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.
The article is entitled “Liposuction: A temporary fix?” In it, I give my critique on a recent article in Obesity magazine online that claimed that fat moves from the thighs to the abdomen after liposuction, and that fat comes back after liposuction. It addresses many issues concerning diet and exercise and what liposuction can and cannot accomplish.
For those of you who have read my blogs on liposuction – you will know the answers to these questions. For those of you who don’t and are curious – I recommend you get the magazine and read the article!
Dr. Cat Begovic M.D.
Posted in: Dr. Cat in the media | November 3, 2010 | Comments Off
I wanted to share with you my “Tips for Success” that was posted on Maria Shriver’s Women’s Conference Blog Nov 2010. http://www.womensconference.org/5-tips-for-succeeding-in-a-man-s-field/
“Girls who look like you don’t become doctors,” said the father of my 8th grade classmate. This was one of the first of many sexist and discouragingcomments I’ve heard in my life. I started modeling at the age of 12, but it had been my dream since I was a child to be a doctor. I remember when I was working a charity as Miss Delaware Teen USA, an older man told me that I was “very pretty” but should still “consider going to college.” He didn’t believe that I had gotten a perfect 1600 on my SAT’s and was starting Harvard University in the fall.
How have I survived being a woman in a man’s field? How have I fought through the stereotypes to come out ahead? A few tips I have learned along the way:
1. Think ahead and have a game plan. I think women are blessed by being great planners. I always knew what my next goal was and then made a list of what I needed to do to accomplish that goal. I would complete each item on that list systematically. This method has helped me stay focused, given me a sense of accomplishment along the way, and kept me from feeling overwhelmed.
2. Ask for advice. As a woman, you may think that asking for advice is a sign of weakness, but it isn’t. Don’t be afraid to ask. Sometimes men will give you helpful tips they usually wouldn’t share because they don’t see you as competition! There is no better way to learn than to talk to those who have done something before you. Usually people love to help, and you can learn from others’ mistakes instead of making your own.
3. Work harder, be tougher, be better. Being a woman in a traditionally man’s field has been challenging. There have been so many times in my life when I was exhausted – working over 120 hours a week as a surgical intern, taking too many classes at Harvard while participating in too many extracurricular activities. OK – so I was extreme! But women can be just as tough and capable as men. Don’t sell yourself short.
4. Exercise and be good to yourself. While leading a busy and stressful life as a surgeon, I always make time to exercise. Taking care of your body is not only good for you physically, but helps refresh you mentally and emotionally. Somehow I always feel more focused after getting a good workout or run. Similarly, getting a facial or massage can be hugely restorative.
5. Dress to impress. If you want to be taken seriously as a professional, you should look the part. No matter how tired I’ve been in my life – running around the emergency room all night, or seeing patients at different hospitals – I always made sure I was dressed nicely, my white coat clean, my hair neat. If you look sloppy, people will think your work is sloppy. Just 15 minutes to brush your hair back or iron your clothes takes you a long way.
Dr. Catherine Begovic
I had the privilege of volunteering at Maria Shriver’s Modern House Call as part of her 2010 Women’s conference this Saturday and Sunday. It was truly a pleasure working with all the other volunteers who shared my passion for helping women with their health care needs. The majority of the women I saw in the health care clinic hadn’t seen a doctor for years and were completely removed from any health care system. Most of them had no insurance and told me that they didn’t know where to go to see a physician.
I took care of a woman who was in her early 50’s who had a very strong family history of breast cancer. Her maternal aunt and sister both had breastcancer. She had not had a mammogram in over ten years! Being a plastic and reconstructive surgeon and taking care of many breast cancer patients, I am especially passionate about early breast cancer detection. To have participated in the emotional and physical struggle of women undergoing surgery and treatment for this disease, I continually stress to women the importance of getting an annual mammogram and physical exam, as well as performing self breast exams. The fact that there was an on-site mammography station at the Modern House Call was truly a blessing for these patients. The women who attended the Modern House Call were able to get screening mammography immediately.
I truly believe that myself and the other volunteers were able to make a difference in the lives of many women who had no access to even the most basic health care. I was glad to be able to assist in providing basic health care screening that most of us take for granted. I feel blessed to have participated in this event and thank all the people who donated resources and time to help women who are truly in need.
I’ve attached a link to a video clip of me on the Woman’s Conference Website. http://www.womensconference.org/the-modern-house-call/
Dr. Catherine Huang Begovic
Breast augmentation research – Recent publication in the Aesthetic Surgery Journal by Dr. Catherine Huang Begovic
One of the most common and disfiguring complications of breast implants is capsular contracture. This is scar tissue that forms around the implant and causes discomfort or distortion of the breast. No one knows what predisposes certain women to develop this scar tissue. There have been different theories such as a genetic predisposition to inflammation forming scar, a small amount of blood around the implant that causes increased inflammation, or a bacterial film that forms around the implant causing an inflammatory response. In surgery I do everything possible to decrease any of these factors – making sure there is absolutely no bleeding or oozing before placing the implant, washing the implant pocket multiple times with saline, antibiotic solution, and betadine to clear out any debris, bacteria, or blood, and changing to new clean and sterile gloves before touching each implant.
I am committed to research to battle the problem of capsular contracture. My latest research has just been published in the Aesthetic Surgery Journal. I’ve copied the abstract below.
Aesthet Surg J. 2010 May;30(3):404-8.
Effects of Singulair (montelukast) treatment for capsular contracture.
BACKGROUND: Capsular contracture (CC) is one of the most common complications of breast augmentation surgery. Leukotrienes are implicated in the inflammatory cascade and have been postulated to be involved in the formation of CC. Therefore, leukotriene antagonists Accolate and Singulair have been prescribed by plastic surgeons off-label to treat and prevent CC. To date, there are no studies investigating the efficacy of Singulair on CC.
OBJECTIVE: The authors retrospectively review a series of patients treated with Singulair to determine whether it improves CC after breast implant surgery.
METHODS: Nineteen patients treated with Singulair by the senior surgeon (NH) after implant placement from March 2006 to November 2009 were included in this study. Follow-up on Singulair efficacy was obtained by a combination of office chart review and standardized telephone questionnaire. Results were characterized as complete improvement, improvement, no change, or worse.
RESULTS: Seventeen patients presented with CC resulting from a variety of breast operations. Two patients who had a history of recurrent CC were prescribed Singulair prophylactically immediately after surgery. Twenty-one breasts with existing CC were included in the total. Two (11%) patients became worse, three (16%) patients had no change, five (26%) improved, seven (37%) completely improved, and two (11%) were prevented from having CC formation.
CONCLUSION: Our preliminary study shows that Singulair improves CC. Breasts with mild CC (Baker score < III) appeared to have better improvement with Singulair compared to those with more severe contracture (Baker score III and IV). Singulair is well tolerated with minimal side effects and can be administered to patients after breast implant surgery to improve CC.