8 ASK THE PROFESSIONAL 10 LETTER FROM THE EDITOR 32 IMAGEine THIS Holiday Gift Guide 36 Spotlight on Spas: The Nemacolin Woodlands Resort Escape the winter blues in nearby Pennsylvania 40 MARIE OSMOND By Maria Orlando Pietromonaco Overcoming adversity with grace, beauty, and resilience 44 HIGHLIGHT ON HOSPITALS South Nassau Communities Hospital: Combining excellence with innovation 52 IMAGE EVENTS interviews 18 SHOCKWAVE HITS THE NATION Q&A with Corey Fox, M.D. Technology to heal pain articles 12 Reframing Your Smile by Edward Gottesman, D.D.S. Successful treatment for the receding gum line 14 A NOSE FOR BEAUTY by Kapil Saigal, M.D. Three steps to a beautiful start for the New Year 16 PERIPHERAL BRAIN STIMULATION by Drs. Andrea Goldberger & Garry Kotack Improve your quality of life with only one treatment 20 YOUR NEW YEAR'S RESOLUTION by Roxanne Carfora, D.O. Take shape for life and be balanced

22 REJUVENATIVE SURGERY by James C. Marotta, M.D. When anything less than a facelift is futile 24 BALANCING YOUR WORKOUTS by Hot Ryde A total fitness experience 26 DERMASWEEP, M.D. by Dina M. Weil A new revolution in microdermabrasion 28 ARE YOU TOXIC? by Evan Shapiro, M.D. and Ina Lutin, R.N.,C.P.C.P.,FAAM Nutritional, gentle cleansing can help restore health and balance 30 FAT GRAFTING by Elizabeth Roya Emami, M.D. Restoring facial volume and filling wrinkles naturally 34 CONNECTING HEALTHCARE AND FITNESS by Sharon Moelis, CPT, MEPD The importance of medical exercise for the elective surgical patient 38 SUFFERING FROM MIGRAINES? by Kaveh Alizadeh, M.D. Surgery could offer relief 42 OUTSMARTING FATHER TIME By Andrew A. Jacono, M.D. Men are jumping on the cosmetic enhancement bandwagon 46 OSTEOARTHRITIS By Evan A. Vieira, D.P.M. A debilitating condition that can affect us all 48 HALITOSIS by Maia Berger, D.D.S. How to prevent chronic bad breath

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IMAGE Has the Answers
Have a question about procedures that can help you look and feel your best? Our doctors and other professionals are among the best in their fields, and they'll be happy to provide you with clear, helpful, authoritative advice and answers to your questions.

Send your questions to: dhimagemag@gmail.com and please mark the subject line ASK THE DOCTOR. Thanks! We're happy to help you.

Q: I am afraid I'm on the road to periodontal disease. My gums bleed when I brush them, and gum disease runs in my family. What can I do at home to prevent it? Is there a regimen I should be following or products I can use?

A: If your gums bleed when you brush your teeth, that can be an early sign of gum disease know as gingivitis. Gingivitis may progress to Periodontitis, a more serious form of gum disease, which can lead to eventual tooth loss. We know now that genetics plays a role in the susceptibility of Gingivitis progressing to Periodontitis, so if you have a positive family history of periodontal disease you may be at risk for early tooth loss.

The most important thing to do is get a screening for periodontal disease from your dentist or a periodontist. Depending on the level of involvement, certain professional therapies may be recommended including scaling and root planing (aka deep cleanings), antibiotics, or more extensive treatments such as gum surgery. Most dental professionals will also recommend frequent cleanings annually with a hygienist, which can prevent gum disease or delay its progression if you already have it.

You should make sure to brush after every meal and don't forget to floss as well. Patients frequently tell me that when they notice their gums bleed they avoid brushing those areas. That's the worst thing you can do. Work especially hard on those areas and remove whatever plaque is causing the inflammation (bleeding). Additionally, using an FDA approved antiseptic mouthrinse such as Listerine will help fight the bacteria that can cause gingivitis, as well as bad breath, in case you have that too.

(Answered by Dr. Edward Gottesman)

Q: With the New Year approaching I am compelled to shed the 20 pounds I've been working on for years. I need some tried and true advice on how to get going once and for all. I love to eat and always feel hungry. I feel like it's almost hopeless!

A: "It's all about balance." In our center, we check for hormones, nutrition, minerals, and metabolic rate. We gather data to correct underlying deficiencies. A side effect of achieving balance is weight loss. Everyone is genetically different and should be treated as such.

(Answered by Dr. Roxanne Carfora)

Q: Every winter I wind up with several vicious colds. As I get older I also get worried about the flu and even pneumonia. What can I do to boost my immune system so I can prevent colds in the first place, or at least be able to fight them once I get them?

A: To start, the best advice I can give you is to make sure you get enough sleep and cut down on your sugar intake. We tend to overdo it during the holiday season and wonder why we then get sick in the winter. With that being said, I have some very effective preventative measures you can take and even some remarkable natural remedies to try at the first onset of a cold.

I am a big believer in vitamin c based on the works of Linus Pauling, and I recommend taking a gram a day of Ester C for prevention and increasing it to 3 grams a day at first symptom. Vitamin C has been shown to have antiviral and anticancer properties. There is some good research that suggests some medicinal mushrooms, such as maitake, can boost immunity by increasing natural killer cells. You can start taking this at the beginning of the season. Also, probiotics have been shown to boost immunity and I would consider taking them long term.

At first sign of onset of symptoms (within 24 hours) I suggest taking the following regimen for a few days; It has been remarkably effective in my practice at decreasing the symptoms and duration of a cold.

1. Zinc lozenges or nasal zinc gel

2. Ester C 1gm 3-4 times a day

3. Vitamin A 10,000 iu/day

4. Vitamin D 10,000 iu/day

5. Oil of oregano comes in capsules or liquid, if using the liquid use a few drops diluted in water 3x/day.

These are suggestions I give to my patients, and I highly recommend you see a doctor who is experienced with supplements before embarking. I do not recommend you take the above for extended periods of time or if you are pregnant.

(Answered by Dr. Dana G. Cohen)

Each year our December/January issue includes a featured section "New Year-New You" and there is no shortage of new products on the market and new procedures at your doctor's office. The hottest new product is from the makers of Grande Lash, MD and it is called Grande Eye Miracle. It smooths out those fine lines and wrinkles, and effectively tucks those bothersome bags in minutes! I am a regular user of Grande Lash, MD for longer eyelashes and I am telling you that it really works, so I cannot wait to begin using their new product. They are offering $10.00 off the retail price if you are an IMAGE Magazine reader, so take advantage of the special.

Long Island Plastic Surgical Group is now offering CoolSculpt, a new non-invasive treatment for fat and cellulite reduction and they are offering a discount to our readers. Dr. Corey Fox is now using a new Shockwave Therapy at his Massapequa location to treat heel pain. This is a pain-free solution to getting back into those sexy shoes. And how about a new particle-free microdermabrasion called DermaSweep? This new procedure can only be licensed to a physician due to its more advanced technology. DermaSweep treats acne, fine lines, sun damage, and lots more. Like I said, the medical technology keeps moving forward, keeping us looking and feeling our very best.

I must mention that we cannot forget that Diet and Exercise are still the best things we can do for ourselves, for that is what we have complete control of. If you need a jump start to those resolutions then I suggest calling on Teresa Carfora, licensed nutritionist and weight loss coach. She will place you on the path to healthy eating habits designed just for you. If you are like me and need a quick kick to get off your butt and exercise, then try Hot Ryde. What I love most about Hot Ryde is that you must book your desired class online in advance therefore you cannot turn back! I book my Yoga and Barre classes at the start of the week so I know that I must show up, no excuses!

So let's all stay clear and live our vision for a good and healthy lifestyle for 2012 and beyond Happy New Year!

IMAGINE THIS
Crabtree & Evelyn New Pomegranate, Argan & Grapeseed Body Collection

Inspired by the succulent fruits and nourishing oils of Morocco, these products feature rich, replenishing botanical ingredients and natural antioxidants that will leave skin feeling velvety soft and supple. Create your own basket from the collection as great holiday gift. Available at www.crabtree-evelyn.com or call 1-800-CRABTREE.

I-mark Sugar Plum Holiday Look

Make your "mark" this holiday with the vibrant shades of purple. Set includes I-Mark eye shadow in Plum Velvet; I-Mark Metallics eye shadow in Sugar Sugar ; Longwear Eyeliner in Foxy Brown; and Nailed It Trend Mini Nail Lacquers in Sure Fire, a festive metallic berry color, and Meltdown, a metallic taupe shade.$22. Available at www.avon.com

Lip Savvy! Lip Glosses in OMG, Purple Rain & VooDoo Baby

Moisturizing Lip Gloss This hydrating gloss contains Hyaluronic Filling Spheres which work to instantly (and painlessly) plump lips while moisturizing and adding volume. With these fun fashion-forward designs, Lip Savvy! will never get lost in your makeup bag! $18. Available at www.belipsavvy.com

Moroccan Getaway Travel Case from Josie Maran

A complete head-to-toe collection of perfectly portable Argan Oil infused essentials. Great for a winter getaway. Features six essentials in sizes safe for your carry-on. Includes the Argon cleansing oil for body, Oil Hair Serum, Daily Moisturizer with SPF40+, 100% Pure Argan Oil, Cleansing Oil for Face, and Whipped Argan Oil Body Butter in Sweet Citrus. $39. Available at Sephora and www.Sephora.com

Diamond Girl Glossy Lip by Larenim

Diamond Girl Glossy Lip Colour with REAL DIAMONDS is a 100% natural formula that imparts enduring moisture and brilliant, non-sticky lustre. Created from emollient, antioxidant-rich extracts of seeds, flowers, fruits and berries, and infused with pure earth minerals. The collection is available in five shades: Seduction, Princess, Mauvelous, Timeless Rose, True Romance and Positively Clear. $17.00 each. Available at www.larenim.com

Ambalu

Ambalu Jewelers is a family-owned retailer and wholesaler that has been manufacturing fine jewelry for over 35 years. Since opening their flagship retail store in Roslyn, New York last year, Ambalu Jewelers has quickly become known throughout Long Island as the premier place for unique and customizable designs. Ambalu Jewelers invites you to see their exquisite collection of fine jewelry and their wide selection of giftware, perfect for the holiday season! To contact them call 516-626-3595

Every Man Jack Body Kit & Shave Kit

This holiday season give the man in your life the total package with a grooming gift set. The new Body Kit in Cedarwood and Shave Kit in Signature Mint come with five pieces to fulfill the grooming needs of every man on your list. $15 per kit. Available at www.EveryManJack.com

Bootie Pies

What a great Holiday Gift! Finally a solution for getting pedicures in the winter! Bootie Pies are cozy boots with a removable front flap to expose the toes. No waiting for toes to dry, or freezing in flip flops! They also just released the new low boot! Bootie Pies are made from high quality suede and leather and come in a variety of colors like Coconut Creme, Chocolate, Blackberry, Boysenberry and Bayberry. High Boot $88 Low Boot $68. Available at www.BootiePies.com

Spa Sonic Skin Care System Face & Body

Polisher- 7 piece Gift Set

A perfect gift or the perfect at-home spa set, new Spa Sonic works to deep cleanse the entire face and body. It is an affordable, waterproof device that's ideal for use in the shower, bath or sink. It operates with 4 attachments (all included): a small brush for the face, a large brush for the body, pumice for rough areas, and a facial sponge for microdermabrasion and reduction of fine lines. The Spa Sonic's dermal penetrating action promotes rapid absorption of skin care products and leaves skin toned and super smooth. $65. Available at Target Stores

Sweet Pea Natural Serenity Spa Gift Basket

Send those far away family members and friends a little "natural restoration" this holiday season. This Asian-inspired bamboo caddy is filled with a sweet pea-scented collection of luxurious and relaxing Apothecary East spa products, including shower gel, body lotion, bath crystals, moisturizing body butter, bar soap, 6 bath fizzers, wooden nail brush & pumice stone, bubble bath, body scrub, large terry cloth natural sponge, and wooden massage roller. $44.99. Available at www.ftd.com

Escape The Winter Blues At The Nemacolin Woodlands Resort
Cold weather got you down? Maybe you need a little winter escape, someplace where you can relax, play, wine and dine. Nemacolin Woodlands Resort might be just what the doctor ordered. Nemacolin is a family and luxury vacation destination, set on 2,000 wooded acres in the Laurel Highlands of Southwestern Pennsylvania. This boutique hotel garners Forbes Five-Star, AAA Five-Diamond rating and is dressed to impress.

The resort features more lodging options than almost any hotel I know, catering to any need, any personal taste. The Chateau Lafayette, inspired by the famed Ritz Paris in France, features a grand reception lobby, Tea Room, and Cigar Bar. It has 124 elegant rooms complete with vaulted ceilings, crystal chandeliers, and two-story Palladian windows. Other accommodations include Falling Rock, styled after the organic architecture of Frank Lloyd Wright; the Lodge, an English tudor design that houses a vast art collection; Townhomes and Luxury homes that offer ample space and privacy; and Maggie Valley, an RV park with all the amenities of a resort hotel room.

When it's time to unwind and take the chill out of your bones, the internationally acclaimed Woodlands Spa is ready to pamper and invigorate. Based on the principles of Feng Shui, their treatments offer many different remedies to rejuvenate your mind, body and soul, all in the midst of lush ambience. With forty well-appointed rooms, including four couple's rooms, the Spa has nearly 100 treatments and services, including aromatherapy, massage, facials, and a salon. There are also saunas, whirlpool baths, and an indoor pool to add to your pleasure.

If you're a foodie no need to fear. Nemacolin boasts an impressive collection of restaurants and lounges, including the Forbes Five-Star and AAA Five-Diamond Lautrec, an innovative fine dining experience. Lautrec received a AAA Five Diamond rating for 2008, 2009 and again for 2010, and is known for its European-style cuisine and prixe fixe menu. Other formal dining options include Aqueous, an upscale steakhouse; Autumn, a farm-to-table concept; and Sunset Terrace, which you'll wait for summer to enjoy. There are several venues for casual fare, as well as an extensive Wine Cellar with over 21,000 vintages within its walls.

For the rugged and adventurous, Nemacolin offers many experiences in the great outdoors. The Adventure Center features a Shooting Academy, an outdoors sporting facility on 140 acres complete with 30-stations, wing shooting, a spacious lodge and Orvis Endorsed Fly Fishing. Or you can spend the afternoon at the Wildlife Academy, home of the Equestrian Center, animal nursery, animal habitats and educational programs. There you can see black bears, zebra, buffalo, tigers and hyenas, just some of over 100 animals that currently call Nemacolin home.

Their ski facilities at Mystic Mountain offer downhill and cross-country skiing enthusiasts, snowboarders, and snow tubers a variety of snow sports. For a different winter experience, you can try snowshoeing or dog sledding on the property's winter trails. When the weather breaks in the spring, the resort offers 36-holes of championship golf on two courses - the Pete Dye designed, PGA-tested Mystic Rock and the traditional Links Course.

If the great outdoors isn't beckoning you, shopping is an option at the 14 specialty shops in Heritage Court, or you can immerse yourself in some culture at a daily art tour of the multi-million dollar Hardy Family Art Collection. My vote would be one of the cooking classes or wine tastings in the resident state-of-the-art Academie du Vin, where Nemacolin's resident Sommelier invites guests for a tasting of world class wines from around the globe.

The surrounding area offers some places of interest as well. Situated just a scenic 10 minutes from the gates of Nemacolin is Ohiopyle State Park. The Park encompasses 19,052 acres of rugged, natural beauty, with the focal point being the Youghiogheny River that passes through the heart of it.

If you're into wine, the Christian W. Klay Winery is one of Pennsylvania's premiere wineries and is just minutes from Nemacolin on the historic National Road. There are also some historic landmarks to venture to, like Fort Necessity, and Falling Water and Kentuck Knob, two architectural masterpieces by Frank Lloyd Wright.

So whether it's a family getaway, romantic interlude, or a much-needed rendezvous with the gals, Nemacolin is worth looking into. IMAGE

Marie Osmond
This issue of Image Magazine is dedicated to a New Year, New You so we thought it a perfect choice to have Marie Osmond for our featured celebrity. She has traversed personal tragedy, divorce, depression, and a battle with her weight and she has overcome each experience with grace, fortitude, and resilience.

She has won the hearts of the world with her radiant smile and genuine nature. Marie is beautiful and charming, yet humble and sincere. She is America's sweetheart, and an accomplished talent across the entertainment spectrum. But above everything, her greatest joy and triumph are her children and family.

Marie Osmond was raised as a member of The Church of Jesus Christ of Latter-day Saints, and the only daughter of nine children. She has endured her existence in the public eye, beginning with her national debut at the age of three on The Andy Williams Show. She became the youngest-ever host of a national television variety show, The Donny & Marie Show (1976-81); and has been performing for almost five continuous decades since.

Overcoming adversity has been an unfortunate pattern in Marie's life. She has been married three times, to two different men. After the birth of her seventh child, she suffered from severe postpartum depression, and wrote about it in her book Behind the Smile. In an interview with WebMd, Marie revealed "I became immobilized. I literally shut down. I could not get through a day. The idea of making a phone call or keeping an appointment seemed impossible." She shares her personal journey through the darkest days, leading up to her recovery. Her purpose for the book is to tell readers "There is light at the end of the tunnel. Part of finding that light is knowing you are not alone."

Another trouble spot in her life has been body image, something she has struggled with since the ripe age of 10. Marie blames most of it on living in the spotlight and the media's expectations of what a star should look like. She coasted through the years with bouts of bulimia, diet pills, and starvation. After the birth of her last child, her weight had climbed to a point of no return. In an interview with Oprah back in 2009, she said "All of a sudden, one day I woke up and I was no longer a size 2-4. I was a 12-14, and I couldn't see it in the mirror. I didn't want to see it." Peaking at 165 pounds, she knew the weight was affecting her happiness, and above all her health, and decided to embark on NutriSystem's plan. She chose their program because it was heart-healthy, easy, and private all issues that were of utmost importance to her.

One of the most devastating events in her life was the loss of her son Michael, who on February 26, 2010, committed suicide by jumping from the eighth floor of his apartment building in Los Angeles. He had reportedly battled depression for most of his life and had been in rehabilitation at the age of 12.

But despite all of the heartache and calamity, Marie has gotten back up each time, forging ahead in her career and personal journey. On Season Five of Dancing With the Stars, 25 million people watched her devotedly, sending her into the finale. Since September of 2008, Marie has performed five nights a week to sold-out crowds and tremendous reviews in Las Vegas at the Flamingo Hotel with her brother Donny, and is doing a Christmas show in Chicago on December 6 24. In April 2011, Marie released a new album with Donny (after 28 years), Donny & Marie, and

this past August, Marie toured across the country with her new solo show "A Little Bit Country and a Whole Lot More."

Besides being an entertainment starlet, Marie is also a savvy businesswoman. Now celebrating 20 years, she has enjoyed much success with Marie Osmond Dolls, and she also has her own line of sewing machines, crafting products, and a top-selling international jewelry line with Giftcraft.

Marie is also an extraordinary philanthropist. She is co-founder of Children's Miracle Network, and also serves as a spokeswoman for the American Heart Association and "Go Red for Women."

As she told WebMd, she leaves us with this: "Life is a work in progress. Enjoy the process." IMAGE

South Nassau Communities Hospital
South Nassau Communities Hospital is about you its mission is to be there when and where you need it. As your hospital, you can count on South Nassau to serve as the guardian of your health, wellness, and quality of life.

South Nassau Communities Hospital is a standard-setting 435-bed hospital that provides state-of-the-art care in cardiac, oncologic, orthopedic, bariatric, pain management, mental health, and emergency services. In addition, it provides emergency and elective angioplasty, is the only hospital on Long Island with the Novalis Tx and Gamma Knife radiosurgery technologies, and operates 14 community-based satellite healthcare programs, including the Center for Weight and Life Management.

The Center for Weight and Life Management, under the direction of Rajeev Vohra, MD, FACS, director of minimally invasive and bariatric (weight-loss) surgery, is designated as a Bariatric Surgery Center of Excellence by the American Society for Metabolic and Bariatric Surgery. Dr. Vohra and the Center have been on the front line of the latest innovations in surgical weight-loss techniques and medical technologies to help thousands of overweight Long Islanders take back their lives and health.

Among Dr. Vohra's surgical methods for weight loss is the laparoscopic gastric sleeve or sleeve gastrectomy. The gastric sleeve is a procedure that does not involve rerouting or reconnecting the patient's intestines and is therefore a much simpler operation than gastric bypass or duodenal switch. Studies have shown that the gastric sleeve is more effective than the gastric band or gastric bypass at reducing the feeling of hunger, and it lowers the patient's risk of experiencing post-operative malnutrition or vitamin deficiency. South Nassau's program is the leading sleeve gastrectomy program throughout Long Island and Queens.

Overall, South Nassau has successfully performed more than 3,500 weight loss surgeries, including gastric sleeve, gastric bypass, LAP-BAND, and revisional surgeries like the StomaphyX. The LAP-BAND was recently approved for use in patients with a BMI as low as 30, with one co-morbidity (such as heart problems or diabetes), making this effective weight loss method available to more patients than ever before. All of Dr. Vohra's weight-loss surgeries are performed laparoscopically, a less invasive surgical method that typically reduces the patient's length of hospital stay. The Center also offers an innovative "Back on Track" revisional surgery program for patients who have had weight loss surgery previously but didn't achieve their goal weight. For patients who qualify, Dr. Vohra and Gregory Nishimura, MD, are among the few surgeons in the U.S. offering single-incision weight-loss surgery. This approach requires a single Ôø‡-inch incision in the bellybutton to perform the gastric sleeve or LAP-BAND procedure.

Drs. Vohra and Nishimura are complemented by a comprehensive weight loss team, including a patient liaison, physician assistant, registered dietitian, and psychologist who are there to support the patient throughout his or her weight-loss journey.

For more information about weight-loss surgery or to reserve a seat at a free seminar regarding weight loss surgery, you can call South Nassau's Center for Weight and Life Management at (516) 374-8631. IMAGE

Image events
Perio NYC hosts a party to introduce their new Interactive Website & LOGO

PerioNYC celebrated the launch of their new interactive website and logo on September 22nd. The event also reaffirmed to the dental community the partnership between Dr. Susan Karabin and Dr. Edward Gottesman. It was an elegant evening at the 61st Street townhouse location of PerioNYC. Colleagues, friends and the media were on hand to celebrate the event.

"Making Strides Against Breast Cancer"

For the third year our team IMAGEine Life walked for the cure at Jones Beach on Sunday October 16th. It is the most inspiring day, early morning on the boardwalk with more than 55,000 people walking for the cure. As crazy and crowded as the boardwalk became by 8am, the beach remains quiet and serene. It was an amazing and emotional PINK day filled with purpose and clarity. Our Long Island community came together to raise $2,900,000 and donations are still coming in. If you would like to donate please visit http://MakingStrides.acsevents.org/LongIsland and place our team name under the word DONATE. It is never too late to give and create more birthdays. We would personally like to thank all the participants who supported us and walked with our team so that we were able to give the gift of $5000.00 to the American Cancer Society

IMAGE Magazine Pink Ribbon Sponsors Worldwide Communications . Armani Exchange . Great Shapes . Vision World

Dr. Karen Barbosa Educates LI Women on Breast Health One Group at a Time

Dr. Karen Barbosa, Long Island's prominent Breast Disease Specialist gives her time whenever possible to educate the Long island community on Breast Cancer Prevention. Dr. Barbosa is truly a women's advocate and has made women's health her platform as a specialist in breast surgery. Her seminars are filled with passion in regard to providing information on prevention, treatment, and all the questions you should be asking your doctors and imaging centers to receive the best possible care. Close to 100 women attended her seminar at the Smithtown Senior Center.

Natural Beauty Derma Spa hosts its monthly "Girls Night Out"

On Thursday, September 15th, Natural Beauty Derma Spa held its monthly Girls Night Out event. This month featured complimentary Visia Skin Care analysis, free Glo Mineral makeovers and special pricing for various spa services. Another highlight of the evening was the introduction of our newest member, plastic surgeon Dr. Elizabeth Roya Emami. Dr. Roya joins Natural Beauty Derma Spa to add the latest in minimally invasive rejuvenation techniques including fillers (Radiesse/Juvederm), Botox and fat grafting (using your own fat). The night was a resounding success and we invite you to join us. Stay up to date with the latest events and specials by following us on Facebook at NaturalBeauty DermaSpa or on our website www.NBDSpa.com.

13th Annual Fall Into Fashion Luncheon for the Diabetes Research Institute

Style, fashion and philanthropy came together at Fresh Meadow Country Club, Great Neck, as guests showed their support for a cure for diabetes. Highlighted by a fashion show presented by RED Valentino in collaboration with STEVEN DANN, the event featured a cocktail hour, luncheon, and auction. The exciting Grand Prize Sweepstake was a three night stay for two at the beautiful and relaxing Canyon Ranch Spa, Lenox, Ma. The DRI is pleased to announce Frances B. Reid as this year's honoree. Fran has served on the Into Fashion committee for many years and continues to support the DRI and those she loves with diabetes.

Shockwave Hits the Nation
Technology to Heal pain
Q&A WITH Corey Fox, DPM

IMAGE: What causes heel pain?

Dr. Cory Fox: The most common cause of heel pain is plantar fasciitis. This is characterized by pain in the bottom of the heel, especially when getting out of bed in the morning, or when first standing after sitting for a while. Sometimes the pain goes away after a few steps, other times it can take minutes to hours.

IM: Why does plantar fasciitis develop?

CF: The plantar fascia is an inelastic ligament that runs from your heel bone to the ball of your foot. It supports your arch and takes your full body's weight with each step you take. Increased tension on this ligament results in irritation at its attachment to the heel bone. This is more prevalent in people with structural problems like flat feet or high arches. Long work hours, demanding sports, or recent weight gain can also contribute.

IM: What is Shockwave therapy?

CF: In short, it's exactly what it sounds like a high-energy acoustic wave that gets aimed at the irritated tissue. It comes from the same science behind the shockwaves used to break apart kidney stones. A pressure wave travels through the skin and stimulates the body's own healing cascade. The shockwaves also stimulate the formation of new blood vessels, which brings more blood cells and the healing factors to the injured tissue. The treatment is safe and effective, and has been evaluated by the FDA with randomized, controlled, double-blinded scientific studies. It has been popular in Europe for decades.

IM: Who benefits from Shockwave therapy?

CF: The ideal patient is someone who has chronic heel pain due to plantar fasciitis, who has not responded to traditional therapies like orthotics, cortisone injections, stretching, physical therapy, and oral medications. It is also very effective for similar heel problems, like Achilles tendonitis. It is not recommended for children, pregnant women, or people taking blood thinners like Coumadin or Plavix.

IM: How is the procedure performed?

CF: The original Shockwave machines produced a painful electromagnetic wave that required anesthesia, sometimes general anesthesia, and needed to be done in a hospital. The newer machines use Radial Shockwave technology, which produces a safe, gentle, pneumatically-induced pressure wave. This is performed in the office and does not usually require anesthesia. It takes about 15 minutes, and may require several treatments about two weeks apart.

IM: What are the advantages?

CF: The main benefit is that it is non-invasive. You can return to work and activities immediately. There are relatively no complications when compared to more traditional treatments. Repeated cortisone injections can actually injure the plantar fascia, weakening it and causing ligament ruptures. Surgery, although very effective, certainly has its drawbacks. Complications of surgery include prolonged swelling, scar formation, and nerve injury.

IM: Are there any other new treatments for heel pain?

CF: Yes, and like shockwave, all the new treatments work by unlocking the body's own healing mechanism. TOPAZ radio frequency coblation uses radio waves to fenestrate the plantar fascia and stimulate new cell and blood vessel formation. This minimally invasive procedure is usually performed in the hospital under sedation and with local anesthesia. It is highly effective like Shockwave. Platelet-rich plasma therapy, or PRP, involves taking your own blood, concentrating the platelets, and injecting them into the painful heel. This is also effective, since platelets contain all the growth factors you need to heal any wound. This can be performed in the office under local anesthesia.

The latest technology for heel pain is exciting, safe, and effective, with very little disability. Orthotics are required to reduce and equalize forces causing the problem. Shockwave and the other new methods cause your body to heal itself, and heal stronger. Patient, heal thyself! IMAGE

REFRAMING YOUR SMILE
Successful treatment for the receding gum line
by EDWARD GOTTESMAN, D.D.S.

Gingival (gum) recession is more common than people realize unless they have it. Recession especially around front teeth leaves some of the teeth's root surfaces exposed, giving a "long-in-the-tooth" appearance. This can make anyone self-conscious.

Studies suggest over 50% of adults aged 18-64 worldwide have some recession; numbers rise with age, and approach 90% for those 65 and older. While recession is most common around the upper permanent first molars, it's most noticeable around front teeth, and may lead to other potentially serious dental problems, including root hypersensitivity and increased susceptibility to root decay. Teenagers can have recession with or without orthodontic treatment; recession is the primary reason dentists refer teens to periodontists.

Causes of Recession

Like any disease or condition, recession has multiple causes. Because your recession may be a first sign of periodontal disease, start by meeting with your dentist. Improper techniques such as vigorous toothbrushing, using the wrong toothbrush, and aggressive flossing are common causes of recession. Your dental team can help optimize your brushing and flossing protocol. Nighttime clenching and grinding (bruxism) can also contribute to recession, so that's important to address as well.

Some people also exhibit a thin gum biotype this means their normal gum tissues are thinner (less than a millimeter in some cases), increasing recession risk, even with correct flossing and brushing. Thinner gums are more vulnerable to everyday trauma and the all-important threat of inflammation from bacterial plaque (biofilm). Recession can begin in adolescence, especially with a thin gum biotype, if permanent teeth come in too far toward the outside (facially), and erode supporting bone and gum. So, buffering or thickening such gum tissue can reduce your risk of recession.

Orthodontic tooth movement can also cause and complicate recession, especially if you're a thin biotype. Tipping the teeth facially may thin the supporting bone along with the gum. Orthodontic patients aged 12 and up often have thin gums around the incisors, where recession is common. It's better to treat recession proactively before orthodontic treatment starts.

Introducing Your Periodontist

As periodontists, we're the first line of treatment for recession with or without periodontal disease so visiting the periodontist is a pivotal step. Early recession treatments involved autogenous (patient's own tissue) gingival grafts, cut from existing gums and sewn over the recession defects; these often caused bleeding, pain, scarring, poor color matches, and a patched appearance. Connective tissue (CT) grafts transfer a portion of the underlying tissue layer of the palate to

recession site. While successful in covering exposed roots, considerable pain and discomfort at the donor site, longer healing, and the tongue-teasing "crater" left by the graft, have reduced their popularity. Autogenous grafts are also limited in size, necessitating multiple surgeries when many teeth are involved.

21st Century Recession Solutions

Recession's outlook has improved. In our practice, we treat recession with a conservative process called allogenic grafting with a purified collagen-containing human skin product called acellular dermal matrix (ADM). ADM grafting can prevent root decay, relieve sensitivity, and eliminate recession by providing a biological framework in which your body can build new tissue. ADM's larger size allows 12 or more teeth to be covered in one visit.

Using minimally invasive techniques similar to those of plastic surgery, your periodontist performs the procedure with high magnification, smaller and fewer incisions, smaller instruments designed for minimal tissue trauma, and extremely fine sutures to secure the graft. The ADM is woven over the recession defects and through "tunnels" under layers of your own gum tissue, which is then stretched over it and sutured in place, maintaining good color and texture match while thickening the tissue. This culminates in less discomfort than autogenous gingival or CT grafts, much faster healing, no scarring, and better overall surgical outcomes. Usually, you'll have only 24-48 hours of swelling and minor discomfort easily managed with over-the-counter anti-inflammatory drugs.

Framing Your Smile With a Healthy, Attractive Gumline

Once you lose gum tissue, it's difficult to recapture. If your teeth need moving, increasing the volume of existing gums before beginning orthodontics can actually prevent recession. Your dentist or orthodontist will usually send you to the periodontist to Plan a gum graft, proactively, establishing a "buffer" for the root surface, thickening the gumline and making it more resilient during tooth movement. This is especially critical for thin gum biotypes.

Be aware that your gumline is as important as tooth form in establishing your ideal smile. Cosmetic smile makeovers, like crowns or ceramic veneers on the upper six front teeth the all-important-and-visible "social six" must address recession. Periodontists can create a more ideal gumline for the restorative dentist. Your periodontist will cover those exposed roots with ADM, bulk up your gums, and harmonize their margins to complement your new crowns or veneers, for a more natural-looking smile all around.

So, if you're embarking on a new smile, make sure your restorative dentist knows you're having ADM graft recession coverage. That way, he or she can preserve ideal form, symmetry, and length of your teeth, and avoid a "long-tooth" appearance by matching the margin heights on those new veneers or crowns with your restored gumline and lipline.

Maintaining your restored gumline is critical as part of your overall periodontal health. Your own continued good oral hygiene must emphasize avoiding habits that originally caused recession, along with controlling inflammation. Collaborate with your dentist, hygienist, and periodontist via ongoing, regular, shared follow-up visits at frequencies appropriate for you. IMAGE

A Nose for Beauty
3 Steps to a Beautiful Start for the New Year!
by Kapil Saigal, M.D.

What's so special about the nose?

The nose stands at the center of our face and dramatically impacts facial appearance. A prominent or crooked nose can distract from other features, such as the eyes. Rhinoplasty (cosmetic nasal surgery) is a remarkable procedure that can restore facial harmony by creating a proportional nose that is natural-looking. Each surgery is customized to your unique features and desires, because there is no universally ideal nose only one that is ideal for a particular face.

The best results must be balanced any unnatural look where the nose is upturned or excessively pointy is a disservice to the goals of cosmetic surgery. My goal is always to refine the size and shape of the nose, to improve balance. I use multiple techniques to provide my patients with a natural-looking nose, invisible incisions, and a rapid recovery. Occasionally, I will also perform nasal surgery to improve obstructed breathing caused by prior surgery or trauma.

I believe there are three steps to achieving a beautiful nose:

1. Allow yourself to dream: Envision yourself as you'd like to be and then think about what it will take to get there. Today there are multiple ways to lift, augment, or reduce problem areas and it can be done in a minimally invasive, natural-looking way!

2. Know that you deserve it. It's ok to treat yourself. Remember that before you can take care of anyone effectively, you've got to take care of yourself. Only when you feel your best can you give your best.

3. Schedule your free consultation. Meet with a board certified surgeon, and talk about your options. He will work with you to develop a plan that you feel comfortable with and that will make a dramatic difference in your life. Remember, little changes can have a big impact!

Why should I trust my face to a specialist?

It's important to find a physician who specializes in plastic surgery of the face and neck and is board certified. They have devoted surgical training exclusively to the anatomy and structures of the face, head, and neck and are uniquely qualified to perform functional cosmetic surgery and provide you with the exceptional results you desire. With rhinoplasty in particular, shape and function are of equal importance. There can be internal deformities that may affect breathing, as well as the structure of the nose, that must be addressed, to allow for an exceptional, functional, and long-lasting cosmetic result. It is also better to find a physician who focuses on a just a few plastic surgery procedures and performs them exceptionally.

How do you accomplish a natural looking nose?

A natural nose is also a nose that 'fits' the rest of the face and, in particular, the chin. A natural angle between nose and forehead and nose and upper lip is one of the features of a natural nose. A soft tip that is not sharply contoured and a bridge that is not overly narrow are critical.

Although there are certain standards for the size of the nose in relation to the face and eyes, this is a very artistic operation where the underlying bone and cartilage are sculpted into a new shape. Because of this, I recommend that patients see pictures of other noses the doctor has operated upon; ultimately the patient's vision must agree with the surgeon's vision.

What is endonasal surgery?

Endonasal, or Closed Rhinoplasty, is a minimally invasive technique where invisible incisions are placed inside the nostrils. This helps with a quicker recovery (often less than seven days), as well as less bruising and swelling. I perform both closed rhinoplasty as well as open (external) rhinoplasty, which is performed through a small inconspicuous incision at base of nose. Since each nose is different, the approach is individualized to the patient, their anatomy, and desired result. In fact, sometimes I will add cartilage in revision surgery to collapsed areas. This cartilage is usually obtained from the nasal septum or the ear (auricular cartilage). I may use this cartilage to camouflage defects, support a drooping tip, or correct irregularities.

Patient expectations after surgery

Most patients return to work and full activity after one week. However, activities that may risk bumping or traumatizing the nose should be limited for four weeks. Bruising around the eyes may occur, though this is rare. Most patients feel remarkably well immediately after the procedure, and have minimal pain.

Age and motivation as factors

Women as early as 14 years or males as early as 15 years may be candidates. An injury might cause a nose to become crooked, which is often how patients initially meet the surgeon. Patients may also be unhappy with a bump, a wide tip, or flaring nostrils. Additionally, breathing or sinus problems may drive a patient to seek a doctor as their primary concern and they may decide to do some cosmetic improvement at the same time. Also, as we age, the nose may lose support and become elongated this can always be corrected! Remember, subtle alterations can greatly improve one's appearance.

Complementary procedures that can accompany surgery

Let's face it: From fine lines and wrinkles to sagging skin, the telltale signs of aging often appear on our faces first. Facial plastic surgery can help turn back the hands of time, allowing us to look as young as we feel. Deciding between surgery and non-surgical treatments, including dermal fillers, botox, and skin care, requires a consultation to discuss the many different options in a customized fashion. Ultimately, I may recommend a variety of options in combination at the same time as surgery to improve overall outcome.

The ideal situation is to find a practice that provides a compassionate environment where you will reach your aesthetic goals on your terms, with the safest and most natural result that can be provided, and a quick and painless recovery. IMAGE

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Have you been diagnosed with a neurological condition such as Parkinson's Disease, Restless Leg Syndrome, or Loughery's Syndrome? Do you have Rheumatoid Arthritis or Lupus? Do you want to finally quit smoking? Are you suffering from migraines, shoulder, neck, back pain or any other chronic pain? Have you had an injury or surgery and not felt well since, or do you simply just want to be healthier?

What is common to all of the above is that they all respond positively to 'Peripheral Brain Stimulation.' A German neurologist, psychiatrist, and research scientist, Dr. Ulrich Werth, has developed a way to impact the quality of life and minimize symptoms for patients with these conditions by using Forever Implant Needles, which activate Peripheral Brain Stimulation (PBS). This permanent, advanced acupuncture is derived from ear acupuncture (auricular), a Chinese technique over 5,000 years old. There are 330 different acupuncture points in the ear. Micro titanium implants are inserted under the skin of the outer cartilage of the ear these implants are called Forever Needles because they stay in the ear indefinitely. The implants are placed to give continuous stimulation, 24 hours/7 days a week, to selected acupuncture points. The implants have no known side effects and they are not magnetic.

This technique (PBS) starts the body to heal on its own by minimizing blockages of any pathways interfering with the energy flow in the body. Over the past 11 years, thousands of patients have chosen this treatment and experienced reduction in their symptoms, medications, and improvement in their quality of life.

Parkinson's disease is a neurological disorder that causes motor function impairment from the destruction of the brain cells that make the neurotransmitter dopamine. The Forever Needles create permanent neural stimulation to the brain, which causes natural production of dopamine. This relieves some of the symptoms of Parkinson's.

This technique may be helpful for other degenerative diseases like Alzheimer's, as long as the procedure is initiated in the early stages. Although this technique cannot cure Multiple Sclerosis (see Leah's story) or other disorders, patients report improvement in their symptoms, increased energy and a better quality of life. Patients struggling with addiction to tobacco, food, alcohol or other addictions also respond well to this therapy. The road to recovery is determined by the patient's desire to help themselves along with the combination of other natural therapies.

As continued research is needed, which will take years, it is the patient's choice to wait for the results of the research or do it now. Dr. Werths' in-house experience of treating over 4500 patients during the last 11 years gives us proof that this technique works. The acupuncture gives the boost, but to sustain it you need adjunct support with a healthy lifestyle, exercise, healthy diet, plenty of water, rest, and supplements.

There are some people who reach a plateau in their recovery and they need to try a new direction. These individuals might just benefit from this care. Advanced acupuncture is a profound way to enjoy and maintain health at every stage of life. Pilot studies show remarkable success, particularly with Parkinson's disease. Following are some patient testimonials:

Enrique's Story

Enrique, a boxer, who in 2006 suffered from strong tremors, bent posture, and speech problems, was tested and diagnosed with Parkinson's Disease. Two hundred micro titanium needles were implanted in the outer ear. He began to feel the difference in his tremors and posture. Today, the only symptom left is a slight tremor. He can stand up straight, and apart from a nasal voice, speaks more clearly than before the treatment. His head feels clear and he was back in school learning another language. The brain scan after 9 months showed an increased dopamine production. Enrique was experiencing fewer symptoms, and treatment has reduced his need for conventional medication.

Leah's Story

Leah was diagnosed with primary, progressive Multiple Sclerosis in 2008, but her symptoms actually started in 2006. She complained about her left side and arm being weak, and her left foot was 'dragging.' After being treated once in 2010, she experienced increased energy (not as tired), her limping had subsided, and she could stand and walk for hours. Other people have commented on how much better she looks. On a scale of 1-10, she states that her improvement is definitely a 10. You can see an interview at http://www.youtube.com/watch?v=z8e8fW9v4eQ.

Daniella's Story

Daniella is a professional musician, a cellist, who could no longer perform. Her arms were wobbling, her voice was trembling, she started to complain about weakness in her left leg, and she had constipation. She had her first treatment in July 2010. Her symptoms improved a lot, but she wanted to get even better, so in November 2010, she received a second treatment. Daniella states that she had a 100% improvement following the second treatment as her hands stopped shaking and all other symptoms disappeared. However, when she had some minor surgery, her symptoms got slightly worse. She is now only taking vitamins and minerals. Her friends tell her she looks much younger, more energetic and happier. See an interview at http://www.youtube.com/watch?v=Yid5JXqsGI8.

Dr. Werth has exclusively trained and certified two health practitioners, Andrea Goldberger D.A.C., D.N.M., DO (mp) and Garry Kotack B.Sc., D.D.S., D.A.C., in this profound and revolutionary technique. Their North American office is located in Toronto, Canada. IMAGE

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YOUR NEW YEAR'S RESOLUTION
TAKE SHAPE FOR LIFE AND BE BALANCED
by ROXANNE CARFORA, D.O.

How many times have you made your News Year's Resolution be about weight loss? Every year we start off fantastically. But soon the parties come, the celebrations in life, and all the food you can eat. We make excuse after excuse, month after month, day after day. The good news is it doesn't have to be like that. What if your body was in Perfect Balance nutritionally and hormonally? This is key, and the side effect of being balanced is you guessed it weight reduction.

So, beginning January 1st (after you have exhausted all your parties), start the New Year thinking about being balanced not losing weight. And begin TAKING SHAPE FOR LIFE.

So here are a few steps to get in balance and take shape for life:

1. Know your food allergens. One of the common causes of weight gain is food allergies. Food allergens cause the "gut" (your intestines) to become inflamed. This inflammation can cause malabsorption of vital nutrients; proper absorption is necessary for your metabolism. Once your allergens are identified, you can follow a food avoidance diet, eliminating the foods that are causing inflammation. You may need to take a probiotic to balance the "good bacteria" in the gut if you are extremely toxic. Now you will be able to absorb nutrients to turn your metabolism ON!

2. Know your metabolic rate. This can be checked by today's great technology. I use a machine called REEVUE. Patients breathe into a tube for 10 minutes while sitting and reading in a comfortable chair. This will calculate how many molecules of oxygen you expend sitting down and calculate the calories YOUR body needs to function. This test is available in some physician's and nutritionist's offices. It is important to "feed your metabolic rate." Often, patients will reduce their calories to the point of starvation mode and actually slow down metabolism.

3. Another thing that slows metabolism is the imbalance of hormones. Many women who are peri-menopausal and post-menopausal have a decline in DHEA. DHEA is the hormone that stabilizes our stress hormone called cortisol. Everyone remembers the commercials for Cortislim?? As cortisol increases, belly fat gets fatter. Cortislim was used to decrease cortisol; however, a decrease can slow metabolism. So again, "It is all about balance."

DHEA is the helper hormone that tries to balance cortisol, so it will not go too high or too low. We begin to drop DHEA naturally in our early 30s, and by the mid 30s we need replacement. You can get your DHEA level checked through blood work your goal is to be at least 100. Some patients must be careful if they have estrogen metabolism issues or if they are male with estrogen issues (prostate enlargement is an estrogen issue). When DHEA is normal it will increase metabolism, increase sex drive, increase energy, and help with weight reduction.

4. Estrogen, progesterone, and testosterone all communicate with cortisol. It is very important that they too are balanced. Again, if you are in your early 30s to late 30s your hormones are already on a decline, so expect some weight gain naturally unless you achieve balance. There are many nutrients that can help with this, and one of them is DHEA. Again, make sure you get your levels checked. Do not take a substance unless you know you are depleted. You can get all your hormone levels checked in routine blood work and many insurance companies cover this. Most women will require 12.5 to 25mg of DHEA and most men require 50mg per day.

As you get into your early 40s to the late 40s, progesterone and estrogen decline. Testosterone in men and woman also declines. These hormones are responsible for a lot of things. In anti-aging medicine it is key to balance hormones naturally using Bioidentical Hormonal Replacement Therapy. Bioidentical hormones are natural and plant derived, and have now advanced in technology to the point of patients maintaining such a higher quality of life. Bioidenticals are ridiculed by many conventional doctors (as I once was), but it really is the lack of knowledge or training that causes this misunderstanding. I take Bioidentical Hormones myself and recommend them highly to my patients. The data and research on this modality is safe and effective, and gives men and woman a choice a choice to not to be depleted and to be balanced.

As I stated before, it is not about losing weight, but it is about balance. This is what gives us a healthy body for life. Get your blood work done not just for your cholesterol, but also for your hormones, vitamins, and minerals. This brings me to the last point.

5. Vitamin and mineral balance. Vitamin D is very important. In anti-aging medicine we consider Vitamin D a prohormone rather than a vitamin. Vitamin D helps the hormone insulin work more efficiently. Insulin is a hormone that is stimulated when you eat too much sugar. The more the sugar, the more insulin increases, the more the fat cells get stimulated to secrete more fat cells. Eventually the body begins to store the fat that insulin is producing. Where does it store it? Right in the abdomen the "pop belly," the "muffin top," the "jelly belly." And it's not so jolly’Ķit is dangerous. This is how many diseases such as heart disease, diabetes, and arterial disease starts.

The great news is you can reverse this by balancing your hormones, vitamins, and minerals. Other minerals that are important for metabolism are zinc, selenium, iodine, and magnesium. All of these can be checked in conventional blood work and can be replaced. Iodine stimulates the thyroid to produce the thyroid hormone. We all know someone that thinks they have a thyroid problem and the doctor tells you everything is normal. Wrong. Have them check your iodine level. It is a vital nutrient for this gland. In anti-aging medicine we call this "sub-clinical hypothyroidism." This is a disease that is present but has not revealed itself in "conventional" blood work.

Identification and treatment of underlying nutritional and hormonal depletions are vital to taking shape for life. This is not a temporary fix, and remember, the side effect of balance is weight reduction.

As a New Years' resolution, every year, I want to share and educate patients on the scientific data that is out there. Medicine is constantly changing and we as doctors must always stay educated and updated, not for ourselves but for our patients. Share this information with your family and friends so we all can make a difference in our health. Let's start TODAY to TAKE SHAPE FOR LIFE. IMAGE

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Rejuvenative Surgery
When Anything Less Than a Facelift is Futile
by James C. Marotta, M.D.

Patients seeking the fountain of youth universally want the same things; they want to look better, refreshed, and natural with as little recovery, pain, and expense as possible. We live at a time when rapidly evolving medical advances and technology have led to a plethora of non-surgical options to treat wrinkles and an aged appearance in general: Botox, Dysport, Restylane, Juvederm, Intense Pulsed Light (IPL), laser, radiofrequency skin tightening, and now ultrasound skin tightening, to name a few.

Patients frequently turn to these non-surgical options before, or in lieu of, even considering rejuvenative surgery out of fear, misconceptions about surgery, and the false idea that these treatments can replace surgery or achieve improvements on par with surgical results. However, that's not to say that non-surgical treatments don't have their value. They can be extremely effective when used for specific problems in the right patient. But with that said, the reality is that no non-surgical aesthetic intervention available today can achieve the permanence, degree of correction, and natural appearance achievable with facial plastic surgery. So when do you throw in the towel on the injections, fillers, and tightening machines? Here is some practical advice.

Don't turn to non-surgical treatments if your main concern is sagging cheeks, a sagging brow, jowls, extremely loose skin, deep wrinkles, or a "turkey neck." Only surgery can markedly lift, tighten, and reposition sagging facial skin, muscle, and fat and permanently augment areas of facial bone loss that occurs with aging. No injectable or skin tightening machine can lift or tighten facial tissue to the same degree as surgery. Botox, Dysport and injectable fillers like Juvederm, simply don't lift. That is not the way they work. They either relax muscles (the opposite of lifting) or fill in folds or wrinkles. Sagging brows, cheeks, jowls, and neck skin will still be there after all the Botox and fillers in the world. Patients definitely look much better after filling in folds and diminishing wrinkles, but frequently notice the left over effects of gravity with bulges and loose skin that cannot be fixed with injectables.

What about the myriad new non-surgical skin tightening machines as popularized on TV shows like the Doctors, Dr. Oz, and Oprah? Surely they can do something to lift and tighten in the way that surgery does? Despite all the press and fanfare in the world, ask any respectable, appropriately credentialed physician provider if they do and the resounding answer will be: "No, not even close."

Why might this be the case? As discussed above, a lot of facial aging has to do with the effects of gravity and time causing drooping or sagging of facial tissues and facial atrophy (shrinking). These changes are way more than skin deep affecting the bone, muscle, fat, ligaments, and skin. Radio-frequency skin tightening devices like Thermage or Titan reach only skin deep. The tightening effect these machines have on the skin is marginal and tens if not hundreds of orders of magnitude less than can be achieved with surgery.

A newer ultrasound-base technology, Ulthera, which I offer in my practice, is the first non-surgical device to achieve an FDA clearance for tissue lifting. Ulthera offers more promise for non-surgical tightening because it uses focused ultrasound not only to tighten the skin, but also to reach into the deeper tissue layers. Ulthera is a great option for patients with mild to moderate facial aging with specific problem areas. However, no non-surgical device can now, or likely will ever be able to, lift, reposition, fill, contour, and essentially "sculpt" away aging in the human face the way a talented surgeon can. I take a three dimensional surgical approach to the face, which I call "Sculpt-Lift-LaserTM", and it affects all aging in the face by sculpting bulges and depressions, lifting sagging tissues, and lasering away wrinkles and skin imperfections.

So if you've had non-surgical treatments in the past and still aren't satisfied with the way you look, it may be that what you're trying to remedy can only be significantly improved with surgical techniques. In general, the more advanced your age and facial aging is, with a greater degree of sagging and wrinkles, the less likely you are to get complete correction of your problem areas with non-surgical methods. Remember, only surgery can really lift. Only surgery can permanently fill and sculpt. Only skin resurfacing like laser can correct wrinkles in a long lasting way. While surgery tends to have a higher up-front cost than non-surgical treatments, the lasting effect of surgery may make it ultimately a cheaper and certainly a more effective long-term solution. For every advance in non-surgical treatments there are equal advances in facial plastic surgical techniques, making today's facial plastic surgery the most lasting, natural appearing, and effective tool we have to treat facial aging. IMAGE

Balancing Your Workouts
For a Total Fitness Experience

With the New Year fast approaching, we could all use a little motivation, inspiration, and fitness wisdom from some professionals in the field. Here to share their expertise are Jennifer Ellwood, Caren Rosenblum, and Kim Montgomery from Hot Ryde.

The CORE Principle

by Jennifer Ellwood, RealRyder indoor certified, spinning instructor, TRX Hot Ryde fitness director.

As the fitness director for Hot Ryde, when I am giving a tour of our studio to a potential client, I have limited time to explain what we have to offer. My objective is for them to not only see the individual studio and classes, but to also see the whole picture. Together, all of the disciplines we offer share a common principle: your CORE. My goal, as an instructor, goes way beyond helping a client achieve weight loss or getting toned arms for that tank top.

While these (and nice abs, of course) are a great by-product, I want to go deeper than that, to help strengthen those core muscles, the ones that support all of us in our daily lives, the ones that really matter. I want our clients to exercise, functionally, in a way that benefits their lives outside of the studio that gives them an enhanced body awareness and balance. This way, they can keep up with their kids, toss a football, pick up grocery bags without straining their backs, or reach their own outdoor fitness goals, whether it be a century ride, a mud run, or a marathon.

The Real Ryder bikes, with their tilting and turning, the TRX straps with their instability, the Barre and Yoga classes with their focus on form, positioning and breath, all help engage the core of the body while offering their own special benefits. Our clients exercise in a safe and comfortable environment, with very personalized attention, so they don't get injured and can continue having a fit and active life for years to come.

When I am leading them through a Real Ryder or TRX class, I have the best seat in the house. Every day, I get to see little smiles come across clients' faces when they finally "get" the bikes, when the side-to-side movement no longer seems awkward, and they find a natural flow. Or when they have released any preconceived notions about how strong they are or how much of an "athlete" they are, and they discover something new about themselves and their bodies.

This awareness then inspires me to think of new and innovative ways to challenge my students, so they are continually taking one step beyond their comfort zones. This "give and take" between our instructors and students is a very special feature of Hot Ryde. For me, personally, the balance of the classes we offer is just that: BALANCE. I do a lot of cardio, both in and out of the studio, and the ability to take an Ashtanga Yoga class to stretch, strengthen, balance, and open the body and mind is much needed. I know the benefits I gain from Ashtanga Yoga, or from doing strength work in TRX, or Barre to help make me a more efficient cyclist and runner when I walk out the door.

Mixing It Up
by Caren Rosenblum, RealRyder indoor certified, spinning instructor, TRX

As the new year comes upon us, it's a perfect time to re-evaluate your exercise routine. Although I am dedicated and rigorous in my training I always emphasize the importance of variety. In order to see results, one must mix it up and shock the body. Clients must continually change the stimulus of their exercise, whether it's in volume, intensity, or movement.

Hot Ryde provides the ideal venue to achieve this. I love teaching cycling on the RealRyders, as they allow one to move on a natural and functional range of motion. Unlike ordinary stationary bikes, they don't force the rider to pedal on one plane. This reduces the risk of injury to the rider and encourages them to challenge their body at their own level.

Music is often the primary inspiration for many of my rides. Clients often lose themselves in a moving song, surprising themselves as their body responds with more strength than they thought possible. This mind/body connection is what it's all about as clients realize the control their mind can have on their physical being. Besides being a killer cardio workout, riders will notice more core work being integrated into the Ryde an added benefit of the RealRyders! And because of our boutique set-up I am able to give one-on-one attention to clients, not only in set-up and instruction, but in reaching their own individual goals.

Rounding out your workout with a barre, yoga, or trx class is easy with the great flow of classes. More and more clients have been joining me in TRX suspension training for an awesome workout combining strength, flexibility, balance, coordination and cardio! Core musculature is activated during every exercise by intentionally displacing your center of gravity. I have noticed improvement in clients' core strength after only a few short weeks of training. This translates to diminishing back issues (something many of us struggle with).

In addition, performance in all sports and daily activities can be enhanced by training in all angles and planes of motion. Once again, the limited class size and one-on-one attention means I can ensure proper form for each client, as well as offering multiple progressions, arrangements and combinations. The mind/body connection is apparent as strength and coordination increases and feelings of empowerment follow.

The Barre/Yoga Experience
By Kim Montgomery YOGA/BARRE instructor, Certified Yoga Therapist

These two healing workouts are designed to massage the body in such a way that the workout becomes an experience. With their intelligent approach to complete wellness, they are exercises one can safely approach for years to come. These workouts are highly recommended for cyclist/spinners and those who do personal training, to stretch out over used muscles.

Combining yoga and At the Barre classes with your cardio workout such as cycling/spinning and TRX classes will help increase strength and endurance, release tension, burn calories, and create more flexibility in the entire body.

Hot Ryde is also great place to host parties, whether it is for a birthday or bridal shower. They will provide catering, classes, and music, and it is a great new trend. Women love the excitement of combining fitness with celebration. Call 516-801-6666 for more information. IMAGE

Goodbye Facial Flaws! Hello Smooth, Soft Skin!
DermaSweep, MD A new revolution in microdermabrasion
by Dina M. Weil

Laugh lines not so funny anymore? Acne got you in hiding? Sunspots showing their true colors? Unfortunately, not everyone can "grow old gracefully," and more often than not, we need a little help to regain our youth.

Our skin is comprised of seven layers. New skin germinates at the lowest layer and slowly rises to the top where it flakes off nature's method of exfoliation. As years pass, the natural process slows and artificial means, such as Microdermabrasion, are necessary to return your skin to its once youthful glow.

What is Microdermabrasion?

Microdermabrasion is a non-surgical procedure that resurfaces the outer layers of the skin. Exfoliation is performed with mineral crystals or a diamond tip, which brushes the skin's surface. This action removes dead and damaged cells at the skin's surface. By eliminating these older surface cells, the skin is left soft and supple while forcing the regeneration of new skin cells.

"There are many forms of Microdermabrasion systems available today, but very few can effectively and evenly remove the top layer of skin," said Dr. Mark Schwartz MD, FACS, and Medical Director of the North Shore Medical Spa. "We offer Dermasweep, MD, which is the newest generation of micro-resurfacing treatments offering a painless alternative to the abrasive machines of the past."

What is DermaSweep, MD?

Dermasweep, MD is a revolutionary new particle-free microdermabrasion that uses an innovative bristle tip technology, which causes less irritation to the skin, while at the same time allowing a more comfortable, aggressive, and rejuvenating treatment. DermaSweep, MD is an advanced medical-grade form of microdermabrasion meaning it is available only to a licensed physician and must be used by a licensed aesthetician under medical supervision.

How does it work?

The system operates using a vacuum pump that gently lifts the skin surface while the device "sweeps away" the dead layer of skin in a precise and controlled manner. The vacuum action of the wand stimulates blood flow and cleanses the pores. The increased blood flow encourages collagen formation, thus firming and toning the skin surface.

What skin conditions can be treated?

DermaSweep, MD offers a variety of adjustable vacuum pressures and multiple micro-bristle treatment tips that are fully customizable to treat patients with the most fragile skin to those with the most resilient. The system provides an unmatched capability to customize each treatment depending on skin type and desired results.

Typical conditions treated include:

Age lines (wrinkles, fine lines & crows feet)

Sun-damaged skin

Hyperpigmentation (regular

brown patches and age spots)

Melasma (irregular brown patches)

Acne

Uneven skin texture

Surgical scars

Stretch marks

Medical Microdermabrasion treatments also combine standard exfoliation with the simultaneous delivery of skin specific topical solutions infused directly into the skin. Topical solutions are formulated to treat specific skin conditions:

Acne - treated with a salicylic acid solution; a medicated solution used for the treatment of acne and clogged pores.

Dehydrated skin - treated with hyaluronic acid containing aloe vera and chamomile. This solution is especially formulated for normal to dry, sensitive skin.

Hyperpigmentation - treated with a skin brightening solution, combining hydroquinone, azelaic acid and kojic acid that work together to lighten pigmentation.

What are the side effects?

The treatment is completely painless. You may feel mild tightening or tingling after exfoliation, but the skin will be quite smooth. The moisture of any topical treatment will leave your skin with a cool, refreshed feeling. There are minimal side effects, which is why it is often described as "the lunch hour" procedure.

When will I see results?

DermsaSweep, MD treatments are approximately 45 minutes in length. You will experience remarkable, visible results after only one treatment. Lasting and more significant results will occur after 4 to 6 treatments spaced 10 days to two weeks apart, supported by a daily post treatment routine. Hyperpigmentation, acne scars, fine lines, and stretch marks will continue to disappear gradually over a series of treatments.

Depending on the condition of your skin, the doctor may advise multiple treatments and/or combining Medical Microdermabrasion with Chemical peels, PhotoFacials, and/or Laser Facial resurfacing treatments for optimal results. If you're undergoing microdermabrasion in combination with laser skin rejuvenation (photo rejuvenation or chemical peels), then the results will last much longer.

How do I know if I am a candidate?

A comprehensive skin analysis is necessary in order to accurately prescribe a targeted treatment that yields the best outcome. The VISIA Skin Analysis system takes all the guesswork out of what is going on at a cellular level of the patient's skin by taking an in-depth photo of the sub-dermal layers of the skin. "It allows us to quantify and scientifically measure eight different skin characteristics and then measure your progress as treatments progress, thus giving us the ability to assess your overall condition, not just the problem," said Dr. Schwartz.

For more information on DermaSweep, MD or how to schedule a free, no-obligation skin and complexion consultation at the North Shore Medical Spa, call 516-441-5110 or visit our website www.NorthShoreMediSpa.com. IMAGE

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Are You Toxic?
Nutritional, gentle cleansing can help you restore good health and natural balance
by EVAN SHAPIRO, M.D. and iNa Lutin, RN,CPCP, FAAM

Have you ever thought about all the toxic elements you are exposed to on a daily basis? The pollutants in the air, our food and water supply, cleansers and cosmetics, are only a few. These toxins can have a negative effect on our overall health.

According to the December 2010 issue of Vitamin Research News, it is impossible to avoid exposure to potentially harmful impurities when "billions of pounds of toxic chemicals, heavy metals, and pesticides are released into the environment through manufacturing, agriculture, medicine and energy production." Our bodies are presented daily with the difficult task of trying to remove these harmful substances. Demanding lifestyles, poor nutrition, and daily stress overload our system's ability to cleanse and detoxify naturally. Our defenses are working hard to protect us but are failing miserably. Without the proper elimination of these impurities, our bodies struggle to maintain good health.

The solution is to incorporate a daily program of nutritional replenishment and gentle cleansing to remove harmful substances and return our bodies to their natural balance. This results in greater health, well-being, and weight loss. Throughout history, cleansing, fasting and herbal remedies have been utilized to promote good health. Cleansing gives the body the chance to rest, regenerate and assist in its natural ability to remove toxins and promote long-term wellness. Isagenix , an established leader in the area of nutritional cleansing improves upon the ancient practice with a Cleanse for Life System that cleanses, replenishes and revitalizes the body with essential nutrients.

In simple terms, the Isagenix Nutritional Cleansing System can be compared to an oil change for your car. We regularly change the oil in our cars because the oil gets dirty and clogged by pollutants. The dirty oil is drained and replaced with clean oil, which helps our cars to run more efficiently. The same can be said for our bodies.

Isagenix Nutritional Cleansing Systems use natural ingredients to assist your liver to cleanse on the cellular level while nourishing it with more than 27 vital nutrients, antioxidants, natural botanical extracts, teas, vitamins, and minerals to help you feel your best. A great side benefit is weight loss for those individuals interested in shedding excess pounds.

The Isagenix Cleanse for Life product is not a diet or colon cleanse. It is a nutritional cleanse for the entire body. Cleansing the toxins we eat, drink, and breathe daily naturally leads to weight loss. Besides helping you lose weight and rid your body of toxins, Cleanse for Life can help you experience increased energy, make you feel more alert and focused during the day, and improve mental and physical performance. It is impossible to prevent impurities from entering our bodies but we can, however, take steps to effectively remove them. IMAGE

If you are interested in additional information about Nutritional Cleansing, the Isagenix products, or weight loss, please contact Ina Lutin, RN at Women's Health and Wellness, 718-281-1800.


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Fat Grafting
Restoring facial volume and filling wrinkles - naturally
by ELIZABETH Roya Emami, M.D.

As we grow older, the layer of fat under our skin begins to thin. This volume loss especially around the eyes can lead to a tired and deflated look to the face, and is one of the earliest and most visible signs of aging. Injectable fillers can help correct this for short periods of time, but what if you want a permanent solution?

The latest technology, Autologous Fat Transfer, replaces this loss with an identical substance excess fat stored somewhere on your own body. Unwanted fatty deposits can now be put to good use, filling wrinkles and restoring facial volume without resorting to artificial fillers, meaning there is virtually no chance of allergic reaction.

Sound too good to be true? It's here, and it's happening every day! Autologous fat injections are a readily available, relatively inexpensive, and completely natural alternative for facial rejuvenation. Your own fat can be harvested from almost any area of the body (although abdomen, flanks, and thighs are preferred), then injected into another area to achieve volume restoration and plumping.

How does autologous fat transfer compare to traditional fillers? Both methods involve applying a small amount of local anesthesia to the treated area to minimize discomfort during the injection, will result in a minor amount of swelling and/or bruising and will provide immediate results. The differences between the techniques, both in application and duration, are significant and worthy of discussion. First and foremost, autologous fat transfer is all natural and guaranteed to be accepted without any possibility of an allergic reaction, because the filler comes from your own body. Transferred fat is a living graft and as such it creates a blood supply much like a skin graft or hair transplant would.

However, because it is meant to be a living transplant, a certain amount of the transferred fat will be reabsorbed by the body. This requires minor "over-filling," which means a small amount of extra fat will be placed in order to allow for this re-absorption. The majority of this "loss" will occur in the first several weeks after the injection, with ideal results in approximately 4 to 6 weeks. As time goes by, the treated area will continue to remodel for approximately 6 months. The general consensus is the fat remaining at 6 months will stay permanently. This is in stark contrast to traditional fillers, which are completely re-absorbed by the body in as little 3 months, or a year at most.

Some patients observe a small increase in size years after their procedure because as the transferred cells become established, they may return to their natural function of storing fat. Another difference between the two methods would be the relative cost. While autologous fat transfer may appear more costly on first glance, the long-lasting results mean the repeat visits necessary with traditional fillers are no longer necessary.

So how does the procedure work? Fat transfer should only be performed by a qualified plastic surgeon with special training and experience in the technology. First, you should have a thorough initial consultation to reveal the areas to be treated as well as the areas to be harvested. A lengthy pre-operative discussion should result in all your questions being answered, as well as a determination of realistic expectations.

On the day of your procedure, you will be taken to the procedure room and allowed to relax while a diluted solution of anesthetic is applied to the harvest area. At the same time, a small amount of local anesthetic will be placed near the area to be injected. Using modern practices, small amounts of fat are removed via a gentle manual liposuction technique and prepared for transfer. Using micro-injection techniques, the fat is then transferred into the recipient areas of the face. At each point during the procedure, you will be allowed to inspect the progress to ensure complete satisfaction with the results. It is important to note this is not traditional liposuction, and there will not be a significant change to the harvested area in terms of size and shape.

Immediately after your procedure, there will be some swelling and potential bruising to the treated areas. This will be the worst on days 2-4 and will begin to resolve after the fourth day. Most patients report complete resolution of these symptoms within one week, and return to all their regular activities of daily living in this time frame. In the hand of an experienced surgeon, the main complications of contour irregularities, poor fat survival, and poor distribution can be minimized.

If you are experiencing volume loss and are in need of facial rejuvenation, perhaps autologous fat transfer is the solution for you. IMAGE

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Connecting Health Care and Fitness
The Importance of Medical Exercise for the Elective Surgical Patient
by Sharon Moelis, CPT, MEPD

Exercise programming is critical to the health, wellness, and recovery of anyone preparing for or who has already undergone elective surgery. There are two primary stages in exercise programming for those undergoing cosmetic and other elective surgeries. Pre-operative exercise provides a customized exercise program geared toward best preparing the client for the rigors of the surgery that lies ahead. Post-operative exercise programs consist of recognizing the client's limitations and enabling exercise progression without re-injury. Both pre- and post-operative exercise programming play an essential role in physical as well as mental preparedness for elective surgery, the recovery period, and for a return to fitness thereafter.

Medical Exercise is a personal training subspecialty that services clients with a broad spectrum of medical conditions. The overarching concept of Medical Exercise is making the connection between health care and fitness. Typical Medical Exercise clients are "post-operative" in that they have undergone surgery or other medical procedures, and have completed a course of physical therapy or other rehabilitation program. However, Medical Exercise is also beneficial for "pre-surgical" clients.

In the case of elective surgery, the client requires exercise programming customized to their particular pre- and/or post-surgical needs, including knowledge of contraindications so that the patient remains safe. The standard for providing such programming is the Medical Exercise Specialist, who is trained and certified in the special skills required to work with clients both before and after elective surgery. While a Medical Exercise Specialist is not a licensed physician, he/she is trained in how medical conditions respond to exercise and understands the underlying anatomy, pathology, and biomechanics of common medical conditions. They are also constantly on the lookout for warning signs/red flags indicating the need to refer to a licensed medical professional.

Pre-operative medical exercise provides customized programming designed to best prepare the client for the stress of the upcoming surgery. Typical exercises may strengthen core muscles, work with muscles soon to be affected by surgery, and generally increase strength and conditioning so that the client will be as healthy as possible pre-surgery. Pre-operative medical exercise programming also looks to engender a proactive psychology; positive thinking that the client is doing the best that they can to prepare for surgery rather than passively waiting for the date of their operation.

Post-operative medical exercise programming essentially provides structured exercise guidelines, which enable the post-surgical client to return to exercise in a safe, comfortable, and effective manner. Key to this phase of medical exercise is acknowledging the client's physical limitations and progressing with each client's fitness program while minimizing the risk of injury. Post-operative medical exercise may also build client strength and confidence, accelerating the recovery period and return to full function.

Both before and after elective surgery, it is critical that exercise programming be customized to accommodate any pre-existing conditions while maintaining focus on conditioning areas of the client's body that will be affected by surgery. While a Medical Exercise Specialist is not trained to offer professional services offered by physical therapists or other licensed therapists, he/she can provide fitness assessments, musculoskeletal analyses, and post-rehab exercise programming. The Medical Exercise Specialist is trained to work in consultation with medical doctors and to identify contraindications where particular exercises are in conflict with a client's medical condition.

A Medical Exercise Specialist is an invaluable resource to making the connection between health care and fitness. The Medical Exercise Specialist will provide educated, professional fitness advice at a time when the client requires unique sensitivity, emotional support, and encouragement during the process of developing customized exercise programming and, most importantly, during the day-to-day fitness training both pre- and post-elective procedures.

When looking for a Medical Exercise Specialist, make sure that the fitness professional chosen is certified by The American Academy of Health, Fitness, and Rehab Professionals (www.postrehab.com), the gold standard for Post-Rehab/Medical Exercise education. The comprehensive nature of the Medical Exercise Specialist certification assures each client that their fitness professional has a high degree of unique knowledge and skills to improve their health and fitness as each client works toward elective surgery, is recovering post-surgery, and generally looking to gain a positive outlook on their fitness and wellness future. IMAGE


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Suffering from Migraines?
Surgery could offer relief
by Kaveh Alizadeh, M.D.

Nearly 45 million Americans suffer from migraines, a debilitating headache often accompanied by nausea and sensory burden that can cause significant pain for hours or even days. Although pharmacological advances have been made for the treatment of migraine headaches, medications may have side effects and create dependence. As patients seek out the different modalities that can successfully relieve migraine symptoms, more and more patients are turning to expert plastic surgeons for innovative surgical solutions.

The latest approach to treating migraines involves Botox, which was approved by the FDA last year for the treatment of this condition. Botox is injected into 'trigger points,' including the forehead, temples, the back of the head, neck, and shoulders, that can temporarily relax the muscles that constrict nerves and lead to migraines. Another approach employed by pain specialists involves the use of nerve blocks with an anesthetic and a steroid. These treatments may provide relief to the irritated nerve and temporarily suspend migraine symptoms. The success of these treatments for a patient will indicate their candidacy for migraine surgery.

For some patients, taking the next step to surgery to reduce migraine symptoms is a life-changing event, even bringing a permanent cure from their symptoms. Migraine surgical solutions will vary from patient to patient depending on the offending muscles identified through injectable treatment methods. A highly specialized plastic surgeon can release the compression of the muscles causing the nerve constriction in the targeted trigger sites.

In the case of forehead muscles, a small segment of facial muscle over the nerves is removed through small hidden incisions near hair-bearing skin. This procedure will also smooth the forehead. In the case of temple muscles, the nerves are detached but not removed. In the back of the head, muscles that encapsulate the nerves may also be removed. When a deviated septum contributes to migraine pain, a septoplasty, or straightening of the septum, is performed along with removal of the turbinates in the nose. Overall, migraine surgery requires one to two hours per site and is done on an outpatient basis with near immediate relief of symptoms if done successfully.

Migraine surgery has garnered notable media attention for its innovation and for the patients who are eager to tell their story about the surgery that ended their struggle with this painful condition. This past summer, CBS News New York featured patient Dale Eadeh, who underwent migraine surgery with Long Island Plastic Surgical Group. Eadeh suffered migraines that struck up to six times a month with some lasting for days. The patient tried numerous treatment programs such as medication, epidural spinal injections, and acupuncture, but none were effective in relieving his migraine symptoms. After successfully undergoing an injectable program, Eadeh was able to move forward with surgery that addressed trigger points in his temple, forehead, and the back of his neck. He has been free of migraines ever since.

Importantly, migraine surgery is best performed by Board Certified plastic surgeons who have had formal training on complex peripheral nerve surgery and a deep understanding of the anatomy and function of the soft tissue and muscles of the face. Choosing a skilled surgeon will optimize the results of the surgery and minimize potential complications.IMAGE


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Outsmarting Father Time
Men are jumping on the cosmetic surgery bandwagon and it's improving their relationships, careers, and self image
by Andrew Jacono, M.D.

With the American male grooming market now worth $3.5 billion, men seem to be changing their attitude about a number of issues that seemed previously to be the preserve of women. Feeling the need to look youthful and appear dynamic well into your 40s, 50s, and 60s has led to men re-thinking their attitudes toward pills, diet, exercise, face-care products, and cosmetic (plastic) surgery. Men increasingly want to change the things they don't like to see in the mirror, and statistics available from the American Society of Aesthetic Plastic Surgery show that surgery is becoming increasingly popular with men as a way to deal with image maintenance and change.

The message is that the way you look can have a substantial impact on how you feel, your relationships, and your career. Today's economy and competitive job market are the overwhelming reasons why interest in facial plastic surgery among men has risen so sharply in the past decade. Not only must one be qualified, but one must project a confident, youthful, and energetic look:

84% of men surveyed believed that physical attractiveness contributed to success and power on the job.

42% felt that improving one thing about their face would help their career.

32% agreed that a more youthful appearance would positively impact job success.

According to the American Academy of Facial Plastic and Reconstructive Surgeons, the most common surgeries performed on men were rhinoplasties, followed by hair transplants, blepharoplasty (eye lid lift surgery) and finally neck lift surgery. In male plastic surgery the procedures are performed differently than in females to maintain a natural appearance that is not feminized. These details are important because men want to look like themselves, simply rejuvenated.

Rhinoplasty in men is different than in women. Male noses have thicker skin and stronger bones, and the aesthetics of the male nose is different. Male rhinoplasty has to address the thick skin in the nose to achieve excellent results. Also, removing the bump or lifting the tip has to be done very conservatively, in order not to feminize the appearance of the nose. Additionally, the nose has to fit other facial features of the male face to achieve a natural outcome. The angle between the nose and the upper lip in a male nose should not exceed 90 degrees; otherwise, the nose appears too rotated or feminine. In the female nose, it should be 105 degrees or higher depending on the distance between nose and lips and other features.

Hair transplants have changed since years past where men had obvious looking "hair plugs." Today we transplant follicular unit micrografts. When performed by an experienced doctor, this technique results in hairlines that both look and function naturally, with minimal interference in lifestyle. Hair grafting has been performed for more than 30 years, but it is only in the past five years that technological advancements, as well as a greater appreciation of hairline aesthetics, have truly made the results of this procedure virtually undetectable. Hairs are taken from the back of the head from areas that are not susceptible to ever going bald; and by transplanting those hairs into bald or thinning areas on the top and front of the head, a permanent and natural-appearing full head of hair can be attained using the individual's own hairs.

Each follicular unit micrograft contains one to three (occasionally four) hairs. Usually a combination of these different sized grafts is used in the hair restoration, with the one-hair grafts going up front in an irregular pattern along the hairline, and the two- and three- hair grafts placed further behind to create more density. To attain the most natural result each graft contains a single follicular unit, the collection of usually two to three hairs all within a tiny bunch, which is the way that hair grows in most individuals. By transplanting using follicular units, the way hair grows naturally, the results of the hair transplantation are virtually undetectable. Precise planting of the transplants in a random pattern results in a hairline that does not look like a line. Follicular unit grafting is the most advanced procedure, requiring a team of trained assistants to cut each graft under the microscope.

In eyelid surgery for men it is important not to change the shape of the eye. In women we usually like to recreate the almond eyelid shape of youth. In men we make an incision inside the eyelids, so no scar is created and the shape of the eye is maintained. Additionally, the lower eyelid bags that make us look tired are repositioned into the deep under eyelid circles, making the eyelids look rejuvenated, not tired. It is not uncommon for men to hear "you look tired and overworked" because of their eyelid appearance. It is important to preserve the fat of the lower eyelid during the eyelid lift, because if the fat bags are removed, it makes the eyes look sunken and potentially sickly.

Men are as sensitive about their "turkey neck" as women are, but do not want a face lift or neck lift procedure. These procedures have longer recovery times and require more surgery. In men there is a procedure where we can make an incision under the chin and remove the hanging neck skin, while tightening the neck muscles that sag with age called the platysma. The immediate effect is that the jawline looks more defined, and it appears that the individual has lost weight because the heaviness under the neck has been removed. A more athletic and energetic appearance is the result. I have performed many surgeries like this on men in the financial industries who have only taken off 4 or 5 days from work, so it is easy to schedule amidst a busy work life.

Male cosmetic surgery can provide a much needed boost for men wishing to enhance their appearance and reverse the signs of aging. It is now more than ever socially acceptable for men to undergo cosmetic procedures to give them an edge both in their personal life and in the workplace. IMAGE

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Osteoarthritis
A debilitating condition that can affect us all regardless of gender or age
by Evan A. Vieira, D.P.M.

Osteoarthritis, or simply arthritis, is a degenerative condition that affects joints. Our joints are supported in part by the firm rubbery buffer known as cartilage, which provides the smooth glide mechanism when we move. However, over time, wear and tear on our joints can cause degeneration of our cartilage and leave our bones rubbing close together. From this can come pain, osteophytes or loose bone fragments, swelling, and loss of motion. Arthritis can affect us all, regardless of gender or age. Obviously, as we age, our cumulative use increases, but patients of all ages can be affected.

Hip and knee replacements are now commonplace in the United States, but arthritis is not exclusive to those joints. The foot and ankle are susceptible to the same type of wear and tear as any other joint, and can suffer from the same ailments. Total ankle replacement is emerging as a remedy for those with ankle arthritis, but has not achieved the same type of mainstream success as hip and knee replacements to date.

One of the more common problems that presents to the doctor's office these days is pain and limited motion at the great toe joint. This condition, called "Hallux Rigidus," is very simply, arthritis of the great toe joint. Even though your great toe joint, or, 1st metatarsophalangeal joint, is a fraction of the size of your knee, it can be equally painful and cause just as much limitation of daily activities. Your great toe plays a key role in propulsion during your gait or walking cycle, and takes a brunt of the forces placed on your body during walking, jogging, and running.

Over time the joint can begin to break down and develop stiffness, pain, and swelling. The exact etiology of the hallux rigidus beyond just normal wear and tear is a highly debated topic, and much more complex then we will get into here. Our goal in this article is to provide a basic understanding of the disease and the most current treatments for it.

Treatments vary greatly depending on the stage of the disease. If we are able to diagnose the symptoms early on, we can try to limit damage with orthotic and shoe modifications as well as control pain with cortisone injections or anti-inflammatory medications. Generally, these treatments are productive for a while, but as the disease continues to progress, it becomes more and more difficult to manage the symptoms.

Over time some patients will develop a bump on top of the joint called an "exostosis." This can cause increased pain and a decrease in motion. Once we see changes like this, surgery becomes a significantly viable option. In some patients we can perform a "cheilectomy," or more simply, remove the bump from the top of the joint, and clean up some of the debris we might find there. This procedure is often times quite effective and successful, however, as with any surgery, proper assessment and patient selection is key.

Once the disease progresses beyond this stage and more significant erosion of the cartilage cap becomes evident, more extensive surgeries come into play. Just like hips and knees, foot and ankle surgeons replace the great toe joint. These implants are similar in structure and function to other implants and often borrow much of the technology that has been developed from large joint replacement. The procedure is performed as an outpatient, and patients are encouraged to weight bear and resume activity as soon as soon they can to gain as much range of motion as possible. Physical therapy and home exercises can increase success rates and aid in regaining function post operatively.

If the disease advances to its final stages and the cartilage erosion is so significant that the bones become flattened and there is basically no motion, then the previous procedures are usually no longer options. Once we get this far along we generally recommend fusion of the joint. Patients compensate for the loss of motion at that joint and are able to function quite well, however, there are limitations. First, for women who still want to squeeze their feet into high heels and suffer the pain, this is not an option. Also, in very physically active athletic people, we try to avoid fusing the joint and find other options.

Hallux rigidus can profoundly affect a person's life, their activities, and overall well-being. We are constantly trying to advance our therapies and treatments to improve outcomes and patient satisfaction. Still, this remains a very difficult condition to treat. As we always discuss, proper evaluation and patient selection are key to any successful surgical procedure, so do your research and ask the doctor questions! IMAGE

HALITOSIS
How to prevent chronic bad breath
by Maia Berger, D.D.S.

What is halitosis? It is derived from the Latin word "Halitus," which means "breath," and "osis," which means "condition." Simply put, halitosis is defined as bad breath or foul odor.

Have you ever experienced someone offering you mints or gums? Someone taking a step back while talking to you? Or someone commenting directly about an odor coming from your mouth? Is chronic bad breath affecting your life socially or professionally?

Causes of Halitosis

There are several underlying causes of halitosis:

1. You can get it from improper daily hygiene (not brushing or flossing as often, which leaves bacteria floating around). This is the most effective way of reducing bacteria and debris in your mouth causing halitosis.

2. Bad breath can be directly related to your diet. What you eat, such as garlic, onions, fish, meat, etc., can affect your breath. Food is absorbed through your bloodstream, continues on to your lungs, and is released when you breathe through the mouth. The odor will remain in your body unless you eliminate the source, which is your food.

3.Your tongue can hold bacteria, especially the back part (dorsum) of your tongue. This is an area you normally don't reach when brushing your tongue.

4.Oral appliances that are not properly cleaned, such as nightguards, mouthguards, and ill-fitting dentures.

5.Existing cavities, abscessed teeth, or dental infections in teeth (such as wisdom teeth) can contain bacteria, which releases an odor.

6.Throat infections.

7.Yeast infections of the mouth.

8.Systemic diseases peptic ulcers, diabetes mellitus, postnasal drip, lung and bronchial infections, liver disease such as fetor hepaticus (rare type of bad breath cause by chronic liver failure), renal infections/renal failure, carcinoma, trimethylaminuria (fish odor syndrome).

9.Gingivitis and periodontitis.

10.Stomach and mouth are enclosed spaces causing odor to be released because the areas are low in oxygen.

11.Smoking causes dry mouth, which in turn causes "smoker's breath."

12.Xerostomia (dry mouth) This is also one of the contributors of chronic bad breath. With dry mouth, there is a significant reduction in saliva. This diminished flow will cause dry mouth, a medical condition that is affected by breathing excessively though the mouth, medications, and dysfunctional salivary glands

13. Sinus infections or foreign bodies in the nose release a bad odor through the nose.

14.Traces of sulfur gases produced by bacteria in the mouth. Anything that produces bacteria growth can cause halitosis.

15.Collections of food in the pockets of the gums, teeth, and tongue that are not removed can increase the odor in your mouth.

Odor usually accumulates after meals and during the night time while you are sleeping. When saliva in your mouth decreases, it prevents the buffering of bacteria and causes dryness in the mouth, causing "morning breath" when you wake up.

How can you tell if you have bad breath?

It's a delicate issue, but you can simply ask a friend, relative, or spouse. Other methods that sound a bit repulsive but do work are these: You can lick your wrist and wait five seconds for the saliva to dry and smell it; or use the back of a spoon and scrap the back portion of your tongue and smell the whitish material on the tongue; if you have dentures or a mouth appliance, put it in a bag and seal it tight for about five minutes and then open and smell it. If there's an odor, there's a chance this will be what your breath will smell like in front of other people.

Once you've assessed you have a case of halitosis, there are several ways you can manage or prevent it.

1.Practice good oral hygiene.

2.Visit your dentist for a check up twice a year for general check-ups to prevent gingivitis, periodontitis, cavities, to get rid of bacteria or plaque buildup around your gums.

3.Stop smoking or chewing tobacco. Discuss with your dentist about smoking cessation.

4.Drink a lot of water this keeps your mouth moist and prevents dry mouth.

5.Use mouthwashes that can temporarily mask the odor

6.Keep a log of what you eat daily and bring it in to your dentist so your dentist can assess the issue.

7.Chew sugarless gum or sugarless candy, especially after you eat, to eliminate the odor

8.Brush your tongue to remove the bacteria and eliminate odor.

9.Rinse your mouth or brush your teeth after foods that contain sulfur, such as fish, meat, and diary.

10.Use toothpaste and mouth rinses that contain stabilized chlorine dioxide or zinc chloride, which will break down the sulfur compounds and reduce mouth odor.

11.You could try a product called Therabreath, a mouth rinse.

There are studies showing that herbs such as thymol (from thyme) and eucalyptol (from eucalyptus, which is contained in Listerine, played a part in decreasing bacteria after at least a 30-second mouth rinse). The oils in these herbs inhibit the growth of bacteria in the mouth, but be careful not to ingest these oils for potential side effects or allergic reactions.

Overall, halitosis can be prevented or eliminated. Make sure you maintain proper hygiene and visit your dentist for routine checkups to prevent chronic bad breath. IMAGE

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