aesthetic plastic surgery procedures

Winter Skin Survival Guide

Posted on December 19th, 2010
Posted by Julene

Hi friends!

By now, your skin has started to reflect the harshness of the change in climate, and once the bit of color from summer fades, we sometimes see all kinds of “badness”. Even those of us who try our best to protect our faces from summer’s rays, know that we have a bit of a glow after summer’s end that can hide some common skin problems. Plus, the naturally paler color of winter skin can expose common pigmentary problems, large pores and fine lines. Our skin is drier due to less humidity in the air and the colder air and winds of winter. Bottom line…winter is typically the perfect time to correct hyperpigmentation, provide hydration and smoothing, and to more deeply correct the signs of aging, which are all more noticeable during the winter.

I have asked my wonderful staff to list some of their favorite skin care products, and they are found below…”Staff picks”!!! Enjoy the list, and as always feel free to ask us about any skin care advice specific to your needs.


CYNTHIA…lists Dermesse Sugar Scrub among her favorite cleansers. She uses it every day, and who wouldn’t want skin like hers…porcelain, I call it! For face, she likes Dermesse Creme Cleanser, especially after laser or chemical peels.

MELANIE, JULENE AND RITA…like Dermesse Cleanser Gel for the refreshing feel it gives oily skin.


CYNTHIA…likes SkinCeutical’s Revitalizing Toner for its nice cucumber extract scent (which is a natural emollient with calming, soothing agents – maybe that’s why she is so unflappable), as well as its lavendar oil (which is anti-inflammatory, antiseptic, and anti-bacterial). She says, “it also contains horsetail, which speeds connective tissue repair…hee haw!” (never mind that’s a noise a donkey makes, not a beautiful horse, Cynthia)

MELANIE, JULENE AND RITA…seem to be in agreement again, that we like Dermesse Toner. It leaves a refreshed feel to the skin and is carefully pH-balanced with the cleanser to set the stage for easier absorption of the corrective products apllied later. It also closes pores to prevent some of the day’s damage and helps to control breakouts.


CYNTHIA, JULENE, MELANIE AND RITA…we all apparently agree, hands down, that Neocutis’ product for hyperpigmentation, Blanche, is the best. It works to fade brown spots, hyperpigmentation and melasma from a unique combination of ingredients, including 4% Hydroquinone and Melaplex. Also, as Cynthia points out…it is formulated with anti-oxidants and hydrates the skin with shea butter and jojoba oil, is steroid free, fragrance free, and non-comedogenic. If you have an intolerance to hydroquinone, like I do, then Kojic acid is a great substitute and can be found in SkinCeuticals’ Phyto Plus. OR…the alternative to a topical for hyperpigmentation is of course to use the laser (Sciton, of course)- for this we would recommend a series of treatments with BBL (broadband light).


CYNTHIA and JULENE…SkinCeuticals’ Retexturizing Activator, used morning and night, improves texture and tone by stimulating enzymes that promote desquamation while hydrating the skin via hyaluronic acid and Kombuchka (say THAT 3 times after a Cocktails and Consults evening) to promote its natural barrier functions. It basically smoothes, resurfaces and moisturizes skin, all at the same time! Cynthia says, “This product is UNBELIEVABLE, and I like to use it every day as well as right before a laser or chemical peel.”

MELANIE and JULENE…Dermesse Exfoliator, which contains a unique blend of alpha-hydroxy acids, gently smoothes skin and is available in 2 strengths.

RITA…likes Dermesse Sugar Scrub for body, and the Dermesse Exfoliator for face.


CYNTHIA…likes NIA 24’s Skin Strengthening Complex Repair Cream, because it has the Pro-Niacin to strengthen the barrier function of skin, as well as vit A to improve texture and elasticity, anti-oxidants green tea and rosemary, and ceramides, evening primrose and wheat germ oil to moisturize the skin. Phew. CYNTHIA and JULENE like SkinCeuticals’ A.G.E. Interruptor and A.G.E. Eye Cream (at night only) due to their ability to improve the creping and thinning of our “mature” skin due to an aging process in older skin called glycation, when excess glucose molecules cause collagen and elastin fibers to stick together leading to the formation of Advanced Glycation End-products (A.G.E.) ie, bad things, which cause wrinkles, ick. Also, we both like Neocutis’ product Lumiere for eyes, which contains Swiss technology growth factors and proteins specifically well-suited for smoothing the delicate eye area. It also contains hyaluronic acid, which is a natural hydrating agent.

YOUNG MELANIE…thinks her skin never looks smoother and pores smaller than when she uses a combination of Dermesse Cleanser Gel, Toner and Exfoliator!

RITA and JULENE…say “Retin A baby!!!” A longtime favorite skin smoothing agent is good old retin A. Many patients find its precursor, retinol, available in different strengths, to be easier and less drying to use, but you can’t argue either’s effects of deep penetration to the dermal layer where wrinkles begin.

***special note to self…for the fastest skin smoothing known in these parts, the Sciton laser is a quick way to smoothe skin utilizing laser peels and profractional treatments, alone or in combination! (Stay tuned for my next blog)


CYNTHIA, JULENE, MELANIE and RITA…we all seem to agree on this one, Nia 24 Sun Damage Repair is a nutrient-rich cream that delivers intense moisture while it improves the appearance of photo-damage on the decolletage, shoulders and hands. As Rita says, results are seen very quickly and within 6 weeks! This product works very well in combination with our laser packages to visibly add to results (when used between laser treatments).

***special note to self…one of the nicest things to add to a good home skin care program, is to work in a couple laser resurfacing treatments a year to slowly eliminate the sun damaged layers


CYNTHIA…likes CE Ferulic Serum in conjunction with either Dermesse or Nia 24’s Mineral Sunscreens.

JULENE…likes Dermesse Sunblock SPF 30.

MELANIE…likes SkinCeuticals’ SPF 50.

RITA…likes Nia 24 also, because it is not oily and it absorbs instantly.


CYNTHIA and JULENE…love the combination of SkinCeuticals’ Hydrating B5 Gel and masque, because they contain hyaluronic acid, the body’s natural hydrator, to bind moisture to the skin. It is often used along with vit C treatments, and is oil-free.

***note to self…if one can improve the overall health of the skin over time, it really will need less topical moisturization, so most moisturizers will only need to be used in the dead of winter when nature’s elements are most harsh!

There you have it! The experts have spoken! But, always after that ONE FAVORITE recommendation, for those of us on a budget who want just a few really good products, I asked each of my staff what single product for each area would they go back into a burning building to save (if they knew they could still get out alive, and the family and household pet were already safe!), and here is what it distilled down to…

for FACE:

CYNTHIA…Phloretin CF is her all-time favorite because it is a serum, it is both preventive as well as corrective, and as an anti-oxidant, it helps to prevent and correct the aging process by supporting elastin and collagen synthesis, while increasing cell turnover, thus giving her skin its radiance and firmness (did you know she’s really 75?) Cynthia uses it at night, and notes that it also contains vit C to help with inflammation and in prevention of skin cancer.

JULENE…realizes that although it is expensive, like Loreal says, “it’s worth it!” I absolutely LOVE Skin Medica’s TNS Essential Serum. I can tell the next morning if I’ve used it or not, because of the smooth, glowing look it gives my skin. Really. It contains the renowned growth factor formula TNS Recovery Complex in one chamber and APS Corrective Complex (a potent mixture of anti-oxidants and peptides) in the other. The combination – and it comes out together in one expensive little clump of liquid gold – has been clinically proven to improve tone, texture and elasticity, and to work on brown spots and wrinkles, as well as to tighten skin and help it regenerate and protect itself. What else is left to fix? Although this is my all-time favorite single nighttime product, I love mixing it up and using a good serum or cream several nights a week, like Neocutis Bio-Gel, Bio-Serum, or Hyalis, or SkinCeuticals’ A.G.E. Inrerrupter. And yes, my cosmetics closet looks like a pharmacy lab.

MELANIE…is a big fan of Dermesse Exfoliator, and says she has man-eating pores the night after she forgets to use it!

RITA…stands by A.G.E. She likes the A.G.E. Interrupter, A.G.E. Retexturizing Activator, and A.G.E. Eye Cream the best.

for the EYES:

CYNTHIAA.G.E. Eye Cream AM and PM. She likes the fact that it is good for menopausal skin and that it contains blueberry extract to help prevent future wrinkles in the very thin eyelid skin. (But won’t we sell less Botox Cynthia? How can that be good?)

JULENE…likes a serum under make-up for daytime use and a cream at night for extra moisturization, so I like Skin Medica’s Uplifting Eye Serum in the morning. RITA likes this too, because it is not oily, and because one tiny drop will take care of both under eye areas, so it lasts a long time. I like either Neocutis’ Lumiere at night or SkinCeuticals’ A.G.E. Eye Cream.

MELANIE…likes Skin Medica’s Eye Repair Cream the best, because it begins to work immediately, and she sees fewer fine lines as early as the next day.

for the NECK:

CYNTHIA…likes Neocutis’ Bio-restorative Hydrogel with PSP (processed skin proteins), or Bio-Gel, because it restores a refreshed appearance to aged, stressed skin.

JULENE…likes Neocutis’ Bio-restorative Skin Cream (Bio-Cream)) with PSP, for the same reasons, but I just like a cream on the neck rather than a gel, because I think it hydrates better, and lasts longer.

MELANIE…likes SkinCeuticals’ A.G.E. Interrupter, because it is not oily and feels like silk! It works very well to diminish fine lines and wrinkles.

RITA…likesItalic A.G.E. Interrupter. (She didn’t say why, so I guess you’ll just have to ask her. She is a woman of few words SOMEtimes.)

Lastly, I asked the girls to comment on any category I forgot, and Cynthia mentioned the wisdom of a good old skin peel periodically. I think this is a very good alternative for those who do not desire the downtime of a facial laser procedure, or the cost. Although the laser procedures go deeper, the 3 minute Skin Medica Peel is great. It can be modified to be either an Illuminize Peel, a Vitalize Peel, or a Rejuvenize Peel, depending upon the strength of the acid chosen and the depth of penetration. A peel can be formulated to produce varying degrees of exfoliation based on each patient’s individual needs, but works on tone, texture, acne, hyperpigmentation, melasma, large pores, fine lines and wrinkles.

Call us with questions!

Ho Ho Ho and Fa La La! Have a wonderful holiday season full of blessings everyone!

Julene, Cynthia, Melanie and Rita

Tips for Surviving the Holidays (and that dreaded “Winter Skin”)

Posted on November 23rd, 2010
Posted by Julene

Happy Thanksgiving everyone!

I am beginning Part I (of III) today… we will have a discussion involving my personal tips for surviving the holidays (how to improve our bodies and weight management tips), and then I also plan to provide tips on how to use the winter months to work on problem skin, to treat existing problems, but also tips on how to take a more proactive stance on anti-aging. I do not have all the answers, mind you, but I certainly have opinions, and isn’t that what blogging is all about Tommy, honey? I get to express my opinions to whoever wants to listen!

As always, feel free to call us for some personal recommendations on anything that suits your fancy. We are hosting another “Cocktails and Consults” here at the office on Friday December 10th, from 10AM to 6PM, during which a portion of our proceeds on services rendered or purchased that day will go to Support The Boys’ Haven. Join us for drinks, appetizers and some live talks and demonstrations on Botox, Juvederm, Sculptra and Vaser Shape. We will have special pricing that day on skin care and injectable products, as well as laser services… and it will help a really good cause. Angela Ariatti is helping us to organize the day’s events, and is our Boys’ Haven sponsor. (She is also Lexie and Kaitlyn’s riding instructor and incredible female role model/mentor, ie., “life coach”).

The most important things to remember when re-evaluating body proportion and “problem areas”, is to do your best to be patient with yourself, and to be realistic as you reset your goals. We can all make some level of improvement in our physical fitness, but a balanced program is required. Diet, exercise, reasonable goals and a real commitment (and sometimes, intervention, surgical or otherwise) are necessary. I am a physician and a plastic surgeon, not a dietician, nutritionist or fitness instructor. I do however, care about my fitness , have done a fair bit of reading and research over the years with respect to diets and exercise disciplines, and have a large experience with different techniques myself on a personal level, and consider my medical background and training to be a sound base for the evaluation and interpretation of various methods of staying fit. Coupled with the fact that I have a significant surgical experience in treating and caring for patients – men and women – who care about their physiques as they age, I think I am at least able to render some sound advice on this subject. So…here are my thoughts, for what they are worth…

After menopause, or even in the pre-menopause or “perimenopausal years”, there is no doubt about it…hormonal fluctuation and decreased metabolic rate are all contributing factors to the slow, steady weight gain many women experience, so that despite sometimes our best attempts to stay lean, we are undone. Finding an exercise program that is truly enjoyable to you is often the key to the next challenge, which is finding the time to work it into a busy schedule. I like to run and bike and ride horses…all of which I like (or must) do outdoors. Although I have a treadmill and elliptical trainer, I much prefer to be outside, so I use these devices mostly in the winter months. Although I think the commitment provided by working out with a trainer is wonderful, motivational and ensures that the proper change and flexibility of varying a workout routine is adhered to, I simply find my schedule too restrictive and inflexible to allow me the luxury of a regular workout with a trainer. (Not to mention the cost involved with finding a good trainer and the typical gym membership.) In recent years, my husband and I have just found it more time-efficient and doable for our schedules to buy a bit of workout equipment to keep at home so that we can work out whenever we want. In addition to our treadmill, elliptical and bike trainer, we have some free weights, and I recently purchased the P90X DVDs to firm up “softer” :-) areas this winter. Basically, any regimen that incorporates some aerobic conditioning and training with resistance training using weights or bands will work, and you don’t have to spend a lot of money on a home gym. Aerobic training that is consistent and maintained at a certain heart rate level for a sustained 30 to 45 minutes 4 to 5 days a week will improve fitness. Much less than that will probably only help you maintain a certain fitness level, rather than improve fitness.

In addition to the proper work out plan, of course one must add a smart diet. Having read all of the diets my patients routinely ask me about, like…The South Beach Diet, Sugar Busters, The Zone, Atkins, etc…I think of things rather simplistically as follows: If calories taken in exceeds calories out, those extra calories will be stored as fat. If we eat the wrong kinds of carbs, they work just like sugar. Most women are fairly protein-deficient and need to eat more lean meat. The best proportion of food calories consumed is about 30% fat, 40% carbohydrate, and 30% protein. When you eat (in relation to the calories you burn that day) is as important as what you eat. Certain types of work out or training periods may change the recommendation of the above things a bit, but in general, these seem to be sound principles. So what I try to do is eat small frequent meals (around 450 cal per snack or meal 6 times a day, or a larger meal earlier in the day with fewer snacks) so that I can burn more easily the calories consumed, try to eat more lean meat and “good carb” vegies, limit sugary foods, consider the rule of portion size (palm of hand size), and not eat after 8PM. I love what is taught in The Zone…that food really is a “drug” that we put in our systems every day, that the food we eat regulates the hormones insulin and glucagon to regulate glucose metabolism and fat storage, and that if we want to better utilize (rather than store as fat) the calories we consume, we must eat to stay in “the zone”, where our body’s glucose levels stay fairly constant, we are utilizing the calories we are consuming, there are not large rises and falls in sugar levels which then cause us to store the excess glucose as fat, and we maintain a stable glucagon and insulin milieu (and therefore, stabilize weight). If it is weight loss we are after, then we MUST consume fewer calories than we utilize, and to avoid muscle loss, that means combining calorie restriction with exercise. Although I learned this from every trainer I have ever known, and I still believe this to be the best way to achieve longterm successful weight loss and improved fitness, I would also say that I now believe that sometimes (especially after the onset of those menopauseal years), that I do see the value of jump-starting one’s slowing metabolism, via alternative means.

We have recently begun to offer short courses of metabolic supplements to some of our surgical and nonsurgical body contouring patients who are trying to achieve timely weight loss in order to enhance results seen with both Vaser Shape, a nonsurgical method of body contouring now available in my office (see my website or previous Blogs) and Vaser Lipo (operative liposuction). We would be happy to evaluate anyone who wants to hear more about HcG injections or sublingual drops in this context. I do believe that patients who can “reset” their metabolic rates with these supplements will be more likely to maintain results they achieve with (Vaser Lipo) or without surgery (Vaser Shape).

The bottom line is that it is really exciting to get to assist patients with their body change goals in a very holistic manner, because as a woman who is also a plastic surgeon, I can help my patients with diet and exercise recommendations, with metabolic supplements and weight management tips, as well as meaningful interventional techniques, ie, Vaser Shape (non-surgical ultrasound body contouring), and Vaser Lipo (surgical liposuction, with or without tummy tucks or lifts).

As always, we welcome the opportunity to design a plan specific to each patient’s needs.

Happy Thanksgiving! (eat more turkey than mashed potatoes)



Posted on November 10th, 2010
Posted by Julene

I took my twins to a 3 day horse trial last weekend outside of Knoxville in the Smoky Mountains. They both compete in the sport of “eventing”, which is a 2 or 3 day horse trial encompassing the elements of dressage, stadium jumping and cross-country jumping. All 3 phases of riding are scored, and the order of finishing places is determined by the lowest penalty scores after all 3 phases of riding are completed. Usually, 2 of the 3 phases of the riding are accomplished in the first day of the horse trial, with the other element finished the final day of the horse trial. The kids may walk the jumping courses with their trainer prior to that phase of the competition, but the horse is not allowed to school either the stadium jumping course or the cross-country course prior to the actual riding of the courses. Dressage is a practiced, coordinated and very controlled test of horse and rider communication, where form and style over the various gaits are judged in a small arena. Stadium jumping is a timed ride over a variety of jumps in an arena, and cross-country jumping is a timed ride over jumps in open fields over several miles of a cross-country course.

The kids on our “recognized” eventing team are trained by Angela Ariatti in Goshen, KY, and range in ages from 12 to 17. They travel the country competing in horse trials that are recognized by the USEA (United States Eventing Association), and accumulate points over the course of a calendar year, culminating in their qualification (or not) for the AEC’s (the American Eventing Championships) year-end competition. This is a competition entered by riders, both amateur and professional, from all over the country, and it serves as a chance for our young riders to associate with and observe high level competitors, many of whom are top-ranked riders in eventing, and even international or Olympic level, competitors.

Angela took 4 of our team members (including my Lexie and Kaitlyn) to River Glen last weekend, a beautiful equestrian park in Tennessee along the banks of the French Broad River. I was so proud of all of the girls, and it was a very mixed weekend of results. We had a rider fall during stadium jumping, which is an automatic elimination from the competition. We had a 6th place finish in the Open Novice division (Lexie), and 2 fourth place finishes, Kaitlyn in Open Beginner Novice, and another in the Open Training division.

All of the kids amaze me over the course of these competitions, because in order to be successful, they learn that all 3 phases of the competition are important, and they all 3 matter. They learn that they must remain focused and competitively optimistic as all 3 phases of the riding progress, and that it is a cumulative score they are seeking. They learn to emphasize their own strengths as well as the strengths of their mounts in order to optimize scores in each of the riding phases, and they learn to persevere on to the next phase of the competition even when one element may not go as well as they’d hoped. They learn to persevere. Can you think of a more valuable lesson in life?

The team member who fell off her horse at stadium stayed to cheer on and support her fellow team-mates even after her own elimination from the competition. Kaitlyn persevered in order to move up consistently through all 3 phases of the competition, from 12th after dressage, to 7th after stadium, to an ultimate 4th after cross-country, behind riders who were all her senior in age grouping and experience.

As the weekend progressed, and as an adult, I thought about how the kids handle the challenge of a 3 day competition, how they handle the nerves and the stess in order to do their best in all 3 phases of the riding. I watch them learn how to watch the mistakes others make and to learn from them, how to plan with Angela their best course of action, and I watch them swallow the hard lumps as they make their own mistakes and learn to go on to the best of their abilities. In the end, Angela only expects them to do the best that they are capable of, and they know this, but it is truly amazing to observe this learning process, for it is a journey they each make.

Achieving goals in life is all about having the courage to dream of the goal, consistently working hard toward that goal, and persevering to never lose sight of the goal…individuals who can do this oftentimes exceed the expectations or achievements of others. And they amaze and inspire us all.

Congratulations girls.

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