel for filling out lips, facial wrinkles and facial folds. It is injected into the skin or lip, and, because no pre-test for reactions is needed, a typical Restylane procedure takes less than 30 minutes. The results can be seen immediately, and no scars or other marks are left on the face.
   Restylane is completely biologically degradable, and as its chief ingredient, hyaluronic acid, is natural and not derived from an animal, it has an advantage over injectable materials containing bovine collagen, which can cause an allergic reaction. Hyaluronic acid is present in all living organisms. In human skin it creates volume where the body's own stores have decreased. Restylane is naturally integrated into the tissue and allows for the free passage of important nutritive elements such as oxygen and hormones. Even though the treated area can swell up, it is usually possible to meet other people and work as normal.
   The length of time that a Restylane treatment lasts is very individual. It depends on the structure of the skin, lifestyle and age as well as on expectations. According to Restylane, in most patients it has treated, about 50-80% of the effect remains after six months. Most people choose to have a touch-up done within a year of the original treatment.
   In a recent study, 158 patients were evaluated by doctors and self-evaluation for up to eight months after treatment. Of the doctors, 78.5% noticed a moderate or marked improvement in the patients after eight months. The corresponding patient satisfaction figure was 73.4%. "Restylane turned out to he particularly suitable for lip augmentation and recontouring," notes the study. "In some cases it can cause an immediate slight asymmetry between the right and left part of the vermillion (upper lip); it is necessary to refrain from correcting it and wait some hours before it resolves spontaneously. The safety evaluation showed a 12.5% rate of immediate adverse effects. These were localised and transient, with no evidence of major systemic side effects. The most common effects were bruising, tenderness and discomfort, which all lasted less than three days.

Targeting the muscle
Botulinum toxin injections (Botox) have been used in medicine since 1973 as a treatment for patients with crossed eyes. By weakening the overactive eye muscles, Botox provided an alternative to surgery. In the 1980s Botox began to be used for cosmetic procedures, such as neutralising overactive brow muscles causing permanent skin creases. Since then Botox has been found to improve neck banding and, to a lesser degree, "crow's feet". Botox may also be used with laser resurfacing to help prevent a recurrence of crow's feet.
   Botox works by inhibiting the release of acetylcholine at the joining site of the nerve to the muscle. This prevents the muscle from contracting. Several areas can be injected simultaneously, but most doctors limit the amount of toxin injected at one time. Serious side-effects are uncommon. The most common problem is temporary bruising.
   In an American Academy of Dermatology study over 32 months, 509 patients bearing wrinkles localised at frontal, glabellar, orbital and cervical regions were selected for treatment, with a total of 1,200 applied areas. A high muscle paralysis degree was reached with the consequent improvement of symptoms in practically all cases. Only 17 patients needed reapplication before four months (3.3%). The academy noted that the effects were noticed within 24-48 hours after injection, and were enhanced in up to seven or ten days, remaining stable for about four to six months. "At the periorbital region, which is the most applied area, there was a significant increase of side portion of eyebrow, providing a more jovial aspect to the patient." The patients' ages ranged from 24 to 81 years, with the sample comprising 431 females and 78 males. The academy concluded Botox to be a "simple, non-surgical, safe and effective method for treating wrinkles, mainly in the lower third of the face. "It presents few complications, is reversible, may be reapplied several times and is easy to be obtained."

Peel away skin problems
Smoother, more beautiful skin is a desirable goal. After we leave our skin problems behind in adolescence, a new set follows in adulthood: wrinkles, mild scarring and blemishes, and conditions caused by sun exposure, smoking and heredity traits. Chemical peeling can offer a solution. Basically, peels are chemicals that are applied to the surface of the skin to remove the top cell layers. These are replaced during healing with new skin.
   "Chemical peels are one of the most flexible treatments to rejuvenate aging skin and erase the marks of sun damage and age," says Gary Monheit, MD, associate professor of dermatology at the University of Alabama Medical Center. "By evaluating the patient's skin type, pigmentation, and degree of sun damage, a dermatologist can individualise the strength and depth of a peel to provide the greatest benefit to the patient." There are three classifications of chemical peels. The mildest is alphahydroxy acids (AHAs), in the middle is trichloroacetic acid (TCA), and the strongest is phenol.
   Peels are performed in nearly the same way. The surgeon or dermatologist begins the peel by cleansing the skin to remove all oils, dirt and soap traces. Hair is moved out of the way. and the chemical carefully applied. Alphahydroxy acids AHAs are a group of organic acids, among them glycolic, lactic and fruit. Glycolic derives from sugar cane; lactic from milk; and fruit from citrus and non-citrus varieties. According to Dr Mark Rubin, a clinical instructor in the department of dermatology at the University of California, San Diego, there has been no study comparing the efficacy of the acids.
   But Dr Rubin says AHA products can be distinguished. "The absorption of an active compound can be markedly influenced by the chemical composition of the base it is mixed in. Therefore, having a chemist put 10% glycolic acid in an ordinary face cream will not necessarily create as effective a 10% glycolic acid cream as one available from a company experienced in creating AHA products. My personal experience with these 'home-made' products has been disappointing." Dr Rubin also points out the importance of the varying degrees of neutralisation on AHA products. Referring to a small study examining the effect of neutralisation on glycolic acid products, Dr Rubin says partially neutralised 10% glycolic acid was found to cause less irritation than non-neutralised formulations. "Partially neutralised glycolic acids products appear to be both well-tolerated and effective," he says.

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