According to the latest statistics from the American Society for Aesthetic Plastic Surgeons (ASAPS), labiaplasty procedures spiked 49% between 2013 and 2016, and this trend is continuing, with more than 12,000 procedures performed by ASAPS members just last year. The increase in interest stems from both aesthetics and function. For instance, the internet is full of what constitutes a "desirable" appearance of the vaginal area implying a "new norm" of more petite appearing labia minora and full, tight labia majora. Due to the popularity of Brazilian waxing, the female anatomy is now more commonly totally visible. A common complaint of patients is excessive redundancy, deflation and hyperpigmentation of the external tissues, which is both a cosmetic concern and a functional problem for women of all ages. Young adolescents feel "abnormal" if the labia minora hang too much or are asymmetric, post-partum women experience changes of laxity and sometimes sexual dysfunction after child birth or weight loss, and¬ menopausal women can experience dryness, tightness, itching and painful sex after aging and hormonal loss. Women’s clothing has expanded to include form-fitting streetwear like yoga pants, exercise clothing and leggings, and excessive tissues can cause rubbing, chafing, irritation, dryness, and fullness that is uncomfortable during exercises like running, biking, horseback riding or even during intimacy.

With this cultural shift and increased media representation, the good news is that board certified and well trained plastic surgeons have fine-tuned surgical techniques that offer safe, effective and aesthetic results while also correcting functional issues for female patients bothered by true symptoms down below. The bad news is that with rapidly increased demand, accompanied by a lack of mandated training for the great numbers and types of practitioners offering treatments, many women fall prey to "botched" surgeries or spend boo-coos of money on ineffective therapies. Good plastic surgical techniques for labia reduction and even clitoral hood reduction yield very high patient satisfaction results and can make all the difference between a life of chronic anxiety and doubt and one of pleasure and self confidence.

Meaningful nonsurgical options using CO2 laser technology now exist to most effectively offer treatment of the functional conditions such as loose vaginal canal (Vaginal Relaxation Syndrome) after childbirth or weight loss, and dryness, itching, vaginitis, tightness, urinary leakage (Genitourinary Syndrome of Menopause) caused by declining estrogen levels in menopausal women or those denied estrogen as after hormonally treated cancers. These lasers can also be used to cosmetically treat the atrophic, loose or hyperpigmented external vulvar skin that occurs with pregnancy and aging, in some cases even eliminating the need for surgical labiaplasty. And finally, these lasers can help treat sexual dysfunction including painful intercourse due to internal vaginal dryness or tightness, laxity due to relaxation, and orgasmic dysfunction.

In a clinical trial that I conducted last year on the use of the CO2RE Intima laser for 40 menopausal women, results showed an astounding 90% patient response rate after just two laser treatments, and a 100% response rate after the recommended three monthly treatments on symptoms of dryness, itching, painful intercourse and urinary leakage. Several of the female patient groups who can be dramatically improved with these treatments are breast cancer and hormonally treated cancer patients who may enter menopause at an earlier age and for whom hormone replacement therapy is not advised, patients with radiation induced dryness, and patients suffering from urinary incontinence or pelvic organ prolapse. Again, not all practitioners offering treatments for these cosmetic and functional issues are necessarily surgically trained or laser experts, so as always, patients should research credentials, board certification, experience and recognition in the field before selecting a provider to ensure the best outcome.

Patient response really is close to 100 percent, as reported by Syneron Candela’s clinical trial, in which histological results confirmed that Profound induced the formation of new collagen, new hyaluronic acid (the substance injected in most facial “fillers”), and most importantly, new elastin in treated skin. Profound is essentially “Fractional Radiofrequency,” in which heat is delivered via tiny pairs of microneedles to the deep layer of skin called the dermis, or in the fatty tissue below the skin.

After comfortably numbing the skin with cream and local anesthetic, patients can opt to have the treatment performed to the full face and neck, or to smaller regional areas like the lower face and neck. The heat delivered by the shorter needles available causes improved skin texture, skin tightening, thickening and smoothing, as well as increased volume in areas where injectable fillers would be placed.

In addition, there are now longer needles available which can reach the fat of the jowls and neck (that “turkey waddle” we hate under the chin) to truly contour these areas much like liposuction of the face and neck. In contrast to the single-treatment option with a one-week recovery process Profound offers, Kybella neck injections must be performed as a two- or three-treatment series over six-week intervals, with several weeks of pretty significant swelling with each injection.

Kybella and other non-surgical device treatments not only require more time to result, due to higher total numbers of treatments required, but also end up being usually more expensive when compared to Profound’s single treatment cost of $2,800 to $4,800, depending on size of the treatment area. If you compare this cost with the cost of the traditional surgical facelift/necklift — which can run anywhere from $12,000 to $15,000 — you can see why this makes patients smile.

Even though a surgical remedy for the neck remains the longest-lasting treatment option for facial and neck aging and will always be the gold standard, not everyone wants surgery. We also don’t recommend having too many facelifts in one’s lifetime in order to avoid that “over-operated look.” The fact is the neck is frequently the problem area which makes patients “pull the trigger” toward finally having facelift surgery, since I am able to keep them happy longer in the face with facial volumizing and laser treatments, which don’t typically help the neck. I am now using Profound to help patients put off the age at which they finally have that surgical lift, as well as to maintain it longer non-surgically.

Since I am actually improving the quality of the skin with Profound, even when the patient finally has that face/necklift, the lift lasts longer due to having “youthenized” the skin quality by previous Profound treatments, hopefully allowing even the surgical facelift patient fewer surgical revisions over time. Finally, facelift surgery doesn’t improve the actual quality of the skin itself, and is rather like “making up the bed with the same bedspread” over time. Profound is as corrective as it as pre-emptive in its effects on skin quality and contouring of the face and neck.

Here is a typical before and after Profound result to consider. The patient is shown pre-treatment, at two months, and at six months. Note the improved skin tone and texture, increased volume in the cheeks and nasolabial folds outside the mouth, reduced fat of the jowls and neck, and overall skin tightening. Recovery is limited to one week of swelling, mild bruising and tiny bumps on the skin’s surface from the needles, which quickly resolve with skin moisturization. I also have been using various growth factors and PRP in the immediate post-treatment period to assist with an improved drug delivery system for these products through the needle holes, as well as to hasten healing from Profound.

And finally, the longer needles are now our favorite single-treatment option for nonsurgical correction of nonfacial skin laxity and cellulite…the topic of a future story to watch for here as we get ready for spring…

GOBBLE ON, but go light on the gravy!!!

The main attraction to the open house — aside from the discounts on services and products — was the Syneron Candela CO2RE Intima vaginal rejuvenation medical laser. The CO2RE Intima uses medical laser technology to address several issues related to vaginal care, from dryness and looseness, to tightness, itching and pain. Dr. Samuels explained it best in her piece about the Intima:

This laser is a fractional CO2 laser which delivers laser energy to cause a natural thickening of the vaginal skin, restoring a more youthful quality to the skin, along with a return of natural lubrication, the formation of new collagen, and the rejuvenation of natural elasticity lost amid declining estrogen levels during menopause or hormonal treatment of breast cancer.

Tab’s View also learned about Sculptra Aesthetic, an injectable poly-L-lactic acid used to restore a youthful appearance in one’s face. The injectable is also used on those suffering from the effects of AIDS and medications aimed at treating the disease, bringing fullness taken away by the disease and treatments back to the face.

Later on, we caught a tech demo featuring another Syneron Candela product, UltraShape. This device uses ultrasound technology to reduce fat without pain or the scalpel. Instead, UltraShape causes the walls of fat cells to collapse, liberating the contents as triglycerides while slimming down one’s appearance.

Aside from tech demos and discounts, the open house had plenty of snacks and beverages for both current and future patients to enjoy. And of course, what would an open house be without a prize giveaway or two? Guests could enter a drawing for a free peel by filling out a slip with their name and contact info, then folding it up and dropping into a fishbowl.

Tab’s View had a wonderful time at Dr. Samuels’s office, and look forward to the next open house.

There are changes in a woman’s body which occur during or months after hormonal treatments for breast cancer, particularly vulvovaginal atrophy (VVA). Many of the symptoms of VVA occur naturally with menopause, are made worse if a woman is given anti-estrogen hormonal therapies in treatment of breast cancer. It’s the topic which often doesn’t come up in the exam room, or if it does, treatment options to offer patients have been limited.

While hormone replacement therapy is an option for menopausal women dealing with symptoms of hot flashes, vaginal dryness, itching and atrophy, painful intercourse, and frequent vaginal infection or stress urinary symptoms, these same hormonal therapies are not options for breast cancer patients. Now, with recent advances in laser technology, there is a safe, non-hormonal option…Laser Vaginal Rejuvenation.

A laser used for many years for facial skin rejuvenation has now been modified with a handpiece to work on vaginal epithelium in much the same way as it works to rejuvenate facial skin: CO2RE Intima. This laser is a fractional CO2 laser which delivers laser energy to cause a natural thickening of the vaginal skin, restoring a more youthful quality to the skin, along with a return of natural lubrication, the formation of new collagen, and the rejuvenation of natural elasticity lost amid declining estrogen levels during menopause or hormonal treatment of breast cancer. The treatment requires three 15-minute, non-painful, in-office laser treatments performed at one-month intervals. Symptoms begin to improve as soon as days after the first treatment, and a single annual re-treatment is usually required to maintain results in the face of continued declining estrogen levels. This laser also works to tighten a loose vaginal vault in the post-partum woman after pregnancy-induced changes – or after weight loss – and is part of the new “Mommy Makeover” revolution!

Here is a short video clip that shows how the laser is placed very comfortably within the vaginal canal. No anesthesia is needed, the treatments are very comfortable and quick, and there is no recovery time. Laxity and hyperpigmentation of the external labial skin can also be improved.

I recently conducted one of the first clinical trials in the U.S. with this revolutionary laser, and our results showed a 97% response rate and symptom reduction. Our patients call it a “life-changing” treatment that they didn’t dream could so effectively restore a sense of self-confidence and feminine well-being. One of our study patients, Rosie, said, “I didn’t even tell my husband I was going to have the laser, and he noticed the tightening and better lubrication the first time we were intimate again after only my second treatment. I was so much more interested in sex and so much more comfortable, and he noticed we didn’t need to use a lubricant. So I told him what I had chosen to do. Everything is different now. I hadn’t realized how much this had affected our relationship in a negative way.” Another of our study patients is a breast cancer survivor who was diagnosed and treated while in her 30’s. She had experienced decades of menopausal symptoms when she presented to me for the CO2RE Intima study complaining of vaginal dryness, irritation and terrible urinary leakage requiring the use of multiple pads daily. Cathy explained, “After one treatment, I stopped using pads altogether, and the increased vaginal lubrication is nothing short of a miracle!”

I have spent my career trying to help women experience their best selves by removing physical sources of concern for them and thereby restoring a better sense of “self” for them in safe and affordable ways, whether this is done with surgery or meaningful non-surgical options. The CO2RE Intima is truly an extension of the surgical labiaplasty option I have long offered women to improve their feminine wellness and to restore vitality to this very important area lost due to childbirth, weight loss, aging, menopause or illness. As a woman, I have always been bothered by what my female patients feel they can’t freely discuss. For too long women have been told there are no viable treatment options for these concerns and that these unwelcome changes are just part of the aging process. This is not true. Finally, women have a source for open and honest dialog and can expect some real help.

If you are a breast cancer survivor or know of a woman who would benefit from learning more about CO2RE Intima treatments to restore intimacy and feminine well-being, call us for more information. During the month of October, we are happy to offer a three treatment laser series for the price of two treatments. You pay for two and get the third treatment for free.

Act Now…There’s Never Been a Better Time to Restore Your Intimate Health!

To learn more about Women’s Intimate Health options visit: awomanstouchmd.com/labiaplasty.php or contact Dr. Samuels at 502-897-9411.

“As a cosmetic plastic surgeon, I help patients navigate this important question every day,” said Julene Samuels, M.D., a plastic surgeon in Louisville, Ky. “Even though I am a surgeon and I love to operate, I realize the limitations of even well-performed plastic surgery. Surgery isn’t always the right choice, and sometimes it’s just too much.”

“Surgery also may not address all of a patient’s concerns in a given area, and may require nonsurgical adjuncts to deliver the optimum result, or to maintain a surgical result over time. Furthermore, since entering private practice in 1994, there are now many more truly meaningful nonsurgical options that are very worthy of consideration than there used to be.”

Here is a list of things to consider as you try to determine if surgery or a nonsurgical option is right for you…

1. How dramatic of a change do you want? Do you want an instant “Wow!” result — like breast implants which will be noticed immediately — or would you prefer a subtle change or improvement over time?
2. Are you okay with multiple treatments to achieve results, or do you prefer a “one and done” approach? Do you have the ability to return for multiple treatments in a nonsurgical series to achieve results?
3. Are you a good medical risk patient for a surgical procedure? Are you opposed to anesthesia (even intravenous sedation), or would you rather avoid it?
4. How much do you want to invest in your procedure? Plastic surgery has become more affordable over the years, but surgical procedures do require more of an investment than nonsurgical options.
5. What about recovery time? Do you have the time to recover from a surgical procedure, or would a nonsurgical treatment with minimal recovery time best suit your schedule?

The discussion surrounding any cosmetic concern should involve a discussion of appropriate surgical as well as nonsurgical options with a board-certified and knowledgeable physician who actually offers both surgical and nonsurgical options. Have you ever heard the phrase, “If all you have is a hammer, the whole world is a nail”?

“There is a line that is written in all my patient charts that goes like this: Risks, benefits, options and alternatives, limitations and revisions outlined,” added Dr. Samuels. “A thorough discussion of the surgical options and alternatives to surgery is the only true route to informed patient consent. Every surgical patient who comes to see us hears about the best nonsurgical options for care of their particular concern first, and then we focus on the surgical options next. That way, my staff and I can help patients figure out whether it is surgery they desire or something else.”

Many times, patients may not be aware good nonsurgical options for their concern exist. Conversely, understanding the limitations of a nonsurgical procedure might mean a change of course to a surgical approach instead.

Per Dr. Samuels: “All patients deserve to hear both nonsurgical and surgical options, the intended results of each, what the anticipated process of each will involve, and then the right choice between surgery or non-surgery can be made.”

There are also many instances where a patient may combine nonsurgical and surgical approaches. Staging results or improving one’s candidacy for surgery may make starting out with a nonsurgical approach the best option, delaying surgery.

It is also common for many patients to choose a more thorough correction via surgery initially, then utilize nonsurgical procedures to maintain surgical results without the need for further surgery or surgical revision.

According to Dr. Samuels, there is definitely a place for nonsurgical treatments in the armamentarium of ways to proactively thwart the aging process. It is often possible now to utilize meaningful nonsurgical treatments at earlier ages to slow the aging process, and to delay the age at which patients present for more aggressive management.

“As a plastic surgeon, I am often asked, ‘Have you had any surgery yet?’ My answer: No, but I will when I run out of good nonsurgical options that make me happy!

“Don’t get me wrong. Sometimes surgery really is the only option. But the real key to cosmetic surgery success is to choose age-appropriate interventions (surgical or nonsurgical), to operate only when necessary.

“And when there is no good or equivalent nonsurgical alternative, [the key is] to choose the right surgical techniques when you do choose surgery; to try to avoid too many surgeries over one’s lifetime; and to use nonsurgical alternatives where appropriate in a proactive manner, or for nonsurgical maintenance.

“In the end, it’s good to have options.”

To learn more about innovative surgical and nonsurgical options contact Dr. Samuels at 502-897-9411.

DR. JULENE SAMUELS, COSMETIC SURGEON

What are the biggest misconceptions patients have about anti-aging treatments?
Most patients undervalue starting early with an anti-aging program and think they need to wait until the signs of the aging process are more significant. However, there are many age-appropriate noninvasive steps a woman can take that make a great difference if practiced regularly, even starting in her twenties and thirties. Doing small but meaningful things daily can help women avoid premature aging and can definitely help women put off the age at which they may require more aggressive intervention.

What's the smallest step that can make the biggest difference in how youthful you look?
A healthy lifestyle including a proper diet, exercise, rest, hydration; daily prescription skin care and avoidance of as many harmful environmental influences as possible-- like unprotected sun exposure and smoking.

What is the best reaction you've ever had to a treatment you've provided?
A patient who came to me after extreme weight loss to deal with too much loose skin on her face, breasts, tummy, thighs and arms. Slowly, and in steps of combination procedures, we did the various face and body lifts to correct all of the skin laxity that had resulted from the weight loss of 180 pounds. The patient cried at the end of three major combination surgeries and told me that even though she knew she had drastically improved her health with the weight loss, that, for a long time, she had become sorry she had lost the weight due to the residual excess skin. It wasn't until after the last surgery that she actually stopped seeing herself as a permanently overweight woman.

We keep a lot of Kleenex in the office for these occasions, and go through it so fast that, one time, after a trip to Sam’s Club, my own husband asked me why we seem to go through so much Kleenex in a plastic surgery office!

Which treatments are you most excited about?
I am a surgeon, and while I love the surgical results I can achieve for women, I fully understand the limitations of surgery, as well as the fact that not all women desire surgical intervention.

I am most excited about new nonsurgical methods of tightening skin, especially in the lower face and neck. For so long, the neck has been the "missing piece of the puzzle." Women hate their aging necks and surgery used to be the only option to really tighten the neck in a meaningful way, since lasers cannot be used as aggressively on the neck as on the face. For skin tightening of the face and neck (and also nonfacial areas), the single greatest new tool is microneedling with audiofrequency. Some of our before and after's almost look like a facelift or neck lift or neck liposuction was done.

Are there any anti-aging cosmetic mistakes that you commonly see?
I am appalled at how often even simple treatments – usually fillers - are overdone. Cosmetic "enhancements" should enhance the positive while de-emphasizing the negative, and restore anatomic elements and tissues to a more youthful, balanced, proportional and naturally beautiful state.

"By delivering RF energy in a fractional manner directly into the reticular dermis using an array of paired microneedle electrodes, we are without a doubt hitting the exact target region," said Julene Samuels, M.D., a plastic surgeon in Louisville, Ky. "The real time in-tissue temperature feedback allows us to quickly and safely reach the clinically proven ideal temperature targets and maintain them for the scientifically determined timeframe for best results."

As David Kent, M.D., a dermatologist and medical director of Dermatologic Surgery Specialists in Macon, Ga. expressed, "Profound is vastly different from ablative fractional laser resurfacing or other RF devices. It is the only RF fractional microneedling device proven to create elastin. Additionally, unlike lasers and other RF devices that create a primarily catabolic injury, which first breaks down collagen, Profound fractional RF causes an anabolic wound healing response, which is like a slowly building fire that stimulates the neocollagenesis, neoelastinogenesis and the production of hyaluronic acid. I’ve been very pleased with it and my patients have been, too."

According to Dr. Samuels, the feedback mechanism features both temperature and impedance monitoring; readings are taken ten times per second within tissue at the treatment site rather than from external monitoring or other means. "We want to control heat to achieve and maintain the maximum safe temperature targets, but also the electrical current flow, which depends on impedance of local tissue," she explained. "Different tissue types have varying impedance, so by sensing changes the current flow between electrode pairs is as consistent as can be. This allows precision in the physical location as well as consistency of energy delivery, temperature of tissue, and the time we maintain therapeutically relevant temperature levels."

With the new SubQ handpiece this same powerful and precise fractional RF delivery mechanism is employed for subcutaneous fat, especially on the neck or jowls, to further craft a more youthful visage. Dr. Kent was involved in clinical trials with the SubQ handpiece. As he explained, "The needles enter the skin at a 75° angle, rather than the 25° angle of the dermal handpiece, and penetrate to the adipose tissue. Precise, controlled energy deposition causes the anabolic wound healing response that seems to persist for quite some time, so as with the dermal handpiece the onset of outcomes takes time. Patients may not easily discern their result because it is so gradual, but when we show them comparison pictures their jaws drop. This new handpiece is very operator friendly, the anesthetic technique is very simple, treatment duration is short, and therapy is quite tolerable. There is no post-procedure pain with only minimal swelling and rapid return to normal activity."

Reference:
1. Alexiades-Armenakas M, Newman J, Willey A, Kilmer S, et al. Prospective multicenter clinical trial of a minimally invasive temperature-controlled bipolar fractional radiofrequency system for rhytids and laxity treatment. Dermatol Surg 2013;39 (2):263-73.

"It's the demeanor as well," she says, "not wanting to appear like I'm superior to them in any way."

Samuels typically spends an hour to an hour and a half with patients on their first visit. Men, who still account for a small minority of her patients, are turning out in ever-increasing numbers.

"If you sit down on your stool and you just have a friendly conversation with somebody and, in the appropriate places, let them get to know you – whether it's through humor or just honesty – people really appreciate that."

Having practiced cosmetic surgery since 1994, Samuels has seen aesthetic treatments by other practitioners come and go. Some of them have left patients disappointed.

A part-time clinical faculty member at UofL, Samuels stresses the importance of knowing your doctor's credentials. Looking at the wall in her office, it's clear she isn't lacking.

Certified by the American Board of Plastic Surgery. Certified by the American Board of Surgery. Awarded Fellowship in the American College of Surgeons. Member of the American Society of Plastic Surgeons. Member of the American Society for Aesthetic Plastic Surgery.

The list goes on.

Samuels begins by asking patients what aspect of their body they see as a flaw. She asks them to describe the look they'd like instead.

And she listens.

Then she explains all the options. Instead of just telling them what she thinks they should do, she gives them enough information to make their own decisions.

"They have to know the ins and outs or they're not a partner in the proposition," she says. "And I am responsible for the result, but if a patient has weighed in on the decision about what the aesthetic goal is, then we're partners in that decision."

Samuels says the objective of any good aesthetic surgeon is to improve people's looks while maintaining all the natural characteristics that make them uniquely beautiful. She always goes for timeless beauty, not just what happens to be trendy.

"Helping somebody look – in their eyes – better, but not too different, is a goal."

Over the years, as her practice has grown, Samuels has been careful to continue giving every patient her full attention.

"They want my time, and I respect that because their time is as valuable as mine," she says. "Our goal is to have people think they're the only one we're taking care of right now."

With expertise and attentiveness, Samuels always aims to create a "boutique" experience that she hopes will exceed her patients' expectations.

"It becomes, then, more like a calling than just a job," she says. "And that’s the difference – because people can go anywhere and get a filler. They can go anywhere and get a breast implant. They can go to a multitude of offices and get Botox. But at the end of every knife and at the end of every needle is the artist."

Indeed, Samuels likens her work to painting a canvas. It was the synthesis of art and science that attracted her to cosmetic surgery in the first place.

"It doesn’t matter if it’s just a filler or Botox. The artistic sense of the person doing that procedure is paramount in terms of the result." VT

FINDING HER CALLING
Julene planned to specialize in general surgery and trauma, but as her training progressed, she started to question how she would manage the demanding schedule while raising a family with her husband. The answer came in the fourth year of her residency program when she began a plastic surgery rotation and found it to be the perfect fit. "I love taking care of women -- not that men don't do it, but plastic surgery patients are mostly female -- and I don't miss the addrenaline of the trauma because plastic surgery is so challenging. It's detail-oriented and precise, requires a really good anatomic knowledge of the entire body, and there are always new techniques and technologies to learn. And while there's certainly trauma in plastic surgery as well, for the most part, it's happy surgery. It's making a difference in women's lives."

A WOMAN'S TOUCH
In her solo private practice, Julene values the opportunity to take care of patients and their families over time. "A woman might first come to me for a breast augmentation, then return for body contouring or a tummy tuck after having children, and come back for a facelift later on, " she says. "Or I'll do a procedure on a patient and she'll bring her mother in for something, too. It's kind of like being a family physician. And it's rewarding having people come with an issue that is a big deal for them and being able to offer a solution that just takes it off their plate. Sometimes people don't realize how much negative energy they spend obsessing about something that can be easily and safely changed."

BEAUTY ON THE INSIDE
People are often surprised to find out that Julene leaves her plastic surgeon's eye at the office. "I'm a very observant person, but when I'm out in public or at a social venue, I don't look at people and think about what they can do to 'look better.' I try to focus on a person's positives and feel that what makes people beautiful or attractive comes from inside. I do, however, notice poor plastic surgery work that leads to distortion. That jumps right out at me."

NOBODY'S PERFECT
One thing Julene struggles with is not letting her professional perfectionism seep into her personl life. "I have to have control when it comes to surgical results or bad things can happen. So, I'm always thinking ahead about possible outcomes and planning what I will do. But in my private life, I can't control everything. I have to let people be imperfect and let circumstances lead to inefficiency. And that's hard for me."

SADDLE UP
Julene is an avid equestrian. She rode horses growing up, and she bought a Thoroughbred when she moved back to Kentucky. "My girls ride, too -- they compete -- and it's been something we do together," she says. "We now have six horses between us. I try to ride several times a week, and I also like to fox hunt when I get the chance." With three of their horses kept on the property, Julene spends a lot of her free time at the barn. "I go out first thing in the morning to clean their stalls and get everytig ready for the day then come home after work and do it again. It's a lot of physical labor, but I love everything about being with the horses."

HIT THE ROAD
When she needs to relax, Julene gets moving. She's competed in several marathons and half-marathons, but now that she's older, she prefers to just run recreationally. "I'll do an occasional 10K with one of my daughters who has taken up running, but I don't want to do marathons anymore," she says. She also bikes to keep up her fitness. "I love to travel while I'm exercising. I have a group of girlfriends who are really good bikers, and we ride together in Louisville and sometimes in Indiana. I would love to do some long-distance biking, like one of those really cool trips where you stay in a five-star place but you're biking all day."

Profound delivers radiofrequency energy beneath the skin through tiny microneedles to add volume and resiliency to the jawline, neck, jowls, nose-to-mouth folds and cheeks. Other energy based technologies help with skin laxity or wrinkles, but not both.

"The ProfoundLift procedure is a win win, and it may help give traditional facelifts a run for their money," says Chicago plastic surgeon, Dr. Steven Bloch, "When used at the optimal settings, Profound may produce up to 89 percent of the improvement seen with a facelift, according to reasearch plublished in Dermatologic Surgery Journal."

Here's how it works. The jowling and laxity is the result of our dwindling suppy of collagen, elastin and hyaluronic acid -- the building blocks of supple skin that snaps back into place. With Profound, the energy is sent directly into the skin's deeper levels to boost all three. It also takes on the lines and wrinkles, without injections. The ProfoundLift fills them naturally from the inside out.

Results don't scream plastic surgery

Unlike other systems that require multiple treatments, Profound is a one and done treatment. "Most people need three days to a week for recovery, and you can wear makeup in a day or two," says Dr. Bloch.

The improvements from a ProfoundLift are gradual and begin to show at one month and continue over the next few months. "Your friends and family will notice you look better, firmer, and brighter, but they won't be able to put a finger on why," adds Dr. Samuels.

To contact Dr. Samuels, call 502-897-9411 or visit www.awomanstouchmed.com for more information about Profound and to schedule a consultation.

Some research suggests it can achieve close to 89% of what a traditional facelift can when the temperatures are optimized. "The concept of microneedling - either with a handheld device, motorized pen, or by radiofrequency energy, is one of the hottest trends in medical aesthetics," says PSP contributing editor Wendy Lewis. "Profound® is the first system that has been clinically proven to stimulate new collagen, elastin, and Hyaluronic acid - the three essential elements of youthful skin, which elevates the treatment to a new level for nonsurgical systems," Lewis adds. - dlm

Yahoo Beauty named Profound one of the "Seven Biggest Beauty Breakthroughs of 2015"

Profound is a needle-based radio frequency treatment that creates new elastin, collagen, and hyaluronic acid and has the ability to lift and contour sagging jawlines. On the face, it can smooth out wrinkles and restore volume to skin. "It's a whole new chapter in lasers," explains Alexiades-Armenakas. "It's the closest we have gotten to a surgical facelift, nonsurgically"

Dr. Julene Samuels, a world renowned cosmetic surgeon, introduced Profound to the Louisville area.