Woman's Way Articles
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Why is Cosmetic Surgery Board Certifcation important?by James E. White, M.D., F.A.C.S.
Dr. James E. White is board certied in General
Surgery by the American Board of Surgery, in venous
disease by the American Board of Phlebology, and incosmetic surgery by the American Board of Cosmetic
Surgery. He is a Fellow of the prestigious American
College of Surgeons, a Diplomat of the American Board
of Phlebology, and a Fellow of the American Academy
of Cosmetic Surgery. Voted Best of the Best in Cosmetic
Surgery, in 2010 and 2011, his ofce, Advanced Surgical
Concepts, 7446 Shallowford Road, Suite 205 in Hamilton
Ofce Park, is fully accredited. He offers a variety of
cosmetic procedures including laser skin resurfacing,
facial llers, minimal invasive cosme tic surgery and
Botox. He may be contacted at 423-648-4011.
WOMAN'S WAY - November 201112
health & wellness
Cosmetic surgeons combine knowledge, surgicalskill, technical expertise and ethics to achieve
their goal of providing
aesthetic enhancement
for their patients. When
choos ing a cosmet ic
surgeon it is important to
select a cosmetic surgeon
who is board certied. In
most states it is legal for
any physician who holds
a valid medical license,
with or without surgical
t ra in ing , to prac t ice
cosmetic surgery. Board certification is important
because it makes certain that your cosmetic surgeon
has the training, qualications and experience needed
to perform your cosmetic surgical procedure safely andskillfully. A board certied cosmetic surgeon has greater
insight into your needs, has knowledge of state-of-the-
art techniques and the surgical skill and judgment to
recommend and perform the cosmetic surgical procedure
that will enhance your appearance effectively and safely.
Having said that, board certication does not
equal quality care or quality outcomes. Having a Tennessee
driver’s license does not make one a good driver—it
only veries that they have successfully completed the
examination and have been issued a license to drive.
In order for a surgeon to become board
certied in any medical specialty, they must go through
a long demanding process that takes years to complete.
The American Board of Cosmetic Surgery [ABCS]is the only certifying board that exclusively tests a
surgeon’s knowledge and experience in cosmetic
surgery. Surgeons develop their cosmetic surgical
skills through post residency training and experience.
The point is that a cosmetic surgeon’s skill and ability
will depend on the surgeon’s cosmetic surgery training
and experience, not on core board-certification.
The number of people seeking cosmetic surgery
has grown rapidly over the past several years. As part
of a greater focus on appearance, people are turning
to cosmetic surgery as one means of enhancing their
appearance. At the same time, more and more doctors are
practicing cosmetic surgery.
Given the growing number of cosmetic surgery
patients and the highly competitive pool of doctors
performing cosmetic surgery, it is vital that you obtain
accurate information regarding cosmetic surgery and thedoctors who perform it. Before you undergo cosmetic
surgery, it is important you become informed about
the doctor’s education, training, experience and proven
competence with respect to the specic procedure you
seek.
Cosmetic surgery may be performed in various
facilities such as hospitals, surgical centers and ofce
settings. An accredited surgical facility must meet certain
minimum standards to obtain and maintain its accreditation.
to you the risks and possible complications, and
potential side effects, including the pros and cons of
the procedure. In addition, ask about the surgeon’s
privileges in an accredited surgery center or a hospitalto perform cosmetic surgery.
As for how you should choose a cosmetic
surgeon or cosmetic surgical center--- You should do
the research locally and online. You can perform a
standard internet search with the name of the doctor or
the procedure about which you would like to receive
more information. What do you see online? Negative or
positive feedback or reviews.
Make sure that your surgeon has a good
reputation, a strong background in the surgical eld,
and above ALL ... that he or she produces good results.
Training is important; board certication is important;
but skill, judgment and artistic detail are evidenced by
experience and outcomes — not board examinations.n
Before the surgery, your doctor should explain
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Ofce-based surgeryby James E. White, M.D., F.A.C.S.
Dr. James E. White is board certied in General
Surgery by the American Board of Surgery, in venous
disease by the American Board of Phlebology, and in
cosmetic surgery by the American Board of Cosmetic
Surgery. He is a Fellow of the prestigious American
College of Surgeons, a Diplomat of the American Boardof Phlebology, and a Fellow of the American Academy
of Cosmetic Surgery. Voted Best of the Best in Cosmetic
Surgery, in 2010 and 2011, his ofce, Advanced Surgical
Concepts, 7446 Shallowford Road, Suite 205 in Hamilton
Ofce Park, is fully accredited. He offers a variety of
cosmetic procedures including laser skin resurfacing,
facial llers, minimal invasive cosme tic surgery and
Botox. He may be contacted at 423-648-4011.
WOMAN'S WAY - October 201114
health & wellness
Surgeons are doing more than just checkups in theirofces these days. Advances in medical technology
have made it possible for
physicians to perform
more advanced and
more complex surgical
procedures in their ofces.
Whether it is vein
surgery, skin cancer
excisions, tummy-tuck,
breast augmentation,
facelift or a complex
biopsy, these procedures
can be completed in an
ofce-based surgery suite. Since most patients want to
avoid an overnight hospital stay after surgery, ambulatory
surgical procedures have become very popular. That’s
why almost one-half of all surgeries are now being done
in an outpatient facility, either connected to a hospital
or in a separate surgical center. More recently, though,
there has been a growing trend for surgery to be done
right in a doctor’s ofce. Ofce-based surgery can offer
the convenience of having a procedure done in a more
comfortable setting with a quick return home. Charges
associated with ambulatory surgery are less than fees
charged at a large hospital. Charges associated with
ambulatory surgery completed in an ofce setting are
substantially lower.
The same anesthetic techniques used in hospitals
and ambulatory surgical centers are used in ofce-based
surgery. They include:
• Local anesthesia, which provides numbness to
a small area of the body, such as a dermatologist might
use to numb the skin around a mole before removing it.
• Monitored anesthesia (sedation/analgesia),during which a patient receives medications that relieve
pain and make the patient drowsy. During surgery, the
patient’s vital signs, including heart rate, blood pressure
and oxygen level, will be watched closely in order to
avoid sudden changes or complications.
• Regional anesthesia, which can include spinal
blocks, epidural blocks or extremity blocks. Spinal and
epidural blocks involve interrupting sensation from the
legs or abdomen by injecting local anesthetic medication
in or near the spinal canal. Other blocks can be performed
for surgery on your extremities, or limbs, blocking
sensations from the arm or leg.
• General anesthesia, which involves the total
loss of consciousness, pain sensation and protective
airway responses.
From the simple removal of a mole to breast
augmentation/reduction, liposuction, hernia repairs or
knee arthroscopies, a rapidly growing number of surgeries
are being performed in doctors’ ofces rather than in
hospitals or ambulatory surgical centers. More complex
procedures are likely to become common in the near
future.
At last review in 2005, an estimated 10 million
procedures were performed annually in doctors’ ofces –
twice the number of ofce-based surgeries performed in
1995. Today, about one out of 10 surgeries is performed
in a doctor’s ofce.
In considering your options when surgery is
advised, here are some items that you should consider
before undergoing surgery in a doctor’s ofce. Ideally,
anesthesia during larger surgical cases should be
delivered or supervised by a person extensively trained in
anesthesia techniques, like a Certied Nurse Anesthetist
or Anesthesiologist. Anesthesia needs are determined by your
medical condition as well as by the type of operation
you will have completed. A doctor’s ofce should
have the necessary emergency drugs, equipment and
procedures in place to care for you in the rare event
of a life-threatening complication. Many states require
licensing or accreditation by a recognized agency. These
agencies regularly inspect such ofces to ensure that
minimum standards of patient care and safety are met.
Ask your doctor if their surgical ofce suites have been
accredited. n
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Neck liposculptureby James E. White, M.D., F.A.C.S.
Dr. James E. White is board certied in General
Surgery by the American Board of Surgery, in venous disease
by the American Board of Phlebology, and in cosmetic
surgery by the American Board of Cosmetic Surgery. He is
a Fellow of the prestigious American College of Surgeons, a
Diplomat of the American Board of Phlebology, and a Fellow
of the American Academy of Cosmetic Surgery. Recently
voted 2010 Best of the Best in Cosmetic Surgery, his ofce,
Advanced Surgical Concepts, 7446 Shallowford Road, Suite
205 in Hamilton Ofce Park, offers a variety of cosmetic
procedures including laser skin resurfacing, facial llers,
minimal invasive cosmetic surgery and Botox. He may becontacted at 423-648-4011.
Many areas of the body can accumulate fat that is
hard to lose, in spite of a healthy diet and vigorous
exercise. The neck is one
such area. Fat deposits in
the neck can detract from
the appearance of the entire
body, making a younger
person seem older, or a t
person seem out of shape.
The face and neck
are usually the rst
features we notice when
we meet someone new, so
improvements in this area
can create a dramatic change. A rm, trim neck gives the
face a more youthful look. Sometimes just having neck
liposculpture completed provides an incentive to makehealthier lifestyle choices, and maintain tness in the
rest of the body. Neck liposculpture can be completed
in an ofce surgery setting using local anesthesia with
sedation. Oftentime, laser application is completed to
the undersurface of the skin just prior to liposuction. The
laser is thought to cause thermal modulation to the skin
resulting in skin tightening. Liposuction can be completed
solo or with the assistance of vibration techniques.
During the initial consultation, your surgeon will
talk with you about the changes you would like to make in
your appearance. He should explain the different options
available, the procedure itself, its risks and limitations,
and costs. You should have a physical examination toevaluate your overall weight, your skin and muscle tone,
and the pattern of distribution of fat deposits. Photographs
should be completed for before and after comparisons. Be
sure to ask all the questions you have about the procedure,
and ask to see photographs of the doctor’s recent patients,
before and after treatment. Learn everything you can
about your options, risks and benets.
Before surgery, the surgeon will mark the precise
areas of the body where the fat is to be removed. During
the procedure, the surgeon makes tiny incisions [1-2mm
in diameter] in the skin, typically in the crease just under
the chin or behind the ear lobes and low in the neck. A
thin tube called a cannula is inserted into the fatty area.
The cannula is used to break up the fat deposits and sculpt
the area to the desired proportions. The newest liposuction
techniques involve the placement of a laser ber or an
ultrasound probe through an open-ended cannula. Laserenergy or high frequency ultrasound energy is delivered
directly to the fatty tissues. This focused high level energy
causes the fat to be emulsied making suction removal
easier. The unwanted fat is removed with a high suction
vacuum, leaving the skin, muscles, nerves, and blood
vessels intact. The high level energy delivered by the
laser ber or by ultrasound can also be used to heat the
undersurface of the skin — thus leading to skin retraction
and skin tightening.
Liposuction can give this area a new streamlined
contour, enhancing the effect of facial features and
WOMAN'S WAY - September 201112
health & wellness
improving the facial prole. Patients who have been self-
conscious about their bulging necklines often feel morecomfortable wearing a range of clothing and jewelry
styles after liposuction. Neck liposuction is minimally
invasive with limited scars, produces consistently good
results, and has a particularly high satisfaction rate among
patients. n
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lines.” Many llers are available on the market; common
llers include: Restylane, Radiesse, Jeuvaderm, Sculptra
and Selphyl. Each of the listed llers are made from
different substances and have different characteristics
and modes of action. Effects and length of time effect
are greatly different for each of the common llers.
Botox is not a ller; but rather a neuromuscular
blockade medication. It is used in conjunction with
llers to help smooth creases caused by overactive
muscles (such as forehead wrinkles, crow’s feet and
frown lines). The llers help lift the cracks in the skin,
while the neuro-blocker causes the underlying facial
muscles to be weak. The weakened muscle is then not
able to contract exposing the wrinkle. Excess facial skin,
fatty deposit or neck skin is more appropriately treated
by skin tightening surgical and non-surgical face and
neck lifts or forehead lifts in conjunction with llers and
or neuromodulators. Depending on the type of facial
ller used, the results may last anywhere from a few
months to a year and a half or more.
Facial rejuvenation is very individualized.That’s why it’s important to discuss your hopes and
expectations during the initial facial consultation with
your surgeon. In your initial consultation, make sure
to discuss and select a treatment option based on your
goals and concerns, your anatomy problems and your
lifestyle. Make sure that your aesthetic ideals match
what your cosmetic surgeon invisions. There is a denite
art involved for appropriate ller injections. It is NOT
paint by numbers; but rather face sculpture—the key is not
the ller; but the artist who is completing the procedure.
When injectables are administered by a qualied surgeon,
complications are infrequent and usually minor in nature.
WOMAN'S WAY - August 2011 13
beauty & fashionWrinkle, wrinkle, go away; don't come another day
A
s we age, our faces begin to show the effects of
gravity, sun exposure and years of facial muscle
movement, such as
smiling and chewing.
The underlying tissues
[collagen and elastin] that
keep our skin looking
youthful and plumped-up
begin to break down with
age. As we continue to use
our facial muscles, the thin
stiffened skin shows signs
of wrinkles often leaving
laugh lines, frown lines,
smile lines and facial creases over the areas where this
muscle movement occurs. Some of the wrinkles are
related to genetics; but most are related to sun exposure.
Facial soft-tissue llers can help ll in these
lines and creases, temporarily restoring a smoother, moreyouthful-looking appearance. When injected beneath the
skin, these llers plump up creased and sunken areas of
the face erasing years away. Injectable llers may be used
alone or in conjunction with a resurfacing procedure, such
as a laser skin treatment, chemical peel or a recontouring
procedure, such as liposuction, fat transfer or mini facelift.
Facial llers or injectable llers are primarily
used to improve the appearance of the skin’s texture. They
can help ll out deep facial wrinkles, creases and furrows,
“sunken” cheeks, skin depressions and some types of
scars like acne pits. They can also be used to add a fuller,
more sensuous look to the lips and improve “lipstick
by James E. White, M.D., F.A.C.S.
Dr. James E. White is board certied in General
Surgery by the American Board of Surgery, in venous
disease by the American Board of Phlebology, and in
cosmetic surgery by the American Board of Cosmetic
Surgery. He is a Fellow of the prestigious American
College of Surgeons, a Diplomat of the American Board
of Phlebology, and a Fellow of the American Academy of
Cosmetic Surgery. Recently voted 2010 Best of the Best in
Cosmetic Surgery, his ofce, Advanced Surgical Concepts,
7446 Shallowford Road, Suite 205 in Hamilton Ofce Park,
offers a variety of cosmetic procedures including laser
skin resurfacing, facial llers, minimal invasive cosmetic
surgery and Botox. He may be contacted at 423-648-4011.
It is wise to search the internet for effects and
characteristics of the above listed facial llers prior to a
facial evaluation and treatment planning. Well educated,
you will be better prepared to discuss options and choiceswith your physician artist. n
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and face, including the lips. Other materials were then
developed that could be used for lip augmentation. Some
of these materials include collagen, facial llers, fat,
and acellular human matrix, just to name a few. Many
new injectable materials used to augment the lips have
become available, and many more are to be approved by
the US Food and Drug Administration (FDA). Temporary
injectable materials are the most common method of lip
augmentation and reshaping. The problem with temporary
injectable llers is the fact that they are temporary.
The newest advanced l ip augmentation
procedures involve the placement of a solid silicon
implant —similar to silicon implants used in breast
augmentation procedures. The solid silicon implant can
be placed into the upper and lower lips through 3mm
incisions in the corner of the mouth. These incision sites
heal rapidly and are barely visible to inspection after
placement. The silicon implants come in several different
sizes for permanent lip enhancement. The old silicon
injections, like the ones completed on Ms. Priscilla
Presley, caused lip deformity with invasive growth into
the lip tissues. Injectable silicon is difficult to removewithout major surgical excision. Silicon implants,
however, can be easily removed if the lip augmentation
look is no longer desired. The silicon implants have a
soft natural feel.
All lip procedures may be performed in an ofce
surgical suite with local anesthetic (eld block, nerve block)
and this is, in fact, an ideal way to work on the lips. With
general anesthesia, the lips become accid and adynamic.
The ability for the patient to move the lips during surgery
is a great advantage during the sculpture phase.
Again, well defined, full lips speak of youth and
WOMAN'S WAY - July 2011
beauty & fashion11
Kissabilityby James E. White, M.D., F.A.C.S.
Dr. James E. White is double board certified in
General Surgery by the American Board of Surgery and
the venous disease American Board of Phlebology. He is
a Fellow of the prestigious American College of Surgeons,
a Diplomat of the American Board of Phlebology, and a
Fellow of the American Academy of Cosmetic Surgery.
Recent ly vo ted 2010 Best of the Bes t in Cosme ti c
Surgery, his office, Advanced Surgical Concepts, 7446
Shallowford Road, Suite 205 in Hamilton Office Park,
offers a variety of cosmetic procedures including laser
skin resurfacing, facial fillers, minimal invasive cosmetic
surgery, Thermage and Botox. He may be contacted at
423-648-4011.
Aesthetic surgery of the lips has evolved as the
eld of cosmetic surgery has evolved, as the study
aesthetic nesse. Luscious
full lips speak of youth and
vitality.
The lips thin as people
age, and the wet line moves
lower in reference to the
dentition. In addition, the
oral commissures begin
to downturn. These thin,
flat, and poorly defined
lips impart a sense of
age. Specific procedures
address each of these labial-aging signs. Some of these
procedures include augmentation to help restore full,
well-dened, and proportional lips that impart a sense of
beauty and youth.
The lips are the most malleable and animate of all
facial features. Many consider them to be the most pleasingfeature of the lower third of the face. Many of the techniques
used on other areas of the face may not work on the lips
because of their 3-dimensional animate nature. With this
in mind, many methods are used to augment the lips and
to change their animate shape, repose shape, or both. The
surgeon must always be aware of how static changes to the
lip change the animate aesthetics and function of the lip.
Patients occasionally refer to this as “kissability.”
Initial attempts at beautifying the lips probably
started with Cleopatra, who colored her lips red. Later,
silicone was used to augment the soft tissue of the body
vitality. Take care to review before and after photographs of
patients treated by your cosmetic surgeon. Make sure that
your ideal of aesthetic sense is the same as your surgeon.
Beware of lip overll; big pink slugs and platypus lips do
not t into the category of “kissability.” n
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WOMAN'S WAY - June 201112
health & wellnessWhat can happen if I don't treat my varicose veins?by James E. White, M.D., F.A.C.S.
Dr. James E. White is double board certied inGeneral Surgery by the American Board of Surgery and
the venous disease American Board of Phlebology. He is
a Fellow of the prestigious American College of Surgeons,
a Diplomat of the American Board of Phlebology, and a
Fellow of the American Academy of Cosmetic Surgery.
Recently voted 2010 Best of the Best in Cosmetic Surgery,
his ofce, Advanced Surgical Concepts, 7446 Shallowford
Road, Suite 205 in Hamilton Ofce Park, offers a variety
of cosmetic procedures including laser skin resurfacing,
facial llers, minimal invasive cosmetic surgery, Thermage
and Botox. He may be contacted at 423-648-4011.
Varicose veins range in severity from small tread-like spider veins to large ropy veins ... cosmetic
to medically signicant.
There are several adverse
consequences of untreated
varicose veins, and their
severity will vary from
person to person depending
on the circumstances.
Many people who don’t
treat their varicose veins
may experience continued
symptoms of pain, fatigue
and swelling of the legs or
ankles. Some varicose veins present without symptoms
and just look bad. More advanced medical problems may
include hyperpigmentation [stains], lipodermatosclerosis
[plastic changes of the skin], venous leg ulcers,
spontaneous bleeding, supercial thrombophlebitis, and
a potentially life-threatening condition called deep vein
thrombosis [DVT].
The varicose veins themselves are not responsible
for the major damages to the body. Blood that pools in
the varicose veins is depleted of oxygen and nutrients.
The veins also do not tolerate high pressure well and
begin to allow red blood cells and uid to leak into
the tissues of the leg. This uid leak causes ankle
swelling. The red blood cells in the tissues cause chronic
inammation and the skin becomes dark and discolored-
iron stains. The medical term for the dark discoloration is
hyperpigmentation. When the skin and the fat under the
skin are inamed for years, the tissues become woodyand rm. The medical term for this woody, hard tissue is
lipodermatosclerosis. A condition that may occur over time,
when there is chronic venous insufciency, is a venous
leg ulcer. The ulcers due to varicose veins are painful and
difcult to heal. Sometimes the ulcers cannot be healed
until the backward blood ow in the veins is corrected.
Another possible consequence of untreated
varicose veins is spontaneous bleeding from the varicose
veins. As the skin over the veins becomes thin, eventually
the vein can be exposed to the outside world and be easily
injured by clothing, bedding, etc. The blood loss can be
signicant and is painless.
Superficial thrombophlebitis (ST) is an
inammation of a vein just below the surface of the skin.
The cause of inammation is not an infection. Rather,
inammation is due to decreased blood ow through the
vein, damage to the vein and blood clotting. The features
of ST include redness to the skin and a rm, tender, warm
vein. Localized leg pain and swelling may occur as well.
Treatment of ST is directed toward reducing the
inammation. Aspirin or Ibuprofen are the drugs of choice.
Compression with graduated support hosiery is important
as well. Fortunately, ST is usually a benign and short-term
condition. Symptoms generally improve in one to two
weeks although the rmness of the vein may persist longer.
Deep vein thrombosis (DVT), unlike ST, can be
associated with signicant and serious medical problems.
DVT is often rst noticed as a “pulling” sensation in
the calf of the lower leg, and it can be quite painful.
Symptoms also include associated warmth, redness and
swelling. The swelling often extends to above the knee.Some patients are at higher risk for developing
DVT. These include:
Over 60 years of age
Recent surgery
History of prior DVT
Prolonged immobility/paralysis
Malignancy
Blood Clotting Disorders
Obesity
Pregnancy and Postpartum
Infection
When a diagnosis of DVT is made, anticoagulation
treatments are often started. Anticoagulation prevents
progression of the blood clot, breaks up the clot and
prevents the clot from traveling to the lungs. If a clot
travels to the lungs it is called a “pulmonary embolus” and
the outcome can be fatal. n
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Ribbon facelift
WOMAN'S WAY - May 20116
beauty & fashionby James E. White, M.D., F.A.C.S.
Dr. James E. White is double board certie
General Surgery by the American Board of Surgery
the venous disease American Board of Phlebology. H
a Fellow of the prestigious American College of Surge
a Diplomat of the American Board of Phlebology, a
Fellow of the American Academy of Cosmetic Surg
Recently voted 2010 Best of the Best in Cosmetic Sur
his ofce, Advanced Surgical Concepts, is located at
Shallowford Road, Suite 205 in Hamilton Ofce P
Advanced Surgical Concepts o ffers a variety of cosm
procedures including laser skin resurfacing, facial l
minimal invasive cosmetic surgery, Thermage and Bo
He may be contacted at 423-648-4011.
I
t was just a few years ago that patients unhappy
with facial droop had limited choices —full
facelift. Advances in
minimally invasive facial
rejuvenation have opened
the eld of choices for
facial lifting. Midface
suspension ribbon lift,
also referred to as a cheek
or midface lift, corrects
sagging midface tissues by
surgically repositioning
them up and to the side.
This accomplishes several
goals: volume enhancement of the midface region,
elimination of hollows in the area, and a gentle smoothing
of the tissues just below the eyes. A successful midface
suspension can be a key step in achieving the youthfulappearance sought after in minimally invasive facial
rejuvenation procedures. As we age our mid face
degrades, deates and descends giving that dragged
out tired look of 'old age.' The area between the lower
eyelids and the mouth is considered the midface. As we
age, the effects of gravity, repeated muscle contraction,
and lifestyle cause the skin, fat, and muscle in this region
to move downwards. When this occurs, the cheeks begin
to look saggy or at, lower eyelids can become puffy
or hollow, circles begin to appear under the eyes, and
the lines between the nose and the corner of the mouth
increase in size.
Good candidates for mid face suspension
ribbon lift are those patients who are starting to see
some droopiness of the brow, cheeks, jowls and/or neck
and would like to see a lift effect, but do not want the
risk, scars, or recovery of a real browlift, facelift, or
necklift operation. The ribbon lift procedure can achieve
60-70 percent of what a real invasive surgical procedure
can deliver without the need for hospital care or general
anesthesia.
During a midface suspension procedure, the
surgeon makes small incisions in the area above the
ear, and in some cases through the mouth. A surgical
ribbon implant is then passed through the cheek tissue
and secured to the soft tissues above the ear. Similar
techniques were tried with suture suspension. The
ribbon allows greater xation than small sutures. In
all cases, the surgeon relies upon the implant ribbon
to temporarily xate the suspended cheek in its newposition. The ribbon material is slowly absorbed and
the tissues created by the body hold the lifted facial
tissues xed in position. This restores cheek volume and
establishes more youthful midface contours. The result
will be a natural, revitalized appearance that doesn’t
appear overdone, plastic or “pulled.”
When performed skillfully, a midface ribbon
lift can deliver a natural but noticeable improvement. It
is frequently performed with other procedures. However,
for many younger patients, under 45 years of age,
midface suspension is often a standalone proced
Good candidates must have realistic expectations an
prepared to follow the postoperative recovery prot
and must be accepting of the risks. Poor candidinclude those patients with unrealistic expectat
have uncontrolled medical illnesses that affect wo
healing, are grossly overweight (with heavy fa
or are excessively thin, have loose skin. The
face ribbon suspension may be combined with o
more minor surgical procedures, such as fat tran
Botox, injectable llers, fractionated skin resurfa
deep chemical peel or photofacial intense pulse l
treatments. All procedures can be completed using l
anesthesia by a cosmetic surgeon as in-ofce minim
invasive facial rejuvenation. n
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Not pulled or plastic
WOMAN'S WAY - April 20116
beauty & fashionby James E. White, M.D., F.A.C.S.
Dr. James E. White is double board cert i
in General Surgery by the American Board of Surg
and the venous disease American Board of Phlebol
He is a Fellow of the prest igious American Coll
of Surgeons, a Diplomat of the American BoardPhlebology, and a Fellow of the American Acad
of Cosmetic Surgery. Recently voted 2010 Best of
Best in Cosmetic Surgery, his office, Advanced Surg
Concepts is located at 7446 Shallowford Road, S
205 in Hamilton Office Park. Advanced Surg
Concepts offers a variety of cosmetic procedu
including laser skin resurfacing, facial fillers, mini
invasive cosmetic surgery, Thermage and Botox.
may be contacted at 423-648-4011.
Not a week goes by that someone doesn't seek
consultation in regard to facial aging with these
very words, “ I want to
look fresh, younger but
not pulled or plastic.”
Well, times have changed
in regard to facial
aesthetics. Gone are the
days of the cookie cutter
facelifts which often
times left patients looking
pulled, pinched or wind
blown. Newer short-scar
mini-lifts, along with
procedures to add facial volume and decrease the lines
and wrinkles, have revolutionized the art of facial
rejuvenation.
As we age, most individuals lose elasticity in
their skin and develop varying degrees of descent along
the jaw line and beneath the chin. The ofce-based
mini face lift is a surgical face lift to address the mid
to lower face/neck with minimal surgical exposure as a
minimally invasive ofce procedure. The post operative
effect provides a more natural appearance with limited
down time when compared to other formal face lift
procedures. Most traditional facelifts are performed
with general anesthesia and involve multiple weeks of
downtime with a long incision beginning at the upper
temples and extending behind the hairline on either
side of the face to the nape. Due to the length of the
formal face lift procedure and the type of anesthesia,
there is an increased risk of complications. The S-Liftminimal incision face lift has been performed since the
late 1990s.
The office based mini face lift not only
tightens skin, it is designed to permanently suspend
the underlying muscles and fibrous structures of the
lower face and upper neck. This suspension of the
lower face offers men and women the benefit of a more
youthful appearance without the “wind blown” look of
a formal face lift.
Key to a natural looking facial rejuvenation
is replacement of lost volume. Facial volume can be
replaced by fillers or fat transfer. Fat transplant is
performed by extracting fat from one area of the body
(typically thighs or abdomen) via liposuction and then
injecting the filtered fat through a syringe to various
areas of the face to increase volume and decreasewrinkles. The fat also has the added benefit of stem
cells.
As we age, our skin thins and appears more
translucent. Sun damage becomes more evident through
age spots and a decrease in collagen is pronounced
through folds and wrinkles. Laser skin resurfacing is an
effective way to correct these issues. The fractionated
CO2 laser, heats and vaporizes skin tissue one spot at a
time. The heat removes superficial layers of the treated
skin while the untouched, surrounding skin aides in
the healing process. This healing process stimulates
collagen, elastin and glycosaminoglycans. Ultima
cell regeneration is induced with production of
skin cells.
Neuromodulators like Botox can alsoinjected to relax facial muscles. It is most bene
for the treatment of lines caused by overactive mus
of the forehead, cheeks and mouth. This makes i
ideal treatment for frown lines, forehead furrows,
also “crow’s feet.” It can also be injected to reverse
downward turn of the angle of the mouth.
As with any cosmetic procedure; cho
your surgical artist well. The combination of m
lifts, volume replacement, neuromodulators and
resurfacing yield more lasting natural facial rejuvena
without the pulled or plastic look of days gone by. n
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WOMAN'S WAY - March 2011
health & wellnessVampire facelift
by James E. White, M.D., F.A.C.S.
Dr. James E. White is double board certie
General Surgery by the American Board of Surgery
the venous disease American Board of Phlebology. H
a Fellow of the prestigious American College of Surgeoa Diplomat of the American Board of Phlebology, an
Fellow of the American Academy of Cosmetic Surg
Recently voted 2010 Best of the Best in Cosmetic Surg
his ofce, Advanced Surgical Concepts is located at 7
Shallowford Road, Suite 205 in Hamilton Ofce Pa
Advanced Surgical Concepts offers a variety of cosm
procedures including laser skin resurfacing, facial ll
minimal invasive cosmetic surgery, Thermage and Bo
To learn more about the Selphyl® system (vampire face
described above, call 423-648-4011.
From "Twilight" to "True Blood," vampires were allthe rage in 2010. And so are procedures that erase
wrinkles from the face. Combine the two trends and you
get the vampire facelift. Normal aging causes loss of
skin elasticity and volume that encourages the formation
of lines, wrinkles and folds. These changes often cause
us to appear angry, tired or stressed even if we aren’t.
There is now available an autologous plate-
let and brin processing procedure that uses your own
blood to prepare a smooth gel for volume replacement,
collagen stimulation and cell renewal. This procedure
eliminates facial folds and wrinkles naturally, by using
your own blood to stimulate collagen regeneration and
volume replacement. Increased skin volume and amaz-
ing rejuvenation occurs as new collagen and blood ves-
sels develop, while your own tissues reverse the signs of
aging.There is no risk of allergic reaction, little to no
bruising, swelling or lumping occurs and long lasting re-
sults are clearly visible within a short time period.
A popular choice for men and women today who
want to defy aging by looking years younger…natural-
ly,... this procedure is today’s safest, most effective way
to naturally promote cell regeneration. It is considered
the next best thing to a facelift without an incision. The
system allows for the safe and rapid preparation of an
activated platelet rich brin matrix (PRFM), in an easy
three step process. A small amount of your own blood
is used to prepare the smooth gel that is injected into
pre-targeted areas of the face and body. This stimulatesnew tissue growth and collagen renewal providing skin
volume that eliminates lines, wrinkles and folds. Your
own new tissues act to reverse the signs of aging.
Treatment involves a fast, easy 20 minutes in
the comfort of an ofce setting using local anesthetics.
Many men and women get their desired results after only
one treatment. Your cosmetic surgeon can personalize a
treatment plan for you to optimize your desired results.
Cost for the procedure ranges from $800-$1200.
The system is FDA cleared and has been safely
and effectively used to treat many thousands of patients
worldwide. It contains only autologous [your own] ac-
tive components and there are no risks of allergic reac-
tions. It has been used extensively in cosmetic plastic
surgery, orthopedics, maxillofacial surgery and for soft
tissue regeneration worldwide. Treatments help to stimu-late your body’s own collagen production which in turn
provides a gradual increase in volume.
One main benet is that it is natural. Platelet-
rich plasma has growth factors and those growth fac-
tors stimulate your own body to make collagen. A small
amount of your blood is drawn and the platelets and -
brin are separated into a concentrate known as the ma-
trix. This is then injected just below the skin to correct
depressions, acne scars, folds and wrinkles. Upon in-
jection, the platelets release growth factors that trigger
cell proliferation thereby
increasing volume and
naturally rejuvenating thetreated areas. Some re-
sults are seen right away,
but the full effect comes
in about three to eight
weeks. Results can last up
to two years with single
injection.
The vampire ller
won't give one super pow-
ers, but it will keep patients looking younger, longe
is the new eco-green, because it's truly recycling at
basic level. n
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WOMAN'S WAY - February 201112
health & wellness Fat transfer
by James E. White, M.D., F.A.C.S.
Dr. James E. White is double board certied
General Surgery by the American Board of Surgery a
the venous disease American Board of Phlebology. He
a Fellow of the prestigious American College of Surgeo
a Diplomat of the American Board of Phlebology, and
Fellow of the American Academy of Cosmetic Surge
Recently voted 2010 Best of the Best in Cosmetic Surge
his ofce, Advanced Surgical Concepts is located at 74
Shallowford Road, Suite 205 in Hamilton Ofce Pa
Advanced Surgical Concepts offers a variety of cosme
procedures including laser skin resurfacing, facial lle
minimal invasive cosmetic surgery, Thermage and Bot
He may be reached at 423-648-4011.
As we age, the underlying collagen and elasticconnective tissues begin to break down and wrinkles
emerge. We also tend to lose
some subcutaneous fat on
our faces. This brings about
a haggard, hollow, or even
skeletal look. Fat grafting
is a natural approach to
restoring a youthful look
to the face that does not
involve removal of skin,
stretching the skin, or the
risk of an unnatural look
that can result from a face
lift. Fat grafting can be
combined with a face lift, if volume is what one needs.
Fat transfer — also called facial fat rejuvenation
— is the process of taking small amounts of fat from onepart of the body and reimplanting it elsewhere, where
it is needed. This fat can be implanted to the lips, the
nasolabial folds (the folds from the corners of the mouth,
nose), the under-eye areas, the cheeks and other parts of
the face and body. It is minimally invasive and can be
completed in an ofce setting to help correct problems
such as volume loss, acne scars and restore a youthful
look to an aging face.
As an injectable ller, fat is almost perfect. It is
soft and feels natural, it does not cause immune problems,
and most people have fat to spare! The fat is harvested
from some other spot on your body, such as you abdomen,
and can be a by-product, if you will, of liposuction
reduction of that area. The main downside to fat grafting
is that the body tends to absorb the transferred fat at least
to some degree. The amount of fat that is implanted and
then absorbed by the body varies. Some older studies
have found that almost all the fat is absorbed, but there
has been a lot of recent improvements in techniques for
harvesting, treating and injecting the fat. Many cosmetic
surgeons are reporting very good, lasting results with the
newer techniques. A lot depends on factors including how
the fat was removed, how it was concentrated and treated,
how much was injected, where it was injected.
To be a good candidate for facial fat grafting,
one has to be in good health, not have any active diseases
or pre-existing medical conditions, and one must have
realistic expectations of the outcome. One may not be a
good candidate for fat grafting if there is a history of poor
wound healing or if the overall health is poor. Fat grafting can be done on almost all areas of
the face and body. However, the most common treatment
sites are the areas under the eyes, the tear troughs under
the eyes, the temples, the cheeks, the chin, the lips, the jaw
line, the forehead, and the glabella (the area just above
the nose in between the brows). Fat grafting has been
used on the breast, buttocks and hips and the sternum.
The site being treated must have good blood circulation
and enough capillaries and larger blood vessels so that
the injected fat cells are nourished and can form their
own blood supply. This is a key factor in getting the b
and longest lasting results. Surgeons are continuing
discover new methods of aesthetic improvements thro
fat grafting. Although fat grafting and other types
grafting are still not perfect, they have certainly com
long way over the last few years.n
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the research locally and online. You can perform
standard internet search with the name of the doctor
on the procedure that you would like to receive mo
information. What do you see online? Negative positive feedback on reviews? Ask those in the waiti
room or others that you know if they have any feedbac
If you are visiting a surgical center, where multip
doctors work, be sure to get the name of THE surgeo
who will be performing your procedure. Make sure th
your surgeon has a good reputation, a strong backgrou
in the surgical eld, and above ALL — that he/s
produces good results. Training is important; but ski
judgment and artistic detail are evidenced by exper ienc
not just board certication.n
WOMAN'S WAY - January 2011
beauty & fashionCosmetic surgery homework
by James E. White, M.D., F.A.C.S.
Dr. James E. White is double board certied
General Surgery by the American Board of Surgery a
the venous disease American Board of Phlebology. He
a Fellow of the prestigious American College of Surgeo
a Diplomat of the American Board of Phlebology, and
Fellow of the American Academy of Cosmetic Surge Recently voted 2010 Best of the Best in Cosmetic Surge
his ofce, Advanced Surgical Concepts is located at 74
Shallowford Road, Suite 205 in Hamilton Ofce Pa
Advanced Surgical Concepts offers a variety of cosme
procedures including laser skin resurfacing, facial lle
minimal invasive cosmetic surgery, Thermage and Bot
He may be reached at 423-648-4011.
A
re you thinking about undergoing cosmetic surgery?
Do your homework!Cosmetic surgery is a
subspecialty that uniquely
restricts itself to the
enhancement of appearance
through surgical and medical
techniques. It is specically
concerned with maintaining
normal appearance,
restoring it, or enhancing
it toward some aesthetic
ideal. Cosmetic Surgery
is a multi-disciplinary and
comprehensive approach directed to all areas of the head,
neck and body. Cosmetic surgery is practiced by surgeons
from a variety of disciplines including board-certied
dermatologists, general surgeons, oral and maxillofacialsurgeons, ophthalmologists, otolaryngologists, plastic
surgeons and physicians from other elds. All of these
disciplines have contributed to the vital growth of
cosmetic surgery and it‘s current practice.
Unlike cosmetic surgery, plastic surgery deals
with the repair, reconstruction or replacement of physical
defects of form, defects from cancer surgery, trauma and
disease processes. Cosmetic surgery deals with tissue
arrangements by enhancement toward an aesthetic goal.
When considering cosmetic surgery, people are almost
universally unaware that there is a difference between
“cosmetic” surgery and “plastic surgery.” For this reason,
they may be easily misled to believe board certication
in plastic surgery evidences a physician’s competence to
perform cosmetic surgery. While board certication by
the American Board of Plastic Surgery may evidence
a physician competent in “plastic surgery,” it does not
necessarily evidence competency in “cosmetic surgery”nor does it demonstrate more “cosmetic surgery”
education, training or experience than that of a board-
certied surgical specialist with post residency training
in cosmetic procedures. A recent article published in
the Plastic Surgery Journals reported that 51 percent
of plastic surgery residents felt that they did not receive
sufcient training in cosmetic surgery procedures during
their plastic surgery residency.
The cosmetic surgery eld is rapidly changing.
Most non-invasive rejuvenation procedures have only
been around for the last seven years. If your plastic
surgeon completed his/her plastic surgery residency
more than seven years ago — chances are he/she
learned the cosmetic procedure techniques just like other
providers at a post residency training course. Choose
your cosmetic surgeon as you would choose any otherhealthcare provider. Consistently, it is the American
Medical Association’s policy that individual character,
training, competence, experience and judgment be the
criteria for granting privileges and that physicians
representing several specialties can and should be
permitted to perform the same procedures if they meet
the criteria.
Surgeons develop their cosmetic surgical skills
through post residency training and experience. The
point is that a cosmetic surgeon’s skill and ability will
depend on the surgeon’s cosmetic surgery training and
experience, not on core board-certication.
As for how you should choose a cosmetic
surgeon or cosmetic surgical center...you should do
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WOMAN'S WAY - January 2009 15
beauty & bridal
by James E. White, M.D., F.A.C.S.
Dr. James E. White is board certified in Genera
Surgery by the American Board of Surgery, is a Fellow of
the American College of Surgeons and is a Diplomat of
the American Board of Phlebology. His office, Advanced
Surgical Concepts, PLLC, Varicose Veins Solutions &
Aesthetic Skin Care, offers a variety of cosmetic procedure
including facial fillers, thermage and botox. Located a
7446 Shallowford Road, Suite 205 in Hamilton Office Park
he may be contacted at 423- 648-4011.
Scar technology
As a natural part of the healing process, a scar forms
as a results of injury and new collagen fibers which
reconnect damaged skin and create a “seam” or scar. The
most common causes for scars include surgical incisions,
traumatic injuries and inflammatory scars. Your options
for getting rid of that scar may depend on the type of scar
that you have. Hairline scars are thin, flat and easy to fade
or hide. Good surgeons strive to place surgical scars in
less conspicuous locations following tension lines of the
body. Careful attention to detail allows for better final
cosmetic results. Unfortunately, we have no control over
traumatic scars — which seem to occur in areas of skin
exposed without fabric protective covers.
Atrophic or depressed scars have a sunken or
pitted appearance. Acne is a frequent culprit. Hypertro-
phy scars are firm, raised accumulations of tissue that
develop from an overabundance of collagen productionand sometimes grow larger that the original wound or
traumatic injury site. These scars are unsightly and can
also be painful. Keloid scars are the largest hypertrophic
scars, often time looking more like tumors than scars.
African-American and patients of Mediterranean heritage
are very susceptible to keloid scarring.
The key to minimal scarring is prevention. For
acne patients, a qualified physician can put together an
effective skincare regimen with specific products that
will help to prevent acne scarring. Blue light therapy or
photodynamic therapy is one of the current cutting edge
technologic procedures for acne. If you are prone to poor
healing with hyper tropic or keloid scars, protective dress-
ings, suture techniques, compression therapy and steroid
injections may reduce the risks. Advanced keloid scars
may respond to radiation therapy in early stages of wound
healing.
Of key importance, ask your surgeon about his
or her suturing techniques and inform the surgeon of
any personal or family history of poor wound healing
problems. Avoid surgeons who close wounds with wide
suture techniques which often leave the “Frankenstein
railroad scars." Look for surgeons who use layer closure
techniques with fast absorbing sutures supported by skinbridges or butterfly bandages.
Multiple techniques can decrease scarring after
the initial skin injury. During the healing phase, simple
topical treatments (ScarGuard, KeloCote, Mederma) and
steroid injections can help to minimize the unsightliness
eight weeks after an inci-
sion has been made. More
invasive laser treatmentscan improve and flatten the
appearance of deeply in-
grained scars.
Coloration chang-
es with red to purple pig-
ment changes at incision
sites are best treated with
intense pulse light (IPL)
photodynamic therapy. IPL
affects color changes in the skin; causing dark skin pig
ments to fade to a more normal coloration. White scar
are devoid of pigment cells and usually will not respond
to therapy. Surgical tattoos can be helpful to camouflag
the white scars in cosmetically sensitive areas.
If all else fails, consider makeup concealers fo
problem scars. Some patient are using temporary tattooto cover scar imperfections while on vacation with skin
areas exposed at the beach. n
of a scar. Scarabrasion by
using a soft bristle baby’s
toothbrush along with frac-
tionated laser treatments
to the healing incision is
helpful in the first six to
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WOMAN'S WAY - December 200812
health & wellness
by James E. White, M.D., F.A.C.S.
Dr. James E. White is board certified in Genera
Surgery by the American Board of Surgery, is a Fellow o
the American College of Surgeons and is a Diplomat o
the American Board of Phlebology. His office, Advance
Surgical Concepts, PLLC, Varicose Veins Solutions & Aesthetic Skin Care, offers a variety of cosmetic procedure
including facial fillers, thermage and botox. Located a
7446 Shallowford Road, Suite 205 in Hamilton Office Park
he may be contacted at 423- 648-4011.
Varicose veins
Varicose veins, those unsightly twisting, bulging rope-like cords on the legs, anywhere from the groin to
ankle affect an estimated 40 percent of women and 25
percent of men of all ages. The problem veins generally
appear from age 20 and forward. Factors leading to vari-
cose veins include heredity, gender, pregnancy, age and
other factors. Some factors may speed up the develop-
ment of this disease and make the veins worse. The major
factors include: pregnancy, prolonged standing in one
place, obesity, hormone levels, and physical trauma from
previous episodes of deep vein thrombosis.
Varicose veins of the rectum are called hemor-
rhoids and varicose veins of the esophagus are called
esophageal varicies. While many people have heard of
varicose veins of the legs, very few truly understand their
underlying cause, and the potential they have for develop-
ing into a serious medical issues.Veins return blood back to the heart to be re-
circulated. To return this blood to the heart, the leg veins
must work against gravity to lift the blood back to the
heart. This gravity effect is multiplied when standing.
Small, one-way valves in the veins open to allow blood to
flow upward, towards the heart, and then close to prevent
it from flowing backwards. Muscle pumps in the lower
limbs push the blood upward with each muscle contrac-
tion. Obstacles in the way of blood return to the heart
[such as pregnancy or obesity] also decrease the ability of
the veins to return the blood back to the heart efficiently.
In addition to the visual appearance, many pa-
tients may experience pain (an aching or cramping feel-
ing), heaviness/tiredness, burning or tingling sensations,leg swelling/throbbing as well as tender areas around the
veins themselves.
Varicose veins occur when the valves in super-
ficial leg veins malfunction or cannot work efficiently.
When this occurs, the valve may be unable to close, al-
lowing blood that should be moving towards the heart
to flow backward (called venous reflux). The vein blood
becomes stagnate, backs up and pressure builds. Blood
collects in your lower veins causing them to enlarge and
become varicose. The veins are very thin walled and
cannot tolerate the increased pressure; they enlarge in
relationship to the added stress. The pressure maybe so
great that fluid can leak from the faulty veins causing
leg swelling leading to dermatitis and skin ulcerations.
Varicose veins have been shown to be the number one
cause for restless leg syndrome.
Conservative measures [like compression hose]
do not treat the underlying cause of the disease process.
Compression therapy helps adjust the superficial vein
pressure to cause the vein blood flow to take other veins
deeper in the limb. Without correction of the mechanical
problem, varicose veins will usually enlarge and worsen
over time. Legs and feet may begin to swell and sensa-
tions of pain, heaviness, burning or tenderness may oc-
cur. Twisted ropey varicose
veins are related to me-
chanical problems and the
usual answer for a mechan-
ical problem is a mechani-
cal therapy. Premiere veincenters use endovenous
laser techniques to per-
manently seal faulty vari-
cose veins in a conserva-
tive non-surgical method.
Advanced varicose veins
may lead to vein inflam-
mation [phlebitis], deep
vein thrombosis [blood
clots] and non-healing ulcers and sores of the lowe
extremities. n
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WOMAN'S WAY - November 2008
beauty & fashion2
by James E. White, M.D., F.A.C.S.
Dr. James E. White is board certified in Gener
Surgery by the American Board of Surgery, is a Fellow
the American College of Surgeons and is a Diplomat
the American Board of Phelebology. His office, Advanc
Surgical Concepts, PLLC, Varicose Veins Solutions
Aesthetic Skin Care, offers a variety of cosmetic procedu
including facial fillers, thermage and botox. Located
7446 Shallowford Road, Suite 205 in Hamilton Office Par
he may be contacted at 423- 648-4011.
Non-surgical eye lift
O
ne of the first places that our face can show aging is
around the eyes — the windows to the soul. Skin andsoft tissues around the eyes start to loosen and sag in the
mid 30’s with loose, lax skin, hoods and wrinkles. Treat-
ments for skin laxity and descent included blephroplasty,
facial lifts and Thermage® which effectively tighten and
lift the skin. Blephroplasty is a surgical technique used to
remove excess lax skin from the upper and lower eyelids.
This surgical procedure is offered to the more severe cases
of skin laxity around the eyes. The Thermage Non-Surgi-
cal System lifts and tightens sagging skin without surgery
by radiofrequency heating of the skin.
As we age, our skin loses elasticity and strength
due to loss of collagen. This supporting material of the
skin [collagen] deteriorates with time and age. If the body
is tricked into replacing the collagen, the skin becomes
thicker and firmer — effecting a more youthful appear-
ance. Most commonly used for face, and eyelid skin lax-ity, the Thermage procedure may also be used to tighten
loose and sagging skin almost anywhere on the body.
The procedure employs a patented radiofrequency [RF]
similar to microwave energy to tighten and gently lift
skin to smooth out wrinkles and renew skin contours. Thesophisticated treatment tip delivers controlled amounts
of RF energy which causes our deteriorated collagen to
contract and be replaced due to simple heat denaturation
of the protein.
With each touch to the skin, the RF device uni-
formly heats a volume of collagen in the deeper layers of
the skin and its underlying tissue while simultaneously
helping to protect the outer layer of the skin from heat
with cooling. The technology is so precise, the outer skin
is cooled while the deeper skin tissue is heated. This deep
uniform heating action causes deep structures in the skin
to immediately tighten. Without damaging the surface
skin, the radiofrequency energy is absorbed by the deep-
est dermal layer of skin tissue where it tightens existing
collagen and triggers new collagen production.
Unlike lasers, the RF procedure can be per-
formed on patients of all skin types. A single treat-
ment session is all that is
needed. The tightening ef-
fect should last from two
to four years according toskin types until the cur-
rent aging process catches
up and starts skin degrada-
tion again. Most patients
experience a brief, deep
heating sensation as the RF
energy is delivered to the
skin and underlying tissue.
Normally, the complete procedure can be performed
just one session lasting from 20 minutes to two hou
depending on the treatment area and the desired resu
General anesthesia is not required, but light sedatives a
recommended prior to treatment. Most patients expe
ence only minor redness, which subsides within an ho
or so after the procedure. Over time, new and remodel
collagen is produced to further tighten skin, resulting
healthier, smoother skin and a more youthful appearan
... that glow from the fountain of youth. The Therma
procedure is available only in the offices of qualifi
physicians who specialize in surgical and non-surgic
cosmetic procedures. n
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WOMAN'S WAY - October 2008
beauty & fashion00
by James E. White, M.D., F.A.C.S.
Dr. James E. White is board certified in General
Surgery by the American Board of Surgery, is a Fellow of
the American College of Surgeons and is a Diplomat of
the American Board of Phelebology. His office, Advanced
Surgical Concepts, PLLC, Varicose Veins Solutions &
Aesthetic Skin Care, offers a variety of cosmetic pro-
cedures including facial fillers, thermage and botox. He
is located at 7446 Shallowford Road, Suite 205 in the
Hamilton Office Park, and may be contac ted at 423-
648-4011.
Sun spots: Actinic Keratosis?
Actinic keratoses (AKs) are rough, scaly tan brown patch-es on the skin, caused by excessive exposure to the sun,
that can sometimes prog-ress into dangerous skincancers. More than 10 mil-lion Americans live withthese skin lesions thinkingthat they represent “agespots”, and far too manypeople ignore them. Un-fortunately, leaving AK’suntreated can have seriousconsequences. Doctors eti-mate that 40% ofskin can-cers [squamous cell carci-nomas, the second leading
cause of skin cancerdeaths in the United States] begin asAKs. For this reason, major medical groups- The Ameri-can Cancer Society, The Skin Cancer Foundation, and the
American Academy of Dermatology — all recommendthat people with AKs seek review and treatment optionsfor them immediately.
AKs are very common on sun exposed parts ofthe face, scalp, ears, chest, back and extremities. Theypresent as rough scaly patches of tan to brown skin.Sometimes these patches can become larger and thickercalled “hyperkeratotic.” These enlarged lesions may thenprogress to changed to frank squamous cell carcinomas.Patients may notice increased redness, tenderness, itch-ing, and burning associated with the thickened roughskin. However, these symptoms can be the same foreither AKs or squamous cell carcinomas. This is whatmakes distinguishing between the two so difficult withouta simple skin biopsy. Left untreated, squamous cell car-cinomasmay become larger, go deeper into the skin, and
eventually spread to other parts of the body by the lymphnodes. This results in thousands of skin cancer deaths each
year, many of which could be prevented with appropriatesurveillance and early intervention.
It is impossible to predict if an AK will evolveinto a squamous cell carcinoma, or at which point it willhappen. Many doctors believe that AKs and squamouscell carcinomas are really the same condition at differentstages of a continuing process. This process begins withminor cell damage and, over time, ultimately results in thecell becoming cancerous. These doctors believe that AKsoccur in the early stages of the process; squamous cellcarcinomas occur in the final stage. One thing, however, iscertain: a significant percentage of AKs develop into squa-mous cell carcinomas. Estimates range from 10% to ashigh as 20% over a 10-year period of patient with knownactinic keratosis.
Long-term exposure to the sun is the single mostsignificant cause of AKs, so the best defense against themis a comprehensive sun protection program. This includeswearing protective clothing and a wide-brimmed hat,
avoiding the sun at midday when ultraviolet rays are stron-gest, staying in the shade as much as possible, andwearinga broad-spectrum sunscreen with a sun protection factor(SPF) of at least 30. Unfortunately many of us alreadyhave sun damaged skin and a more aggressive approach isneeded.
Surgical excision, freezing and electrodessicationhave been the main tools to deal with AK’s. Advancedtechnology is now available with photodynamic therapy.Levulanic Photodynamic Therapy uses photochemicalmethods to target minimally to moderately thick Grade1 or 2 AKs (AKs that have not yet become enlarged andthick). This therapy is unique because it uses light acti-vated drug therapy to destroy AK’s in their early stages.The 2-step process consists of treatment to the affectedskin with a weak acid solution which is chemically altered
by exposure to certain wavelengths of light.When levulanic acid is applied to Grade 1 or 2
AKs, the solution is absorbed by the AK cells where itis converted to a chemical that makes the cells extremelysensitive to light. Topical Solution is applied to the AK’swith incubation for the recommended time in order to al-low the solution to penetrate the target cells. Target AK’sare porous and absorb more of the levulanic acid than doesnormal skin cells.
After an incubation period, the painted skinis then treated with blue light with wavelengths in the400-450 nm, which is the second and the final step inthe treatment. The levulanic acid is changed to a toxicsubstance which kills the abnormal cells in which the acidwas concentrated during the incubation period with gentlesparing of the normal skin. Over a few days, these abnor-mal cells die, crust over and slough off with new skin asreplacement. The most common side effects include scal-ing/crusting, hypo/hyper-pigmentation, itching, stinging,
and/or burning, erythema and swelling.
Photodynamic therapy has proven very effective
for thin early actinic kerotosis skin lesions. The treatmenthas been proven to reverse the signs of early skin cancers.
Medicare as well as most insurance agencies will pay for
this valuable therapy. n
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WOMAN'S WAY - October 2008
health & wellness
25
by James E. White, M.D., F.A.C.S.
Dr. James E. White is board certified in General Surger
by the American Board of Surgery, is a Fellow of the American
College of Surgeons and is a Diplomat of the American Boar
of Phelebology. His office, Advanced Surgical Concepts, PLLC
Varicose Veins Solutions & Aesthetic Skin Care, offers a variety o
cosmetic procedures including facial fillers, thermage and botox
Located at 7446 Shallowford Road, Suite 205 in Hamilton Offic
Park, he may be contacted at 423- 648-4011.
Sun spots: Actinic Keratosis?
A
ctinic keratoses (AKs) are rough, scaly tan brown
patches on the skin, caused by excessive exposure tothe sun, that can sometimes progress into dangerous skincancers. More than 10 million Americans live with theseskin lesions thinking that they represent “age spots”, and
far too many people ignore them. Unfortunately, leavingAK’s untreated can have serious consequences. Doc-tors estimate that 40 percent of skin cancers [squamous
cell carcinomas, the second leading cause of skin cancerdeaths in the United States] begin as AKs. For this reason,major medical groups —The American Cancer Society,
The Skin Cancer Foundation, and the American Academyof Dermatology — all recommend that people with AKsseek review and treatment options for them immediately.
AKs are very common on sun exposed parts ofthe face, scalp, ears, chest, back and extremities. Theypresent as rough scaly patches of tan to brown skin.
Sometimes these patches can become larger and thickercalled “hyperkeratotic.” These enlarged lesions may then
progress to changed to frank squamous cell carcinomas.Patients may notice increased redness, tenderness, itch-ing, and burning associated with the thickened rough skin.However, these symptoms can be the same for either AKs
or squamous cell carcinomas. This is what makes distin-guishing between the two so difficult without a simple
skin biopsy. Left untreated, squamous cell carcinomasmay become larger, go deeper into the skin, and eventu-ally spread to other parts of the body by the lymph nodes.
This results in thousands of skin cancer deaths each year,many of which could be prevented with appropriate sur-veillance and early intervention.
It is impossible to predict if an AK will evolveinto a squamous cell carcinoma, or at which point it willhappen. Many doctors believe that AKs and squamous
allow the solution to pene-trate the target cells. Target
AK’s are porous and ab-sorb more of the levulanicacid than does normal skin
cells.After an incuba-
tion period, the paintedskin is then treated withblue light with wavelengths
in the 400-450 nm, which is the second and the final stepin the treatment. The levulanic acid is changed to a toxisubstance which kills the abnormal cells in which the acid
was concentrated during the incubation period with gentlsparing of the normal skin. Over a few days, these abnormal cells die, crust over and slough off with new skin as
replacement. The most common side effects include scaling/crusting, hypo/hyper-pigmentation, itching, stingingand/or burning, erythema and swelling.
Photodynamic therapy has proven very effectivfor thin early actinic kerotosis skin lesions. Treatment ha
proved to reverse the signs of early skin cancers. Medicarand most insurances pay for this therapy. n
cell carcinomas are really the same condition at differentstages of a continuing process. This process begins withminor cell damage and, over time, ultimately results in
the cell becoming cancerous. These doctors believe thatAKs occur in the early stages of the process; squamouscell carcinomas occur in the final stage. One thing, how-
ever, is certain: a significant percentage of AKs developinto squamous cell carcinomas. Estimates range from 10percent to as high as 20 percent over a 10-year period of
patients with known actinic keratosis.Long-term exposure to the sun is the single most
significant cause of AKs, so the best defense against them
is a comprehensive sun protection program. This includeswearing protective clothing and a wide-brimmed hat,avoiding the sun at midday when ultraviolet rays are stron-
gest, staying in the shade as much as possible, and wearinga broad-spectrum sunscreen with a sun protection factor(SPF) of at least 30. Unfortunately many of us already
have sun damaged skin and a more aggressive approach isneeded.
Surgical excision, freezing and electrodessica-
tion have been the main tools to deal with AK’s. Ad-vanced technology is now available with photodynamictherapy. Levulanic Photodynamic Therapy uses photo-
chemical methods to target minimally to moderately thickGrade 1 or 2 AKs (AKs that have not yet become enlarged
and thick). This therapy is unique because it uses light ac-tivated drug therapy to destroy AK’s in their early stages.The 2-step process consists of treatment to the affected
skin with a weak acid solution which is chemically alteredby exposure to certain wavelengths of light.
When levulanic acid is applied to Grade 1 or 2
AKs, the solution is absorbed by the AK cells where it isconverted to a chemical that makes the cells extremelysensitive to light. Topical Solution is applied to the AK’s
with incubation for the recommended time in order to
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WOMAN'S WAY - September 2008
beauty & fashion10
by James E. White, M.D., F.A.C.S.
Dr. James E. White is board certified in Genera
Surgery by the American Board of Surgery, is a Fellow o
the American College of Surgeons and is a Diplomat
the American Board of Phelebology. His office, Advance
Surgical Concepts, PLLC, Varicose Veins Solutions &
Aesthetic Skin Care, offers a variety of cosmet ic pro
cedures including facial fillers, thermage and botox. H
is located at 7446 Shallowford Road, Suite 205 in th
Hamil ton Office Park, and may be contac ted at 423
648-4011.
Spider veins
D
uring the height of summer, many of us put on short
and bathing suits, eager to expose our lower limbsto the light of day that we
have longed for all winter.
But for the estimated 80
million adults in the Un-
tied States who suffer from
spider and varicose veins,
summer may be a time to
draw attention away from
the legs.
Spider veins, also
known as telangiectasia,
or broken capillaries, form
when groups of blood ves-
sels close to the surface of the skin dilate and break. As
a result, fine-lined networks of red, blue or purple veins
— each barely more than the width of a hair — appear onthe thighs, calves and ankles. The veins may form patterns
resembling a sunburst, a spider web, or a tree with branch-
es, but can also emerge as short, unconnected lines.
Although physicians don't know exactly what
causes spider veins, they do know some risk factors for
developing them. Spider veins tend to run in families. If
your mother or sister has them, you likely will too. Es-
trogen also may play a role (by relaxing the vein walls),
which could explain why women are more likely to get
spider veins than men. The upsurge of hormones at pu-
berty, birth control pills, pregnancy and hormone replace-
ment therapy all have been connected to the development
of spider veins. Age also makes one ripe for the condition.And an injury, such as being hit in the leg with a softball,
increases the chance of developing spider veins later in
that same area — even if that injury occurs early in life.
Spider veins can be treated and eliminated with
two major forms of therapy: sclerotherapy and surface la-
ser light treatments. Before treatment begins, a plan of at-
tack must be formulated. First a physical examination and
ultrasound examination should be completed to determine
the source of the spider veins. Often time patients have
sclerotherapy or laser procedures completed with some
results and decrease of the spider veins, just to have the
veins reappear in a few months. In these cases, the source
for the vein pressure wells from below the skin surface in
a web of veins called reticular veins. If the larger reticular
veins are not dealt with, the surface spider veins will never
go away. Larger reticular veins and spider veins can be
closed using ultrasound guided foam sclerotherapy. A
foamy sclerosant solution is injected directly into the larg-
er reticular veins and spider veins. Ultrasound guidance is
used for the deeper veins. The foam sclerotherapy solution
causes a chemical burn to the small veins. The veins col-
lapse and with compression stick together. The vein walls
heal together causing the vein to no longer act as a vein.
The body absorbs the tissue over a few months. Sclero-
therapy solutions have been around since the turn of th
century. Saline — strong salt solutions — were used unt
more advanced sclerosant medications have yielded bette
results. Small, fine spider veins or telangiectic matts ca
be addressed with topical lasers or intense pulsed ligh
(IPL). Laser therapy for spider veins is mainly directe
at post sclerotherapy clean-up to address veins that are s
small a needle can not be placed into the vessel for solu
tion injection. IPL uses intense light in the laser range t
safely penetrate the outer surface of the skin. Varicos
veins and spider veins have different coloration than th
surrounding skin. Red and blue colors absorb the energ
from the laser light, causing the vein walls to be supe
heated. The heat causes the veins to collapse and wit
compression stick together. Physician review and ultra
sound mapping are primary to determine the best ap
proach for the elimination of unsightly spider veins. n
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beauty & fashionWOMAN'S WAY - August 200822
by James E. White, M.D., F.A.C.S.
Dr. James E. White is board certified in Genera
Surgery by the American Board of Surgery and is a Fellow
of the American College of Surgeons. His office, Advanced
Surgical Concepts, PLLC, Varicose Veins Solutions &
Aesthetic Skin Care, offers a variety of cosmetic procedure
including facial fillers, thermage and botox. He is located
at 7446 Shallowford Road, Suite 205 in the Hamilton Office
Park, and may be contacted at 423-648-4011.
Neck liposuction
A
s we age, certain areas of the body can accumulate
fat that is hard to lose, in spite of a healthy diet andvigorous exercise. The neck is one such area. Fat deposits
in the neck can detract from the appearance of the entire
body, making a younger person seem older, or a fit person
seem out of shape. Liposuction can give this area a new
streamlined contour, enhancing the effect of facial features
and improving the facial profile. Patients who have been
self-conscious about their bulging necklines often feel more
comfortable wearing a range of clothing and jewelry styles
after liposuction. Neck liposuction produces consistently
good results and has a particularly high satisfaction rate.
During the initial consultation, your surgeon will
talk with you about the changes you would like to make in
your appearance. He should explain the different options
available, the procedure itself, its risks and limitations andcosts. You should have a physical examination to evaluate
your overall weight, your skin and muscle tone and the
pattern of distribution of fat deposits. Be sure to ask all
the questions you have about the procedure, and ask to
see photos of the doctor’s recent patients, before and after
treatment. Learning everything you can about your op-
tions, risks and benefits is the key to making an informed
decision.
Before surgery, the surgeon will mark the precise
areas of the body where the fat is to be removed. Before
and after photographs should be taken. An intravenous
(IV) line will be inserted in a vein in your arm to make
sure the fluid level in your body stays within healthy limits
throughout the procedure. Neck liposuction is very safe
and can be completed in an office setting surgical suite.
You may be given sedatives for relaxation in addition tonumbing medications for local anesthesia.
During the procedure, the surgeon makes tiny
incisions (1-2mm in diameter) in the skin, typically in
the crease just under the chin or behind the ear lobes and
low in the neck. A thin tube called a cannula is inserted
into the fatty area. The cannula is used to break up the fat
deposits and sculpt the area to the desired proportions. The
newest liposuction techniques involve the placement of a
laser fiber or an ultrasound probe through an open ended
cannula. Laser energy or high frequency ultrasound en-
ergy is delivered directly to the fatty tissues. This focused
high level energy causes the fat to be emulsified making
suction removal easier. The
unwanted fat is removed
with a high suction vacuum,
leaving the skin, muscles,
nerves and blood vessels in-
tact. The high level energy
delivered by the laser fiber
or by ultrasound can also
be used to heat the under-
surface of the skin — thus
leading to skin retraction
and skin tightening.
The face and neck
are usually the first features we notice when we meet some
one new, so improvements in this area can create a dramatic
change. A firm, trim neck gives the face a more youthfu
look. Sometimes just having this neck liposuction done
provides an incentive to make healthier lifestyle choice
and maintain fitness in the rest of the body. n
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by James E. White, M.D., F.A.C.S.
Dr. James E. White is board certified in Gener
Surgery by the American Board of Surgery and is a Fello
of the American College of Surgeons. His office, Advance
Surgical Concepts, PLLC, Varicose Veins Solutions
Aesthetic Skin Care, offers a variety of cosmetic procedure
including facial fillers, thermage and botox. He is located a
7446 Shallowford Road, Suite 205 in the Hamilton Offic
Park, and may be contacted at 423-648-4011.
Face the music
Tumescent liposuction of the face and neck are lesscomplex surgical procedures completed in the
office to remove unwanted
fat deposits. The phrase
liposuction of the “face
and neck” is somewhat
misleading. To be more
specific, liposuction in
this general area involves
the submental (below the
jaw) chin, the jowls and a
small area of the cheeks.
Women who have local
deposits of subcutaneous
fat in the face and neck and
who have excessively wrinkled skin will often get better
results from liposuction combined with either a laserresurfacing or a chemical peel, than they would from
a facelift. Younger women who have good skin elasticity,
liposuction alone can also produce dramatic improvement
and is a much simpler and safer procedure than a facelift.
Men often choose tumescent liposuction over a facelift
because the tell-tail scars and the surgical-look of a facelift
are difficult to hide with short hair and are not acceptable
for a man.
Not all patients are good candidates for liposuction of the
face and neck. For some patients a mid-face lift would be
the preferred procedure according to the goals for facial
rejuvenation. Short scar mid facelift may be pre- ferred by a
woman who has large folds of skin on the neck withlittle subcutaneous fat. Submental chin includes the
area below the margin of the jaw, and extends onto
the front of the neck. Regardless of one’s age, an inherited
localized collection of excess fat beneath the chin makes
one look chubby, older and less athletic. Liposuction is
usually the simplest, safest and least expensive way to treat
this cosmetic problem.
Jowls represent a small focal accumulation of fat on the
lower cheek overlying the jaw bone. Prominent jowls
make a person look old and are a cosmetic concern for both
women and men. Cheeks with too much subcutaneous fat
can make a person appear chubby. These types of fat
deposits are usually the result of an inherited tendency that
is resistant to exercise and diet. Tumescent liposuction using
very small cannulas (less than 1.5 mm in diameter)
can correct this cosmetic problem totally by local anesthesiaand with virtually no scars.
Liposuction does not eliminate facial wrinkles, but there are
modern cosmetic facial resurfacing techniques that do.
Facial wrinkles, blotchy pigmentation and acne scars can all
be treated by any one of several techniques, including laser
resurfacing, chemical peel, dermabrasion or a combination
of these techniques. A combination of liposuction plus
wrinkle removal can often provide a better overall
cosmetic improvement with less down time than a
formal facelift.
The tiny incisions used for liposuction of the neck
and face do not require sutures. Not closing in- cision
with sutures and allowing open drainage of the blood-tinge
anesthetic solution minimizes postoperative bruising anedema. Absorptive pads are applied to absorb th
drainage and are held in place by an elastic compressio
garment. An elastic compression garment is worn afte
liposuction of face and neck during the first 18 t
36 hours after surgery. As soon as the drainage has ceased
a compression garment is no longer necessary. I
the old days of liposuction, surgeons required that patien
wear a compression garment for two to six week
but there is no evidence that this prolonged compressio
provides any benefit.
Tumescent liposuction is the safest and usually the mo
effective technique for removing fat from the chin, cheek
and jowls. Liposuction involves fewer complications, fewe
scars, avoids the dangers of general anesthesia, has a mo
rapid recovery, lowers cost, and typically gives a mor
natural appearance when compared to a formal facelift.
beauty & fashionWOMAN’S WAY - June/July 200830
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beauty & fashionWOMAN’S WAY - May 200818
by James E. White, M.D., F.A.C.S.
Dr. James E. White is board certified in Gener
Surgery by the American Board of Surgery and is a Fello
of the American College of Surgeons. His office, Advance
Surgical Concepts, PLLC, Varicose Veins Solutions
Aesthetic Skin Care, offers a variety of cosmetic procedur
including facial fillers, thermage and botox. He is located
7446 Shallowford Road, Suite 205 in the Hamilton Offic
Park, and may be contacted at 423-648-4011.
Scratch the surface
Skin that is smooth and supple with a warm glow is a
sure sign of youth. As we age, our skin is marked
with reminders of our past
experiences. The canvas
of skin tells a tale of our
sun exposure, wrinkles,
superficial scars caused
by acne, surgery or trauma.
The etched skin surface
is then painted by color
(pigment) changes or
defects in the skin, such
as liver spots or coffee
spots and tattoos. Stressed
by smoking and environ-
mental chemicals, all combined, our skin shows the signs
of aging.
Skin repair techniques have been around for centuries:
chemical peels were very popular in the early part ofthe 20th century, but with a price: scarring and pigment
changes. Now safer high tech laser resurfacing techniques
result in consistent skin resurfacing, also with a price: the
cost of technology. Each technique, from chemical peels
to laser resurfacing, have similar properties. They cause
controlled damage to the skin, causing the underlying
skin to rapidly reproduce and slough off the old damaged
skin, resulting in new, more youthful skin in place of the
timeworn and etched skin.
Laser resurfacing uses heat induced by laser light to destroy
and remove (vaporize) the upper layers of the skin. This
causes new skin to grow. It is typically used to remove or
improve the appearance of wrinkles, shallow scars (from
acne, surgery or trauma), tattoos and other skin defects.
The laser sends out brief pulses of high-energy light
that are absorbed by water and certain substances in the
skin called chromophores. The light is changed into heat
energy, and the heat then vaporizes thin sections of skin,
layer by layer. As the wounded area heals, new skin grows
to replace the damaged skin that was removed during the
laser treatment.
The CO2 (carbon dioxide) laser is the most common type of
laser used for resurfacing. Fractionated lasers are also used
frequently and are growing in popularity because they do
a similar job, but penetrate less deeply and therefore heal
more quickly. Laser resurfacing is usually very precise and
causes little damage to the surrounding skin and tissue. It is
done most often on the face, but it may be done on skin in
other areas of the body. Laser resurfacing is usually done in
a doctor’s office. The time needed for healing and recovery
after laser resurfacing varies according to the size and depth
of the treated area.
Chemical peeling is completed by applying a chemical
solution to the skin. Mild scarring and certain types
of acne may be treated. The procedure enables new,
regenerated skin to appear, improving the appearance ofthe condition. Chemical peels are generally recommended
for discoloration caused by acne, not deep pitted scars.
Commonly used chemical peels are glycolic and lactic acid,
which are also available for home use.
Subcision (undermining), needling with dermabrasion
are used for depressed scars, pitted scarring and ice pick
type scars. During a subcision session, a small needle is
used to break up the scar tissue underneath the depression.
Subcision along with needle rolling are highly effective
methods in the treatment of depressed scars, but usually
require multiple sessions depending on the number and
depth of the scars. These sessions are normally spaced four
weeks apart, and require five to seven days downtime after
the procedure.
Skin manipulation techniques have been used by physician
for decades. When used correctly, the techniques fool th
skin to insight repair without scarring, pigment changes
significant down time. n
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beauty & fashionWOMAN’S WAY - April 200810
by James E. White, M.D., F.A.C.S.
Dr. James E. White is board certified in Gener
Surgery by the American Board of Surgery and is a Fello
of the American College of Surgeons. His office, Advanc
Surgical Concepts, PLLC, Varicose Veins Solutions
Aesthetic Skin Care, offers a variety of cosmetic procedu
including facial fillers, thermage and botox. He is located
7446 Shallowford Road, Suite 205 in the Hamilton Offi
Park, and may be contacted at 423-648-4011.
L
aser resurfacing uses heat induced by laser light to
destroy and remove (vaporize) the upper layers ofthe skin. This causes new
skin to grow. It is typically
used to remove or improve
the appearance of wrinkles
shallow scars (from acne,
surgery or trauma) and
other skin defects. The
laser sends out brief pulses
of high-energy light that
are absorbed by water and
certain substances in the
skin called chromophores.
The light is changed into
heat energy, and the heat then vaporizes thin sections of
skin, layer by layer. As the wounded area heals, new skin
grows to replace the damaged skin that was removed during
the laser treatment.
The CO2 (carbon dioxide) laser is the most common type of
laser used for resurfacing. Fractionated lasers are also used
frequently and are growing in popularity because they do
a similar job, but penetrate less deeply and therefore heal
more quickly with little or no down time. Laser resurfac-
ing is usually very precise and causes little damage to the
surrounding skin and tissue. It is done most often on
the face, but it may be done on skin in other areas of the
body like the chest, back and hands.
The areas to be treated by laser resurfacing are cleaned and
marked with a pen. A nerve block with a local anesthetic is
usually used to numb the area before treatment. You may
also be given a sedative or anti-anxiety medication. If your
entire face is going to be treated, you may need stronger
Treatment of scars and wrinklesanesthesia (in some cases, general anesthesia), pain relievers
or sedation. You may be given goggles to wear to prevent
eye damage by the laser. The laser is passed over the skin,
sending out pulses. Each pulse lasts less than a millisec-ond. Between passes with the laser, the skin may be cooled.
The number of passes required depends on how large the
area is and what type of skin is being treated as well as
the type laser used for the treatment. Thin skin around the
eyes, for instance, requires very few passes with the
laser. Thicker skin or skin with more severe lesions requires
a greater number of passes. The pulses from the laser may
sting or burn slightly, or you may feel a snapping sensation
against your skin. Laser resurfacing is usually done in
a doctor’s office or out-patient surgery center.
Laser resurfacing may be used to remove or improve the
appearance of:
• Wrinkles
• Superficial scars caused by acne, surgery or trauma that
are not growing or getting thicker
• Color (pigment) changes or defects in the skin, such as
liver spots (lentigines), port-wine stains or coffee spots.
(Any growth that could be malignant should be evaluated
using a biopsy before laser resurfacing is done.)
In general, laser resurfacing tends to have good results w
fairly low risks. Wrinkles caused by aging and long-ter
sun exposure, such as those around the eyes and moutrespond well to laser resurfacing. The long-term results f
these types of wrinkles are unknown, and you should ke
in mind that new wrinkles will probably appear as your sk
continues to age. Wrinkles caused by repeated moveme
and muscle use (such as those on the forehead or along t
sides of the nose) may be improved but not eliminated. Th
often come back months or years after treatment becau
the muscles continue to perform the activities that caus
the wrinkles before treatment. n
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beauty & fashionWOMAN’S WAY - February 20088
by James E. White, M.D., F.A.C.S.
Dr. James E. White is board certified in Gener
Surgery by the American Board of Surgery and is a Fello
of the American College of Surgeons. His office, Advance
Surgical Concepts, PLLC, Varicose Veins Solutions
Aesthetic Skin Care, offers a variety of cosmetic procedur
including facial fillers, thermage and botox. He is locate
at 7446 Shallowford Road, Suite 205 in the Hamilton Offic
Park, and may be contacted at 423-648-4011.
Minimal invasive tumescent liposuction
Liposuction is the most commonly performed cosmetic
procedure in the United States. Liposuction or
liposculpture is defined as
the removal of fat from
deposits beneath the skin
using a hollow stainless steel
tube (called a cannula) with
the assistance of a powerful
vacuum. Liposuction can
be accomplished either
with the use of general
anesthesia in a hospital/
outpatient surgery center, or
with heavy IV sedation, or
totally by local anesthesia in a surgery office setting.
Tumescent liposuction refers to a technique of liposuction
that uses larger volumes of very dilute local anesthesia fluid
which is injected into the fat, causing the targeted areas to
become tumescent, or swollen and firm. Along with thetumescent effect, the area and covering are anesthetized or
totally numb. If used in safe doses, large areas of fat can be
removed using local anesthesia alone in a surgery office
setting without the need for general anesthesia.
The ideal candidate for tumescent liposuction is physically
fit and eats well-balanced meals, but is unable to reduce
a fatty deposit that is well localized and often seems to
involve a genetic susceptibility. In the past, surgeons
completed liposuction under general anesthesia removing
large volumes of fat at one mega surgical session; the
surgery required blood transfusions because blood
loss in the aspirate was significant. Dr. Jeffery Klein, a
dermatologic surgeon, is credited as the originator of the
tumescent technique in the 1980s. This technique has
allowed liposuction to be performed with the patient under
local anesthesia while minimizing blood loss and the risks
of general anesthesia. Since its inception, liposuction
performed with the tumescent technique has had an
excellent safety profile.
Traditional liposuction cannulas (stainless steel tubes)
have a relatively large diameter and remove large volumes
of fat rather quickly. However, with the use of large
cannulas (diameter greater than three millimeters), there
is an increased risk of irregularities and depressions in the
skin post procedure. The tumescent technique permits the
use of small microcunnulas which in turn yield smoother
cosmetic results. Microcannulas with a diameter less than
three millimeters allow fat to be removed in a smoother and
more uniform fashion. Some surgeons prefer larger cannulas
under general anesthesia because it allows liposuction to be
performed more quickly. But with any artistic media, quick
is not necessarily better.
With general anesthesia, pain is apparent the moment
that the patient awakes from anesthesia; these patients
usually require narcotic medications for pain control.
Patients who undergo tumescent liposuction generally
do not require narcotic medications post procedure as the
tumescent anesthetic effect may last as long as 24 hours after
completion of the liposculpture. The tumescent technique for
liposuction is unquestionably the safest form of liposuction
when performed correctly (not excessively). As opposed
to general anesthesia techniques for liposuction, there
have been no reported deaths associated with tumescent
liposuction totally by local anesthesia techniques.
Tumescent liposuction patients must have realistic
expectations. The ideal candidate is only 20-30 lb.
overweight with focal adipose accumulations unresponsive
to diet and exercise. Common anatomic areas for liposucti
include the upper and lower abdomen, the flanks (lo
handles), breast, outer and inner thighs, inner knees, arm
and back, the neck, ankles and calves.n
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health & wellnessWOMAN’S WAY - January 2008 2
by James E. White, M.D., F.A.C.S.
Dr. James E. White is board certified in Gener
Surgery by the American Board of Surgery and is a Fello
of the American College of Surgeons. His office, Advance
Surgical Concepts, PLLC, Varicose Veins Solutions
Aesthetic Skin Care, offers a variety of cosmetic procedur
including facial fillers, thermage and botox. He is located
7446 Shallowford Road, Suite 205 in the Hamilton Offic
Park, and may be contacted at 423-648-4011.
Endovenous laser therapy for varicose veins
Up to 40 percent of women and 18 percent of men
have problems with severe varicose veins. Slow
stagnate venous blood
return to the heart often
causes leg aches, burning
pain, stinging pain and,
with time may lead to non-
healing skin ulcerations
of the distal limbs. The
bulging blue and sprawl-
ing ropy varicose veins
that prompted your “no
shorts” rule can now be
effectively resolved without
fear of surgery, pain or long
recovery periods, thanks to endovenous laser treatment
(EVLT). Before EVLT, vein stripping surgery was themainstay of vein therapy, along with compression stockings.
In place of the “stripping” surgical procedures that required
the leg to be cut open and faulty veins to be cut out, the new
EVLT laser procedure is minimally invasive and neither
is necessary.
Evaluation of symptomatic varicose veins starts with a
detailed history and physical examination. A detailed
ultrasound review of the lower extremities is completed to
map out the limb veins to determine the site of the faulty
valves and their relationship to the varicose veins. The veins
are not constant like arteries; each person has unique vein
patterns and unique varicose vein problems. A personalized
attack plan is necessary with ultrasound mapping to plan
efficient eradication of the problem varicose veins.The endovenous laser treatment costs less than traditional
stripping surgery for varicose veins and usually takes less
than two hours to complete. EVLT can be administered
in an outpatient setting without general anesthesia and
minimal scarring. Ultrasound is used to map out the
main veins at the time of EVLT. After a local anesthetic is
applied, a thin laser fiber passes through a needle injected
into the leg (usually near the knee). The faulty vein or veins
are then sealed using high energy laser techniques.
The limbs are then wrapped for a short period of time
with compression wraps. Sometimes, EVLT is used in
conjunction with sclerotherapy where a sclerosing
solution is injected into small spider veins. This causes
the small veins to seal, allowing for a better cosmetic final
result.
But, before you stop shopping for shorts again, your
condition first needs to be properly evaluated to ensure
that you are a candidate for EVLT laser therapy. This
procedure is not for spider veins or for cosmetic reasons.
The patients who are best candidates for EVLT laser therapy
have significant ropy varicose veins which cause the
symptoms of burning, stinging, heavy leg sensations along
with leg swelling, and who have failed more conservative
treatment options.
Not every patient is a good candidate for EVLT, but it
does work well for most. Traditional surgery still has
its advantages for some (more severe) cases. Based on
physical exam and a detailed ultrasound, your physician
should be able to find out if the EVLT procedure would
be the right course of action for you. Most insuran
carriers and Medicare cover payment for varicovein therapies as long as it is medically necessary and n
just for cosmetic reasons. n
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WOMAN’S WAY - December 2007
beauty & fashion19
by James E. White, M.D., F.A.C.S.
Dr. James E. White is board certified in Genera
Surgery by the American Board of Surgery and is a Fellow
of the American College of Surgeons. His office, Advanced
Surgical Concepts, PLLC, Varicose Veins Solutions &
Aesthetic Skin Care, offers a variety of cosmetic procedures
including facial fillers, thermage and botox. He is located a
7446 Shallowford Road, Suite 205 in the Hamilton Office
Park, and may be contacted at 423-648-4011.
Hope in a jar
N
ew anti-aging skin creams claim to do as much as
medical and surgical procedures, but can they reallydeliver the same wrinkle-
relaxing, age-defying
re-sults as some pricey
filler injections, Botox or
surgery? If you’re skeptical
about what you see in
print or on the internet,
you’re not alone.
U n l ike me d ic a t ions ,
cosmeceuticals are not
regulated by the Food
and Drug Administration
(FDA). Drug companies are
required by the FDA to perform extensive trials and testing
prior to claims of performance or efficacy of the medication.
The cosmetic industry has little or no regulations; making itdifficult to find substantial trials and testing of “creams,
serums, potions and cosmeceuticals,” having stated the
disclaimer for testing. Skin cream technology for the most
part is focused on a few areas: collagen production,
healing and antioxidants.
One of the major ways our skin ages is through the loss of
collagen, a naturally occurring substance that keeps
our skin looking plump, lifted and smooth. The collagen is
a scaffolding which supports our skin. As time ticks by, we
lose some collagen because of natural aging, sun exposure,
smoking and pollution. These exposures increase the rate at
which our natural cellular process occurs. The cell aging
process releases molecules called “free radicals” or oxidantsinto the skin. The link to aging? Free radicals attack and
destroy additional collagen support structures, and
without that support, skin sags and forms wrinkles.
Many creams claim to increase the collagen content of our
skin. One problem, penetration of the outer skin. Our skin
is a barrier maintained between us and the environment
which makes us water tight, limiting water based liquids
from entering or exiting the body. So how do creams
“penetrate” the skin? Water based moisturizers stay on the
surface with little penetration of the outer surface of the
skin. Deep penetration into the skin requires more
expensive synthetic peptides with fatty acids. The fatty
acids allow products to be transported to the deeper layer of
skin. Once the product is delivered to the skin, companies
claim increased collagen production in 4-12 weeks.
Limited studies have shown that collagen is produced withthe creams, but not anywhere near what happens during
collagen production with wound healing.
On the front lines of anti-aging is a group of antioxidants.
Antioxidants attack oxidants, free radicals before they have
a chance to destroy our collagen supply. An ingredient
derived from the “coffee berry” is now hailed as the
strongest antioxidant with the most powerful anti-aging
ingredient to date. The same coffee which wakes you up
in the morning, may also add a kick to your complexion.
Coffee berries contain high levels of antioxidants. But are
these and other antioxidant advances enough to guarantee
anti-aging results?
Before you reach for hope in a jar, take a critical look atyour facial skin. If you have never used anything on your
face, you are probably more likely to see results simply
because you are doing something for your skin. A Consumer
Reports investigation found the current crop of anti-
aging creams fall short of delivering on their “promises”
— a conclusion shared by some cosmetic doctors.
Cosmeceuticals can do some wonderful things for the skin
by diminishing brown spots, improving skin texture and
making the skin feel smooth again. Cosmeceuticals have
limited effects in filling wrinkles. Until published medical
studies are available, it may be up to consumers to decide
for themselves if even the cosmetic results have merit from
the cosmeceutical.
The best hope in a jar at this point: 1) stay out of the sun;
2)wear sunscreen; 3) keep your skin well moisturized; 4)
use estrogen replacement. Are we closer to the proverbial
Fountain of Youth? The answer, it seems, depends onwhether you need a trickle or a roaring river from the
fountain.n
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WOMAN’S WAY - November 20074
health & wellness
by James E. White, M.D., F.A.C.S.
Dr. James E. White is board certified in Gener
Surgery by the American Board of Surgery and is a Fello
of the American College of Surgeons. His office, Advanc
Surgical Concepts, PLLC, Varicose Veins Solutions
Aesthetic Skin Care, offers a variety of cosmetic procedu
including facial fillers, thermage and botox. He is located
7446 Shallowford Road, Suite 205 in the Hamilton Offi
Park, and may be contacted at 423-648-4011.
Skin cancer: See spot. See spot change. See a surgeon.
A
bout a million people in the U.S. are diagnosed with
skin cancer every year. According to current estim-ates, 40 to 50 percent of
Americans who live to age
65 will have skin cancer at
least once in their lifetime.
Although anyone can get
skin cancer, the risks are
greatly increased if you
have fair skin that freckles
easily — often with red or
blond hair and blue or light-
colored eyes. Fortunately,
even though skin cancer is
the most common type of
cancer, it is not the reason for most cancer deaths.
The two most common kinds of skin cancer are basal cell
carcinoma and squamous cell carcinoma — often called
non-melanoma skin cancer. Basal cell carcinoma accountsfor more than 90 percent of all skin cancers in the U.S. It
is a slow-growing cancer that seldom spreads to other parts
of the body. Squamous cell carcinoma also rarely spreads,
but does so more often than basal cell carcinoma.
Melanoma is another type of cancer that occurs in the
skin in the melanocytes or the pigment cells. Of the three,
melanoma is the most aggressive, and with metastasis can
result in death.
Ultraviolet (UV) radiation from the sun is the main cause of
skin cancers. Even artificial sources of UV radiation, such
as sunlamps and tanning beds, have been linked to causes of
skin cancer. People who live in areas that get high levels of
UV radiation from the sun are more likely to get skin cancer.
And, as you guessed, in fair skin colored people.Most skin cancer appears after age 50, but the sun’s
damaging effects begin at an early age. Therefore,
protection should start in childhood. Protective clothing
such as sun hats and long sleeves can block out the sun’s
harmful rays. Also, lotions that contain sunscreen can
protect the skin. Sunscreens are rated in strength according
to a sun protection factor (SPF) which ranges from 2 to
30 or higher. Those rated 15 to 30 block most of the sun’s
harmful rays.
Surgery is often used as a treatment for skin cancer. There
are several types of surgery depending on the stage and
location of the cancer. Shave biopsy — simple excision
and formal excision of suspicious skin lesions — are the
first steps for diagnosis and treatment. Management of
skin cancer is based on the cell type, location of the tumor
and extent of the tumor. Superficial skin cancers can
often be “cured” by surgical excision alone. Dysplasticor abnormal appearing moles are sampled using a scalpel.
The skin sample is sent off for a more detailed microscopic
control so it can be determined whether all cancer has been
removed.
When the doctor suspects a cancer has gone beyond stage
0, samples of the nearest lymph nodes may also be taken
using a biopsy. The surgery is normally done using local
anesthetic as an in-office procedure. The removed moles
or skin samples will be analyzed and if they prove to be
melanoma cancer, it may be necessary to have a second
surgical operation to remove the entire melanoma, includi
some of the health skin around it to allow for safety marg
Possible treatments for advanced melanoma tumors a
chemotherapy or radiation. At least 80 to 90 percent of patients who have been diagnosed with a melanoma canc
can be cured with a good prognosis.
Develop a regular routine to inspect your body for any sk
changes. If any growth, mole, sore or skin discolorati
appears suddenly or begins to change, see a surgeon. Ea
of the skin cancer types can be treated if detected early. T
ABCs of skin cancer include:
A - Asymmetry. You should notice the general look of yo
moles or growth. For example, if one half of the mole
growth does not match the other half.
B - Border irregularity. If the edges of the growth a
ragged, notched or blurred.
C - Color. The pigmentation of the growth is not unifor
Shades of tan, brown and black are present. Dashes of re
white and blue add to the mottled appearance.
D - Diameter. A width greater than six millimeters (abo
the size of a pencil eraser), can be an indicator of
abnormal skin growth. Generally, any new mole growth
non-healing skin ulcer should be a concern. n
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WOMAN’S WAY - October 2007 1
beauty & fashion
by James E. White, M.D., F.A.C.S.
Dr. James E. White is board certified in Genera
Surgery by the American Board of Surgery and is
Fellow of the American College of Surgeons. His office
Advance d Surgi cal Conc epts , PLLC, Varicose Vein
Solutions & Aesthetic Skin Care, offers a variety of cosmeti
procedures including facial fillers, thermage and botox
The office is located at 7446 Shallowford Road, Suit205 in the Hamilton Office Park. He may be contacted a
423-648-4011.
Melasma: The mask of pregnancy
Melasma is an acquired hyperpigmentation of sun-
exposed skin areas, or in plain English, “dull brownspots.” It presents as symmetric hyperpigmented spots
which can be separated or
bunched together along
the cheeks, nose, the upper
lip, the chin and the fore-
head, and can occasionally
occur in other sun-exposed
locations. Melasma spots
are dark, irregular brown-to-
black patches that gradually,
over time, may develop into
mask-like patterns.
The exact cause of
melasma is uncertain. In
many cases, there is a direct relationship with female
hormonal activity because melasma occurs with pregnancy
and with the use of oral birth control pills. Other
factors related to melasma include “sun” sensitizing
medications, mild ovarian or thyroid dysfunction, and
certain cosmetics.
Yet the most important factor in the development
of melasma is exposure to sunlight. Without the strict
avoidance of sunlight, potentially successful treatments
of melasma are doomed to fail. Tanning bed exposure has
increased the incidence of melasma in the United States.
Melasma, though distressing, is a benign process.
Melasma is rare before puberty and most commonly
occurs in women during their reproductive years. Although
it can affect anyone, melasma is particularly common in
women, especially pregnant women and those who are
taking oral contraceptives or hormone replacement therapy
with facial peels using alpha hydroxy acids or chemica
peels with glycolic acid. Yet, some of the most dramati
changes in melasma spots have been attained with laser ski
resurfacing treatments. In all of these treatments, the effectare gradual and a strict avoidance of sunlight is require
before, during and after completion of therapy. The use o
broad-spectrum sunscreens with physical blockers such a
titanium dioxide and zinc dioxide is preferred over that wit
other chemical blockers. This is because UV-A, UV-B an
visible lights are all capable of stimulating pigmen
production. Say goodbye to the tan beds! Last, but not leas
cosmetic makeup can be used to reduce the appearanc
of melasma. Melasma, though annoying, has no know
relationship to skin malignancy. n
(HRT) medications. It is much more common in women
than in men; in fact, women are affected in 90 percent of
cases. When men are affected, the clinical presentation
is identical. Melasma does not cause any other symptomsbeyond the cosmetic discoloration. However, the facial
discoloration can be devastating.
Persons of any race can be affected by melasma,
however, it is much more common in people of darker
skin types than in lighter skin types, and it may be more
common in light brown skin types from areas of the world
with intense sun exposure. Melasma is also prevalent in men
and women of Native American descent (on the forearms)
and in men and women of German/Russian Jewish descent
(on the face).
Melasma is usually diagnosed by a physician visually
or with assistance of a Wood’s lamp (black lamp). Under
the Wood’s lamp, excess melanin pigments in the epidermis
can be identified. Some melanin deposits are superficial in
the skin while others may be deep in the dermis. The deeper
the pigment deposits, the more difficult it is to treat. The
discoloration of melasma usually disappears spontaneously
over a period of several months after giving birth or
stopping the oral contraceptives or hormone replacement
therapy.
Treatments to hasten the fading of the discolored
patches include; topical depigmentation creams, acid peels,
and laser skin resurfacing. Depigmentation creams such
as hyproquinone (HQ) can be used directly on the dark
spots. HQ is a chemical that inhibits a specific enzyme
involved in the production of melanin pigments. Acids
ointments are used to increase skin cell turn-over, pushing
the brown discolorations to the surface so rapidly that it
results in pigment fading. Other acid treatments are thought
to decrease the activity of melanocytes or pigment cells.
When topical treat-ments fail, most patients proceed
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WOMAN’S WAY - September 2007
beauty & fashion
by James E. White, M.D., F.A.C.S.
Dr. James E. White is board certified in Gener
Surgery by the American Board of Surgery and is a Fello
of the American College of Surgeons. His office, Advance
Surgical Concepts, PLLC, Varicose Veins Solutions
Aesthetic Skin Care, offers a variety of cosmetic procedur
including facial fillers, thermage and botox. The office
located at 7446 Shallowford Road, Suite 205 in the HamiltoOffice Park. He may be contacted at 423-648-4011.
Fractionated skin resurfacing by cutting edge technology
As we age, the accumulative effects of wear and tear
damage begin to show in our skin. We loose the glow of
youth to be replaced by aged
leather-like skin with areas
of color blemishes. Skin
resurfacing has been used
to trick the body to replace
the old skin with new skin.
Deep chemical peels and
CO2 laser skin resurfacing
are techniques that have
been used as ablative skin
resurfacing. Basically, the
upper layers of the skin are
“burned” by the chemical
peel or laser like a second-degree burn. The upper layers of
skin slough off over three to four weeks, being replaced by
new pink, smooth skin. The results are impressive; however,the down time and pain involved is extensive.
Recent technology with laser fractionation has
decreased the down time to a minor outpatient procedure
with minimal discomfort, resulting in 12 hours of skin
pinkness without all the slough. Laser energy is passed
through a special lens causing the laser energy to fractionate
into thousands of microbeams. These microbeams penetrate
the upper layers of the skin surface to cause areas of
microtreatment zones which the body replaces with new
skin.
Think of pixels in a digital photograph when you
think of fractionated skin resurfacing. If you look at a
digital image in extreme magnification, you’ll see that the
image is actually comprised of thousands of tiny spots of
color (pixels). Similarly, fractionated laser skin resurfacing
produces thousands of tiny treatment zones on the skin
known as microthermal zones. These laser microbeams
penetrate deep into the dermis and eliminate old epidermal
pigmented cells. The fractionated laser is so precise that it
penetrates through the outer layers of the skin as if it were a
window and leaves it and the surrounding tissue completely
intact.
This “fractional” treatment allows the skin to heal
faster than if the entire area were treated at once, using the
body’s natural healing process to create new, healthy tissue
to replace skin imperfections. Just as a damaged painting is
delicately restore one small area at a time, or a photographic
image is altered pixel by pixel, fractionated laser treatments
improve your appearance by affecting only a fraction of
your skin at a time with thousands of tiny microscopic laser
spots.
Fine to deep wrinkles, acne pitting scars, old surgicalscars, discolorations and rough skin texture are just a few of
the areas improved by fractionated laser treatments. Laser
treatment targets between 20 and 25 percent of the skin’s
surface at each treatment. Clinical studies suggest that,
on average, an effective treatment regimen is four to six
treatment sessions spaced about two to three weeks apart.
Depending upon your condition and schedule, you and
your physician may choose to space treatment sessions
even further apart. Results are immediate and progressive.
Optimal improvement is usually visible in four to six
months after completion of the treatment series. Because
fractionated laser treatments spare the healthy tissue, it is
effective even on delicate skin areas, such as the neck, che
and hands.
Fractionated laser skin resurfacing is complete
with minimal discomfort. Patients experience a mil
sunburn sensation for about an hour and then minim
discomfort. The treated skin will have a pinkish tone f
12-24 hours. This is a sign that the skin is healing normall
Swelling is minimal and generally resolves in 12 hours. On
may apply makeup or shave soon after treatment. Som
patients are able to return to routine activities the same da
of treatment. Others require a little more time, dependin
upon their skin condition and treatment. n
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health & wellness
WOMAN’S WAY - August 2007
by James E. White, M.D., F.A.C.S.
Dr. James E. White is board certified in Gene
Surgery by the American Board of Surgery and is a Fell
of the American College of Surgeons. His office, Advanc
Surgical Concepts, PLLC, Varicose Veins Solutions
Aesthetic Skin Care, offers a wide variety of cosme
procedures including facial fillers, thermage and bot
The office is located at 7446 Shallowford Road, Su
205 in the Hamilton Office Park. He may be contacted
423-648-4011.
Office-based mini facelift
D
egradation of skin elasticity, deflation of facial volume
and descent or falling of facial structures are anunfortunate effect of aging.
The traditional facelift
addresses each of these
issues, but with a price:
down time and expense.
Many men and women 40
to 65+ who don’t wish to
look their true calendar
age consider facelift pro-
cedures to erase sagging
jo wls an d th at lo os e,
draping, wrinkled skin
under the chin.
The office-based mini facelift is a mid-range mini
surgical facelift to address the mid to lower face. The post
operative effect provides a more natural appearance withlimited down time when compared to other formal facelift
procedures. Most “traditional” facelifts are performed with
general anesthesia and involve multiple weeks of downtime
and a long incision beginning at the upper temple and
extending behind the hairline on either side of the face to the
nape. The minimal incision mini facelift, which has been
performed since the late 1990s, is the basis for the office-
based mini facelift. The mini facelift proves an overall
lift to the lower region of the face and upper neck, offering
significant age-diminishing effects with minimal downtime
and lasting results.
upper neck. The leftover redundant skin is then tailored
match. The incision is carefully closed using plastic surg
techniques designed to reduce tension and minimize avisible scarring.
In some cases, a small incision will also be m
under the chin to remove excess tissues; this tuck w
liposuction of the neck and jowl area may be perform
in conjunction with the mini facelift for optional aesthe
results in the neck region.
Unlike the conventional facelift that may res
in a “pulled back” appearance, the mini facelift offers v
natural-looking results. Patients enjoy an overall firmi
of the lower facial area, noticeable jaw line definition a
a more elegant neckline. Generally, the results obtain
with the mini facelift are predictable and quite drama
sometimes erasing five, ten, even fifteen years from on
appearance. n
The mini facelift is designed for men and
women who want to stay ahead of the “Ds” of the aging
process: Degradation, Deflation, Descent. As we age, most
individuals lose elasticity in their skin and develop varying
degrees of descent along the jaw line and beneath the chin.
The mini facelift not only tightens skin, it is designed to
suspend the underlying structures of the lower face and
upper neck. This suspension of the lower face offers the
benefit of a more youthful appearance without the wind
blown look of a formal facelift. This “turn back of time”
from the mini facelift will last until the normal aging
process resumes for the individual. Lifestyle choices,
heredity, bone structure, skin type and sun exposure all play
a part in determining how long the mini facelift surgical
results will last for each individual.
The mini facelift is an outpatient procedure that
usually takes one to two hours to perform, depending
on age of the patient and the degree of facial correction
desired. Oral pre-medications are given to help relax the
patient, local block is used for the skin. A small, relaxedS-shaped incision is made beginning along the sideburn,
extending along the front of the ear, around the earlobe
and up to the hair line back from the ear toward the nape
of the neck. Great attention is given to the placement of
the incision line to provide an inconspicuous scar after
healing. Short skin flaps are created with meticulous care.
The underlying connective tissues and facial musculatures
are gently lifted and tightened using a simple suture
technique. The sutures are anchored to dense tissue around
the facial bones to suspend the sagging facial tissues. This
suspension enhances the appearance of the jaw line and
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