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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



Ofce-based surgeryby James E. White, M.D., F.A.C.S.



disease by the American Board of Phlebology, and in

cosmetic surgery by the American Board of Cosmetic


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



Neck liposculptureby James E. White, M.D., F.A.C.S.


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



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.



disease by the American Board of Phlebology, and in

cosmetic surgery by the American Board of Cosmetic


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



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



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



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



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



WOMAN'S WAY - March 2011

health & wellnessVampire facelift


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



WOMAN'S WAY - February 201112

health & wellness Fat transfer


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



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



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


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



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



WOMAN'S WAY - January 2009 15

beauty & bridal


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



WOMAN'S WAY - December 200812

health & wellness



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


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



WOMAN'S WAY - November 2008

beauty & fashion2


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


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




beauty & fashion00


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


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




health & wellness

25


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



WOMAN'S WAY - September 2008

beauty & fashion10



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


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



beauty & fashionWOMAN'S WAY - August 200822



Surgery by the American Board of Surgery and is a Fellow

of the American College of Surgeons. His office, Advanced



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





Surgery by the American Board of Surgery and is a Fello

of the American College of Surgeons. His office, Advance



including facial fillers, thermage and botox. He is located a

7446 Shallowford Road, Suite 205 in the Hamilton Offic


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 preferred 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 incision

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



beauty & fashionWOMAN’S WAY - May 200818






Aesthetic Skin Care, offers a variety of cosmetic procedur




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



beauty & fashionWOMAN’S WAY - April 200810




of the American College of Surgeons. His office, Advanc




7446 Shallowford Road, Suite 205 in the Hamilton Offi


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



beauty & fashionWOMAN’S WAY - February 20088







including facial fillers, thermage and botox. He is locate

at 7446 Shallowford Road, Suite 205 in the Hamilton Offic


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



health & wellnessWOMAN’S WAY - January 2008 2










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



WOMAN’S WAY - December 2007

beauty & fashion19



Surgery by the American Board of Surgery and is a Fellow

of the American College of Surgeons. His office, Advanced


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


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



WOMAN’S WAY - November 20074

health & wellness








7446 Shallowford Road, Suite 205 in the Hamilton Offi


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



WOMAN’S WAY - October 2007 1

beauty & fashion



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



WOMAN’S WAY - September 2007

beauty & fashion







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



health & wellness

WOMAN’S WAY - August 2007


Dr. James E. White is board certified in Gene

Surgery by the American Board of Surgery and is a Fell



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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