If you are willing to part with a good amount of your hard earned cash to buy unusual vitamins in skin creams that promise to erase fine lines and prevent skin aging, you are probably willing to purchase some shares in the Brooklyn Bridge as well. Truth is, those exotic items will do little more than smooth out your wallet, so says many dermatologists.

Though there are many creams on the market which contain vitamins known as antioxidants, very few are effective in preventing or reversing skin damage. Antioxidants are known to prevent agents called free radicals from damaging cells in the body and on the skin. Free radicals are the result of normal body function but they may also be created by other means. Exposure to ultraviolet radiation, smoking and other environmental hazards can also cause the problem radicals.

In a presentation to the American Academy of Dermatology’s annual meeting by Karen E Burke M.D. (New York City Dermatologist), she explained that almost all topical formulations contained very low concentrations of antioxidants that were poorly absorbed at best. Only three antioxidants have been proven to be of benefit, Dr. Burke explained, when applied (via creams or lotions) to the skin. Those are Vitamins C, E and the mineral selenium.

Another problem with skin preparations is that the active ingredients usually have very short term effects. There are some products soon to be released that may deliver better concentrations to the skin and increase their absorbability, but they haven’t been released yet and the probability is the exotics will not be numbered among them.

Recent animal studies found that when selenium is taken orally (or absorbed through the skin), it provided protection against both everyday and excessive UV damage. Another study showed that selenium also delayed the development of skin cancer in the animals. it must be pointed out, however, that though the results are promising, studies in human subjects must still be done and evaluated.

It has also been suggested that supplementation with 400 international units of vitamin E daily will help reduce photodamage, wrinkles and improve skin texture. It is also noteworthy to report that a skin cream carrying vitamin C is a difficult proposition since it reacts (the C) immediately when exposed to Oxygen and begins to deteriorate. Stable products are under development but none are truly available at this time.

Based on this information, ladies, it is recommended that you keep your hard earned money in your wallet and don’t blow it on products to leave your wrinkles in place while moving the contents of your wallet from you to them.

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In traditional liposuction, a powerful vacuum force literally tears excess fat from beneath the skin and suctions it out of the body through a hollow tube called a cannula. In UAL, a special cannula carries high-frequency sound waves into the body to burst the fat cells and turn them into a liquefied creamy solution that can be suctioned out more easily and with less bleeding. The result, in the hands of specially trained surgeons, can be a smoother, more sculpted body contour.

UAL usually is used in combination with traditional liposuction. Traditional liposuction alone may also achieve very satisfactory results when used appropriately by an experienced doctor. But UAL is entering the mainstream of cosmetic surgery as an important adjunct tool for several reasons:

• It causes less trauma to the patient’s body. Traditional liposuction employs a high-powered vacuum to separate the fatty tissue from its place in the body. Much less power is needed to suction away the emulsified fat resulting from ultrasound treatment. Generally speaking, you can expect to experience less bleeding and therefore less visible bruising afterward.
• UAL allows your doctor to have more sensitive control of the contouring process. A doctor who includes UAL among the tools available may be able to be more precise in contouring your body. Many doctors report a feeling of more aesthetic control in those cases.
• UAL frees the surgeon from the arduous physical workout required by traditional liposuction when contouring body areas where large volumes of fat are to be removed. Sometimes these operations require hours of high-energy activity by the doctor. UAL-dissolved fat cells are not only easier to vacuum from the body, but also in many cases can be removed with more precision. Without as much need to vigorously thrust the traditional cannula into the fatty layer, the doctor potentially is able to devote more attention to the aesthetic aspects of the procedure, becoming more of a body sculptor.
• UAL is very helpful in both men and women when treating firm, fibrous areas such as the upper back. Men have particularly fibrous tissue in the chest and the “spare tire” area. When men gain weight, their breasts often become fatty. This very fibrous area is easier to treat with ultrasound-assisted liposuction.
• UAL’s ability to smooth out the fatty tissue makes it a helpful tool in revising previous liposuction procedures. Contour irregularities caused by previous liposuction may include areas of significant scar tissue which are more easily addressed with UAL.

Liposuction, whether utilizing UAL or not, may be performed in a surgeon’s office-based facility, in an outpatient surgery center, or in a hospital. If a large volume of fat is to be removed, or if an invasive procedure (such as tummy tuck or face lift) is being performed in combination with it, the doctor likely will require you to be in the hospital.

Ultrasound-assisted liposuction has been performed on many thousands of patients. Ultrasonic energy has been used for medical purposes for many years. Common uses of ultrasonic energy include prenatal fetal monitoring, removing cataracts, and cleaning teeth! All forms of modern liposuction normally are safe if you are in good physical and psychological health, the operating facility is properly equipped, and the doctor is trained and experienced. The same is true of UAL when the physician has completed an appropriate, hands-on training course.

UAL is a powerful tool. If your surgeon expects to use UAL as part of your body contouring plan, it is imperative that he or she has a high level of experience in its use. You should feel free to ask how many such procedures the doctor has performed, and to see before-and-after pictures of former patients.

While UAL is a useful tool to use in conjunction with traditional liposuction, your doctor may recommend other procedures to help meet your body contouring goals. For example, you may find that a tummy tuck (abdominoplasty) is appropriate either instead of or in conjunction with liposuction.

You should discuss the risks of liposuction, and specifically UAL, with your doctor. All such procedures carry the potential cosmetic complications of irregularities of the skin�s surface, areas of uneven pigmentation, and asymmetry. There are some relatively minor risks specifically involving ultrasound-assisted liposuction, including:

• UAL cannulas currently are greater in diameter and require a slightly longer incision. The incision is placed in a less-visible location when possible, requires a single stitch to close, and leaves a small scar. The size of the UAL cannula limits where it can be used. Smaller fatty areas such as the ankles and neck are better treated with traditional liposuction. Smaller UAL cannulas are expected to be introduced in the near future.
• UAL causes a slightly higher rate of temporary collections of fluid beneath the skin (seromas). These little pillows dissipate quickly or can be drawn off with a syringe at an office visit.
• There is a small risk of minor burns to the skin caused by the heat from the ultrasound device. This complication is extremely rare in the hands of an experienced UAL surgeon.

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The most common birthmark found on babies is the hemangioma or strawberry. These are non-cancerous tumors composed of numerous blood vessels. Hemangiomas appear in the first few weeks of life on about 1 out of every 10 infants. Girls are more commonly affected than boys.
The hemangioma tumor may start as a pinpoint-sized red dot. Within a few months, the hemangioma usually reaches its full size, which can be anywhere from one to several inches in diameter. Once it has fully developed (typically 10 to 12 months after birth), the tumor begins a prolonged period of shrinking.

In more than 50 percent of children with a hemangioma, the tumor has completely disappeared by the age of five. Seventy percent of children see their tumor clear up by their seventh birthday. If a child is not free of the hemangioma by the age of 10, it is unlikely that the birthmark will go away on its own.
Port-wine stains are also vascular birthmarks but are only seen in about three to five children out of every 1,000 born in North America. These birthmarks differ significantly from hemangiomas. They start as a thin mat of abnormally large capillaries clustered together in the upper part of the dermis just beneath the surface of the skin. Although pale, they are usually evident at birth, and are most often located on the face or neck.

As the child grows, the port-wine stain grows proportionately and deepens in color. It may also suddenly expand because of changes in the circulatory system or hormonal fluctuations such as those that occur during puberty.

Over the years, port-wine stains continue to darken and thicken. At the end of childhood, the birthmark is typically bright red. In early adulthood, it may appear deep claret. By middle age, it is usually deep purple, and may have developed a thickened, pebbly texture. These birthmarks often distort facial features and can interfere with the way the lips, nose, or eyes function.

Unlike port-wine stains and strawberries, which are vascular in nature, brown birthmarks (often called caf-au-lait spots) are the result of pigment abnormalities, the cause of which is unknown. Up to 10 percent of all babies born will have these tan-colored birthmarks.

Melanocytes, the specialized cells that produce the skin pigment melanin, are located in the lowest (basal) layer of the epidermis (the upper layer of the skin). Melanocytes produce melanin inside microscopic packages called melanosomes. As melanocytes migrate to the surface of the epidermis, they transfer the melanin-laden melanosomes to other skin cells and to the hair follicles. This is what gives people their individual skin and hair color. Caf-au-lait birthmarks are composed of abnormal, often unusually large, melanosomes. These birthmarks range in size from less than one inch to about eight inches in diameter.

Lasers affect birthmarks by emitting an intense colored light that is absorbed by the targeted cells. Since vascular and pigmented birthmarks are different colors, they are treated with different colored laser light.

Before the introduction of the argon laser in the early 1970s, physicians had little success in treating vascular birthmarks without leaving disfiguring scars or causing serious side effects. Unfortunately, the argon laser also had the potential to leave scars, particularly when used to treat children. In the mid-1980s, the flashlamp-pumped pulsed dye laser became commercially available. It was developed specifically to treat children’s port-wine stains.

The pulsed dye laser is tuned to penetrate just far enough into the skin to reach the deeper components of vascular birthmarks. The laser beam is flashed on and off electronically. This enables it to deliver the maximum energy needed to instantly incinerate red blood cells and then shut off before surrounding normal tissue is affected. Both port-wine stains and hemangiomas can be safely and effectively treated with the pulsed dye laser.

Caf-au-lait birthmarks are treated with a number of lasers that have been specifically designed to selectively destroy melanin-containing cells. The safest and most effective of these lasers employ a rapid-fire shuttering system, called Q-switching, that flashes the laser beam on and off in nanosecond bursts. Like a pulsed dye laser, Q-switching ensures that adjacent tissue is not burned by the laser’s heat. The ruby laser, the alexandrite laser, and the Nd:YAG laser are the three most common Q-switched lasers used to treat pigmented birthmarks.

Birthmarks can be treated with the laser at any point in life. However, most physicians agree that the sooner a child has a disfiguring birthmark removed, the better it is for both the child and parent.

Removing a red or brown birthmark usually requires multiple treatments. Laser treatment is not particularly painful, and there is no recuperation needed after treatment. Most patients describe the procedure as feeling as if someone is snapping a rubber band rapidly against their skin. As you can imagine, most children do not willingly tolerate the procedure. This is difficult for most parents. However, if treated at a young age, children will not remember the procedure. More importantly, they will never have to deal with their birthmark, be self-conscious about their appearance, or feel alienated by their peers.

In summary, if you have a vascular or pigmented birthmark and would like it removed, you should consult an experienced laser surgeon. Find out his or her success rate for removing or improving birthmarks similar to yours. If your child has a vascular birthmark, it is essential that he or she be examined by a physician as soon as possible. Certain vascular birthmarks are associated with underlying abnormalities of the brain and eye.

With today’s advanced laser treatment of birthmarks, there is no reason for anyone to spend a lifetime dealing with the discomfort and embarrassment so often caused by a disfiguring birthmark. As with any surgical procedure, there are risks of complications and total removal of the birthmark cannot be guaranteed. However, in almost all cases, patients report a high level of satisfaction with laser treatment of birthmarks.

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We are, fortunately or not, the products of our forebears. We inherit their genes for better or worse. We do not get to select the genes for tall, slender, muscular, high metabolism, no weight gain, and so on. Therefore, many of you may have curves in the wrong places. And no amount of dieting and exercise seems to really correct the problems. The reason for this is that you are born with a fixed number of fat cells that are distributed in your own unique pattern. When you gain weight, individual fat cells increase in size, and when you lose weight, cells shrink. Since “spot weight reduction” does not exist - and therefore you cannot lose weight in just the right spots and not in other areas - liposuction is the only way to accomplish this.

Through liposuction those unfortunate areas that remain protuberant regardless of what you do can be eliminated and shaped to just the right contour. And this shape change is permanent! The fat cells that have been removed cannot grow back. But you still can gain weight. Only it will go to some area other than what was liposuctioned. And this may not be an area you wish to be fat - like your ankles, arms or face. So please do consider the benefits of liposuction. But do not forget to show good sense and restraint in your eating habits and continue to exercise regularly.

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Here are the major benefits of liposuction alone, as compared with the standard, open procedure:

• Less scarring. The 12-inch incisions from standard breast-reduction surgery discourage many people who otherwise might seek help for undesirably large breasts. Liposuction requires a single, half-inch incision in the crease under each breast.
• Faster recovery. Less postoperative pain and bruising makes recovery easier.
• No changes in nipple sensation.
• No breast-feeding problems later.
• No chance that there will be difficulty in reading future mammograms.
• Simpler method of correcting previous reduction surgery that has resulted in breasts of different sizes.

This liposuction-only breast reduction procedure is not appropriate for women whose breasts have:

• Less than 35 percent fatty tissue as indicated by a screening mammogram.
• Thin skin and stretch marks (called striae).
• Significant breast drooping, also called ptosis.

On average, at least half the breast is made up of fatty tissue. The rest is glandular tissue. Reduction is achieved by removing the fatty tissue via liposuction. The ratio of fatty tissue to glandular tissue in your breast determines how much reduction can be accomplished. In my opinion, all patients should have a screening mammogram before breast liposuction for an exact determination of the volume of fat. Just feeling the breast (called palpation) is a poor substitute for a mammogram. It is not advisable to perform liposuction for breast reduction if your breast is primarily glandular tissue, with little fat in it, because the ratio of fat-to-gland tissue limits the degree of reduction possible. This situation, however, is unusual and probably limited to less than 1 percent of patients.

When a doctor offers liposuction-only breast reduction surgery, you should make sure he or she has experience and success with the procedure. The operation is technically and aesthetically demanding and requires considerable training for the doctor to become comfortable with this approach.
The remarkable elasticity of the skin and its impressive ability to shrink toward the center of the breast, moves the nipple upward. This, along with the removal of the weight of the fat, makes liposuction-only reduction the preferred choice for most people. We first thought that women beyond their 30s would not have sufficiently elastic skin to produce a good result with liposuction of the breast. However, our results from performing liposuction on men of various ages with enlarged breasts (gynecomastia) showed that the skin shrinks well, the skin contracted nicely and conformed to the new shape. Equally important, the shrinking process repositions the nipple and its surrounding areola upward toward the center of the breast by as much as two and one-half inches. In fact, the areola itself, which has grown larger as the breast gets more pendulous, shrinks back toward a normal size.

If your enlarged breasts have extreme ptosis, conventional surgery may be required. Another option may be to undergo liposuction and to determine later if a conventional reduction is also necessary. Yet another option is to undergo liposuction in conjunction with conventional treatment. A reduction of breast volume with initial liposuction allows the use of smaller-than-usual incisions in the standard surgery that might follow.

Older Women

Because of these observations about elasticity and centripetal shrinking, we began offering liposuction-only breast reduction to older women, 60 years old and above. Older women, even in their 60s and, at times, even older, tend to be more realistic about their expectations of breast reduction surgery. If you are older, you likely will not expect to return to your teenage anatomy and can tolerate some degree of ptosis, or drooping. Older women are more focused on decreasing their breast volume than with the exact position of their areola-nipple complex, and are satisfied if this can be done with a much less invasive operation and a much shorter recovery.

Older patients tell us that they like the results of the procedure. They look thinner and feel much less matronly just from the reduction in breast volume. The liposuction-only approach also helps many patients with enlargement particularly on the side toward the armpit, called the lateral side. This condition causes their breasts to seem to float out of their bras, making the patient look very squarish. Sometimes this is one of the main reasons these patients seek surgical help. Because correctly performed breast liposuction always should be performed more aggressively on the lateral breast than the opposite or medial side, the floating breast problem often disappears with the procedure.

After liposuction-only reduction surgery, women in the older age group wear a supportive bra for three months, and the younger women wear one for one month. (A new baseline mammogram, at least six months after surgery, is also recommended.)

Potential Complications

We have not seen any complications from the liposuction-only procedure, although theoretically complications would be the same as for any type of liposuction. Infection is extremely rare. Problems of symmetry are possible. A temporary decrease in the breast’s sensitivity to stimulation is a possible side effect, as is the appearance of small bruise spots (ecchymosis).

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Here is the sequence of approaches that has led to this development.

Traditional Liposuction

Traditional liposuction (called suction-assisted lipoplasty, or SAL) has been popular for the past 15 years in helping patients achieve a more attractive body contour. SAL, however, is not as effective as desired in small liposuction areas as well as areas that are more fibrous, such as the back and buttocks. Neither is it optimal in revision cases, where previous liposuction has been performed. The powerful vacuum required by SAL makes the removal of fat somewhat unpredictable.

Ultrasound-assisted Liposuction (UAL)

In only the past five years, a newer technique called ultrasound-assisted liposuction (UAL) has helped overcome some of the problems of SAL. With this way of removing fat, high-frequency sound waves are transmitted through the suction wand (called a cannula). UAL melts the fat located extremely close to the cannula, allowing the tissue to be suctioned out of the body more gently. The surgeon becomes more of a sculptor, able to shape the body with this �airbrush� and achieve a more predictable and more uniform result.

More than a third of plastic surgeons use UAL as part of their everyday practice. It is a much more sophisticated operation than SAL and requires the purchase of some expensive equipment, so not all offer it. Once they learn the technique and have the experience of truly sculpting the human body, very few go back to using only traditional liposuction.

Circumferential Liposuction

Even with UAL, however, a woman sometimes winds up with a straighter, male-like silhouette. That’s because fat deposits are removed mainly from specific problem areas of the body. Bulges of fat may be gone, but a shapely figure does not necessarily result.

Only a couple of years ago we developed a new technique called circumferential liposuction that builds on previous technology to produce a highly attractive result. In the past, liposuction surgeons almost always avoided suctioning fat from certain locations, such as the front and inner thigh, buttock, and back areas. They were reluctant to operate on these areas where the fat layer might be thinner and harder to suction. They believed it was not as safe to operate there and feared cosmetic complications such as irregular contouring would result.

The introduction of UAL enables the surgeon to work almost effortlessly in the middle fat layer of these areas. The middle fat layer is where most liposuction should be performed. It really is a surgical layer, not so deep that other body tissues are threatened and not so shallow that cosmetic irregularities will show up. It is a safe zone for liposuction. A couple of years ago we discovered that surgeons could safely use UAL all the way around the thighs, hips, abdomen, flanks and calfs, in fact, around almost every part of the body into which a cannula could be inserted. No one previously had advocated this circumferential approach; in routine liposuction I feel that this technique is essential in order to obtain uniform, excellent results for body contouring. UAL makes it not only feasible and safe, but also allows for improved results in experienced hands. A major key is for the surgeon to be trained to recognize what layer of fat is being operated on and to recognize the appropriate point to quit operating in that area.

The combination of UAL and SAL with the circumferential technique has resulted in what we call finesse liposculpture. This technique now has totally changed how we perform body contouring surgery. We are now in the process of training large numbers of doctors in this new way of looking at body silhouette surgery.

Body Contouring Cycle

Liposuction of any kind is not a treatment for obesity or weight loss. Liposuction truly is a body-sculpting procedure. It produces or re-creates an improved body silhouette. You should not fall for the myth or marketing promises that it will take pounds off your weight. Of course the fat you lose with liposuction has a certain amount of weight, but it will not stay off without your sticking to all aspects of the body contouring cycle.

The cycle includes:

• Diet and exercise. You can defeat your new body silhouette if you don’t adopt a healthy diet and a prudent exercise plan.
• Lifestyle changes. Eliminate tobacco, drink plenty of water, keep your skin moisturized, and get plenty of sleep.
• Liposuction and other body contouring procedures. This may include tummy tucks and other operations.

Safety Issues

Liposuction performed correctly in a healthy, normal patient carries no excessive risk. The key is to choose your surgeon wisely. Make sure he or she is board-certified and operates in an accredited hospital (or in an accredited outpatient surgical facility with operating privileges at a nearby hospital). An anesthesiologist or certified registered nurse anesthetist should be in attendance.

People often seem to take safety for granted. But with the proliferation of doctors advertising themselves as liposuction specialists, you must ask those questions directly. Any hesitancy on the part of the doctor to address these concerns should be a red flag for you.

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Many women express concerns about growing older. It takes a remarkable person, male or female, who is not affected by our society’s expectations of what is most desirable - appearing eternally young, thin, sexy, and beautiful.

If you are contemplating aesthetic plastic surgery, it’s imperative to consider the following questions:

1. How do you feel about yourself as a person?

This question relates to self-esteem, which is very important to look at prior to surgery because it will influence your feelings about the outcome. When contemplating this question, it’s important to determine whether you are looking at yourself from the inside or from the outside. If you’re coming from a place of discontent with yourself, it’s important to address this issue in therapy prior to undergoing surgery.

2. Are you motivated by the fear of aging?

Do you see growing older as being positive or negative? Some people believe that you’re only as old as you feel. In fact, the research on mind-body medicine supports the idea that our thoughts and beliefs affect our physical bodies all the time. If we feel young at heart and do not expect to age rapidly, we probably will not. The opposite is also true.

3. What are your reasons for wanting to change the way you look?

If you feel good about yourself and want to feel even better, this is a healthy motivating factor for pursuing aesthetic surgery. On the other hand, if you’re electing to have aesthetic surgery following a significant life change or event (i.e. divorce, mid-life crisis, etc.), it’s highly possible that you may not feel good about yourself. Likewise, when you’re considering aesthetic surgery to satisfy your partner’s desires and not your own, it’s recommended that you receive some counseling to sort out these issues and put them in perspective so that you can make the best decision for yourself.

4. What are your expectations regarding aesthetic surgery? Are they realistic?

This is a crucial question to explore prior to making permanent changes to your physical body. Everyone has certain core beliefs about themselves. These beliefs can strongly influence how situations and events in their lives turn out. It’s important to keep in mind that aesthetic surgery can enhance your outward appearance, but it cannot change who you are inside, or make you someone you have not been in the past.

5. Are you totally resolved in your decision to proceed with the surgery?

It’s important to settle any ambivalence you may have regarding your decision. An essential fact to keep in mind is that nothing is perfect, and there are no quick fixes.

6. Are you willing to accept less-than perfect results?

Perfection is impossible, and the results of aesthetic surgery will not stop the aging process. However, healthy lifestyle habits may prolong the positive results. Nonetheless, you need to consider how you will cope with the outcome if the surgery does not exactly meet your expectations, or if there are complications.

7. Do you have a support system in place to help you through this process?

As with any life change, it’s important to have family and/or friends who are aware of what you are doing and will be there for you after the surgery.

8. How will you deal with emotional changes that may occur after aesthetic surgery?

This is a function of your expectations going into surgery and your beliefs about how it will affect your life. This is an issue that may be discussed with a counselor when contemplating this type of life change.

The decision to pursue aesthetic surgery can be a very exciting step in your life. However, it’s imperative to remember that — as with other important life decisions — motivating factors, beliefs, and expectations are crucial to consider. Look carefully at all the reasons why you are considering this procedure and how this procedure could change your life. Be sure to discuss these issues either with your plastic surgeon or a therapist. A healthy sense of one’s self prior to undergoing cosmetic changes is one of the best ways to ensure positive and successful results.

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1. Are you in satisfactory physical and mental health? And I do mean to emphasize mental!
2. For whom do you want to do this surgery?
3. What do you expect the surgery to accomplish?
4. Are you a perfectionist?

Question #1 reminds us that cosmetic plastic surgery is entirely elective. It is not necessary for health. Its goal is purely and simply one of enhancing the quality of life. Therefore, if you are in less than ideal health, the risks of surgery, even cosmetic plastic surgery, are not worth taking if the surgery places you at greater risk of a serious or life-threatening complication or problem. Mental health is equally important. Procedures that alter one’s appearance can be emotionally destabilizing for one who has a condition of mental illness.

Question #2 speaks to the fact that these surgical procedures are for the benefit of the patient, and only secondarily for someone else. You should never undergo aesthetic surgery because someone else wants you to change your appearance. It is your face and body. If you are happy with your appearance, you do not need to change it. In fact, you ultimately could regret making a change for someone other than yourself.

Question #3 asks you to scrutinize what you expect to gain by the surgery. Are you unhappy with your life and think that aesthetic surgery will change it for you? Do you believe that a job promotion will be yours because of a new face, larger bustline or shapelier figure? Do you think aesthetic surgery will enable you to find prince or princess charming, or save a failing marriage or relationship? These are serious misconceptions. Aesthetic surgery can only rejuvenate or enhance your outward appearance. It will not change who you really are. It will not give you talent or insight that you do not already possess. Happiness, like beauty, is more than skin deep. If, on the other hand, you are young at heart and want your outward appearance to match your self-image, aesthetic surgery is ideal for you. Your expectations should only be that an outward improvement will be made. What you do with that outward improvement is entirely up to you.

Question #4 is very important. While in some areas and endeavors being a perfectionist may be an asset, when it comes to being a cosmetic surgery patient it may be a curse. In fact, it is probably one of the major reasons not to have cosmetic surgery.

If you are truly a perfectionist, you will probably never be happy with cosmetic surgery. Why? Because there really is no true perfection possible in plastic surgery. There is only good surgery. The variables are too great. The process of healing does not grant perfection. There cannot be absolute symmetry, eradication of every wrinkle, scarless surgery, and so on. Therefore, if you can be candid and truly honest with yourself and in doing so find that this description of perfectionism is you, do yourself (and plastic surgeons) a favor and do not even consider cosmetic surgery. If, however, you are looking to make some changes and improvements that you can enjoy every day when you look in the mirror, give cosmetic plastic surgery a chance.

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Whenever a permanent tooth is lost, the surrounding and supporting bone is also lost. Periodontal disease destroys the jawbone around a tooth, which, in turn, causes tooth loss. If a tooth is removed because of decay, the bone is often lost in the extraction process. However, no matter how a tooth is lost, its supporting bone structure begins to shrink (atrophy). Bone atrophy is a serious problem that sometimes cannot be adequately corrected with bridgework or dentures. Severe jawbone atrophy can lead to cosmetic changes in the structure of a patient’s face and cause the appearance of premature aging. Only a permanent tooth replacement, such as a dental implant and crown, can prevent bone loss.

Today, almost anyone who has lost a tooth or teeth is a candidate for permanent tooth replacement. Age is not a limiting factor. As long as you are in good health, and have no extenuating medical conditions, you may be able to receive permanent tooth replacements.

In the past, the quantity and quality of a patient’s jawbone could make permanent tooth replacement difficult, unadvisable, or impossible. If too much bone had been lost through disease, trauma, or atrophy, implants could not be predictably inserted. Fortunately, there are now a wide variety of regenerative procedures that are available to correct problems of bone deficiency.

The preferred procedure for regenerating bone quantity and quality is a bone graft using the patient’s own bone. This procedure is called an autologous graft or autograft. Synthetic materials and bone bank materials can also be used, but the success rate is not yet as high as with an autograft. With future advances in biotechnology, the need for autografts will diminish. Until these genetically engineered or purified substances are available to doctors, techniques using the patient’s own bone are best.

If the need for grafting is not extensive, then bone from the mouth area is used. Bone is often borrowed from where the wisdom teeth were or from below the lower front teeth. The area from which the bone is borrowed is not weakened and does not create visible changes. Removing and grafting bone in the mouth is not considered to be major surgery. It is routinely performed in the periodontist’s office and requires only local anesthesia. The procedure is not particularly painful, and most patients need only one day of rest before they can return to their normal activities.

If extensive grafting is required, then other parts of the body are used as donor sites. Very often, bone marrow (the tissue filling the cavities of bones) is borrowed from either the hip or the top of the tibia (the larger of the two bones of the leg between the knee and the ankle). The tibia is an excellent source of bone for grafting. Feel just below your knee. Notice how thin the skin is in this area. Access to the tibia in this area is easy; it heals quickly, and leaves only a tiny scar. If bone marrow is borrowed from this area, then the procedure is generally performed in an outpatient surgery center with the assistance of an anesthesiologist and orthopedic or plastic surgeon. As with the jaw, borrowing bone marrow from the tibia does not weaken it.

In the past, patients have been told they were not candidates for permanent tooth replacement because their sinuses were too large, too low, or in the way. Sinuses are air spaces above the upper back teeth. They vary in size from person to person. Sinuses tend to get larger as we grow older. They also enlarge when upper back teeth have been lost. However, with today’s bone grafting techniques, sinuses can be gently manipulated to allow for permanent tooth replacement. The only exception to altering the sinuses is when a person has an active sinus condition or is a heavy smoker.

Today virtually everyone can receive permanent tooth replacements. If bone quantity or quality is poor, it can be improved with grafting procedures. If the sinuses are in the way, they can be gently move out of the way without creating sinus problems. In rare cases, the mandibular nerve in the back of the lower jaw may be very close to where an implant is needed. Even in these cases, techniques and technologies are available to safely provide patients with permanent tooth replacement.

In summary, the statements, You don’t have enough bone to place an implant, and You can’t permanently replace that tooth should never be made or accepted today.

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In fact, acne scars do go deep into the skin. This is what makes their appearance so obvious. It is also what makes them difficult to effectively treat. While scars left by acne are either hypertrophic (raised) or atrophic (depressed), atrophic scars are more typical. These scars can range from wide, saucer-like craters to narrow, deep pits that make the skin look as if it has been jabbed with an ice pick.

Over the years, doctors have used a variety of surgical techniques to smooth out atrophic acne scars, including dermabrasion, chemical peels, and injection of filler materials such as silicone, collagen, or fat. In a technique called punch grafting, a little core of skin containing a single scar is cut out with a metal hole punch. A tiny plug of normal skin, usually taken from behind the ear is put in its place to fill in the cavity. Unfortunately, none of these treatment procedures has ever been regarded as totally successful.

Injections with filler agents such as collagen or fat are effective for only a limited period of time. The body eventually absorbs these injected materials, the depression returns, and reinjection is necessary to maintain the desired effect.

Acne pits extend deep into the dermis (one of the inner layers of skin tissue). The atrophic scars commonly extend below the level where skin can be removed easily by dermabrasion or chemical peel resurfacing techniques. Only very deep chemical peels or aggressive dermabrasion has significant effect. Scarring and pigment changes are common complications with both techniques. However, cosmetic surgeons with extensive experience in performing dermabrasion often can provide patients with satisfactory improvement.

The high-energy pulsed carbon dioxide laser is a safer, generally more effective technique for treating atrophic, or depressed, acne scars. (Hypertrophic — or raised — scars are treated with a 585 nm flashlamp-pumped pulsed dye laser.) Precision is the chief advantage of laser treatment over other resurfacing methods. An experienced laser surgeon can usually peel as deeply as needed into the dermis in order to have the maximum possible positive effect without compromising the skin’s ability to regenerate a normal new surface.

Clinical studies have shown that laser resurfacing typically provides a 50 to 80 percent improvement in the appearance of atrophic acne scars. (One hundred percent means that the scars are totally eliminated.) To a great extent, the degree of success depends on the scars. Shallow, soft, saucer-like depressions respond best; tough, fibrous ice-pick scars are the most resistant to treatment.

Patients with extremely deep or extensive scarring may require more than one resurfacing procedure. Repeat treatments should be delayed by at least 9 to 12 months in order to permit the skin time to fully heal after the first procedure. Typically, patients see the most dramatic changes following the first treatment, and more subtle, yet still measurable improvements, after the second treatment.

Deep laser resurfacing to eradicate acne scars results in immediate facial swelling, with raw, sensitive exposed skin. Swelling and discomfort peak in 24 to 48 hours. Within two to three days, the swelling improves, but the skin is still sensitive to the touch. The treated skin remains red for several weeks, with complete recovery requiring a year or more.

Deep laser resurfacing for acne scars is a significant surgical procedure. Recuperation is relatively slow and painful. However, if you are among the multitude of people who have spent their adult lives living with the self-consciousness caused by acne scars, laser resurfacing offers you the potential for significant long-standing cosmetic improvement.

As with any surgical procedure, complications are possible with laser resurfacing. Your physician should explain the possible complications to you. A full understanding of the potential risks and benefits will help you make a better and more informed decision for yourself.

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