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The Anti-Aging Program

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Index
Page 1: Creases, Crow’s Feet and Scowl Lines
Page 2: Furrows and Hollows
Page 3: Sagging skin
Page 4: Uneven Skin Tone
Page 5: Baggy, Saggy Eyelids
Page 6: Unwanted hair
Page 7: Love Handles, Double Chins and Other Flabby Areas
Page 8: Look Before You Leap
Page 9: Cosmetic vs. Reconstructive
Page 10: Rise of the Medispa

We’ve yet to discover a fountain of youth, but we do know the causes of aging: programmed cell death, hormone depletion, and poor lifestyle choices such as excessive alcohol and tobacco use.
Knowing how aging happens has led to procedures that slow or hide its inevitable signs. Local doctors are ready to help.
Here are the most common signs of aging and the latest procedures and treatments. Every procedure has risks, so discuss your health history with your doctor to determine if you’re a good candidate.
(Prices listed vary, so ask your doctor for a global fee, which includes operating room costs and anesthesia.)
 

Creases, Crow’s Feet and Scowl Lines

Lines caused by the movement of muscle, often referred to as “expression lines” or “dynamic wrinkles,” begin to appear in your 20s around your eyes, on your forehead and above your mouth. Loss of collagen and fat can deepen the lines.

Stop them  Botox can be injected into the lines to temporarily reduce muscle contractions. “I love the results,” says Dr. Susan Kirchdoerffer, who has had the shots and performs the treatment at her medical spa, Reflections, in North Wilmington. “You look more awake and happy.”

Recovery  Not much, though there’s the possibility of bruising and swelling.

Risks  Though rare, patients may experience headaches or temporary drooping.

Results  Lasts about four months  on average.

Price  Most doctors charge by the unit, $10 to $15. Others charge by the area, $325 for the forehead or $375 for crow’s feet.
 

Page 2: Furrows and Hollows

 

Furrows and Hollows

Grouchy old men might earn their name simply because they have an overactive glabella, the space between the eyebrows. Blame frowning, as well as the loss of fat. Without fat, the face falls into folds. To fix the glabella, as well as the deep furrows that run from the nostril to the mouth, the hollows underneath the eyes and sunken cheeks, you may need a filler.

Stop them  Non-animal stabilized hyaluronic acid mimics naturally occurring hyaluronic acid, which adds fullness to the body. Brand names include Restylane, Juvederm and Perlane. The material is injected into the targeted area, which is usually pretreated with a topical anesthetic or nerve block.

Recovery  You may have redness and swelling at the injection site for two days and bruising up to 10 days.

Risks  Temporary lumps, firmness or ropy nodules at the site.

Results  Eight months to a year.

Price  $400 and up per syringe. (Nasolabial folds usually require one syringe.) Lips may require multiple injections to build fullness.


Stop them  Poly-L-lactic acid builds collagen. The brand name is Sculptra, which is injected into the site after a topical anesthetic or nerve block. Results develop over time. “It is generally for large areas, the size of a hand,” says Dr. Joseph Danyo, a cosmetic surgeon in Greenville.

Recovery  There might be tenderness, bruising or swelling for up to 15 days.

Risks  Bumps under the skin.

Results  About two years, sometimes  more.

Price  A series of five treatments can run between $3,000 and $5,000.


Stop them  Calcium hydroxylapatite is made from material that occurs naturally in our bones. Sold as Radiesse, it is injected into areas that have received a local anesthetic. It is not recommended around the lips.

Recovery  You might notice swelling, bruising and redness for a few days.

Risks  Nodules can form.

Results  About a year.

Price  About $800 per syringe. You may need more than one.


Stop them  Polymethylmethacrylate microspheres in a bovine collagen gel is sold as Artefill. Touted as permanent, it’s marketed for smile lines, though it’s been greeted with some hesitation. Hair follicles can become abscessed, says Dr. Mehdi Balakhani of Newark and Greenville. Plus, if the doctor injects too much, you might be stuck with too much filler. Artefill contains a temporary anesthetic, but your doctor may suggest additional anesthetic.

Recovery  There’s the potential for redness, tenderness, itching and swelling for a few days.

Risks  Lumps and abscesses are a worst-case scenario. Because of the bovine collagen, you’ll need a skin test to determine if you’re allergic.

Results  Five years and up.

Price  $800 per syringe on average.


Stop them  Fat injection, or fat transfer, has been around for some time, but only recently has it become popular. “It’s the hottest thing in facial rejuvenation,” says Dr. Christopher Saunders, a cosmetic surgeon with offices in Chadds Ford, Newark and Brandywine Hundred. Fat is removed from an area, such as the love handles, cleaned, then injected into another area. Surgeons build up the fat slowly, like adding clay to a sculpture.  “You build it up vertically as well as horizontally,” says Dr. Peter Coggins of Greenville.

Recovery  Swelling may last three weeks.

Risks  Unlike Restylane or Juvederm, the fat comes from your own body, which reduces the risks.

Results  Some fat—at least 20 percent—will get reabsorbed. The amount will vary from person to person.

Price Depends on the anesthesia and operating room costs. The price for both lips runs $900 to $1,200.
 

Page 3: Sagging Skin

 

Sagging Skin

With the loss of fat, skin can droop off your bones like a dress on a hanger. Its texture also can lead to sagging. Like cross-linked fibers, firm skin holds things in place—until it begins to thin. “After age 40, the skin gets 10 percent thinner every 10 years,” says Dr. Abdollah Malek of Newark. Smoking speeds the process. So can childbearing, which taxes skin on the tummy.

Stop It  Thermage uses radiofrequency energy to tighten skin and existing collagen, which stimulates new collagen. Thermage was used mainly on the face, but Dr. David Zabel of Nouveau Medispa in Newark has used it on the neck, and his partner Dr. Lawrence Chang has used it on the body. “I get better results on the body than I do with the face,” Chang says. The procedure gets mixed reviews. “It has to be the right patient,” Zabel says. “You have to be selective or it won’t meet the patient’s expectations.”

Recovery  Skin might be red for a few days.

Risks  Possible blisters, though patients rarely report irregularities in the results.

Results  Some experience an improvement that can last up to two years.

Price  $2,000 to $3,500.


Stop It  Alma Accent XL radiofrequency, circled on the skin for 20 to 30 minutes, “causes the skin to shrink,” Danyo says. “And it can reduce fat as well.”

Recovery  Mild reddening for a few days.

Risks  Bad technique could result in burns.

Results  Two years or longer.

Price  $500 per treatment. Three to five are needed in two- to four-week intervals.


Stop It  Tummy tucks involve a hipbone-to-hipbone incision above the pubic area, the removal of excess skin, then the tightening of muscles. Many include liposuction. “We can go all the way to the middle of the back to reach the fat pads,” Malek says. Mini-tummy tucks may work for patients with small pooches, such as those from a C-section.

Recovery  Can take weeks and you will have a significant scar below the bikini line. All of which is why many patients ask about mini-tummy tucks.  

Risks  This is major surgery involving general anesthesia. There’s the risk of blood clots.

Results  Permanent with proper diet and exercise.

Price  $5,000 to $7,000, depending on the amount of work.
 

Page 4: Uneven Skin Tone

 

Uneven Skin Tone

Need proof that sun affects your skin? Stand naked with your back to a mirror. Now look at your buttocks. Notice how even the tone is compared to the skin on your arms and face. Several procedures address age spots, brown spots and redness. A few even tighten the skin.

Stop It  Peels come in various strengths and formulations. Balakhani prefers a 30-perent tricholroacidic acid peel. During the treatment, your skin might sting, which for some necessitates a mild sedation.

Recovery  For deeper peels, you’ll need at least a week before venturing out in public. Light peels result in a shorter hiatus. Expect swelling, oozing and serious exfoliation.

Risks  Persistent redness and ultimate de-pigmentation. Brown discolorations can be permanent.

Results  Two years.

Price  Up to $680.


Stop It  Intense pulsed light can reduce redness and brown spots. Doctors apply a numbing cream, but it can still sting.

Recovery  Some redness and swelling for a day. Cold compresses and elevation help.

Risks  Improper technique can cause burns. Scarring is rare.

Results  Touch-ups are common, and IPA may not work on every spot.

Price  About $200 for the face. You’ll likely need multiple treatments.


Stop It  Fraxel Re:Pair CO2 Laser makes millions of microscopic dots in the skin, leaving some intact, instead of removing layers at a time. “You heal much quicker and there are fewer complications,” says Dr. Jonathan Pontell. The procedure evens skin tone, eliminates fine wrinkles and promotes collagen. The treatment involves topical and some local anesthetic.

Recovery  Redness and swelling may last for two days. By day four you can go out with makeup.

Risks  Loss of color, increase in color, infection and scarring.

Results  You will continue to age, but you can prolong the results with sunscreen and proper skincare.

Price  $2,000 for isolated areas, up to $5,000 for the full face and neck.


Stop It  Dr. Asher Carey of Dover gets a dual effect by pairing the Erbium laser, designed to remove superficial and moderately deep lines and wrinkles, with the YAG laser, which is used for several purposes, including skin-tightening and removal of facial veins. “You can resurface the skin and make wrinkles less noticeable,” Carey says. “So far the results we’re getting are very good.”

Recovery No downtime. Possible redness.

Risks Sores along the area treated.

Results Deep wrinkles may return within a year. Some patients require only one treatment. Others may need several.

Price  $500 to $800 for one treatment, depending on the time required and the areas treated.
 

Page 5: Baggy, Saggy Eyelids

 

Baggy, Saggy Eyelids

The fat pads that support skin near our eyes loosens as we age and slips into the wrong spots. Muscle around the eyes also weakens. “Like the abdominal muscles, it stretches out, no matter what we do,” Balakhani says.

Stop them  Blepharoplasty tightens muscles and removes excess fat. Incisions may be made in the creases around the eyes or inside the lid. Doctors may also add filler to the hollow section near the corner of the lower eye, known as the “tear trough.”

Recovery  Expect tenderness, swelling and bruising. The area may itch and you could experience dry eyes for weeks.

Risks  Scarring, dry eyes, infection and difficulty closing your eyes.

Results  Five years and up.

Price  $2,000 for one set of lids; $3,800 if you get all four done. The price increases if you want general anesthesia.
 

Page 6: Unwanted hair

 

Unwanted hair

Aging men often sprout hair in their ears and on their shoulders. Women suddenly develop whiskers on their chins and above their lips. Hormones are the culprit. Indeed, women might not have a problem until they hit a menopausal age, when their hormones go off kilter.

Stop It  “If it is done properly, you can see an 85 percent to 90 percent reduction” with laser hair removal, Kirchdoerffer says. Just about any area is fair game—even the ears. Most patients are interested in removing hair from the armpits, upper lip, chin and bikini line. O’Leigh Cosmetic Center’s Med Spa in Elkton has a machine made by Alma Lasers with a continuously moving cold head that reduces, if not eliminates, the sting or burn.

Recovery  Tolerable redness and some swelling, but no down time.

Risks  Rare risk of blisters, scarring and a change in skin texture.

Results  Several months to years.

Price Most cases require three to six treatments. Total cost for a lip might run $400. Lip and chin could run up to $750.
 

Page 7: Love Handles, Double Chins and Other Flabby Areas

 

Love Handles, Double Chins and Other Flabby Areas

Any middle-aged person will tell you that our metabolism slows. Exercise can help offset the change, but many of us have difficulty making time. Liposuction removes excess fat for a smoother appearance. But it’s not just about love handles and saddlebags. Zabel removes fat from under the chin, where it often gathers with age. “To some extent, it can tighten the skin,” he says. Doctors use a narrow tube to break up the cells and vacuum out unwanted fat.

Recovery  Elastic garments can control swelling. There might be bleeding, temporary numbness, burning or pain.

Risks  Infection, a reaction to the anesthesia, blood clotting and fluid loss. Less severe risks include bruises and scars, a numbing skin and changes in pigmentation.

Results  If you follow an exercise and nutrition program, results could last indefinitely.

Price  The chin is on the low end of the spectrum, about $1,200. Saddlebags and abdomen are about $2,500 each.


Lose It  Smartlipo is a quick laser body sculpting procedure performed under local anesthesia. The doctor uses a laser fiber to convert fat to oil. The process helps tighten tissues during the same session. “I’ve taken up to 2 liters off people in the office,” says Danyo.

Results  Are visible within a week but you’ll see improvements for up to 12 weeks.

Recovery  Most people go back to work after two days, but they may wear compression bandages for two weeks.

Risk  Infection and hematomas are rare but possible. Scarring or lopsided results.

Results  Prolonged if you follow a diet and exercise.

Price  $3,000 to $6,000.
 

Page 8: Look Before You Leap

 

Dr. Susan Kirchdoerffer with a patient in her medical spa, Reflections, in North Wilmington. Photograph by Greg SachsLook Before You Leap

When considering your first cosmetic procedure, here are some things to know.

• Most surgeons will not charge for a consultation. “It’s so easy to come in and to learn what different surgeons do,” says Dr. Abdollah Malek, who has offices in Newark and Lewes. “Look at before-and-after photographs.”

• Ask about the global fee, which includes every cost associated with procedure. Make sure the doctor is not quoting you only his or her fee. Depending on the procedure, your total cost might also include an operating room and anesthesia.

• Bring photographs of what you looked like at a younger age. Doctors will also take photographs in the office. “The patients and I can put our thoughts together as to what areas we can improve,” Malek says.

• Show photographs of noses or other features that you admire on others, including celebrities. But be realistic. “A lot of things we do have become more natural-looking, as far as rhinoplasty and breast augmentation,” Malek says. “An old-fashioned rhinoplasty you can recognize from a distance.”

• Discuss your options. “A lot can be done with minimally invasive surgery,” Malek says. Or noninvasive surgery, for that matter.  “People want effective results but they don’t want the downtime,” says Dr. Lawrence Chang, a cosmetic surgeon in Newark. Depending on your age, a full facelift might give you more bang for the buck than Thermage or a mini facelift.

Dr. David Zabel, who practices with Chang, agrees. To help determine a procedure, he’ll compare patients’ looks to their actual age. He’ll assess the extent of any wrinkles. He’ll also look at the patient’s subcutaneous fat, which can be more of a factor for body-contouring procedures than facial procedures.

“If patients are anticipating a significant weight loss or they’re actively trying to lose weight, I recommend delaying the cosmetic procedure,” he says. Patients who’ve tried to lose 15 pounds for the past two years—without success—might be considered stable. Talk to the doctor about your history.

• Ask the doctor not only about his or her credentials but also how many times he or she has performed the procedure.
 

Page 9: Cosmetic v. Reconstructive

 

Dr. Mehdi Balakhani consults with a patient. Cosmetic v. Reconstructive

Extreme makeover shows have led many to believe that cosmetic surgeons primarily correct or enhance our natural assets to make our appearances more pleasing. But cosmetic surgery is really rooted in plastic surgery, the area of medicine that involves reconstructing or repairing defects.

“Plastic surgery was pretty much born out of helping to repair war injuries, birth defects and facial injuries,” says Dr. Lawrence Chang, a plastic surgeon in Newark.

Though many plastic surgeons now concentrate on cosmetic procedures, most still do reconstructive work—albeit some more than others. Dr. Mehdi Balakhani, who has offices in Newark and Wilmington, does all types of reconstructive surgery, including repairing or reconstructing eyelids and noses after cancer surgeries.

Chang also does reconstructive surgery, in addition to cosmetic surgery. There is sometimes a fine line between the two. Consider post-bariatric body contouring, which performed after massive weight loss leaves a patient with sagging skin.

Like many plastic surgeons, Dr. Katheryn Warren, who has a Newark practice, takes her turn in the emergency room, where she once operated on a patient whose lip was bitten off by a horse. In her own practice, she often does breast reconstruction on cancer patients, and not only for those who’ve undergone a mastectomy. Radiation can cause breast malformations in patients who’ve had a lumpectomy.

The rules for finding a physician skilled in reconstructive are the same as for finding a cosmetic surgeon. Ask about his or her experience, review before and after photos, and ask about credentials.
 

Page 10: Rise of the Medispa

 

The procedure scheduling area at Nouveau Medispa in Newark. Photograph by Don Pearse photographers, inc Rise of the Medispa

In 2005, Dr. Susan Kirchdoerffer, a family doctor, sought another way to build her practice.  She looked at herself for the solution. She’d always liked spa treatments, and the term “medspa” or “medispa” was just coming into vogue. “It seemed like it would be beneficial,” she says. “It complements a family practice.”

Reflections opened in Brandywine Hundred in November 2006. “It’s fun, the revenue potential is there, and it makes people happy to come here,” Kirchdoerffer says.

Though definitions vary, most experts agree that a medical spa is run by a licensed healthcare professional. Suellen Scheiner, a registered nurse, runs O’Leigh Cosmetic Center’s Med Spa in Elkton, which is affiliated with husband Dr. Marc Scheiner’s cosmetic surgery practice.

Similarly, Nouveau Medispa in Newark is located at Advanced Plastic Surgery Center. The spacious spa blends futuristic lighting and fixtures with contemporary but elegant furnishings. “It’s unique,” says Dr. Lawrence Chang, a cosmetic surgeon in the practice.

Dr. Christopher Saunders has medspas in two of his three locations, and the third floor of Dr. Abdollah Malek’s Centre for Plastic Surgery is devoted to a medical spa.

As Kirchdoerffer proves, doctors affiliated with medspas need not be plastic surgeons. Dr. Kelly King, an emergency room doctor, is a partner at Thé Medspa at the Village of Five Points in Lewes, which opened last February. He is onsite five days a week.

Dr. Jeffrey Kerner of Via Medical Day Spa in Wilmington specializes in anti-aging medicine. Dr. David Cloney, a general-trauma surgeon and president of the medical staff at Bayhealth, is the owner of Attitudes Medi Spa in Milford.

Attitude’s clinical director, Jeannette Smith, says clients are not concerned that Cloney is not a plastic surgeon. The procedures offered at Attitudes are noninvasive. “If you wanted plastic surgery, then of course you’d want a plastic surgeon,” she says.

The physicians train to give injections, such as Botox and other fillers, in the same way that plastic surgeons do, says Terri Kerner of Via Medical Day Spa.

Maintaining credibility is about knowing the boundaries. Kirchdoerffer, for instance, leaves certain procedures—such as using fillers underneath the eyes—to surgeons experienced in that area.

In the future, expect more medical spas to open. There are even chains. Consider Monarch MedSpa, which has five locations, including one in Greenville.

How to choose? Kerner recommends selecting a spa affiliated with a local physician. Services might make a difference. The MedSpa is also a full salon. For some, it’s all about the atmosphere. Via features feather beds, duvets and spa music. “It’s not a sterile doctor’s environment,” Kerner says.

Whatever your choice, always interview the practitioner during a consultation. Performing laser hair reduction, Botox injections and intense pulsed light treatments all require skill and training. 

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