Hands are among our most important body parts, but we rarely think about them. As instruments that accomplish our will, it’s difficult to imagine life without them. Think about all our hands do for us throughout our life.
As children, our hands helped us explore and learn about our big, wide world. They steadied us as we learned to walk, caught us as we fell, helped us get back up, and tied our shoes for the first time. Hands feed us and clean us. Their gestures communicate meaning to others. Hands are our most important tools for lifting, carrying, grasping, and manipulating. Our hands use man-made tools for writing, grooming, driving, sports, making music, building, and for every activity in our daily life. We’ve used them to dry the tears of loved ones. Our hands might have a shiny, metallic ring on them as an exclamation to the world that we’ve found the love of our life. They also might have trembled and shook as we held our children for the first time or as we said good-bye to a loved one for the last time.
Our hands have always been there for us. Our hands and faces represent us to others. Our hands are always on display. A large portion of the grey matter in our brain is devoted to the functioning of our faces and hands. Perhaps that’s why they are the two leading characteristics of our body image and self-esteem.
When it comes to our faces, we are experts with our anti-aging routines-cleansers, toners, masks, scrubs, serums, oils, creams, oh my! But when it comes to our hands? Yeah, not so much. Even if we do have an anti-aging hand-care regimen, we often apply it only once or twice a day and rarely reapply after every hand wash. It’s no wonder that our hands can be a dead giveaway of our age. But that needn’t be the case for these sun-exposed appendages that do so much for us.
Hand rejuvenation therapies have been around for years, and help our hands look younger. As we age, skin and soft tissue on the exposed areas of the hands changes (‘tis a cruel joke that the fat seems to leave our hands and go to our stomachs and thighs). Hands lose fullness of contour, and skin elasticity diminishes. Knuckles may appear more prominent. Veins and tendons may impart a bluish color and bumpy texture. Sun exposure and other influences add tan or brown irregular patches or spots, and the skin becomes loose and wrinkled.
Treatment with a soft tissue filler restores lost volume and improves the appearance of aging hands instantly. Radiesse® is a natural product (Merz Pharmaceuticals) that we’ve used successfully for this application. Radiesse® is FDA approved to use with lidocaine (an anesthetic) to reduce discomfort of the injection. The filler is massaged into place and hands appear softer and smoother.
Radiesse® lasts for about a year, so treatment may need to be repeated. However, it has been found that Radiesse® has some long-term benefits as well as. It can actually stimulate natural collagen production in the treatment sites thus helping the skin’s matrix repair itself over time.
Other hand rejuvenation therapies improve skin surface aging: Our GOLD Rx resolves pigment spots and stimulates collagen production within the skin. Laser treatment or Intense Pulsed Light fades surface pigment, and sunblock should also be applied on top of the hands to protect these sun exposed areas and prevent further aging changes.
Greeting others with our hands is a universal element of humanity. Every culture has a greeting involving hands…a hand shake, a wave, a salute. Hands are always on display and should match the age of our face. In caring for your face and body with your hands, don’t forget the hands themselves!
You want the best result, and the best surgeon. How can you tell? Truthfully, the surgeon with the highest standards for his or her own performance reliably holds the highest standards across the board. The best surgeon will have the highest level of training and certification, and will offer you the best care, and likely the best result.
So how can you know? Plastic surgeon or cosmetic surgeon? The differences may surprise you. Because of common misconceptions surrounding cosmetic plastic surgery, you should understand what’s behind the scrubs and the white coat.
Operations that improve the human body are called Plastic Surgery after the Latin plasticus: that may be molded. The two types of plastic surgery are reconstructive surgery, after injuries, and aesthetic (cosmetic) surgery, to improve appearance. Cosmetic surgery is only a part of plastic surgery, but to perform it well, the physician must be fully trained in the entire specialty.
1. All plastic surgeons are cosmetic surgeons but not all cosmetic surgeons are plastic surgeons.
Board Certified Plastic Surgeons have more training and ARE qualified to perform both reconstructive and aesthetic/cosmetic surgery.
A Cosmetic Surgeon is NOT certified to perform plastic/reconstructive surgery.
2. The American Board of Plastic Surgery (ABPS) is the ONLY board approved by the American Board of Medical Specialties (ABMS), which accredits surgical training programs.
Plastic Surgeons ARE certified by the American Board of Plastic Surgery (ABPS).
The American board of Plastic Surgery does NOT acknowledge Cosmetic Surgeons.
3. Don’t all certifying boards have high standards? My surgeon said he’s board certified.
Confirm not only that that your doctor is “Board Certified,” but that he/she is certified by the American Board of Plastic Surgery (ABPS).
Cosmetic Surgeons who claim to be board-certified may have received their certificate from the American Board of Cosmetic Surgery; the American Board of Medical Specialties (ABMS) does NOT recognize this board.
4. Is my surgeon trained to perform my surgery?
After graduating medical school, a Board Certified Plastic Surgeon must be selected among many applicants for residency training in Plastic Surgery. If chosen, the physician learns how to be a surgeon for three to five years, then trains for at least three more years in plastic surgery. Training involves closely supervised continuous evaluation and management of many complex clinical situations, and matures the surgeon personally and professionally. Successful completion of the post-graduate residency years qualifies the surgeon for written and oral examinations administered by the American Board of Plastic Surgery. Surgeons must submit an entire year of his or her surgical accomplishments for the exam. Surgeons are not eligible for the exam until they have been practicing plastic surgery independently for two years or longer.
There are no such requirements for Cosmetic Surgeons. Cosmetic surgeons are doctors who merely decide to perform cosmetic surgery in their practice. The may be certified in any medical specialty such as a gynecology, dermatology, family physician, ear,-nose-throat, etc. Their training may consist of several short weekend courses to a one-year cosmetic surgery fellowship.
5. Why do hospitals and surgery centers only allow doctors certified by the American Board of Plastic Surgery(ABPS) to perform cosmetic procedures?
Because they know the difference! Board Certified Plastic Surgeons CAN perform both reconstructive and aesthetic/cosmetic surgery in hospital or outpatient surgery centers.
Cosmetic Surgeons are NOT privileged for cosmetic surgery at these facilities and are not allowed to perform reconstructive plastic surgery. For this reason, cosmetic surgeons usually perform surgery in office based operating rooms.
6. The American Society of Plastic Surgeons (ASPS) embraces excellence in plastic surgery. Education, research, intellectual exchange and promoting unity are core values.
Only doctors certified by the American Board of Plastic Surgery(ABPS) can become a member of the American Society of Plastic Surgeons (ASPS)
7. The American Society for Aesthetic Plastic Surgery (ASAPS) is an exclusive privilege and requires proven excellence in aesthetic/cosmetic plastic surgery.
- Members MUST be certified by the American Board of Plastic Surgery(ABPS).
- Participate in accredited Continuing Medical Education (CME) programs.
- Document the performance of a significant number and variety of cosmetic surgical cases to demonstrate a wide range of experience
- Be sponsored by two ASAPS-members to ensure that the applicant’s professional reputation meets the high standards required by The Aesthetic Society.
- Abide by ethical standards for professional conduct outlined by the Society’s Bylaws, Code of Ethics, and Conflict of Interest Policy observed by all ASAPS members.
ASAPS does not offer membership to doctors who are trained in specialties other than plastic surgery; therefore Cosmetic Surgeons do NOT meet these requirements.
For cosmetic surgery, your safest choice is a surgeon certified by the American Board of Plastic Surgery who is also a member of the American Society of Plastic Surgeons and/or the American Society of Aesthetic Plastic Surgeons. Quality is the difference.
Better understanding of aging anatomy is heralding a NEW era of smaller, safer, easy recovery plastic surgical procedures with long lasting changes that essentially prevent an aged appearance for your entire adult life. Even in your sixties, seventies, and eighties, with annual, bi-annual, or semi-annual maintenance and attention to smaller procedures, men and women can manifest youthful vibrance and allure. You’ll NEVER lie about your age, your appearance will do it for you.
Gravitational settling of facial soft tissue is managed by segmental (minor) lifts rather than a full face and neck lift. Cheek lift, temporal brow-lift, eyelid-lift, ear-lobe lift are all office procedures. Even minor face and neck lift operations can be performed safely and comfortably in the office while you’re awake and relaxed. Some skin sagging is corrected by removal and re-arrangement of descending tissue. Examples of this are jowl removal ,lip-lift, and “anguloplasty” (corner of lip lift) procedures. Skin wrinkling can be treated by laser or by filling with fat or off-the-shelf products. Hollows on the aging face create shadows that send a signal of darkness, depression, and sadness. Others interpret this as hostility and avoid you. The face should reflect light, and be bright. Small implants, fat grafting, minor surgical lifts, and off the shelf fillers re-shape surface contours to reflect light in a youthful way.
Subtle improvements offer the added advantage that others notice you look good, but don’t really know that something was done. You still look like yourself, but younger. Although major rejuvenation still requires a trip to the operating room for general anesthesia, Dr. Steve Laverson, a San Diego Plastic Surgeon, performs many improvements in the office under local anesthesia. Among these minor enhancements, he includes brow-lift, upper and lower eyelid lifts, cheek-lift, minor nose re-shaping, lip shaping and lip lifting, facial fat transfer or filler, neck liposculpture, jowl removal, laser skin smoothing and wrinkle removal, laser skin tightening, and others.
Procedures to maintain youth are secondary to healthy lifestyle, especially moderate diet and regular exercise. Cosmetic and plastic surgery are most effective in the context of ideal body weight and overall fitness.
Choosing minor procedures doesn’t mean they can be performed well by a “minor” cosmetic surgeon. Certification by the American Board of Plastic Surgery means your plastic surgeon has met the highest standard for his or her own performance, which increases the chance that he or she will hold himself or herself to the highest standard for your care and your result.
Dr. Steve Laverson is certified by the American Board of Plastic Surgery, is a member of the American Society of Aesthetic Plastic Surgeons, the American Society of Plastic Surgeons, a fellow of the American College of Surgeons, and has been in practice in North San Diego County since 1993. For consultation, call his Encinitas office at 858-295-4001 or visit feelbeautiful.com.
Innovative approaches for preventing and controlling pain after cosmetic surgery may be combined to help patients tolerate procedures as much as they will enjoy the result. New methods we incorporate include:
1. Surface (topical) anesthetics before skin injection: These can include Ethyl Chloride, a fine spray that instantaneously freezes the skin, overwhelming nerves that transmit pain impulses with sensation of cold so that subsequent painful stimulus is not recognized. Also, local anesthetics such as benzocaine, prilocaine, lidocaine, and tetracaine are now formulated into creams or gels that promote better penetration through your skin surface to create numbness in the area to be treated. These applications are spread over the area to be treated 20-30 minutes beforehand to allow absorption into the skin. Covering the skin with plastic wrap prevents evaporation, and may improve effectiveness. These skin anesthetics are popular before cosmetic laser and injectable enhancements.
2. Regional anesthetics: These include injection of local anesthetics to neutralize a specific sensory nerve that transmits pain from a specific area of the skin. Lips are among the most highly sensitive areas of your face and body, so this method is valuable before lip augmentation with filler. Dr. Laverson uses topical anesthetic on the skin, then carefully numbs the specific nerves that supply sensation to your lips. This allows completely pain free lip enhancement. Filler must be placed well within the substance of the lips, and topical (surface) anesthetic doesn’t penetrate deeply enough to sufficiently numb your lips without addition of a regional anesthetic to block pain impulses.
3. Cannulas for injection instead of needles: Blunt tipped fine sterile cannulas are now marketed to allow distribution of cosmetic injectables within the face or body without painful needles. These cannulas offer the added benefit of avoiding nerve or blood vessel injury. Sharp needles more easily cut small nerves and vessels beneath the skin, leading to bruising and other side effects. Blunt tipped cannulas, when carefully used, are more likely to push aside these structures, allowing injection to proceed with less trauma to surrounding tissues.
4. Long acting local anesthetics: Use of injectable anesthetics and/or anesthetics to moderate pain for as long as three days after surgery is available thanks to Pacira Pharmaceuticals’ introduction of Exparel®. Now FDA approved, this long acting local anesthetic (bupivacaine) is packaged biochemically as a “liposomal suspension” (within tiny lipid globules) for slow release. Exparel® can be distributed within your tissues before surgical closure. While not totally eliminating post-surgical pain, your discomfort may be reduced to a much more tolerable level. Use of Exparel® may diminish your dependence on narcotic analgesics such as morphine, oxycodone, meperidine, hydromorphone, and hydrocodone, all of which have undesirable side effects.
5. Nausea prevention: One cannot discuss advances in pain control without mentioning nausea prevention. The classically most effective analgesics are narcotic medications which promote nausea, easily their most miserable side effect. First off, if you are nauseated after rhinoplasty, breast implants, or tummy tuck, you’re unable to hold down pain medicine. You’re not only nauseated, but in pain, a difficult combination. Second, if you’re vomiting after nose, face, breast, or liposuction surgery, the entire experience of aesthetic enhancement becomes tainted with bad memories. We plastic surgeons want to prevent nausea and vomiting as much as possible, knowing that if you are miserable, you’re less likely to come back for more. The introduction of anti-nausea medications such as ondansetron (Zofran®), aprepitant (Emend®), scopolamine skin patch (Transderm SCOP®), and alvimopan (Entereg®) combined with traditional anti-nausea treatments droperidol, metoclopramide, and others offer much improved pain control by narcotics and a better surgical experience.
6. Finally, discovery and use of non-narcotic analgesics are helping. Intravenous acetaminophen (Ofirmev®) given toward the end of major surgery, ketorolac (Toradol®) in the recovery room, and tramadol extended release (Ultram® ER) at home to supplement narcotic medications offer significant relief with minimal side effects. Also, muscle relaxers such as Carisoprodol (Soma®) are useful.
As we age, facial contours change as a result of mechanical, biochemical, genetic, and environmental processes. These phenomena are noticed by ourselves and by others. Celebrities, including our current first lady, cannot avoid the aging process. Michelle Obama, who recently celebrated her 50th birthday, has had cosmetic procedures and plans to continue using Botox® cosmetic and perhaps having plastic surgery in the future. “Women should have the freedom to do whatever they need to do to feel good about themselves,” the first lady told People magazine.
We couldn’t agree more, Michelle. That’s our philosophy as well: doing whatever it is to make you feel beautiful. As women age, a common question asked is, “How do I restore my youth?” There are many ways to restore your beauty without surgery, although well planned and performed aesthetic procedures offer even more dramatic results.
Restoration of beautiful and/or youthful facial features by injection of fillers, neuromodulator(s), the use of laser, light, and radiofrequency techniques are often used by Dr. Laverson in our Encinitas office. FDA approved cosmetic injectables and energy sources can relax muscles that cause aging wrinkles, fill and smooth existing wrinkles, tighten skin, remove excess or sagging fat, and resurface your complexion to restore youthful allure and glow.
At 57-years old, Christie Brinkley looks amazing with the help of some great plastic surgery. Brinkley has admitted to having plastic surgery in the form of a facelift and a blepharoplasty (eyelid surgery) to get rid of the sagging eyes, and a mini necklift to get rid of the sagging jowls. In addition to the surgical procedures, it is likely that this former supermodel uses fillers to keep her cheeks looking firm and plump. While this gorgeous face has landed Christie Brinkley many roles on Broadway, it is her hands that tell the true story.
In order for Brinkley to conceal her true age it is suggested that she use laser treatments or even chemical peels to get rid of the age spots and wrinkles that are extremely visible on the backs of her hands. Her focus now should be to create a smoother appearance on her hands to go along with the soft appearance of her face.
The hands are easily forgotten when it comes to fighting the aging process but as evident by the photo of Christie Brinkley it is just as important to take care of our hands as it is the rest of our body. After all, the appearance of the hands is a true sign of age.