I was recently on “The Doctors” TV show where I performed a revision surgery on a patient who had liposuction previously and was left with significant asymmetries. In the last few months, I’ve taken care of many patients who needed their previous surgery fixed. The severity of their problems ranged from subtle contour irregularities to noticeable asymmetries including shelves or chunks of fat left behind. Some of the worst cases I’ve had to fix involved previous mesotherapy – where injections marketed as “fat dissolving” actually resulted in numerous rocks of scar tissue in the fat. These revision cases are usually extremely challenging to fix. There is often a lot of scar tissue present in the areas of previous surgery so blending the asymmetries takes a lot of surgical planning and skill.
When it comes to body sculpting, as with any surgery, it is important to go to an experienced and trained plastic surgeon. Liposuction and body sculpting requires technical skill and an artistic eye to create an ideal silhouette. Good communication between patient and surgeon are essential. As with any surgical procedures, there are always potential risks involved. When it comes to liposuction or any fat removal procedure, there is always a chance of asymmetries, lumps, dents, or un-evenness. However an experienced and trained surgeon can minimize the chances of any of these complications from occurring.
For patients who have had less than desirable results, it is often emotionally challenging for them to undergo a second revision surgery. Many of my patients told me that they had lost hope that there was any chance of fixing their surgery and because of their previous bad experience; they were hesitant to have a second procedure
For the patients who come to me with previous liposuction complications, I always make sure to help them set realistic expectations for what revision surgery can do for them. Sections of fat left behind can be removed and blended into the surrounding areas to create a smoother contour and asymmetries can usually be corrected. Dents and areas where too much fat was taken can be lifted and fat grafted. However, for areas where there is a lot of scar tissue or deep dents, I caution patients that the scar or dents often re-form.
In general, it’s always best to have surgery performed correctly the first time. I always encourage patients to do their research and make sure they have all their questions and concerns answered before proceeding with surgery.
Dr. Cat Begovic
In Fitness RX magazine this month, I talk about skin health. I review the basics on skin aging and discuss vitamins and oral supplements that can help improve the appearance of the skin. I’ve attached the full article below for those of you who are interested in reading!
Also, this Friday Jan 13, I perform complex revision liposuction surgery on “The Doctors”TV show on ABC. In my segment a patient had previously had
liposuction several years ago but was left with significant asymmetries. She had a large shelf of fat left behind on her stomach that was visible even with clothes on. She also had several areas where there were chunks of fat on her stomach and also a ridge of fat along her back. Her previous doctors had told her there was nothing that could be done! Watch her transformation revision surgery! We will post it soon on our website on the MEDIA page.
Dr. Cat Begovic M.D.
Nutritional supplements for skin health
An article published in September’s New Scientist magazine discussed a potential anti-wrinkle pill. Independent researchers contacted by the magazine remain skeptical about the pill until there is scientific research to support these claims. When it comes to anti-aging and anti-wrinkle ingredients, consumers are bombarded with marketing and fancy packaging without really knowing if a product works. In all fairness, proving an ingredient or product works is difficult because with test groups there are many factors, such as diet, genetics, environment and weight, that affect aging and create alterations in the data. There is much more data in the scientific literature on topical ingredients— I reviewed and published these findings a few years ago.1 However, when it comes to oral supplements, specifically for anti-wrinkling, there is limited scientific data. Although many studies do not focus specifically on skin wrinkles, there is evidence that nutritional supplements do improve skin health and have beneficial actions on the skin.2,3 Here I will discuss some of the commonly used anti-aging supplements for the skin, the theory behind their action, and some research found in the scientific literature.
Biology of Wrinkling and Skin Aging
It’s first important to understand how skin ages. There are two main processes that contribute to aging: genetics and the environment. Environmental exposure to ultraviolet (UV) radiation, smoking, wind and chemicals cause roughness, fine lines, sagging, irregular pigmentation and decreased skin elasticity.1,4 The primary mechanism by which UV and other factors damage skin cells is by creating reactive oxygen species that damage nucleic acids, lipids and proteins, including collagen.5 When collagen is damaged, the structural integrity of the skin is compromised, which causes wrinkle formation. Damage to nucleic acids contributes to the formation of skin cancers.
Nutrition and Skin Health
Good nutrition is essential to the skin. Deficiencies in certain vitamins are evidence that nutrients are critical to skin health. Vitamin A deficiency causes dry skin, dry hair, and delayed wound healing. Vitamin B deficiency causes hyper-pigmentation and discoloration of the skin. Vitamin C deficiency causes scurvy, resulting in skin blisters, bleeding gums, and delayed wound healing. It is well known that what you put into your body reflects on the outside as well.
Antioxidants are believed to fight aging and wrinkles, since antioxidants neutralize the reactive oxygen species that damage the skin. The skin protects itself with naturally occurring antioxidants, such as vitamins A, C and E, squalene, and coenzyme Q-10. Therefore, most anti-wrinkle supplements contain these vitamins. Antioxidants are found in many botanical supplements as well, including grape seed, red wine resveratrol and fruit-based supplements. Selenium— which is found in nuts, chicken, eggs, fish— and beta-carotene— which is found in orange and red fruits and green leafy vegetables— are two other commonly used antioxidants. Although antioxidants are commonly accepted as anti-aging molecules, there are unfortunately few studies that specifically show that antioxidant supplementation decreases wrinkle formation.6 This doesn’t mean that they don’t work; there is just limited clinical data to prove this.
Several studies have shown that oral vitamin C or vitamin E supplementation does cause increases in skin vitamin C and vitamin E content.7,8 In several experiments on human skin cells grown in a laboratory, vitamin C, vitamin E and beta-carotene were all found to protect cells from UVB-induced oxidative damage— the primary mechanism of wrinkle formation.9,10 However, most of the studies on these antioxidants are focused on their anti-skin cancer properties or whether they protect against sunburn, rather than their anti-wrinkle properties. Many of these studies do show that these antioxidants help prevent skin cancer and also increased resistance to sunburn. However, there are also a few studies that show no statistically significant improvement.
Omega-3 fatty acids, which are most commonly derived from fish oil, are believed to be involved in skin health and collagen regulation. Again, there are little to no studies that specifically look at omega-3 supplementation and wrinkle improvement. Most studies look at omega-3 as a skin cancer protective agent or skin inflammation modulator. Omega-3 has been used in patients with psoriasis and eczema because of its anti-inflammatory effects. One study also showed an inverse relationship between omega-3 fatty acids and skin tumor markers in skin biopsied from human subjects, suggesting that it helps in skin cancer prevention.11 Numerous animal studies have demonstrated that omega-3 supplementation also helps sunburn prevention and UV-induced erythema.
There have been many studies on the photoprotective effects of green tea extract and polyphenols on human skin cells in culture.12,13 The chemical components of green tea act as antioxidants. However, there are only a few clinical studies performed on human test groups investigating the anti-aging properties of green tea. One long-term study, where subjects were given green tea supplements for two years, showed a significant improvement in overall skin solar damage after six months and improvement in skin erythema and telangectasias after 12 months.14 Similar results have been found in numerous animal studies.
There have been some convincing clinical studies on soy isoflavone supplementation to improve the appearance of skin. One double-blind, placebo-controlled study on women who were given supplementation of soy isoflavone showed some improvement of fine wrinkles and cheek skin elasticity.15 Another study, which evaluated skin biopsies of post-menopausal women after soy isoflavones supplementation for six months, showed an increase in epidermal thickness and an increase in collagen in the dermis.16 Animal studies and studies on human cells in culture also show photoprotective effects.
Although there is limited data specifically investigating nutritional supplements on skin aging and wrinkle prevention, there is a large body of evidence showing that many nutrients are beneficial for the skin and overall health. Living a healthy lifestyle is critical to having good, healthy skin. Also, avoiding smoking and sun exposure are two of the most important things one can do to prevent premature aging and skin damage. I always tell my patients to eat foods rich in antioxidants, drink lots of water, and exercise. Taking care of your body on the inside is essential to looking young from the inside out.
Dr. Catherine Begovic is a Harvard-educated, UCLA-trained female plastic surgeon in Beverly Hills, California who completed not one, but two surgical training programs. She is the featured surgeon and medical host for Beauty TV and has published or presented over 40 articles in scientific journals and meetings on topics ranging from molecular biology, cancer, anti-aging, skin care, fat stem cells, to vaginal cosmetic surgery. For more information on Dr. Begovic, visit www.makeyouperfect.com.
1. Huang, CK and Miller T. The Truth about Over-the-Counter Topical Anti-Aging Products: A Comprehensive Review. Aesthetic Surg J 2007;27:402-412.
2. Boelsma E, Hendriks HJF, Roza L. Nutritional skin care: health effects of micronutrients and fatty acids. Am J Clin Nutr 2001;73:853-64.
3. Piccardi N, and Manissier P. Nutrition and nutritional supplementation. Impact on skin health and beauty. Dermato-Endocrinology 2009;1(5):271-4.
4. Gendler EC. Analysis and treatment of the aging face. Dermatol Clin 1997;5:561-567.
5. Harman D. Free radicals in aging. Mol Cell Biochem 1998;84:55-61.
6. Tebbe B. Relevance of oral supplementation with antioxidants for prevention and treatment of skin disorders. Skin Pharmacol Appl Skin Physiol 2001;14(5):296-302.
7. McArdle F, Rhodes LE, Parsiew R, et al., UVR-induced oxidative stress in human skin in vivo: effects of oral vitamin C supplementation. Free Radic Biol Med 2002;33(10):1355-62.
8 Ekanayake-Mudiyanselage S, Draemer K, Thiele JJ. Oral supplementation with all-Rac- and RRR-alpha-tocopherol increases vitamin E in human sebum after a latency period of 14-22 days. Ann N Y Acad Sci 2004;1031:184-94.
9. Jin GH, Liu Y, Jin SZ et al., UVB induced oxidative stress in human keratinocytes and protective effect of antioxidant agents. Radiat Environ Biophys 2007;46(1):61-8.
10. Offord EA, Gautier JC, Avanti O et al. Photoprotective potential of lycopene, beta-carotene, vitamin E, vitamin C, and carnosic acid in UVA-irradiated human skin fibroblasts. Free Radic Biol Med 2002;32(12):1293-303.
11. van der Pols JC, Xu C, Boyle GM. Serum omega-3 and omega-6 fatty acids and cutaneous p53 expression in an Australian population. Cancer Epidemiol Biomarkers Prev 2011;20(3):530-6.
12. Silvergerg JI, Jadgeo J, Patel M. Green tea extract protects human skin fibroblasts from reactive oxygen species induced necrosis. J Drugs Dermatol 2011;10(10):1096-101.
13. Elbling L, Herbacek I, Weiss RM, et al., Hydrogen peroxide mediates EGCG-induced antioxidant protection in human keratinocytes. Free Radic Biol Med 2010; 15;49(9):1444-52.
14. Janjua R, Munoz C, Gorell E, et al. A two-year, double-blind, randomized placebo-controlled trial of oral green tea polyphenols on the long-term clinical and histologic appearance of photoaging skin. Dermatol Surg 2009;25(7):1057-65.15. Izumi T, Saito M, Obata A et al. Oral intake of soy isoflavone aglycone improves the aged skin of adult women. J Nutr Sci Vitaminol (Tokoyo) 2007;53(1):57-62.
16. Accorsi-Neto A, Haidar M, Simoes R et al., Effects of isoflavones on the skin of postmenopausal women. Clinics (Sao Paulo) 2009;64(6):505-10.
Posted in: Plastic surgery and Pregnancy | January 5, 2012 | Comments Off
In general, with any cosmetic procedure, especially when it comes to body contouring, it is best that your weight is stable before proceeding with surgery. Therefore I tell patients who want to get liposuction or an abdominoplasty that they should wait several months after having their baby. There is no harm to the baby or the patient to having these surgeries before pregnancy, however, because of weight fluctuations and body changes that occur with pregnancy, they may need a second procedure later.
The same thing holds for breast surgery, especially if you are thinking of having a breast lift or reduction. Because the breasts expand and then deflate after pregnancy, you may need to have your lift revised after pregnancy depending on how your body changes. For breast implants, the shape may hold through pregnancy, but it really depends on your anatomy. I know many women who happened to get pregnant just after they had implant surgery and in most cases they retained a nice shape. Of course, you should expect that your breasts will expand greatly with pregnancy on top of the increase from the implants.
For other procedures of the face like rhinoplasty, eyelid, or brow lifts, the anatomy varies less with pregnancy so it wouldn’t be a problem to have the surgery before pregnancy.
Dr. Catherine Begovic M.D.