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War
Again
st
2 Aesthetic Science Institute: The War Against Aging
Aging
!
How to
Win
in the
Youth
Game
How to Win in the Youth Game 3
Foreword
“You’re beautiful.” There, I said it. That’s the
compliment you’ve been waiting for.
Of course you do. Compliments aren’t enough. People can say nice
things, but if you don’t believe it, it’s not enough.
The reality is that we are our first and harshest critics. We ask for
cosmetic procedures and we fight aging for ourselves and not for
others. We are in the Youth Game because we want to feel better and
look better than we do today.
The Youth Game is about more than looks. It’s also about that “get up
and go,” that “joie de vivre” that you remember having in your
twenties… and now you want it back. Compliments and plastic surgery
won’t help if you don’t have the energy you’re missing. Where can we
find the magic bullets and the special formula to get back our joy of
living? Popeye the Sailor had spinach to get a boost of energy – where
is our spinach?
The Youth Game is about what you put into your body: vitamins,
hormones, antioxidants, CoQ10, fish oils, smart pills, amino acids….
It’s about exercise and relaxation.
6 Aesthetic Science Institute: The War Against Aging
The Youth Game is also about the knife and the laser. When you have
your energy back, then it’s time to think about how you want to change
your appearance.
www.asimd.com
Your Self-Image and Plastic Surgery
Because the changes resulting from plastic surgery are often dramatic
and permanent, it's important that you have a clear understanding of
how surgery might make you feel-- long before a procedure is
scheduled. http://www.plasticsurgery.org/public_education/
... ... ... ... ...
Do looks matter?
Dr Kate Gleeson, a psychologist working at The Centre for Appearance
Research, conducted a study among university students, and discovered
that they all carried with them the barbs of childhood. “Nasty comments
that other people had made about their appearance when they were only
five or six had stuck firmly in their psyche. One girl wore only black
because she believed she had pudgy legs, even though her body was
now very slim,” says Gleeson.
The American Society for Aesthetic Plastic Surgery reports an increase
of 23 per cent in cosmetic procedures. A recent survey showed that half
of all Americans approve of cosmetic medical procedures.
TABLE OF CONTENTS
Chapter 1 10
INTRODUCTION
Chapter 2 12
MUST WE GET OLD SO QUICKLY?
Chapter 3 15
FACE THE FACTS
• TO CREAM OR NOT TO CREAM?
• THE BRILLIANCE OF BOTOX
• FILL TO YOUR HEART'S CONTENT - AT A PRICE
Chapter 4 38
KEEP YOUR HEART TICKING ON TIME
• ANTIOXIDANTS, VITAMINS, MINERALS, ENZYMES, AND
HOMEOPATHIC HELPERS
• CoQ10 - A MOST IMPORTANT VITAMIN
• ALPHA LIPOIC ACID - UNIVERSAL ANTI OXIDANT?
• FISH OILS - NOTHING FISHY ABOUT THE RESULTS
• HUMAN GROWTH HORMONE
Chapter 5 51
HORMONES - HEAVEN OR HELL?
• WHY WORRY ABOUT HORMONES?
• TESTOSTERONE - FOR MEN ONLY?
• A SOLUTION TO ANDROPAUSE-WHATEVER AILS MEN
• VIAGRA - COCKED AND READY TO FIRE
• GET TO LOVE AVENUE IN THE FAST LANE!
Chapter 6 67
FOOD FOR THOUGHT - POWER OR POISON ?
• A - DIETARY PLANNING
• B - PRESCRIPTION WEIGHT LOSS MEDICINES
• C - OVER THE COUNTER AND HERBAL REMEDIES -
BETTER SAFE THAN SORRY
Chapter 7
EXERCISE - WHAT'S ENOUGH? 78
How to Win in the Youth Game 9
Chapter 8
ARTHRITIS - DON'T LET IT GET YOU DOWN 83
Chapter 9
COSMETIC SURGERY- CUTTING UP 89
WHO'S DOING WHAT
Chapter 10
THE ENDOSCOPE - A DIFFERENT POINT OF VIEW 127
Chapter 11
FLASH GORDON ARRIVES … OR AT LEAST HIS LASERS
DO!
Chapter 12
ANESTHESIA - IT'S NOT ALWAYS A GAS! 140
Chapter 13
FROM THE TOP OF THE HEAD TO THE BOTTOM OF THE
TOES 144
• BALDNESS - NO LONGER IS IT A HAIRY EXPERIENCE!
• THE EYES HAVE IT! 152
• CAN YOU HEAR ME NOW? 155
• SMILE, Even if you’re not on Candid Camera 157
• BREAST SURGERY – Get it on or off your chest 161
• FAT, FAT - DO I ALWAYS HAVE TO DIET? 167
• I'VE GOT YOU UNDER MY SKIN - CELLULITE 173
• WAYS TO LOSE WEIGHT WHEN ALL ELSE FAILS
• THE VAGINA - IT'S NOT ALWAYS A MONOLOGUE 184
• THE THIRD LEG - LENGTHEN IT? 186
• VEIN? WHAT'S THE BEST COURSE? 190
• SHOO THE SHOE BLUES AWAY 196
Chapter 14
GET SET AND READY TO GO 196
A - FROM I TO I
B - WHEN AND WHERE DO I START?
Being in private practice in Beverly Hills for over 30 years has given
me a great deal of interpersonal experience with over 20,000 patients. I
consider every one of them as a star. I thought that retirement would
enable me to leave the hectic arena of daily stress, but as much as I love
Kathleen (my wife of 38 years) and the occasional 250-yard drive off
the tee, it's hard to keep this racehorse in the paddock.
My associates and I propose to give you a guide to help you along the
way encompassing many phases that will avoid the pitfalls of
superficial hype. After all, the more things change, the more basic
truths remain the same!
Read on and enjoy the journey. Maybe the magic of rejuvenation can
really get you and your loved ones fit for life! So far, it has worked for
me!
www.asimd.com
Chapter 2
Must we get old so quickly?
What is old? Must we equate chronological age with metabolic aging?
In 1960 there were about 3,000 people over 100 in the USA. Today
there are over 100,000 centenarians and that group is increasing at a
geometrical rate. In fact those individuals living to reach 85 or over are
the fastest growing segment of our population.
You don't have to look in the mirror to see the signs of aging. Every
day gradual changes in every cell and organ contribute to the effects
that we see and feel.
Is there any way to slow down the process? More and more scientist
and physicians seem to think so. Let's go into a brief system review of
the changes that the calendar brings.
Brain
After the age of 20 it starts getting smaller, losing firmness and with it
some of the memory capability and thought processes as well.
Endocrines
In women menopause is feared by some almost as much as malignancy,
because of declining levels of estrogen , progesterone and testosterone
(more about this later).
In men, testosterone levels start their descent after the age of 30, with a
progressive decline in sexual desire and performance. While the
testosterone level goes down, the prostate increases in size affecting
over 90% of men by the age of 70.
How to Win in the Youth Game 13
Joints
Cartilage wears away and the cushion between the bones disappears
resulting in osteoarthritis. Flexibility decreases as well, but not the pain
associated with movement.
Lungs
Somewhere between the ages of 20 and 80, lung capacity may fall by as
much as 40% even with exercise and no smoking.
Metabolism
All of the glands including adrenal, pituitary and pancreas decrease
their output resulting in a myriad of digestive, sexual and thinking
problems. Almost 50% of woman and 33 % of men over 45 experience
various types of sexual dysfunction that are the basis of a burgeoning
worldwide industry.
Muscle Strength
If you exercise, you won't lose 5 to 10 percent of your muscle mass
each decade after the age of 20 (like your couch potato friends), but lose
some you well.
Vision
Acuity diminishes, cataracts increase, the retina degenerates.
Hair
If you have the right genes, you may keep your hair, but the strength
and color gradually fade.
Skin
If you’re reading this far, you know that wrinkles, sagging, spots and
sun damage are near the top of my level of interest, but improvement
can not happen by the knife alone!
Summary
Not a pretty picture, is it? Maybe we can’t stop the inevitable, but why
make it easy for Father Time? Let’s get started and see what we can do
to make the most of what we have and even improve on it?
Before we get into what's new, let's pay homage to the physician Galen
who first developed the basic formula for cold cream: oil, beeswax and
water. And it happened in the 2nd century AD. Added ingredients can
come from the sea, from animal, vegetable, fruit or mineral, ever
expanding the multibillion dollar business that shows no signs of
bursting at the seams. It is more and more apparent that there is nothing
superficial about the connection between a person's looks and the way
they feel.
Let's look at some of the real changes that these chemicals cause.
Cole Porter's immortal classic "I've Got You Under My Skin” couldn't
be a more appropriate way to start this phase of our journey, because
part of staying young is mirrored by the surface.
Skin is the largest organ in our body, accounting for over nine square
feet of surface area and 20 percent of our weight. It is complex
stratified into three compartments, epidermis, dermis and subcutis (or
hypodermis), and contains hair follicles, sweat glands and sebaceous
glands (oil producers). Its functions are many:
The various layers of the skin are the targets of constant irritation (e.g.,
sun exposure, smoking) or therapeutic relief by topical or surgical
methods. As we shall see, there's much more than meets the eye.
stay young and beautiful, let's see what's for real and what’s just “pie in
the sky.” Sorry, but a little science is necessary, at least to become
familiar with the labels. There are several skin cells that are vital in
maintaining the properties of the skin.
Epidermis
Keratinocytes (ke RAH ti no sight) make up 80 to 90 percent of the
epidermis, the top layer of the skin. Their entire life cycle is 30 to 40
days as they journey upward to the surface to be shed. They are very
sensitive to exposure to ultraviolet light, which, when unchecked,
causes damage to their DNA, the gateway to
cancerous changes. They are the targets of chemical peels, laser
resurfacing and topical agents, which we'll discuss later.
Dermis
This thin layer is made up of cellular and extra-cellular elements that
interact within a scaffold. This scaffold maintains the integrity of the
skin as the barrier to damage.
Elastin - These fibers are necessary for the skin and all other organs to
stretch and recoil (like a rubber band). They occupy only one to two
percent (by dry weight) of sun-protected skin. Materials like hylaronic
acid, glycosamine, and fibril are becoming household words due to their
increasing presence in creams, pills and fillers. All of these and others
are necessary parts of the dermal framework.
Retinol
This pure form of vitamin A probably becomes metabolized into
retinoic acid in the skin. Since it is less concentrated, retinol is less
irritating than retinoic acid, but less effective.
Kinerase
A newer product that some people compare to trentinoin, although it
probable is more of a moisturizer.
Vitamin E
This antioxidant works the same as Vitamin C by protecting the skin.
Moisturizers
Take your pick. They work by supplying the stratum corneum with
liquid protection from the extreme elements - wind, cold, heat. To
some investigators, moisturizers do more harm than good on the
cosmetic scene. Does "dry skin" have to be nourished? Must moisture
be restored? Why don't children and men need moisture as well?
Adverse effects?
Some well-known practitioners in the field (Dr. Obagi) have linked the
habitual use of moisturizers to dependencies, increased skin sensitivity
and possibly accelerated aging. I and many other surgeons who have
spent countless hours washing our hands have never needed assistance
to overcome dry palms. Moisturizers can actually aggravate some
dermatological problems, such as acne rosaceae, seborrhea, and clogged
20 Aesthetic Science Institute: The War Against Aging
Let’s go to the doctor! He has some serious solutions for all kinds of
skin problems!
Stronger solutions
Trichloracetic Acid (TCA)
This is the most commonly used agent in strengths ranging from 20 to
50 percent. By destroying the outer layer of the skin, it stimulates the
dermis to produce more collagen and elastin, resulting in fewer
wrinkles. This is the mechanism for all chemical peels. The deeper you
go up to a point, the better and longer lasting the result. But, as the
saying goes, "no pain, no gain." The increase in discomfort must be
dealt with by varying degrees of sedation and anesthesia.
Phenol
I discussed this at length over 30 years ago and nothing has changed my
mind about it. Phenol is the most effective method of skin rejuvenation
with the possible exception of newer lasers IN THE PROPER HANDS!
Let’s not get too medical. The neurotoxin blocks an important enzyme,
acetylcholine, which signals muscles to function by contracting. The
botulism toxin can stop your muscles from functioning, so therefore it is
a potential powder keg.
But here modem science has come to the rescue. Take a poison, refine
and purify it, use it in small amounts on specific parts of the body and
the results are truly INTOXICATING. By the end of 2004, botox
injections were the most popular cosmetic treatment in the world. They
provide happiness to countless millions, not to mention to the TV
stations, magazines and newspapers that have run the ubiquitous
commercials on a daily basis.
24 Aesthetic Science Institute: The War Against Aging
Frown muscles
Before After
Before After
The late 1980's marked the first time a purified botulinum (trademark
Botox) was used in humans to treat certain ocular disorders. While
treating crossed eyes and eyelid spasms by temporarily weakening the
How to Win in the Youth Game 25
From this auspicious beginning, Botox has risen to Number One with
no obvious contender in sight, and now with the complete approval of
the FDA. Even the tyro has heard of the increase in the number of
Botox parties where a group of patients gather together to save a little
time, a little money and share a camaraderie.
Like the title of a popular song of the late 1950's, "Little Things Mean a
Lot,” Botox is sealed in small vials and packaged in 100 units. The
lethal dose is 3,000 to 3,500 units. The average treatment ranges from
30 to 100 units, leaving a large safety margin. Thus a poison has
become a pleasure.
But wrinkles are not the only target for which botox is intended. The
medical improvements of cosmetic surgery are legion, ranging from
achalasia (esophageal spasm, a spasm in the esophagus) to athlete’s foot
to migraine to hyperhydrosis (sweaty palms and armpits) to other forms
of muscle spasm that are beyond the scope of our discussions. In
addition, new uses seem to be springing up on a monthly basis.
Side Effects
(Usually due to poor administration by someone inexperienced.)
1. Eyelid and eyebrow drooping
2. Difficulty in swallowing
3. Muscle weakness (too much too soon)
4. Antibody production - no results (fortunately less than 5 percent)
The pessimists with their philosophy of “the glass is half-empty” will
pick up this banner of negativity. However, the legions crying for
continued treatment stand ready to crush these objections.
What's Available?
Aside from Botox, a form of Botulinum A manufactured by Allergan
(the number one in use), there are several other medical toxins
available. Myobloc is the newest and is made from botulinum B. It has
the advantage of being more stable in liquid form and works on those
patients who have developed a resistance to Botox.
Do you have spastic muscles? Need to soften the signs of aging such as
jowls? Do you want to turn a frown into a smile? Get out the needle.
What's not!
Do you have spots or blotches?
Do you have lizard-like skin?
Is your collagen in need of tightening?
Do your neck and cheek areas remind you of a bloodhound?
Don't worry because we are here to help with laser, the surgical knife,
chemical peels and hormonal adjustment. Our own Dr. Jason Pozner is
one of the foremost administrators in the art of Botox treatments and
has contributed to several books on the subject.
For those avid researchers who need a more thorough exploration into
other uses of Botox, I would recommend The Botox Book by Lautin,
How to Win in the Youth Game 27
Is Botox forever?
No. Three to six months.
Does it make sense to keep paying for fewer
wrinkles? Is there a more permanent
procedure?
Sure -- Light laser. It’s expensive, but paying for
a one-time procedure might work better than
multiple visits to the bovine injection station.
In fact, Jason Pozner, the Light Saber expert on
the ASI staff, takes a pay cut two days each
month to teach other doctors the finer techniques
of this delicate procedure. Some doctors travel
28 Aesthetic Science Institute: The War Against Aging
The search began in the late 19th century when a Dr. Neuber used a
person’s own fat to correct facial depressions. There is even a reported
case of the successful implantation of a fatty tumor (Lipoma) taken
from the buttock of a patient to replace breast tissue removed at the
same time. In the early 1900's, the paraffin injection craze swept the
world until, alas, almost every patient developed foreign body tumors
with resulting disfiguration and infections.
When combined with other material (would you believe even snake oil
in “The Sakari Formula”?), silicone injections can give patients terrible
experiences. In some cases, there were granules, infection, tumors,
sometimes resulting in the removal of massive amounts of face and
breast tissue. Attempts to stop its discriminate use resulted in only
seven centers in the USA being authorized to use minimal amounts by
the American Society of Plastic Surgery and the FDA for 20 years.
Collagen occurs within the skin and its loss secondary to aging causes
sagging wrinkling and decreased smoothness. At first it was
manufactured from animal (cow tissue) and required sensitivity allergy
How to Win in the Youth Game 29
Here are some of the newer injectible fillers: Inamed, Zyplast, Zyderm,
Restylane, Perlane; they are comprised almost primarily of hylaronic
acid molecules. The latter is a natural structural element occurring in
the skin, subcutaneous connective tissues, and synovial fluid. Since
hylaronic acid is identical in all living tissues, there is less chance of
reaction, although occasionally a few reactions in humans have been
reported. It has the advantage of lasting over twice as long as collagen
and has enjoyed popularity, particularly in Europe.
Radiesse - this product has burst into the rejuvenation scene with a roar.
The principle component of this material is synthetic calcium
hydroxylapatite a biomaterial with over 20 years of use in orthopedics,
neurosurgery, otolaryngology (ear nose and throat) and ophthalmology.
Calcium hydroxylapatite is the main mineral constituent of bone and
teeth. It is suspended in a gel carrier for injection. After instillation,
the gel (carboxy menthyl cellulose CMC) is replaced by soft tissue
growth, while the carbon crystals remain at the site of injection. The
result may be one to three years of improvement compared to 3 to 4
months with collagen at a bargain price of $600/cc (cubic centimeter).
While the initial expense may seem high, there is less need for repeated
injections, which is the case with other fillers. Longer-lasting results
suggest that this may be a way to go at the present time.
30 Aesthetic Science Institute: The War Against Aging
Reviderm-Intra (Treviderm)
This material is made up of dextran beads suspended in a non animal
hylan gel. The proposed mechanism of action is similar to articoll,
causing a foreign body reaction that results in new collagen formation
on a permanent basis. It is used to treat wrinkles, skin defects, and in
Europe for lip augmentation. A preliminary study of 300 patients
seems to confirm its permanence but no FDA approval as yet.
Hylaform Gel - This is made from hylaronic acid taken from rooster
combs of domestic stock. A more concentrated from called SYNVISC
is used to treat osteoarthritis of the knees with FDA approval. It is used
world wide for wrinkles, scars and lip fills, with an effect lasting up to
three times as long as collagen it also is easier to inject. Who's chicken
now?
Fat Injections
What a great idea! Why not make a small incision in hidden areas like
the lower abdomen or buttocks, use a careful liposuction or harvesting
technique to gather fat cells, and then inject them into the lips, local
folds or other crevices as needed? We usually offer fat injection as an
adjunct to facial surgery, but in our hands and in the experience of
How to Win in the Youth Game 31
many others, the results are equivocal. Fat cells do not take as readily
as skin grafts, but the use of fat injection continues.
Dermal Fat Grafts have been used with success for decades with
varying degrees of success. The proclivity for dermis (deep layer to be
accepted makes it an ideal choice for deeper folds between the eyes and
the nasolabial (nose and lip) lines. However, before implanting these
grafts through a small incision, the surgeon must remove the entire
layer of outer skin (epidermis). If just a few cells are left, subcutaneous
cysts with infections may result. Therefore, the use of dermal fat grafts
is limited.
32 Aesthetic Science Institute: The War Against Aging
Alladerm - Human skin with living cells removed - used like Gore-Tex
in folds or rolls and acts as a matrix for tissue growth. Cynetra is the
injectible form.
How to Win in the Youth Game 33
So what's a person to do? Know your options, know your doctor and
listen to his advice. I do!
34 Aesthetic Science Institute: The War Against Aging
INJECTIBLE FILLERS
Name Composition Uses Length of FDA
effectivenes Available
s
Zyderm Animal Fine lines, 3-4 months Yes
Zyplast Collagen wrinkles
Lip
enhancement
Rest lane Hylaronic Acid Fine lines 6 - 12 Pending
Perlane Present in all wrinkles, lip months
Species enhancement
Radiesse Calcium Same as above 3-5 years Pending
Hydroxyl +Cheekbone
Apatate +Chin
(Synthetic) +Soft Tissue
Main enhancement
constituent of
bone and teeth
Cosmoderm Human Same as above 3-4 months Yes
Cosmoplast Collagen Zyderm and
(no skin test Zyplast
required)
Articoll Methacrylate, Wrinkles and 2-3 months No
Microspheres Scars
and
Bovine Collagen
Hylaform Hylaronic Acid Wrinkle, Scars 3-6 months No
Gel (from rooster lip
combs) enhancement
Reviderm Dexran Beads in Wrinkles, Permanent No
Intra Hylan Gel Atrophic scars
and lips
Silicone Silica (man Wrinkles and Permanent Only
Biopolymer made Scars but difficult Ophthalmic
polymer) to keep Use
from
shifting
Ectoplast 50 Soluble Elastin Wrinkles and 1 year No
and Animal Scars
Collagen
(skin test)
New Fill Polylactic Acid Soft Tissue Two years Yes
(Sculptra) Hands, Cheeks,
Liposuction
Defects
Chapter 4
Keep Your Heart
Ticking On Time
You don't have to be a genius to know that a young heart is the key to
remaining vibrant and energetic. With the amount of information
pouring into our awareness highway, perhaps a brief summary of where
current thinking stands is in order.
VITAMINS:
Vitamin A - Fat soluble improves the normal process of enhancing the
immune system and promoting eye and liver health.
Vitamin B12 - aids in food metabolism, necessary for red blood cell
formation, prevents cataracts, acts in cell reproduction and growth.
38 Aesthetic Science Institute: The War Against Aging
AMINO ACIDS
l-cysteine, taurine, 1-methionine, important in all phases of cell
metabolism including muscle building, fat metabolism, liver, eye and
brain protection.
ANTIOXIDANT MINERALS
Minerals are catalysts for many biological reactions and are important
in maintaining and no nutrition would occur. Hormones, enzymes and
cells metabolism are intimately associated with these trace elements. So
is the proper functioning of the central nervous system, muscles and
heart. Without these minerals, no skin would heal, no muscle would
twitch.
Copper - Aids in bone fixation, hemoglobin and red blood cell activity,
works with Vitamin C and zinc to form elastin, increases healing, and
plays a role in hair and skin coloring and taste sensitivity.
ENZYMES
Enzymes are energized protein molecules, necessary for life which are
found in all living cell. They catalyze and regulate every biochemical
reaction in the human body. The food we eat, the energy we use all
need enzymes for utilization. There are three enzymes types. Two
(digestive and metabolic) are produced by our body when needed.
Food enzymes are introduced into the body through the raw foods we
ingest. Some of these enzymes have antioxidant properties.
HOMEOPATHIC HELPERS
DHEA - dehydroplandrosterone - Introduced about 20 years ago and is
currently enjoying an increasing popularity. In addition to possibly
controlling the levels of fibrinogen and c-reactive protein it has the
ability to improve many of the symptoms attributable to both andro-
and menopause. This is due to the fact that it is metabolized to produce
both testosterone and estrogen, a bonus for many and a curse for a few
such as men with prostrate cancer or severe prostatic hypertrophy
(“large size”). Women with estrogen-dependent cancers should also be
aware. Better to be under a physician’s care!
DHEA has been shown to prevent obesity, diabetes, cancer and heart
disease, stimulate the immune system and even extend longevity.
These observations led investigators to theorize that some of the
degenerative changes associated with human aging could be linked
to a progressive deficit in circulating DHEA. Thus, DHEA may
represent biomarkers of healthy aging.
-- Dr. Brizell
Melatonin
This is a time-keeper hormone secreted by the pineal gland and is
regarded by some as holding the secret to aging. It seemingly works in
harmony with growth hormones to maintain tissue health and promote
sleep. It’s implications in being a possible anti-cancer therapy are being
explored. A recent study in Europe showed a statistical improvement in
the one-year survival rate of advanced metastatic (spread) cancers. To
use the words of many a Jewish grandmother, it couldn’t hurt to take
melatonin. Besides, it helps you sleep.
In his review article, Dr. Parker analyzed the biochemical reasons and
other important criteria for evaluating the potential and therapeutic
applications of an antioxidant.
• Is the antioxidant able to neutralize free radicals?
• Does the antioxidant have a chelating effect on metals?
• Does the antioxidant interact with similar components?
• What are the effects on gene activity?
• Availability and how well is it absorbed?
• Does it concentrate in tissue cells?
• Is the antioxidant active in fat and water metabolism?
1. It is readily absorbed.
2. It neutralizes free radicals in both fat and aqueous (water)
metabolism.
3. It regenerates other antioxidants like Vitamin C and E, CoQ 10 and
some amino acids.
4. It has metal-chelating properties.
5. It may have an effect on genes and regulatory proteins involved in
normal growth and metabolism.
The downside is small because those patients with B12 deficiency may
cause a worsening of symptoms. But aside from occasional skin rashes
and hypoglycemia in diabetics, no serious side effects have been
reported even at high doses.
How to Win in the Youth Game 41
Fish Oils –
There’s Nothing Fishy about the
Results
If you want to believe the American Heart Association (and you
should), fish oil supplements drastically reduce the risk of sudden death.
They came to this conclusion by studying over 11,000 patients who had
suffered a heart attack within three months before the start of the study.
- aging
- hypertension
- arthritis
- memory loss and dementia
- adult diabetes
So, take your fish oil and slip off the hook of these debilitative
disorders.
42 Aesthetic Science Institute: The War Against Aging
You need the catalysts -- we all do! So, do the right thing and look for
the catalysts in the pills you take. – Dr. Brizel
44 Aesthetic Science Institute: The War Against Aging
The Four Gs
So what is a person to do? Anyone seriously interested needs
professional guidance. Although there are many claims for adding
certain compounds to enhance health, there are some potential side
effects, particularly for someone contemplating surgery. For instance,
the four Gs (ginger, garlic, ginko biloba and ginseng) have been shown
to have some deleterious effects.
Ginger - It may alleviate nausea but bleeding time is increased (the
time it takes to stop bleeding).
Garlic - Whether your breath is bad or not, garlic can lower blood
lipids and it has antioxidative properties. However, it can also increase
bleeding time.
Gingko Biloba - It may clear your mind a little, but it also increases
bleeding time.
Ginseng - It is used to increase energy, but when combined with certain
stimulants, it can increase heart rate and blood pressure. It may also
cause blood to clot too readily.
Summary
There you have it... This information is a mouthful, to say the least,
and it’s an awful lot to swallow, but in divided doses, it may be just the
right medicine for you.
Next Birthday: 57
But the stress of daily living brings its own demands. The barrage of
environment, chemicals, stress in the career and increases in newly
recognized diseases and hormonal abnormalities has tempered the joy of
so-called liberation.
As we all admit, most people are confused about aging and the role
hormones play in accelerating the process of slowing it down. And the
media doesn't help. It seems that not a week goes by when some study
is quoted about the erroneous_ information given to the public by
overzealous practitioners.
What is the news not telling the public? Can the same hormones that
keep us young and vital for so many years become a slow poison as we
grow old?
The estrogen hormone is not derived from human sources. It owes its
existence to pregnant horses. It’s surprising that more women don't
whinny while they're on Premarin. Similarly, Provera is derived from
petroleum by-products.
What can a patient do? Let’s get some hormonal level readings and
compare them to the patient’s symptoms.
1. Energy Level - Sluggishness
2. PMS symptoms - Night sweats hot flashes
3. Mental State - Anxiety depression, memory
4. Weight gain
5. Sexuality – declining interest.
6. Muscle time – soreness, long recovery after using the muscle
7. Bone and Joint problems
1. Capsules
2. Vaginal creams
3. Topical creams and gels
4. Sublingual drops
5. Suppositories
6. Lozenges
7. Dermal patches
It is obvious that the dosage will vary with age, the onset of stress,
menopause, but who, why, what, where, and how are questions that
must be answered and asked at periodic intervals. If a person should
take only one or a combination of hormones is a decision that can not
be made without thorough evaluation.
48 Aesthetic Science Institute: The War Against Aging
Where are the male hormones produced? The adrenals and ovaries.
As we age, the output decreases. You saw that between the ages of 20
to 40 the amount of female circulating testosterone decreases by up to
50 percent. With the onset of menopause another 30 to 50 percent
disappears. So, while hot flashes and vaginal dryness may make the
headlines, for some women (not all) the decrease in sexual arousal is
strictly related to the level of testosterone. In addition, some
medications like birth control pills, certain mood elevators and some
blood pressure medications add to a further decrease.
A Solution to Andropause
(and whatever else ails the men?)
We are quick to recognize the word "menopause" as an integral part of
our treatment program targets to maintain youth and vitality but what
about the male counter part?
The waist thickens and the pot belly appears, the muscles begin to lose
their tone and an increasing loss of well being, libido and unexplained
sadness start to fill the air. For awhile it was to be accepted as a part of
growing old, but there's nothing graceful about it.
What is andropause?
It is slightly different in meaning than menopause which is derived from
the Greek words menses (periods) and pauesis (stop). Greek words
andro (male) and pauesis (stop) and is appropriately named "when
masculinity ceases" or at least begins to slow down. Malcolm
Carruthers in his excellent treatise Revolution has given us several
check lists for self-diagnosis before running off to seek professional
help.
0 1 2 3 4
1. Fatigue – tiredness, etc.
2. Depression- low mood
3. Irritability- bad temper
4. Anxiety- nervous
5. Memory loss - decrease concentration
6. Relationship problems at home
7. Decrease sex drive - libido
8. Erection or potency problem
9. Increase skin dryness
10. Increase sweating day or night
11. Joint or back aches
12. Loss of fitness
13. Heavy drinking
Total
• Add 4 points for each of these - mumps, orchitis, testicular problems, prostate
inflammation, vasectomy and urinary infections.
• Andropause rating 0-9 okay. 10-19 possible, 20-29 likely, 30-39 think about
treatment, 40+ run, don't walk, for help.
Sounds like a no-brainer. Maybe not. There are natural concerns about
possible problems involving the prostate gland, the liver and heart. This
stems from the fact that the first pill produced almost 70 years ago,
methyltestosterone, was found to cause liver damage (even resulting in
cancer), increased cholesterol levels and prostate growth. It can still be
obtained over the counter in some parts of the world and should be
avoided at all costs.
At the present, there are many safer forms of treatment that should be
obtained from an expert in the field. It pays to do a little investigation,
particularly with the Internet available.
As we well know, the ideal match would be a teenage boy with a more
mature woman. But aside from a few well-publicized exceptions
usually ending in prison time for the unlucky lady, such is not the case.
What is a man to do when faced with a partner who has a reawakened
sexual zeal after her hormone replacement therapy (HRT), one of the
modern miracles of our time? Thanks to Pfizer, Viagra comes to the
rescue.
1998 marked the dawn of a new era with the introduction and FDA
acceptance of VIAGRA. It came about quite by accident because it was
the product of studies testing nitric oxide, a relatively new compound to
be tested within the human body within the last ten years or so. It was
hoped that by playing around with its metabolism, a pill could be
developed that would dilate the blood vessels of the heart and relieve
the pain of angina. A researcher at Pfizer set up a study of a drug call
SILDENAFIL (Viagra). This was known to increase nitric oxide
production, but unfortunately did little to ease chest pain. When he
asked his patients to return their pills, many refused, saying that while
their chest pains remained their erections returned with a BANG! And
so it was that a wonder drug was born with quick FDA blessing.
Medications
Viagra - If it's good for the gander how about the goose? Early studies
suggest that it increases lubrication and vaginal engorgement, thereby
increasing sexual response.
Testosterone, Estrogen
We've discussed it at length, there's no doubt that these hormones are
some of the things you can't do without. Go back and check out the
previous section.
How to Win in the Youth Game 57
Alternative Medicines
Ginko Biloba - The Chinese have loved it for centuries. It may:
1. increase vascular flow to the genitals
2. increase activity of prostaglandins
3. affect serotonin and norepinephrine activity
4. but remember it also thins the blood!
Ginseng - it may increase the efficacy of the body' own sex hormones,
but it also may give hormonally sensitive tumors a boost, so beware!
The time is here to recognize that both sexes deserve whatever help
they can get to lead a useful life behind closed doors as well. It's
obvious that we need a guide, now more than ever, but the results are
well worth it!
Chapter 6
Food for Thought –
Power or Poison?
Sir Henry Taylor, a 19th century intellectual, made this telling quote:
“His food was glory, which was poison to his mind and peril to his
body.”
Truer words may never have been spoken and since Sir Henry lived
from 1800 to 1886, he obviously practiced what he preached and used
his mouth for something besides speaking.
Food, of course, is the fuel for running the human machine. The whole
trouble with eating is the associations it carries. From infancy to the
grave, we use it to satisfy some psychological and emotional hungers.
It is love, a fact established by the nursing or feeding mother, indelibly
etched into our being. It can make up for frustration, rejection, failure,
and a lousy sex life. And when it comes to socializing, isn't it usually a
meal that is set before us with a dazzling display of culinary delights?
Read the papers, watch the news, open the magazines - it's no mystery
at all! Sue McDonald’s, give Burger King and Taco Bell the heave ho,
surely we couldn't have been to blame!
Now, let's get down to the subject at hand. One out every two
Americans is overweight and our children and grandchildren are
heading there at a precipitous rate. How many people have become rich
telling us what or what not to eat, what time and in what combination to
nourish ourselves, what pills or spells to expose ourselves to in the quest
for a better me? We've touched on emotional and binge eating. Before
you throw your hands up in frustration and head for the refrigerator,
we'll give you a compass to help you stay on course.
Obesity
What is obesity? Simply defined, it is too much fat for your body mass.
As you all know by now, it can open a Pandora's box of problems - type
2 diabetes, high blood pressure, gall stones, and arthritis for openers.
Of course clinicians have a handy table for calculating it - THE BODY
MASS INDEX (BMI).
BMI TABLE
Weight Height
(Pounds) (feet, inches)
5'0" 5'3" 5'6" 5'9" 6’0" 6'3"
140 27 25 23 21 19 18
150 29 27 24 22 20 19
160 31 28 26 24 22 20
170 33 30 28 25 23 21
180 35 32 29 27 25 23
190 37 34 31 28 26 24
200 39 36 32 30 27 25
210 41 37 34 31 29 26
220 43 39 36 33 30 28
230 45 41 37 34 31 29
240 47 43 39 36 33 30
250 49 44 40 37 34 31
Desirable = 19-24
Overweight = 25-30
Over the top = more than 30.
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This table will let you know what your BMI score is, unless you're built
like the Hulk.
Zone - If you like the middle of the road and agree that high carb
living can be "dead wrong,” this is for you. Proponents maintain that
40% carbohydrates, 30% fat, 30% protein is the ratio that promotes
youthful energy and vigor.
Eat More, Weigh Less - Dr. Dean Ornish, well known for his
success in reversing arterial heart blockages without surgery or drugs,
takes a different approach. He contends that a high-fiber, low-fat
vegetarian diet will keep you healthy while losing weight. In addition,
he champions exercise and has a different notion of the origins of our
eating habits in prehistoric times. If you can live without meat, all
62 Aesthetic Science Institute: The War Against Aging
sugar and most fat, be my guest. There's no doubt you may live longer
if you don't go crazy at mealtime.
"Eat the food you love and lose weight" is their motto and they use the
“point system.” Each food is assigned a number of points on the basis
of its calories, total fat, and fiber content. Depending on your starting
point, you may consume a certain number of points on a daily basis.
For instance, a six-ounce steak = 8 points while a cup of broccoli is 0
points. Stay in your daily range calculated on body weight, earn points
by exercising, have intense group support, and you’ll be successful
enough to get a "point number" on many food labels. It's no wonder
that WW is so popular and the Bible of many.
Pritikin Plan - If you're over 40, you've at least heard of this, a low-
fat diet based on vegetables, grains and fruits. For over 30 years,
thousands of people have gone to Pritikin Longevity Centers, learning
how to eat and prepare meals while reducing stress. Exercise is a
necessary ingredient. At the present time, Pritikin has introduced the
"Calorie Density Solution.” Fill up on foods that have relatively fewer
How to Win in the Youth Game 63
calories per pound and you will stay healthy and slim. If a pound of
chocolate chip cookies has 2140 calories and a pound of cucumbers has
100 or so, which one should the dieter choose?
That's a quick overview: easy to put down on paper, but hard to stick to
in the real world. Some of us turn to prescriptions and herbal assists in
times of need or frustration, so a brief scan of the popular ones is in
order to set the record straight.
Most available drugs fall into the "appetite suppressant" category. These
medications work by increasing two brain chemicals, serotonin and
catecholamine, that trick the body into thinking that is not hungry or
full. These include: Didrex, Tenuate, Saganor, Adipex, Meridia, and
Phenteramine. The latter was part of the ill- fated Redux which was
hailed as the ultimate solution in the 1990s until heart valves started to
malfunction at an alarming rate.
Meridia
Meridia is the only weight loss medication currently approved for long
term use but recently questions are being raised about its safety as well.
Be careful!
Do they work? If you think that a loss of 5-22 lbs over a year is ok-yes!
Some people have lost more than 10% of their body weight, but
effectiveness diminishes after 6 months of use. Potential addiction is
always a consideration, not to mention other side effects like
hypertension, sweating, constipation, headaches, and anxiety, to name a
few.
Over-the-Counter Remedies
Foolish enough to try it on your own, without some proper medical
advice? We'll go though some of the more popular products, most of
which are appetite suppressants, lately combined with so-called fat or
carb blockers.
• Chitosan - It's the rage now because this preparation made from
starch found in shell fish skeletons does bond with fats in the GI tract
and is not absorbed. In theory, it should work but in practice the
amount you really have to take with a meal is a meal in itself!
• Glucomannan - Watch out for this one! Made from a root, this herb
works by delaying the absorption of glucose from the intestines. It does
seem to promote weight loss by swelling up the gut to create the feeling
of fullness. The only trouble is that somewhere along the way quite a
few people have gotten a little too full , resulting in intestinal and
esophageal obstruction !It's even banned in some countries. So?
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• Guar Gum - It's a thickening agent for food and medications and
works like glucomannan. Same problems plus blood sugar level
fluctuations. Steer clear!
• Herbal Diuretics - Most of these come from caffeine and are found in
many over the counter compounds and herbal products. Various
products can cause renal failure (juniper), brain damage (equistine), or
convulsions (horse tail or shave grass). If that's not enough, they don't
work either!
Conclusions?
I know we've touched a few nerves in this part of the journey, but let's
try to summarize some salient points. To be effective, you must
consider changing a lifelong lifestyle. Besides eating well, you need to
increase and handle psychological problems more efficiently. Make
sure that whatever path is chosen, it must lead to a place that provides
life-long comfort and easy compliance. Don’t look for a quick fix -
slow and steady wins the race. If you need help, don’t be afraid to hold
out your hand. Just make sure that whoever grabs it is the right kind of
guide!
The reasons for exercising are so numerous that an entire book would
not be enough. Since I am not an exercise physiologist, but do still
know that every morning is a call to arms (and legs and stomachs), let's
make a list of why everyone should be motivated.
The two types of exercise are aerobic and anaerobic. The former
stresses the development of cardiovascular strength by intermittent
increases to the heart rate at periodic intervals. In that way the heart
becomes more efficient by increasing the amount of blood pumped at
each beat. A person with an "athletic heart" has a far slower heart rate
at rest with a marked capacity to instantly rev up when the situation
arises. No mystery to joggers, runners, swimmers, racket ball players
and bikers.
ANAEROBICS
Exercise that focuses on isometric resistance,
strengthening muscles and weightlifting
Heredity
Some of us are unlucky enough to have a defective gene responsible for
the production of collagen, a major component of cartilage. This results
in more rapid deterioration of joints, even with common use.
Obesity
The age old culprit rears its head again. Remember that we are
machines and overloading weight bearing areas increases the risk of
wear and tear, particularly of the back, hips, and knees.
Injuries
Have you seen a football game lately? They may look like heroes when
they go back on the field, taped and anesthetized, but look at them 20
years later! Broken bones and severe falls don't help either. Overuse of
certain joints such as fingers and knees increases the chances of
developing OA.
How to Win in the Youth Game 71
What is Cartilage?
We've all seen it in its natural form if we've eaten a drumstick. It's that
firm, glistening, rubbery material covering the ends of bones in normal
joints. Its function is to reduce friction and act a "shock absorber.”
Because it contains more than 70% water, cartilage can change shape to
absorb impact with change of position by compressing then rebounding
to its original form. When we walk or stand, some water leaves the
cartilage to coat the joint. When we sit down, the water returns to
restore the lining to its original shape. As we age, the cartilage may
wear down, the water content decreases, diminishing elasticity,
increasing stiffness and susceptibility to damage. Tendons and
ligaments stretch, bones rub against each other without a cushion
resulting in pain and deformity.
When a joint is inflamed, the cartilage breaks down and the ease and
range of motion is compromised. OA does not cause fever, weight loss,
or anemia. X-ray examination easily confirms the diagnosis.
Treatment
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Medications
1. Pain relievers such as non-steroid, anti-inflammatory drugs (NSAID)
such as aspirin naproxen, ibuprofen, Tylenol and Celebrex.
2. Creams, sprays of many of the above ingredients applied directly to
the affected area.
3. Unfortunately, there is no concrete proof that any of these remedies
reverse or slow down the progression of OA. Patients seeking effective
alternatives have spurred a remarkable increase in the use of
supplements.
Supplements
1. Glucosamine - there are several published articles from reputable
sources attesting to its effectiveness in repair and maintenance of joints.
2. MSM (methylsulfonylmethane) - this is a natural occurring
compound found in all living things that acts as an analgesic and anti-
inflammatory agent. It is important in the constant renewal of cell
structure and there are reports of an 80% decrease in pain after 6 weeks
of use.
3. Vitamins - C, D, K, and E all have been shown to play a role in
maintaining joint health and facilitating bone and cartilage metabolism.
4. Minerals - silica, boron, zinc, manganese, selenium, molybdenum,
and copper. More and more of these ingredients are found in
multivitamin formulations or the health food sections.
5. Omega-3 fatty acids - no difficulty in adding this compound,
because even if there were no other advantage, its protection of the
cardiovascular system is well established.
Exercise
What better way to improve joint movement and strengthen the
surrounding muscles to diminish the strain of motion? Be smart and
stick to low- impact or non-impact workouts like swimming, walking,
or biking on flat surfaces. Unless you're a masochist and enjoy more
pain, skip jogging and high-impact aerobics.
How to Win in the Youth Game 73
Supports
Canes and crutches, but let's work hard to never get there!!!!
Weight Control
Hard to digest as we've already discussed, but the benefits are not
necessarily confined to the better looking image in the mirror.
Surgery
I've had two hip replacements already, thanks to some screwed-up
genes, so here I can speak from personal experience. This procedure,
together with knee-joint replacement, is becoming more commonplace.
There are some limitations of activities (goodbye, tennis), but pain
relief and the promise of relative permanence of the prostheses as the
implanted materials and design improve with each passing year make
this a godsend for countless sufferers. Walking is a lot better than a
wheel chair!
The Future
We have recently seen the introduction of SYNVISC, a hyaline
compound that is injected directly into knee joints, resulting in
remarkable improvement in symptomatology. What doors will stem
cell research open? Our knowledge of genetic structure is another path
to explore. But for now, the best we can do is treat our body like the
temple it is, and maintain it inside and out even if Mother Nature throws
us a few curves.
TIP: When you have back pain, don’t listen to your friends.
Most people recommend “bed rest.” Unfortunately, after
staying in bed more than three days, the back muscles that
are in spasm also begin to weaken. The best way to recover
is to gently walk. Your body was built to walk, so do it. Even
a slow walk while you’re in pain is better than just lying there
because the other back muscles that are not in pain can be
exercised.
Chapter 9
Cosmetic Surgery –
Cutting Up
Who’s doing what
When I co-authored a book Beauty by Design in 1979, it was clearly
obvious to me that the rapid changes in knowledge and technique were
bound to have an effect on the way we perceived and did things.
Cosmetic surgery is now accompanied by innovations and procedures
that enhance and prolong youth fullness both inside and out. However,
although the roads may have been repaved, the basic routes remain
unchanged in finding the way to a better existence.
I have had two little sayings always get my patients or friends to smile.
An Example of
Before and After:
Brow lift
Forehead and Browlift - The endoscope has changed the method more
than any other technique. With proficiency, lines, muscles and wrinkles
can be removed or modified through several small incisions.
How to Win in the Youth Game 77
Trading Faces
What a good plastic surgeon can do
Before
Quite a finish…
Facial Implants
Side view
How to Win in the Youth Game 83
Before After
Chin Implant with a nose job
Quite handsome now!
Chin augmentation with nose job, eyelid lift and face lift.
Skin Rejuvenation
Chemical Peel - Tried and true by those who know, but rapidly
succumbing to ...
Laser peel
Body Procedures
Liposuction - It didn't even exist when I started practice. Now it’s all
the rage, but beware -- know the operation and the operator.
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Body Lift - With the increasing amount of weight loss in some patients
secondary to bariatric surgery, greater amounts of tissue are removed
and moved at the same time to achieve remarkable results.
How to Win in the Youth Game 87
Body lift
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4
2
1
5
3
Before
After
How to Win in the Youth Game 89
A good result.
Breast Augmentation
How to Win in the Youth Game 91
A little of both
Eyelid Surgery
What Doctors Call It: Blepharoplasty
What Does It Involve? Fat and excess skin removed to eliminate bags
and pouches
Operating Time: 1-2 hours
How Long Does It Last? 5 to 10 years
When Are All the Stitches Out? 5 to 7 days
Return to Work or School: 7 days
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Before After
Chin Augmentation and neck lift, plus Rhinoplasty (nose job)
Otoplasty
Ear Surgery
What Doctors Call It: Otoplasty
What Does It Involve? Cartilage reshaped to “pin back” ears
Operating Time: 1 to 2 hours
How Long Does It Last? Forever
When Are All the Stitches Out? Not applicable
Return to Work or School: 7 days
Chin surgery
What Doctors Call It: Mentoplasty
What Does It Involve? Implants to augment receding chin or small
cheekbones.
Operating Time: 30 to 45 minutes
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Cheekbone surgery
What Doctors Call It: Malarplasty
What Does It Involve? Often done in combination with facelift or
rhinoplasty to improve profile
Operating Time: 30 to 45 minutes
How Long Does It Last? Forever
When Are All the Stitches Out? 5 to 7 days
Return to Work or School: 5 to 7 days
How to Win in the Youth Game 99
Before
Chemical peel
What Doctors Call It: Chemical exfoliation or facial rejuvenation
What Does It Involve? A caustic solution removes the outer skin layer,
decreasing wrinkles, age spots and pigmentation problems.
Operating Time: 1 hour
How Long Does It Last? Some results last forever, depending on the
agent.
When Are All the Stitches Out? Not applicable
Return to Work or School: 10 to 14 days
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What are the threads? They are made of a nylon like material called
polypropylene and have directional cogs. After being inserted in the
skin, they form a support structure for the tissues.
Who are the best candidates? Patients with premature aging, drooping
of the tissues, and a flossed flat face.
How is it done? Under local anesthesia or light sedation, the threads are
placed under the skin using a special needle. After insertion, the tissue
is lifted on the cogs at the desired level.
Body Procedures
Breast augmentation (breast enlargement, “bigger breasts”)
What Doctors Call It: Augmentation mammoplasty
What Does It Involve? An implant is added to enlarge the size and
improve the breast’s shape.
Operating Time: 1-2 hours
How Long Does It Last? Forever; you might have to swap inserts
When Are All the Stitches Out? 7 to 10 days
Return to Work or School: 7 to 14 days
Breast Lift
What Doctors Call It: Mastopexy
What Does It Involve? Excess skin is removed and breast tissue is sewn
together to increase support and elevate the nipple.
Operating Time: 90 minutes to 3 hours
How Long Does It Last? Forever
When Are All the Stitches Out? 7 to 14 days
Return to Work or School: 7 to 14 days
Liposuction
What Doctors Call It: Suction assisted lipectomy
What Does It Involve? Fat is suctioned from thighs, hips, abdomen,
face, etc.
Operating Time: 45 minutes to one hour
How Long Does It Last? If you do not gain wait, forever.
When Are All the Stitches Out? 5 to 10 days
Return to Work or School: 10 to 14 days
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Tummy tuck
What Doctors Call It: Abdominoplasty
What Does It Involve? Loose skin is removed, muscles are tightened;
the procedure is sometimes combined with liposuction.
Operating Time: 2 to 3 hours
How Long Does It Last? Forever
When Are All the Stitches Out? 7 to 21 days
Return to Work or School: 10 to 21 days
Body Lift
What Doctors Call It: Circumferential Torsoplasty
What Does It Involve? Loose skin is removed from the front, back and
muscles, and lower skin is advanced to higher levels, like a pair of pants
Operating Room Time: 6 to 8 hours
How Long Does It Last? Forever
When Are All the Stitches out? 14 to 21 days
Return to Work or School: 21 days
Non-surgical Procedure
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That's part one - the viewing device. To actually perform the surgery, a
separate incision must be made in a different location through which a
surgical instrument (such as a scalpel, scissors, or forceps) must be
inserted and taken to the tissue to be worked upon. For the younger
generation accustomed to using both hands for computer games, it's a
no-brainer. For some of the more seasonal vets, it takes a little getting
used to.
There are some obvious advantages. With an endoscope the scars are
much smaller, likely to be hidden and the recuperation shorter. Let's go
through a procedure relevant to cosmetic surgery to illustrate.
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Forehead Lift:
Prior to endoscope use it was necessary to make a long incision usually
from ear to ear to do the job. With the endoscope, 3 or more incisions
less than 1" are all that is necessary to disrupt the muscles and raise the
eyebrows. The risk of sensory loss from nerve damage is decreased as
well as the possibility of bleeding bruising or swelling. In addition
many other endoscopic procedures can be performed under local
anesthesia and sedation with out an overnight stay.
Forehead lift
A Thought
I’m too young to have a full face lift. I’m thinking of
doing a simple thread lift.
Response: Are you over 40? How long will a thread lift
last? Five years, maximum? Why not think about a
full face lift, which lasts a lot longer?
PIGMENTED LESIONS
Oh, beauty, where is your mark? For some movie stars and models,
their signature, for others an unsightly blemish. There are many lesions
amenable to improvement, but not all. The most common ones treated
by laser are sunspots, usually in the older population (greater than 40).
However, some lesions are a definite no-no!
The ABC rule provided here is for the doctors and patients alike:
Avoid treating a cancerous lesion
Biopsy anything suspicious
Consult a specialist before laser treatment
The key is not to have visions of sugar plums in our heads, when all you
can expect are some M and M's.
LASER HAIR REMOVAL - For all the female hair pluckers and
shavers and the males resembling King Kong, what a breakthrough!
Before lasers, electrolysis was the only Rx available -- with poor
results. At the present time, this safe and effective technology is
How to Win in the Youth Game 113
available. Aside from unwanted facial, trunk and extremity hair, some
follicles pulled behind the ears in men after face-lifts can be zapped as
well as growth in the ears. In addition, removal from flaps used for
reconstruction and pilonidal cysts are some of the other applications.
Laser Resurfacing
The modern concept of treating photo aging is to use a combination of
modalities. Before the availability of laser machines, popular methods
for removing the superficial layers of the skin and permitting
regeneration included dermabrasion (scrubbing the skin) and chemical
peels. Unfortunately, many of these results depended upon the skill
and experience of the operator. However, the first popular laser, which
used a continuous wave of carbon dioxide, produced similar results in
the wrong hands. The problems usually were due to excessive damage
to the dermis, inhibiting regeneration and resulting in prolonged healing
times and in some cases severe scaring. To some extent, this has been
limited by the introduction of lasers that bypass the surface and attack
several components of the extra cellular matrix (the under surface
mentioned earlier), resulting in tightening and other signs of
rejuvenation. The combination of preparing the skin by the application
of certain creams (alpha hydroxyl compounds) before treatment,
whether by lasers or by surgery and laser in combination, followed by a
regimen to maintain the benefits for treatment makes one thing clear.
Know your doctor, preferably your entire team of care givers, before
you make your decision! The following tables will help.
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How to Win in the Youth Game 115
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Nw 42nd st.
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Swelling
Laser: Moderate
Chemical: Massive
Dermabrasion: Massive
Pain
Laser: Minimal to none
Chemical: Severe
Dermabrasion: Severe
Risk of hypopigmentation
Laser: Mild to moderate
Chemical: High
Dermabrasion: Mild to moderate
A Laser result.
Chapter 12
Anesthesia –
It's not necessarily a gas
No discussion of any operation experience would be complete without
dealing with the nuances of anesthesia improvements that have
paralleled advances in surgical techniques.
When I was younger, I was both cook and server in my operations suite.
The first 7,000 or so of my patients had me at the anesthesia controls.
Although I am more than a little egotistical, in this respect I was not
stupid. Part of residency training included six months of exquisite
experience under the tutelage of some of the best anesthesiologists in
the LA area of the time.
But like everything else, not so subtle changes have occurred. As out
patient surgery has grown, so has the phalanx of anesthesiologists and
quicker techniques that are needed to bring the patient to a state of
normalcy without much risk.
Now we come down to the nitty gritty - choosing the pilot. Taking
local anesthesia aside for a moment when we deal with general
anesthesia techniques we have a choice - nurse anesthesia or
anesthesiologist. Only one is a doctor. It's very much a kin to
delivering a baby. Who would you rather have at the foot of the bed?
A midwife or an obstetrician!
How to Win in the Youth Game 121
www.asimd.com
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Chapter 13
FROM THE TOP OF YOUR HEAD TO
THE BOTTOM OF YOUR FEET
Medical Treatments
1988 marked a milestone in the treatment of hair loss, when the FDA
approved the first medication for scalp applications to regrow hair -
Minoxidil (2 to 5 percent). It was obvious that, while it could slow
down or halt hair loss and even regrow hair in the vertex in some cases,
the frontal areas remained unaffected. In addition, daily application is
necessary for the medication to be effective.
Nero fringes and hair at the sides, you maybe eligible for a successful
experience.
Hair grafts are compatible composite skin grafts that must include the
root to be successful. The first common method of transplant was the
punch invented by Dr. Orentreich. The current treatment is simply a
variation of the theme, like planting a garden. The implants have
become smaller and smaller, the sessions longer and longer and the
number of implants at one time have increased dramatically.
The results are not immediate. It isn't instant hair. The new follicle
goes into shock and the hair falls out. After 2 or 3 months and a lot of
looking in the mirror, a fuzzy appearance followed by real genuine hair,
that with proper planning is "good to go" for the next 50 years or so.
The permanent genetics trigger is in the follicle and is constantly
reloading.
Here we compile a list of drugs that are known to cause hair loss in
some patients:
Cholesterol-lowering drug: clofibrate (Atromis-S) and gemfibrozil
(Lopid)
Parkinson Medications: levodopa (Dopar, Larodopa)
Ulcer drugs: cimetidine (Tagamet), ranitidine (Zantac) and famotidine
(Pepcid)
Anticoagulants: Coumadin and Heparin
Agents for gout: Allopurinol (Loporin, Zyloprim)
Antiarthritics: penicillamine, auranofin (Ridaura), indomethacin
(Indocin), naproxen (Naprosyn), sulindac (Clinoril), and methotrexate
(Folex)
Drugs derived from vitamin-A: isotretinoin (Accutane) and etretinate
(Tegison)
Anticonvulsants for epilepsy: trimethadione (Tridione)
Antidepressants: tricyclics, amphetamines
How to Win in the Youth Game 129
Here beauty and youth are frequently on parallel paths, but recent
advances in corrective surgery have given us more of an edge in the
fight to improve not only our appearance, but our sight as well.
LASIK
You've heard about it, seen it advertised, but I bet you didn't know it
stands for: Laser Assisted In Situ Keratomieuses (now you can forget
it). This is a relatively new type of laser surgery for correcting
nearsightedness and astigmatism. LASIK, sometimes referred to as
"flip and zap,” works by making a small flip in the cornea and removing
some of the tissue under the opening. Because of the preciseness of the
laser beam, the offending tissue can be removed without damaging the
surrounding structures.
The benefits are manifold. The procedure takes 10-15 minutes per eye,
it is performed in the surgeon's office or same-day outpatient center and
requires no hospital stay. Pain is minimal and aftercare is
straightforward.
130 Aesthetic Science Institute: The War Against Aging
Home Care:
1. You may need an eye patch or bandage for a few days after the
operation.
2. Sometimes vision is blurry for several days, so work and driving are
a no-no for awhile.
3. Eye drops may be prescribed to decrease inflammation or chance of
infection for a time.
4. Vigorous exercise, eye makeup and water activities are put on the
shelf for a bit and that even includes showers. So come clean!
The Downside
As with all technical advances once the new kid on the block flexes his
muscles, proves superior again and again and he soon takes over.
LASIK is quickly replacing PRK and RK as the procedure of choice
particularly as its use increases and the risk of complications continues
to decline. But they do exist and should be considered.
How to Win in the Youth Game 131
Then we must mention the heavy hitters which are exceedingly rare: 1.
infection (keratitis)
2. development of glaucoma secondary to increased intraocular
pressure
3. Dare I say it - blindness, but the odds are beyond winning the
lottery range.
Remember this is cosmetic, but after you know the facts and are
satisfied with your choice of surgeon, go for it! You can still wear great
glasses!
132 Aesthetic Science Institute: The War Against Aging
Before you throw your hands in the air or bemoan our fate, there is a
light at the end of the tunnel and it's not an oncoming train. The last
few years have seen some significant advances in the treatment of
hearing loss. The newer hearing aids are digitalized, smaller and
virtually unnoticeable, so wearing them causes less embarrassment.
New surgical techniques are enabling people to hear words and sounds
that were impossible to think of.
How to Win in the Youth Game 133
That's not all. Recent studies have revealed genetic mutations that
predispose people to this malady, preparing the way for experiments in
gene therapy. What can we do in the meantime?
The field of cosmetic dentistry has spread somewhat more slowly then
surgery, but there is hardly a city or town that doesn't have a cosmetic
dentist in it's phone book.
Cosmetic dentists can whiten teeth, replace missing teeth and repair
chipped teeth through any number of techniques including bleaching,
dental implants, porcelain binders, bonding, dental crowns and bridges.
How to Win in the Youth Game 135
Dental Implants - Artificial teeth are placed in the gums and bone
structure to replace missing teeth.
Bridges - Just like the name implies. 2 crowns and a dental implant are
used to fill the empty space. The crowns are placed on either side
connecting to the dental implant that replaces the missing tooth.
Appliances
Braces - This is the active phase whereby continuous pressure is applied
to achieve movement in specific directions. They consist of brackets or
plastic applied to the teeth with wire or a bonding agent. The pressure
is adjusted many times during the course of treatment to guide the teeth
to their new position. Braces can be stainless steel, plastic or ceramic
the latter two substances being chosen for cosmetic reason. Costs are
directly proportional to the type of braces and the length of treatment.
Breast Surgery –
Get it off (or on) your
chest!
Here's the truth - the female breast is a modified sweat gland and skin
appendage, but what a modification!
Where implants go
138 Aesthetic Science Institute: The War Against Aging
In our society, breasts are a yardstick (more or less) in the sexual and
sensual evaluation of a woman and in her own mind as well. The only
thing comparable in the male is the size of his penis.
In many respects you can consider the breast to be very much like a
weight suspended from an elastic band. For a while the strength and
elasticity are enough to hold the breast in its proper position, but after a
time the band stretches and both the shape and position will change.
For some I don't have to tell you what pregnancies, breastfeeding and
weight change have done to the image you see in the mirror. One of the
sadness of losing extra pounds is that thinner face and smaller hanging
breast show up long before a slim waistline or fashionable butt.
For most of the world's women, it is the inadequacy of the bust curve
that is the problem. I have made quite a reputation by ADDING to
what is in short supply. Consider that upwards of 300,000 women have
augmentation procedures on a yearly basis in the U.S. alone.
How to Win in the Youth Game 139
About 10 years ago there was uproar about the safety of silicone
implants and their possible linkage to auto immune disease like Lupus,
Fibromyalgia, and other collagen problems. The original giant in the
implant industry, Dow Corning, went into chapter 14 bankruptcy and
set aside several billions to settle its caseload. Since I was a designer of
a popular implant, I did not escape unscathed.
After years of bantering and controversy, there has not been a proven
case of the direct relationship between the implant and the onset of
autoimmune disease. However, the myth of forever has been shattered.
The implants have to be monitored to check their integrity.
Manufacturers have taken care to strengthen the silicone sac to prevent
early disruption. The majority in use today are saline filled implants
which provide an easy way to replace the problem- much like changing
a flat tire.
How about the other side of the coin? Reduction mammoplasty and
mastopexy have been refined (they still are two of my favorites). No
140 Aesthetic Science Institute: The War Against Aging
longer a hospital procedure, the scars are shorter as well as the time of
the operation For most post operative complications are markedly
reduced and awareness of the population has increased, thanks to Dolly
Parton and Oprah among others.
Let me set aside one fear -- any of the procedures has not been shown
to increase the incidence of cancer. On the contrary, in my experience
with over 5,000 augmentations, I think the insertion of an implant may
actually decrease the incidence. Could this be due to the continual
activation of the immune system by a foreign body? And as long as
we're on the subject of cancer, it was almost 40 years ago that I
championed an alternative to radical mastectomy at a meeting of the
American College of Surgeons - a Subcutaneous Mastectomy. It has
fallen by the wayside, but the road to smaller and smaller excisions for
malignancy with better and better immediate reconstruction techniques
has given women hope instead of mutilating despair. It strikes me as
funny because
at that talk I suggested that if cancer of the penis were as common as
breast cancer within 45 seconds the male surgical establishment would
have discovered an alternate method of treatment. It only took us about
100 years!
Just a word to the men: Don't think you're the forgotten sex. Some
plastic surgeons are the advocates of chest augmentation for men. It's a
little tricky, but for those who've had it, most feel good about their new
image, the result of any insert under the pectoral muscle.
Most of
the
patients
have
Do I Always Have to
Diet?
Fat, Fat - Make it Go
Away
When this author first wrote about body contouring in the 70's, little did
he realize that we were on the brink of an explosion called liposuction –
or did he?
Since it's relatively new to some, we'll deal with the basics. It's
invariably an outpatient procedure done under the gamut of anesthetic
techniques ranging from local to general anesthesia. The most common
technique involves making small incisions, and inserting small tubes
through which a solution containing xylocaine (a local anesthetic) and
saline is introduced into the areas to be treated. This serves to numb the
area and decreases bleeding during and after the operation. Following a
brief wait, a vacuum suction tube is inserted into the incisions and by
carefully measured strokes, removes the offending tissue. Afterwards a
girdle or stocking is applied, which remains for several weeks until the
tissues conform to the new planes. Aside from stopping strenuous
exercise for 2-4 weeks, return to normal activities takes a matter of
days.
We now have:
1) Microliposuction- for those people who want to look good in
miniskirts and cropped shirts.
All well and good, but you can't get to Carnegie Hall if you haven't
practiced, practiced, practiced. The same goes for the surgeon you
choose!
144 Aesthetic Science Institute: The War Against Aging
A few raindrops to consider: If you're over 35, you may need some
skin removed because your elasticity may be compromised.
Therefore, for some patients, liposuction is not the answer and there
will always be tummy tucks, buttock and body lifts to improve body
curves. A few new doors are opening. It may be possible to harvest
stem cells from the suctioned material. These primordial cells have
shown the ability to differentiate into different types of tissue such as
fat, nerve, cartilage and muscle in the laboratory under proper
conditions. Will it be possible to suspend the cellular aging process in
this way? We're only beginning on this part of the journey, but this
may be a fast track in the future.
Before liposuction
No visible scars
A Little of Both
Medlineplus.gov
What is cellulite?
The dictionary says it is lumpy fat found in the thighs and buttocks of
some women. The fat is believed to be trapped in pockets beneath the
skin. Fat cells on the lower part of the body store fat six times more
readily than those on the upper body. They also release fat six times
less readily. This makes weight loss from the lower body almost
impossible without looking emaciated from the waist up. It is not
something which plagues the obese or slightly portly. Anybody, the
skinny kid or the muscle woman at the gym, can fall prey.
OK, we know where it is, but what causes cellulite and how do we
get rid of it?
There is no definite cure yet, because there are any number of factors
causing it. Diet and exercise go a long way in helping to prevent it, but
if you've chosen the wrong parents, too bad.
Let's start with things that I think don't work or at least recommend that
you show me otherwise.
Body Wraps
You might as well wrap your brains if you fall for this line of baloney.
Sweat it out and, as soon as you drink a glass or two, it's back.
Cellulite Pills
Don't you think if any of them worked, the producers would be
zillionaires? If they contain stimulants like ephedra or ma huang, you
may lose weight all over, but remember you have to lose a lot before
you see a little down there!
This machine was invented in France in the early 80's and after 15 years
of use, it found its way into the USA to be approved by the FDA as a
Class I device. At the time, it was the only machine to temporarily rid
the body of the appearance of cellulite and improve skin texture and
irregularities. How does it work? It is a combination vacuum device
and massage machine that lifts the skin, theoretically stretching the
septa while massaging the tissue to “free the fat cells” from their fibrous
connection. The resulting improvement has been reported to be due to
increased circulation or increased collagen growth that strengthens the
connective tissue to prevent the fat globules from pressing through the
honeycomb, thereby hiding the dimpling.
The bottom line is, if there is any way to improve the appearance of
cellulite, there must be a physical interference or contact with the fat in
question. So what's left?
External Ultrasound
This may work, albeit not in larger amounts yet. The sound waves can
cause the outer wall of the fat cells to burst. The body then removes the
debris through its regular waste removal system. No big trials yet, but
promising. Remember, Ultrashape is being tested (warning, warning).
Mesotherapy
You have to hand it to the French even if you don't agree with their
politics. In 1958 Dr. Michel Pastor devised a technique to treat
everything but the kitchen sink – rheumatism, infectious diseases,
circulatory disturbances and, yes, even cellulite! Mesotherapy involves
injecting small amounts of homeopathic medicines immediately under
150 Aesthetic Science Institute: The War Against Aging
the skin surface, which somehow breaks down the cellulite and
improves circulation. Each treatment takes about 10 minutes and is
tolerable without much pain being reported. Micro-injections are given
two times a week over a 4-to-8-week period, giving measurable results.
At the present moment, the recommended maintenance is on a yearly
basis over a 4-to-6-week period.
Lipostabil not only can treat cellulite, but it can destroy lipomas (fatty
tumors) as well. Side effects are minimal, limited to bruising, and
lipostabil is part of the treatment techniques of thousands of European
and South American physicians. What else is it good for? Minor and
medium sculpting of specific areas of the body like - stomach (want a
perfect six-pack surgery?), upper arms, chin, hips and thighs.
fit into a size 10 (originally size 16). Maybe we'll be able to join the
chorus! One way or another, the audience is hoping that this is a hit.
If you fall into these categories, you are at especially high risk for
obesity-related problems, such as diabetes, high blood pressure and
heart disease. If you have a BMI of 40, your risk of premature death
by any cause will increase by 50% to 150%.
Before the use of the endoscope, operations to decrease the size of the
stomach and intestines were uncommon, but the last ten years has seen
the development of more and more "Bariatric Surgery Centers,” proudly
heralded in newspapers, magazines, TV sports and the Internet.
Bariatics is the name for that branch of medicine that deals with the
prevention, treatment and control of diseases related to obesity. For
most of those people getting there it means surgical intervention sooner
or later.
1) Be 75 pounds overweight
2) Have failed nutritional and medically supervised diets
3) Be willing to make certain necessary changes in eating habits
4) Be between the ages of 18 and 60
5) Have not had previous weight loss surgery
6) Your BMI is over 40 or between 35-39 with life-threatening
conditions (hypertension, etc.) 7) Have no history of alcohol abuse
8) Be willing to go through psychological and medial evaluations to
evaluate all possible causes of obesity other than intake
Roux-en Y
This was the most widely used and successful operation until recently.
By a variety of techniques (stapling, banding and sutures) the size of the
stomach is turned into a small pouch to limit the amount of food needed
to give a feeling of fullness. Next, a Y-shaped section of the small
intestine is attached to the pouch to bypass a significant portion of the
upper parts. This procedure reduces absorption of calories and
nutrients.
attaching the pouch to the lower jejunum with one less attachment - it is
the Mini-Gastric Bypass.
One way to do it
Notice that the stomach and part of
the upper small intestine have been
avoided by entering lower down the
tube. The stomach is also smaller.
The object of man's desire, the ultimate goal of youth, is the victim of
use for childbirth and is, under the best of conditions, not exempt from
aging. In addition to laxity and loss of muscle tone, many women area
displeased with the external appearance of their genitalia. So what's a
woman to do? The answer is plenty.
First let's talk about the outside: the labia majora and menora. That's
right men, women do look at Playboy models, too, and don't want to
look ugly down there. Some women complain about the unevenness of
elongated lips and, occasionally, large labia can be pulled inside during
intercourse (ouch!). Chafing can be a problem as well during everyday
activities. Here a plastic surgeon or gynecologist can come to the
recourse, using either simple surgical or laser techniques. Only local
anesthesia is necessary and, within a couple of weeks, you're ready to
face the world or that special someone.
Incontinence
There are a growing number of patients who have involuntary loss of
urine with sneezing, coughing, laughing, exercising or sex. This is due
to vaginal relaxation as the tone, strength and muscle control
diminishes. The sensual sexual gratification is lost and women have
been the butt of male jokes on more than one occasion due to the
enlargement of their cavity.
www.gyneflex.com
The joke and asides still exist and although less drastic nowadays, don't
tell that to a man who has lost his ability to perform.
Let's talk about the problems on an anatomical and physiological level.
It's called "erectile dysfunction" or ED for those in the business.
but, how about the rest of us when the magic pills, hormones, or direct
shots fail?
Before 1960, treatment of any kind was rare. People with ED were sent
to the psychiatrist couch with little else to offer not now. Let's talk
about the surgical approaches that are available.
One week later, the scene is repeated. Our little guy, very pale and
soaked in perspiration, approaches the not-so-gentle giant and remarks,
“It's not any longer, but already it’s turning black!"
Funny, you say? Not for some. How about a current contraption on the
market called the Hangman? It features 10 to 22 ounce weights and the
designer claims that by hanging it from the penis for a few hours a day
you can gain as much as one-and-a-half inches within a year. I'll bet!
160 Aesthetic Science Institute: The War Against Aging
Devices to avoid
There are some operations that make a little more sense, if the concept
makes any sense at all. There is a procedure that cuts some ligaments
that attach the member to the pubic bone. The organ will be almost two
inches longer when not in use (maybe the boys in the gym won't stare?)
but, when called to attention, the increase is virtually negligible. If
girth is a problem, dermal fat grafts or fat injections may make it
thicker, but not longer or stronger.
The fact is that most men had much bigger expectations and are visibly
disappointed. Complaints range from pain to ugly penises, scars and
impotency.
you still suffer from penis envy, make a move toward the therapist's
couch. You may find out that the power of the wand is not measured in
inches!
Vein? –
What's the Best Course?
If you walk around the streets, particularly during the hot spring or
summer days, you shouldn't be surprised to know that millions of men
and women have varicose vein disorders. According to a national data
bank survey by the American Society of Aesthetic Plastic Surgery,
sclerotherapy (injections) is the sixth most commonly performed non-
surgical procedure in the US, comprising over 500,000 treatments
yearly.
Increased age plays a role because, over time, the elastic lamina and the
smooth muscle layers degenerate as well.
Varicose veins
Treatment
So, what do we do about veins big or small, whether they are on the
face, body or leg? The treatment is either medical or surgical,
depending on severity or location.
The standard for treatment of spider or reticular veins is sclerotherapy.
This involves the careful injection of solution that irritates the venous
walls, causing them to collapse and disappear. Compression by
bandaging is appropriate when indicated. Alternatively, some of the
newer lasers are effective as well.
With the public’s and physicians’ fascination for lasers, could the light
at the end of the tunnel by anything but?
path to the vein's origin. As the magical wand is slowly removed, the
vein is zapped by turning on the power (laser or thermal). Imagine – an
outpatient procedure, no real downtime and results that are permanent.
Before After
Patient Satisfaction
Symptom Pretreatment After After
6 weeks 2 years
Leg Pain 85% 6% 5%
Leg Fatigue 85% 12% 5%
Edema
(swelling) 19% 8% 0%
Father Time is a severe adversary and since the average person will
walk the equivalent of four times around the world in the course of a
lifetime, is it any wonder that feet bear the brunt of the burden for many
of us?
Most of the problems that befall us don’t necessarily wait until we reach
the later decades. Flat feet, athlete’s feet and fungal infections surely
can put a crimp in anyone’s step.
Let’s talk about aging feet first. Corns, calluses and bunions can show
up anytime, thanks to the torturers we laughingly call shoemakers. For
some reason, designs seem to be far more important than comfort and
function. The ladies know what I’m talking about. Add to this fact that
the fat pads that cushion the foot frequently diminish over time, that
arthritis and arteriosclerosis increase with the years and it’s easy to see
why your tootsies are sore.
For those of you with specific cosmetic problems, never fear! Surgical
intervention is an ever-increasing reality. Some of you may be upset
because your second toe is longer than the big toe – it’s called Morton’s
Toe. A pretty easy procedure, if you’re so inclined, removes a small
portion of the bone from one of two joints to bring it down to its proper
size.
Toes too short? Like penises, toes can get a little visible length with a
silicone strut. After a two-day bed stay and a month of care, you can
proudly parade your perfect digits for all the world to see.
The bottom line: if your feet are giving you trouble, hike down to the
foot specialist. Relief may be just a spray or a shoe change away. If
not, you’ve landed in the right chair anyway!
www.asimd.com
Chapter 14
Get Set and Ready to Go
From I to I to I...
In my younger days, I used to joke with some of my
friends and patients and say, “I’m the best left lower
eyelid and right upper eyelid surgeon in the world.”
Although that really was not the extent of my expertise,
perhaps in my mind that was a portent of things to
come.
Questions to ask…
What is the extent of your training and experience in your
field?
Are you board-certified in an accredited specialty?
Can I see some of your results?
Are you published?
Is your facility accredited to handle the procedure and any
unforeseen problems, should they arise?
How to Win in the Youth Game 171
The mirror is a good place, a real evaluation of what you don’t like and
a realistic expectation of what you can expect. Separate fact from
fiction.
Don’t be blinded by the metaphors and come-ons from so many
directions. Recognize that whatever path you take, sometimes you can’t
do it alone. Do your homework and be careful in your choice of
traveling assistants and aides, whether it be exercise or your diet.
Suggested Reading
Cosmetic Surgery for Dummies by R. Merrell Olesen, Olesen Marie. B.
V.
Change Your Looks, Change Your Life: Quick Fixes and Cosmetic
Surgery Solutions for Looking Younger, Feeling Healthier, and Living
Better by Michelle Copeland
You Don't Need Plastic Surgery: The Doctor's Guide to Youthful Looks
with No Surgery, No Pain, No Downtime by Everett M. Lautin, Suzanne
M. Levine, Kathryn Lance
Your Best Face: Looking Your Best without Plastic Surgery by Brandith
Irwin, Mark McPherson
www.asimd.com
Chapter 15
Appendix
This book is updated by visiting the web pages of ASI (asimd.com).
Medlineplus.gov A web site paid for by the U.S. government and the
National Institutes of Health, providing “trusted health information for
you.”
Old is dead.
Young is what you can be.