This article appeared in the Southern Marin Mother’s Club newsletter.

More information on the Southern Marin Mother’s Club can be found at www.southernmarinmoms.com

Dr. Carolyn Chang, San Francisco Plastic Surgeon

Feeling Good Looking Good

Medically Necessary Mommy Makeovers

Can you have your cake and eat it too? I spoke with San Francisco Mommy Makeover specialist Dr. Carolyn Chang about the growing trend of combining necessary medical procedures with elective cosmetic surgery in order to achieve the “ultimate” in mommy makeovers.  As we know, pregnancy takes its toll on you physical appearance.  It unfortunately, can also take its toll on your body from a medical perspective.  Some of the least discussed medical issues that can arise after pregnancy include the appearance of abdominal and umbilical hernias, and urinary incontinence and urgency.  These conditions can seriously interfere with your quality of life and in some case, even be detrimental to your health.  As women are more open with their physicians, these problems are being discussed.  Surgical options are often the only solution, and more and more moms are asking to have the procedures that they need performed in conjunction with the elective cosmetic surgeries that they want.  I also spoke to Dr. Michelle Li, a General Surgeon, and Dr. Alexandra Haessler, an OB/GYN to help better understand the medical procedures themselves.

What combination procedures are you seeing most?

Dr. Chang: The overwhelming majority of my combination requests involve combining a tummy tuck with either a hernia repair or some sort of gynecological procedure.  The hernias usually became prominent after pregnancy and are most often located at the belly button or in the anterior abdominal wall.  Gynecological procedures can include a wide variety of medical conditions that need to be treated.  Common ones include procedures for incontinence after surgery, fibroid or polyp removals, tubal ligations, and hysterectomies.  Certainly breast procedures and liposuction can also be performed in conjunction with the treatment for these medically necessary conditions.

How are pregnancy-related hernias repaired?

Dr. Li: A hernia is a protrusion of any tissue or organ outside of where it normally lies.  Hernias tend to occur at areas of natural weakness, and may be caused by increased pressure or tension on those areas.  In pregnancy, the persistent and increasing pressure on the abdominal wall as the fetus grows can cause stretching at those weakened areas.  A hernia will become evident when it becomes large enough that tissue or organs can fall through it and often appear as a persistent “bulge”.  This is most often located in the groin or in the belly button.

Simple post-partum hernias are treated by bringing together and reinforcing the tissues of the abdominal wall that have separated, preventing the organs within the abdomen from “spilling through.”  The hernia repair will fix the abnormal bulge, but will not usually significantly restore the contour of the entire abdominal wall, and for that reason, many women elect to undergo a tummy tuck at the same time.

As a rule, most hernia repairs that occur during pregnancy are deferred until after delivery.  If, however, the bowel becomes entrapped in the hernia, the woman may feel pain, nausea, and bloating.  If this becomes the case, prompt surgical intervention is necessary.

What can be done for women who are experiencing urinary incontinence and urgency after childbirth?

Dr. Haessler: Pregnancy and childbirth may be associated with trauma to the pelvic area and can involve muscular, connective tissue, or nerve injury, which is often undetected by the patient.  These factors may contribute to weakening of the tissue that supports the pelvic organs.  When the pelvic organs are not well supported they often do not function properly.  Symptoms of pelvic floor dysfunction can include new urinary urgency, incontinence or incomplete bladder emptying.  Occasionally, the vaginal walls protrude into or outside of the vagina causing an uncomfortable pressure or bulge.  Other conditions may occur, such as a gaping of the vaginal opening or problems with defecation.  If a woman develops these symptoms after a birth, she may be suffering from such a condition. These conditions are rarely dangerous; however they can interfere with sexual function and significantly impact a woman’s quality of life.

Typically, if the symptoms do not improve with time and pelvic floor strengthening exercises, several minimally invasive surgical procedures are available to resolve the problem.  The most common procedure is designed to treat urinary incontinence that occurs during exertion, such as exercise or coughing.  It involves placement of a small sling between the vagina and urethra. In this case, the support under the urethra is restored.  After the surgery, most women report they are able to resume a full range of exercise and activities while remaining dry.  They often wonder why they had not had the surgery earlier.

These procedures are typically short in duration and thus are very safe to be performed in conjunction with other procedures such as a tummy tuck.

What are the advantages and disadvantages of the combination surgery approach?

Dr. Chang: The main advantage for busy moms is minimizing recovery time.  One recovery allows for maximal results with the least time away from the family.  The other advantage, of course, is that she is able to have the cosmetic procedure that she wants with the procedure that she needs, and that makes having surgery much more palatable. It’s like a gift with purchase!  And finally, there can be some financial benefit to combing procedures.  Although the cosmetic portion is never covered by insurance, depending upon the insurance plan, some of the hospital charges and anesthesia costs for the cosmetic portion can be subsidized by the medically necessary portion.   A word of caution, however, is that the savings may not be as significant as one would think due to the constraints of insurance plans and hospital billing practices.  But in the end, every little bit does help.

The main disadvantage to combining procedures is that the recovery may be a little more extensive than if only one of the procedures was performed.  In my experience, however, I have found that this extra time for recovery and discomfort has been relatively minor and short lived, and that overall recovery time is still much shorter for a combination procedure.

How do I know if I am a candidate for a combination surgery?
Just ask! Your physician will be able to guide you as to the safety and feasibility of combining procedures.  He or she can also provide you with references for surgeons that can perform the desired procedures.

View the KGO News segment about the Starlux Laser

Dr. Carolyn Chang, San Francisco Plastic Surgeon

You can view Palomar’s initial press release here.

The Starlux laser is a fractional non-ablative laser that works beneath the skin surface to increase collagen content in the skin. Small columns of micro beams emanate from the laser, penetrate the skin, and work in the dermal layers.  A stretch mark represents an area of the skin that has thinned due to excessive stretching, hormonal changes, or steroid use.  By increasing the amount of collagen in these damaged areas, the skin “plumps,” and the depth of the stretch mark is reduced.  Unlike the older ablative lasers, the skin surface itself is not damaged or abraded, and so many of the undesirable side effects that we saw before with lasers are avoided.  There is virtually no down time, and the major side effect profile involves the potential for hyperpigmentation, or darkening of the skin.  Fortunately, if this occurs, the pigmentary change gradually resolves in most patients.

Because skin types are variable, the response to the treatments are variable, and so results can vary widely, from only a mild improvement to a major improvement.  In general, however, one should see some improvement overall.  In order to achieve the best results, 2 or 3 total treatments may be necessary, and improvement can be noted even as far a year after initial treatment.

I am especially excited about this application for the Starlux laser.  It will allow my “mommy makeover” patients to achieve an even more complete abdominal rejuvenation.  The tummy tuck brings the abdominal area back to pre-pregnancy shape, and the Starlux laser will be able to improve the skin quality and texture.  For those who don’t wish to undergo surgery or don’t need it, this treatment will potentially provide a welcome relief to unsightly stretch marks!

abdominal stretch marks before treatment

abdominal stretch marks after treatment

For more information, Dr. Narurkar and I recently participated in an instructional webinar for Palomar Medical.  You can view this webinar at this link. And you can read the original research protocols and results here.

Dr. Carolyn Chang, San Francisco Plastic Surgeon

Surprisingly, there are a number of great smaller, relatively easy, pick-me-ups that can make a big impact.  These procedures are less invasive, concentrated in one smaller area, and require minimal downtime.   Here are my favorite suggestions for a more youthful 2010:

Spot Liposuction
It is amazing how achieving more definition in one spot area can give you a leaner, more defined appearance.  Some of the best spot areas to target include the arms and on the flanks (aka love handles).  Liposuction performed under the chin in the neck area can give you the appearance of a neck lift, and is a favorite among my younger patients who are just starting to see early sagging and bagging.

Incisionless (hidden incision) Lower Lid Blepharoplasty
This procedure is also known as a transconjunctival lower lid blepharoplasty and is a subtle way to peel back the years.  In this procedure, the incision is located on the inside of the lower lids, so the healing is less noticeable.  Excess fat that causes the look of under eye bagginess can be removed through these hidden incisions, giving the lower lid a firmer, smoother appearance.

Fat Sparing Upper Lid Blepharoplasty
This procedure is a more modern version of the traditional upper eyelid lift.  As a result, it is less invasive, easier to recover from, and more natural appearing, especially over the long term.  Traditionally, with an upper eyelid lift, the goal is to brighten the eyes by removing the excess skin that droops over the eye with aging.  Along with this, the excess fat around the upper lid is removed as well.  The newer fat sparing technique emphasizes a more conservative fat removal to prevent a sunken or unnatural appearance over time.  Because less fat is removed, the procedure is less extensive, and can easily be performed in the office under a local anesthetic.  This is not your mother’s eyelid lift!

If you would like more information on any of these procedures, please contact us.  We would be glad to answer any questions that you may have.

And Have a Happy, Healthy New Year – Cheers!

Dr. Carolyn Chang, San Francisco Plastic Surgeon

Its flagship product, the Bio-restorative Skin Cream, contains the company’s proprietary ingredient, PSP™, the most complete protein blend of Human Growth Factors, Cytokines, and Interleukins available to rejuvenate and soothe skin.

Not only is it a great product for anti-aging, but it also helpful after facial cosmetic procedures to promote healing, a real plus in my clinical practice.  It can even be used in combination with other topical treatments such as anti-rosacea medications, anti-acne medications, or retinoids to help soothe and treat the skin.

The Bio-restorative Skin Cream’s effectiveness in helping to reduce the signs of facial skin aging has been shown in several clinical studies.

The detailed results of the anti-aging studies can be found by clicking the links below.

Clinical Data: 2 Month Study
Clinical & Histology Data: 6 Month Study
Reduction of Skin Wrinkle Depth

The Neocutis product line also includes an eye cream, a daily sunscreen moisturizer combo, as well as Blanche.  This product helps to even out the skin tone by treating hyper-pigmentation and melasma.  Blanche was recently chosen by Allure Magazine as the 2009 winner of the Best Beauty Editors’ Choice Breakthrough Award.

For more information on the complete line of products, visit www.neocutis.com.

Dr. Carolyn Chang, San Francisco Plastic Surgeon

“What aspect of physical beauty do you find most appealing in another person?”

People in their 20s-40s responded that they considered a fit, well-proportioned body to be most important.  For those in their 50s and 60s, youthful skin was the most important.

But when people were asked, “Which part of your body are you most concerned about,” the answers were different.  Only those in their 30s responded that they were most concerned about their body.  Everyone else was more concerned with their face!

Beauty standards that we have for ourselves are apparently not the same as those we have for others.

Other interesting findings in this study include the fact that in regards to the body, more people were concerned with their abdomen and hips than their breasts for each decade.  And when asked what “the most important reason to maintain your physical appearance” was, the overwhelming reason across all decades was to boost self-confidence.  The second most popular reason for those in their 20s was “to attract potential partners.” For those in their 30s, 40s, and 50s, the number two reason was “to increase professional opportunities,” and for those in their 60s, it was “to help make friends.”

You can access the original summary from the American Society for Aesthetic Plastic Surgery at http://www.surgery.org/media/news-releases/how-do-our-attitudes-about-beauty-change-as-we-age

And the actual Beauty for Life survey results at http://www.surgery.org/downloads/BFLUserSurvey.pdf

Dr. Carolyn Chang, San Francisco Plastic Surgeon

Mesotherapy involves a series of injections of various substances that will dissolve fat cells.  Over time, the body absorbs the by-products, and the fat in the area disappears.  This treatment has been available in various parts of the world, including Europe, and increasingly in the United States, and has always been a source of controversy and speculation.

I recently came upon an interesting and alarming article detailing a study recently published in the journal Clinical Infectious Diseases.  This paper reported a series of difficult to treat infections after courses of mesotherapy in 16 patients.  The authors noted that surgical drainage was the most effective in treating these infections.

Other important risks to note about mesotherapy are that it can result in prolonged swelling and redness in the area of injection, and residual lumpiness and unevenness can occur.  The injection substances themselves are unregulated and vary from practitioner to practitioner.  The procedure is not FDA approved and not recommended by the American Society of Plastic Surgeons.

When it comes to mesotherapy – it is definitely an example of “if it’s too good to be true, then it probably is.”  For dissolving fat, nothing works better than a healthy diet and regular exercise, and maybe a little bit of liposuction, if all else fails!

Read the full article from Reuters : Fat-dissolving Procedure Carries Risk  http://bit.ly/142Xiz

Dr. Carolyn Chang, San Francisco Plastic Surgeon

Jane Ford, co-founder of Benefit Cosmetics

Whether it’s a small tweak or a major overhaul, immediately after, the swelling and bruising from the procedure may have you in hiding longer than you would like. Luckily, in most cases, the temporary changes to your face are easy to camouflage. So what are the best products on the market that can help you put your best face forward as soon as possible? Who better to ask the tricks of the trade than a true expert – Jane Ford, beauty powerhouse and co-founder of the global beauty brand Benefit Cosmetics.

I recently sat down with the very fabulous Jane to get her recommendations for the perfect post-operative regimen.  Of course, once the healing is done, these Benefit products are perfect for looking gorgeous everyday too!

Jane starts with the basics:
“Always, always invest in good moisturizing. I just love our Dear John facial cream (one of Elle Magazine’s top 5 picks)…quite honestly, I can’t find one better.” 

Eyecon eye cream is terrific for puffiness. She also recommends Ooh la Lift for under eye tightening and brightening to maintain your results.

Next the camouflage:
Over your moisturizer you’ll want to apply That Gal, a raspberry -based skin primer and brightener.

She also recommends purchasing a Play Stick in the appropriate shade for strategic camouflaging.  This should be used all over eye (under and on lids) as well as around ears. It’s also chamomile and lavender-based for gentleness.

Jane adds, “I love this because it’s really easy to use. It provides a matte finish and can also double as a light weight foundation if mixed with moisturizer.” Stay clear of concealers that have too much oil…”They may have a mite too much shine for post-op use.”

For the final overall coverage, Jane prefers Benefit’s cream to powder foundation, Some Kind of Gorgeous (deemed the world’s best foundation by Elle Magazine).

Time for color:
For a gentle looking, healthy glow, try Dallas, a subtle powder bronzer, and the company’s bestselling Posie cheek tint.

Go for a natural eye using soft brown mascara and possibly a soft dark brown eyeliner for lining the upper and lower lids. Consider using the Big Beautiful Eyes kit – both for eye color and lining.  The kit comes in warm neutral hues and provides you with all you need to line, define, and contour your eyes like a professional.

To add definition to the face, keep the brows filled.   Try the winner of Allure’s 2008 best brow product, Brow Zing.

Compliment your look with a very natural lip color…no pinks or reds. Use a neutral soft lip liner.  Fill in the lips with just a hint of gloss.

For the finish, get a pretty, soft, luminescent look with Dandelion, a super light-weight soft pink powder for all over face.

Jane’s Final Tip
Get brows and lashes dyed two days before your surgical procedure.  It will give your face definition afterwards.

And at the end, I couldn’t resist asking – what is the one product that Jane absolutely cannot live without (surgery or no surgery)?

It’s That Gal, of course.

Thanks for all of your wonderful suggestions Jane!

Benefit Cosmetics, the “friskiest luxury brand“can be found at over 2000 beauty counters in more than 30 countries.  Or you can just look at www.benefitcosmetics.com.

Dr. Carolyn Chang, San Francisco Plastic Surgeon

We could talk all day about the celebrities who have undergone procedures ending in unfortunate results, but we hardly talk about who is doing it right … primarily because they are doing it so right that we don’t know that they’re doing it at all. And yes, I do understand that genetics and timeless beauty play a role in some of this. But, those of us who are “in-the-know,” know that there are other forces at work here too.

Regular maintenance, coupled with the know how to make small, subtle changes, are the key to prolonging a natural, youthful look.

The 30’s
The 30’s are a time to really beef up your skin care regimen.  This is when the early signs of aging really start to show in your skin. The five tenets of good skin care are to cleanse, exfoliate, moisturize, repair, and protect.  In English, that means a cleanser, a gentle exfoliant a few times a week, a non-comedogenic moisturizer to balance your skin, a reparative product like a retinoid to build collagen or an antioxidant like vitamin C to neutralize free radicals, and a sunscreen.  Laser treatments like IPL photofacials or Fraxel treatments can go a long way to restoring a youthful glow by evening out your complexion.  And if you have furrows and fine wrinkles, Botox may be a good option to prevent them from getting deeper.

The 40’s
The 40’s are a time when the effects of gravity really start to settle in and the face starts to lose facial fat.  Eyelids start to get droopy and baggy, cheeks start to get hollow, and the neck and jaw line starts to sag.  Different people have different rates of aging.  These changes can start in the mid to late thirties for some.  Others may not notice these things until well into their 40’s.  In general though, subtle facial cosmetic surgery tweaks freshen up your face.  These smaller procedures most commonly include eyelid surgery or brow surgery to wake up your eyes.  Liposuction under the chin or a natural neck and jowl lift may be appropriate for others.

Often the best results are some small surgical procedures combined with the noninvasive fillers and Botox to restore facial fullness and erase fine lines.  Laser resurfacing to improve the quality of the skin can also complement nicely.  I call this the multimodal approach to combating aging.  And I would bet that this is what Demi has been doing all along.

The 50’s and 60’s
The 50’s and 60’s are definitely the decades when surgery tends to be the best option for freshening up.  Gravity has definitely set in, and often just the noninvasive treatments are not enough to get you the result that you want.  The face and necklift is usually the cornerstone to a successful facial rejuvenation in these decades.  I recommend a very natural approach because I think that this stands the test of time.  Who wants their “designer” facelift to go out of style?!    This is also the time when the multimodal approach is very effective, as the surgery will fix the contour problems and the dermatologic tools will improve the skin quality.

Did she or didn’t she??  And so, whether she did or didn’t, we salute Demi, along with Cindy Crawford, Brooke Shields, and Michelle Pfeiffer, for being ageless beauty icons and for making 40 the new 20, and 50 the new 30.

Dr. Carolyn Chang, San Francisco Plastic Surgeon

Here’s to a great new look for both of you!

Dr. Carolyn Chang, San Francisco Plastic Surgeon