Surgeons restore youth to sagging bodies

LONGMONT — What has lines, brown spots and sags? Your skin as it ages.

But having the skin of your dreams is no joke for many people as aesthetic procedures advance. Just about any skin problem, from varicose and spider veins to rosacea (the flushed face), freckles, wrinkles, acne scars and bags can be treated with either a non-invasive technique or through surgery.

Statistics show that more people every year are opting for cosmetic procedures. More than 1.3 million people had cosmetic plastic surgery performed by board-certified plastic surgeons in 2000, an increase of 227 percent from 1992, according to the American Society of Plastic Surgeons. In 2000, the five most popular procedures were liposuction, breast augmentation, eyelid surgery, Botox injections (where a toxin is injected into muscle to paralyze it) and facelifts.

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Dr. Peter Schmid, who runs the Institute of Aesthetic Plastic & Reconstructive Surgery in Longmont, says the reasons for increases are twofold.

“Aesthetic surgery has become very popular, initially from the exposure in the media, and second, the acceptability of having the procedures,” Schmid says. “Since individuals are living longer and healthier lives, they become more attuned to their physical features. People want to look as good as they feel. With the option of elective cosmetic surgery, there is a new option in their lifestyles.”

Schmid took out a loan to establish his business in 1993, but would not disclose any specific financial information except costs for procedures. At his practice, the most common elective procedures are facelifts, eyelid tucks, laser resurfacing, liposuction, rhinoplasty (“nose job”) and hair restoration. About 75 percent of his clients are women and 25 percent are men, although more men are coming in each year.

“The gender is specific as to what they are looking for,” Schmid says. “Men want hair transplantation, liposuction and rhinoplasty. (They also want) some very light skin care. Botox injections are very common in men. They like to have some wrinkles alleviated.”

It used to be that only the rich and famous could afford the expensive procedures. Tabloid magazines would show pictures of stars scurrying out of a clinic with a scarf draped over their heads as they went home to recuperate.

Things have changed. Schmid says the number of treatments has grown with advancing technology. While some procedures do require going under the knife, fewer make it absolutely necessary.

“The initial techniques were all very surgical,” Schmid says. “They were more traumatic in the past. What the trend has been toward is safety, reduced recovery, less traumatic invasive techniques.”

With the non-invasive techniques, more subtle results are achieved.

“The consumer is looking to improve upon a look, but not to drastically change their lives,” Schmid says. “We are tending toward more closed techniques with endoscopic surgery — very small, limited incisions, and then do traditional work through those incisions.”

Certain procedures will most likely require even the smallest incisions, such as eyelid tucks, where the skin is pulled tighter to remove wrinkles and drooping lids. The facelift is another procedure requiring incisions, whereby the skin is pulled back and tacked in place along the hairline to reduce visible scars.

Less drastic treatments deal with just the top layer or several layers of skin.

Superficial therapy entails using a topical cream such as glycolic acid or Retin-A, both of which “eat away” the top layer of skin cells. Next would be a peel to the skin or microdermabrasion to the skin. Microdermabrasion is performed with a jet of fine mineral crystals that look a bit like sugar. These crystals are vacuumed across the skin to remove the dead and damaged skin cells and to stimulate the collagen beneath the surface of the skin.

A chemical peel would be the next level of treatment. Alphahydroxy acids (AHAs), such as glycolic, lactic or fruit acids produce light peels for the treatment of fine wrinkling, areas of dryness, uneven pigmentation and acne.

Trichloroacetic acid (TCA) is most commonly used for medium-depth peeling. Fine surface wrinkles, superficial blemishes and pigment problems are commonly treated with TCA.

Phenol is the strongest of the chemical solutions and produces a deep peel. It is used mainly to treat patients with coarse facial wrinkles, areas of blotchy or damaged skin caused by sun exposure, or pre-cancerous growths. Since phenol sometimes lightens treated areas, your skin pigmentation may be a determining factor as to whether or not this is an appropriate treatment.

During the last 10 to 12 years, people have heard about the traditional, carbon dioxide laser; a resurfacing laser, says Schmid. It removes skin layer by layer to the deeper ones of the skin, the dermis, where collagen is stimulated and produced.

“We thought this would replace chemical peels, but it has not,” Schmid says.

The cutting edge for non-invasive systems is the family of intense pulsed light and laser systems.

“Essentially the way they differ from others is they are not burning or removing the surface layer of the skin,” Schmid explains. “Light energy is attracted to deep targets such as blood vessels, pigments and lesions. (The laser) bypasses the top layer of skin and becomes very focused at those targets. What it can do is it heats up the blood vessels and closes them and shatters pigments, then warms up the dermis, and that promotes collagen production. It leaves the surrounding skin untouched.

“You go through a series of sessions, such as five sessions,” he says. “It is really excellent for patients with photo-damaged skin.”

The Intense Pulsed Light System was developed by a company called ESC Sharplan in 1996. Background studies were conducted by California physician Patrick Bitter. Schmid began using the system in his Longmont office six months ago.

He has seen it work wonders for broken capillaries, age spots and freckles. It also treats people with irregular texture and has been shown to reduce pore size and to soften light wrinkles. The other benefit of the therapy is for spider veins on legs. It also treats certain tattoos and can remove hair for several months or up to a year.

Not everyone is a candidate for cosmetic surgery, says Schmid. It is important to have to have realistic expectations, he says.

“I have to understand patients’ motivations. They have to understand that by changing appearance, it doesn’t change who they are. It won’t secure happiness.”

Schmid has seen the most life-changing results in patients who have congenital birth defects that seem to distract people from the person inside, and also for those who have suffered major scarring in an accident.

“We want to get them out in society and not have them focus on the feature. In that situation, it is very gratifying.”

But Schmid says physicians should watch out for certain personality types who may not be suitable for cosmetic procedures. One such type is a person who suffers from body dismorphic disorder. These individuals will focus on a feature, and it affects their relationships. They will obsess over a mole or small blemish, and it causes isolation. The other type is someone who suffers from Adonis complex. Schmid explains that people are brainwashed to think they have to have physiques they see in magazines despite the fact that models are often on steroids or their photos have been digitally enhanced.

“I have beautiful, attractive people who want to be perfect. In that situation, cosmetic surgery is probably for the wrong reasons. I don’t think that elective surgery is going to touch upon your soul.”